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International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.
Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study.
OBJECTIVE: To explore inequalities in human resources for health (HRH) in relation to all cause and cause specific mortality globally in 1990-2019. DESIGN: Observational study. SETTING: 172 countries and territories. DATA SOURCES: Databases of the Global Burden of Disease Study 2019, United Nations Statistics, and Our World in Data. MAIN OUTCOME MEASURES: The main outcome was age standardized all cause mortality per 100 000 population in relation to HRH density per 10 000 population, and secondary outcome was age standardized cause specific mortality. The Lorenz curve and the concentration index (CCI) were used to assess trends and inequalities in HRH. RESULTS: Globally, the total HRH density per 10 000 population increased, from 56.0 in 1990 to 142.5 in 2019, whereas age standardized all cause mortality per 100 000 population decreased, from 995.5 in 1990 to 743.8 in 2019. The Lorenz curve lay below the equality line and CCI was 0.43 (P<0.05), indicating that the health workforce was more concentrated among countries and territories ranked high on the human development index. The CCI for HRH was stable, at about 0.42-0.43 between 1990 and 2001 and continued to decline (narrowed inequality), from 0.43 in 2001 to 0.38 in 2019 (P<0.001). In the multivariable generalized estimating equation model, a negative association was found between total HRH level and all cause mortality, with the highest levels of HRH as reference (low: incidence risk ratio 1.15, 95% confidence interval 1.00 to 1.32; middle: 1.14, 1.01 to 1.29; high: 1.18, 1.08 to 1.28). A negative association between total HRH density and mortality rate was more pronounced for some types of cause specific mortality, including neglected tropical diseases and malaria, enteric infections, maternal and neonatal disorders, and diabetes and kidney diseases. The risk of death was more likely to be higher in people from countries and territories with a lower density of doctors, dentistry staff, pharmaceutical staff, aides and emergency medical workers, optometrists, psychologists, personal care workers, physiotherapists, and radiographers. CONCLUSIONS: Inequalities in HRH have been decreasing over the past 30 years globally but persist. All cause mortality and most types of cause specific mortality were relatively higher in countries and territories with a limited health workforce, especially for several specific HRH types among priority diseases. The findings highlight the importance of strengthening political commitment to develop equity oriented health workforce policies, expanding health financing, and implementing targeted measures to reduce deaths related to inadequate HRH to achieve universal health coverage by 2030.
COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries.
BACKGROUND: The COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC). METHODS: We sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness. RESULTS: Planning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability. CONCLUSION: Countries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.
Assessing the impact of COVID-19 management on the workload of human resources working in India’s National Tuberculosis Elimination Program (preprint)
Background In 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with managing COVID-19, stretching human resource (HR) capacity beyond its limits. As part of an assessment of HR involved in TB control in India, The World Bank Group and partners conducted an analysis of the impact of COVID-19 on TB human resources for health (HRH) workloads, with the objective of describing the extent to which TB-related activities could be fulfilled and hypothesizing on future HR requirements to meet those needs. Methods The study team conducted a WISN analysis according to standard WHO methodology to classify the workloads of priority cadres directly or indirectly involved in TB control activities as over-, adequately or under-worked, in 18 districts across seven states in India. Data collection was done via telephone interviews, and questions were added regarding the proportion of time dedicated to COVID-19 related tasks. We carried out quantitative analysis to describe the time allocated to COVID-19 which otherwise would have been spent on TB activities. We also conducted key informant interviews (KII) with key TB program staff about HRH planning and task-shifting from TB to COVID-19. Results Workload data were collected from 377 respondents working in or together with India’s Central TB Division (CTD). Approximately 75% of total respondents (n = 122) reported carrying out COVID-19 tasks. The average time spent on COVID-19 tasks was 4 hours / day (n = 72 respondents). Multiple cadres highly instrumental in TB screening and diagnosis, in particular community outreach (ASHA) workers and CBNAAT/TrueNAAT laboratory technicians working at peripheral, block and district levels, were overworked, and spending more than 50% of their time on COVID-19 tasks, reducing time for TB case-finding. Qualitative interviews with laboratory technicians revealed that PCR machines previously used for TB testing were repurposed for COVID-19 testing. Conclusions The devastating impact of COVID-19 on HR capacity to conduct TB case-finding in India, as in other settings, cannot be overstated. Our findings provide clear evidence that NTEP human resources did not have time or essential material resources to carry out TB tasks during the COVID pandemic without doing substantial overtime and/or compromising on TB service delivery. To minimize disruptions to routine health services such as TB amidst future emerging infectious diseases, we would do well, during periods of relative calm and stability, to strategically map out how HRH lab staff, public health resources, such as India’s Health and Wellness Centers and public health cadre, and public-private sector collaboration can most optimally absorb shocks to the health system.
[Implementation of the plan of action for human resources for health and the COVID-19 pandemic responseImplementação do plano de ação sobre recursos humanos para a saúde e a resposta à pandemia de COVID-19].
Objectives: Systematize and analyze the response actions related to human resources for health during the pandemic, reported by 20 countries of the Region of the Americas in the mid-term evaluation of the Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 (Pan American Health Organization, 2018), and assess the importance of the policies on human resources for health (HRH) and on HRH management expressed in the Plan of Action and in the Strategy on Human Resources for Universal Access to Health and Universal Health Coverage during health emergencies and in normal times. Methods: Reports on actions taken in 20 countries of the Region against COVID-19 and for HRH were selected and systematized. These were classified as immediate contingency actions, actions related to installed capacities, and emerging actions. Results: The capacity to plan and manage HRH in countries depends on their installed, functional structures and competencies. The pandemic highlighted the need to have new job profiles, improve precarious working and contractual conditions, emphasize the gender perspective, and address numerical gaps in certain areas and levels of care. Conclusions: Linking the monitoring of the Plan of Action with the COVID-19 response demonstrated the importance of HRH governance, management, and installed capacities when responding to health emergencies and in normal times. The analysis suggests a need to review existing public policies, models of care that can guide current and future needs in HRH, the profiles required, working conditions, and ways to close numerical gaps, among other issues. The pandemic enabled countries to innovate in response to demands. The Strategy and the Plan of Action remain in place to guide and strengthen the performance of human resources for health. Objetivos: Sistematizar e analisar as ações de resposta relacionadas aos recursos humanos para a saúde durante a pandemia, relatadas por 20 países da Região das Américas na avaliação intermediária do Plano de ação sobre recursos humanos para o acesso universal à saúde e a cobertura universal de saúde 2018-2023 (Organização Pan-Americana da Saúde, 2018), e avaliar a importância das políticas e da gestão de recursos humanos expressas na estratégia e no plano durante emergências de saúde e em tempos normais. Métodos: Foram selecionados e sistematizados relatórios sobre ações contra a COVID-19 e recursos humanos para a saúde de 20 países da Região. As ações foram classificadas em ações imediatas de contingência, ações relacionadas às capacidades instaladas e ações emergentes. Resultados: As capacidades de planejamento e gestão de recursos humanos para a saúde nos países dependem das estruturas e das competências instaladas e funcionais. A pandemia tornou visível a necessidade de ter novos perfis de trabalho, melhorar as precárias condições de trabalho e contratuais, tornar visível a perspectiva de gênero e solucionar lacunas numéricas em determinadas áreas e níveis de atenção. Conclusões: A vinculação das ações contra a COVID-19 com o monitoramento do plano demonstrou a importância da governança, da gestão e das capacidades instaladas relacionadas aos recursos humanos para a saúde, para responder a emergências de saúde e em tempos normais. A análise convida à revisão das políticas públicas existentes, dos modelos de atenção necessários para orientar as necessidades atuais e futuras dos recursos humanos para a saúde, os perfis exigidos, as condições de trabalho e a cobertura das lacunas numéricas existentes, entre outras questões. A pandemia permitiu inovações nos países para responder à demanda. A estratégia e o plano continuam vigentes para orientar e fortalecer o desempenho dos recursos humanos para a saúde.
Meeting of the Ad Hoc Working Group on Human Resources for Health in Small Countries in the European Region: progress, action and next steps, 27–28 January 2022 (in-person and online)
Two years into the COVID-19 pandemic, health workforces (HWF) in small countries were faced with huge demands, having to address challenges related to a relatively limited capacity in human resources for health. The need to take small-country specificities into account in planning effective HRH policy responses continues to be highly relevant. The main objectives of the Meeting of the Ad Hoc Working Group on Human Resources for Health in Small Countries of the WHO European Region were to: share information and provide a regional update on policy tools and resources for HWF challenges in a webinar forum open to various WHO networks; understand the impact of the pandemic on HRH planning and development (member-country experiences, and national HWF priorities for the next 2–3 years); discuss the Group’s action plan for 2022–2023 and agree on priorities; and hold on-line consultations with three sub-sets of small countries (island countries, continental countries and city-states). The meeting revealed the importance of collaborative working – both within the health sector and between the health and non-health sectors – to improve health systems in small countries and concluded in proposing areas in which small countries could be supported to this end.
Cocreation in Health Workforce Planning to Shape the Future of the Health Care System in the Philippines
Cocreation in health workforce planning in the Philippines led to relationship building between policy makers and researchers who jointly identified solutions to address challenges in the health care system. Key Messages The COVID-19 pandemic presented strategic opportunities to strengthen national health workforce planning to shape future health care systems that are responsive both during normal times and during crises. We describe our health workforce planning process based on a cocreation model that built a relationship between researchers and policy makers to coproduce recommendations to strengthen primary care and advance universal health coverage in the Philippines. We applied 2 approaches to project the future supply of 10 selected health professions and estimated the demand for primary care services at national and subnational levels;our analysis provided spaces for policy recommendations on issues related to health workforce quantity, skill mix, and distribution. Key Implication Lessons from our experience may guide policy makers, program managers, and researchers in low- and middle-income countries as they navigate the challenges in their health workforce through cocreation where the research addresses policy-relevant questions and the resulting policy is informed by the research evidence. Background: The Philippines passed landmark legislation in 2019 on universal health coverage, including reforms in the development of its health workforce, an essential building block of responsive health care systems. Health Workforce Planning Cocreation Process: We based our planning process on a model of cocreation defined as sharing power and decision making to solve problems collaboratively and build consensus around action. Through cocreation with policy makers, researchers, and other stakeholders, we performed projection studies on 10 selected health professions and estimated the need for primary care at national and subnational levels, which was the most extensive health workforce projection carried out by the Philippine Department of Health to date. We determined health workforce requirements based on target densities recommended by the World Health Organization and a health needs approach that considered epidemiological and sociodemographic factors. In consultation with stakeholders, we interpreted our analysis to guide recommendations to address issues related to health workforce quantity, skill mix, and distribution. These included a broad range of proposals, including task shifting, expanding scholarships and deployment, reforming health professionals' education, and pursuing a whole-of-society approach, which together informed the National Human Resources for Health Master Plan. Conclusions: Our cocreation model offers lessons for policy makers, program managers, and researchers in low- and middle-income countries who deal with health workforce challenges. Cocreation led to relationship building between policy makers and researchers who jointly performed the research and identified solutions through open communication and agile coordination. To shape future health care systems that are responsive both during normal times and during crises, cocreation would be essential for evidence-informed policy development and policy-relevant research.
Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study.
BACKGROUND: Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy. AIM: This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory. METHODS: Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg's ideas of intrinsic and extrinsic factors. FINDINGS: All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg's Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution. CONCLUSION: Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.
Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries.
BACKGROUND: Governments 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. METHODS: This retrospective cohort study used databases of RoS beneficiaries from South Africa, Botswana, Eswatini and Lesotho. We ascertained the period of funding for beneficiaries between 2000 and 2010, study programme, selection criteria, study country and if they completed their studies. Records were sought to track beneficiaries' service and fulfilment of their RoS obligations. Data were sought at the provincial level in South Africa and nationally for the other three countries. Binomial logistics regression and Kaplan-Meier survival estimates were used to determine risk factors and predictors of defaulting. RESULTS: Most beneficiary enrolment (eg, decision on why they were funded, socioeconomic status, disability status, high school results) and service data (eg, health facilities where they worked, how long they worked at each health facility, movement between health facilities) were not available. A total of 5616 beneficiaries were drawn from the four countries' databases. Of those with full data available, 21.7% (229/1056) were retained/served beyond their obligatory period and 20.2% (213/1056) were still serving. A total of 24.3% (95% CI: 21.7% to 26.9%; n=257/1056) of beneficiaries in the final subanalysis of two South African provinces fulfilled their contractual obligations. Only 32.2% (277/861) of beneficiaries undertook internship within their funding provinces. Governments needed to fund six beneficiaries to have one beneficiary complete their contractual obligation if they undertook internship outside their province. CONCLUSION: Record keeping in all countries was poor, hampering the effectiveness of RoS schemes. Of the units with full data available, the retention rate was below 25%, and internship being undertaken outside the funding province was associated with higher defaulter rates, calling for a policy overhaul.
Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study.
BACKGROUND: Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middle-income countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. METHODS: A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical officers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. RESULTS: Most of the respondents were females (62.90%), married (84.62%), with certificate level (55.74%), and nurses as qualification (36.60%) as well as attached to Health Center 3 level (61.28%). Significant individual factors associated with retention included having a certificate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staff, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. CONCLUSION: The study established that indeed several individual and social demographics, health system and career-related factors are significantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.
Introduction: Health systems in developing countries suffers from both input and productivity issues. We examined the status of three domains of human resources for health, i.e., availability and distribution, capacity and productivity, and motivation and job-satisfaction, of the health-care workforce employed in the public health system of Haryana, a North Indian state. Methodology: The primary data were collected from 377 public health facilities and 1749 healthcare providers across 21 districts. The secondary data were obtained from government reports in the public domain. Bivariate and multivariate statistical techniques were used for evaluating district performances, making inter-district comparisons and identifying determinants of motivation and job-satisfaction of the clinical cadres. Results: We found 3.6 core health-care workers (doctors, staff nurses, and auxiliary nurses-midwives) employed in the public health-care system per 10,000 population, ranging from 1.35 in Faridabad district to 6.57 in Panchkula district. Around 78% of the sanctioned positions were occupied. A number of inpatient hospitalizations per doctor/nurses per month were 17 at the community health center level and 29 at the district hospital level; however, significant differences were observed among districts. Motivation levels of community health workers (85%) were higher than clinical workforce (78%), while health system administrators had lowest motivation and job satisfaction levels. Posting at primary healthcare facility, contractual employment, and co-habitation with family at the place of posting were found to be the significant motivating factors. Conclusions: A revamp of governance strategies is required to improve health-care worker availability and equitable distribution in the public health system to address the observed geographic variations. Efforts are also needed to improve the motivation levels of health system administrators, especially in poorly performing districts and reduce the wide gap with better-off districts.
Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews.
OBJECTIVES: Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. DESIGN: An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. DATA SOURCES: Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. ELIGIBILITY CRITERIA: We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. RESULTS: 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. CONCLUSION: To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.
Implementation of policy and management interventions to improve health and care workforce capacity to address the COVID-19 pandemic response: a systematic review.
BACKGROUND: The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries' range of policies and management interventions implemented to improve HCWs' capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. METHODS: The literature was searched in PubMed, Embase, Scopus, LILACS-BVS, WHO's COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. RESULTS: The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI's CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). CONCLUSIONS: Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.
Why move abroad? Factors influencing migration intentions of final year students of health-related disciplines in Nigeria.
BACKGROUND: Limited human resource for health may impede the attainment of health-related sustainable development goals in low-income countries. This study aims to identify migration factors among final-year students of health-related disciplines at a Nigerian university, reflecting trends in Nigeria and sub-Saharan African countries. METHODS: A cross-sectional study was conducted using a semi-structured, self-administered questionnaire to collect data from 402 final-year students of Medicine/Dentistry, Nursing, Pharmacy and Occupational therapy Physiotherapy at Obafemi Awolowo University, Ile Ife. Univariate, bivariate and multivariate data analysis were conducted and a p-value < 0.05 was taken as statistically significant. RESULTS: The mean age of the respondents was 24.3 ± 2.3 years. Most (326; 81.1%) respondents had intentions to migrate and majority (216; 53.7%) of respondents had an unfavourable attitude towards practising in Nigeria. Students of Nursing constitute the highest proportion (68; 91.9%) of those willing to migrate (p = 0.009). The common preferred destinations for those who intend to migrate were the United Kingdom (84; 25.8%), Canada (81; 24.8%), and the United States of America (68; 20.9%). Respondents who had favourable attitude towards practicing abroad (AO.R: 2.9; 95% C.I 1.6-5.2; p = 0.001) were three times more likely to have migration intentions compared with those who had an unfavourable attitude towards practicing abroad, while the odds for those who had favourable attitude towards practicing in Nigeria (AO.R: 0.4; 95% C.I 0.2-0.7; p = 0.002) was two times less than those who had an unfavourable attitude towards practice in Nigeria. Respondents who desire specialist training (AO.R: 3.0; 95% C.I 1.7-5.4; p < 0.001) were three times more likely to have intention to migrate abroad when compared to those who were undecided or had no desire to pursue specialist training. CONCLUSION: Most respondents had the intention to migrate abroad after graduation and this could be attributed to the desire for specialist training and their attitude towards practising in Nigeria. Interventions aimed at improving specialist training in Nigeria and incentivizing health care practice may reduce migration trends among Nigeria's health professionals in training.
OBJECTIVES: To estimate the current gap and the necessary supply of human resources for care (HRC) for older people experiencing severe care dependence in Latin America and the Caribbean (LAC). DESIGN: Simulation study using previous estimations of severe care dependence for LAC countries. SETTING AND PARTICIPANTS: Older people (aged 65+) experiencing severe care dependence in 26 countries of LAC. METHODS: We calculated the current gap and the necessary supply of HRC in 2020, 2035, and 2050 assuming a mix of complementary human resources, in line with regional standards for long-term care (LTC) schemes, and differing levels of care coverage. RESULTS: Considering 100% coverage of LTC services for the population 65+ experiencing severe care dependence, the region will need almost 5 million people working full-time in the sector. This figure is expected to increase to more than 14 million by 2050. Nurse assistants and nurses will be the professional profiles in highest demand. In addition, the region requires 2 million rehabilitation professionals in 2020, and this figure will increase to more than 6 million in 2050. CONCLUSIONS AND IMPLICATIONS: The rapid aging process in LAC will bring several challenges and opportunities to the region. Countries should start designing strategies to reduce the current gaps of HRC to meet older people's care needs in the coming years, in terms of both quantity and competencies, to help ensure that their human rights are met.
One size does not fit all: an application of stochastic modeling to estimating primary healthcare needs in Ethiopia at the sub-national level.
BACKGROUND: Primary healthcare systems require adequate staffing to meet the needs of their local population. Guidelines typically use population ratio targets for healthcare workers, such as Ethiopia's goal of two health extension workers for every five thousand people. However, fixed ratios do not reflect local demographics, fertility rates, disease burden (e.g., malaria endemicity), or trends in these values. Recognizing this, we set out to estimate the clinical workload to meet the primary healthcare needs in Ethiopia by region. METHODS: We utilize the open-source R package PACE-HRH for our analysis, which is a stochastic Monte Carlo simulation model that estimates workload for a specified service package and population. Assumptions and data inputs for region-specific fertility, mortality, disease burden were drawn from literature, DHS, and WorldPop. We project workload until 2035 for seven regions and two charted cities of Ethiopia. RESULTS: All regions and charted cities are expected to experience increased workload between 2021 and 2035 for a starting catchment of five thousand people. The expected (mean) annual clinical workload varied from 2,930 h (Addis) to 3,752 h (Gambela) and increased by 19-28% over fifteen years. This results from a decline in per capita workload (due to declines in fertility and infectious diseases), overpowered by total population growth. Pregnancy, non-communicable diseases, sick child care, and nutrition remain the largest service categories, but their priority shifts substantially in some regions by 2035. Sensitivity analysis shows that fertility assumptions have major implications for workload. We incorporate seasonality and estimate monthly variation of up to 8.9% (Somali), though most services with high variability are declining. CONCLUSIONS: Regional variation in demographics, fertility, seasonality, and disease trends all affect the workload estimates. This results in differences in expected clinical workload, the level of uncertainty in those estimates, and relative priorities between service categories. By showing these differences, we demonstrate the inadequacy of a fixed population ratio for staffing allocation. Policy-makers and regulators need to consider these factors in designing their healthcare systems, or they risk sub-optimally allocating workforce and creating inequitable access to care.