Retention Of Human Resources For Health Research Articles

Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries

BackgroundGovernments use return-of-service (RoS) schemes to train, employ and retain health professionals in the public sector. We determined the effectiveness of RoS schemes in four Southern African countries.MethodsThis retrospective cohort...

Exploratory Study on Municipalization of Health in Angola – Characterization of Human Resources for Health staffing and Health Units’ managers’ profile in Healthcare services and Training institutions of Cabinda Province

In Angola, the scarcity of human resources for health (HRH) is well known. Lately, there has been a focus on education and professional training structures, as well as the necessary profile of health units’ managers. The general objective of this study was to describe the perceptions of HRH Managers of Primary Health units of Cabinda Province about HRH training and retention. A cross-sectional observational study was performed, with semi-structured interviews supported by a survey, followed by a focus group, addressed at a convenience sample of HRH and Health Units managers in the province of Cabinda. 10 health units participated, where 13 managers were interviewed. As for the HRH profile, there is a majority of nurses, with a ratio of nurses to physicians of 8.6:1. As for the profile of managers, only three are postgraduate technicians in management. Training schools’ output in the previous year was 746 senior and middle technicians. Managers cited two main areas of improvement as essential to address the HRH imbalances in Cabinda: "Leadership empowerment" and "Improving information system efficiency". Opportunities were identified to improve the training of Health students, retention of HRH and managers of Health and training units in Cabinda. The definition of policies for HRH in Cabinda should focus on improving health teaching and management conditions with a special focus on empowerment of leaderships, and reinforcing the use of management tools and information systems. Desirably, implementing Management, Control and Quality Assurance Systems. Keywords: Health Workforce; Quality of Health Care; Health Management; Angola

Retention of medical doctors and nurses in rural areas of Odisha state, India – a policy analysis

Purpose Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The purpose of this paper is to assess the relevant policies and provisions with respect to health care professionals, aiming to develop feasible retention strategies in rural areas of Odisha state of India. Design/methodology/approach The study employed documentary review and key informant interviews with policy elites (health planners, policy maker, researchers, etc.). The document review included published and unpublished reports, policy notifications and articles on human resources for health (HRH) in Odisha and similar settings. Throughout the study, the authors adapted World Health Organization’s framework to study policies relevant to HRH retention in rural areas. The adapted framework comprised of the four policy domains, education, regulation, financial incentives, professional and personal support, and 16 recommendations. Findings In Odisha, the district quota system for admission is not practiced; however, students from special tribal and caste (Scheduled Tribe and Scheduled Caste) communities, Socially and Educationally Backward Classes of citizens, and Persons with Disabilities have some allocated quota to study medicine and nursing. Medical education has a provision of community placement in rural hospitals. In government jobs, the newly recruited medical doctors serve a minimum of three years in rural areas. Doctors are given with location-based incentives to work in remote and difficult areas. The government has career development, deployment, and promotion avenues for doctors and nurses; however, these provisions are not implemented effectively. Originality/value The government could address the rural retention problems, as illustrated in the study and put in place the most effective policies and provisions toward recruitment, deployment and attraction of HRH in remote and rural areas. At the same time, implementation HRH strategies and activities must be rigorously monitored and evaluated effectively.

The current situation of human resources for health in the province of Cabinda in Angola: is it a limitation to provide universal access to healthcare?

BackgroundAngola is among sub-Saharan African countries dealing with a crisis of Human Resources for Health (HRH). The province of Cabinda, besides the efforts, still suffers from both HRH shortage and a badly distributed health workforce. In Cabinda, one can find urban concentration and rural shortages of healthcare professionals, many rural areas’ healthcare facilities often secured only by basic or medium level HRH; and difficulties in developing HRH retention strategies in rural areas where most services are covered by foreign HRH. This study aims at analysing the situation of HRH in the province of Cabinda. It considers organizational issues, policies and practices resulting from the HRH strategy followed in the recent years, moreover the creation of a medical school. The context that affects the distribution of the health workforce is analysed to contribute to the development of evidence-based policies that promote a better HRH allocation in the poorest and distant villages in the province.MethodsA mixed-methods study was developed, combining a quantitative and qualitative approach to analyse HRH situation in the province of Cabinda. Data was collected from key informants, selected by intentional sampling from public and private health organizations, to respond to a questionnaire and a semi-structured interview. Quantitative and qualitative data was analysed with descriptive and inferential statistics and content analysis respectively. The study was complemented by a comprehensive desk review.ResultsResults show a clear change in HRH data from 2011 to 2015 with significant fluctuations due to variations in retirement, migration and lack of regular public HRH recruitment tenders. HRH density is apparently better in rural when compared with urban areas. However, one should bear in mind that often HRH allocated to rural areas do not stay there, which leads to real geographical imbalances. Factors like lack of proper incentives for HRH retention and social support goes against significant HRH management efforts contributing to this result. Whereas HRH are financed by the State General Budget, the majority of health facilities are still dependent on the Provincial Health Secretariat budget.ConclusionThe study provides a broader view of the current HRH situation in Cabinda Province. Geographical imbalances and other issues with impact in delivering universal access to healthcare are highlighted.

Human resources for health in Peru: recent trends (2007\u20132013) in the labour market for physicians, nurses and midwives

BackgroundMost analyses of gaps in human resources for health (HRH) do not consider training and the transition of graduates into the labour market. This study aims to explore the labour market for Peru’s recent medical, nursing, and midwifery graduates as well as their transition into employment in the Ministry of Health’s (MOH) system.MethodsData from four different datasets, covering 2007–2013, was used to characterize the patterns of recently trained physicians, nurses, midwives, and postgraduate-trained physicians that enter employment in the MOH system, and scenario analyses were used to describe how this rate of entry needs to adapt in order to fill current HRH shortages.ResultsHRH graduates have been increasing from 2007 to 2011, but the proportions that enter employment in the MOH system 2 years later range from 8 to 45% and less than 10% of newly trained medical specialists. Scenario analyses indicate that the gap for physicians and nurses will be met in 2027 and 2024, respectively, while midwives in 2017. However, if the number of HRH graduates entering the MOH system doubles, these gaps could be filled as early as 2020 for physicians and 2019 for nurses. In this latter scenario, the MOH system would still only utilize 56% of newly qualified physicians, 74% of nurses, and 66% of midwives available in the labour market.ConclusionAt 2013 training rates, Peru has the number of physicians, nurses, and midwives it needs to address HRH shortages and meet estimated HRH gaps in the national MOH system during the next decade. However, a significant number of newly qualified health professionals do not work for the MOH system within 2 years of graduation. These analyses highlight the importance of building adequate incentive structures to improve the entry and retention of HRH into the public sector.

Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach.

This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

Health professionals in Kenya: strategies to expand reach and reduce brain drain of psychiatric nurses and psychiatrists.

This paper highlights the extent of the brain drain in relation to human resources for health (HRH) that is currently challenging Kenya, and suggests strategies that have the potential to change current working environments and improve HRH retention rates. Governments in partnership with health professional bodies and regulators could improve the working conditions for psychiatrists and mental health nurses: by promoting career choices in mental health; by providing accessible professional development opportunities; and by easing workload pressures by expanding service reach through thoughtfully planned and delivered task-shifting to primary care. While these strategies have the potential to make a significant difference, the evidence suggests a brain drain will continue as long as working conditions remain sub-optimal and global HRH shortages persist.

Developing effective policy strategies to retain health workers in rural Bangladesh: a policy analysis.

IntroductionRetention of human resources for health (HRH), particularly physicians and nurses in rural and remote areas, is a major problem in Bangladesh. We reviewed relevant policies and provisions in relation to HRH aiming to develop appropriate rural retention strategies in Bangladesh.MethodsWe conducted a document review, thorough search and review of relevant literature published from 1971 through May 2013, key informant interviews with policy elites (health policy makers, managers, researchers, etc.), and a roundtable discussion with key stakeholders and policy makers. We used the World Health Organization’s (WHO’s) guidelines as an analytical matrix to examine the rural retention policies under 4 domains, i) educational, ii) regulatory, iii) financial, and iv) professional and personal development, and 16 sub-domains.ResultsOver the past four decades, Bangladesh has developed and implemented a number of health-related policies and provisions concerning retention of HRH. The district quota system in admissions is in practice to improve geographical representation of the students. Students of special background including children of freedom fighters and tribal population have allocated quotas. In private medical and nursing schools, at least 5% of seats are allocated for scholarships. Medical education has a provision for clinical rotation in rural health facilities. Further, in the public sector, every newly recruited medical doctor must serve at least 2 years at the upazila level. To encourage serving in hard-to-reach areas, particularly in three Hill Tract districts of Chittagong division, the government provides an additional 33% of the basic salary, but not exceeding US$ 38 per month. This amount is not attractive enough, and such provision is absent for those working in other rural areas. Although the government has career development and promotion plans for doctors and nurses, these plans are often not clearly specified and not implemented effectively.ConclusionThe government is committed to address the rural retention problem as shown through the formulation and implementation of related policies and strategies. However, Bangladesh needs more effective policies and provisions designed specifically for attraction, deployment, and retention of HRH in rural areas, and the execution of these policies and provisions must be monitored and evaluated effectively.

English

Available literature shows that retention of human resources for health is underpinned by a number of factors in Motivation-Hygiene Theory key which include human resource development, financial incentives, and personal and professional support mechanisms. These are all linked to motivation and productivity. There is convergence of opinion that staff retentions required packaging different bundle of incentives depending on the staff cadres and location in the health service delivery system. This paper which was premised on literature review analyzes the main issues that impinge on retention of human resources for health in the region and Uganda in particular. It further delves into the options that the ministry of health and government of Uganda can consider to minimize staff migration from rural areas to greener pastures. The discourse in this paper ends with a conclusion against the backdrop of how these challenges can be addressed and the emphasis for pragmatic approaches as opposed to theoretical perception in addressing the challenges in human resources for health retention.   Key words: Human resources for health, human resource retention.

Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study

The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.

Uses of population census data for monitoring geographical imbalance in the health workforce: snapshots from three developing countries.

BackgroundImbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options.MethodsPopulation-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group.ResultsStrong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations.ConclusionsThe problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation.