Shortage Of Health Care Workers Research Articles

Access to and quality use of non-communicable diseases medicines in Nepal.

Noncommunicable diseases are a major healthcare problem in Nepal and their burden is increasingevery year. Noncommunicable diseases (NCDs) bring additional challenges to the Nepalese healthcaresystem which is already experiencing infrastructure shortages, poor service delivery, inadequate essential medicines coverage and shortages of healthcare workers. The Nepal government provides a limited number of free essential medicines through the free essential healthcare services program. This consists of a basic healthcare package provided through primary healthcare (PHC) facilities and district hospitals. Though around 40 essential medicines are provided without charge, studies have reported problems with access especially in all rural areas. There is a need to improve access to, coverage and quality use of medicines. The government has decided to provide some free medicines for NCDs alongside free essential medicines to be distributed via current healthcare structures. Though well intended, this decision will put extra strain on the essential medicines program. It should be supplemented by a comprehensive NCDs policy that takes account of the issues of sustainability and quality use of medicines. Complex cases of NCDs will be managed by tertiary hospitals but most of the cases of NCDs especially for rural people and the poor will end up in secondary level public hospitals (district and zonal hospitals). Therefore, the government needs to strengthen these public hospitals. Meanwhile, given the severity of the NCDs problem in Nepal, the Ministry of Health and Population (MoHP) should liaise with nongovernmental and missionary hospitals especially in rural areas to run NCDs management services. The Ministry should encourage these hospitals to run hospital pharmacies to improve people’s access to and quality use of NCDs medicines. At the primary healthcare level, the Ministry could run NCDs prevention and control programs but existing PHC workers need training to perform proper dispensing of NCDs medicines. PHC facilities need a medical record system so that they can address the needs of NCDs patients requiring long term medication supply via a proximate PHC facility.

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

BackgroundAn adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.MethodFifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.ResultsThere was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.ConclusionsBotswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Strengthening Midwifery to End Preventable Maternal, Child, and Newborn Deaths

During the 50th anniversary of the American College of Nurse-Midwives (ACNM) in 2005, a Call to Action was presented to the membership. This call addressed the severe healthcare workforce capacity issues the world was facing at the time and the resulting impact on maternal and child health outcomes in low resource countries.1 The components of the Call to Action revolved around the need for advocacy to improve working conditions for midwives in these low resource settings, specifically in the areas of health and safety, salary and benefits, and professional development. While some improvements have been made over the ensuing decade, many countries still face a profound deficit of healthcare workers. On the 60th anniversary of ACNM, we examine the persistent global shortage of healthcare workers and its impact on maternal, child, and newborn mortality and morbidity, the increased attention on midwives as we approach the post-millennium development goals era, and the work of ACNM in response to the Call to Action issued a decade ago.

Profile, perceptions and future expectations of medical laboratory scientists in Namibia.

Public healthcare systems in sub-Saharan Africa are challenged by healthcare worker shortages, loss of trained staff and attrition to the private sector. Studies have historically focused on medical doctors, nurses and pharmacists, with limited focus on medical laboratory scientists. This study addresses the professional perspectives and expectations of the first two classes of biomedical science students, who graduated from the Polytechnic of Namibia in 2012 and 2013. A questionnaire was developed to capture qualitative and quantitative data from fourth-year students completing their final semester. Data collected included: demographic information; students' experience; professional expectations; and perceptions about the future of biomedical science education in Namibia. Amongst the 42 of 45 enrolled students who completed the questionnaire, nearly two-thirds anticipated working in government hospitals (29%) or industry (35%), with fewer planning careers in private hospitals (12%) or academia (14%). Most expressed an interest in working abroad (64%) and/or in the capital (64%), with fewer interested in small urban areas (48%). Only 7% expressed interest in working in a rural area. Regarding their view of the future of biomedical science in Namibia, 38% responded that it was encouraging, whereas the rest responded that it was uncertain (52%), negative (2%) or unknown (7%). Members of the first graduating classes of Namibia's nascent Biomedical Science degree programme reported a perceived lack of opportunity for professional advancement in the field if they remained in Namibia. Continued thought needs to be given to develop sustainable strategies and opportunities to retain Namibian biomedical laboratory scientists in Namibia.

Lessons learned from integrating simultaneous triple point-of-care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala

Mother-to-child-transmission of HIV, syphilis, and hepatitis B virus (HBV) remains a challenge in Guatemala, especially in rural regions. A triple antenatal screening program for these infections using point-of-care (POC) testing offered through outreach teams was implemented in the municipality of Puerto de San José. One year following program implementation, antenatal care coverage increased to 99.6% (32.5% increase, P<0.001), testing uptake increased to 50.3% for HIV and syphilis (143.9% (P<0.001) and 1.3% (P=0.89) increase, respectively), and HBV testing increased from 0 to 42.2%. Lessons learned showed that, despite the expansion of triple antenatal POC screening in rural Guatemala, a shortage of healthcare workers and poor supply chain management limited screening uptake. Moreover, training is essential to help health workers overcome their fear of communicating positive results and improve partner notification. Engagement of community health workers was essential to build local capacity and facilitate community acceptance.

Curriculum challenges faced by rural-origin health science students at South African medical schools

Background. The current shortage of healthcare workers in rural communities demands attention. The sourcing of rural-origin students (ROSs) has been suggested, but retention of these students in their chosen degrees is crucial. Addressing the tertiary education challenges that ROSs face is critical to ensuring their success. Objective. To focus on the various challenges influencing throughput of ROSs. Method. This article is one of a series of investigations into various aspects of university life and career choices of health science students. Data were collected at three South African universities by the Collaboration for Health Equity through Education and Research (CHEER) collaborators. Ethical permission was sought from each institution. Health science students at the relevant institutions consented to completing a self-administered questionnaire. The data were analysed on SPSS and χ2 tests were used to describe the statistical significance of the results. Results. Academic course content was the greatest challenge as perceived by students. Differences between rural and urban students were significant in all aspects of university life studied. Technological challenges were five times more common for ROSs. Differences between first- and final-year students were not as marked, although the personal challenges and academic course content became easier as students progressed through their degree. Conclusion . Although ROSs face similar challenges as students of urban origin, in some instances these are enhanced and magnified. These students are more likely to find various aspects of university life challenging. To improve the success and retention of ROSs, adequate support structures are essential

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.

The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration. Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC. A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n=220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used. Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R²=0.452, F=59.40, P<0.001). Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC. Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.

Strengthening healthcare delivery in Haiti through nursing continuing education.

The aim of this paper was to (1) highlight nursing continuing education as a key initiative for strengthening healthcare delivery in low-resource settings, and (2) provide an example of a nursing continuing education programme in Haiti. Haiti and other low-resource settings face extreme challenges including severe shortages of healthcare workers, high rates of nurse out-migration and variations in nurse competency at entry-to-practice. Nursing continuing education has the potential to address these challenges and improve healthcare delivery through enhanced nurse performance and retention; however, it is underutilized in low-resource settings. A case study is presented from the Hôpital Universitaire de Mirebalais in Mirebalais, Haiti of a new nursing continuing education programme called the Beyond Expert Program. The case study highlights eight key dimensions of nursing continuing education in low-resource settings: (1) involving local stakeholders in planning process, (2) targeting programme to nurse participant level and area of care, (3) basing course content on local context, (4) including diverse range of nursing topics, (5) using participatory teaching methods, (6) addressing resource constraints in time and scheduling, (7) evaluating and monitoring outcomes, and (8) establishing partnerships. The case study provides guidance for others wishing to develop programmes in similar settings. Creating a nursing continuing education programme in a low-resource setting is possible when there is commitment and engagement for nursing continuing education at all levels of the organization. Our report suggests a need for policy-makers in resource-limited settings to make greater investments in nursing continuing education as a focus of human resources for health, as it is an important strategy for promoting nurse retention, building the knowledge and skill of the existing nursing workforce, and raising the image of nursing in low-resource settings.

Impact of HR retention strategies in healthcare: The case of Qatar

Retention of healthcare workers is an international challenge. The World Health Organization (WHO) warned that in two decades, the shortage of healthcare workers will double. This puts a pressure on the policy makers to come up with serious HR interventions to retain their employees and ensure the delivery of high quality care. In Qatar, the healthcare sector depends greatly on expatriates. This unique characteristic imposes risk on the stability of the healthcare workforce. Therefore, the Qatar National Health Strategy (2011–2016) emphasises the importance of exercising effective HR retention strategies. This review tries to explain the relationship between the retention strategies and employees’ satisfaction and performance and how they impact the quality of care as perceived by patients/clients.

The Care of Injured Patients Admitted to Mulago National Referral Hospital in Kampala, Uganda

Background: Injury represents a growing global health crisis. Uganda, like much of Sub-Saharan Africa, faces little pre-hospital and medical infrastructure, severe shortages of healthcare workers and a large and growing disease burden from injury. This study aimed to describe the epidemiology of injured patients admitted to Mulago National Referral Hospital in Kampala, Uganda and determine their use of surgical resources. Methods: We used data from a cross-sectional study in 2007-08 involving 1833 patients admitted to Mulago Hospital with ICD 10-based injury diagnoses to analyze inpatient injury care based on demographics, mechanism of injury, diagnosis, operative care, hospital length of stay, and outcomes. Results: The median age was 25y, 76% were men. Injuries from road traffic crashes (61%) or assault (25%) resulted orthopedic (37%) or head injuries (28%). 30% of patients (n=542) underwent operation, mostly orthopedic (n=312, 58%). Needing operations and needing orthopedic procedures had longer hospital stays (6d vs. 1, p<0.0001) and (11d p<0.0001), respectively. Only four cases of intracranial drainage and 58 deaths were noted (3%). Conclusions: Orthopedic and head injuries are main causes for injury-related admission to Mulago Hospital. Patients requiring orthopedic procedures have long stays. Tracking injury morbidity and mortality is a worthwhile priority in this setting, but require greatly improved medical record systems and public health surveillance.

From research to practice in child and adolescent mental health

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The challenge: streamlining HIV treatment and care while improving outcomes.

ART coverage among HIV-positive population varies, depending on the countries, between 10% (e.g. Indonesia) and 65% (Botswana). Death rates and new HIV infections have been linked to ART coverage. Therefore, streamlining tasks and roles to expand treatment and care and to provide quality and equitable health is an ongoing concern globally. One concept that has been applied to improve the delivery of HIV services is that of task shifting. Defined as the systematic delegation of tasks from doctors to cadre with less training such as nurses or lay workers, task shifting has been used as an effective strategy to address the current healthcare worker shortage in many African countries. A body of literature supports the use of task shifting as a successful approach in delivering healthcare services including HIV testing, counselling and ART treatment. In addition, in a time of economic burden and scare resources, task shifting may also help to relieve the situation. This concern is highlighted in recommendation of WHO to strengthen and expand human capacity among healthcare workers. The major issues that are raised are: How can task shifting be implemented in a way that is sustainable? How can clinical care services be organized to maximize the potential of the task-shifting approach while ensuring safety, efficiency and effectiveness? What preconditions must be met, what are the country-specific factors that will guide decision-making in the implementation of task shifting? In addition, task shifting should be implemented alongside other efforts to increase the numbers of skilled health workers. Quality assurances mechanisms should provide the necessary checks balances to protect both service users and health workers.

Emigration-related attitudes of the final year medical students in Croatia: a cross-sectional study at the dawn of the EU accession

AimTo investigate the emigration-related attitudes of final year medical students in Croatia at the dawn of the EU accession in 2013.MethodsAll final-year medical students at four Croatian medical schools (Zagreb, Rijeka, Split, and Osijek) were invited to participate in a cross-sectional survey on emigration attitudes.ResultsAmong 260 respondents (response rate 61%), 90 students (35%) reported readiness for permanent emigration, expecting better quality of life (N = 22, 31%), better health care organization (N = 17, 24%), more professional challenges (N = 10, 14%), or simply to get a job (N = 8, 11%), while the least common expectation were greater earnings (N = 7, 10%). The most common target countries were Germany (N = 36, 40%), USA and Canada (N = 15, 17%), and UK (N = 10, 11%). In a multivariate analysis, readiness for permanent emigration was associated with an interest in undertaking a temporary training abroad (odds ratio [OR] 6.87; 95% confidence interval [CI] 2.83-16.72), while the belief that the preferred specialty could be obtained in Croatia appeared protective against emigration (OR 0.26; 95% CI 0.12-0.59).ConclusionDespite shortages of health care workers in Croatia, the percentage of students with emigration propensity was rather high. Prevalent negative perception of the Croatian health care and recent Croatian accession to the EU pose a threat of losing newly graduated physicians to EU countries.

Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda.

BackgroundHIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda.MethodsThis was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data.ResultsThree themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women – particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program.ConclusionIntegration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.

A strategy for developing future academic leaders for South Africa in a resource-constrained environment.

A key challenge in addressing the shortage of health care workers in resource-constrained environments is ensuring that there is optimal academic capacity for their training. South Africa's University of KwaZulu-Natal has placed academic and research capacity building at the heart of its program with the Medical Education Partnership Initiative in a program called ENhancing Training and REsearch capacity and Expertise (ENTREE). The program aims to increase the quantity, quality, and retention of health care graduates. It is premised on the basis that research capacity development will lead to an increase in teachers who will be essential to improving the quality and quantity of health care workers needed to meet South Africa's health challenges. This is being achieved through four components of the program: (1) infusion of the undergraduate program with research modules; (2) attraction of academically talented students in the middle of their undergraduate program into a parallel track that has research capacity as its major thrust; (3) attraction of qualified health care personnel into a supported PhD program; and (4) providing strong research ethics training and mentorship. A significant proportion of the program is being executed in rural training sites, to increase the probability that trainees will return to the sites as mentors.

Book Review: Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care

Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care Riane Eisler, JD and Teddie M. Potter, PhD, RN. Indianapolis, IN: Sigma Theta Tau International, 2014, 354 pages, $54.95.In Transforming Interprofessional Partnerships: A New Framework for Nursing and Partnership-Based Health Care, authors Riane Eisler and Teddie M. Potter examine the role of two contrasting paradigms, domination and partnership, in nursing education and practice. Their analysis depicts how a shift to the partnership model can achieve the three aims often cited as needed for an improved health care sys- tem: improved quality and satisfaction, improved access for all populations, and reduced costs per capita.Past health policy theories have posited that these three aims are impossible to improve simultaneously (e.g., increased quality and/or access will cost more). It has further been argued that these aims are even more difficult to achieve given the current shortage of health care workers and the increased acuity of the patient population, due in part to changes in Medicare reimbursement such as the evolu- tion of diagnosis-related groups which has led to earlier discharge of less acutely ill patients. However, the authors argue that through integration of the partnership paradigm into Interprofessional Education and Collaborative Practice (IPECP), these goals can be met, and a more practice-ready workforce will be available.The authors detail the characteristics of each paradigm and present many ex- amples. The domination model is authoritarian (hierarchical), male-dominated, and tolerant of abuse, and based on a belief that these attributes should be the norm for all relations. The partnership model sees power as shared, gender roles as equal, and violence as abhorrent, and is based on a belief that relations should be empathic and mutually respectful. In the partnership model, nurses are free to implement nursing's unique medicine, with its holistic emphasis that ministers to the totality of body, mind, and spirit. Nursing is an integral part of interdisciplin- ary "medicine" and must reclaim the ancient meaning of that word. However, the uniqueness of nursing medicine must also be recognized, as demonstrated by Potter 's BASE model of nursing-Being present, Active caring, Stories (or narrative evidence), and Evidence from science. This model demonstrates how nurses go beyond allopathic medicine's emphasis on using only A and E (actions or treatments and scientific evidence). Nursing medicine adds the other compo- nents: being present (at the bedside, home, or community) and honoring stories or narratives of patients' and families' needs which, in turn, can provide the most cost-efficient treatment plans. Efficiency is achieved in part because in a partner- ship model, all health-related disciplines engage in sharing of knowledge, obser- vations, and i nnovations, thus reducing overlap and repetition. Partnering also decreases stress, thus lowering expensive turnover of providers.The authors see the need to incorporate two new sociological theories into IPECP: Eisler 's theories of Cultural Transformation and Caring Economics. These theories specifically address correcting the emphasis of imbalances in power, gender inequalities, and the low value assigned to the work of caring. A partner- ship model of Caring Economics measures economic growth as more than national gross domestic product. …

Mid-level healthcare personnel training: an evaluation of the revised, nationally-standardized, pre-service curriculum for clinical officers in Mozambique.

IntroductionMozambique suffers from a critical shortage of healthcare workers. Mid-level healthcare workers, (Tecnicos de Medicina Geral (TMG)), in Mozambique require less money and time to train than physicians. From 2009–2010, the Mozambique Ministry of Health (MoH) and the International Training and Education Center for Health (I-TECH), University of Washington, Seattle, revised the TMG curriculum. To evaluate the effect of the curriculum revision, we used mixed methods to determine: 1) if TMGs meet the MoH's basic standards of clinical competency; and 2) do scores on measurements of clinical knowledge, physical exam, and clinical case scenarios differ by curriculum?MethodsT-tests of differences in means examined differences in continuous score variables between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related and demographic factors associated with assessment scores on each of the three evaluation methods at the p<0.05 level. Qualitative interviews and focus groups inform interpretation.ResultsWe found no significant differences in sex, marital status and age between the 112 and 189 TMGs in initial and revised curriculum, respectively. Mean scores at graduation of initial curriculum TMGs were 56.7%, 63.5%, and 49.1% on the clinical cases, knowledge test, and physical exam, respectively. Scores did not differ significantly from TMGs in the revised curriculum. Results from linear regression models find that training institute was the most significant predictor of TMG scores on both the clinical cases and physical exam.ConclusionTMGs trained in either curriculum may be inadequately prepared to provide quality care. Curriculum changes are a necessary, but insufficient, part of improving TMG knowledge and skills overall. A more comprehensive, multi-level approach to improving TMG training that includes post-graduation mentoring, strengthening the pre-service internship training, and greater resources for training institute faculty may result in improvements in TMG capacity and patient care over time.

Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.

Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.

International Federation of Nurse Anesthetists' Anesthesia Program Approval Process

The International Federation of Nurse Anesthetists is improving anaesthesia patient care through a voluntary Anesthesia Program Approval Process (APAP) for schools and programmes. It is the result of a coordinated effort by anaesthesia leaders from many nations to implement a voluntary quality improvement system for education. These leaders firmly believe that meeting international education standards is an important way to improve anaesthesia, pain management and resuscitative care to patients worldwide. By 2013, 14 anaesthesia programmes from France, Iceland, Indonesia, Philippines, Sweden, Switzerland, Netherlands, Tunisia and the USA had successfully completed the process. Additional programmes were scheduled for review in 2014. Faculty from these programmes, who have successfully completed APAP, show how anaesthesia educators throughout the world seek to continually improve education and patient care by pledging to meet common education standards. As national governments, education ministers and heads of education institutions work to decrease shortages of healthcare workers, they would benefit from considering the value offered by quality improvement systems supported by professional organizations. When education programmes are measured against standards developed by experts in a profession, policy makers can be assured that the programmes have met certain standards of quality. They can also be confident that graduates of approved programmes are appropriately trained healthcare workers for their citizens.

Work‐related quality of life of Ugandan healthcare workers

To describe perceived work-related quality of life of Ugandan healthcare workers. A secondary aim was to seek participant input on ways to improve work environments. Poor patient outcomes, decreased employee motivation and decisions to leave the organization have been linked to poor work conditions. Interventions to correct healthcare worker shortage in developing countries require information about work quality of life. Descriptive cross-sectional study conducted in health and educational settings in Uganda in July 2011. Participants completed the Biographical Information Scale demographic questionnaire and the validated 24-item Work-Related Quality of Life scale. Sample included 146 healthcare workers employed in various settings. Participants reported poorer quality of work life on the work conditions, control at work and home-work interface subscales. Participants perceived stress at work to be low and experienced higher job career satisfaction. There was a significant relationship between work-related quality of life, gender and hours worked. Participants' suggestions to improve work life ranged from simple no-cost suggestions to more complex system level interventions. Work-related quality of life was low in this convenience sample. Perceived stress at work was lower than expected, but may have been due to nurses' expectations of a normal work assignment. Predominantly women, the participants had significant caregiving responsibilities. Nurses must acquire a seat at the table where crucial decisions about nursing and its future are made. By advancing leadership skills, nurses can effectively advocate for organizational changes that address broad factors related to increasing job satisfaction, and retaining and attracting nurses. Nurses can influence work quality of life individually and collectively by identifying workplace concerns, demanding safe work environments, fostering teamwork and enhancing professional growth.