Retention Of Healthcare Workers Research Articles

Recruiting and retaining healthcare workers in Scotland to a longitudinal COVID-19 study: a descriptive analysis

BackgroundRapid timescales for the design and delivery of research were common during the COVID-19 pandemic. The recruitment and retention of healthcare workers (HCWs) as participants in research studies are notoriously challenging, but this was exacerbated during the pandemic by the unprecedented demand placed on the workforce. The SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN study) is a prospective multicentre cohort study following HCWs in the UK. This paper discusses the strategies and challenges associated with recruitment and retention of HCW participants in Scotland.MethodsThere were 44,546 HCWs recruited to the SIREN study, of whom 6,285 were recruited by research teams at ten different research sites in Scotland between October 2020 and March 2021. Information on target and actual sample size, availability of resource, recruitment rate, and recruitment and engagement strategies by site was collated from SIREN study documentation and discussions with local key SIREN site staff. Individual-level data from 6,153 HCW participants with ongoing consent for all data usage were also collated, including socio-demographic data and information on withdrawal (in first year) and opt-in to a study extension after one year. Factors associated with these outcomes were explored in logistic regression analyses.ResultsDifferent recruitment strategies were used in each site according to local agreements, protocol and staff capacity, with the recruitment period ranging from 13 to 160 days. The locally-agreed recruitment target was met in four sites. The proportion of participants who withdrew in the first year ranged from 3.1 to 24.8% by site, while subsequent opt-in to a 12-month study extension ranged from 28.6 to 74.8%. The sites with the highest proportions of withdrawals were the same four sites with lowest proportions of opt-in. On an individual level, there was a lower level of retention among younger participants, and those from lower socio-economic backgrounds and minority ethnic groups.ConclusionsSite-specific factors including research-readiness likely had a significant influence on recruitment and retention, more so than the specific recruitment or retention strategies employed. Independent of site factors, individual-level variables influenced recruitment and retention, suggesting targeted strategies may be needed to promote research engagement among particular socio-demographic groups.

Psychosocial workplace safety in mental health services - Commentary and considerations to improve safety.

Psychosocially unsafe workplaces are related to burnout, especially amongst trainees and psychiatrists. Burgeoning research on psychosocial workplace safety indicates the importance of organisational governance to reduce adverse professional, and consequently patient, outcomes in healthcare by balancing job demands and resources. We provide a brief commentary on the relevance of the concept of the Psychosocial Safety Climate model for mental health services and healthcare workers, and considerations for action. Based on the Extended Job Demand-Resource model, the Psychosocial Safety Climate model has been developed and validated in community and healthcare environments. Psychosocial safety is also an Australian workplace safety requirement. An important direction to improve working conditions, reduce adverse outcomes, and improve recruitment and retention of healthcare workers, may be to adopt and formalise psychosocial workplace safety as a key performance indicator of equal importance to productivity for mental healthcare services.

Assessing the job preferences of senior medical students for mandatory service: a discrete choice experiment.

To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. This cross-sectional survey was conducted among 144 medical students. To estimate students' preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.

Organizational trust breaches among nurses and aides: A qualitative study.

Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust. Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted.

Landscape analysis of healthcare workforce and resilience actions in the Sahelian context of high security challenge areas: The case of Burkina Faso.

Access to health services is a major challenge in developing countries in general, particularly those affected by insecurity. The availability of sufficient quantity and quality of equitably distributed healthcare workforce is a major obstacle, yet it is an essential pillar of an effective and efficient national health system. Burkina Faso, similar to other countries in the Sahel, has been affected by an unprecedented security crisis that has severely tested the functionality of health facilities and the availability of healthcare workforce. To describe the landscape of healthcare workforce and to analyse the actions taken by the government and other stakeholders to improve the resilience of the system and the retention of healthcare workers in the context of major security challenges. This is a transversal, descriptive and analytical study carried out in Burkina Faso in 2023 through a documentary review, analyses of databases collected from health districts and regional directorates, focus groups and a national triangulation workshop with key informants. The study shows that, with the closure and minimal functioning of certain health facilities in security-challenged areas, healthcare workforceare concentrated in the urban areas of regional and district capitals, to the detriment of rural areas. Some staff become in an irregular situation regarding the administration. To strengthen resilience to the crisis, the main solutions have been implemented: (i) enhancing the community platform with the recruitment of 15,000 community-based health volunteers, (ii) delegating tasks to community health agents, (iii) simplified approaches, (iv) advanced health posts and mobile clinics, (v) redeployment to the most stable structures, (vi) thinking about legislation in crisis situations. Community resilience through the delegation of tasks to community-based health workers and strengthening of the community health platform has helped ensure the continuity of care in insecure areas. However, the optimization of innovative and attractive strategies will further improve the retention and return of healthcare workers in rural areas affected.

Inspiring rural youth to consider healthcare careers through an interprofessional healthcare traveling roadshow.

There are well-documented shortages of healthcare providers in rural and remote communities worldwide, and these shortages correlate with inequitable health outcomes for rural peoples. Despite a wide array of efforts to remedy the issue, these shortages persist to this day. The Healthcare Traveling Roadshow (HCTRS) is a grassroots initiative that began in 2010 to help address the shortage of healthcare providers in rural communities throughout British Columbia. Since its inception, the HCTRS has been predicated on three evidence-based guiding principles which have been shown to markedly increase the rate at which healthcare students choose to practice rurally. These principles are: (1) to showcase healthcare careers as viable and realistic options for rural youth (high school students) using interactive stations and near-peer teaching; (2) to expose healthcare students to rural communities and showcase them as a potential opportunity for their future practice; and (3) to provide a unique interprofessional experience to healthcare students from diverse healthcare careers and backgrounds. Through the synergy of these three principles the HCTRS aims to increase the longitudinal recruitment and retention of healthcare workers in underserved rural communities. This paper will share our experience from 15 years of running this initiative, for those hoping to implement similar programs in other areas of the world.

Mental Health: a focus on retention of healthcare workers

Abstract Introduction Shortages of healthcare workers are an important challenge for European hospitals. High turnover rates are considered one of the major factors responsible for the outflow of healthcare workers. In the METEOR project, we focus on turnover intentions, job satisfaction and burnout as critical determinants for turnover among healthcare workers in four European countries (i.e. Belgium, the Netherlands, Italy and Poland). Methods The METEOR project included three types of data collection methods. First, we identified and analysed the existing determinants of job retention among healthcare workers from literature. Second, we collected data in eight European hospitals by conducting an online survey to assess turnover intentions related to the work climate, job satisfaction and burnout. Third, we organised 12 co-creation and consensus-building workshops with key stakeholders to collect qualitative data on job satisfaction and job retention. Results First, based on our survey, 17% of physicians and 9% of nurses intend to leave their hospital, while 9% of physicians and 13% of nurses intend to leave healthcare. Second, the determinants found in literature for job retention were categorized into six themes: personal characteristics, job demands, employment services, working conditions, work relationships, and organizational culture. The main determinants were job satisfaction, career development and work-life balance. Third, the workshops showed that nurses and physicians are highly engaged in their patient-work, but are drained by paperwork, an unhealthy work-life balance, a lack of teamwork, limited development opportunities and no appreciation from supervisors. Conclusions The intermediate results of the METEOR project show that there is no one-size-fits-all solution to tackle the problem of job retention in healthcare. Initiatives to retain people in healthcare must respond to multiple factors, as they stay (or leave) for a variety of reasons.

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

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

Education to Prepare Health Professionals for Rural Practice

Rural and remote communities are challenged by an incongruous combination of poorer health and deficits of health workers. Health professionals working in rural and remote practice contexts are largely educated with standardised curriculum content designed for urban-dominant systems, even though non-urban populations account for approximately half of the global population. Education is one strategy considered pivotal to recruitment and retention of health care workers in rural areas, yet has received less research attention than strategies such as rural background, incentive schemes and clinical placements. Peer reviewed literature published in English between 2011-2021 were obtained, guided by PRISMA-P guidelines (Shamseer, 2015). The aim of this review was to examine how health professionals are currently being prepared for rural practice. Following key health database searches 189 relevant articles were retrieved, of which 26 articles met the inclusion criteria for final analysis. This review identified a heavy reliance upon standardised curricula delivered via clinical and interprofessional placements with little attention to specific rural curriculum content or pedagogic strategies tailored to rural and remote practice. Three themes were developed from the literature: Context (‘learning to think differently’, ‘relationships’, and ‘health leadership’), Curriculum and Pedagogy (‘rural clinical placements’ and ‘interprofessional education’). There is a paucity of educational design and evaluation research to assess the value of education strategies that prepare health professionals to work in rural places. Identifying key rural pedagogic strategies can support curriculum content, experiences and assessment that provide health professionals with the competence, confidence and skills to sustain careers in rural and remote practice.

Demographic and Organisational Factors as Predictors of Retention Among Health Care Workers in South West Nigeria

Retention of healthcare workers in Nigerian healthcare facilities is a crucial issue in Nigeria, which has a deficiency of qualified medical personnel. In recent times, unlike ever witnessed before, the quality and accessibility of healthcare services in Nigeria are seriously threatened by low healthcare worker retention. The cause of low retention among healthcare workers in Nigeria is unknown, hence, a need to investigate the predictive influence of demographic and organizational factors on employee resilience among healthcare workers in Nigeria. A total of 798 healthcare workers (92 medical doctors, 401 nurses, 92 radiologists, 75 pharmacists, 134 MBBS, and Equivalent while 4 technicians) were purposively selected for the study. Outcomes revealed that gender (β = .26, t= 8.55, p<.05), age (β = .22, t= 4.24, p<.05), state of origin (β = .06, t= 2.09, p<.05), marital status (β = .23, t= 7.17, p<.05) and education (β =-.38, t= -11.24 p<.05), job satisfaction (β = -.18, t= -2.95, p<.05) and perceived organizational support (β = .22, t= 2.99 p<.05) significantly predicted retention among healthcare workers. It was concluded that being female and unmarried, having negative/low job satisfaction, and perceiving positive/high organizational support predicted employee retention.

A qualitative inquiry of rural-urban inequalities in the distribution and retention of healthcare workers in southern Nigeria.

IntroductionGlobally, the population in rural communities are disproportionately cared for by only 25% and 38% of the total physicians and nursing staff, respectively; hence, the poor health outcomes in these communities. This condition is worse in Nigeria by the critical shortage of skilled healthcare workforce. This study aimed to explore factors responsible for the uneven distribution of healthcare workers (physicians and nurses) to rural areas of Ebonyi State, Nigeria.MethodsQualitative data were obtained using semi-structured in-depth interviews and focus group discussions from purposively selected physicians, nurses, and policymakers in the state. Data was analysed for themes related to factors influencing the mal-distribution of healthcare workers (physicians and nurses) to rural areas. The qualitative analysis involved the use of both inductive and deductive reasoning in an iterative manner.ResultsThis study showed that there were diverse reasons for the uneven distribution of skilled healthcare workers in Ebonyi State. This was broadly classified into three themes; socio-cultural, healthcare system, and personal healthcare workers’ intrinsic factors. The socio-cultural factors include symbolic capital and stigma while healthcare system and governance issues include poor human resources for health policy and planning, work resources and environment, decentralization, salary differences, skewed distribution of tertiary health facilities to urban area and political interference. The intrinsic healthcare workers’ factors include career progression and prospect, negative effect on family life, personal characteristics and background, isolation, personal perceptions and beliefs.ConclusionsThere may be a need to implement both non-financial and financial actions to encourage more urban to rural migration of healthcare workers (physicians and nurses) and to provide incentives for the retention of rural-based health workers.

First wave of COVID-19 in Quebec: Healthcare workers' motivation to treat infected patients

Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients. To evaluate factors modulating HCWs' willingness to treat COVID-19 infected patients. HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients. A total of 430HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08). Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.

Retention of healthcare workers 1 year after recruitment and deployment in rural settings: an experience post-Ebola in five health districts in Guinea

BackgroundGuinea undertook health workforce reform in 2016 following the Ebola outbreak to overcome decades-long shortages and maldistribution of healthcare workers (HCWs). Specifically, over 5000 HCWs were recruited and deployed to rural health districts and with a signed 5-year commitment for rural medical practice. Governance structures were also established to improve the supervision of these HCWs. This study assessed the effects of this programme on local health systems and its influence on HCWs turnover in rural Guinea.MethodsAn exploratory study design using a mixed-method approach was conducted in five rural health districts. Data were collected through semi-structured questionnaires, in-depth interview guides, and documentary reviews.ResultsOf the 611 HCWs officially deployed to the selected districts, 600 (98%) took up duties. Female HCWs (64%), assistant nurses (39%), nurses (26%), and medical doctors (20%) represented the majority. Findings showed that 69% of HCWs were posted in health centres and the remaining in district hospitals and the health office (directorate); the majority of which were medical doctors, nurses, and midwives. The deployment has reportedly enhanced quality and timely data reporting. However, challenges were faced by local health authorities in the posting of HCWs including the unfamiliarity of some with primary healthcare delivery, collaboration conflicts between HCWs, and high feminization of the recruitment. One year after their deployment, 31% of the HCWs were absent from their posts. This included 59% nurses, 29% medical doctors, and 11% midwives. The main reasons for absenteeism were unknown (51%), continuing training (12%), illness (10%), and maternity leave (9%). Findings showed a confusion of roles and responsibilities between national and local actors in the management of HCWs, which was accentuated by a lack of policy documents.ConclusionThe post-Ebola healthcare workers policy appears to have been successfully positive in the redistribution of HCWs, quality improvement of staffing levels in peripheral healthcare facilities, and enhancement of district health office capacities. However, greater attention should be given to the development of policy guidance documents with the full participation of all actors and a clear distinction of their roles and responsibilities for improved implementation and efficacy of this programme.

Predictors of professional quality of life among nurses–A cross sectional study

A good practice environment is a vital aspect of the staffing and retention of health care workers, especially of nurses affecting patient care. This study investigates the predictors of nurses’ Professional Quality of Life working in public hospitals and private hospitals. A cross-sectional design was utilized, including 374 nurses conveniently sampling selected in two public hospitals and two private hospitals in the Philippines using a Practice Environment Scale of the Nursing Work Index and Professional Quality of Life scale having a good psychometric property, respectively. The overall mean score for practice environment for Nurses is at a low level, whereas the mean Professional Quality of Life score was at a moderate level. Age is significantly associated with the burnout subscale (r=-0.119, p<0.021) and with secondary traumatic stress (r=-0.193, p<0.001). Monthly salary is significantly associated with the compassion satisfaction subscale (r=-0.140, p=0.007) and STS (r=0.107, p=0.038). Meanwhile, the working hours' figure is significantly associated with compassion satisfaction subscale (r=-0.133, p=0.010). Finally, the practice environment of nurses shown is significantly associated with compassion satisfaction subscale (r=-0.426, p=0.007) and secondary traumatic stress (r=0.524, p<0.001). Filipino nurses have a lower practice environment and moderate professional quality of life. The predictors of the professional quality of life of nurses were age, monthly salary, working hours, and their practice environment. Specifically, the higher the salary and the shorter the working hours, the better their professional quality of life. Additionally, the poorer the practice environment, the lower the professional quality of life.

Assessing the impact of a motivational intervention to improve the working lives of maternity healthcare workers: a quantitative and qualitative evaluation of a feasibility study in Malawi

BackgroundGlobally too many mothers and babies die during childbirth; 98% of maternal deaths are avoidable. Skilled clinicians can reduce these deaths; however, there is a world-wide shortage of maternity healthcare workers. Malawi has enough to deliver 20% of its maternity care. A motivating work environment is important for healthcare worker retention. To inform a future trial, we aimed to assess the feasibility of implementing a motivational intervention (Appreciative Inquiry) to improve the working lives of maternity healthcare workers and patient satisfaction in Malawi.MethodsThree government hospitals participated over 1 year. Its effectiveness was assessed through: a monthly longitudinal survey of working life using psychometrically validated instruments (basic psychological needs, job satisfaction and work-related quality of life); a before and after questionnaire of patient satisfaction using a patient satisfaction tool validated in low-income settings with a maximum score of 80; and a qualitative template analysis encompassing ethnographic data, semi-structured interviews and focus groups with staff.ResultsThe intervention was attended by all 145 eligible staff, who also participated in the longitudinal study. The general trend was an increase in the scores for each scale except for the basic psychological needs score in one site. Only one site demonstrated strong evidence for the intervention working in the work-related quality of life scales. Pre-intervention, 162 postnatal women completed the questionnaire; post-intervention, 191 postnatal women participated. Patient satisfaction rose in all three sites; referral hospital 4.41 rise (95% CI 1.89 to 6.95), district hospital 10.22 (95% CI 7.38 to 13.07) and community hospital 13.02 (95% CI 10.48 to 15.57). The qualitative data revealed that staff felt happier, that their skills (especially communication) had improved, behaviour had changed and systems had developed.ConclusionsWe have shown that it is possible to implement Appreciative Inquiry in government facilities in Malawi, which has the potential to change the way staff work and improve patient satisfaction. The mixed methods approach revealed important findings including the importance of staff relationships. We have identified clear implementation elements that will be important to measure in a future trial such as implementation fidelity and inter-personal relationship factors.

Rural Employment of Health Care Workers: A Longitudinal Cohort Study.

Preserving and increasing the health care workforce in rural areas has become imperative due to the shortage of health care workers serving rural populations. However, limited data are available on long-term patterns of employment in rural settings among health care workers. We analyzed the National Longitudinal Survey of Youth, which enrolled a nationally representative sample of adolescents in 1979 and tracked their career outcomes through 2016. Using the US Census Bureau occupation codes, we identified participants who worked in health care occupations, and we classified their employment in rural versus urban areas. Of the 1,007 respondents (including 109 doctoral health professionals), 70% worked only in urban locations, 13% worked only in rural locations, and 17% worked in both rural and urban locations during their health care career. Rural upbringing, White race, and female gender were associated with rural employment. Among nondoctoral health professionals, lower educational attainment was associated with increased likelihood of working only in rural settings. Our study indicates the rural workforce is split between workers who are only employed in rural settings, and those who are intermittently employed in rural and urban settings. Therefore, retention of health care workers in rural settings and recruitment of workers from urban settings to practice in rural areas are important strategies for addressing the rural health care worker shortage. Rural upbringing, previously described as predictive of physician practice in rural locations, appears the strongest predictor of rural employment for both doctoral health professionals and nondoctoral health professionals.

Working with older people with dementia: motivations and demotivations among health carers

Purpose Motivation is central to the ongoing professional development, performance and retention of healthcare workers. Despite the increasing prevalence of people with dementia (PwD) and the associated demand for geriatric nurses, there exists a paradoxical shortage. The purpose of this paper is to explore the motivation and demotivation of healthcare professionals for working with older PwD, challenges faced, factors influencing intention to leave the field of work and methods to enhance staff motivation to continue working with this group. Design/methodology/approach This grounded-theory study used thematic analysis to synthesise data from 13 semi-structured interviews relating to the motivating and demotivating factors of healthcare professionals (nurses and healthcare assistants) for working with older PwD in a hospital setting. Findings Staff were motivated by previous personal experiences, personal characteristics and the fulfilment of the carer–patient relationship. Conversely, staff were mostly demotivated by organisational and working environment factors (e.g. poor leadership characteristics, inadequate staffing levels, lack of development opportunities), negatively influencing their intention to remain in employment. Research limitations/implications The generalisability of the results is limited by the size of the sample. Different organisational strategies/interventions (i.e. support, training, recognition and rewards) are necessary to nurture staff motivation, improve retention, create positive working environments and enhance patient care. Originality/value This study offers numerous ways in which to address factors contributing to demotivation in working with PwD, thereby helping to improve staff retention and support the needs of a growing population.

Retention of health care workers at health facility, trends in the retention of knowledge and correlates at 3rd year following training of health care workers on the prevention of mother-to-child transmission (PMTCT) of HIV\u2013National Assessment

BackgroundKnowledgeable Health Care Workers (HCWs) are indispensable for the proper management of clients. We investigated retention of HCWs at health facility and retention of knowledge at 18, 24 and 36 months after training and correlates for retention of knowledge at 3rd year.MethodsA cross-sectional study was conducted among 1000 HCWs, 710 were trained and 290 untrained working at the PMTCT of HIV services in health facilities of the ten regions of Cameroon. A Multiple Choice Questionnaire (MCQ) on HIV management with focus on PMTCT of HIV was used to assess retention of HCWs at the health facility and retention of knowledge. Summary statistics described mean scores for retention of HCWs and retention of knowledge. One-way Analysis of Variance summarized the differences in retention of knowledge over time after training. Correlates for retention of knowledge were investigated by logistic regression analysis.ResultsThe retention of HCWs at health facilities in PMTCT of HIV services was 85%. Trained HCWs had higher mean scores for retention of knowledge than untrained HCWs, p < 0.001. Knowledge attrition was observed from 18, 24 to 36 months following training. Differences in the mean scores for retention of knowledge were observed between state-owned with private and confessionary health facilities but not among trained HCWs at 18, 24 or 36 months. Highest mean scores for retention of knowledge were observed in District Hospitals, Sub-Divisional Hospitals, and Integrated Health Centres. Correlates for retention of knowledge were: gender, type of health facility, location, longevity at PMTCT services, trained others and had means to apply what was trained to do.ConclusionRetention of trained HCWs at health facilities was high, mean scores for retention of knowledge was average and knowledge attrition was observed over time. This research is critical to understand where interventions may be most effective.

Occupational tuberculosis in healthcare workers in sub-Saharan Africa: A systematic review

ABSTRACTThis article investigates the incidence, prevalence and factors associated with occupational tuberculosis (TB) in healthcare workers (HCWs) in sub-Saharan Africa (SSA). Studies were extracted from MEDLINE, PsycINFO, CINAHL, Cochrane Library, and SCOPUS databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from inception to the 2nd of June 2017. Twenty-one studies met the inclusion criteria. The median prevalence of latent TB infection in HCWS was 62% (IQR 22%) and the median incidence of TB disease was 3871/100,000 (IQR 9314/100,000). The risk factors associated with LTBI or active TB disease were workplace, history of contact with TB patients, and longer duration of employment. The findings of this review demonstrate that the risk of acquiring TB among HCWs in SSA is high. This may impact on the recruitment, longevity and retention of HCWs.

Introducing an E-learning Solution for Medical Education in Liberia.

Background:The Ebola virus epidemic and civil war in Liberia left the country in need of strengthening the health workforce. E-learning in medical education provides relevant learning opportunities for students, develops faculty competencies, and assists with the retention of healthcare workers. The Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI), the College of Health and Life Sciences (COHLS) at the University of Liberia (UL), and the Health Resources and Services Administration (HRSA) formed a partnership to create an e-learning solution for the COHLS.Objective:This article outlines the implementation of an e-learning solution for the COHLS in Monrovia, and describes the challenges met, the key successes achieved, and the lessons learnt.Methods:An initial scoping visit to Liberia was followed by three further on-site visits. Problems identified were: very limited or no network and computer resources, no internet connection, intermittent power, and lack of IT skills. We followed an evolutionary approach to infrastructure implementation by trying various solutions before settling on an offsite-hosted solution using Software as a Service (SaaS). Local staff were upskilled to administer this while remote support from Stellenbosch IT was provided. A stable internet connection was established. Staff and students can access the Learning Management System (LMS) 24/7 using mobile devices and laptops. Workshops were held where staff were taught how to produce online teaching material. Each class has at least one teaching assistant to assist lecturers with uploading and indexing material on the LMS.A benchmarking visit by COHLS faculty to Stellenbosch University took place, during which an e-learning strategic plan was drawn up. Further online workshops were conducted, and teaching materials were placed on the new LMS.Outcomes:The intranet that was established consisted of internet connection and software as a service in the form of Office 365, providing access to several products and services. The e-learning model attended to technology and human resources simultaneously. The e-learning strategy aimed to improve teaching and learning at the COHLS, boost the number of qualified doctors, reduce the workload on lecturers, and be scalable in the future.Conclusion:It is challenging to implement e-learning in medical education. Inadequate infrastructure, limited bandwidth, lack of skilled IT staff, unreliable power supply, time commitment, and ongoing maintenance all need to be overcome. The creation of an e-learning solution for the COHLS over a period of 15 months was enabled by the common vision and close collaboration of the three partners. This model can potentially be replicated across other faculties in the University of Liberia and other educational institutions in Liberia.