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Malin KJ, Zemlak J, Christianson J, Leiberg J, Grabert L. Feasibility and acceptability of studying full-time nurse faculty salaries. BMC Nurs 2024; 23:511. [PMID: 39075519 PMCID: PMC11287827 DOI: 10.1186/s12912-024-02186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The nursing shortage is driven, in part, by the critical shortage of nursing faculty. Consequently, qualified potential nursing students are being turned away from nursing schools each year. The preeminent issue influencing the United States nurse faculty workforce shortage is salary; financial compensation is higher in clinical and private-sector settings than educational settings. The purpose of this study is to describe current full-time nurse faculty salary, sources of income, and perceived need for more income, as well as the feasibility and acceptability of research focused on full-time nurse faculty salaries, so to guide future nursing faculty workforce research. METHODS Using a cross-sectional study design, full-time nursing faculty working in a Midwestern state in the United States completed a survey inclusive of fixed choice and free text response options focused on income (individual gross, faculty, and secondary), demographics, and feasibility/acceptability of the survey instrument. Descriptive statistics were used to describe salary, sources of income, and perceived need for additional income. Feasibility and acceptability were evaluated by descriptive statistics examining three feasibility and acceptability questions, and by comparing demographic differences between participants who answered income questions compared to those who did not using t tests, x2 tests, and Wilcoxon signed rank tests. RESULTS One hundred and eighty-three full-time nurse faculty completed the survey in six weeks, representing 27% of the full-time nurse faculty workforce in the state. Over half of participants, 57%, reported having another job(s) in addition to their full-time faculty position to support basic living expenses. Most respondents reported willingness to share financial/salary data and viewed the survey to be acceptable. CONCLUSIONS Research focused on nursing faculty salaries was feasible and acceptable to those who chose to participate in the study. Perceived income needs may be an important factor driving career decisions for nursing faculty. Future research should focus on delineating how salary influences the decision to enter or stay in the nursing faculty workforce. Further, this study can inform policy recommendations on how to best measure and report nurse faculty salary and the gap between clinical salaries and faculty salaries.
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Affiliation(s)
| | - Jessica Zemlak
- College of Nursing, Marquette University, Milwaukee, USA
| | | | - Jessica Leiberg
- School of Nursing, The University of Wisconsin Madison, Madison, USA
| | - Lisa Grabert
- College of Nursing, Marquette University, Milwaukee, USA
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Ma H, Chiang SC, Lin MH, Chang HT, Ming JL, Chen TJ, Chen YC. Understanding the factors associated with nurse employment in clinics: Experiences in Taiwan. J Chin Med Assoc 2024; 87:670-677. [PMID: 38819144 DOI: 10.1097/jcma.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The shortage and distribution of nurses affect healthcare access in aging societies. Limited research has explored the nursing workforce in clinics, which is vital for healthcare delivery. This study aimed to investigate the shortage and distribution of nurses in clinics in Taiwan, considering geographical, institutional, and specialty variations. METHODS We conducted a cross-sectional analysis of the national nursing workforce in Western medicine clinics in Taiwan using open government data. The nursing practice rate (NPR) was calculated. The ratio of clinics employing nurses (RCN) was determined by calculating the percentage of clinics with nurses in each category. A logistic regression model was fitted to examine the factors associated with nurse employment, including urbanization level and different specialty clinics. Adjusted odds ratios (OR) and 95% CIs were calculated. RESULTS The study revealed an overall NPR as low as 59.1%, and a decreasing trend with age. Among the 11 706 clinics in the study, nearly a quarter did not employ nurses, with an overall RCN of 72.3%. Urbanization level and clinic specialty were associated with nurse employment ( p < 0.05). After adjusting for urbanization level, the fitted regression model identified the top three specialties as plastic surgery (OR = 11.37, RCN = 96.8%), internal medicine (OR = 1.94, RCN = 84.1%), and orthopedics (OR = 1.89, RCN = 83.6%), while the bottom three were otolaryngology (OR = 0.59, RCN = 61.5%), psychiatry (OR = 0.49, RCN = 57.1%), and rehabilitation medicine (OR = 0.30, RCN = 45.2%). Nurses were more likely to be employed in areas at urbanization level 1 (OR = 1.17), 3 (OR = 1.37), and 6 (OR = 1.48), which represent highly urbanized areas within the urban, suburban, and rural categories, respectively, than in urbanization level 4. CONCLUSION Clinics in Taiwan showed nursing shortages and maldistribution, with 72.3% RCN and variations based on urbanization and specialty. These factors may be considered in nursing research conducted in other countries to inform future workforce planning.
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Affiliation(s)
- Hsin Ma
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of family medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of family medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of family medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jin-Lain Ming
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Family Medicine, Taipei Veterans General Hospital Hsinchu Branch, Hsinchu, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of family medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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McQuide PA, Brown AN, Diallo K, Siyam A. The transition of human resources for health information systems from the MDGs into the SDGs and the post-pandemic era: reviewing the evidence from 2000 to 2022. HUMAN RESOURCES FOR HEALTH 2023; 21:93. [PMID: 38041066 PMCID: PMC10691099 DOI: 10.1186/s12960-023-00880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND This review paper offers a policy-tracing trend analysis of national experiences among low- and middle-income countries in strengthening human resources for health information systems (HRHIS). This paper draws on evidence from the last two decades and applies a modified Bardach's policy analysis framework. A timely review of the evidence on HRHIS and underlying data systems is needed now more than ever, given the halfway mark of the Global Strategy on Human Resources for Health: Workforce 2030 and the protracted COVID-19 pandemic and other global health emergencies, over and above the increasing need for health and care workers to provide essential health services. MAIN TEXT Considering World Health Assembly resolutions and HRH-related global developments between 2000 and 2022, we targeted peer-reviewed and gray literature covering the inception, impact, bottlenecks, and gaps of HRHIS. We also considered results from a Bill and Melinda Gates Foundation-funded project that assessed HRH data systems in 21 countries and the use of HRH data and information for policy, planning, and management. Aligned with the National Health Workforce Accounts (NHWA), we identify priority themes related to digital priorities for HRHIS and governance/leadership and present case studies of five countries that pursued different pathways to successfully develop their HRHIS. Over the last two decades, considerable progress has been achieved through a scaled-up implementation of HRHIS combined with the skills needed to analyze and use data, sustain systems functionality, and make systematic improvements over time. Global health development aid investments and technical innovations have led to advancements in HRHIS, district health information software (DHIS2), and partner collaborations during the HIV/AIDS, Ebola, and COVID-19 crises. Although the progressive implementation of NHWA continues to steer country-level efforts through standardized indicators and regular reporting, traditional challenges remain, such as data systems fragmentation, lack of interoperability between systems, and underutilization of reported data. Encouragingly, some countries demonstrate strong governance and leadership capacities and others strong HRHIS digital capacities. Both HRH and health service data are needed to inform on-demand decisions during times of emergencies and pandemics as well as during routine essential health services delivery. Evidence-based examples from distinctive countries demonstrate that reliable HRHIS is achievable for better planning and management of the health and care workforce.
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Affiliation(s)
- Pamela A McQuide
- Global Health Workforce Consultant, IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, United States of America.
| | | | - Khassoum Diallo
- Coordinator Data, Evidence and Knowledge Management UHL Division, World Health Organization, Geneva, Switzerland
| | - Amani Siyam
- Health Information System, Regional Office for South-East Asia, World Health Organization, Geneva, Switzerland
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Najafpour Z, Arab M, Shayanfard K. A multi-phase approach for developing a conceptual model for human resources for health observatory (HRHO) toward integrating data and evidence: a case study of Iran. Health Res Policy Syst 2023; 21:41. [PMID: 37264403 DOI: 10.1186/s12961-023-00994-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Evidence-informed policymaking on human resources for health (HRH) has been directly linked with health system productivity, accessibility, equity, quality, and efficiency. The lack of reliable HRH data has made the task of planning the HRH more difficult in all settings. AIM This study aimed to develop a conceptual model to integrate HRH data and evidence. METHODS The current study is a mixed-method study conducted in three phases: a rapid literature review, a qualitative phase, and an expert panel. Firstly, the electronic databases were searched up to 2018. Then, in the qualitative phase, semi-structured interviews with 50 experts were conducted. Data analysis was performed using the content analysis approach. After several expert panels, the draft of the model was validated with 15 key informants via two Delphi rounds. RESULTS Our proposed model embraces all dominant elements on the demand and supply side of the HRH in Iran. The conceptual model consists of several components, including input (regulatory system, structure, functions), educational system (pre-service and in-service education), health labor market structure, process (technical infrastructure), and output (productions, policymaking process). We considered networking toward sustainable interaction among stakeholders, and also the existence of capacity to integrate HRH information and produce evidence for actions. CONCLUSION The proposed model can be considered a platform for developing a harmonized system based on the HRH data flow to evidence-informed decision-making via networking. We proposed a step-by-step approach for the sustainability of establishing a national human resources for health observatory (HRHO). The proposed HRHO model can be replicable and flexible enough to be used in different context domains.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, Public Health Faculty, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mohammad Arab
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Shayanfard
- Physics and Materials Science Research Unit, University of Luxembourg, Luxembourg, Luxembourg
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Fernandes Q, Augusto O, Machai H, Pfeiffer J, Carone M, Pinto N, Carimo N, Ramiro I, Gloyd S, Sherr K. Scrutinizing human resources for health availability and distribution in Mozambique between 2016 and 2020: a subnational descriptive longitudinal study. HUMAN RESOURCES FOR HEALTH 2023; 21:33. [PMID: 37085868 PMCID: PMC10122375 DOI: 10.1186/s12960-023-00815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/07/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Overall, resilient health systems build upon sufficient, qualified, well-distributed, and motivated health workers; however, this precious resource is limited in numbers to meet people's demands, particularly in LMICs. Understanding the subnational distribution of health workers from different lens is critical to ensure quality healthcare and improving health outcomes. METHODS Using data from Health Personnel Information System, facility-level Service Availability and Readiness Assessment, and other sources, we performed a district-level longitudinal analysis to assess health workforce density and the ratio of male to female health workers between January 2016 and June 2020 across all districts in Mozambique. RESULTS 22 011 health workers were sampled, of whom 10 405 (47.3%) were male. The average age was 35 years (SD: 9.4). Physicians (1025, 4.7%), maternal and child health nurses (4808, 21.8%), and nurses (6402, 29.1%) represented about 55% of the sample. In January 2016, the average district-level workforce density was 75.8 per 100 000 population (95% CI 65.9, 87.1), and was increasing at an annual rate of 8.0% (95% CI 6.00, 9.00) through January 2018. The annual growth rate declined to 3.0% (95% CI 2.00, 4.00) after January 2018. Two provinces, Maputo City and Maputo Province, with 268.3 (95% CI 186.10, 387.00) and 104.6 (95% CI 84.20, 130.00) health workers per 100 000 population, respectively, had the highest workforce density at baseline (2016). There were 3122 community health workers (CHW), of whom 72.8% were male, in January 2016. The average number of CHWs per 10 000 population was 1.33 (95% CI 1.11, 1.59) in 2016 and increased by 18% annually between January 2016 and January 2018. This trend reduced to 11% (95% CI 0.00, 13.00) after January 2018. The sex ratio was twice as high for all provinces in the central and northern regions relative to Maputo Province. Maputo City (OR: 0.34; 95% CI 0.32, 0.34) and Maputo Province (OR: 0.56; 95% CI 0.49, 0.65) reported the lowest sex ratio at the baseline. Encouragingly, important sex ratio improvements were observed after January 2018, particularly in the northern and central regions. CONCLUSION Mozambique made substantial progress in health workers' availability during the study period; however, with a critical slowdown after 2018. Despite the progress, meaningful shortages and distribution disparities persist.
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Affiliation(s)
- Quinhas Fernandes
- National Directorate of Public Health, Ministry of Health, Maputo City, Mozambique.
- Department of Global Health, University of Washington, Seattle, WA, United States of America.
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Eduardo Mondlane University, Maputo, Mozambique
| | - Helena Machai
- Directorate of Human Resources, Ministry of Health, Maputo City, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Anthropology, University of Washington, Seattle, WA, United States of America
| | - Marco Carone
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Norton Pinto
- Directorate of Human Resources, Ministry of Health, Maputo City, Mozambique
| | - Naziat Carimo
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Industrial & Systems Engineering, University of Washington, Seattle, United States of America
- Department of Epidemiology, University of Washington, Seattle, United States of America
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Mulligan KM, Jella TK, Cwalina TB, Tsai EC, Parr AM, Woodrow SI, Wright JM, Wright CH. Projected timeline to achieve gender balance within the United States neurosurgical workforce exceeds 150 years: a National Plan and Provider Enumeration System analysis. J Neurosurg 2023; 138:1088-1097. [PMID: 35932267 DOI: 10.3171/2022.4.jns212968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite incremental progress in the representation and proportion of women in the field of neurosurgery, female neurosurgeons still represent an overwhelming minority of the current US physician workforce. Prior research has predicted the timeline by which the proportion of female neurosurgery residents may reach that of males, but none have used the contemporary data involving the entire US neurosurgical workforce. METHODS The authors performed a retrospective analysis of the National Plan and Provider Enumeration System (NPPES) registry of all US neurosurgeons to determine changes in the proportions of women in neurosurgery across states, census divisions, and census regions between 2010 and 2020. A univariate linear regression was performed to assess historical growth, and then Holt-Winter forecasting was used to predict in what future year gender parity may be reached in this field. RESULTS A majority of states, divisions, and regions have increased the proportion of female neurosurgeons from 2010. Given current growth rates, the authors found that female neurosurgeons will not reach the proportion of women in the overall medical workforce until 2177 (95% CI 2169-2186). Furthermore, they found that women in neurosurgery will not match their current proportion of the overall US population until 2267 (95% CI 2256-2279). CONCLUSIONS Whereas many studies have focused on the overall increase of women in neurosurgery in the last decade, this one is the first to compare this growth in the context of the overall female physician workforce and the female US population. The results suggest a longer timeline for gender parity in neurosurgery than previous studies have suggested and should further catalyze the targeted recruitment of women into the field, an overhaul of current policies in place to support and develop the careers of women in neurosurgery, and increased self-reflection and behavioral change from the entire neurosurgery community.
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Affiliation(s)
| | - Tarun K Jella
- 1Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Thomas B Cwalina
- 1Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Eve C Tsai
- 2Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Ann M Parr
- 3Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Sarah I Woodrow
- 4Department of Neurological Surgery, Cleveland Clinic, Akron, Ohio; and
| | - James M Wright
- 5Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Christina H Wright
- 5Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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Boniol M, McCarthy C, Lawani D, Guillot G, McIsaac M, Diallo K. Inequal distribution of nursing personnel: a subnational analysis of the distribution of nurses across 58 countries. HUMAN RESOURCES FOR HEALTH 2022; 20:22. [PMID: 35248061 PMCID: PMC8898534 DOI: 10.1186/s12960-022-00720-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/20/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Nursing personnel are critical for enabling access to health service in primary health care. However, the State of the World's Nursing 2020 report showed important inequalities in nurse availability between countries. METHODS The purpose of this study/analysis was to describe the differences in nurse-to-population density in 58 countries from six regional areas and the relationship between differences in access to nurses and other indicators of health equity. RESULTS All countries and income groups showed subnational inequalities in the distribution of nursing personnel with Gini coefficients ranging from 1 to 39. The latter indicated situation such as 13% of the population having access to 45% of nurses in a country. The average max-to-min ratio was on average of 11-fold. In our sample, the African region had the highest level of subnational inequalities with the average Gini coefficient of 19.6. The European Region had the lowest level of within-country inequalities with the average Gini coefficient being 5.6. A multivariate analysis showed a clustering of countries in three groups: (1) high Gini coefficients comprised mainly African countries; (2) moderate Gini coefficients comprised mainly South-East Asian, Central and South American countries; (3) low Gini coefficients comprised mainly Western countries, Japan, and Korea. The analysis also showed that inequality in distribution of nurses was correlated with other indices of health and inequality such as the Human Development Index, maternal mortality, and life expectancy. CONCLUSIONS This study showed that there is a high level of geographic inequality in the distribution of nurses at subnational level. Inequalities in nursing distribution are multifactorial, to improve access to nurses, policies should be bundled, tailored to the local context and tackle the various root causes for inequalities.
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Affiliation(s)
- Mathieu Boniol
- Health Workforce Department, World Health Organization, Geneva, Switzerland.
| | - Carey McCarthy
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Deen Lawani
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Gilles Guillot
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Michelle McIsaac
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Khassoum Diallo
- Health Workforce Department, World Health Organization, Geneva, Switzerland
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Akoku DA, Tickell KD, Niamien KR, Kemper KE, Yacouba D, Kouyate S, Kouassi DA, Balachandra S, Swor M, Luxenberg AK, Gloyd S, Kone A. The association between health workforce availability and HIV-program outcomes in Côte d'Ivoire. HUMAN RESOURCES FOR HEALTH 2022; 20:18. [PMID: 35183202 PMCID: PMC8858454 DOI: 10.1186/s12960-022-00715-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the distribution of HIV-program staff and the extent to which their availability influences HIV programmatic and patient outcomes. METHODS The study was a facility level cross-sectional survey. Data from October 2018 to September 2019 were abstracted from HIV program reports conducted in 18 districts of Côte d'Ivoire. The distribution of staff in clinical, laboratory, pharmacy, management, lay, and support cadres were described across high and low antiretroviral therapy (ART) volume facilities. Non-parametric regression was used to estimate the effects of cadre categories on the number of new HIV cases identified, the number of cases initiated on ART, and the proportion of patients achieving viral load suppression. RESULTS Data from 49,871 patients treated at 216 health facilities were included. Low ART volume facilities had a median of 8.1 staff-per-100 ART patients, significantly higher than the 4.4 staff-per-100 ART patients at high-ART volume facilities. One additional laboratory staff member was associated with 4.30 (IQR: 2.00-7.48, p < 0.001) more HIV cases identified and 3.81 (interquartile range [IQR]: 1.44-6.94, p < 0.001) additional cases initiated on ART. Similarly, one additional lay worker was associated with 2.33 (IQR: 1.00-3.43, p < 0.001) new cases identified and 2.24 (IQR: 1.00-3.31, p < 0.001) new cases initiated on ART. No cadres were associated with viral suppression. CONCLUSIONS HCWs in the laboratory and lay cadre categories were associated with an increase in HIV-positive case identification and initiation on ART. Our findings suggest that allocation of HCWs across health facilities should take into consideration the ART patient volume. Overall, increasing investment in health workforce is critical to achieve national HIV goals and reaching HIV epidemic control.
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Affiliation(s)
- Derick Akompab Akoku
- Health Alliance International, Abidjan, Côte d'Ivoire.
- Department of Global Health, University of Washington, Seattle, USA.
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Seydou Kouyate
- Health Alliance International, Abidjan, Côte d'Ivoire
- Health Alliance International, Seattle, WA, USA
| | - Daniel A Kouassi
- Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Shirish Balachandra
- Center for Global Health/Division of Global HIV and TB (DGHT), Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - Meghan Swor
- Affiliation of Center for Global Health/Division of Global HIV and TB (DGHT), Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - Audrey Knutson Luxenberg
- Center for Global Health/Division of Global HIV and TB (DGHT), Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire
| | - Steve Gloyd
- Department of Global Health, University of Washington, Seattle, USA
- Health Alliance International, Seattle, WA, USA
| | - Ahoua Kone
- Department of Global Health, University of Washington, Seattle, USA
- Health Alliance International, Seattle, WA, USA
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Kunjumen T, Okech M, Deki, Asamani JA, Mohamed N, Nuruzzaman M. Multi-country case studies on planning RMNCH services using WISN methodology: Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea. HUMAN RESOURCES FOR HEALTH 2022; 19:155. [PMID: 35090493 PMCID: PMC8796320 DOI: 10.1186/s12960-021-00671-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Globally, many countries are adopting evidence-based workforce planning that facilitates progress towards achieving sustainable development goals for reproductive, maternal newborn and child health. We reviewed case studies on workforce planning for reproductive maternal newborn child health services at primary care level facilities using workload indicators of staffing need in five countries. METHOD Using available workload indicators for staffing need reports from Bangladesh, Ghana, Kenya, Sultanate of Oman and Papua New Guinea, we generated descriptive statistics to explore comparable workload components and activity standards, health service delivery models with an emphasis on the primary care levels and the specific health occupations offering interventions associated with reproductive maternal, newborn and child health services. RESULTS The health services delivery models vary from one country to another. The results showed variability in the countries, in the workload components and activity standards of each regardless of facility level or occupational groups involved. All the countries have decentralized health services with emphasis on comprehensive primary care. Reproductive, maternal and new-born child health care services include antenatal, postnatal, immunization, family planning, baby wellness clinics, delivery and management of integrated minor childhood illnesses. Only Sultanate of Oman offers fertility services at primary care. Kenya has expanded interventions in the households and communities. CONCLUSION Since the health care services models, health services delivery contexts and the health care worker teams vary from one country to another, the study therefore concludes that activity standards cannot be adopted or adapted from one country to another despite having similar workload components. Evidence based workforce planning must be context-specific, and therefore requires that each country develop its own workload components and activity standards aligned to their local contexts.
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Affiliation(s)
| | - Mollent Okech
- World Health Organisation, Port Moresby, Papua New Guinea
| | - Deki
- World Health Organisation, Suva, Fiji
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Dubey S, Vasa J, Zadey S. Do health policies address the availability, accessibility, acceptability, and quality of human resources for health? Analysis over three decades of National Health Policy of India. HUMAN RESOURCES FOR HEALTH 2021; 19:139. [PMID: 34774088 PMCID: PMC8590377 DOI: 10.1186/s12960-021-00681-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions-availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known. METHODS We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI-1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years. RESULTS NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch. CONCLUSION India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.
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Affiliation(s)
- Sweta Dubey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra India
- Government Medical College and Hospital, Nagpur, Maharashtra India
| | - Jeel Vasa
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra India
- Rajarshi Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra India
| | - Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra India
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
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Schleiff MJ, Aitken I, Alam MA, Damtew ZA, Perry HB. Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Res Policy Syst 2021; 19:113. [PMID: 34641898 PMCID: PMC8506097 DOI: 10.1186/s12961-021-00757-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the sixth of our 11-paper supplement entitled "Community Health Workers at the Dawn of New Era". Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. METHODS We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. RESULTS The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. CONCLUSION Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training-not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.
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Affiliation(s)
- Meike J. Schleiff
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Iain Aitken
- Management Sciences for Health, Ministry of Public Health, Kabul, Afghanistan
| | | | | | - Henry B. Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Rodés CH, Daré JVL, de Araujo BC, Graciani L, João SMA, Germani ACCG, Schmitt ACB. The physiotherapy workforce in the Brazilian Unified Health Care System. HUMAN RESOURCES FOR HEALTH 2021; 19:101. [PMID: 34419076 PMCID: PMC8379878 DOI: 10.1186/s12960-021-00642-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/10/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. OBJECTIVE To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. METHOD Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test. RESULTS The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. CONCLUSION Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.
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Affiliation(s)
- Carolina Hart Rodés
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - João Vitor Lovato Daré
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Carolina de Araujo
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leonardo Graciani
- Departamento de Geografia da Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia Maria Amado João
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Carolina Basso Schmitt
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Hastings-Tolsma M, Temane A, Tagutanazvo OB, Lukhele S, Nolte AG. Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study. Health SA 2021; 26:1524. [PMID: 34192066 PMCID: PMC8182560 DOI: 10.4102/hsag.v26i0.1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION This research provides evidence of the midwifery experience with implications for needed health policy change.
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Affiliation(s)
- Marie Hastings-Tolsma
- Louise Herrington School of Nursing, Faculty of Nursing/Midwifery, Baylor University, Dallas, Texas, United States of America
| | - Annie Temane
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Oslinah B. Tagutanazvo
- Department of Midwifery Science, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
| | - Sanele Lukhele
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Anna G. Nolte
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
- Netcare Education, Netcare, Johannesburg, South Africa
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Fields L, Perkiss S, Dean BA, Moroney T. Nursing and the Sustainable Development Goals: A Scoping Review. J Nurs Scholarsh 2021; 53:568-577. [PMID: 34056841 DOI: 10.1111/jnu.12675] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE In 2015, all member states that comprise the United Nations unanimously adopted the Sustainable Development Goals (SDGs), a set of ambitious and inclusive targets toward global economic, social, and environmental betterment. Nurses have a key role to play in the achievement of the SDGs. The aim of this article was to conduct a scoping review to synthesize the literature related to nursing and the SDGs. METHODS This scoping review utilized Arksey and O'Malley's five-stage framework. Several electronic databases were searched for literature published from 2015 to 2020 using the key words "nurse OR nurses OR nursing" and "Sustainable Development Goals OR SDGs". FINDINGS A total of 447 articles were identified through the databases searches, of which 35 articles were deemed relevant and included for final review and content analysis. Analysis of relevant literature on nursing and the SDGs revealed two distinct, yet connected, perspectives: the nurse and the profession. CONCLUSIONS Individual nurses may feel disconnected from the SDGs and struggle to relate the goals to their clinical role, calling for an increase in awareness and education on the goals. The wider profession could also increase both research and policy with relation to the SDGs, strengthening nursing's position to have a voice in and contribute towards achievement of the goals. CLINICAL RELEVANCE Individual nurses and the wider nursing profession have opportunities to more meaningfully contribute to the SDGs, beginning with an increased awareness through education and a commitment to research and participation in local and global decision making.
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Affiliation(s)
- Lorraine Fields
- PhD Candidate, Lecturer, School of Nursing, University of Wollongong, NSW, Australia
| | - Stephanie Perkiss
- Senior Lecturer, School of Accounting, Economics and Finance, University of Wollongong, NSW, Australia
| | - Bonnie Amelia Dean
- Senior Lecturer, School of Nursing, University of Wollongong, NSW, Australia
| | - Tracey Moroney
- Professor; Head of School, School of Nursing, University of Wollongong, NSW, Australia
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Sonderegger S, Bennett S, Sriram V, Lalani U, Hariyani S, Roberton T. Visualizing the drivers of an effective health workforce: a detailed, interactive logic model. HUMAN RESOURCES FOR HEALTH 2021; 19:32. [PMID: 33706778 PMCID: PMC7953552 DOI: 10.1186/s12960-021-00570-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND A strong health workforce is a key building block of a well-functioning health system. To achieve health systems goals, policymakers need information on what works to improve and sustain health workforce performance. Most frameworks on health workforce planning and policymaking are high-level and conceptual, and do not provide a structure for synthesizing the growing body of empirical literature on the effectiveness of strategies to strengthen human resources for health (HRH). Our aim is to create a detailed, interactive logic model to map HRH evidence and inform policy development and decision-making. METHODS We reviewed existing conceptual frameworks and models on health workforce planning and policymaking. We included frameworks that were: (1) visual, (2) comprehensive (not concentrated on specific outcomes or strategies), and (3) designed to support decision-making. We compared and synthesized the frameworks to develop a detailed logic model and interactive evidence visualization tool. RESULTS Ten frameworks met our inclusion criteria. The resulting logic model, available at hrhvisualizer.org , allows for visualization of high-level linkages as well as a detailed understanding of the factors that affect health workforce outcomes. HRH data and governance systems interact with the context to affect how human resource policies are formulated and implemented. These policies affect HRH processes and strategies that influence health workforce outcomes and contribute to the overarching health systems goals of clinical quality, responsiveness, efficiency, and coverage. Unlike existing conceptual frameworks, this logic model has been operationalized in a highly visual, interactive platform that can be used to map the research informing policies and illuminating their underlying mechanisms. CONCLUSIONS The interactive logic model presented in this paper will allow for comprehensive mapping of literature around effective strategies to strengthen HRH. It can aid researchers in communicating with policymakers about the evidence behind policy questions, thus supporting the translation of evidence to policy.
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Affiliation(s)
- Serena Sonderegger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Veena Sriram
- University of British Columbia, Vancouver, BC, Canada
| | - Ummekulsoom Lalani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Shreya Hariyani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Winkelmann J, Muench U, Maier CB. Time trends in the regional distribution of physicians, nurses and midwives in Europe. BMC Health Serv Res 2020; 20:937. [PMID: 33046077 PMCID: PMC7549210 DOI: 10.1186/s12913-020-05760-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends. METHODS We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR). RESULTS There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives. CONCLUSIONS The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
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Affiliation(s)
- Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Ulrike Muench
- Department of Social and Behavioural Sciences, University of California San Francisco, School of Nursing, 3333 California Street, Ste 455, San Francisco, CA, 94118, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, School of Medicine, 3333 California Street, Ste 455, San Francisco, CA, 94118, USA
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany
- Center for Health Outcomes and Policy Research, University of Pennsylvania, School of Nursing, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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Jesus TS, Landry MD, Dussault G, Fronteira I. Classifying and Measuring Human Resources for Health and Rehabilitation: Concept Design of a Practices- and Competency-Based International Classification. Phys Ther 2019; 99:396-405. [PMID: 30561749 DOI: 10.1093/ptj/pzy154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/28/2018] [Indexed: 02/09/2023]
Abstract
The burden of physical impairments and disabilities is growing across high-, middle-, and low-income countries, but populations across the globe continue to lack access to basic physical rehabilitation. Global shortages, uneven distributions, and insufficient skill mix of human resources for health and rehabilitation (HRH&R) contribute to such inequitable access. However, there are no international standards to classify HRH&R and to promote their global monitoring and development. In this article, we conceptually develop an international classification of HRH&R based on the concept of monitoring HRH&R through their stock of practices and competencies, and not simply counting rehabilitation professionals such as physical or occupational therapists. This concept accounts for the varying HRH&R configurations as well as the different training, competencies, or practice regulations across locations, even within the same profession. Our perspective specifically develops the concept of a proposed classification, its structure, and possible applications. Among the benefits, stakeholders using the classification would be able to: (1) collect locally valid and internationally comparable data on HRH&R; (2) account for the rehabilitation practices and competencies among nonspecialized rehabilitation workers (eg, in less resourced/specialized contexts); (3) track competency upgrades or practice extensions over time; (4) implement competency-based human resources management practices, such as linking remuneration to competency levels rather than to professional categories; and (5) inform the development of (inter-)professional education, practice regulation, or even task-shifting processes for the whole of HRH&R. The proposed classification standard, still in a concept-development stage, could help drive policies to achieve the "right" stock of HRH&R, in terms of practices and competencies.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Rua da Junqueira 100, Lisbon 1349-008, Portugal
| | - Michel D Landry
- Duke Doctor of Physical Therapy Division, Duke University Medical Center, and Duke Global Health Institute, Duke University, Durham, North Carolina, United States
| | - Gilles Dussault
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon
| | - Inês Fronteira
- Global Health and Tropical Medicine, WHO Collaborating Center on Health Workforce Policy and Planning, and Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon
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Woldemichael A, Takian A, Akbari Sari A, Olyaeemanesh A. Availability and inequality in accessibility of health centre-based primary healthcare in Ethiopia. PLoS One 2019; 14:e0213896. [PMID: 30925153 PMCID: PMC6440637 DOI: 10.1371/journal.pone.0213896] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Achieving fair access to healthcare and improving population health are crucial in all settings. Properly staffed and fairly distributed primary health care (PHC) facilities are prerequisites to ensure accessible healthcare services. Nevertheless, availability and accessibility issues are common public health concerns, especially in under-resourced countries including Ethiopia. Measuring inequalities in accessibility of healthcare resources guide policy decisions to improve PHC services and ultimately achieving universal health coverage (UHC). PURPOSE To assess availability and measure magnitude and trend of inequalities in accessibility of health centre-based PHC resources in Ethiopia during 2015 to 2017. METHODS We conducted a cross-sectional population-based analysis of district-level data collected from 16th December 2017 until 24th May 2018. Afar, Dire-Dawa, and Tigray regions were purposefully included in the study to represent the four pastoralist/semi-pastoralist, three urban and four agrarian regions in Ethiopia, respectively. We used ratios, different inequality indices and Gini decomposition techniques to characterise the inequalities. RESULTS In 2017, median of health centres (HCs) per 15,000 inhabitants and their Gini indices (GIs) for Afar, Dire-Dawa, and Tigray were 0.781, 0.566, 0.591 vs. 0.237, 0.280, 0.216 respectively. Median overall skilled health workers (SHWs) per 10,000 inhabitants were 5.250, 7.539, and 6.246, respectively. These accounted for 11.80%, 16.94% and 14.04% of the WHO target of 44.5 to achieve SDGs. The corresponding GIs for the regions were 0.347, 0.186 and 0.175. Despite a higher overall SHWs inequality in the urban districts of Tigray (GI = 0.301), only Tigray showed significant inequality reductions in GHE (p < 0.001) and in all categories of SHWs (p < 0.05). CONCLUSIONS Our analysis provided a clear picture of availability and inequalities in PHC resources across three regions in Ethiopia. Identifying contributing factors to low densities and high inequalities of SHWs may help improve PHC services nationwide, along with pathway towards UHC.
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Affiliation(s)
- Abraha Woldemichael
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
- National Institute for Health Research, Tehran, Iran
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Harper BD, Nganga W, Armstrong R, Forsyth KD, Ham HP, Keenan WJ, Russ CM. Where are the paediatricians? An international survey to understand the global paediatric workforce. BMJ Paediatr Open 2019; 3:bmjpo-2018-000397. [PMID: 30815583 PMCID: PMC6361365 DOI: 10.1136/bmjpo-2018-000397] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care. DESIGN Survey of identified paediatric leaders in each country. SETTING Paediatric association leaders worldwide. MAIN OUTCOME MEASURES Paediatrician numbers, provision of primary care for children, age of transition to adult care. RESULTS Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of 0.5 (IQR 0.3-1.4) in low-income countries to 72 (IQR 4-118) in high-income countries. Africa and South-East Asia reported the lowest paediatrician density (median of 0.8 paediatricians per 100 000 children, IQR 0.4-2.6 and median of 4, IQR 3-9, respectively) and fewest paediatricians entering the workforce. 82% of countries reported transition to adult care by age 18% and 39% by age 15. Most countries (91%) but only 64% of low-income countries reported provision of paediatric preventative care (p<0.001, Cochran-Armitage trend test). Systems of primary care provision varied widely. A majority of countries (63%) anticipated increases in their paediatric workforce in the next decade. CONCLUSIONS Paediatrician density mirrors known inequities in health provider distribution. Fewer paediatricians are entering the workforce in areas with already low paediatrician density, which may exacerbate disparities in child health outcomes. In some regions, children transition to adult care during adolescence, with implications for healthcare training and delivery. Paediatrician roles are heterogeneous worldwide, and country-specific strategies should be used to address inequity in child health provision.
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Affiliation(s)
- Beth D Harper
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Waceke Nganga
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Kevin D Forsyth
- Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Hazen P Ham
- Global Pediatric Education Consortium, Chapel Hill, North Carolina, USA
| | - William J Keenan
- Department of Pediatrics, Saint Louis University, St Louis, Missouri, USA
| | - Christiana M Russ
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Pepler E, Martell RC. Indigenous model of care to health and social care workforce planning. Healthc Manage Forum 2018; 32:32-39. [PMID: 30514121 DOI: 10.1177/0840470418809105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Indigenous people have always had the end in mind-a long range vision for the health and wellbeing of their families and communities. Creating Indigenous solutions-oriented approaches to strategic health and social care workforce planning is an essential component to the realization of self-determination and empowerment, accessible health services, community participation, and flexible approaches to care. This article suggests using an Indigenous "models of care" population health approach to health and social care workforce planning that takes a critical thinking, systems thinking, and design thinking approach using digital tools (eg, scenario planning and population health simulation). It also proposes to increase the number of Indigenous professionals through Indigenous partnership initiatives with professional groups and academic institutions. This article is written to encourage discussion on the use of a whole system approach to developing Indigenous models of health delivery and to inform strategic services and workforce planning.
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Affiliation(s)
- Eileen Pepler
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca C Martell
- 2 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hastings-Tolsma M, Foster SW, Brucker MC, Nodine P, Burpo R, Camune B, Griggs J, Callahan TJ. Nature and scope of certified nurse-midwifery practice: A workforce study. J Clin Nurs 2018; 27:4000-4017. [PMID: 29679403 PMCID: PMC7992184 DOI: 10.1111/jocn.14489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe the nature and scope of nurse-midwifery practice in Texas and to determine legislative priorities and practice barriers. BACKGROUND Across the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives' work environment and scope of practice. DESIGN Mixed methods research utilising prospective descriptive survey and interview. METHODS An online survey was administered to nurse-midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed. RESULTS The survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full-time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years. CONCLUSIONS An ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice. RELEVANCE TO CLINICAL PRACTICE Robust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long-term service in underserved areas, and development of skills crucial for impacting health policy change.
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Affiliation(s)
| | | | - Mary C. Brucker
- School of Nursing, Georgetown University, Washington, District of Columbia
| | - Priscilla Nodine
- College of Nursing, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca Burpo
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Barbara Camune
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas
| | | | - Tiffany J. Callahan
- Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet 2018; 391:1538-1548. [PMID: 29395268 DOI: 10.1016/s0140-6736(18)30104-1] [Citation(s) in RCA: 270] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/04/2023]
Abstract
Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.
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