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Abstract 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.

Abstract 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.

Abstract Background

Even though trust is placed at the central point in ensuring proper functioning of the health systems, studies remain scant on how it affects both the implementation and uptake of COVID-19 response measures in low- and middle-income countries such as Tanzania. This study, therefore, explored the role of trust in the implementation and uptake of recommended COVID-19 response measures including vaccines from the perspective of health professionals in Tanzania.

Methods

This cross-sectional qualitative study was implemented in four of Tanzania’s thirty-one regions. Qualitative data was collected through 26 in-depth interviews held with regional and district disease outbreak response teams, district cold chain co-ordinators and health facility in-charges. In addition, five focus group discussions and seven group interviews were conducted with healthcare workers from the lower-level health facilities. Thematic analysis was conducted and applied the trust constructs.

Results

Interpersonal trust and health system trust emerged as two major themes in the study. Interpersonal trust was reported to stem from lack of transparency that instigated fear, worries, and confusion regarding the implementation and uptake of the recommended response measures. The distrust was mainly between health professionals in health facilities and those assigned to isolation centres as well as between patients and community members. On the other hand, the health system trust was shaped by mixed feelings regarding COVID-19 vaccine national decisions, and conflicting messages from national officials, politicians and religious leaders on COVID-19 responses, safety, and effectiveness of the vaccines. Questions surrounding the short duration of clinical trials, indeterminate post-vaccination protection duration, impotence-linked beliefs, freemasonry notion and unclear vaccinated cards information are other reported contributory factors to mistrust in the health system. However, after a comprehensive health education and experience in COVID-19 vaccination administration most professionals affirmed the effectiveness of the vaccines in limiting infections and its severe consequences.

Conclusion

Participants indicated limited trust at both interpersonal and health system levels aggravated by lack of transparency, unclear and conflicting messages on COVID-19 infections and response measures. Enforced transparency on pandemics alongside standardised messages from the reliable sources is crucial in enhancing trust in implementation and uptake of the recommended response measures.

Abstract Background

Primary healthcare (PHC) is a crucial strategy for achieving universal health coverage. Ethiopia is working to improve its primary healthcare system through the Optimization of Health Extension Program (OHEP), which aims to increase accessibility, availability and performance of health professionals and services. Measuring current accessibility of healthcare facilities and workforce availability is essential for the success of the OHEP and achieving universal health coverage in the country.

Methods

In this study we use an innovative mixed geospatial approach to assess the accessibility and availability of health professionals and services to provide evidence-based recommendations for the implementation of the OHEP. We examined travel times to health facilities, referral times between health posts and health centers, geographical coverage, and the availability and density of health workers relative to the population.

Results

Our findings show that the accessibility and availability of health services in Somali region of Ethiopia is generally low, with 65% of the population being unable to reach a health center or a health post within 1 h walking and referral times exceeding 4 h walking on average. The density of the health workforce is low across Somali region, with no health center being adequately staffed as per national guidelines.

Conclusions

Improving accessibility and addressing healthcare worker scarcity are challenges for implementing the primary care roadmap in Ethiopia. Upgrading health posts and centers, providing comprehensive services, and training healthcare workers are crucial. Effective outreach strategies are also needed to bridge the gap and improve accessibility and availability.

Abstract Background

Routine health facility data provides the opportunity to monitor progress in quality and uptake of health care continuously. Our study aimed to assess the reliability and usefulness of emergency obstetric care data including temporal and regional variations over the past five years in Tanzania Mainland.

Methods

Data were compiled from the routine monthly district reports compiled as part of the health management information systems for 2016–2020. Key indicators for maternal and neonatal care coverage, emergency obstetric and neonatal complications, and interventions indicators were computed. Assessment on reliability and consistency of reports was conducted and compared with annual rates and proportions over time, across the 26 regions in of Tanzania Mainland and by institutional delivery coverage.

Results

Facility reporting was near complete with 98% in 2018–2020. Estimated population coverage of institutional births increased by 10% points from 71.2% to 2016 to 81.7% in 2020 in Tanzania Mainland, driven by increased use of dispensaries and health centres compared to hospitals. This trend was more pronounced in regions with lower institutional birth rates. The Caesarean section rate remained stable at around 10% of institutional births. Trends in the occurrence of complications such as antepartum haemorrhage, premature rupture of membranes, pre-eclampsia, eclampsia or post-partum bleeding were consistent over time but at low levels (1% of institutional births). Prophylactic uterotonics were provided to nearly all births while curative uterotonics were reported to be used in less than 10% of post-partum bleeding and retained placenta cases.

Conclusion

Our results show a mixed picture in terms of usefulness of the District Health Information System(DHIS2) data. Key indicators of institutional delivery and Caesarean section rates were plausible and provide useful information on regional disparities and trends. However, obstetric complications and several interventions were underreported thus diminishing the usefulness of these data for monitoring. Further research is needed on why complications and interventions to address them are not documented reliably.

Abstract

Health workforce planning has become a significant global problem considering there are estimates of an 18 million healthcare provider shortfall by 2030. There are two mechanisms to address healthcare worker shortages: (1) domestic education of those professions and (2) integration of internationally educated health professionals. Integration of internationally educated health professionals into the Canadian healthcare system requires: (1) reductions in systemic and administrative barriers and (2) development, testing, and implementation of credential equivalency recognition systems. The goal of this scoping review was to identify systems that are employed to determine credential equivalency, with a focus on Canada. The scoping review was carried by employing: (1) a systematic literature search (9) and (2) a website and grey literature Google search of professional governing bodies from a selection of medical/allied healthcare professions, but also other non-medical professions, such as law, engineering and accounting. Seven databases were searched to identify relevant sources: MEDLINE, CINAHL Plus with Full Text, PsycINFO, SPORT Discus, Academic Search Complete, Business Source Complete, and SCOPUS. The search strategy combined keyword, text terms, and medical subject headings (MeSH) and was carried out with the help of a health sciences librarian. Seven articles were included in the final manuscript review from the following professions: nursing; psychology; engineering; pharmacy; and multiple health professions. Twenty-four health-related professional governing body websites were hand searched to determine systems to evaluate international equivalency. There were many systems employed to determine equivalency, but there were no systems that were automated or that employed machine-learning or artificial intelligence to guide the evaluation process.

Abstract 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.

Abstract Background

Northwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services.

Methods

The study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries.

Results

Findings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services—especially among health workers seeking MHPSS services—findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach.

Conclusion

The study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.

Abstract Background

Health systems’ weakness remains one of the primary obstacles towards achieving universal access to quality healthcare in low-income settings. Performance-based financing (PBF) programs have been increasingly used to increase access to quality care in LMICs. However, evidence on the impacts of these programs remains fragmented and inconclusive. We analyze the health system impacts of the PBF program in the Democratic Republic of the Congo (DRC), one of the largest such programs introduced in LMICs to date.

Methods

We used a health systems perspective to analyze the benefits of PBF relative to unconditional financing of health facilities. Fifty-eight health zones in six provinces were randomly assigned to either a control group (28 zones) in which facilities received unconditional transfers or to a PBF program (30 zones) that started at the end of 2016. Follow-up data collection took place in 2021–2022 and included health facility assessments, health worker interviews, direct observations of consultations and deliveries, patient exit interviews, and household surveys. Using multivariate regression models, we estimated the impact of the program on 55 outcomes in seven health system domains: structural quality, technical process quality, non-technical process quality, service fees, facility management, providers’ satisfaction, and service coverage. We used random-effects meta-analysis to generate pooled average estimates within each domain.

Results

The PBF program improved the structural quality of health facilities by 4 percentage points (ppts) (95% CI 0.01–0.08), technical process quality by 5 ppts (0.03–0.07), and non-technical process by 2 ppts (0–0.04). PBF also increased coverage of priority health services by 3 ppts (0.02–0.04). Improvements were also observed for facility management (9 ppts, 0.04–0.15), service fee policies, and users’ satisfaction with service affordability (14 ppts, 0.07–0.20). Service fees and health workers’ satisfaction were not affected by the program.

Conclusions

The results suggest that well-designed PBF programs can lead to improvements in most health systems domains relative to comparable unconditional financing. However, the large persisting gaps suggest that additional changes, such as allocating more resources to the health system and reforming the human resources for health management, will be necessary in DRC to achieve the ambitious global universal health coverage and mortality goals.

Trial registration

American Economics Association Trial registry AEARCTR-0002880.

OBJECTIVE: This study aimed to assess the impact of a high-fidelity simulation interprofessional education (IPE) activity at a large, historically Black university (HBU) on perceptions of IPE. PARTICIPANTS: Student participants represented various allied health care professions; the majority were female and enrolled in the pharmacy professional program. Health administration, nutrition and dietetics, nursing, respiratory therapy, and clinical lab science programs were also represented. METHODS: Participants were randomly assigned to IPE teams of 6-7 individuals. The 1-day activity transpired at a high-fidelity simulation facility and included a pre-briefing, simulated scenario with high-fidelity mannequins, and a faculty-guided video-assisted debriefing session. The patient scenario was designed by subject area faculty experts and featured an adult patient on hemodialysis. Participants completed pre and post-activity questionnaires that included the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R) instrument. RESULTS: Participants completed pre (n=107) and post-activity (n=81) questionnaires. There was a significant increase from the pre-event (M=3.90, SD 0.91) and post-event score (M=4.22, SD 0.84) for the SPICE-R item regarding understanding "the roles of other professionals within the interdisciplinary team"; t(186)= -2.471, p=0.01. The SPICE-R item score for "health professionals should collaborate in teams" also significantly increased from the pre-event (M=4.28, SD 0.80) to the post-event (M=4.53, SD 0.73); t(186)= -2.209, p=0.03. CONCLUSIONS: Participation in a 1-day high-fidelity simulation-based IPE activity at a HBU has the potential to positively change students' perceptions of IPE. Future studies should consider the impact of IPE on perceptions of diversity.

AIMS: Engaged and trained faculty to support and role-model interprofessional education (IPE)-related concepts and behaviors are vital in the development, implementation, and sustainability of IPE academic teaching and training programs. Thus, recruitment of engaged faculty is essential for effective IPE expansion, scalability innovation, and sustainability across a variety of schools, programs, and students. The primary aim of this descriptive study was to implement a strategy to recruit and engage new IPE faculty and determine the strategy's effectiveness in increasing faculty's intent to participate in future IPE. A secondary aim was to identify implementation recommendations for this strategy as a first step of IPE faculty engagement. METHODS: An introductory experiential recruitment and engagement strategy for new Faculty Observers was developed. The project used a descriptive study design and data were gathered through pre- and post-program online self-administered surveys completed by Faculty Observer participants. The surveys included questions about demographics, rating usefulness of activities, engagement motivators, and willingness to facilitate in the future. RESULTS: Fifteen faculty with no or limited IPE experience participated. Post-survey results indicated that 85% of the participants expressed willingness to participate in this program in the future, and 100% would recommend using this experiential recruitment and engagement strategy. DISCUSSION: A "dip your toes in the water" experiential strategy for IPE faculty recruitment and engagement was effective in recruitment of new IPE faculty.

INTRODUCTION: Several universities modified interprofessional education (IPE) to a virtual format, showing similar outcomes as IPE delivered through an in-person format. This study aimed to describe perceptions of 106 students from programs in occupational therapy, dietetics, nursing, athletic training, and speech-language pathology (SLP) following an established IPE activity in a virtual format. This information will add to previous literature through inclusion of 5 healthcare programs as well as identifying attitudes from each discipline. both of which will enhance future IPE curriculum development. METHODS: Following the IPE event with a case study, participants wrote reflective essays describing their perceptions of the virtual IPE experience. Four researchers analyzed the reflective essays using thematic analysis. RESULTS: Findings revealed four themes: beneficial learning experience, roles, the more the merrier, and logistics. Participants felt overall that the virtual IPE experience was beneficial, but the logistical issues of the online format as well as students' amount of participation created negative perceptions. Participants from dietetics expressed the most positive comments (70%), followed by occupational therapy (69%), athletic training (67%), speech-language pathology (54%) and nursing (48%). Undergraduate students (dietetics and nursing) made 4% more positive comments than graduate students (SLP, athletic training, occupational therapy). DISCUSSION: Participants shared that the virtual IPE experience is beneficial for optimal holistic care and felt some components of the IPE experience prepared them for real-world clinical practice. However, logistical issues (large group size and online format) prevented equal participation and establishing a connection with other participants.

OBJECTIVE: Experiential interprofessional education (IPE) fostering socialization to interprofessional teams is essential to clinical practice. Inclusion of authentic patient voices cultivates an understanding of social factors that patients face. We qualitatively assessed how experiential IPE framed around social determinants of health (SDH) and socioecological model (SEM) influenced early health profession students' development of interprofessional socialization while working with patients. Secondarily, we explored how students shifted their mindsets for future interactions. METHODS: Fifty-one health profession students participated in the Longitudinal Interprofessional Family-based Experience (LIFE), a virtual, 13-week experiential IPE opportunity during which students interacted with patients living with chronic illnesses through two interviews. Prompts representing aspects of working on an interprofessional team while interacting with a patient framed around social factors affecting healthcare were coded using the constant comparative method of analysis. Themes were derived and tallied for frequencies. RESULTS: Themes from prompt related to working with an interprofessional team included: 1) perspectives, 2) informative, and 3) collaboration. Themes related to patients as a team member included: 1) active listening, 2) patients of similar/dissimilar back¬grounds, 3) person-centered care, and 4) awareness. Themes derived from prompt about future collaborations included: 1) collaboration, 2) awareness, and 3) person-centered care. CONCLUSIONS: This SDH-focused experiential IPE advanced the understanding among early learners of how social factors that patients experience are barriers to how care is delivered and interprofessional teams must collaborate to consider factors to support patients.

BACKGROUND: In Belgium, the Planning Commission for Medical Supply is responsible for monitoring human resources for health (HRH) and ultimately proposing workforce quotas. It is supported by the Planning Unit for the Supply of the Health Professions. This Unit quantifies and forecasts the workforce in the healthcare professions on the basis of a stock and flow model, based on trends observed in the past. In 2019, the Planning Unit asked the KCE (Belgian Health Care Knowledge Centre) to develop additional forecasting scenarios for the midwifery workforce, to complement the standard historical trend approach. The aim of this paper is to present the development of such forecasting scenarios. METHODS: The Robust Workforce Planning Framework, developed by the Centre for Workforce Intelligence in the UK was used to develop alternative midwifery workforce scenarios. The framework consists of four steps (Horizon scanning, Scenario generation, Workforce modelling, and Policy analysis), the first two of which were undertaken by KCE, using two online surveys and five workshops with stakeholders. RESULTS: Three alternative scenarios are proposed. The first scenario (close to the current situation) envisages pregnancy and maternity care centred on gynaecologists working either in a hospital or in private practice. The second scenario describes an organisation of midwife-led care in hospitals. In the third scenario, care is primarily organised by primary care practitioners (midwives and general practitioners) in outpatient settings. CONCLUSIONS: The Robust Workforce Planning Framework provides an opportunity to adjust the modelling of the health workforce and inform decision-makers about the impact of their future decisions on the health workforce.

Refugee patients benefit from interdisciplinary approaches that address trauma-related migration in culturally responsive ways. This qualitative evaluation assessed the interdisciplinary trauma-based course for refugee populations. The qualitative data comes from focus groups and surveys to evaluate medical, social work, and public health students' perceptions of the interprofessional education course of refugee patient care. The evaluators analyzed qualitative data through a thematic content analysis method. Following key themes emerged from students' reflections: (1) collaboration in interdisciplinary learning, (2) role of clinical learning, (3) skills and knowledge related to refugee population care, (4) improvements for interprofessional education, and (5) strengths of the interprofessional education course. The Interprofessional Refugee Health Elective course enhanced their knowledge and competence in refugee health care. Educators, students, and the patient population will benefit from investing in interprofessional education courses that focus on specific needs and complex care management for refugee patients.

OBJECTIVE: The primary objective was to describe the pedagogical approach of conducting 2 Interprofessional Education (IPE) sessions focused on IPE Collaborative (IPEC) Core Competencies in a required pharmacy and nursing didactic course. The secondary objective was to use quantitative and qualitative methods to assess students' self-reported IPE knowledge, skills, and attitudes after the IPE sessions. METHODS: Sessions consisted of active learning exercises with supplemental lectures, emphasizing students work together to find optimal solutions to both clinical and nonclinical problems. Time was allotted for debriefing and discussion. Students completed a post-session reflection with 6 guided questions to collect qualitative themes. Participants also completed the W(e) Learn Interprofessional Program Assessment Scale, a survey designed to assess student perceptions of the interprofessional sessions. We used t tests for comparing scores among relevant subgroups. RESULTS: From 2017-2019, 263 students attended 2 annual IPE sessions in a required, introductory course. Small group didactic activities with faculty-led debriefing were included in each session. A total of 111 students fully completed the scale and average scores were high (Mean = 197.5, SD = 15.96). Thematic analysis of reflections revealed that students recognized teamwork, mutual respect, effective communication, and understanding the roles and responsibilities of the interprofessional team helped improve patient care. CONCLUSION: Including joint IPE sessions in a foundational didactic course was a feasible and successful IPE component. Sessions provided students with experience practicing foundational skills for interprofessional communication and teamwork. Students reported high satisfaction and valued the sessions, as indicated by quantitative surveys and qualitative themes.