Health Manpower Research Articles

Role of Rawalpindi Medical University Students in Perspective of Public Health

Role of Rawalpindi Medical University Students in Perspective of Public Health

Postgraduate medical education: The history and development of competency-based training program in Nepal

Nepal is a small, lower-middle-income country; with a population of around 30 million. As per WHO, Nepal has a low doctor-patient ratio (0.7/1000) and even lower specialists (e.g., surgical) workforce (0.003/1000); additionally, data from Nepal Medical Council show the number of postgraduate specialists is 1/3rd of the total registered doctors. The mismatch in the doctor-patient ratio is further aggravated by the overwhelming number of doctors in urban areas; when 80% of the population are in rural Nepal. This inequitable discrepancy in the healthcare system requires: proper training of competent medical graduates, a fair distribution across the country, and effective changes in the healthcare system. Competency-based medical education plays an important role in: standardizing education, training competent doctors, and deploying them where they are needed the most. The Government of Nepal has recently established Medical Education Commission-which plans to oversee the entrance exams; and expand the postgraduate training to be conducted by private hospitals, previously not affiliated with any medical colleges or universities.
 Historically, Civil Medical School started training compounders and dressers in Nepal in 1934. A big milestone was achieved with the establishment of the Institute of Medicine under Tribhuvan University in 1972, which has continued to train all categories of health manpower needed in the country. In 2006 Nepal Medical Council developed “Regulations for Post-graduate Medical education”. Thereafter, several institutions started providing postgraduate training, for example: the BP Koirala Institute of Health Sciences, Kathmandu University, National Academy of Medical Sciences, and Patan Academy of Health Sciences (PAHS). The PAHS conducts PG programs and post-PG fellowships in line with competency-based medical education. In addition to formative assessments, research thesis, and a publishable article; PAHS requires its trainees to be certified in a pre-set of entrustable professional activities (EPAs) and to master eight Core Competencies domains in: Professionalism, Patient-centered care, Procedural skills, Clinical Reasoning, Communication, Scholarship, Leadership, Community orientation.
 The number of medical colleges in Nepal has since expanded to 24 (medical 21 and dental colleges 3). Private medical colleges make up about 3/4th of the total medical colleges in Nepal. This makes the inclusion and regulation of more components of the competency-based curriculum in postgraduate training programs, and its monitoring, somewhat of a challenge.

The inverse care law: implications for universal health coverage in Nigerian rural communities

Background: The inverse care law states that the availability of good healthcare tends to vary inversely with the need for it in the population served. This situation is easily observable in developing countries like Nigeria, and poses a threat to the attainment of universal health coverage (UHC) in rural communities. Objective: To examine how the inverse care law plays out in the Nigerian healthcare system, and how this may lead to a difficulty in achieving UHC in rural communities. Materials and Methods: Standard procedures were used in locating, selecting, extracting and synthesizing data. Electronic databases and internet resources such as PubMed, Google Scholar, SCOPUS and Web of Science were searched. Selection of studies was conducted by a two-stage process. Data extraction was done using data extraction forms. During data synthesis, major themes, strengths, weaknesses and critical gaps in each paper were identified. Results: There are several factors that boost the operation of the inverse care law in the Nigerian healthcare system. How this poses a threat to the attainment of UHC has also been documented. Among these are limitations in the range of services provided in rural healthcare facilities, inadequate production and maldistribution of health personnel, and low health manpower retention in rural areas. Conclusion: There is a need for concerted efforts by the government to address the factors that facilitate the inverse care law in the Nigerian healthcare system. This is necessary for the attainment of UHC specifically and the Sustainable Development Goal number three generally.

Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression.

Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.

Volunteering during the COVID-19 pandemic: Attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria.

Volunteering within the health-care sector is crucial during pandemics. This study aimed to assess the attitudes and perceptions of clinical medical and dental students in Lagos, Nigeria, about volunteering during the coronavirus disease 2019 (COVID-19) pandemic. A descriptive cross-sectional study was conducted amongst medical and dental students undergoing clinical postings at the two public universities in Lagos, Nigeria, using total population sampling. Data were collected using a web-based questionnaire and analysed using Statistical Package for the Social Sciences. Chi-square test and logistic regression analysis were used to test for association at the level of significance of 5%. The mean age of the respondents was 23.3 years ± 2.6 standard deviation and 62.5% were females. The majority (82.9%) of the respondents agreed to volunteer if provided with adequate personal protective equipment (PPE) and if adequately trained to do so (79.3%). Although perceived as dangerous, the majority (91.2%) of the respondents considered volunteering during the COVID-19 pandemic as a form of educational experience. Compared to the final-year students, penultimate year students were more likely to volunteer in the event of a health manpower shortage. The final-year students were more likely to volunteer if government made the request. Female students were more likely than male students to volunteer even if they were not compensated but would require parental approval. Medical and dental students perceived their involvement during the COVID-19 pandemic as a form of educational experience but would require adequate training and PPE. There is a need to train and provide adequate PPE for them to function as volunteers.

Study of pattern of common chief complaints in patients seeking dental care in private dental institution of Andhra Pradesh, India

Introduction: Provision of proper dental health care depends on many factors like health manpower, infrastructure and compliance from the patients. Among all these the demand for dental health care is usually represented by chief complaints (CCs) form the patient which makes the basic pillar for further evaluation and management. Aims and Objectives: To find out the pattern of chief complaints by the dental patients attending the private dental institution in Andhra Pradesh. Materials and method: A hospital based cross sectional study was conducted at G Pulla Reddy Dental College and Hospital, Kurnool Andhra Pradesh in the month of July 2017. Details regarding age, sex and chief complaints or the reason for visiting the hospital was collected. Results: A total of 1308 visited the hospital during the study period and all of them were included in the study. The demand for treatment was majorly from the 21-30 years age group (27.52%) followed by 31-40years and 11-20years age group. Toothache (32.3%) was the most common CC followed by decayed tooth (19.1%), wants to remove tooth (9.5%). The elderly age group had CC in the form of toothache (31.48%); wants remove the tooth (22.22%) followed by loose tooth (18.51%). Conclusion: From this study it can be concluded that there are variations in dental visits with respect to different age groups and gender. Large scale studies with complete and accurate data collection will definitely aid dental care in a manner by which dental health care programmes at national level can effectively implemented. Keywords: Chief Complaints, Dental, Treatment seeking

The medical organization of primary care: competitiveness and reputation

The article investigated the state of the competitive environment on the market of medical services of the Krasnodar territory, which included socio-economic indicators needed to understand current market conditions such as the number of medical organizations of primary care and health manpower; the volume of paid medical services, rendered to population of the region and individual costs for medical services; the investment performance of the industry, the possibility of participation of private medical organizations in the implementation of the Territorial program of obligatory medical insurance. The author's interpretation reveals the concept of «business reputation of a primary-level medical organization». It is proved that the «business reputation» on the Internet or online reputation has become a strategic tool for ensuring the competitive advantages of a primary - level medical organization. The content analysis of Internet resources conducted in the study showed that the online reputation of a primary care organization is primarily patient reviews (negative and positive), and online reputation management in the Internet is continuous work with patient reviews, the process of communicating with the audience, publishing information materials, etc. Monitoring popular sites on this topic prodoctorov.ru and Yandex. Search and analysis of patient reviews of medical organizations in Sochi allowed the authors to assess the online reputation of primary care organizations. In conclusion, the article presents an algorithm for managing online reputation on the Internet to ensure the competitiveness of primary care organizations.

Universal Health Coverage in India: Where Rubber Hits the Road?

AbstractPoverty and healthcare issues are the most debatable topics today. Developing countries like India have as much as 45% of its population trapped in poverty because of various urgent healthcare needs. Universal health coverage (UHC) is a unique insurance system to provide financial protection to the marginalized groups of the country. It facilitates appropriate and immediate health needs, including required diagnostic, therapeutic and operational costs. However, UHC, a unique plan which focuses on the disadvantaged sections of the society, has some serious lacunae when it comes to its implementation in real life. This includes finances and human resources. Experts are reallocating adequate budgetary expenditure on healthcare issues, and in the meantime, a shortage of skilled health manpower is hunting down the UHC scheme in India. In recent times, different state governments are increasing budget allocation for the health sector. UHC is targeting low-income and poor families, forgetting the affordable and timely healthcare by way of improving services offered at the primary health centers and rapid expansion of the skilled health manpower across the country. UHC needs to focus on health paradigm systems, including improved healthcare-seeking behavior, nutrition, sanitation, potable water, reducing maternal and infant mortality, and dissemination of information of current technology to provide quality health services to the underserved and marginalized population of the country. These changes would symbolize a real way forward toward the immediate fulfillment of UHC goals for India.

Evaluation and analysis on the degree of patients′ trust in community TCM physicians under the TCM service capability promotion program

Objective To evaluate the degree of trust of patients in community traditional Chinese medicine(TCM)physicians, based on the TCM service capability promotion program, and to analyze the impacts by TCM prevention and health care service. Methods 1 391 patients at 22 primary health service centers in 3 cities from Zhejiang province were investigated using the Chinese version of Wake Forest Physician Trust Scale(WFPTS)in September, 2017. Quantitative and qualitative variables were described by mean±SD, and ratio respectively. Differences were compared by t test, ANOVA and Kruskal-Wallis test. Results Chinese version of WFPTS had good reliability and validity in measuring community TCM physicians. The average scoring of patients′ trust in community TCM physicians was 38.00±6.42, while their benevolence and competence were 19.14±3.41, 18.82±3.50 respectively.For patients with different demographic characteristics, their quantity and the way to acquire and utilize TCM prevention and health care service had different degrees of trust in community TCM physicians. Patients′ gender, age, awareness and utilization of TCM prevention and health care service, etc. affect the degree of trust in community TCM physicians. Conclusions Patients have higher degree of trust in community TCM physicians, and improving the rate of awareness and utilization of TCM prevention has positive impacts on the degree of trust in these physicians. It is proposed that health knowledge education be strengthened and skills of community TCM physicians′ capacity be enhanced through various ways. Key words: Community health service; Health manpower; TCM physician; Doctor-patient trust; Prevention and health care service

Present situation of the staff of ultrasound departments in Shanghai medical institutions

Objective To investigate the current basic situation of the staff of ultrasound departments in Shanghai′s medical institutions, for providing references in making management policy of these professionals. Methods Questionnaire surveys on human resource and service ability were made to all the ultrasound departments of medical institutions in Shanghai in December 2013 and November 2018 respectively. Data of the two surveys were compared and analyzed, and were descriptively analyzed by mean and percentage. Results The number of ultrasound professionals per 10 000 people in Shanghai was 1.04 in 2018. Tertiary hospitals had advantages in the number of the professionals, and the proportion of professional qualification, age, education background and professional title of the professionals. Compared to those data in 2013, the number of ultrasound professionals had increased 31.8% in 2018. The proportion of medical practitioners with medical imaging specialty was 95.6%(2 063/2 158), and had increased by 4.7 percent. The medical services workload of ultrasound was 19.82 million person-time, and had increased 45.8%. Conclusions Development of ultrasound departments was rapid, but the development of professionals was unbalanced with the development of medical services. It is suggested to strengthen training of ultrasound professionals and improve the system of hierarchical medical system. Key words: Health manpower; Ultrasonography; Professional and technical personnel; Shanghai

Covid 19 in Karnataka; Recent scenario and instant measures to suppress the pandemic

In Karnataka, Covid caseload has crossed one lakh mark on 27 th July 2020. July month witnessed a new record, adding at least 85 percent of all cases in the state since March 9, 2020. The Covid infection is rising at faster rate. The major reasons for rising this infection are; very lenient/absurd quarantine policy, slow rate of testing in the initial phase and poor health infrastructure and manpower under public health facilities. This status of public health facility is a inherent problem does exist before Covid 19 enters the state. The entry of this pandemic potential virus has made the system still to suffer. The poor anticipation and insufficient preparedness for Covid 19 added to already the burning fury. Lack of people cooperation also equally true. Now almost lock down is unlocked, therefore the suppressing the virus should be with an immediate extra measures. The state cannot continue lockdown for a long period as financial crisis already set in. Preparing for this pandemic does not mean we have to sideline non covid health needs. The immediate steps should be that, certain proportion of beds shall be reserved at all level of health facilities to treat the Covid and non covid patients also. The major key to suppress the virus will be, effective tracing, increasing the testing, isolating the needy and efficient treatment. The government should enhance the capacity building of our health system in terms of Covid specific infrastructure as well as manpower without delay. Mass rapid testing should be initiated especially in urban wards and ward wise Covid Care Centers (CCC) shall be established on priority base. Private hospitals shall ensure their social responsibility and ethics.

Obstacles faced by nurses working in Covid-19 unit: A developing country view point

The fiery role played by nurses as frontline warrior in the fight against Covid-19 is commendable. At times of high demand of health manpower to manage patients affected by Covis-19 pandemic nurses are coming forward willingly to work tirelessly for long, uncertain shifts. The experience of working in an isolation unit could be physically, emotionally and psychologically draining for nurses. Although healthcare workers tried to fight back the disease in a short spell of time but nurses are facing issues regarding management, work environment, family cross infection, self-infection risk, assault, emotional & physical drain and psychological stress. These issues need to be addressed to keep nurses morale up. Training to work in isolation unit is the need of the hour keeping in mind, they also may be victim of psychological exhaustion. online platforms could be easier and mass approach to deal with psychological issues among nurses working as frontline warriors.

Strategies of India against coronavirus disease-2019: A strengths, weaknesses, opportunities, and threats analysis

The coronavirus disease-2019 is a rapidly progressing pandemic that has jeopardized health infrastructure in many countries. India was to some extent successful to slow the rate of spread of disease by implementing multipronged strategies. Unfortunately, despite all efforts, the disease is rapidly progressing in India. The aim of this review is to critically appraise the strategies adopted by the Government of India to tackle this pandemic and to suggest suitable strategies for the current scenario. Strengths, weaknesses, opportunities, and threats analysis was done to assess the current scenario. Delayed and selective implementation of regulation on international travel, self-reporting of symptoms and undue reliance of thermal scanning for screening at the point of entry screening, poorly monitored home quarantine strategy with noncompliance, narrow testing strategy at the beginning with inability to capture asymptomatic case were some of the loopholes identified in the existing strategy. Improvement of inter-sectoral coordination by the development of Multi-disciplinary Epidemic Management board, involvement of AYUSH, judicious use of health manpower, and capacity development for indigenous production of personal protective equipment and other logistics, up-gradation of rural health facility and preparedness for second wave are the key recommendations.

Impact of COVID-19 pandemic on orthopedic practice-Results of a survey from a Covid hotspot in India

Introduction: COVID-19 pandemic has drastically affected medical practice including the specialty of Orthopedics. This study aims to analyze and quantify its actual impact on practice amongst the orthopedic Surgeons in Chennai. Materials and Methods: We did an online survey among the practicing orthopedic surgeons in Chennai. A questionnaire to assess pre-COVID and post-COVID quantum of practice, with a time frame between 23rd of March 2020 and 31st of May 2020, was done and analyzed. Results: 101 orthopedic surgeons participated in this survey with a response rate of 15%. Senior surgeons comprised the major share-45.5% of the participants of this survey. Among the surgeons who participated in the survey, 49.5% of them declared that their Outpatient practice during this pandemic dropped by more than 75%. The percentage of surgeons who operated <5 cases per week before pandemic was 39.4%, which rose to 94.1% during the pandemic. Though 76.2% of the surgeons continued to attend trauma cases during the pandemic with risk involved none of the surgeons became COVID positive during study period. Discussion: Chennai became a COVID-19 hotspot and its impact was evident in various spheres of orthopedic practice. Health manpower management underwent drastic change to adapt to the new challenges put forth. Injury and orthopedic case demographics had a major shift towards domestic injuries and geriatric health care seekers approaching hospitals. RTA’s reduced in number. OP and OR case volume during pandemic were reduced significantly in comparison to pre-COVID times showing the quantum of COVID-19 impact.

Effectiveness of interventions by nurse practitioners for prevention and control of noncommunicable diseases in low- and middle-income countries: A systematic review protocol

Introduction: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable disease (NCD) prevention programs due to a shortage of health manpower. Task shifting to nurses is a viable and effective solution to address the health-care human resource crisis. The major advantage of involving nurses is that they are the largest, skilled, and already established workforce in any health-care institution. Despite the effectiveness of NCD interventions by nurse practitioners (NPs), there is a relative lack of evidence from LMICs which prevents the scale-up of the NPs model for better health outcomes. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by NPs for the management of chronic NCDs in LMICs. Methods and Analysis: Electronic databases, i.e., PubMed, Excerpta Medica Database (EMBASE), CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs in the English language shall be searched between 2004 and 2019 (last 15 years). Research designs to be included are randomized controlled trials, before–after studies, and Quasi-experimental studies. The primary outcome includes the change in behavioral risk factors, physiological risk factors, and clinical parameters. Subgroup and sensitivity analysis will be performed. Ethics and Dissemination: Ethical approval has been obtained from the institute ethics committee. Results will be disseminated through peer-reviewed scientific journals and presentation at national and international conferences. Study Design: Systematic review. PROSPERO registration number CRD42019118430

Strengthening public healthcare systems in India; Learning lessons in COVID-19 pandemic.

COVID-19 pandemic has involved nations and incapacitated the health systems globally. The pandemic preparedness has been tested with immense losses. Universal health coverage is needed more than ever to recuperate from the effects of the current pandemic. Post pandemic, many lessons need to be learnt especially for developing economies like India where public healthcare system is grossly inadequate to take care of health needs of citizens. World Health Organization's framework of six health system building blocks was utilized to study the lessons learnt and actionable points in the post pandemic period. Participation in Global Health Security Alliance has to be stepped up with involvement in Joint external evaluation and development of epidemiological core capacities. National Health Security Action Plan needs to drafted and available for health emergences. Ayushman Bharat scheme should incorporate elements to address surge capacity at the time of health emergencies and measures to deliver care at the time of pandemic. Technology through telemedicine, m-health, and digital platforms or apps should contribute to trainings, supervision, and facilitation of healthcare delivery at remote locations. Open data sharing policies should be developed for the practice of evidence-based public health. Public healthcare system and health manpower trained in epidemiology should be given a boost to have system readiness to respond in case of future pandemics.

Human Development in India with Special Reference to Health

Human resource development has been acknowledged to be a key factor in the process of economic growth, as the character and pace of economic and social development of any country are ultimately determined not by its capital of its material resources but by human resources. The abundant physical resources alone cannot benefit the growth of the country without human resources component, which transforms physical resources into productive resources. Human resource should also be looked after properly and continuously regarding various aspects like development and economic, social and psychological aspects. Public health facilities are allocated on the basis of primary health centers dispensaries through which preventive and primitive care is provided. India spends about 4.9 per cent of its GDP on health with the share of public expenditure fixed at 0.9 per cent compared to private is 4 per cent of private expenditure. The private healthcare is much larger and widespread than public health services. The improvement people in the health status been one of the major thrust areas for the social development programs of the country. Over the last five decades, India has built up vast health infrastructure and manpower at primary, secondary and tertiary care in government, voluntary and private sectors.

A cross sectional study of thrombocytopenia in malaria positive cases in a tertiary care hospital of Bareilly

Background: To find out correlation of thrombocytopenia with malaria. Malaria is a protozoal disease caused by infection with parasite of genus Plasmodium. Thrombocytopenia is a common and early sign of malarial infection and 60-80% thrombocytopenia is observed in malarial cases and present more frequently and severe in complicated P. falciparum malaria.Methods: A cross sectional study done in Central Pathological Lab of Department of Pathology, RMCH, Bareilly. Blood samples collected in ethylenediaminetetraacetic acid vial and blood smear was examined for malaria parasite within red blood cells. Malaria rapid test was done for detection of Plasmodium species and platelet count was done.Results: 780 cases of malaria was studied from September 2018 to December 2018, male predominance of 54.5%, maximum malarial positive cases 26.92% in the age group of 21-30 years, maximum 86.28% cases were of P. vivax, and thrombocytopenia was observed in 91.54% cases.Conclusions: Mostly developing countries with limited resources and trained health manpower are malaria-endemic region of world. Thrombocytopenia is associated with both P. vivax and P. falciparum infections. In our study significance association between malaria and thrombocytopenia has been observed. We suggest malaria should be a consideration in all patients with fever and thrombocytopenia.

Study on the relationship between career anchor and career orientation of doctors in Sir Run Run Shaw Hospital

Objective To use the career anchor scale to understand the career development route preference of doctors, so as to provide a reference for their individual career planning and positioning, encourage them to realize their personal value, and provide scientific decision-making basis for hospital human resource management. Methods The career anchor scale was used and a career orientation scale was established. In June 2017, a group sampling survey was conducted among doctors at a university affiliated hospital in Zhejiang province, and 790 valid questionnaires were collected. The questionnaire covered 40 items, with the self-report 6 subscale and the χ2 test used for comparison of rates. Results Eight types of career anchors were commonly distributed among doctors, among which the technical/functional anchor was the main career anchor, scoring 24.45±5.11 points. There was a correlation between doctors′ career anchors and their career orientations, among which the managerial career anchors scored the highest, with a correlation coefficient of 0.228. Conclusions The career anchor theory can be used to guide the career development of employees and establish a multi-career development ladder for doctors. Key words: Health manpower; Doctors; Career anchor; Career orientation; Career planning

FAKTOR-FAKTOR YANG MEMPENGARUHI KEPATUHAN PASIEN GANGGUAN JIWA MELAKUKAN PENGOBATAN RUTIN KE PUSKESMAS SIDODADI KECAMATAN KOTA KISARAN BARAT KABUPATEN ASAHAN TAHUN 2018

Mental health is a state where one is free from mental disorders and has a positive attitude to describe maturity and personality. Based on preliminary studies at Sidodadi Public Health Center, patients suffering from anxiety as many as 26 people and patients suffering from depression as many as 38 people. The purpose of this study is to determine the factors that influence the patient's compliance with mental disorders doing routine treatment to Sidodadi Health Center District West Kisaran City Asahan Region 2018, with the type of quantitative writing that is analytic. The population in this writing is the entire head of the family of patients who have mental disorders anxiety and depression that is as many as 64 people. The sampling technique used is total sampling. Data were collected by interviews using the questionnaire. Data analysis was done univariate and bivariate with the Pearson correlation test. The findings of the research showed that there was significant influence between family attitudes, family support, the distance of Health Center, support of health workers. The most dominant variable that influenced the patient's compliance with mental disorder to do routine treatment is the support of health manpower 5.8 times. Head of Health Center to encourage health workers to continue to visit the family home of mental disorders so that they can help the healing process or care for people with mental disorders.