Nursing engagement in research priorities focused on health systems and services in Latin America countries
A strong nursing research agenda in Latin America is fundamental to universal health coverage. Nursing science can make important contributions to the health of Latin American people through knowledge generation that directly informs nursing practice, professional education, and health policy.Methods
We used a cross-sectional survey design to assess nursing involvement in health systems and services research in Latin America in five priority areas: Policies and education related to nursing human resources; Structure, organization and dynamics of health systems and services; Science, technology, innovation, and information systems in public health; Health policies, governance, and social control; and Social studies in the health field.Results
Nursing and midwifery participants (N = 856) from Latin American countries completed the survey. Respondents who reported conducting research focused primarily on Policies and Education related to Nursing Human Resources and Structure, Organization, and Dynamics of Health Systems and Services. Across the five priority areas, more nurses reported using research findings and/or being aware of research than conducting research.Conclusions
Survey results indicate that nursing research in Latin America is currently disproportionately focused on nursing education and practice. More research focused on information technology, nurse’s impact on public health, and the threats posed by nurse migration is needed to better address health needs of Latin American populations.
Tackling brain drain at Chinese CDCs: understanding job preferences of public health doctoral students using a discrete choice experiment survey
Given the demands for public health and infectious disease management skills during COVID-19, a shortage of the public health workforce, particularly with skills and competencies in epidemiology and biostatistics, has emerged at the Centers for Disease Controls (CDCs) in China. This study aims to investigate the employment preferences of doctoral students majoring in epidemiology and biostatistics, to inform policy-makers and future employers to address recruitment and retention requirements at CDCs across China.Methods
A convenience sampling approach for recruitment, and an online discrete choice experiment (DCE) survey instrument to elicit future employee profiles, and self-report of their employment and aspirational preferences during October 20 and November 12, 2020. Attributes included monthly income, employment location, housing benefits, children’s education opportunities, working environment, career promotion speed and bianzhi (formally established post).Results
A total of 106 doctoral epidemiology and biostatistics students from 28 universities completed the online survey. Monthly income, employment location and bianzhi was of highest concern in the seven attributes measured, though all attributes were statistically significant and presented in the expected direction, demonstrating preference heterogeneity. Work environment was of least concern. For the subgroup analysis, employment located in a first-tier city was more likely to lead to a higher utility value for PhD students who were women, married, from an urban area and had a high annual family income. Unsurprisingly, when compared to single students, married students were willing to forgo more for good educational opportunities for their children. The simulation results suggest that, given our base case, increasing only monthly income from 10,000 ($ 1449.1) to 25,000 CNY ($ 3622.7) the probability of choosing the job in the third-tier city would increase from 18.1 to 53.8% (i.e., the location choice is changed).Conclusion
Monthly income and employment location were the preferred attributes across the cohort, with other attributes then clearly ranked and delineated. A wider use of DCEs could inform both recruitment and retention of a public health workforce, especially for CDCs in third-tier cities where resource constraints preclude all the strategies discussed here.
Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B...
Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique.Methods
A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B).Results
Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care.Conclusion
CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.
Significant progress has been made to advance Maternal, Newborn and Child Health (MNCH) in Ethiopia. Further, the country has enshrined equity as a core value in their strategic and development frameworks and policies. Although national statistics show improved health outcomes, there exists persistent inequities in avoidable health risks and premature deaths. Additionally, the improving health statistics mask the disparities in health outcomes based on education, employment status, income level, gender and ethnicity dimensions.
The EquiFrame framework was used to assess the extent to which equity was entrenched in MNCH health policies and plans. The framework, which describes core concepts against which health policies and plans can be assessed, also provides a scoring criterion for policy assessment. The framework was modified to include the concept of intersectionality, which is increasingly gaining significance in the health policy ecosystems. The policies and plans reviewed in this analysis exercise were selected based on (1) their relevance – only policies and plans in force as of the year 2020 were considered; (2) availability in the public domain as this study was limited to desk research; and (3) relevance to MNCH. A total of five policies and plans were analyzed and evaluated against the 15 core concepts presented in the modified EquiFrame framework. Following the outcomes of the assessment, documents were ranked as either being low, moderate, or high, in exhaustively addressing the core concepts.
The Ethiopia Health Sector Transformation Plan (2016–2020) is the only policy or plan that earned a high ranking. The other four policies and plans were ranked as moderate. This shows that while majority of the Ethiopian health sector policies and plans exist and address the core health equity concepts, they fail to: (i) spell out plans to implement and monitor the proposed interventions; and (ii) demonstrate evidence that the interventions were implemented or monitored. With the global goal of leaving no one behind, future policy development in Ethiopia needs to prioritize equity considerations in order to enhance the ongoing health improvement.
Medical specialist distributions in Ecuador: a geographical and temporal analysis of data from 2000 to 2017
Knowledge of medical specialists' numbers and geographical distribution are essential for planning health services and health workforce supply. However, although the distribution of physicians is a significant concern for society and policymakers in Ecuador, no studies have evaluated the distribution of specialists in the country. This study aimed to explore the geographical and temporal distribution of medical specialists in Ecuador over 18 years from 2000 to 2017 and analyse its implications for health planning and medical training.Methods
We conducted an ecological time-series study based on the National Statistical Register of Resources and Health Activities data. This register provides administrative information for health professionals working in public and private health institutions. Rates of medical specialists by year, geographical area, and speciality were estimated. We used joint-point analyses to identify time trends for medical specialists and physicians in training.Results
From 2000 to 2017, medical specialists grew from 2737 to 10,929. The rate of medical specialists per 10,000 population increased from 4 in 2000 to 10.3 in 2017. Based on Joint point analysis, two temporal trends were identified. Between 2000 to 2015, specialists increased by 4.1% per year, and between 2015 and 2017, they increased by 20% per year. For the entire study period, three cities (Quito, Guayaquil, and Cuenca) accounted for more than 50% of the specialists in the country. However, medical specialists in other cities and rural areas increased from 37% in 2000 to 46% in 2017. The provinces of Esmeraldas, Carchi, Bolívar and Los Ríos presented rates of less than 6 specialists per 10,000 population by 2017. Of the 46 medical specialities identified by 2017, three represented more than 30% of the professionals (gynaecology 12%, paediatrics 11% and family and community health 8.4%).Conclusions
This study shows that the number of medical specialists in Ecuador has increased significantly over the last two decades, although with inequalities in the distribution of specialists between provinces and regions. The results of this study provide background for the Ecuadorian health system when introducing Human Resources of Health (HRH) policies.
Type of Findings Generated by the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis.
Progress towards the 2030 sustainable development goals: direct and indirect impacts on neurological disorders
The United Nations’ Sustainable Development Goals (SDGs) were set forth in 2015 as a blueprint for all nations to create a more sustainable future together. These 17 social, environmental, and economic goals have established targets to meet globally by the year 2030, with a focus on pro-poor initiatives, gender equality, and ending hunger. The relationship of the SDGs with neurological disorders and how the achievement of the SDGs intersects with the future of neurological practice have not been comprehensively examined. However, the incidence of neurological disorders, the outcomes of people living with neurological disorders, and the training of future neurologists can be interlinked, directly or indirectly, with programming for the SDGs and their eventual achievement. Each SDG is reviewed in the context of neurology. This lens can inform programming and policy, enhance research and training, and improve inter-sectoral action for neurological disorders worldwide.
The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission.Methods
Pre- and post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post-evaluation online training survey using Qualtrics was distributed to assess participants’ satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities.Results
A total of 8797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3 days) and consisted of in person, virtual or self guided training. Of the 8105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2370 (25%) trainees, and 1768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers.Conclusion
Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. Successful implementation of an emergency response training such as this short-term IPC training initiative in response to the COVID-19 pandemic, requires speed, rigor and flexibility of its design and delivery while building on pre-existing systems, resources, and partnerships.
Prevalence and associated factors for workplace violence among general practitioners in China: a national cross-sectional study
General practitioners (GPs) were at risk of violence in their everyday working lives. Workplace violence (WPV) among GPs is a global public health concern. This study aimed to investigate the prevalence and factors associated with WPV among GPs in China.Methods
A cross-sectional study was conducted among 4376 GPs in eastern, central, and western China between March and May 2021 using a structured self-administered questionnaire. The multivariable stepwise logistic regression model was used to examine the factors associated with WPV among GPs in China.Results
Among these respondents, 14.26% of them reported exposure to WPV in the past 12 months. GPs who were female, practised in a rural area, made home visits occasionally, worked in a fair or good practice environment or work environment, and had a fair or good relationship with patients were less likely to encounter any type of WPV. In addition, GPs who served patients over 20 per day and worked overtime occasionally or frequently were more likely to be exposed to WPV. The determinants of WPV varied in different types of WPV and sexes.Conclusions
The prevalence of WPV among GPs is low in China. Our findings could inform the measures to reduce the WPV among GPs.
Planning human resources and facilities to achieve Sustainable Development Goals: a decision-analytical modelling approach to predict cancer control requirements in Indonesia.
Evaluation of the first two Frontline cohorts of the field epidemiology training program in Guinea, West Africa
The 2014–2016 Ebola virus disease outbreak in West Africa revealed weaknesses in the health systems of the three most heavily affected countries, including a shortage of public health professionals at the local level trained in surveillance and outbreak investigation. In response, the Frontline Field Epidemiology Training Program (FETP) was created by CDC in 2015 as a 3-month, accelerated training program in field epidemiology that specifically targets the district level. In Guinea, the first two FETP-Frontline cohorts were held from January to May, and from June to September 2017. Here, we report the results of a cross-sectional evaluation of these first two cohorts of FETP-Frontline in Guinea.Methods
The evaluation was conducted in April 2018 and consisted of interviews with graduates, their supervisors, and directors of nearby health facilities, as well as direct observation of data reports and surveillance tools at health facilities. Interviews and site visits were conducted using standardized questionnaires and checklists. Qualitative data were coded under common themes and analyzed using descriptive statistics.Results
The evaluation revealed a significant perception of improvement in all assessed skills by the graduates, as well as high levels of self-reported involvement in key activities related to data collection, analysis, and reporting. Supervisors highlighted improvements to systematic and quality case and summary reporting as key benefits of the FETP-Frontline program. At the health facility level, staff reported the training had resulted in improvements to information sharing and case notifications. Reported barriers included lack of transportation, available support personnel, and other resources. Graduates and supervisors both emphasized the importance of continued and additional training to solidify and retain skills.Conclusions
The evaluation demonstrated a strongly positive perceived benefit of the FETP-Frontline training on the professional activities of graduates as well as the overall surveillance system. However, efforts are needed to ensure greater gender equity and to recruit more junior trainee candidates for future cohorts. Moreover, although improvements to the surveillance system were observed concurrent with the completion of the two cohorts, the evaluation was not designed to directly measure impact on surveillance or response functions. Combined with the rapid implementation of FETP-Frontline around the world, this suggests an opportunity to develop standardized evaluation toolkits, which could incorporate metrics that would directly assess the impact of equitable field epidemiology workforce development on countries’ abilities to prevent, detect, and respond to public health threats.
Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state
The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh.Methods
The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs.Results
The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct.Conclusion
The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.
Relationship between training supervision and evolution of the density of GPs: a 3-year cohort study on French cities between 2018 and 2021
There is an uneven distribution of general practitioners (GPs) across territories of developed countries leading to inequalities in access to health care. Countries are implementing incentive or coercive policies depending on the characteristics of their health system. Several studies suggest that the location of practical training may influence the location of GPs’ practices. The objective of this study is to investigate the existence of a relationship between training supervision and evolution of the density of GPs in French municipalities between 2018 and 2021.Methods
The evolution of the density of GPs in almost all French municipalities between 2018 and 2021 was followed up. A bivariate statistical analysis was carried out to look for a relationship between the evolution of the density of GPs and the number of training supervisors. Other bivariate analyses were carried out with other factors likely to influence the density of GPs, such as the existence of financial aid in the territory or the age of GPs. A multivariate analysis with all the significant variables in bivariate analysis was then carried out using the stepwise descending method.Results
A total of 34 990 (99.9%) French municipalities were included in the follow-up. Among these, 9427 (26.9%) had a GP and 3866 (11%) had a GP involved in the training supervision. The density of GPs in French cities decreased on average by 2.17% between 2018 and 2021. Territories without training supervisors decreased by 4.63% while those with at least one increased by 1.36% (p < 0.01). This significant relationship was also found in multivariate analysis.Conclusion
The training supervision is associated with a better evolution of density of GPs in French municipalities. This association persisted when other factors were considered. The results of this 3-year follow-up may lead us to consider the training supervision as a factor to regulate the distribution of GPs.
Building patient trust in health systems: A qualitative study of facework in the context of the Aboriginal and Torres Strait Islander Health Worker role in Queensland, Australia.
WHO competency framework for health authorities and institutions to manage infodemics: its development and features
In April 2020, the World Health Organization (WHO) Information Network for Epidemics produced an agenda for managing the COVID-19 infodemic. “Infodemic” refers to the overabundance of information—including mis- and disinformation. In this agenda it was pointed out the need to create a competency framework for infodemic management (IM). This framework was released by WHO on 20th September 2021. This paper presents the WHO framework for IM by highlighting the different investigative steps behind its development.Methods
The framework was built through three steps. Step 1 included the preparatory work following the guidelines in the Guide to writing Competency Framework for WHO Academy courses. Step 2 was based on a qualitative study with participants (N = 25), identified worldwide on the basis of their academic background in relevant fields of IM or of their professional experience in IM activities at the institutional level. The interviews were conducted online between December 2020 and January 2021, they were video-recorded and analyzed using thematic analysis. In Step 3, two stakeholder panels were conducted to revise the framework.Results
The competency framework contains four primary domains, each of which comprised main activities, related tasks, and knowledge and skills. It identifies competencies to manage and monitor infodemics, to design, conduct and evaluate appropriate interventions, as well as to strengthen health systems. Its main purpose is to assist institutions in reinforcing their IM capacities and implementing effective IM processes and actions according to their individual contexts and resources.Conclusion
The competency framework is not intended to be a regulatory document nor a training curriculum. As a WHO initiative, it serves as a reference tool to be applied according to local priorities and needs within the different countries. This framework can assist institutions in strengthening IM capacity by hiring, staff development, and human resources planning.
An overview of health workforce education and accreditation in Africa: implications for scaling-up capacity and quality
For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualified health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region.Methods
A cross-sectional study was conducted using a standardized questionnaire from January 2018 to April 2019. All the 47 countries in the Region were invited to complete a structured questionnaire based on available secondary information from health sector reports, annual HRH reports, country health workforce profiles, and HRH observatories and registries.Results
Data from 43 countries in the World Health Organization African Region in 2018 show that there were 4001 health training institutions with 410, 1469 and 2122 being medical, health sciences, and nursing and midwifery schools, respectively, and 2221, 1359 and 421 institutions owned by the public, private for-profit and private not-for-profit sectors, respectively. A total of 148 357 health workers were produced in Region with 40% (59, 829) being nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Overall, 31 countries (79%) in the Region have an accreditation framework for the health training institutions and seven countries do not have any accreditation mechanism.Conclusion
To achieve universal health coverage, matching of competencies with population needs, as well as increasing capacities for health worker production to align with demand (numbers and skill-mix) for improved service delivery should be prioritized, as this would improve the availability of skilled health workforce in the Region.
The organisation of the 24-h day for hospital nurses in two 12-h shifts has been introduced with value propositions of reduced staffing costs, better quality of care, more efficient work organisation, and increased nurse recruitment and retention. While existing reviews consider the impact of 12-h shifts on nurses’ wellbeing and performance, this discussion paper aims to specifically shed light on whether the current evidence supports the value propositions around 12-h shifts. We found little evidence of the value propositions being realised. Staffing costs are not reduced with 12-h shifts, and outcomes related to productivity and efficiency, including sickness absence and missed nursing care are negatively affected. Nurses working 12-h shifts do not perform more safely than their counterparts working shorter shifts, with evidence pointing to a likely negative effect on safe care due to increased fatigue and sleepiness. In addition, nurses working 12-h shifts may have access to fewer educational opportunities than nurses working shorter shifts. Despite some nurses preferring 12-h shifts, the literature does not indicate that this shift pattern leads to increased recruitment, with studies reporting that nurses working long shifts are more likely to express intention to leave their job. In conclusion, there is little if any support for the value propositions that were advanced when 12-h shifts were introduced. While 12-h shifts might be here to stay, it is important that the limitations, including reduced productivity and efficiency, are recognised and accepted by those in charge of implementing schedules for hospital nurses.
The risk of spreading emerging and reemerging diseases has been increasing by the interactions of human – animal – ecosystems and increases account for more than one billion cases, a million deaths and caused hundreds of billions of US dollars of economic damage per year in the world. Countries in which their household income is dependent on livestock are characterized by a strong correlation between a high burden of zoonotic disease and poverty. The One Health approach is critical for solutions to prevent, prepare for, and respond to these complex threats. As part of the implementation of the Global Health Security Agenda, Ethiopia has embraced the One Health approach to respond to the existing and emerging threats. Several developments have been made to pioneer One Health schemes in Ethiopia which includes establishment of the National One Health Steering Committee and Technical Working Groups, prioritization of zoonotic diseases based on their impact on human and livestock, the development of prevention and control working documents for prioritized zoonotic diseases, joint disease surveillance and outbreak investigation, prioritization of zoonotic diseases, capacity building and other One Health promotions. Nevertheless, there are still so many challenges which need to be addressed. Poor integration among sectors in data sharing and communication, institutionalization of One Health, lack of continuous advocacy among the community, lack of financial funds from the government, limited research fund and activities on One Health, etc. are among many challenges. Hence, it is critical to continue raising awareness of One Health approach and foster leaders to work across disciplines and sectors. Therefore, continuous review on available global and national one health information and achievements to provide compiled information for more understanding is very important.