Healthcare Professionals In Rural Areas Research Articles

The impact of incentive scheme on rural healthcare workforce availability: a case study of Kazakhstan

BackgroundDuring the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme.MethodsInterrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020.ResultsThere was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals.ConclusionFuture research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas.

Improving the Recruitment and Retention of Healthcare Professionals in Rural Areas: Evidence from the medical doctors of six districts of India

Background: The Human Resource in Health (HRH) crisis is one of the most critical constraints to achieving health and development goals. In this study, the WHO's recommendations were used to highlight the health workforce issues in remote and rural areas with a prime focus on four major policy domains: education, regulatory, financial incentives, and professional and personal support. Objectives: Medical doctors are one of the essential frontline health workers for primary health care in rural India. This study adopted World Health Organization's (WHO's) human resource policy framework to evaluate doctors' responses in understanding the recruitment and retention of medical doctors in rural areas. Materials and Methods: A cross-sectional, descriptive study was conducted in the rural and remote areas of Odisha state, India. A multistage sampling procedure was used to select the participants, who were all government medical doctors working in rural and remote locations. The primary outcome measure is percentage responses using WHO’s Human Resource policy framework Results: Medical doctors working in rural and remote areas perceived the practice as challenging. They were mainly least satisfied with the items asked in the professional and personal support domain. However, more than half of the doctors (56.7%) are eager to work in remote and rural areas for the next three years. Conclusion: Public health administrators and policymakers should create an enabling environment and design interventions encouraging doctors to stay in remote areas. Most importantly, this includes a political and financial commitment to achieve targeted interventions.

Assessing Patient Rights Awareness Among Healthcare Professionals in Rural Areas of a Less Developed Country Without an Official Patient Bill

Awareness of patients’ rights is critical in the provision of healthcare services to ensure protection of these rights and satisfaction of patients. A thorough assessment of patient rights awareness among the physicians and nurses in a rural area of an underdeveloped country was performed, to generate valuable information for possible curriculum adjustments in medical schools and to inform health administrators on the essence to improve the awareness of patient rights among healthcare professionals of these rural areas. 223 active physicians and nurses from the public and private hospitals of different levels in Tiko Sub-Division completed self-administered questionnaires. The study reveals poor knowledge of a patient’s right to make decision about the treatment option, right to refuse treatment and the right to receive medical care in an emergency before payment of the service, among physicians and nurses. Also, the overall patient rights awareness level among the respondents was rated 85%, which signifies an awareness level of standard but requires improvement. The result of this study suggests extended education of healthcare professionals about the rights of a patient, with emphasis on those with no or lower length of work experience. Also, the study further suggests adequate knowledge of patients’ rights and its importance be instilled in medical students of the undeveloped world, be known to, respected and implemented by health administrators and healthcare professionals.

Global best practices in recruiting and retaining healthcare workers in rural areas (literature review)

A significant issue for global healthcare is recruitment and retention of doctors and nurses, especially in rural areas. It threatens continuity and accessibility of medical care for a large segment of the population.The aim of this article was to summarize currently available data on healthcare recruitment practices, particularly in rural areas, and key factors influencing retention of healthcare professionals. This will allow to develop evidencebased strategies for recruitment and retention of healthcare workers in the Russian Federation and reduce personnel shortage. International and Russian full-text articles were searched for in PubMed, ScienceDirect, Cochrane Library, Google Scholar, and eLibrary databases.All the studied factors influencing recruitment and retention of healthcare professionals in rural areas were grouped into four main categories: financial, social, professional, and personal. Modern healthcare recruitment strategies were divided into three groups: financial, organizational, and instructional.The review results suggest that the Russian Federation uses the majority of global strategies to recruit and retain healthcare professionals in rural areas. However, there are some activities that have not been adopted in our country. They may be included in healthcare management practices to increase the effectiveness of regional programs for development of human capital in healthcare.

Career mobility of maternal care providers in Mali: a mixed method study on midwives and obstetric nurses

BackgroundAn important strategy to reduce maternal and child mortality in Mali is to increase the number of deliveries assisted by qualified personnel in primary care facilities, especially in rural areas. However, placements and retention of healthcare professionals in rural areas are a major problem, not only in Mali but worldwide, and are a challenge to the health sector. The purpose of this study was to map the mobility of midwives and obstetric nurses during their work lives, in order to better understand their career paths and the role that working in rural areas plays. This article contributes to the understanding of career mobility as a determinant of the retention of rural health professionals.MethodsA mixed method study was conducted on 2005, 2010, and 2015 cohorts of midwives and obstetric nurses. The cohorts have been defined by their year of graduation.Quantitative data were collected from 268 midwives and obstetric nurses through questionnaires. Qualitative data had been gathered through semi-structured interviews from 25 midwives and stakeholders. A content analysis was conducted for the qualitative data.ResultsUnemployment rate was high among the respondents: 39.4% for midwives and 59.4% for obstetric nurses. Most of these unemployed nurses and midwives are working, but unpaid. About 80% of the employed midwives were working in urban facilities compared to 64.52% for obstetric nurses. Midwives were employed in community health centers (CSCom) (43%), referral health centers (CSRef) (20%), and private clinics and non-governmental organizations (NGO) (15%). The majority of midwives and obstetric nurses were working in the public sector (75.35%) and as civil servants (65.5%). The employment status of midwives and obstetric nurses evolved from private to public sector, from rural to urban areas, and from volunteer/unpaid to civil servants through recruitment competitions. Qualitative data supported the finding that midwives and obstetric nurses prefer to work as civil servant and preferably in urban areas and CSRef.ConclusionThe current mobility pattern of midwives and obstetric nurses that brings them from rural to urban areas and towards a civil servant status in CSRef shows that it is not likely to increase their numbers in the short term in places where qualified midwives are most needed.

Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali.

The availability and retention of healthcare professionals in rural areas and remote areas is a challenge to the health sector worldwide. Attracting people who are most likely to be interested in rural practice can be conducive to the sustainable availability of health services in rural areas where health facilities are typically understaffed and existing professionals often underqualified. This article aims to contribute to the rural pipeline evidence, and reports on the findings of a study that investigated the career choices of midwifery and obstetric nurse students in Mali. The article enquires into the relationship between their intention to practice in rural areas and the different components of the rural pipeline. A mixed method study using a survey, semi-structured interviews, and document analysis was conducted from October to December 2017 on third-year midwifery and obstetric nurse students and school-managers. Descriptive statistics and bivariate analysis were performed for quantitative data, and content analysis was carried out for the qualitative data. Key findings suggest that students prefer urban locations for living and for work. The intention to work in rural areas seems to be influenced by the current living situation (currently living in a rural area) or having attended secondary school or professional training in rural areas.

Trainees' preferences regarding choice of place of work after completing medical training in traditional or problem-based learning/community-based education and service curricula: a study in Ghanaian medical schools.

Career choices, recruitment and subsequent retention of healthcare professionals in the rural areas are a major worldwide concern and challenge to the health sector, leading to human resource shortages, resulting in poor quality health care for rural communities. Medical education has integrated community-oriented medical education strategies in undergraduate medical training to help address the challenges of health care in rural communities. These strategies are likely to impact the strategies of delivering the content of undergraduate medical curricula. This study explored medical trainees' preferences regarding place of work and choice of specialty after completing training using either the traditional or mixed problem-based learning/community-based education and service (PBL/COBES) curriculum in Ghanaian medical schools. This study was a cross-sectional descriptive design using a questionnaire consisting of 25 open- and close-ended questions. The questionnaire was administered to first-, third- and sixth-year students of two medical schools in Ghana: University of Ghana School of Medicine and Dentistry (UG-SMD) and University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS). UG-SMD uses the traditional method of teaching and learning, whilst UDS-SMHS uses PBL/COBES curriculum in the training of their students. Associations between gender, type of curriculum, choice of specialty and practice location were assessed using the χ2 test. Logistic regression analysis was performed to determine the association between medical school and curriculum type and students' preparation for rural practice while controlling all other factors. Qualitative data analysis of answers to open-ended questions was performed, applying the principles of thematic analysis. Of the students from PBL/COBES track, 64.2% were male, and from the traditional track 52.0%. The majority (74.1%) of students from PBL/COBES track indicated that their medical school curriculum adequately prepared them for rural practice as compared to those from the traditional track (35.1%). The willingness of third-year students at UDS-SMHS to choose to practise in rural areas after graduation decreases as compared to their colleagues in first and sixth years. Students from the traditional track were 80% less likely to state that their medical school curriculum adequately prepared them for rural practice compared to students from the PBL/COBES track (odds ratio=0.19, confidence interval=0.13-0.28, p=0.001). Students following the PBL/COBES curriculum stated that the program was very useful and could influence their choice of future practice location. Students following the traditional curriculum called for the introduction of innovative teaching methodology incorporating rural outreach programs as part of the medical curriculum. Students using the PBL/COBES curriculum indicated that their curriculum adequately prepared them for future rural practice. Students following the traditional curriculum called for the introduction of an innovative teaching methodology incorporating rural outreach programs. This, they believed, would help them cultivate an interest for rural practice and also increase their willingness to choose rural practice after graduation from medical school.

The Ubiquitous Healthcare Facility Framework: A Proposed System for Managing Rural Antenatal Care

Ubiquitous computing is playing a vital role in the provision of healthcare services through advanced technologies. The ubiquitous environment where resources can be accessed by anyone at anytime regardless of location have brought revolution in delivery and accessibility of healthcare services even in remote areas. Therefore, in recent years more research contributions can be seen to propose digitalized healthcare services in the form of mobile and eServices that are accessible through ubiquitous devices. To exploit the underlining potential of ubiquitous computing, in this research we have proposed a ubiquitous healthcare framework for provision of healthcare services in remote rural areas in province of Punjab, Pakistan. The research has employed a case study research approach to understand the phenomena in depth and in its real context. The unit of analysis is provision of antenatal and child healthcare services at basic health units in the selected region. The case study is constructed through field study by engaging healthcare professionals working at basic health units and data is collected through focus group interviews with healthcare professionals. A proof-of-the-concept ubiquitous framework is proposed as part of the case study by constructing various services to facilitate healthcare professionals in rural areas. To evaluate the proposed ubiquitous framework, an evaluation framework based on usability, information system and ISO models is constructed. Hypothesis are constructed to measure user satisfaction through twelve constructs of the evaluation framework that include availability, adaptability, memorability, effectiveness, responsiveness, cognitive load, error recovery, ease to understand, ease of learning, efficiency of use, navigation, and execution. The data is collected through field surveys by conducting walkthroughs with healthcare professionals in rural areas. The analysis of the data is carried out by employing structured equation modeling in SPSS. The results provide highly significant relationship between constructs and user satisfaction. The study findings show that the healthcare problem in rural areas could be addressed through ubiquitous solutions however, while designing, constructing and evaluating these solutions, the involvement of relevant community is crucial.

Strategies for Retaining Health-Care Professionals in Rural Areas of India

Strategies for Retaining Health-Care Professionals in Rural Areas of India

The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana.

BackgroundCareer choices and placements of healthcare professionals in rural areas are a major problem worldwide, and their recruitment and retention to these areas have become a challenge to the health sector. The purpose of this study was to investigate the effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in a rural area.MethodThis cross sectional survey was conducted among 56 pioneering graduates that followed a Problem Based Learning/Community Based Education and Service (PBL/COBES) curriculum. Using a mixed methods approach, open-and closed-ended questionnaire was administered to 56 graduates. Cross tabulation using Chi-square test were used to compare findings of the quantitative data. All qualitative data analysis was performed using the principles of primary, secondary and tertiary coding.ResultsAll 56 graduates answered and returned the questionnaire giving a 100 % response rate. 57.1 % (32) of them were male. Majority of them lived in towns (41.1 %) and cities (50 %) prior to medical school. A significant number of graduates (53.6 %,) from the cities, without any female or male predominance said COBES had influenced their choice of specialty. Again, a significant proportion of graduates from the towns (60.9 %,) and cities (67.8 %,), indicated that COBES had influenced them to work in the rural area. However, there was no significant difference between males and females from the towns and cities regarding the influence of COBES to work in the rural area.Qualitative data supported the finding that COBES will influence graduates willingness to work in the rural areaConclusionThe majority of graduates from the towns and cities in Ghana, with a male predominance, indicated that COBES may have influenced their choice of specialty and willingness to practice in the rural areas despite their town or city based upbringing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0602-8) contains supplementary material, which is available to authorized users.

EN to RN: The transition experience pre- and post-graduation

The context for this study is a conversion program for enrolled nurses (ENs) or division 2 level nurses who want to further their career as a registered nurse (RN) or division 1 nurse. While the conversion program is available to both metropolitan and rural nurses, it is designed specifically for experienced rural ENs. The conversion program is able to offer an educational alternative that does not disrupt family life or adversely impact the rural nursing workforce. This alternative is necessary for both the rural EN's career opportunities and for the health outcomes of rural communities in particular. This article reports on the experiences of the first cohort to graduate from the EN to RN conversion program. The conversion program offers three semesters of advanced standing within a seven-semester Bachelor of Science (Nursing) degree. The advanced standing or recognition of prior learning is awarded to applicants with more than one year's clinical experience, regardless of the type of enrolled nurse course completed. Enrolled nurses with a technical college qualification or higher meet university entry criterion but students from a hospital-based program are required to complete a mature-age university entry test. The degree to which the three semesters of advanced standing within an external conversion course for ENs would adversely affect participants' transition to student status and course completion is not known. The conversion program: The two-year, fully external EN conversion program relies on learning centre partnerships with country hospitals and agencies. Teaching strategies consist of a mix of external-mode strategies, including fully web-based units, and a compulsory eight-day on-campus foundation study block at the beginning. The compulsory study block provides the opportunity for students to familiarize themselves with the various areas of the university they need to contact as an external student, prepare for expectations of their first unit, including assessment expectations, and to practise selected nursing skills that are not common to the EN role. With the program being delivered from the metropolitan area of a vast state that occupies one-third of the Australian landmass, a key feature is the establishment of rural learning centres to support students. Apart from two of the seven clinical units in their course, the designated rural academic mentors arrange clinical placements in school-approved health care agencies situated locally or in nearby towns. This later strategy avoids the necessity for students to relocate to the metropolitan area or larger towns to complete the clinical component of the course. The conversion program has enrolled a limited number each year since 2000 and continues to be in high demand. Rural ENs are given preference and metropolitan enrolled nurses are included when quota allows. The purpose of this article is to describe the two aspects of the transition experiences of graduates from an external conversion degree. First, their transition experience from experienced enrolled nurse to undergraduate student and, second, from graduate to novice RN. Participants were volunteer graduates from the Bachelor of Science (Nursing) two-year conversion degree. The 10 study participants were mature-age females, aged between 33 and 53 years (mean = 42 years). Five were from rural areas. Their educational background included hospital-based diploma or technical college certificate. Data were collected using open-ended questions in semi-structured interviews. The interviews were transcribed and thematic analyses of the data were undertaken. Major categories were identified and relationships among them detailed. The four categories identified included adjusting to higher education, achieving academically, becoming critical thinkers and adjusting to the RN role: accepting responsibility. Participant responses in this study have highlighted the necessity for timely responses to email, feedback on assignments and more mentor support for rural students during the course. Participants report changing the way they approached their nursing practice. The transition experiences for participants in the external conversion program are generally positive although, as with other studies, the transition to student status is stressful. However, the course is able to facilitate the career aspirations of the study participants and to contribute to the retention of nursing staff in rural areas. Strategies to provide career opportunities for health-care professionals in rural areas are always a challenge. As one such strategy, the external mode EN to RN conversion program has proven to be effective for experienced ENs.