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Li W, Gillies RM, Liu C, Wu C, Chen J, Zhang X, Cheng B, Dai J, Fu N, Li L, Liu S, Sun H. Specialty preferences of studying-abroad medical students from low- and middle-income countries. BMC MEDICAL EDUCATION 2023; 23:158. [PMID: 36922811 PMCID: PMC10015544 DOI: 10.1186/s12909-023-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study explored the specialty preferences of China-educated international medical students (IMSs), who are mainly from low- and middle-income countries (LMICs) and constitute a potential medical workforce both for their home countries and foreign countries, and the influence of migration intentions on their specialty preferences. METHODS A cross-sectional, questionnaire-based survey was conducted at 5 universities in China. The questionnaire link was distributed electronically among the IMSs at the 5 universities via emails. The questionnaire enquired IMSs' demographic information, migration intentions and their specialty preferences. The Chi-square test was applied to determine the influence of the respondent's gender, intention to practise in the home country and intention to practise in a high-income country on their specialty choices. The Chi-square test was also applied to determine the influence of the respondent's gender, year of study and country of origin on their preferences for generalist-orientated or non-generalist orientated specialties. RESULTS Altogether, 452 IMSs returned their responses, yielding a response rate of 64.1%. Approximately half of the IMSs planned to not return to their home country. The most selected specialty was general surgery and the least selected specialty was physical medicine and rehabilitation. No significant differences were evident in most specialty preferences between those who intended to return home and those who intended to stay abroad. Among the IMSs having intentions of returning to their home country, male students tended to choose a generalist-orientated specialty, while female students tended to choose a non-generalist-orientated specialty. CONCLUSION China-educated IMSs could play important roles in the primary care services as well as other shortage specialties both for their home countries or foreign countries. Therefore, it is recommended that governments in these countries plan migration and recruitment policies that cater for these studying-abroad medical students from LMICs, especially in this challenging time during the COVID-19 pandemic.
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Affiliation(s)
- Wen Li
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Robyn M Gillies
- School of Education, The University of Queensland, 4072, Brisbane, Australia
| | - Chang Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Changhao Wu
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Jiayi Chen
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China
| | - Xiaoning Zhang
- School of Management, Xuzhou Medical University, 221004, Xuzhou, China
| | - Bin Cheng
- School of International Education, Weifang Medical University, 261053, Weifang, China
| | - Jing Dai
- College of International Education, Guilin Medical University, 541199, Guilin, China
| | - Ning Fu
- School of International Education, Shandong First Medical University & Shandong Academy of Medical Sciences, 271016, Tai'an, China
| | - Lin Li
- Language and Literature School, Hebei North University, 075000, Zhangjiakou, China
| | - Shenjun Liu
- School of International Education, Xuzhou Medical University, No.209 of Tongshan Road, Yunlong District, 221004, Xuzhou, Jiangsu, China.
| | - Hong Sun
- School of Basic Medicine, Xuzhou Medical University, Xuzhou, China.
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Amatya R, Mishra K, Karki K, Puri I, Gautam A, Thapa S, Katwal U, Veer S, Zervos J, Kaljee L, Prentiss T, Zenlea K, Maki G, Rayamajhi PJ, Khanal NK, Thapa P, Upadhyaya MK, Bajracharya D. Post-implementation Review of the Himalaya Home Care Project for Home Isolated COVID-19 Patients in Nepal. Front Public Health 2022; 10:891611. [PMID: 35655453 PMCID: PMC9152279 DOI: 10.3389/fpubh.2022.891611] [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: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 01/08/2023] Open
Abstract
Background: The emergence of coronavirus disease 2019 (COVID-19) has resulted in a pandemic that has significantly impacted healthcare systems at a global level. Health care facilities in Nepal, as in other low- and middle-income countries, have limited resources for the treatment and management of COVID-19 patients. Only critical cases are admitted to the hospital resulting in most patients in home isolation. Methods Himalaya Home Care (HHC) was initiated to monitor and provide counseling to home isolated COVID-19 patients for disease prevention, control, and treatment. Counselors included one physician and four nurses. Lists of patients were obtained from district and municipal health facilities. HHC counselors called patients to provide basic counseling services. A follow-up check-in phone call was conducted 10 days later. During this second call, patients were asked about their perceptions of the HHC program. Project objects were: (1) To support treatment of home isolated persons with mild to moderate COVID-19, decrease burden of hospitalizations, and decrease risks for disease transmission; and, (2) To improve the health status of marginalized, remote, and vulnerable populations in Nepal during the COVID-19 pandemic. Results Data from 5823 and 3988 patients from May 2021-February 2022 were entered in initial and follow-up forms on a REDCap database. The majority of patients who received counseling were satisfied. At follow-up, 98.4% of respondents reported that HHC prevented hospitalization, 76.5% reported they could manage their symptoms at home, and 69.5% reported that counseling helped to limit the spread of COVID-19 in their household. Conclusions Telehealth can be an essential strategy for providing services while keeping patients and health providers safe during the COVID-19 pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | - Siddhesh Veer
- Global Health Initiative, Henry Ford Health, Detroit, MI, United States
| | - John Zervos
- Global Health Initiative, Henry Ford Health, Detroit, MI, United States
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health, Detroit, MI, United States
| | - Tyler Prentiss
- Global Health Initiative, Henry Ford Health, Detroit, MI, United States
| | - Kate Zenlea
- Global Health Initiative, Henry Ford Health, Detroit, MI, United States
| | - Gina Maki
- Henry Ford Hospital, Department of Infectious Disease, Detroit, MI, United States
| | - Pawan Jung Rayamajhi
- Curative Service Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Narendra K Khanal
- Curative Service Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Pomawati Thapa
- Curative Service Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Upadhyaya
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu, Nepal
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Sutarsa IN, Kasim R, Steward B, Bain-Donohue S, Slimings C, Hall Dykgraaf S, Barnard A. Do General Practitioners in a Visiting Medical Officer Arrangement Improve the Perceived Quality of Care of Rural and Remote Patients? A Qualitative Study in Australia. Healthcare (Basel) 2022; 10:healthcare10061045. [PMID: 35742096 PMCID: PMC9223112 DOI: 10.3390/healthcare10061045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In rural and remote Australia, general practitioners (GPs) provide care across the continuum from primary to secondary care, often in Visiting Medical Officer (VMO) arrangements with a local hospital. However, little is known about the role of GP-VMOs in improving the perceived quality of care and health outcomes for rural and remote communities. Methods: We collected qualitative data from three GP-VMOs (all aged >55 years) and 10 patients (all aged over 65 years) in three local health districts of New South Wales, Australia. Thirteen in-depth interviews were conducted between October 2020 and February 2021. We employed thematic analysis to identify key roles of GP-VMOs in improving the perceived quality of care and health outcomes of rural and remote patients. Results: Our study advances the current understanding regarding the role of GP-VMOs in improving the perceived quality of services and health outcomes of rural and remote patients. Key roles of GP-VMOs in improving the perceived quality of care include promoting the continuity of care and integrated health services, cultivating trust from local communities, and enhancing the satisfaction of patients. Conclusions: GP-VMOs work across primary and secondary care creating better linkages and promoting the continuity of care for rural and remote communities. Employing GP-VMOs in rural hospitals enables the knowledge and sensitivity gained from their ongoing interactions with patients in primary care to be effectively utilised in the delivery of hospital care.
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Affiliation(s)
- I Nyoman Sutarsa
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80232, Bali, Indonesia
- Correspondence:
| | - Rosny Kasim
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Ben Steward
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Suzanne Bain-Donohue
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Claudia Slimings
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Sally Hall Dykgraaf
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Amanda Barnard
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
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Tang L, Yang H, Mao Z, Li Q, Li S. The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study. BMC MEDICAL EDUCATION 2022; 22:393. [PMID: 35597977 PMCID: PMC9124415 DOI: 10.1186/s12909-022-03456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is an acute shortage of general practitioners (GPs) in China, and GP trainees seem to be less willing to develop their career as a GP. This study aimed to investigate negative factors influencing the career intention of GPs in eastern China from the perspective of trainees taking standardized residency training, as to identify the barriers of GP trainees becoming registered GPs, and to provide a policy-making basis for GP recruitment and retention. METHODS A qualitative description design by the purposive sample was carried out in two training bases of Jinan and Qingdao in eastern China. Face-to-face, in-depth, semi-structured interviews were conducted, audiotaped, and transcribed using thematic analysis. RESULTS Twenty-one trainees participated in this study. Thematic analysis generated five major themes: (1) low social recognition, (2) low professional identity, (3) low remuneration level, (4) imperfect training system, and (5) influence of policy factors. CONCLUSIONS Our results identified various negative factors influencing the career intentions of trainees. In order to overcome the hurdles and increase the attractiveness of GP, it is recommended that the government and the public should create a supportive environment, which can be beneficial to the construction and development of GP.
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Affiliation(s)
- Lei Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
| | - Huan Yang
- Department of Human Resources, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, 322000 Yiwu, China
| | - Zhuxin Mao
- School of Public Administration, Southwestern University of Finance and Economics, 611130 Chengdu, China
| | - Quan Li
- Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
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Rawal LB, Sun Y, Dahal PK, Baral SC, Khanal S, Arjyal A, Manandhar S, Abdullah AS. Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal. PLoS One 2022; 17:e0261518. [PMID: 34990481 PMCID: PMC8735630 DOI: 10.1371/journal.pone.0261518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction
Non-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal.
Methods
We used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts.
Results
The mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801–0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities.
Conclusion
We conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.
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Affiliation(s)
- Lal B. Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
- Translational Health Research Institute, and School of Social Sciences, Western Sydney University, Penrith, Australia
- * E-mail: , (LBR); (ASA)
| | - Yuewen Sun
- Global Health Institute, Duke Kunshan University, Jiangsu, China
| | - Padam K. Dahal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Rockhampton, Australia
| | | | - Sudeepa Khanal
- HERD International, Kathmandu, Nepal
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | | | - Abu S. Abdullah
- Global Health Institute, Duke Kunshan University, Jiangsu, China
- Duke Global Health Institute, Duke University, Durban, NC, United States of America
- Boston University School of Medicine, Boston Medical Center, Boston, MA, United States of America
- * E-mail: , (LBR); (ASA)
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Sutarsa IN, Kasim R, Slimings C, Bain-Donohue S, Barnard A. Effects of employing primary care doctors in hospital to improve the quality of care and health outcomes of rural patients: A systematic scoping review. Aust J Rural Health 2021; 29:492-501. [PMID: 34423514 DOI: 10.1111/ajr.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/02/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe effects of employing primary care doctors in hospital care and their roles in improving the quality of care and health outcomes of rural and remote patients. DESIGN A systematic scoping review. SETTING Peer-reviewed publications were sourced from 3 online journal databases (PUBMED, SCOPUS and Web of Science). PARTICIPANTS All study designs from peer-reviewed journals that discussed effects of employing primary care doctors in hospital care Interventions: employing primary care doctors in hospital care. MAIN OUTCOME MEASURES Positive and negative consequences of employing primary care doctors in hospital care, and the roles of primary care doctors in improving the quality of care and health outcomes. RESULTS A total of 12 articles met the inclusion and exclusion criteria. Positive outcomes included improved access to specialised treatment, improved continuity of care, reduced waiting list and admission rates, improved skills, competence and confidence of primary care doctors, and increased satisfaction from both health providers and patients/families. Negative consequences reported included increased prescriptions and poorly documented history and physical examinations. CONCLUSION Employing primary care doctors in hospital care can fill the gaps in the delivery of acute care, emergency medicine and maternity care. Primary care doctors bring advanced clinical skills and a patient-centred approach to the hospital care. They also improve the quality of referrals leading to freed-up clinical capacity of tertiary hospitals to treat more serious conditions. The provision of acute or emergency care and secondary care in rural and remote areas should be directed towards patient-oriented not provider-oriented policies.
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Affiliation(s)
- I Nyoman Sutarsa
- Rural Clinical School, Medical School, The Australian National University, Acton, ACT, Australia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Rosny Kasim
- Rural Clinical School, Medical School, The Australian National University, Acton, ACT, Australia
| | - Claudia Slimings
- Rural Clinical School, Medical School, The Australian National University, Acton, ACT, Australia
| | - Suzanne Bain-Donohue
- Rural Clinical School, Medical School, The Australian National University, Acton, ACT, Australia
| | - Amanda Barnard
- Rural Clinical School, Medical School, The Australian National University, Acton, ACT, Australia
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Neupane P, Bhandari D, Tsubokura M, Shimazu Y, Zhao T, Kono K. The Nepalese health care system and challenges during COVID-19. J Glob Health 2021; 11:03030. [PMID: 33692885 PMCID: PMC7914404 DOI: 10.7189/jogh.11.03030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Prajwal Neupane
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Dilip Bhandari
- Department of Neurosurgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Yuzo Shimazu
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Tianchen Zhao
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan
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Rawal L, Jubayer S, Choudhury SR, Islam SMS, Abdullah AS. Community health workers for non-communicable diseases prevention and control in Bangladesh: a qualitative study. Glob Health Res Policy 2020; 6:1. [PMID: 33407942 PMCID: PMC7786185 DOI: 10.1186/s41256-020-00182-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh. METHODS We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders' consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n = 4); key informant interviews with central level health policymakers/ managers (n = 15) and focus group discussions with CHWs (4 FGDs; total n = 29). Participants in a stakeholder consultative meeting included members from the government (n = 4), non-government organisations (n = 2), private sector (n = 1) and universities (n = 2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. RESULTS The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation. CONCLUSION Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.
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Affiliation(s)
- Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, 400 Kent Street, Sydney, NSW, Australia.
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia.
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, Australia.
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh.
| | - Sohel R Choudhury
- National Heart Foundation Hospital and Research Institute, Mirpur 2, Dhaka, 1216, Bangladesh
| | | | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, 8 Duke Avenue, Kunshan, 215347, People's Republic of China.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
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Rawal LB, Kharel C, Yadav UN, Kanda K, Biswas T, Vandelanotte C, Baral S, Abdullah AS. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study. BMJ Open 2020; 10:e040350. [PMID: 33318116 PMCID: PMC7737104 DOI: 10.1136/bmjopen-2020-040350] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/21/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/OBJECTIVE The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal. DESIGN We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders' consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically. SETTING Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level. PARTICIPANTS We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6). RESULTS The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation. CONCLUSION Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW's capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.
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Affiliation(s)
- Lal B Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, NSW, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
- Translational Health Research Institute (THRI) and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | | | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kie Kanda
- School of Nursing and Midwifery, Western Sydney University, Australia, Sydney, New South Wales, Australia
| | - Tuhin Biswas
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | | | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu 215347, China, Kunsan, China
- School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, USA
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Carmone AE, Kalaris K, Leydon N, Sirivansanti N, Smith JM, Storey A, Malata A. Developing a Common Understanding of Networks of Care through a Scoping Study. Health Syst Reform 2020; 6:e1810921. [PMID: 33021881 DOI: 10.1080/23288604.2020.1810921] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The phrase "Networks of Care" seems familiar but remains poorly defined. A health system that exemplifies effective Networks of Care (NOC) purposefully and effectively interconnects service delivery touch points within a catchment area to fill critical service gaps and create continuity in patient care. To more fully elaborate the concept of Networks of Care, we conducted a multi-method scoping study that included a literature review, stakeholder interviews, and descriptive case studies from five low- and middle-income countries. Our extended definition of a Network of Care features four overlapping and interdependent domains of activity at multiple levels of health systems, characterized by: 1) Agreement and Enabling Environment, 2) Operational Standards, 3) Quality, Efficiency and Responsibility, and 4) Learning and Adaptation. There are a series of key interrelated themes within each domain. Creating a common understanding of what characterizes and fosters an effective Network of Care can drive the evolution and strengthening of national health programs, especially those incorporating universal health coverage and promoting comprehensive care and integrated services. An understanding of the Networks of Care model can help guide efforts to move health service delivery toward goals that can benefit a diversity of stakeholders, including a variety of health system actors, such as health care workers, users of health systems, and the wider community at large. It can also contribute to improving poor health outcomes and reducing waste originating from fragmented services and lack of access.
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Affiliation(s)
- Andy E Carmone
- Clinical Sciences, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Katherine Kalaris
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Nicholas Leydon
- Global Delivery Programs, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Nicole Sirivansanti
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Jeffrey M Smith
- Maternal, Newborn & Child Health, Bill & Melinda Gates Foundation , Seattle, Washington, USA
| | - Andrew Storey
- Maternal and Neonatal Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | - Address Malata
- Office of the Chancellor, Vice Chancellor, Malawi University of Science and Technology , Limbe, Malawi
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Firew T, Gebreyesus A, Woldeyohannes L, Ebrahim F, Patel S. Human resources for emergency care systems in Ethiopia: Challenges and triumphs. Afr J Emerg Med 2020; 10:S50-S55. [PMID: 33318902 PMCID: PMC7723913 DOI: 10.1016/j.afjem.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022] Open
Abstract
Emergency care is in its nascency in most of the world and emergency health systems are developing throughout Africa, including Ethiopia. Ethiopia is a LMIC African nation that has committed to strengthening emergency care systems. A historical perspective provides the background of Ethiopian emergency care with the development of an emergency care taskforce to the first residency program and subsequent development of the Emergency and Critical Care Directorate. The goals of the directorate are discussed as well as their role in the development of the national integrated emergency medicine curriculum. Concurrently the development of multiple residencies as well as a nursing emergency and critical care training increased the human resources for emergency medicine. Recently, the WHO and Ministry of Health-Ethiopia have been working together to roll out an integrated emergency care system development agenda throughout the country bolstered by the recent passing of a world health assembly resolution to strengthen emergency care co-led by Ethiopia. With all the successes of Ethiopia in increasing human resources there have been both triumphs and challenges. The development of human resources for emergency care systems in Ethiopia provides insights and lessons learned to other nations on a similar pathway of strengthening emergency care systems.
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Affiliation(s)
- Tsion Firew
- Department of Emergency Medicine, Columbia University, New York, USA
- Ministry of Health - Ethiopia, Addis Ababa, Ethiopia
| | - Alegnta Gebreyesus
- Ministry of Health - Ethiopia, Addis Ababa, Ethiopia
- St. Paul's Hospital Millennium Medical College, Department of Emergency Medicine and Critical Care, Addis Ababa, Ministry of Health - Ethiopia, Addis Ababa, Ethiopia
| | | | | | - Shama Patel
- Ministry of Health-Ethiopia, Addis Ababa, Ethiopia
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
- Corresponding author.
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Gupta P, Agrawal PKB, Gauchan B. Prevalence of Thyroid Disorder in A Primary Care District Hospital of Nepal. JNMA J Nepal Med Assoc 2019; 57. [PMID: 31477943 PMCID: PMC8827590 DOI: 10.31729/jnma.4240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Thyroid disorders are among the common endocrine disorders and may approximate diabetes in prevalence. District hospitals are in frontline to manage chronic disorders including thyroid. Primary care workforce of physicians and mid-level providers together deliver care in these hospitals. Few hospitals are equipped with tests to diagnose thyroid disorders. The objective of the study is to find the burden of thyroid disorder in a district hospital of Nepal. METHODS This was a descriptive cross sectional study conducted in Bayalpata Hospital. One year data from July 2017 to June 2018 was collected from the electronic health record system. Data was collected from 999 patients through convenient sampling where thyroid function test was done. Subgroup analysis was done on basis of gender, symptoms at presentation and comorbidities. RESULTS Prevalence of thyroid disorder in a district hospital of Nepal was 171 (17.11%) at 95% confidence interval, range occurring from 14% to 20%. Among them, 130 (76%) had hypothyroidism and 41 (24%) had hyperthyroidism. Prevalence of thyroid disorder among female was 147 (14.7%) and among male was 24 (2.4%). The most common symptom was depressed mood followed by nonspecific pain disorder, thyroid swelling, paresthesia and menstrual disturbances and common comorbidities reported were depression, diabetes, hypertension, anxiety disorder and chronic gastritis. CONCLUSIONS Our study showed the burden of thyroid disorders in a primary care district hospital with hypothyroidism being more common than hyperthyroidism. Thyroid disorder must be addressed on time to lower the burden. However, most of the rural population of Nepal lack in matters of lack of resources. So, it is suggested for the need to equip the health centers with thyroid tests and integrated workforce of physicians and mid-level providers in care delivery of thyroid disorders.
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Affiliation(s)
- Priyanka Gupta
- Department of Medical Services, Bayalpata Hospital, Achham, Nepal,Correspondence: Dr. Priyanka Gupta, Department of Medical Services, Bayalpata Hospital, Achham, Nepal. , Phone: +977-9849221720
| | | | - Bikash Gauchan
- Department of Medical Services, Bayalpata Hospital, Achham, Nepal
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