Cadre Of Workforce Research Articles

Examining the absorption of post-internship medical officers into the public sector at county-level in devolved Kenya: a qualitative case study

BackgroundAfter Kenya’s decentralization and constitutional changes in 2013, 47 devolved county governments are responsible for workforce planning and recruitment including for doctors/medical officers (MO). Data from the Ministry of Health suggested that less than half of these MOs are being absorbed by the public sector between 2015 and 2018. We aimed to examine how post-internship MOs are absorbed into the public sector at the county-level, as part of a broader project focusing on Kenya’s human resources for health.MethodsWe employed a qualitative case study design informed by a simplified health labour market framework. Data included interviews with 30 MOs who finished their internship after 2018, 10 consultants who have supervised MOs, and 51 county/sub-county-level managers who are involved in MOs’ planning and recruitment. A thematic analysis approach was used to examine recruitment processes, outcomes as well as perceived demand and supply.ResultsWe found that Kenya has a large mismatch between supply and demand for MOs. An increasing number of medical schools are offering training in medicine while the demand for MOs in the county-level public sector has not been increasing at the same pace due to fiscal resource constraints and preference for other workforce cadres. The local Department of Health put in requests and participate in interviews but do not lead the recruitment process and respondents suggested that it can be subject to political interference and corruption. The imbalance of supply and demand is leading to unemployment, underemployment and migration of post-internship MOs with further impacts on MOs’ wages and contract conditions, especially in the private sector.ConclusionThe mismatched supply and demand of MO accompanied by problematic recruitment processes led to many MOs not being absorbed by the public sector and subsequent unemployment and underemployment. Although Kenya has ambitious workforce norms, it may need to take a more pragmatic approach and initiate constructive policy dialogue with stakeholders spanning the education, public and private health sectors to better align MO training, recruitment and management.

Public Health Management Cadre in India: Challenges and Road Ahead

The efforts of developing the health workforce cadres in India have been advocated for a long time. The Government of India released the booklet on implementing the Public Health Management Cadre (PHMC) as envisaged under National Health Policy 2017 was certainly a catalyst for the country. This commentary reviews the course of implementing public health cadre in India and the challenges in establishing the core principles of a Multidisciplinary health workforce. The paper suggests that the proposed cadre needs a swift implementation in the States/UTs to address the impediments to health systems in the country.

Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review

BackgroundSelf-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up.ObjectiveTo describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs.MethodRecent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach.ResultsOf the 755 retrieved documents, 34 were included in this review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018–2021). This review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes.ConclusionThis scoping review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes.RegistrationThe protocol for this review was registered in the protocols.io repository (https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1).

The Importance of Pre-employment Job Motives in Predicting Voluntary Salesforce Turnover in the Gig Economy

ABSTRACT Purpose Given the considerable visible and hidden costs associated with voluntary job turnover and the fact that independent contract workers (“gig workers”) can change jobs with ease, it is imperative for managers and scholars to understand the reasons why someone joins a company in an effort to hire workers who will stay with the company longer. Method A commercial research panel company, Dynata, was used to collect data from current and former independent contract workers. After a rigorous screening protocol, data were collected retrospectively from 495 current and 456 former direct sellers, since direct selling is one of the oldest forms and largest categories of gig work. A binary logistic regression analysis enabled prediction of voluntary job turnover based on the number of reasons for joining the company. Findings Findings from statistical analysis of the reasons for joining a company showed that the greater the number of reasons given for joining, the greater the likelihood of staying with the company. Additionally, statistically significant differences were observed between the current and former direct sellers for nine of the 12 reasons investigated. Importantly, from a predictive modeling perspective, it was possible to predict whether a direct seller would stay with the company or quit the company based on the number of reasons for joining the company. Implications The research has implications for both theory and practice. Utilizing theoretical underpinnings from organizational and behavioral management literatures, pre- and post-employment variables establish the framework for pursuing a better understanding of pre-employment motives for joining a company. Despite calls for more research on individual differences in joining a company, past research efforts may have been hindered by the failure to explore new approaches, new agendas, and new methodologies. Theoretically, the research shows that there is a need to ensure the inclusion of pre-employment motive constructs in examining the construct of voluntary job turnover. Managerially, the cost of turnover is significant, and this is particularly true for salesforce turnover. Reducing the rate of voluntary salesforce turnover even by a small percentage could (1) lead to greater effectiveness, efficiency, and profitability for companies, (2) result in less time invested in a job for which an individual is not necessarily motivated to pursue successfully long-term, and (3) ensure consistent product and service delivery for customers. Originality Little is known about gig workers, and this research project focuses on one of the original gig workforce cadres, direct selling. Additionally, this research is unique in its approach to collecting data retrospectively from current and former independent contract workers as well as in the predictive abilities offered by the data and subsequent statistical modeling.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Addressing the workforce capacity for public health surveillance through field epidemiology and laboratory training program: the need for balanced enhanced skill mix and distribution, a case study from Tanzania.

IntroductionSkill mix refers to the range of professional development and competencies, skills and experiences of staff within a particular working environment that link with specific outcome while responding to client needs. A balanced skill-mix and distribution of core human resources is important to strengthen decision-making process and rapid responses. We analysed graduates´ information of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) between 2008-2016, distribution of skill-mix and the surveillance workforce-gaps within regions.MethodsTrainees´ data of nine cohorts enrolled between 2008 and 2016 were extracted from the program database. Distribution by sex, region and cadres/profession was carried out. An indicator to determine enhanced-skill mix was established based on the presence of a clinician, nurse, laboratory scientist and environmental health officer. A complete enhanced skill-mix was considered when all four were available and have received FELTP training.ResultsThe TFELTP has trained 113 trainees (male=71.7%), originated from 17 regions of Tanzania Mainland (65.4% of all) and Zanzibar. Clinicians (34.5%) and laboratory scientists (38.1%) accounted for the most recruits, however, the former were widely spread in regions (83% vs. 56%). Environmental health officers (17.7%) were available in 39% of regions. The nursing profession, predominantly lacking (6.2%) was available in 22% of regions. Only two regions (11.7%) among 17 covered by TFELTP presented complete skill-mix, representing 7.7% of Tanzanian regions. Seven regions (41%) had an average of one trainee.ConclusionThe TFELTP is yet to reach the required skill-mix in many regions within the country. The slow fill-rate for competent and key workforce cadres might impede effective response. Strategies to increase program awareness at subnational levels is needed to improve performance of surveillance and response system in Tanzania.

ELearning for health system leadership and management capacity building: a protocol for a systematic review

IntroductionHealth leadership and management capacity are essential for health system strengthening and for attaining universal health coverage by optimising the existing human, technological and financial resources. However, in health systems,...

A global picture of pharmacy technician and other pharmacy support workforce cadres.

IntroductionUnderstanding how pharmacy technicians and other pharmacy support workforce cadres assist pharmacists in the healthcare system will facilitate developing health systems with the ability to achieve universal health coverage as it is defined in different country contexts. The aim of this paper is to provide an overview of the present global variety in the technician and other pharmacy support workforce cadres considering; their scope, roles, supervision, education and legal framework.Material and methodsA structured online survey instrument was administered globally using the Survey Monkey platform, designed to address the following topic areas: roles, responsibilities, supervision, education and legislation. The survey was circulated to International Pharmaceutical Federation (FIP) member organisations and a variety of global list serves where pharmaceutical services are discussed.Results193 entries from 67 countries and territories were included in the final analysis revealing a vast global variety with respect to the pharmacy support workforce.Roles and competencyFrom no pharmacy technicians or other pharmacy support workforce cadres in Japan, through a variety of cadre interactions with pharmacists, to the autonomous practice of pharmacy support workforce cadres in Malawi.ResponsibilitiesFrom strictly supervised practice with a focus on supply, through autonomous practice for a variety of responsibilities, to independent practice.SupervisionFrom complete supervision for all tasks, through geographical varied supervision, to independent practice.EducationFrom on the job training, through certificate level vocational courses, to 3–4 year diploma programs.Legislation, regulation and liabilityFrom well-regulated and registered, through part regulation with weak implementation, to completely non-regulated contexts.ConclusionThis paper documents wide differences in supervision requirements, education systems and supportive legislation for pharmacy support workforce cadres globally. A more detailed understanding of specific country practice settings is required if the use of pharmacy support workforce cadres is to be optimized.

Documenting the evolution of the relationship between the pharmacy support workforce and pharmacists to support patient care.

Since 2009 there has been a focus on the relationship between pharmacy technicians, pharmacy support workforce cadres and pharmacists in the literature. 2009–2011 saw a framework of role evolution develop, with publications from 2012 to 2015 documenting further maturity in the development of practice models for improved patient care and optimal use of personnel. The dominant narrative in the published academic literature has been made by certain high- income countries (mainly Canada, Denmark, United Kingdom and the United States of America). In these countries there are significant numbers of pharmacists available and there has been an increasing interest to utilize pharmacy support workforce cadres to allow the extension of clinical roles of pharmacists in these contexts. This is not a systematic presentation of all the literature available but rather a commentary overview supported by key papers. Key points from this literature include:•The initial interest in this area resulted from a growing desire to increase the visibility of the pharmacist in line with the evolution of pharmacy practice, investigating how to move the pharmacist away from administrative roles and more towards clinical care. In this context the optimal use of other pharmacy cadres has gained momentum with numerous examples provided where pharmacists have been able to extend their clinical role with greater use of pharmacy technicians or other pharmacy support workforce cadres.•As an expanded role for a variety of pharmacy support workforce cadres has developed, issues around education, regulation and registration have been discussed. As has the importance of clearly defining the role of both the pharmacist and other pharmacy cadres in specific practice settings. Where these partnerships have been developed successfully there has been detailed attention to change management and stakeholder engagement, with improved patient care as the focus. Significant guidance has been provided to aid implementation.•In more recent years, pharmacy support workforce roles have expanded in some country practice settings, moving from administration and supply functions to independent checking of prescriptions by cadres and more recently to the management of patient adherence programs (e.g. United Kingdom, USA).•With a continued focus on freeing up the pharmacist for expanding clinical roles, the most recent literature (USA), explores the need to further develop the leadership skills of the pharmacy support workforce.(To allow the reader to clearly understand the country of origin of the themes presented, care has been taken to note the country of origin of the papers used in this commentary).

“Health supply chain personnel: an integral part of the health workforce.”

“Health supply chain personnel: an integral part of the health workforce.”

Efficiencies in AIDS Programming

Finding “efficiencies” in global HIV programs is the buzzword of the hour. This term has peppered speeches of everyone from Global AIDS Ambassador Eric Goosby to President Clinton and Bill Gates. Even UNAIDS is utilizing new frameworks for costing HIV interventions focusing on strategic investments instead of needs-based costing. “Efficiency” here is generally taken to mean “do more with less” — save lives with fewer resources and win the war against HIV without funding increases.Although there are efficiencies to be gained, additional up-front investments are necessary to turn the tide against HIV and save future costs. It is also important to highlight what efficiency talk avoids: the other 3 “E's”: equity, effectiveness, and empowerment. This Commentary will critically examine efficiency rhetoric and discuss achievable efficiencies in treatment and healthcare delivery that also meet equity, effectiveness, and empowerment goals.

Public health manpower: An alternative model

The Bhore committee observed that "if nation's health is to be built, the health program should be developed on the foundation of preventive health work and that such activities should proceed side by side with the treatment of patients." The committee defined two categories of workforce: one for the personal care and the other for the public health namely, public health nurses and sanitary inspectors for public health and nurse, midwife, and pharmacist for personal care. Recommendations of successive health committees lead to amalgamation of personal care services and public health services. Single focus programs and amalgamation of different cadre of Grassroots staff lead to dilution of public health services and more focused on different program-based personal care services. To carry out public health services, we need a sufficiently knowledgeable, well-skilled and competent mid-level supervisory public health workforce who can support and strengthen the performance of the existing multipurpose workers. Increased understanding of the influence of different determinants on health and well-being and also scientific progress to combat the environmental and biological effects on health has widened the gap between the actual need of human resources and expanding public health services needs. Keeping in view of the above and meet the challenges, a 3-year course of Bachelor in Public Health is conceived by the Indian Academy of Public Health. Professional responsibilities expected from this new cadre of workforce are also discussed in this article.