Influencing Health Workers Research Articles

Factors influencing health workers' adherence to malaria treatment guidelines in under-five children in Nigeria: A scoping review.

Malaria is a leading cause of mortality in children aged 5 years and below in Nigeria. Treatment guidelines stipulate among other recommendations, testing by microscopy or a rapid diagnostic test (RDT) before treatment. Non-adherence to these guidelines portends a challenge, especially among vulnerable under-five children. This study explored the factors influencing Nigerian public health workers' (HWs) adherence to these guidelines in under-five children. A review of literature published between 2011- 2023 was conducted on Web of Science, Ovid Embase, Medline, Global Health, CAB Abstracts, Scopus, and Global Index Medicus. Data was extracted and analyzed under 4 themes: diagnosis, compliance with test results, use of recommended treatment, post-treatment counselling and severe malaria management. Nineteen (19) studies were included for review. Training and supervision, RDT and antimalarial availability, good knowledge of, and positive perception of RDTs promoted adherence to mRDT use. A lack of confidence in RDTs and age (≥ 40 years) fuelled presumptive treatment, especially among clinicians. mRDT and artemisinin-based combination therapy (ACT) stockouts dissuaded HWs from adhering to case management guidelines. Caregiver pressure for treatment was identified as a barrier to compliance with test results. It is important to design context-specific strategies to improve adherence to guidelines for malaria case management, especially in under-five children. Training on the guidelines should be tailored, needs-based, and continuous, and HWs should be supportively supervised in implementing case management. Maintaining an adequate supply of quality-assured mRDTs and antimalarials can facilitate adherence to the guidelines.

Factors influencing health worker compliance in implementing patient safety goals in Indonesia: Systematic review

The compliance rate of health workers in patient safety is not fully good at 68.7% and the implementation of patient safety in Indonesia is not optimal at 74.2% whereas in 2016 in Indonesia there were still 31 cases related to patient safety. To determine the factors that affect the compliance of health workers in the implementation of patient safety goals using a systematic review approach. This study uses a systematic review method from 9 studies using a quantitative approach commonly called a meta-analysis. The search for the source of this research data uses PRISMA flow charts from several databases such as Google Scholar, garuda portal, ProQuest, and Elsevier. Where published in the last 10 years (2013-2023). 25 variables were the same in the study between one researcher and another, namely age, gender, marital status, number of dependents, length of work, nurse knowledge, nurse motivation, supervision, nursing, organizational influence, educational status, compliance behavior, ability, supervisor support, fellow nurse support, workplace comfort, employment status, motivation, perception, nurse compliance, 6 patient safety goals, patient safety culture, patient identification, patient safety events, and patient fall prevention. The average P-Value value is 0.180, the minimum value of P-Value = 0.000, and the maximum value of P-Value = 0.995. 8 dominant factors influence health workers in implementing patient safety goals. 8 dominant factors influence health workers in implementing patient safety goals, namely knowledge, length of work, nurse work motivation, nurse perception, stress level and workload, nurse compliance, organizational influence, and supervisor support.

Factors influencing health worker compliance in implementing patient safety goals in Indonesia: Systematic review

The compliance rate of health workers in patient safety is not fully good at 68.7% and the implementation of patient safety in Indonesia is not optimal at 74.2% whereas in 2016 in Indonesia there were still 31 cases related to patient safety. To determine the factors that affect the compliance of health workers in the implementation of patient safety goals using a systematic review approach. This study uses a systematic review method from 9 studies using a quantitative approach commonly called a meta-analysis. The search for the source of this research data uses PRISMA flow charts from several databases such as Google Scholar, garuda portal, ProQuest, and Elsevier. Where published in the last 10 years (2013-2023). 25 variables were the same in the study between one researcher and another, namely age, gender, marital status, number of dependents, length of work, nurse knowledge, nurse motivation, supervision, nursing, organizational influence, educational status, compliance behavior, ability, supervisor support, fellow nurse support, workplace comfort, employment status, motivation, perception, nurse compliance, 6 patient safety goals, patient safety culture, patient identification, patient safety events, and patient fall prevention. The average P-Value value is 0.180, the minimum value of P-Value = 0.000, and the maximum value of P-Value = 0.995. 8 dominant factors influence health workers in implementing patient safety goals. 8 dominant factors influence health workers in implementing patient safety goals, namely knowledge, length of work, nurse work motivation, nurse perception, stress level and workload, nurse compliance, organizational influence, and supervisor support.

Understanding the factors influencing health workers’ choice of workplace locations: a qualitative description of primary healthcare workers’ perspectives in Nigeria

Background Universal access to a qualified, skilled, motivated and equitably distributed health workforce is pertinent for the delivery of quality health services needed to achieve national health sector goals and sustainable development goals. However, there remains a shortage of health workers attributed to health workers’ choices of not taking up postings due to the characteristics of workplace locations, amongst other factors. This study sought to understand the factors influencing primary healthcare workers’ choice of workplace locations in Nigeria. Methods This study applied a qualitative research design. We interviewed 41 primary healthcare workers, including nurses, midwives, and community health practitioners, in Bauchi and Cross River States in Nigeria. The interviews elicited responses on the important issues that health workers consider when thinking of taking up or staying in a work location. Results We found that the working conditions, living environment and human resources for health (HRH) management practices influence the choice of work location amongst health workers. For working conditions, the quality of facilities, workload concerns, the scope of practice and community support were suggested as important factors. The living environment, specifically the availability of quality housing or an allowance to pay for quality accommodation, availability of transport facilities, and quality schools for children’s education were suggested as important factors. Lastly, the HRH management practices linked to supportive management, remunerations, career advancement and continuing education were highlighted as central factors. Conclusions Our study highlights the importance of work location to health workers. In practice, there is a need for policymakers and health planners to gain and apply contextual evidence on factors influencing health workers’ choice of workplace locations in health and HRH planning and management. This is pertinent in designing and implementing tailored interventions for ensuring the equitable distribution of health workers.

Factors Influencing Brain Drain Among Health Workers in Ghana

Purpose: The advent of the covid-19 pandemic exacerbated the need for more professional health workers to serve as front-line workers in hospitals in Ghana and other developing countries. This study aimed to ascertain the factors influencing health workers' brain drain in Ghana.
 Methodology: The study was a survey with an accessible population of 15510 people in different categories of health workers. Sampling was through stratification for a sample size of 400 respondents across the Greater Accra Region of Ghana. Structured questionnaires were used for the data collection and analyzed using the Statistical Package for Social Sciences (SPSS) as a statistical tool to generate descriptive statistics that included the mean, standard deviation and ranks based on which inferences were drawn.
 Findings: The study found that government inaction on the conditions of service of health workers such as low remuneration, inadequate opportunities for staff development, poor equipment replacement policies, political interferences in their workplaces, high standards of living and inadequate housing and personal reasons amount to the reasons why Ghana is losing the majority of her finest health workers to the developed nations. The study concluded that the migration of healthcare professionals from developing to developed nations has negative effects on the delivery of healthcare in Ghana especially coming out of a deadly pandemic.
 Recommendation: The study recommends that government deals with the motivation and hygiene factors as well as the push and pull economic factors that drive many health workers to seek "greener pastures" outside the country hence the trend could continue in the coming years.

Factors influencing health workers’ compliance with the WHO intermittent preventive treatment for malaria in pregnancy recommendations in the Northern Region, Ghana

BackgroundAlthough IPTp-SP is a lifesaving World Health Organization (WHO) recommended preventive intervention for pregnant women in malaria-endemic regions, IPTp-SP uptake in the Northern region of Ghana is much lower than the sub-optimal national coverage level. Assessing the extent of health workers’ compliance and its associated factors will generate valuable pointers to be targeted at the program level. The study examined the factors influencing health workers’ compliance with the WHO recommended guidelines for IPTp-SP in the Northern Region.MethodsA cross-sectional study among 315 health workers in the Northern region was conducted. Semi-structured questionnaires were used to collect data on health workers’ sociodemographic characteristics, facility-based factors and knowledge level. Data were collected on health workers’ compliance with the recommended practices through covert observations using a checklist. Facility observations were carried out using a checklist. Crude and adjusted logistic regression were used to determine predictors of health workers’ compliance, at a 5% significance level adjusting for clustering.ResultsOf the 315 health workers studied, the median age was 29 years (26–34 years). Females constituted (80.5%; 252) of the 313 workers. The majority (47.4%;148) of the 312 health workers were midwives. Overall, 56.2% (CI 51.0 – 62.0) were adequately complying with the recommended guidelines. Lower levels of compliance were recorded in health centres 15.6% (5.0 – 33.0) and CHPS compounds 21.2% (11.0 – 35.0). The factors associated with compliance included health workers’ knowledge (aOR = 7.64, 95% CI 4.21 – 13.87, p < 0.001), job satisfaction (aOR 10.87, 95% CI 7.04 – 16.79, p < 0.001), in-service training (aOR 10.11, 95% CI 4.53 – 22.56, p < 0.001), supervision (aOR 4.01, 95% CI 2.09 – 7.68, p < 0.001), availability of job aids (aOR 3.61, 95% CI 2.44 – 5.35, p < 0.001), health workers experience (aOR = 10.64, 95% CI 5.99 – 18.91, p < 0.001) and facility type (aOR 0.03, 95% CI 0.01–0.07, p < 0.001).ConclusionCompliance with the recommended IPTp-SP guidelines is suboptimal in the region, with lower-level health facilities recording the least compliance levels. Health centres and CHPS facilities should be prioritized in distributing limited resources to improve health worker quality of care for antenatal care clients.

Health workers' social networks and their influence in the adoption of strategies to address the stillbirth burden at a subnational level health system in Uganda.

Health workers' peer networks are known to influence members' behaviours and practices while translating policies into service delivery. However, little remains known about the extent to which this remains true within interventions aimed at addressing the stillbirth burden in low-resource settings like Uganda. The objective of this study was to examine the health workers' social networks and their influence on the adoption of strategies to address the stillbirth burden at a subnational level health system in Uganda. A qualitative exploratory design was adopted on a purposively selected sample of 16 key informants. The study was conducted in Mukono district among sub-national health systems, managers, health facility in-charges, and frontline health workers. Data was collected using semi-structured interview guides in a face-to-face interview with respondents. The analysis adopted a thematic approach utilising Atlas. ti software for data management. Participants acknowledged that workplace social networks were influential during the implementation of policies to address stillbirth. The influence exerted was in form of linkage with other services, caution, and advice regarding strict adherence to policy recommendations perhaps reflective of the level of trust in providers' ability to adhere to policy provisions. At the district health management level and among non-state actors, support in perceived areas of weak performance in policy implementation was observed. In addition, timely initiation of contact and subsequent referral was another aspect where health workers exerted influence while translating policies to address the stillbirth burden. While the level of support from among network peers was observed to influence health workers' adoption and implementation of strategies to address the stillbirth burden, different mechanisms triggered subsequent response and level of adherence to recommended policy aspects. Drawing from the elicited responses, we infer that health workers' social networks influence the direction and extent of success in policy implementation to address the stillbirth burden at the subnational level.

Factors influencing health workers\u2019 compliance with outpatient malaria \u2018test and treat\u2019 guidelines during the plateauing performance phase in Kenya, 2014\u20132016

BackgroundHealth workers’ compliance with outpatient malaria ‘test and treat’ guidelines has improved since 2010 but plateaued from 2014 at suboptimal levels in Kenya. This study examined the factors associated with high but suboptimal compliance levels at facilities with available malaria tests and drugs.MethodsData from four national, cross-sectional health facility surveys undertaken between 2014 and 2016 in Kenya were analysed. Association between 31 factors and compliance with malaria testing (survey range (SR): 65–69%) and no anti-malarial treatment for test negative patients (SR: 90–92%) were examined using multilevel logistic regression models.ResultsA total of 2,752 febrile patients seen by 594 health workers at 486 health facilities were analysed. Higher odds of malaria testing were associated with lake endemic (aOR = 12.12; 95% CI: 5.3–27.6), highland epidemic (aOR = 5.06; 95% CI: 2.7–9.5) and semi-arid seasonal (aOR = 2.07; 95% CI: 1.2–3.6) compared to low risk areas; faith-based (FBO)/ non-governmental organization (NGO)-owned compared to government-owned facilities (aOR = 5.80; 95% CI: 3.2–10.6); health workers’ perception of malaria endemicity as high-risk (aOR = 3.05; 95% CI: 1.8–5.2); supervision with feedback (aOR = 1.84; 95% CI: 1.2–2.9); access to guidelines (aOR = 1.96; 95% CI: 1.1–3.4); older patients compared to infants, higher temperature measurements and main complaints of fever, diarrhoea, headache, vomiting and chills. Lower odds of testing were associated with febrile patients having main complaints of a cough (aOR = 0.65; 95% CI: 0.5–0.9), a rash (aOR = 0.32; 95% CI: 0.2–0.7) or a running nose (aOR = 0.59; 95% CI: 0.4–0.9). Other factors associated with compliance with test negative results included the type of diagnostic test available at the facility, in-service training, health workers’ age, and correct knowledge of the targeted treatment policy.ConclusionsTo optimize outpatient malaria case-management, reduce testing compliance gaps and eliminate overtreatment of test negative patients, there is a need to focus on compliance within low malaria risk areas in addition to ensuring the universal and continuous availability of ‘test and treat’ commodities. Targeting of older and government health workers; dissemination of updated guidelines; and continuing with in-service training and supportive supervision with feedback is essential. Lastly, there is a need to improve health workers’ knowledge about malaria testing criteria considering their perceptions of endemicity.

Investigating Job Satisfaction Among Emergency Department Workers In A Private Hospital During The Pandemic

In Indonesia during the COVID-19 pandemic situation, there is a surge of health care demand that leads to exhaustion and resignation of health workers. The emergency department plays an important role in providing care in Surya hospital, but many factors due to the unpredictable nature of the emergency department influence health workers’ satisfaction. Managing job satisfaction is essential as it increases the commitment and human capital potential of an employee, which subsequently contributes to the quality of care provided to the patients. This research investigates job satisfaction among health workers in the emergency department of Surya Hospital. In-depth semi-structured interviews and direct observations were employed in the study. From this study synergized teamwork increases emergency workers’ job satisfaction. On the other hand, complex recruitment processes, lack of compensation and benefits policy, and ineffective communication flow decrease job satisfaction. This research could guide the mediation between health workers and hospital management in providing a better working environment in the emergency department

FACTORS AFFECTING COPING STRATEGIES FOR HEALTH WORKERS IN DEALING STIGMA DUE TO COVID-19

Coping strategies used by health workers in dealing with community stigma due to Covid-19 are varied. The influencing factors include individual characteristics such as gender, marital status, profession, education level, marital status, salary, sift and others. The purpose of this study was to determine the factors that influence health workers in the selection of coping strategies. The design of this study was cross-sectional. The population is health workers who work in health services in Indonesia with a total of 530 samples through incidental sampling technique. The research instrument used a Brief Cope Inventory which consists of 28 question items with 14 subscale items. Data analysis used univariate, bivariate and multivariate. The coefficient of determination obtained is 0.125, meaning that the variability of the dependent variable that can be explained by independent variability is 12.5% ​​or about 87.5% the rest is explained by other factors outside the model, which means that it cannot be explained by the model including physical health factors and psychology.

Evaluation of health surveillance system attributes: the case of neglected tropical diseases in Kenya

BackgroundControl of preventive chemotherapy-targeted neglected tropical diseases (PC-NTDs) relies on strengthened health systems. Efficient health information systems provide an impetus to achieving the sustainable development goal aimed at ending PC-NTD epidemics. However, there is limited assessment of surveillance system functions linked to PC-NTDs and hinged on optimum performance of surveillance system attributes. The study aimed to evaluate surveillance system attributes based on healthcare workers’ perceptions in relation to PC-NTDs endemic in Kenya.MethodsA cross-sectional health facility survey was used to purposively sample respondents involved in disease surveillance activities. Consenting respondents completed a self-administered questionnaire that assessed their perceptions on surveillance system attributes on a five-point likert scale. Frequency distributions for each point in the likert scale were analysed to determine health workers’ overall perceptions. Data was analysed using descriptive statistics and estimated median values with corresponding interquartile ranges used to summarise reporting rates. Factor analysis identified variables measuring specific latent attributes. Pearson’s chi-square and Fisher’s exact tests examined associations between categorical variables. Thematic analysis was performed for questionnaire open-ended responses.ResultsMost (88%) respondents worked in public health facilities with 71% stationed in second-tier facilities. Regarding PC-NTDs, respondents perceived the surveillance system to be simple (55%), acceptable (50%), stable (41%), flexible (41%), useful (51%) and to provide quality data (25%). Facility locality, facility type, respondents’ education level and years of work experience were associated with perceived opinion on acceptability (p = 0.046; p = 0.049; p = 0.032 and p = 0.032) and stability (p = 0.030; p = 0.022; p = 0.015 and p = 0.024) respectively. Median monthly reporting timeliness and completeness rates for facilities were 75 (58.3, 83.3) and 83.3 (58.3, 100) respectively. Higher-level facilities met reporting timeliness (p < 0.001) and completeness (p < 0.001) thresholds compared to lower-level facilities.ConclusionHealth personnel had lower perceptions on the stability, flexibility and data quality of the surveillance system considering PC-NTDs. Reporting timeliness and completeness rates decreased in 2017 compared to previous surveillance periods. Strengthening all surveillance functions would influence health workers’ perceptions and improve surveillance system overall performance with regard to PC-NTDs.

Factors of Influencing Health Workers in Providing Early Complementary Breastfeeding in dr. Iskak Hospital Tulungagung

Breast milk is the best food God creates for newborns. Artificial feeds for infants mixed using today's technology, were not able to match the benefits of breast milk. The purpose of the study was to analyze Factors affecting the Health Worker in giving the Early Breastfeeding in dr. Iskak Hospital Tulungagung. The research design used in the research is Analytical Observation. The population is health workers who have babies 6-12 months of age. The sample size was 67 respondents using Cluster Random Sampling technique. Independent variable of research is knowledge, distance, and family support. The dependent variable of the research is the early feeding of breast milk supplements. Data were collected by using questionnaire, then the data were analyzed by using logistic regression. The results showed that most have residence distance to the workplace as far as 3 KM as many as 44 respondents (65.7 %), most have good knowledge as many as 64 respondents (95.5 %) , most have high family support as much as 45 respondents (67.2%) , most respondents gave ASI without MP-ASI as much as 42 respondents (62,7%) . Statistical test results that Overall Statistics with a significance value of (p) 0, 000 which means that there are variables that affect the administration of MP-ASI and variable most affect family support with a value of (p) of 0.000. The conclusion of this study is family support affects in health workers in providing early breastfeeding in dr. Iskak Hospital Tulungagung.

Temporal circuits and social triage in a Papua New Guinean Clinic

This article examines how the temporalities generated by the “NGOization” of public health can lead to exclusionary forms of social and clinical triage. Through an ethnographic case study of a public–nongovernmental organization partnership HIV/STI clinic in the Highlands of Papua New Guinea, I discuss how ideas about the nature of nongovernmental institutions – as different from the long-established “government” and “church”/“mission” services – influence health workers’ triage practices. By contextualizing this case study within broader ideological and material transformations in Papua New Guinea, I show how “NGO time” interfaces with other forms of temporality. I argue that local ideas about what nongovernmental organizations are, where they come from, and to whom they are accountable are essential to understanding how “NGO time” might lead to exclusionary practices. More broadly, I suggest that an ethnographic approach to the “nongovernmental” must first consider the local specificity of “government” as a cultural object.

Peer-driven quality improvement among health workers and traditional birth attendants in Sierra Leone: linkages between providers' organizational skills and relationships.

BackgroundSierra Leone has among the poorest maternal and child health indicators in the world and investments in public health have been predominately to increase demand for services, with fewer initiatives targeting supply side factors that influence health workers’ work environment. This paper uses data from the Quality Circles project in a rural district of Sierra Leone to achieve three objectives. First, we examine the effect of the intervention on organizational skills and relationships among coworkers as well as between health workers and traditional birth attendants. Second, we examine whether changes in organizational skills are associated with changes in relationships among and between formal and informal health providers and between health providers and clients. Third, we aim to further understand these changes through the perspectives of health workers and traditional birth attendants.MethodsThe Quality Circles project was implemented in Kailahun District in the Eastern province of Sierra Leone from August 2011 to June 2013, with adjacent Tonkolili District serving as the control site. Using a mixed-methods approach, the evaluation included a quantitative survey, in-depth interviews and focus group discussions with health workers and traditional birth attendants. Mean values of the variables of interest were compared across sub-populations, and correlation analyses were performed between changes in organizational skills and changes in relationships.ResultsThe results demonstrate that the Quality Circles intervention had positive effects on organizational skills and relationships. Furthermore, improvements in all organizational skill variables – problem-solving, strategizing and negotiation skills – were strongly associated with a change in the overall relationship variable.ConclusionsThe Quality Circles approach has the potential to support health workers to improve their organizational skills and relationships, which in turn can contribute to improving the interpersonal dimensions of the quality of care in low-resource contexts. This method brings together peers in a structured process for constructive group work and individual skill development, which are important in low-resource contexts where active participation and resourcefulness of health workers can also contribute to better health service delivery.

What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania?

BackgroundIn countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers’ satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics. This study explores the workplace satisfaction of health workers in primary health clinics in rural Tanzania.MethodsOverall, 70 health workers in rural Tanzania participated in a self-administered job satisfaction survey. We calculated mean ratings for 17 aspects of the work environment. We used principal components analysis (PCA) to identify groupings of these variables. We then examined the bivariate associations between health workers demographics and clinic characteristics and each of the satisfaction scales.ResultsResults showed that 73.9% of health workers strongly agreed that they were satisfied with their job; however, only 11.6% strongly agreed that they were satisfied with their level of pay and 2.9% with the availability of equipment and supplies. Two categories of factors emerged from the PCA: the tools and infrastructure to provide care, and supportive interpersonal environment. Nurses and medical attendants (compared to clinical officers) and older health workers had higher satisfaction scale ratings.ConclusionsTwo dimensions of health workers’ work environment, namely infrastructure and supportive interpersonal work environment, explained much of the variation in satisfaction among rural Tanzanian health workers in primary health clinics. Health workers were generally more satisfied with supportive interpersonal relationships than with the infrastructure. Human resource policies should consider how to improve these two aspects of work as a means for improving health worker morale and potentially rural attrition.Trial registration(ISRCTN 17107760)

The meaning of ethically charged encounters and their possible influence on professional identity in Norwegian public health nursing: a phenomenological hermeneutic study

In today's health care, new health reforms focus on market values and demands of efficiency influence health workers' professional practice. Norwegian public health nurses work mainly with healthy populations, but the children, families and young people they meet can be in vulnerable and even dependent situations. Strategies in coping with ethically challenging encounters can be important for the identity of the profession. The aim of the study was to illuminate public health nurses' experiences of being in ethically charged encounters and to reflect upon how these experiences can influence their professional identity. A purposive sample of 23 Norwegian public health nurses with experience ranging from 0.5 to 25 years narrated about their work-related experiences. The interviews were interpreted with a phenomenological hermeneutic method inspired by the philosophy of Paul Ricoeur. Four themes were identified: feeling responsible, being committed, feeling confident and feeling inadequate. These experiences were related to both work and private life and involved an emotional commitment to the well-being of children, young people and families. On the basis of the findings, it can be estimated that PHNs are committed to their work, and defending children's rights is a strong driving force. Responsibility for service users is a deciding factor that can overshadow institutional demands. It seems as if value conflicts mobilised courage which is essential in maintaining moral strength. This is in turn important for a strong professional identity and can have positive implications for the quality of public health nursing work.

Factors Influencing Motivation and Retention of Primary Healthcare Workers in the Rural Areas of Oyo State, Nigeria

Limited data exist on retention of primary healthcare (PHC) staff in rural areas, crippling the already fragile healthcare systems in Nigeria. This study investigated why PHC staff would or would not want to work in rural areas and how they could be retained. Four hundred and twelve (412) health workers and caregivers, and 21 key informants were interviewed in Ona-Ara LGA. Logistic regression statistics was used to analyse quantitative data and narrative for qualitative data. There was no significant factor influencing health workers' unwillingness to work in rural areas and, relationship between their demographic characteristics and perceived reasons to do so. Combined factors influencing PHC workers' willingness to work in rural areas influenced use of PHC. Financial and non-financial incentives are responsible for workers' motivation to work in rural areas. The mal-distribution of health facilities and health workers between urban and rural areas must be addressed.

Assessment of factors influencing retention of health workforce in rural and remote areas of Odisha, India

Background: The scarcity of qualified health workers in rural areas is directly affecting delivery of health services and their quality. Diverse interventions have been instituted by central and state governments to attract health workers to rural areas and to enhance the retention of qualified workers. However the reasons for not willing to remain in rural and remote areas are still poorly understood. This study explores factors influencing health workers retention in rural and remote Odisha. Methods: We carried out the study in six districts of Odisha selected randomly from three geographic and administrative regions of the state. We used a mixed methods approach to study this question using both quantitative and qualitative data. A total of 226 semi-structured interviews were conducted with doctors, nurses, pharmacists, multipurpose health workers (MPHW) and laboratory technicians. A multi stage stratified random sampling was used for selecting study participants working at sub centers, primary health centers and community health centers. Results: We found that excepting few districts, the ratio of MPHW (F) to population is around 5000 in the state which is at par with the prescribed norms. The ratio of government allopathic doctor, laboratory technician and staff nurses to population are: 13000, 40000 and 15000, respectively. Majority of health staffs perceive “strong personal will to serve people”, “physical infrastructure”, “training opportunities”, “support by seniors”, “good schooling for their children” and “promotion avenues after certain years of rural service” is very important for continuing to work in rural and remote areas. Most of the participants were found to be satisfied with the support they received from their seniors and the local community, and respect and trust of their patients.The major dissatisfiers for working in rural areas included existing promotional avenues after rural service, physical infrastructure, and schooling facility for their children. Five primary reasons ranked in order of priority cited by the study participants for continuing at the same place were, namely, permanent government service, pension facility, social service, source of regular income and job satisfaction Discussion/Recommendations: Professional growth in the form of promotion and skill development, suitable physical infrastructure at workplace and schooling for their children along with additional monetary incentives were the key and inter-relating factors influencing the retention of health workforce in rural and remote areas. Hence a combination of interventions like monetary incentives with enhanced career opportunities for professional growth (training, higher studies and promotion), scholarships and preference of seats in reputed (residential) schools to the children of staff working in rural and remote areas and suitable physical infrastructure at workplace would be more effective than financial incentives alone. There is a need for clearly defined human resource policy for health personnel across all cadres with defined parameters for performance appraisal, transfer and promotion.

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

BackgroundIn 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI.MethodsA discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis.ResultsReimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)).ConclusionsProvider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid.

Health Workers and their Retention: The Situation of Health Care Work in Leprosy Settlements in Abia, Ebonyi and Oyo States of Nigeria.

Introduction: Retention of trained, qualified and motivated health workers is a key component for health system strengthening and achieving world health organization’s (WHO) global strategy for reducing leprosy burden and sustaining leprosy control activities. Study aimed to elucidate the factors and conditions that influence health workers’ job satisfaction in settlements. Materials and method: A total of 31 health workers employed in the three settlements were studied. Data were collected using semi-structured focus group discussion and in-depth interview. Further, situational analyses and informal observation of the activities in the settlements were done. Also Nottingham’s life satisfaction index was used to assess job satisfaction of health workers. Data were analyzed qualitatively and quantitatively. Results: There was acute shortage of highly qualified health staff in the settlements. Two factors, personal factors and institutional factors affected health workers’ retention negatively. Workers remained in one post for prolonged periods of time before earning promotion. In all, 10 (76.9%)of health workers in Abia and 8(72.7%) in Ebonyi States stayed 6-9 years respectively on one post before earning promotion while 4(57.1%) from Oyo stayed 3-7 years. Conclusion: the study showed that retention of health workers in the three settlements was associated with better conditions of service like increased allowances and salaries. Key words: health care, motivation, leprosy, incentive, settlement, and salary