Retention Of Healthcare Workers Research Articles

International nurse migration from India and the Philippines: the challenge of meeting the sustainable development goals in training, orderly migration and healthcare worker retention

ABSTRACTThis paper examines nurse migration from India and the Philippines through the lens of the sustainable development goals (SDGs) 4.3 (access to training), 10.7 (orderly and responsible migration) and 3.c (retention of health workers). The international migration of health workers has increasingly featured on the agenda of global health agencies. Ameliorating the negative impact of international nurse emigration from low-income nations has been addressed by several western governments with the adoption of ethical recruitment guidelines, one element of an orderly migration framework. One of the challenges in creating such guidelines is to understand how the emigration of trained nurses influences health education and clinical training systems within nurse exporting nations such as India and the Philippines, and how these relate to various SDGs. This paper maps the connections between India’s and the Philippines’ increasing role in the provision of nurses for international markets and the SDGs related to training and migration governance and the retention of health workers. The paper calls for greater attention to the global structuring of migrant mobility in order to assess national abilities to meet SDG goals in these areas.

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

Deployment and retention of a sufficient number of skilled and motivated human resources for health (HRH) at the right place and at the right time are critical to ensure people's right to access a universal quality of health care. Vision Tokyo 2010 Network, an international network of HRH managers at the ministry of health (MoH) level in nine Francophone African countries, identified maldistribution of a limited number of healthcare personnel and their retention in rural areas as overarching problems in the member countries. The network conducted this study in Senegal to identify the determining factors for the retention of qualified HRH in rural areas, and to explore an effective and feasible policy that the MoH could implement in the member countries. Doctors, nurses, midwives and superior technicians in anesthesiology who were currently working (1) in a rural area and had been for more than 2 years, (2) in Dakar with experience of working in a rural area or (3) in Dakar without any prior experience working in a rural area were interviewed about their willingness and reasons for accepting work or continuing to work in a rural area and their suggested policies for deployment and retention of healthcare workers in rural areas. In-depth interviews were conducted with policy makers in MoH, asking for their perceptions on human resource management in health and about their suggested policies for deployment and retention. A total of 176 healthcare workers and eight policy makers were interviewed. The willingness to face challenges in a new place was one of the main reasons for accepting work in rural areas. The identified factors to motivate or demotivate healthcare workers in rural areas were related to pre-service and in-service education, regulatory systems, financial and non-financial incentive schemes and environmental support. Factors not included in WHO's global recommendation but highly valued in this study were (1) the fairness, transparency and predictability of human resource management by the MoH and (2) employment status, ie permanent government staff versus contract staff. Financial incentive schemes were less commonly suggested. Family bonding and religious-related non-financial incentive schemes were found to be specific factors in Senegal, but would also be applicable in countries where family and religion play important roles in the values of healthcare workers. Improved HRH management, eg the transparency of human resource management by the MoH, was identified as a pre-condition of any policy implementation related to HRH. This factor can be considered in other countries struggling to retain healthcare workers in rural areas. The Vision Tokyo 2010 Network or HRH managers' network in Francophone Africa, Senegal MoH and the research team plan to conduct a quantitative survey to confirm the generalizability of the results of this qualitative survey, and to identify the most effective combination of policies to improve the retention of qualified healthcare workers and seek their implementation in other countries in the region as network activities.

Factors Influencing Recruitment and Retention of Healthcare Workers in Rural and Remote Areas in Developed and Developing Countries: An Overview.

Shortage of healthcare workers in rural and remote areas remains a growing concern both in developed and developing countries. This review aims to synthesize the significant factors impacting healthcare professionals’ recruitment and retention in rural and remote areas, and to identify those relevant for developing countries. This paper included the following steps: exploring scientific literature through predetermined criteria and extracting relevant information by two independents reviewers. The AMSTAR tool was used to assess the methodological quality. Of the 224 screened publications, 15 reviews were included. Four reviews focused on recruitment factors, and another four reviews focused on retention factors. The remaining focused both on recruitment and retention factors. The most important factors influencing recruitment were rural background and rural origin, followed by career development. Opportunities for professional advancement, professional support networks and financial incentives were factors impacting retention. While the main factors influencing recruitment and retention have been largely explored in the literature, the evidence on strategies to reduce the shortage of healthcare workers in rural area, particularly in developing countries, is low. Further research in this field is needed.

Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90 % of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve “hands-on” skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate progress. Respondents emphasized evaluating effectiveness, feasibility, and equity impacts of health system interventions. A prominent role for implementation science, evidence for policy advocacy, and interdisciplinary collaboration were identified as critical areas for knowledge generation to improve maternal health in the post-2015 era.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-015-0044-5) contains supplementary material, which is available to authorized users.

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

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

Lifestyle modification for the primary prevention of type 2 diabetes mellitus in the Canadian Aboriginal population

Canada’s Aboriginal populations have significantly higher rates of type 2 diabetes compared to non-Aboriginal Canadians. In First Nations populations living on reserve, the rates are more than double. Large randomized controlled trials (RCTs) have shown that intensive lifestyle modification in individuals with impaired glucose tolerance can decrease the overall incidence of diabetes by up to 22%.
 Implementing lifestyle interventions into clinical practice remains a significant challenge because of both limited resources and uncertainly about optimal program design. Most studies have focused on translation into the primary care setting, and have shown moderate benefits. However, there have been no trials examining the feasibility and effectiveness of RCT-based lifestyle modification in Canadian Aboriginal communities. Canadian initiatives have so far focused on school-based healthy lifestyle curriculum and community awareness, but have had little success in reducing weight.
 Factors such as community remoteness, cultural diversity, poor retention of health care workers, and lack of access to healthy food are significant barriers to implementing lifestyle modification programs in Canadian Aboriginal communities. More importantly, these communities face systemic inequalities that must be addressed in order to achieve meaningful and sustained lifestyle changes.

Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya.

BackgroundThe World Health Organization (WHO) and the Government of Kenya alike identify a well-performing health workforce as key to attaining better health. Nevertheless, the motivation and retention of health care workers (HCWs) persist as challenges. This study investigated factors influencing motivation and retention of HCWs at primary health care facilities in three different settings in Kenya - the remote area of Turkana, the relatively accessible region of Machakos, and the disadvantaged informal urban settlement of Kibera in Nairobi.MethodsA cross-sectional cluster sample design was used to select 59 health facilities that yielded interviews with 404 health care workers, grouped into 10 different types of service providers. Data were collected in November 2011 using structured questionnaires and a Focus Group Discussion guide. Findings were analyzed using bivariate and multivariate methods of the associations and determinants of health worker motivation and retention.ResultsThe levels of education and gender factors were lowest in Turkana with female HCWs representing only 30% of the workers against a national average of 53%. A smaller proportion of HCWs in Turkana feel that they have adequate training for their jobs. Overall, 13% of the HCWs indicated that they had changed their job in the last 12 months and 20% indicated that they could leave their current job within the next two years. In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana. The working environment is rated as better in private facilities. Adequate training, job security, salary, supervisor support, and manageable workload were identified as critical satisfaction factors. Family health care, salary, and terminal benefits were rated as important compensatory factors.ConclusionsThere are distinct motivational and retention factors that affect HCWs in the three regions. Findings and policy implications from this study point to a set of recommendations to be implemented at national and county levels. These include gender mainstreaming, development of appropriate retention schemes, competitive compensation packages, strategies for career growth, establishment of a model HRH community, and the conduct of a discrete choice experiment.

Development of a brief instrument for assessing healthcare employee satisfaction in a low-income setting.

BackgroundEthiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC) survey for use in hospitals and health centers throughout Ethiopia.MethodsLiterature reviews and cognitive interviews were used to generate a staff satisfaction survey for use in the Ethiopian healthcare setting. We pretested the survey in each of the six hospitals and four health centers across Ethiopia (98% response rate). We assessed content validity and convergent validity using factor analysis and examined reliability using the Cronbach alpha coefficients to assess internal consistency. The final survey was comprised of 18 questions about specific aspects of an individual's work and two overall staff satisfaction questions.ResultsWe found support for content validity, as data from the 18 responses factored into three factors, which we characterized as 1) relationship with management and supervisors, 2) job content, and 3) relationships with coworkers. Summary scores for two factors (relationship with management and supervisors and job content) were significantly associated (P-value, <0.001) with the two overall satisfaction items. Cronbach's alpha coefficients showed good to excellent internal consistency (Cronbach alpha coefficients >0.70) for the items in the three summary scores.ConclusionsThe introduction of consistent and reliable measures of staff satisfaction is crucial to understand and improve employee retention rates, which threaten the successful achievement of the Millennium Development Goals in low-income countries. The use of the SEHC survey in Ethiopian healthcare facilities has ample leadership support, which is essential for addressing problems that reduce staff satisfaction and exacerbate excessive workforce shortages.

Commentary: Scaling up HIV treatment in resource-limited countries: The challenge of staff shortages

Scaling up antiretroviral therapy (ART) in resource-limited countries is a major challenge for health professionals and program managers due to the large number of patients and the severe shortage of health-care workers. The estimated number of patients in those settings requiring ART in 2009 was 14.6 million, of whom 64 per cent were not yet treated. The World Health Organization estimates that there is an overall deficit of more than 4 million physicians, nurses, midwives, and support workers for achieving the essential health interventions and the Millennium Development Goals (including the scaling up of HIV care). Strengthening the health systems through education, job-specific training, recruitment, and retention of health-care workers is imperative. In the meantime, task shifting is a key element of the response to the staff shortages, but further innovative models of care delivery are needed.

Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial

BackgroundIn low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions). This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS), on staff retention and satisfaction, and quality of patient care.Methods/DesignA cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants) in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours), intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation.DiscussionThe PALM PLUS trial aims to address a key problem: strengthening middle-cadre health care workers to support the broader scale up of HIV/AIDS services and their integration into primary care. The trial will test whether the PALM PLUS intervention improves staff satisfaction and retention, as well as the quality of patient care, when compared to usual practice.Trial RegistrationCurrent controlled Trials: ISRCTN47805230

Factors Related to Retention of Postgraduate Trainees in Obstetrics–Gynecology at the Korle-Bu Teaching Hospital in Ghana

The retention of health care workers in developing countries is a key component to reducing the current health care workforce crisis. The availability of postgraduate medical training in developing countries could be an appropriate adjunctive solution. The authors investigated factors that led obstetrics-gynecology (ob/gyn) residents at a university-based academic training program at the Korle-Bu Teaching Hospital (Accra, Ghana) to stay in Ghana for training and explored why the residents expect to stay in (or leave) Ghana after training. In July 2006, the authors surveyed 20 residents and conducted semistructured interviews with a subset of 9 residents. Nineteen respondents (95%) reported they would have left Ghana if postgraduate training had not been available, 16 (80%) reported that becoming an ob/gyn specialist was important to them, 15 (75%) indicated that the program trained them to practice in Ghana, and 17 (85%) were certain they would stay in Ghana after completing the program. Both quantitative and qualitative data supported the idea that three factors contribute to the retention of ob/gyn physicians in Ghana: (1) the presence of a postgraduate training program in Ghana, (2) residents' commitment to serve the people of Ghana, and (3) residents' feelings that physicians can "make it" economically in Ghana. Postgraduate training is an important contributor to the retention of physicians in country. Partnerships between academic health centers in developed and developing countries provide opportunities to address the global health care crisis in a significant and sustainable way.

Changing roles and responses of health care workers in HIV treatment and care

A key limiting factor in the scale up and sustainability of HIV care and treatment programmes is the global shortage of trained health care workers. This paper discusses why it is important to move beyond conceptualising health care workers simply as 'inputs' in the delivery of HIV treatment and care, and to also consider their roles as partners and agents in the process of health care. It suggests a framework for thinking about their roles and responses in HIV care, considers the current evidence base, and concludes by identifying key areas for future research on health care workers' responses in HIV treatment and care in low and middle income settings.

The impact of undergraduate rural education on recently graduated physiotherapists

Recruitment and retention of health care workers has long been a problem for the rural workforce. One of the methods used to address this problem is exposure to rural practice at an undergraduate level. One such initiative is the Rural Professional Issues Program for undergraduate physiotherapists at the University of South Australia. This study assessed the impact of this program using a questionnaire issued to newly graduated physiotherapists in rural and metropolitan areas who had the opportunity to participate in the program. The results do not support the belief that prior rural experience influences the recruitment of graduates to country areas but do show that such experience assists in the making of an informed career choice. Newly graduated physiotherapists reported very similar professional roles and levels of professional support regardless of their geographical location.