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Liu R, Zhao Q, Dong W, Guo D, Shen Z, Li Y, Zhang W, Zhu D, Zhang J, Bai J, Ren R, Zhen M, Zhang J, Cui J, Li X, Miao Y. Assessing public health service capability of primary healthcare personnel: a large-scale survey in Henan Province, China. BMC Health Serv Res 2024; 24:627. [PMID: 38745226 PMCID: PMC11094852 DOI: 10.1186/s12913-024-11070-4] [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: 12/05/2023] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The public health service capability of primary healthcare personnel directly affects the utilization and delivery of health services, and is influenced by various factors. This study aimed to examine the status, factors, and urban-rural differences of public health service capability among primary healthcare personnel, and provided suggestions for improvement. METHODS We used cluster sampling to survey 11,925 primary healthcare personnel in 18 regions of Henan Province from 20th to March 31, 2023. Data encompassing demographics and public health service capabilities, including health lifestyle guidance, chronic disease management, health management of special populations, and vaccination services. Multivariable regression analysis was employed to investigate influencing factors. Propensity Score Matching (PSM) quantified urban-rural differences. RESULTS The total score of public health service capability was 80.17 points. Chronic disease management capability scored the lowest, only 19.60. Gender, education level, average monthly salary, professional title, health status, employment form, work unit type, category of practicing (assistant) physician significantly influenced the public health service capability (all P < 0.05). PSM analysis revealed rural primary healthcare personnel had higher public health service capability scores than urban ones. CONCLUSIONS The public health service capability of primary healthcare personnel in Henan Province was relatively high, but chronic disease management required improvement. Additionally, implementing effective training methods for different subgroups, and improving the service capability of primary medical and health institutions were positive measures.
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Affiliation(s)
- Rongmei Liu
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qiuping Zhao
- Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Dan Guo
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Mingyue Zhen
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jiajia Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Jinxin Cui
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Xinran Li
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, No.100 Kexue Road, Zhongyuan District, Zhengzhou, Henan, 450001, China.
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Martineau T, Mansour W, Dieleman M, Akweongo P, Amon S, Chikaphupha K, Mubiri P, Raven J. Using the integration of human resource management strategies at district level to improve workforce performance: analysis of workplan designs in three African countries. HUMAN RESOURCES FOR HEALTH 2023; 21:57. [PMID: 37488651 PMCID: PMC10367416 DOI: 10.1186/s12960-023-00838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems. METHODS The study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined. RESULTS About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans. CONCLUSIONS The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving 'health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.
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Affiliation(s)
- Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Wesam Mansour
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Amsterdam, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Patricia Akweongo
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Amon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | | | - Paul Mubiri
- Makerere University School of Public Health, Kampala, Uganda
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Martineau T, Ozano K, Raven J, Mansour W, Bay F, Nkhoma D, Badr E, Baral S, Regmi S, Caffrey M. Improving health workforce governance: the role of multi-stakeholder coordination mechanisms and human resources for health units in ministries of health. HUMAN RESOURCES FOR HEALTH 2022; 20:47. [PMID: 35619105 PMCID: PMC9134719 DOI: 10.1186/s12960-022-00742-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/15/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND A cohesive and strategic governance approach is needed to improve the health workforce (HW). To achieve this, the WHO Global Strategy on Human Resources for Health (HRH) promotes mechanisms to coordinate HRH stakeholders, HRH structures and capacity within the health sector to support the development and implementation of a comprehensive HW agenda and regular reporting through WHO's National Health Workforce Accounts (NHWA). METHODS Using an adapted HRH governance framework for guidance and analysis, we explored the existence and operation of HRH coordination mechanisms and HRH structures in Malawi, Nepal, Sudan and additionally from a global perspective through 28 key informant interviews and a review of 165 documents. RESULTS A unified approach is needed for the coordination of stakeholders who support the timely development and oversight of an appropriate costed HRH strategy subsequently implemented and monitored by an HRH unit. Multiple HRH stakeholder coordination mechanisms co-exist, but the broader, embedded mechanisms seemed more likely to support and sustain a comprehensive intersectoral HW agenda. Including all stakeholders is challenging and the private sector and civil society were noted for their absence. The credibility of coordination mechanisms increases participation. Factors contributing to credibility included: high-level leadership, organisational support and the generation and availability of timely HRH data and clear ownership by the ministry of health. HRH units were identified in two study countries and were reported to exist in many countries, but were not necessarily functional. There is a lack of specialist knowledge needed for the planning and management of the HW amongst staff in HRH units or equivalent structures, coupled with high turnover in many countries. Donor support has helped with provision of technical expertise and HRH data systems, though the benefits may not be sustained. CONCLUSION While is it important to monitor the existence of HRH coordination mechanisms and HRH structure through the NHWA, improved 'health workforce literacy' for both stakeholders and operational HRH staff and a deeper understanding of the operation of these functions is needed to strengthen their contribution to HW governance and ultimately, wider health goals.
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Affiliation(s)
- Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Wesam Mansour
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Fiona Bay
- Friends of Waldorf Education, Stuttgart, Germany
| | | | | | | | | | - Margaret Caffrey
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Tilahun B, Endehabtu BF, Gashu KD, Mekonnen ZA, Animut N, Belay H, Denboba W, Alemu H, Mohammed M, Abate B. Current and Future Needs for Human Resources for Ethiopia's National Health Information System: Survey and Forecasting Study. JMIR MEDICAL EDUCATION 2022; 8:e28965. [PMID: 35412469 PMCID: PMC9044145 DOI: 10.2196/28965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/17/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Strengthening the national health information system is one of Ethiopia's priority transformation agendas. A well-trained and competent workforce is the essential ingredient to a strong health information system. However, this workforce has neither been quantified nor characterized well, and there is no roadmap of required human resources to enhance the national health information system. OBJECTIVE We aimed to determine the current state of the health information system workforce and to forecast the human resources needed for the health information system by 2030. METHODS We conducted a survey to estimate the current number of individuals employed in the health information system unit and the turnover rate. Document review and key-informant interviews were used to collect current human resources and available health information system position data from 110 institutions, including the Ministry of Health, federal agencies, regional health bureaus, zonal health departments, district health offices, and health facilities. The Delphi technique was used to forecast human resources required for the health information system in the next ten years: 3 rounds of workshops with experts from the Ministry of Health, universities, agencies, and regional health bureaus were held. In the first expert meeting, we set criteria, which was followed by expert suggestions and feedback. RESULTS As of April 2020, there were 10,344 health information system professionals working in the governmental health system. Nearly 95% (20/21) of district health offices and 86.7% (26/30) of health centers reported that the current number of health information system positions was inadequate. In the period from June 2015 to June 2019, health information technicians had high turnover (48/244, 19.7%) at all levels of the health system. In the next ten years, we estimate that 50,656 health information system professionals will be needed to effectively implement the Ethiopia's national health information system. CONCLUSIONS Current health information system-related staffing levels were found to be inadequate. To meet the estimated need of 50,656 multidisciplinary health information system professionals by 2030, the Ministry of Health and regional health bureaus, in collaboration with partners and academic institutions, need to work on retaining existing and training additional health information system professionals.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu F Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun D Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke A Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health Systems Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Netsanet Animut
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Hiwot Belay
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Wubshet Denboba
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Hibret Alemu
- Data Use Partnership Project, John Snow, Inc (JSI), Addis Ababa, Ethiopia
| | - Mesoud Mohammed
- Policy, Planning, Monitoring and Evaluation Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Biruk Abate
- Policy, Planning, Monitoring and Evaluation Directorate, Ministry of Health, Addis Ababa, Ethiopia
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Ramsden R, Davies S, Colbran R, Haigh A, Connors M, Nott S, Lowe E, Edwards M, Clegg R, Bagnulo S, Pit S. Collaborative care: Primary health workforce and service delivery in Western New South Wales-A case study. Aust J Rural Health 2021; 29:768-778. [PMID: 34586698 PMCID: PMC9292276 DOI: 10.1111/ajr.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/01/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore how four small towns in rural New South Wales known as the 4Ts are addressing challenges accessing quality care and sustainable health services through a collaborative approach to workforce planning using the collaborative care framework. DESIGN Descriptive case study approach. SETTING The collaborative care project was developed as a result of ongoing partnerships between 2 rural Local Health Districts, 2 Primary Health Networks and a non-governmental health workforce organisation. The collaboration works with 5 subregions each comprising 2 or more rural communities. This paper focuses on the 4Ts subregion. PARTICIPANTS Stakeholders of the collaborative design including organisations and the community. INTERVENTION A place-based approach to co-designing health services with community in one sub-region of Western New South Wales. MAIN OUTCOME MEASURES A synthesis of field observations and experiences of community and jurisdictional partners in implementation of the 4Ts subregional model. Mapping of implementation processes against the collaborative care framework. RESULTS The collaborative care framework is a useful planning and community engagement tool to build health workforce literacy and to impact on system change at the local level. We identify key elements of effectiveness in establishing the 4Ts model, including the need for coordinated health system planning, better integrating existing resources to deliver services, community engagement, building health workforce literacy and town-based planning. CONCLUSION This study adds to the body of knowledge about how to successfully develop a collaborative primary health care workforce model in practice. The findings demonstrate that the implementation of a collaborative primary health care workforce model using the collaborative care framework can improve service access and quality, which in turn might facilitate workforce sustainability.
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Affiliation(s)
- Robyn Ramsden
- NSW Rural Doctors Network, Newcastle, NSW, Australia
| | - Sarah Davies
- NSW Rural Doctors Network, Newcastle, NSW, Australia
| | | | - Amelia Haigh
- Western Local Health District, Dubbo, NSW, Australia
| | | | - Shannon Nott
- Western Local Health District, Dubbo, NSW, Australia
| | - Estrella Lowe
- NSW Rural Doctors Network, Newcastle, NSW, Australia
| | | | - Richard Clegg
- Tottenham Doctors Support Group, Tottenham Health Advisory Council - WNSW LHD, Dubbo, NSW, Australia
| | | | - Sabrina Pit
- NSW Rural Doctors Network, Newcastle, NSW, Australia
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Cosgrave C. The Whole-of-Person Retention Improvement Framework: A Guide for Addressing Health Workforce Challenges in the Rural Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2698. [PMID: 32295246 PMCID: PMC7216161 DOI: 10.3390/ijerph17082698] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/03/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022]
Abstract
People living in rural places face unique challenges due to their geographic isolation and often experience poorer health outcomes compared to people living in major cities. The struggle to attract and retain an adequately-sized and skilled health workforce is a major contributing factor to these health inequities. Health professionals' decisions to stay or leave a rural position are multifaceted involving personal, organisational, social and spatial aspects. While current rural health workforce frameworks/models recognise the multidimensional and interrelated influences on retention, they are often highly complex and do not easily support the development of strategic actions. An accessible evidence-informed framework that addresses the complexity but presents the evidence in a manner that is straightforward and supports the development of targeted evidence- and place-informed retention strategies is required. The 'Whole-of-Person Retention Improvement Framework' (WoP-RIF) has three domains: Workplace/Organisational, Role/Career and Community/Place. The necessary pre-conditions for improving retention through strengthening job and personal satisfaction levels are set out under each domain. The WoP-RIF offers a person-centred, holistic structure that encourages whole-of-community responses that address individual and workforce level needs. It is a significant response to, and resource for, addressing avoidable rural health workforce turnover that rural health services and communities can harness in-place.
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Affiliation(s)
- Catherine Cosgrave
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Docker St, Wangaratta, VIC 3677, Australia
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