Context Of Health Sector Reform Research Articles

Аналіз проблем кадрового забезпечення первинної медичної допомоги в контексті реформування галузі охорони здоров’я в Україні

У статті висвітлюється стан реформування галузі охорони здоров’я України на засадах сімейної медицини, зокрема, зосереджено увагу на проблемі кадрового забезпечення первинної ланки у процесі реформування. Наведені статистичні дані щодо динаміки кадрового дефіциту, розглядаються основні заходи, які здійснюються державою для вирішення цієї проблеми, запропоновані інші кроки, що дозволять поліпшити стан забезпечення сімейними лікарями та середнім медичним персоналом центрів первинної медичної допомоги, серед яких особлива увага приділяється питанням соціально-економічного захисту медичних працівників та їх безперервного професійного розвитку.

Determinants of village doctors\u2019 job satisfaction under China\u2019s health sector reform: a cross-sectional mixed methods study

BackgroundTo strengthen rural health workforce, the Chinese government has launched a series of policies to promote the job satisfaction of village doctors since the health sector reform. The purpose of this mixed-method study is to describe village doctors’ job satisfaction under the context of health sector reform and investigate the associated factors.MethodsData was obtained from a survey of village doctors across three Chinese provinces in 2014. Using a multistage sampling process, quantitative data was collected from village doctors through the self-administered questionnaire and analyzed by multilevel logistic regression models. Qualitative data was collected through face-to-face semi-structured interviews on both village doctors and health managers. Theoretical coding was then conducted to analyze qualitative data.ResultsAmong the 1221 respondents, 48.6% felt satisfied with their job. Older village doctors with less of a workload and under high-level integrated management were more likely to feel satisfied with their job. Village doctors who earned the top level of monthly income felt more satisfied, while on the county level, those who lived in counties with the highest GDP felt less satisfied. However, enrollment in a pension plan showed no significant difference in regards to village doctors’ job satisfaction.Among 34 participants of qualitative interviews, most believed that age, income, and integrated management had a positive influence on the job satisfaction, while pension plan and basic public health care policies exhibited negative effects. Also, the increasing in availability of healthcare and health resources along with local economic development had negative effects on village doctors’ job satisfaction.ConclusionVillage doctors’ job satisfaction was quite low in regards to several determinants including age, income, workload, enrollment in a pension plan, integrated management, and county economic and medical availability development.

Sustaining leprosy services in the changing context of health sector reform.

National leprosy control programmes currently face a number of changes to the environment within which they operate. This paper examines the issues arising from these. It focuses, in particular, on those arising from changes in the structure of the health sector as a result of policies of health sector reform which are being considered or adopted in many developing countries. These include decentralization, financing strategies, greater role for the private and NGO sectors and the integration of vertical programmes. The paper is structured around a number of key steps in the development of a strategy for sustainability of appropriate leprosy services. These are the assessment of the epidemiological, social and health services context, development of programme objectives, planning of human and financial resources, development of the strategy, mapping the roles of potential actors, development of regulatory and incentive mechanism, action planning and managing change and, finally, re-evaluation of the programme objectives and service delivery organization. The paper stresses the importance of process in developing ownership of a strategy. It concludes with a set of key questions which it suggests need to be addressed by leprosy programme managers in the development of a proactive response to the changes.