Information Workforce Research Articles

English

Women account for a sizeable number of Information and Communication Technologies (ICT) workforce in India. This paper makes an attempt to find out women’s status in emerging areas of IT in India. This paper firstly tries to find out factors affecting women’s access to ICT education in India. It also tries to find out factors affecting participation in ICT employment. The paper addresses issues regarding IT education availability for all women. Policy recommendations are given regarding women participation in IT sector. Key words: Women, information and communication technologies (ICT), access to ICT, IT workforce.

Understanding Nurse Consultant role engagement in metropolitan and rural contexts

Summary Background Role ambiguity is known to impact negatively on role effectiveness. Nurse Consultants (NCs) are clinical leaders in Australia and similar roles exist internationally. Factors that lead to role ambiguity for NCs include dynamic and complex health care contexts and roles. To reduce ambiguity there is an urgent need to demonstrate NCs' contribution to health care outcomes. Aim This paper reports findings of a study exploring the role, scope and level of engagement of the NC across metropolitan and rural context in New South Wales, Australia. Design This study used a cross sectional sequential mixed method design examining the complex and multifaceted nature of the NC's work. Method NCs were recruited across rural and metropolitan services in a large local health district in New South Wales, Australia. Phase one used a validated questionnaire to gather work engagement and activity data, phase two involved interviews with NCs and others stakeholders. Phase one findings are presented in this paper. Results Work engagement patterns were influenced by role grade (1, 2 or 3), higher grades engaging at higher levels across domains and health sectors. NCs in rural locations had greater emphasis on education, clinical leadership and clinical consultancy and significantly more direct patient contact in their roles. Conclusion NCs engage consistently across domains of practice, contributing across multiple health sectors with flexibility to fulfilling health service needs. Findings highlight the relevance of the role in meeting dynamic workplace needs for high level nursing expertise and inform role application, implementation and workforce planning initiatives.

Modified international e-Delphi survey to define healthcare professional competencies for working with teenagers and young adults with cancer

ObjectivesTo provide international consensus on the competencies required by healthcare professionals in order to provide specialist care for teenagers and young adults (TYA) with cancer.DesignModified e-Delphi survey.SettingInternational, multicentre study.ParticipantsExperts were...

Measuring the Rheumatology Workforce in Canada: A Literature Review.

The number of rheumatologists per capita has been proposed as a performance measure for arthritis care. This study reviews what is known about the rheumatologist workforce in Canada. A systematic search was conducted in EMBASE and MEDLINE using the search themes "rheumatology" AND "workforce" AND "Canada" from 2000 until December 2014. Additionally, workforce databases and rheumatology websites were searched. Data were abstracted on the numbers of rheumatologists, demographics, retirement projections, and barriers to healthcare. Twenty-five sources for rheumatology workforce information were found: 6 surveys, 14 databases, 2 patient/provider resources, and 3 epidemiologic studies. Recent estimates say there are 398 to 428 rheumatologists in Canada, but there were limited data on allocation of time to clinical practice. Although the net number of rheumatologists has increased, the mean age was ≥ 47.7 years, and up to one-third are planning to retire in the next decade. There is a clustering of rheumatologists around academic centers, while some provinces/territories have suboptimal ratios of rheumatologists per capita (range 0-1.1). Limited information was found on whether rural areas are receiving adequate services. The most consistent barrier reported by rheumatologists was lack of allied health professionals. In Canada there are regional disparities in access to rheumatologist care and an aging rheumatologist workforce. To address these workforce capacity issues, better data are needed including information on clinical full-time equivalents, delivery of care to remote communities, and use of alternative models of care to increase clinical capacity.

Demographics of the Australian orthotic and prosthetic workforce 2007-12.

Objective Health workforce data are vital to inform initiatives to meet the future healthcare needs of our society, but there are currently no data describing the Australian orthotic and prosthetic workforce. The aim of the present study was to describe demographic changes in the Australian orthotic and prosthetic workforce from 2007 to 2012. Methods In the present retrospective time series study, data from the Australian Orthotic Prosthetic Association member database were analysed for trends from 2007 to 2012. Data describing the absolute number of practitioners, the number of practitioners per 100000 population, age, gender, state or territory of residence and service location (i.e. metropolitan, regional and remote) were analysed for significant changes over time using linear regression models. Results Although the number of orthotist/prosthetists in Australia increased (P=0.013), the number of orthotist/prosthetists per 100000 population remained unchanged (P=0.054). The workforce became younger (P=0.004) and more female (P=0.005). Only Victoria saw an increase in the proportion of orthotist/prosthetists in regional and remote areas. There was considerable state-to-state variation. Only Victoria (P=0.01) and Tasmania (P=0.003) saw an increase in the number of orthotist/prosthetists per 100000 population. Conclusions The orthotic and prosthetic workforce has increased proportionately to Australia's population growth, become younger and more female. The proportion of practitioners in regional and remote areas has remained unchanged. These data can help inform workforce initiatives to increase the number of orthotist/prosthetists relative to the Australian population and make the services of orthotist/prosthetists more accessible to Australians in regional and remote areas. What is known about the topic? Currently, there are no demographic data describing changes in the Australian orthotic and prosthetic workforce over time. These data are vital to inform initiatives to increase the size of the workforce, locate practitioners where health services are most needed and thereby plan to meet the future health care needs of our society. What does this paper add? This paper describes changes in the Australian orthotic and prosthetic workforce, where previously these data have not been available as part of federal initiatives to plan for future workforce needs. What are the implications for practitioners? Demographic data describing changes in the orthotic and prosthetic workforce are needed to inform workforce initiatives that improve access in regional and remote Australia, and retain a younger and more female workforce.

Mapping the UK information workforce in the library, archives, records, information management, knowledge management and related professions

ABSTRACTA workforce mapping project was carried out in the UK between August 2014 and October 2015. It was commissioned by the Chartered Institute of Library and Information Professionals (CILIP) and the Archives and Records Association (ARA) to enhance understanding of the nation's workforce in Library, Archives, Records, Information Management, Knowledge Management and related professional roles. Based on the statistical analysis of secondary data sources such as the UK Labour Force Survey, as well as responses to an online survey, a long‐needed data baseline was produced by a project team of six from Edinburgh Napier University. Key findings relate to an estimated population of 86,376 workers, their general demographics, qualifications and memberships and the diversity of the population as a whole. Of particular interest are the findings on pay differences and seniority according to gender, and the low ethnic diversity of the population surveyed.

Estimating the Annual Volume of Hematologic Cancer Cases per Hematologist-Oncologist in the United States: Are We Treating Rare Cancers Too Rarely?

BACKGROUNDWhile hematologic cancers comprise only 10% of all malignancies, they are divided into >100 distinct World Health Organization subtypes. It is known that higher volume of care is generally associated with better clinical outcomes. However, such a volume-outcome relationship in the medical management of hematologic cancers has not been rigorously explored. The American Society of Clinical Oncology (ASCO) National Census of Oncology Practices shows that the majority of hematologist-oncologists in the United States (US) have a combined hematology-oncology practice (J Oncol Pract 2013). In this study, we estimated the annual number of new and established patients with major hematologic cancers seen on average by a hematologist-oncologist in the US. METHODSWe estimated the number of hematologist-oncologists working in the US using the ASCO workforce information system data from 2011. We utilized statistics from the Surveillance Epidemiology and End Results (SEER) Program to determine the incidence and 37-year limited prevalence of hematologic cancers in 2011. We used 'first malignant tumor per site' statistics as the tumor inclusion method. For potentially curable hematologic cancers (acute lymphocytic leukemia, acute myeloid leukemia, Burkitt lymphoma, diffuse large b-cell lymphoma, Hodgkin lymphoma, and marginal zone lymphoma), we used the estimated 1-5 year survival rates from SEER and excluded patients who survived >5 years, since relapses are rare afterwards. Because prevalence estimates of chronic myelomonocytic leukemia, myelodysplastic syndromes, and certain subtypes of non-Hodgkin lymphoma are unavailable, we were unable to calculate the number of annual established cases. For myeloproliferative neoplasms, we obtained the prevalence estimate from Mehta J, et al (Leuk Lymphoma 2014). We derived the distribution of major non-Hodgkin lymphoma subtypes from the National Cancer Data Base (NCDB) Participant User File. RESULTSThe ASCO workforce information reported a total of 13,084 hematologist-oncologists working in the US in 2011. The Table summarizes the average number of specific hematologic cancer cases seen per hematologist-oncologist in 2011. CONCLUSIONHematologic cancers are relatively rare but complex. In the US, a hematologist-oncologist on average cares for only 1-2 new patients of any subtype of hematologic cancers annually. The number of established patients is correspondingly low. These numbers are expected to vary by practice setting and disease specialization. As the diagnosis and management of hematologic cancers becomes more sophisticated, future research should explore the potential of a volume to clinical outcome relationship for these providers.TableHematologic CancerAverage Annual Number of Cases per Hematologist-Oncologist in the USNew CasesEstablished CasesAll CasesAcute lymphocytic leukemia0.41.41.8Acute myeloid leukemia11.52.5Chronic lymphocytic leukemia1.110.711.8Chronic myeloid leukemia0.42.73.1Chronic myelomonocytic leukemia0.1--Hodgkin lymphoma0.72.73.4Multiple myeloma1.66.37.9Myelodysplastic syndromes1.2--Myeloproliferative neoplasms0.622.222.8Non-Hodgkin lymphoma5.1--Anaplastic large cell0.1--Burkitt0.10.30.4Diffuse large B-cell268Follicular1.1--Hairy cell leukemia0.1--Lymphoplasmacytic0.1--Mantle-cell0.3--Marginal zone0.52.12.6Peripheral T-cell, not otherwise specified0.1-- DisclosuresNo relevant conflicts of interest to declare.

Health managers' views on the status of national and decentralized health systems for child and adolescent mental health in Uganda: a qualitative study.

BackgroundRobust health systems are required for the promotion of child and adolescent mental health (CAMH). In low and middle income countries such as Uganda neuropsychiatric illness in childhood and adolescence represent 15–30 % of all loss in disability-adjusted life years. In spite of this burden, service systems in these countries are weak. The objective of our assessment was to explore strengths and weaknesses of CAMH systems at national and district level in Uganda from a management perspective.MethodsSeven key informant interviews were conducted during July to October 2014 in Kampala and Mbale district, Eastern Uganda representing the national and district level, respectively. The key informants selected were all public officials responsible for supervision of CAMH services at the two levels. The interview guide included the following CAMH domains based on the WHO Assessment Instrument for Mental Health Systems (WHO-AIMS): policy and legislation, financing, service delivery, health workforce, medicines and health information management. Inductive thematic analysis was applied in which the text in data transcripts was reduced to thematic codes. Patterns were then identified in the relations among the codes.ResultsEleven themes emerged from the six domains of enquiry in the WHO-AIMS. A CAMH policy has been drafted to complement the national mental health policy, however district managers did not know about it. All managers at the district level cited inadequate national mental health policies. The existing laws were considered sufficient for the promotion of CAMH, however CAMH financing and services were noted by all as inadequate. CAMH services were noted to be absent at lower health centers and lacked integration with other health sector services. Insufficient CAMH workforce was widely reported, and was noted to affect medicines availability. Lastly, unlike national level managers, lower level managers considered the health management information system as being insufficient for service planning.ConclusionManagers at national and district level agree that most components of the CAMH system in Uganda are weak; but perceptions about CAMH policy and health information systems were divergent.

The Midwifery Workforce: ACNM 2012 and AMCB 2013 Core Data.

Core data are crucial for detailing an accurate profile of the midwifery workforce in the United States. The American College of Nurse-Midwives (ACNM) and the American Midwifery Certification Board, Inc. (AMCB), at the request and with support from the US Health Resources and Services Administration (HRSA), are engaged in a collaborative effort to develop a data collection strategy (the Midwifery MasterFile) that will reflect demographic and practice characteristics of certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. Two independent datasets, one collected by ACNM in 2012 and one by AMCB in 2013, were examined to determine key workforce information. ACNM data were collected from the online Core Data Survey sent to ACNM members. AMCB data were extracted from information submitted online by applicants seeking initial certification in 2013 and applicants seeking to recertify following 5 years of initial certification. The ACNM 2012 survey was partially or fully completed by 36% (n = 2185) of ACNM members (N = 6072). AMCB respondents included 100% of new certificants (N = 539) and those applying for recertification in 2013 (n = 1323) of the total 11,682 certificants in the AMCB database. These two datasets demonstrate that midwives remain largely white, female, and older in age, with most engaged in clinical midwifery while employed primarily by hospitals and medical centers. Differences were reported between the ACNM membership and AMCB certification datasets in the numbers of midwives holding other certifications, working full-time, attending births, and providing newborn care. The new collaboration among HRSA, ACNM, and AMCB, represented as the Midwifery MasterFile, provides the opportunity to clearly profile CNMs/CMs, distinct from advanced practice registered nurses, in government reports about the health care workforce. This information is central to identifying and marketing the role and contribution of CNMs/CMs in the provision of primary and reproductive health care services.

Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town

BackgroundDistrict and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town.MethodsBetween 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists’ roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature.ResultsFive main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions.ConclusionsSimilar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.

A Census of Actively Licensed Physicians in the United States, 2014

Marked changes have occurred in health care delivery in the United States with the implementation of the Affordable Care Act (ACA), including the advancement of integrated health systems, the introduction of patient centered medical homes and the creation of accountable care organizations. With millions of Americans newly insured, never has there been a more pressing need for accurate physician workforce information and planning. Opinions vary about the nature and degree of anticipated physician shortages, and health care workforce determinations are fraught with variables and uncertainties that are challenging to address definitively. Identifying accurate information about the nation's currently licensed physician workforce, however, is an important starting point. This article reviews data received in 2014 by the Federation of State Medical Boards from the nation's state medical and osteopathic boards about the current supply of actively licensed physicians in the United States and the District of Columbia. Our census data demonstrates the total population of licensed physicians (916,264) has increased by 4% since 2012, and the nation, on average, added 12,168 more licensed physicians annually than it lost. The average physician is now older (by a year), predominantly male (but increasingly female at entry level) and increasingly a graduate of a medical school in the Caribbean. Meanwhile, the percentage of physicians with a single state medical license has remained constant at 79%.

Developing a Multi-Regional Statewide Nursing Workforce Forecast Model Requires Innovation and Collaboration

A key message from the Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health, addresses the need for better health care workforce data collection and information infrastructure, which is a prerequisite for effective workforce planning and policy making. Health care workforce forecasting models provide a mechanism for making future projections, which can be valuable in quantifying supply and demand and identifying the most appropriate strategies to prevent future shortages. Forecasts or predictions about future nursing supply and demand at the state level, although becoming more prevalent, are limited to a minority of states using a variety of methodologies. The Louisiana Multi-Regional Statewide Nursing Workforce Forecasting Model offers a unique and powerful tool to both monitor and forecast changes in the supply of, and demand for nurses at both the state and regional levels relative to specific health care settings. Development of such a model requires collaboration with agencies and/or entities having access to state-level data as well as the support of stakeholders interested in using the model in strategic planning and policy development. A key message from the Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health, addresses the need for better health care workforce data collection and information infrastructure, which is a prerequisite for effective workforce planning and policy making. Health care workforce forecasting models provide a mechanism for making future projections, which can be valuable in quantifying supply and demand and identifying the most appropriate strategies to prevent future shortages. Forecasts or predictions about future nursing supply and demand at the state level, although becoming more prevalent, are limited to a minority of states using a variety of methodologies. The Louisiana Multi-Regional Statewide Nursing Workforce Forecasting Model offers a unique and powerful tool to both monitor and forecast changes in the supply of, and demand for nurses at both the state and regional levels relative to specific health care settings. Development of such a model requires collaboration with agencies and/or entities having access to state-level data as well as the support of stakeholders interested in using the model in strategic planning and policy development.

Practice Patterns and Characteristics of Nurse Practitioners in the United States: Results From the 2012 National Sample Survey of Nurse Practitioners

A National Sample Survey of Nurse Practitioners was conducted in 2012 to provide a national estimate of the nurse practitioner (NP) workforce and new information on services provided by NPs, their specialty areas, and job satisfaction. Data from almost 13,000 respondents show that 76% of NPs in the workforce are trained in primary care and 48% of NPs in patient care provide primary care. There is also evidence of increased proclivity to specialize in primary care among the most recent graduates, indicating that NPs will continue to play a critical role in improving access to primary care.

Do Skill Mix and High Tech Matter for Hospitals' Competency in Adopting Electronic Health Records?

Health workforce plays an important role in the adoption of electronic health records (EHRs). Hospitals have cited barriers around hiring a competent workforce to adopt EHRs. The literature does not adequately relate organizational and health workforce competency with EHR adoption, which makes it difficult to monitor and evaluate any programs targeting trying to improve this problem. In this study, we develop an index measuring hospitals’ competency in adopting electronic health records (EHRs) using Item Response Theory. We test to what extent hospitals’ skill mix and high tech capacity influence their competency. We use health IT data from Health Information and Management Systems Society (HIMSS) Analytics Database and workforce and high tech data from the Centers of Medicare and Medicaid Services (CMS) Provider of Services file. We found that hospitals with a larger share of registered nurses (RNs) had higher EHR competency, but environments with more high tech potentially compete for their attention and results in lower EHR competency. Technicians, therapists, and lower skilled nurses that interact with high tech apparently transfer their knowledge and skills into higher EHR competency. Future EHR adoption incentives should target lower competency hospitals with insufficient workforce and less technological capacity.

Informing the scale-up of Kenya's nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production.

BackgroundGiven the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya.MethodsThis study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data. To assess pre-service attrition between training enrolment and registration with the nursing council, data for a cohort that enrolled in training from 1999 to 2004 and completed training by 2010 was analyzed. Multivariate logistic regression was used to test for factors that significantly affected attrition. To assess the capacity of nurse training institutions for scale-up, qualitative data was obtained through key informant interviews.ResultsFrom 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers. Key factors identified by the nursing faculty included congestion at clinical placement sites, limited clinical mentorship by qualified nurses, challenges with faculty recruitment and retention, and inadequate student housing, transportation and classroom space. Pre-service attrition among the cohort that enrolled between 1999 and 2004 and completed training by 2010 was found to be low (6%).ConclusionTo scale-up the nursing workforce in Kenya, concurrent investments in expanding the number of student nurse clinical placement sites, utilizing alternate forms of skills training, hiring more faculty and clinical instructors, and expanding the dormitory and classroom space to accommodate new students are needed to ensure that increases in student enrolment are not at the cost of quality nursing education. Student attrition does not appear to be a concern in Kenya compared to other African countries (10 to 40%).

Enhancing the American Society of Clinical Oncology Workforce Information System With Geographic Distribution of Oncologists and Comparison of Data Sources for the Number of Practicing Oncologists

The American Society of Clinical Oncology (ASCO) 2007 workforce report projected US oncologist shortages by 2020. Intervening years have witnessed shifting trends in both supply and demand, demonstrating the need to capture data in a dynamic manner. The ASCO Workforce Information System (WIS) provides an infrastructure to update annually emerging characteristics of US oncologists (medical oncologists, hematologist/oncologists, and hematologists). Several possible data sources exist to capture the number of oncologists in the United States. The WIS primarily uses the American Medical Association Physician Masterfile database because it provides detailed demographics. This analysis also compares total counts of oncologists from American Board of Internal Medicine (ABIM) certification reports, the National Provider Identifier (NPI) database, and Medicare Physician Compare data. The analysis also examines geographic distribution of oncologists by age and US population data. For each of the data sources, we pulled 2013 data. The Masterfile identified 13,409 oncologists. ABIM reported 13,757 oncologists. NPI listed 11,664 oncologists. Physician Compare identified 11,343 oncologists. Mapping of these data identifies distinct areas (primarily in central United States, Alaska, and Hawaii) that seem to lack ready access to oncologists. Efforts to survey oncologists about practice patterns will help determine if productivity and service delivery will change significantly. ASCO is committed to tracking oncologist supply and demand, as well as to providing timely analysis of strategies that will help address any shortages that may occur in specific regions or practice settings.

State Medical Boards' Perceptions of a Minimum Data Set and Current Practices for Collecting Physician Information

ABSTRACT Recent media coverage has focused on the supply of physicians in the United States, especially with the impact of a growing physician shortage and the Affordable Care Act. State medical boards and other entities maintain data on physician licensure and discipline, as well as some biographical data describing their physician populations. However, there are gaps of workforce information in these sources. The Federation of State Medical Boards' (FSMB) Census of Licensed Physicians and the AMA Masterfile, for example, offer valuable information, but they provide a limited picture of the physician workforce. Furthermore, they are unable to shed light on some of the nuances in physician availability, such as how much time physicians spend providing direct patient care. In response to these gaps, policymakers and regulators have in recent years discussed the creation of a physician minimum data set (MDS), which would be gathered periodically and would provide key physician workforce information. While proponents of an MDS believe it would provide benefits to a variety of stakeholders, an effort has not been attempted to determine whether state medical boards think it is important to collect physician workforce data and if they currently collect workforce information from licensed physicians. To learn more, the FSMB sent surveys to the executive directors at state medical boards to determine their perceptions of collecting workforce data and current practices regarding their collection of such data. The purpose of this article is to convey results from this effort. Survey findings indicate that the vast majority of boards view physician workforce information as valuable in the determination of health care needs within their state, and that various boards are already collecting some data elements. Analysis of the data confirms the potential benefits of a physician minimum data set (MDS) and why state medical boards are in a unique position to collect MDS information from physicians.

The Role of Private Foundations in Addressing Health Care Workforce Needs

There is an increased awareness among policy makers, providers, and educators that the size, composition, geographic distribution, and skill mix of the health care workforce is of great importance in determining the likelihood of success in achieving our societal goals for health care reform. As academic and governmental institutions work to address these pressing questions, private foundations can and should play an important role in supporting the design, execution, and evaluation of innovative educational programs that will address these needs. Foundations also can and should play a role in generating information that will better inform health care workforce policies and in convening thought leaders to make recommendations that will advance the field of workforce studies.The author details current efforts by the Josiah Macy Jr. Foundation and other private foundations to address health care workforce needs. Foundations can play important roles as catalysts for change in our educational processes, and they can serve as important links between education and health care delivery systems. Partnerships among foundations and between private foundations and federal agencies can be powerful forces in helping to better align the skills of future health professionals with changing patient demographics and a changing health care system.

Developing the flexible library and information workforce.

Flexibility is a vaguely defined media buzzword connoting the progressive, forward-looking workplace. Employers report that increased labour market flexibility has made them more cost-effective, efficient, better able to deal with customer and employee demands and the implementation of new technology. But what is happening to those workers who make up the flexible workforce? For a while in the 1980s it seemed that flexibility could do no wrong; now, however, the shortcomings of flexible labour markets are becoming
 more apparent.

Establishing a health information workforce: innovation for low- and middle-income countries

BackgroundTo address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative.MethodsData were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment.ResultsAn average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues’ misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%).ConclusionsThe development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.