Perspectives Of Health Workers Research Articles

Retention of health workers in Malawi: perspectives of health workers and district management

BackgroundShortage of human resources is a major problem facing Malawi, where more than 50% of the population lives in rural areas. Most of the district health services are provided by clinical health officers specially trained to provide services that would normally be provided by fully qualified doctors or specialists. As this cadre and the cadre of enrolled nurses are the mainstay of the Malawian health service at the district level, it is important that they are supported and motivated to deliver a good standard of service to the population. This study explores how these cadres are managed and motivated and the impact this has on their performance.MethodsA quantitative survey measured health workers' job satisfaction, perceptions of the work environment and sense of justice in the workplace, and was reported elsewhere. It emerged that health workers were particularly dissatisfied with what they perceived as unfair access to continuous education and career advancement opportunities, as well as inadequate supervision. These issues and their contribution to demotivation, from the perspective of both management and health workers, were further explored by means of qualitative techniques.Focus group discussions were held with health workers, and key-informant interviews were conducted with members of district health management teams and human resource officers in the Ministry of Health. The focus groups used convenience sampling that included all the different cadres of health workers available and willing to participate on the day the research team visited the health facility. The interviews targeted district health management teams in three districts and the human resources personnel in the Ministry of Health, also sampling those who were available and agreed to participate.ResultsThe results showed that health workers consider continuous education and career progression strategies to be inadequate. Standard human resource management practices such as performance appraisal and the provision of job descriptions were not present in many cases. Health workers felt that they were inadequately supervised, with no feedback on performance. In contrast to health workers, managers did not perceive these human resources management deficiencies in the system as having an impact on motivation.ConclusionA strong human resource management function operating at the district level is likely to improve worker motivation and performance.

“Il diabete è per me…”: la prospettiva degli operatori sanitari

To analyze the representations and meanings of diabetes from the health workers perspective through an ethnographic approach. Participants who attended a national conference on diabetes care were asked to write a narrative responding to the question: "For me, diabetes is...". Narratives were qualitatively analyzed by two researchers following the principles of content analysis. Nvivo software was used to organize and code the data. Of the 147 conference participants, 140 narratives were analyzed: 86 written by nurses, 54 by physicians. Six themes emerged: The disease which summarizes the biomedical and biopsychosocial definitions of diabetes; The patient's illness experience, which describes the impact of diabetes on the patients lives; The clinician's experience, where clinicians fear the impact (actual or potential) of diabetes on their families or themselves; The clinician-patient relationship, where the importance of a good patient-clinician relationship and the related emotions are described; and The social and healthcare system, which describes the healthcare system as an aid as well as an obstacle in patients' care. Despite some academic description of diabetes, our results showed that health care workers, especially nurses, have a profound comprehension of the patient illness experience that sometimes leads to the identification with patients. The relationship and patient education were described as a complex and challenging area of practice for both professions. Training on relational and emotional skills could improve the patients care.

Antiretroviral treatment of HIV in Uganda: a comparison of three different delivery models in a single hospital

This exploratory study examined health worker's perspectives and the type of HIV care received in three different delivery models of antiretroviral treatment (ART) at St Francis Hospital, Kampala, Uganda. Two of the clinics were financed by external donors and the third through out-of-pocket payments. Key informant interviews with health workers investigated potential challenges with ART care, and exit interviews with patients collected data on the care received. Despite the fact that all three clinics were located in the same hospital, services offered and quality of care varied extensively. Health staff at all ART clinics identified the lack of collaboration between different HIV programmes and low patient adherence as the main challenges. More women than men accessed ART through the externally financed programmes. These programmes provided more comprehensive care because of higher staff density and more frequent laboratory monitoring compared to the private clinic. Despite these shortcomings and the fact that prescriptions were often renewed without a preceding medical check-up at the private clinic, many chose to pay a monthly average equivalent of US$60 for ART in return for privacy and access to drugs without HIV disclosure requirements. Stigma and fear of abandonment were thought to be the main barriers for access to ART.

'We are also dying like any other people, we are also people': perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia

In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region. Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment. The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained 'in hiding', did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.

Intimate partner violence among Afghan women living in refugee camps in Pakistan

The purpose of this paper is to explore events and factors that lead to conflict in the home in the Afghan refugee setting, and the current status of the health sector's ability to respond to evidence of conflict. Qualitative interviews were conducted with 20 women of reproductive age and 20 health workers serving these women in an Afghan refugee camp near Peshawar, Pakistan, during the summer of 2004. In particular, this paper analyses women's explanations of how various marriage traditions may be linked to conflict in the home and how the interactions of different family members may be related to conflict. The relationships of women with their parents-in-law and husbands are highlighted in particular, and a model developed to explore the choreography of their relationships and the ways in which these dynamics may encourage or inhibit violence. The perspectives of health workers on the ways in which the health system responds to family conflict and violence are also presented. Finally, this paper provides information that helps to frame the issues of family violence and conflict in long-term refugee populations for intervention designers and those who are working to craft a health sector response to this problem.

Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India

To assess household practices that can affect neonatal health, from the perspective of caregivers and health workers; to identify signs in neonates leading either to recognition of illness or health-care seeking; and to ascertain the proportion of caregivers who recognize the individual items of the integrated management of neonatal and childhood illnesses (IMNCI) programme. The study was carried out in a rural community in Sarojininagar Block, Uttar Pradesh, India, using qualitative and quantitative research designs. Study participants were mothers, grandmothers, grandfathers, fathers or "nannies" (other female relatives) caring for infants younger than 6 months of age and recognized health-care providers serving the area. Focus group discussions (n = 7), key informant interviews (n = 35) and structured interviews (n = 210) were conducted with these participants. Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers, 70.5% reported home deliveries conducted by local untrained nurses or relatives, and most mothers initiated breastfeeding only on day 3. More than half of the caregivers recognized fever, irritability, weakness, abdominal distension/vomiting, slow breathing and diarrhoea as danger signs in neonates. Seventy-nine (39.5%) of the caregivers had seen a sick neonate in the family in the past 2 years, with 30.38% in whom illness manifested as continuous crying. Health care was sought for 46 (23%) neonates. Traditional medicines were used for treatment of bulging fontanelle, chest in-drawing and rapid breathing. Because there is no universal recognition of danger signs in neonates, and potentially harmful antenatal and birthing practices are followed, there is a need to give priority to implementing IMNCI, and possible incorporation of continuous crying as an additional danger sign.

Maternal mortality: Barriers to care at the health facility – health workers perspective

Maternal mortality is a public health hazard and it is a measure of the standard of healthcare system of a given society. Maternal mortality represents one of the starkest and most unacceptable gaps between the developed and developing countries with 98% of all maternal deaths occurring in developing countries. Over 90% of maternal deaths in developing countries are preventable and should be prevented. There is no single pathway to achieving this goal; the approach must be multidimensional. Poor infrastructural development in many developing countries especially sub-Saharan Africa impact adversely on maternal mortality. (excerpt)

“Villagers”: Differential treatment in a Ghanaian hospital

Differential treatment of patients by health workers in African medical institutions is acknowledged by patients, health workers and policy-makers alike to be an obstacle in the realization of government objectives of equity in health care. This qualitative study understands the production and legitimization of differential treatment from the perspective of health workers. On the basis of qualitative field material from a hospital in Northern Ghana the relation between socio-cultural, biomedical and bureaucratic aspects of hospital practice is explored through a focus on categorizations of patients. It is concluded that to blame the “bad attitudes” of health workers for differential treatment is not an adequate explanation. It is important to acknowledge that differential treatment can be understood as a form of agency, and is related to the conditions of hospital work and to the professional and social identities of health workers.

How do health workers and community members perceive and practice community participation in the Bamako Initiative programme in Nigeria? A case study of Oji River local government area

The objective of this study was to assess the perceptions and practices of health workers and households in relation to community participation in the Bamako Initiative programme (BI). The study was conducted in Oji River local government area of South-East Nigeria where the BI program has been operational since 1993. A pre-tested questionnaire was used to collect information from 20 health workers charged with operating the BI in 20 health centres. In addition, focus group discussions were conducted with members of the district and village health committees. Community participation from both health worker and community perspectives seem to have been enhanced by the introduction of BI, despite some constraints. However, the communities were not involved in core areas of community participation, and the health workers seem to be resisting their participation fully. It is concluded the community participation in BI could be improved if expectations were made explicit. This improvement should take into consideration the desires and priorities of the communities and issues impeding participation should be addressed.

Perspectives of health workers regarding primary health care delivery to the rural population in the Bothaville district.

This article reports on the views of public health workers regarding recent changes in the delivery of primary health care to people living and working in the Bothaville rural area. These changes in mobile health care form part of the Initiative for Sub-District Support's programme to provide sustained, concerted support to sub-districts to bring about improvements in health care management and health care delivery. Main shortcomings of the recent changes were identified as inadequate transportation facilities in rural areas, insufficient information dissemination to rural dwellers and lack of farmers' participation in rural health matters. Furthermore, poor communication and co-operation between different public health services prevailed and the need for an integration of these services was emphasised.

THE NEED FOR UPSTREAM THINKING

It has been said that medical workers are like life‐savers standing beside a fast‐flowing river. Every so often a drowning person is swept down, the lifesaver jumps in rescues and rescusitates them. Just as he or she has finished another drowning person appears and the imperative of saving people is such that there is never time to go upstream and see who is pushing everybody in. In public health terms the task of refocussing upstream is in part that of reorientating the education, training and perspective of health workers so that, for instance, the consultant in charge of a coronary care unit becomes interested in coronary prevention or the accident and emergency surgeon becomes active in road safety and the fight against drunken driving. However, the task is also about refocussing the population as a whole away from victim‐blaming towards a rounded understanding of what needs to be done.