Turn-over rate of academic faculty at the College of Health Sciences, Addis Ababa University: a 20-year analysis (1991 to 2011)
Faculty turn-over affects both workers and organizations. Turnover of faculty and researchers is increasing alarmingly and costing the universities and the country at large. Fast turnover of health professionals from the health system and from academic institutions has recently received substantial attention from both academia and health sector managers. This paper calculates the faculty turnover rate at the College of Health Sciences of Addis Ababa University during the period of September 1991 to August 2011.Methods
The study was conducted at the College of Health Sciences, Addis Ababa University. Retrospective analysis of employee records was done. All records of the faculty that were working in the College during the 20-year period, starting from September 1991 to August 2011 were retrospectively reviewed. Data were collected from the employee records accessed from the College’s human resources database and supplemented by payroll sheets and different reports. A structured checklist was used to extract the required data from the database. The crude turnover rate for academic faculty was calculated.Results
Within the 20-year period of September 1991 to August 2011, a total of 120 faculty members left. The overall turn-over rate was 92.8 %. The rate in the most recent five years (172 %) is 8.5 times higher than the rate for the first five years (20 %). The average retention period before the termination of an employment contract was 4.9 years. The top five departments where employment contracts were relatively higher include: Nursing 15 (15.6 %), Internal Medicine 12 (12.5%), Public Health 10 (10.4%), Pediatrics 9 (9.4%) and Surgery 9 (9.4%). About two thirds (66.6%) of the faculty who were leaving were at the ranks of assistant professorship and above.Conclusion
This study revealed that outflow of faculty has been continuously increasing in the period reviewed. This implies that the College had been losing highly skilled professionals with considerably higher costs in monetary terms. In this regard, an urgent response is required to retain or significantly decrease the outflow of faculty. Different motivation and retention mechanisms should be identified and implemented. Various modalities of faculty development programs should also be initiated.
Right time, right place: improving access to health service through effective retention and distribution of health workers
This editorial introduces the 'Right time, Right place: improving access to health service through effective retention and distribution of health workers’ thematic series. This series draws from studies in a range of countries and provides new insights into what can be done to improve access to health through more effective human resources policies, planning and management. The primary focus is on health workforce distribution and retention.
The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades.Methods
SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature.SWOT analysis
Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices.Conclusion
Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker.
The shortage of physicians in Japan is a serious concern, particularly in specialties like pediatrics. The purpose of this study was to investigate recent changes in the geographic distribution of pediatricians and the factors underlying this change.Methods
We investigated the numerical changes in the pediatrician workforce (2002 to 2007) per 100,000 of the population under the age of 15 years in 369 secondary medical areas throughout Japan, using attributive variables such as population size, social and economic status, and pediatric service delivery. We performed principal component analysis and multiple regression analysis.Results
We obtained two principal components: one that reflected the degree of urbanization and another that reflected the volume of pediatric service delivery. Only the first component score was positively correlated with an increased pediatrician workforce per 100,000 of the population under the age of 15 years. We classified the secondary medical areas into four groups using component scores. The increase in pediatrician workforce during this period was primarily absorbed into the two groups with higher levels of urbanization, whereas the two rural groups exhibited little increase. Pediatricians aged 50 to 59 years increased in all four groups, whereas pediatricians aged 30 to 39 years decreased in the two rural groups and increased in the two urban groups.Conclusions
The trends of the pediatrician workforce increase generally kept pace with urbanization, but were not associated with the original pediatrician workforce supply. The geographic distribution of pediatricians showed rapid concentration in urban areas. This trend was particularly pronounced among female pediatricians and those aged 30 to 39 years. Given that aging pediatricians in rural areas are not being replaced by younger doctors, these areas will likely face new crises when senior physicians retire.
For more than love or money: attitudes of student and in-service health workers towards rural service in India
While international literature on rural retention is expanding, there is a lack of research on relevant strategies from pluralistic healthcare environments such as India, where alternate medicine is an integral component of primary care. In such contexts, there is a constant tug of war in national policy on “Which health worker is needed in rural areas?” and “Who can, realistically, be got there?” In this article, we try to inform this debate by juxtaposing perspectives of three cadres involved in primary care in India—allopathic, ayurvedic and nursing—on rural service. We also identify key incentives for improved rural retention of these cadres.Methods
We present qualitative evidence from two states, Uttarakhand and Andhra Pradesh. Eighty-eight in-depth interviews with students and in-service personnel were conducted between January and July 2010. Generic thematic analysis techniques were employed, and the data were organized in a framework that clustered factors linked to rural service as organizational (salary, infrastructure, career) and contextual (housing, children’s development, safety).Results
Similar to other studies, we found that both pecuniary and non-pecuniary factors (salary, working conditions, children’s education, living conditions and safety) affect career preferences of health workers. For the allopathic cadre, rural primary care jobs commanded little respect; respondents from this cadre aimed to specialize and preferred private sector jobs. Offering preferential admission to specialist courses in exchange for a rural stint appears to be a powerful incentive for this cadre. In contrast, respondents from the Ayurvedic and nursing cadres favored public sector jobs even if this meant rural postings. For these two cadres, better salary, working and rural living conditions can increase recruitment.Conclusions
Rural retention strategies in India have predominantly concentrated on the allopathic cadre. Our study suggests incentivizing rural service for the nursing and Ayurvedic cadres is less challenging in comparison to the allopathic cadre. Hence, there is merit in strengthening rural incentive strategies for these two cadres also. In our study, we have developed a detailed framework of rural retention factors and used this for delineating India-specific recommendations. This framework can be adapted to other similar contexts to facilitate international cross-cadre comparisons.
Associations between employee and manager gender: impacts on gender-specific risk of acute occupational injury in metal manufacturing
Prior research has shown increased risk of injury for female employees compared to male employees after controlling for job and tasks, but have not explored whether this increased risk might be moderated by manager gender. The gender of one’s manager could in theory affect injury rates among male and female employees through their managers’ response to an employee’s psychosocial stress or through how employees differentially report injuries. Other explanations for the gender disparity in injury experience, such as ergonomic factors or differential training, are unlikely to be impacted by supervisor gender. This study seeks to explore whether an employee’s manager’s gender modifies the effect of employee gender with regards to risk of acute injury.Methods
A cohort of employees and managers were identified using human resources and injury management data between January 1, 2002 and December 31, 2007 for six facilities of a large US aluminum manufacturing company. Cox proportional hazards models were employed to examine the interaction between employee gender and whether the employee had female only manager(s), male only manager(s), or both male and female managers on injury risk. Manager gender category was included as a time varying covariate and reassessed for each employee at the midpoint of each year.Results
The percentage of departments with both female and male managers increased dramatically during the study period due to corporate efforts to increase female representation in management. After adjustment for fixed effects at the facility level and shared frailty by department, manager gender category does not appear to moderate the effect of employee gender (p = 0.717). Manager category was not a significant predictor (p = 0.093) of time to first acute injury. Similarly, having at least one female manager did not modify the hazard of injury for female employees compared to males (p = 0.899) and was not a significant predictor of time to first acute injury (p = 0.601).Conclusions
Prior findings suggest that female manufacturing employees are at higher risk for acute injury compared to males; this analysis suggests that this relationship is not affected by the gender of the employee’s manager(s).
Approximately 70 to 80% of healthcare errors are due to poor team communication and understanding. High-risk environments such as the trauma setting (which covers a broad spectrum of departments in acute services) are where the majority of these errors occur. Despite the emphasis on interprofessional collaborative practice and patient safety, interprofessional teamworking in the trauma setting has received little attention. This paper presents the findings of a scoping review designed to identify the extent and nature of this literature in this setting. The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched from January 2000 to April 2013 for results of interprofessional teamworking in the trauma setting. A hand search was conducted by reviewing the reference lists of relevant articles. In total, 24 published articles were identified for inclusion in the review. Studies could be categorized into three main areas, and within each area were a number of themes: 1) descriptions of the organization of trauma teams (themes included interaction between team members, and leadership); 2) descriptions of team composition and structure (themes included maintaining team stability and core team members); and 3) evaluation of team work interventions (themes included activities in practice and activities in the classroom setting).
Descriptive studies highlighted the fluid nature of team processes, the shared mental models, and the need for teamwork and communication. Evaluative studies placed a greater emphasis on specialized roles and individual tasks and activities. This reflects a multiprofessional as opposed to an interprofessional model of teamwork. Some of the characteristics of high-performing interprofessional teams described in this review are also evident in effective teams in the community rehabilitation and intermediate care setting. These characteristics may well be pertinent to other settings, and so provide a useful foundation for future investigations.
ADad 11: Needs and Service Provisions for Anxiety Disorders Among Adolescents in a Rural Community Population in India
Despite the need to have adolescent-centric policies and mental health services, India is yet far from having one. The authors aimed at generating opinions on the need to have adolescent focused policies and clinical services using the data on Anxiety Disorders they collected from the community.Methods
This qualitative study used Focus Group Discussions (FGD) to generate opinions on the various needs to enhance better mental health services and policies for adolescents in India. A Modified Delphi technique was used with experts in mental health to prioritize these needs. Experts gave their plans on how to approach the needs during the in-depth interviews.Results
The mental health professionals viewed scaled-up mental health services to include adolescent mental health services; improve the consumer opinion about public sector health providers; strengthening the government hospitals; capacity building among the health sector and non-health sector; research in service delivery models and policy changes as the needs. The parents felt the need to address the stigma associated with their children’s mental illness, minimize the barriers in approaching mental health services and involve non-medical agencies in mental health care. These needs were prioritized and solutions to these problems were discussed.Conclusions
India-centric and adolescent specific mental health policies and services need to be developed as well as integrated into the existing health system in India.
There is a severe healthcare workforce shortage in sub Saharan Africa, which threatens achieving the Millennium Development Goals and attaining an AIDS-free generation. The strength of a healthcare system depends on the skills, competencies, values and availability of its workforce. A well-trained and competent laboratory technologist ensures accurate and reliable results for use in prevention, diagnosis, care and treatment of diseases.Methods
An assessment of existing preservice education of five medical laboratory schools, followed by remedial intervention and monitoring was conducted. The remedial interventions included 1) standardizing curriculum and implementation; 2) training faculty staff on pedagogical methods and quality management systems; 3) providing teaching materials; and 4) procuring equipment for teaching laboratories to provide practical skills to complement didactic education.Results
A total of 2,230 undergraduate students from the five universities benefitted from the standardized curriculum. University of Gondar accounted for 252 of 2,230 (11.3%) of the students, Addis Ababa University for 663 (29.7%), Jimma University for 649 (29.1%), Haramaya University for 429 (19.2%) and Hawassa University for 237 (10.6%) of the students. Together the universities graduated 388 and 312 laboratory technologists in 2010/2011 and 2011/2012 academic year, respectively. Practical hands-on training and experience with well-equipped laboratories enhanced and ensured skilled, confident and competent laboratory technologists upon graduation.Conclusions
Strengthening preservice laboratory education is feasible in resource-limited settings, and emphasizing its merits (ample local capacity, country ownership and sustainability) provides a valuable source of competent laboratory technologists to relieve an overstretched healthcare system.
Measuring governance at health facility level: developing and validation of simple governance tool in Zambia
Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level.Methods
Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9.Results
The 95% one-sided confidence interval for Cronbach’s alpha was between 0.69 and 0.74 for the 16 items.
The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies.Conclusions
The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach’s alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.
The present paper investigates the potential benefits of a strong safety culture (SC). Specifically, we build on the organizational support theory to explore the direct and indirect effects of SC on firm performance. Partial least squares method is used to analyze the data collected from a survey among 251 Canadian plants. The results show that SC is associated with several performance indicators all linked to sustainable development (i.e., environmental, financial, and safety performance). Importantly, our findings also suggest that the relationships between SC and environmental/safety performance are mediated by the actual level of implemented environmental/safety practices within plants. We conclude the paper by highlighting the study’s limitations and contributions as well as theoretical and managerial implications.
The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system –a multiple case study
Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level.Methods
We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs.Results
The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers.Conclusion
Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs indicates that the NTCP supports, rather than strengthens, the local health system. Moreover, there is potential for this support to be enhanced. Positive synergies between the NTCP and district health systems can be achieved if opportunities to strengthen the district health system are seized. The question remains, however, of why managers do not take advantage of the opportunities to strengthen the health system.
The Alabama Coalition for a Healthier Black was a demonstration of concept project. This paper is a descriptive and qualitative overview of this 2.5 year project. Limited key project results are reported here. Located in the rural Black Belt region of Alabama this coalition had several key aims: to develop a collaboration between primary care and mental health care through co-location of services; use of video-conferencing capability to provide mental health services more efficiently; enhanced training in rural healthcare; and development of stigma reduction campaigns along with other coalition partner specific initiatives. Co-location and telepsychiatry implementation produced the major challenges and resulting adaptations to original aims. Despite many challenges these new service patterns were put into place and appear to be sustainable.
In order to test the implementation of the guidelines for environmental labels and declarations in agri-food SMEs, a firm which operates in the pasta chain was chosen as it was considered representative of the Sicilian economic system. After a brief description of the sector and the pilot firm, the path followed by the firm towards the choice of a voluntary environmental labelling system which suited its peculiarities will be reported. Following the iterative procedural steps and making use of decision support instruments, the organisation has given to its distributors and consumers the necessary information for a conscious choice of eco-compatible products and the relevant information connected with the phases of the productive process, the product itself and the performance in terms of environmental impact. The experience resulting from the application of the guidelines proposed to the pilot firm has shown how it is possible to choose the voluntary communication system, closer to the business reality, by starting from the analysis of the company activities and of the expectations of the management, the stakeholders and their environmental awareness.
The right to health is proclaimed by the United Nations in the Declaration of Human Rights of 1948. In 1981, the right to health became a goal of the new Millennium. Nevertheless, in the Millennium goals, the concern for health occupies only the fourth position. Why is health not, for the Millennium, a priority goal and, more precisely, the first? What are the implications of a “secondarization” of health care? Our point will be to demonstrate why we should not count on the Millennium goals to achieve “health for all,” In this paper, we will first refer to the theories of justice implicitly evocated by policies that give or do not give a priority to health care. Secondly, we will describe the ethical basis which supports the primary health care definition and the policies which pursue this aim. Finally, we will show that we would take a better account of both poverty and “health for all,” if we would conceive primary health care not only as fundamental needs but also as capabilities (as A. Sen or M. Nussbaum does).
The purpose of this chapter is to argue that the past sociological notion of the intact family-qua-family composed of two parents of the opposite gender and two children, is not longer tenable. This argument, of course, about the decline of the family, as conceived in the past, does not mean that the profession of Family Psychology should decline as well. It means that different conceptions about the family unit have evolved in the last half a century. Those conceptions will remain of interest to such a professional organization.
A major cause for excessive medical costs in the USA is excessive attention to predictive factors and neglect of causal factors. It is much better to prevent the cause than just the symptoms created by the cause. We use signs and symptoms associated with past harmful events as factors for predicting possible risk of future harm. Predicting future outcomes allows us to hope for ways that we might prevent future harm.
A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options
Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes.Methods
Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships.Results
Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms.
Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable.Conclusions
The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH.
The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs.
Purpose The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors. Method A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review. Results We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff. Conclusions Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.