Rural Health Workers Research Articles

Attraction and retention of qualified health workers to rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria

INTRTODUCTION: A shortage of health workers is a major problem for Nigeria, especially in rural areas where more than 70% of the population live. At the primary care level, trained community health officers provide services normally reserved for doctors or medical specialists. The community health officers must therefore be supported and motivated to provide effective quality healthcare services. This study aimed to determine factors that will attract and retain rural and urban health workers to rural Nigerian communities, and to examine differences between the two groups. A cross-sectional survey measured health workers' work experience, satisfaction with, and reasons for undertaking their current work; as well as reasons for leaving a work location. Data were also gathered on factors that attract health workers to rural settings and also retain them. RESULTS; Rural health workers were generally more likely to work in rural settings (62.5%) than their urban counterparts (16.5%). Major rural motivators for both groups included: assurances of better working conditions; effective and efficient support systems; opportunities for career development; financial incentives; better living conditions and family support systems. The main de-motivator was poor job satisfaction resulting from inadequate infrastructure. Rural health workers were particularly dissatisfied with career advancement opportunities. More urban than rural health workers expressed a wish to leave their current job due to poor job satisfaction resulting from poor working and living conditions and the lack of career advancement opportunities. Motivational factors for attraction to and retention in rural employment were similar for both groups although there were subtle differences. Addressing rural health manpower shortages will require the development of a comprehensive, evidence-based rural health manpower improvement strategy that incorporates a coordinated intersectoral approach, involving partnership with a range of stakeholders in rural health development.

Accidental exposure to body fluids among rural health workers in North-Western Nigerian State of Sokoto

Primary health facilities in Nigeria provide health care services to the rural majority of Nigeria population and often provide such services within inclement settings that pose high risk to their staff. The objective of this survey is to determine the exposure experiences of 420 primary care providers from the various cadres selected through a multistage random sampling process in primary health care (PHC) facilities in the headquarters of the 23 Local Government Areas in Sokoto State using questionnaire structured to elicit related information. Exposure prevalence among study group was found to be 58.3% with needle prick contributing the highest proportion of exposure (33.08%) and with the highest rate of 19.76% among respondents. Generally, exposure was highest among doctors (2.28 exposures per doctor), followed by the nursing staff and senior community health extension workers. The outpatient department was found to be the point of service with the highest risk of exposure. Training on safety in health care setting followed by on-site mentoring and safety practice monitoring mechanism with periodic supportive supervision are recommended to enhance adherence to safety practice. The establishment of safety policy and incorporation of safety education in educational institutions are long term preventive measures.Keywords: Primary health care facilities, PHC workers, accidental exposure, safety policiesJournal of Pharmaceutical and Allied Sciences, Vol. 7 No. 3 (2010)

Peer group intervention reduces personal HIV risk for Malawian health workers.

To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi. Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection. The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences. Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors. The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention. Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.

Analysis of the influence factors for promoting appropriate health technologies at primary level

Objectives To analyze the influence factors for promoting appropriate health technologies to rural health workers in Zhejiang province. Methods 1957 health workers from county and township levels were surveyed by questionnaires, regarding their use of appropriate technologies. Results The influence factors for rural health workers to employ such technologies include their medical competency, training approach and technical categories. Those medical workers of higher education are Key words: Rural health; Appropriate health technology; Promotion

Rural Research Capacity Building Program: capacity building outcomes

The Rural Research Capacity Building Program commenced in 2006 with the aim of developing research skills in rural health workers. The program was based on the capacity building principles of workforce development, organisational development, resource allocation, partnership and leadership. Qualitative methods were used to assess capacity building outcomes. A sample of candidates from the 2006 and 2007 cohorts were selected for interview using stratified random sampling and supplemental purposive sampling. Twenty-five individual semi-structured interviews were conducted with candidates, their managers and mentors. Interviews were thematically analysed. The program components of teaching, mentoring and networking led to the development of research skills in candidates undertaking the program. This workforce development resulted in workplace change, particularly where the candidate's project was 'close to practice' and they had management support. The leadership shown and partnerships developed by the program managers enhanced the workforce development and organisational change outcomes. Resources, such as backfill and incidentals, were useful for candidates, but practicalities, such as availability of replacement staff, limited effectiveness. This study showed the value of using a capacity building framework and demonstrated that undertaking research on a topic close to practice positioned candidates to drive change within their organisation.

WHO Recommendations to improve retention of rural and remote health workers - important for all countries

The World Health Organization 2010 Global Policy Recommendations: ‘Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention’ is a notable milestone in rural health policy. This report, with preface by WHO Director General Dr. Margaret Chan, recognizes at the very highest level that the half of the world’s population that lives in rural and remote areas faces enormous difficulties in accessing appropriate and equitable health care.

The prevention and control of road traffic injuries in rural communities: input from community health workers in rural Twiserkan, Iran

Preventing road traffic injuries (RTIs) in rural areas poses particular challenges. This study highlights potential countermeasures and barriers as identified by health workers responsible for local community health and safety...

Context counts: training health workers in and for rural and remote areas

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i)a rural background; (ii)positive clinical and educational experiences in rural settings as part of undergraduate medical education; and (iii)targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. We give examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. We demonstrate how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.

Oxidative Stress in Rat Testis and Epididymis Under Intermittent Hypobaric Hypoxia: Protective Role of Ascorbate Supplementation

Hypobaric hypoxia (HH), an environmental condition of high altitude encountered by mountaineers, miners, and observatory, rural health, border patrol, and rural education workers, jeopardizes normal physiologic functions in humans. The present study was conducted to evaluate the effects of intermittent HH (IHH; equivalent to 4600 m above mean sea level) on oxidative stress and the protective role of dietary ascorbic acid on rat testis and epididymis. Ten-week-old male Wistar rats were assigned to 1 of 6 groups: 1) normobaric (Nx), 2) Nx + physiologic solution (Nx + PS), 3) Nx + ascorbic acid (Nx + AA), 4) IHH, 5) IHH + PS, or 6) IHH + AA. Animals subjected to IHH were exposed for 96 hours followed by normobaric conditions for 96 hours for a total of 32 days. The control groups (2 and 5) were injected with doses of PS, and the treated groups (3 and 6) were injected with doses of AA (10 mg x kg(-1) body weight) at an interval of 96 hours. Rats were sacrificed on day 32 after initiation of the protocol. The testis and epididymis were collected to determine the activity and expression of glutathione reductase and the levels of lipid peroxide formation. An epididymal sperm count was also performed in each animal. The results of this study revealed that IHH induced lipid peroxidation, a reduction in glutathione reductase activity in testis and epididymis, and a significant decrease in epididymal sperm count. Treatment with AA prevented these changes. In conclusion, AA was capable of decreasing oxidative stress in testis and epididymis under IHH. This protection by AA of the IHH-induced lipid peroxidation can be explained in part by the preservation of glutathione reductase activity in these organs.

Improving universal precautions and client teaching for rural health workers: a peer-group intervention

Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.

Factors associated with motivation of health workers in Moshi rural district 2005

Objectives; To assess the staffing gap by cadre in the health facilities, determining the proportion of health workers motivated and assessing the factors associated with their motivation Study design; Descriptive cross sectional study Settings; Moshi Rural district Results; It was found that the staffing gap were 42.3%, 38.2% and 46.2% in the hospitals, health centres and dispensaries respectively. Comparison was made between the public, private and religious health facilities. It was found that 21.2%, 62.5% and 95.8% of health workers from public, private and religious health facilities respectively reported of presence of enough working equipment in their health facilities. In addition 36.1%, 54.3% and 81.6% of health workers from public, private and religious health facilities were being promoted when deserving. From the information above it is evident that health workers from religious health facilities have the highest level of motivation, those from the private health facilities are moderately motivated while those from public health facilities are poorly motivated. Conclusion and Recommendations Motivation of health workers and availability of working equipments in Moshi rural is highest in religious health facilities, moderate in private health facilities and lowest in public health facilities . Efforts should be made to find affordable means of motivating the rural health workers so as to improve their performance and ultimately the health status of Tanzanians.

Rural male health workers in Western Jamaica: Knowledge, attitudes and practices toward prostate cancer screening.

Background:Statistics have shown that since 1988, a significant percentage of males are unwilling to seek medical care. The question is if they had the knowledge, worked in the health system and were educated, would this be any different?Aim:The current study aims to fill this void in the literature by examining the perception of rural male health workers (from the Western Region) about prostate examination, and why they are reluctant to inquire about the probability of having, or the likelihood of not having prostate cancer.Materials and Methods:The study utilized primary cross-sectional data that was collected during February and March 2008 from 170 males (ages 29 years and older), health-care workers who were employed in particular rural health institutions in Jamaica (i.e. Western Regional Health Authority). SPSS was used to analyze the data.Results:When the respondents were asked “Have you ever heard about the screening procedure for prostate?” 71.2% indicated yes, but only 27.1% had got their prostate checked by a health practitioner. When respondents were asked to state what influenced their choice of not doing a digital rectal examination, 20.6% indicated comfort level; 9.4% stated the gender of the health practitioner, 5.3% mentioned fear and others did not respond. Of those who had the examination 2 years ago, 96.5% did not state the choice of method.Conclusion:The current study is limited in terms of its generalizability to rural males or rural males in Western Jamaica, but it does provide an insight into the difficulty of men in breaking away from culture.

Outcome evaluation of community health promotion intervention within a donor funded project climate in Papua New Guinea

The Australian Agency for International Development (AusAID) funded Women and Children's Health Project sought to improve the health of women and children throughout Papua New Guinea between 1998 and 2004. The project utilised education, community development and health promotion interventions aimed to increase community support for the health of women and children. An outcome evaluation in 2006 investigated the long-term impact of the project using a multi-methods approach and covering 10 selectively sampled provinces, 19 districts and 93 communities. Qualitative data were collected from 175 interviews (national to village level) and 77 community discussions. Quantitative data from national, provincial and district levels were examined to attempt to validate findings. The evaluation found new-health-knowledge initiated changes to lifestyle practices and improved physical health and social and economic well-being in villages where volunteers and staff had been trained. Factors influencing success were a health-motivated person acting as a catalyst for change, empowered leadership through new community governance structures, effective visual tools and village health volunteers linking community and rural health workers. Failure was attributed to poor understanding of community development, limited information sharing, a 'top down' approach to community development and weak community leadership. The project's community health interventions improved the interaction between the community and health system, and influenced improved use of maternal and child health services. Evaluation suggests sustainable improvements in health can be achieved through community led and maintained activity.

Occupational Stress among Rural Health Workers in Mashhad District, Northeast Iran.

This study explores the level of Occupational Stress and main sources of occupational and personal stress among Rural Health Workers (RHW) of the health network of Mashhad district. The first part of the Occupational Stress Inventory (OSI) (called the Occupational Roles Questionnaire (ORQ)) was used to measure the Rural Health Workers occupational stress (N=172). A number of extra questions were also added to measure their specific sources of stress. The questionnaires were distributed among RHW in a meeting held in the Health District Center in the city of Mashhad. The mean score of stress for the investigated subjects on OSI and all of its dimensions was within the normal range. On some dimensions such as role overload and role ambiguity however, about 40% of the Health Workers had middle to sever stress. Type of employment, distance of the village to the nearest city, number and combination of Health Workers in rural health clinics showed to have a significant impact on the RHW stress as well. As the RHW Job is concerned, role overload and role ambiguity are the main sources of stress, which may have an adverse effect on the quality of their services. Type of employment, distance of the village to the nearest city, number and combination of Health Workers at the health center also put pressure on RHW that need to be taken under consideration in planning for improving RHW quality of work Life.

Effect of the Rural Rescue System on Reducing the Mortality Rate of Landmine Victims: A Prospective Study in Ilam Province, Iran

In several Iranian provinces, there are large numbers of landmines that threaten the lives of many civilians. Ilam is one of the most polluted areas with 1,086 injuries from landmines between 1989 to 1999, with an overall mortality rate of 36.4%. A remarkable number of deaths occurred before the injured were conveyed to the hospital. In this survey, the effects of on trauma outcome of the use of prehospital trauma life support provided by trained paramedics and rural health workers as first responders were examined. In an interventional, prospective study, 4,834 persons (general physicians, nurses, rural health workers, and emergency technicians, high- and low-educated people, layperson villagers, and nomads) were trained in one level of advanced (for general physicians and nurses) and four levels of basic life support courses during two years (2000-2001). Following the training, the data from 288 landmine victims who were referred to the main hospital in Ilam (trauma center) were registered prospectively (2001-2005). The effects of prehospital trauma life support training were assessed by using the Injury Severity Scale (ISS) score and prehospital physiologic severity (PSS) score. There were 288 injuries from landmines in the Mehran region between 2002 and 2005. The mean ISS score was 20.3 with a median of 13. Forty percent were severely injured with an ISS score >15. Of the injured who received prehospital care at the Mehran Emergency Center, the mean value of the PSS scores was 6.40, which improved to 7.43 in the hospital (p = 0.01; 95% CI for difference -0.72 to -0.45), in comparison with 5.97 in the injured who were conveyed to Ilam Hospital directly (mean of ISS was approximately equal in both groups). The total mortality rate was 27% between 2001 and 2005. Prehospital educations and training help improve PSS scores and reduce the death toll of landmine accidents in the remote areas.

Improving trauma care in rural Iran by training existing treatment chains

Iran has a major land mine injury problem in its border areas. Mine injuries have a high mortality and morbidity, and the injuries generally occur in remote areas. Iran has a well developed system of rural health workers and clinics, covering most border areas. These have mainly had prevention, immunization and curative treatment for medical conditions as their focus. We hypothesized that adding a short training in trauma care to the already existing system of rural health workers would improve the care for trauma victims. The objective of the present study was to describe the training and evaluate its effect using mortality and change in physiological function of victims after prehospital treatment as outcome measures. The training was arranged in villages and clinics in the border area. Physicians, nurses and emergency technicians from a local emergency clinic, the Mehran Clinic, were given a two-day course with monthly refreshers; while rural healthcare workers and lay people were given shorter training courses in their villages. All patients treated were registered and patients were followed up. Physiological changes after treatment was assessed with a modified three-component 'revised trauma score'. Patients entered the system directly through the local emergency clinic (some with prehospital treatment before arriving at the local emergency clinic). Some were transferred to the referral university hospital, and there they could be compared with a convenience comparison group of patients transported directly to the referral university hospital without treatment during transportation. During the three-year study period 109 physicians, nurses and 76 emergency technicians (behwarses) were trained, while 4649 lay persons had first-responder training. A total of 366 patients were treated by the system. Prehospital support was given to 238 victims before admission to the primary clinic. We found no difference in mortality between patients with and without first-responder treatment. In all, 226 of these patients were transferred to the university hospital. During the period a group of 245 other victims of injury was admitted directly to the university hospital. The physiological status of the transferred victims improved significantly by treatment from the emergency clinic to the university hospital with a mean improvement in the Physiological Severity Score (PSS) of 1.11 (95% CI 0.98-1.24). The PSS of the intervention group was significantly higher than the status of the group brought directly to the university hospital without treatment during transportation (difference 0.73, 95% CI difference 0.55-.91, p < 0.0005). We found that the existing rural healthcare system in Iran's western border area could be upgraded to care for mine victims and victims of other injuries by using available resources. This system improved the physiological status of the victims during transportation, and was able to handle penetrating as well as blunt injury. The use of existing health structures should be considered when planning improvements.

Time will tell

Time will tell

China's village doctors take great strides

China's barefoot doctors were a major inspiration to the primary health care movement leading up to the conference in Alma-Ata, in the former Soviet Republic of Kazakhstan in 1978. These health workers lived in the community they served, focused on prevention rather than cures while combining western and traditional medicines to educate people and provide basic treatment. Dr Philip Lee, then a professor of social medicine at the University of California in San Francisco, wrote glowingly in the Western Journal of Medicine about China's primary health care system after visiting the country in 1973 as part of a United States of America (USA) medical delegation. He said prior to the founding of the People's Republic of China in 1949, epidemics, infectious disease and poor sanitation were widespread. picture today is dramatically different ... there has been a pronounced decline in the death rate, particularly infant mortality. Major epidemic diseases have been controlled ... nutritional status has been improved [and] massive campaigns of health education and environmental sanitation have been carried out. Large numbers of health workers have been trained, and a system has been developed that provides some health service for the great majority of the people. [ILLUSTRATION OMITTED] Dr Zhang Zhaoyang, the deputy director general of China's Department of Rural Health Management, says the barefoot doctor scheme had a profound influence on the Declaration of Alma-Ata. research in the 1970s found problems relating to the health-cost burden and unequal distribution of health resources. To try to solve the inequality, it did research in nine countries, including four cooperation centres in China. China's experience inspired WHO to launch the health for all by 2000 programme. Zhang says the barefoot doctor scheme, initiated by central government but largely administered locally, had its origins in the 1950s. name barefoot doctor became popular in late 1960s after an editorial in the People's Daily by Chairman Mao in 1968, he says. name 'barefoot doctor' originated in Shanghai because farmers in the south were often barefoot working in the paddy field. But China's village doctors had been there long before. In 1951, the central government declared basic health care should be provided by health workers and epidemic prevention staff in villages. In 1957, there were already more than 200 000 village doctors across the nation, enabling farmers to receive basic health care at home and work every day. The barefoot doctor scheme was simply the reform of medical education in the 1960s. In areas lacking medicine or doctors, village doctors could go through short-term training--three months, six months, a year--before returning to their villages to farm and practise medicine. Zhang says the scheme has evolved over the decades, though the term barefoot doctor is no longer used. scheme has never stopped. In the early 1980s, the State Council (the Central People's Government, the highest executive organ in China) directed that barefoot doctors, after passing an examination, could qualify as a 'village doctor'. Those who failed would be health workers and practise under the guidance of the village doctors. The village doctors and rural health workers still undertake the most primary health work--prevention, education, maternal and child health care, collecting disease information. The quality of [care provided by] rural doctors keeps increasing in line with social and economic development. Dr Liu Xingzhu, the programme director at the Fogarty International Centre at the National Institutes of Health in the USA, was a barefoot doctor from 1975-1977. Aged 19, his senior secondary school classes were interrupted during the Cultural Revolution drive to equip people with practical skills. county's health bureau organized medical training in my school and provided free accommodation and food. …

Tagore's Ideas of Social Action and the Sriniketan Experiment of Rural Reconstruction, 1922--41

Rabindranath Tagore's Institute for Rural Reconstruction based at Sriniketan was pioneering in its time and the culmination of his long period of endeavour to redeem the neglected Indian village and bridge the gap between the city and the village. He had two objectives: to educate the villagers in self-reliance and to bring back to the villages ‘life in its completeness’ with ‘music and readings from the epics,’ as in the ‘past.’ He recruited a stellar team of agronomists, rural health workers, and village-level teachers – notably Leonard Elmhirst from England and his own son, Rathindranath Tagore – who initiated many of the more successful elements basic to rural development work.

Tagore's Ideas of Social Action and the Sriniketan Experiment of Rural Reconstruction, 1922–41

Rabindranath Tagore's Institute for Rural Reconstruction based at Sriniketan was pioneering in its time and the culmination of his long period of endeavour to redeem the neglected Indian village and bridge the gap between the city and the village. He had two objectives: to educate the villagers in self-reliance and to bring back to the villages 'life in its completeness' with 'music and readings from the epics,' as in the 'past.' He recruited a stellar team of agronomists, rural health workers, and village-level teachers – notably Leonard Elmhirst from England and his own son, Rathindranath Tagore – who initiated many of the more successful elements basic to rural development work.