Using modeling and scenario analysis to support evidence-based health workforce strategic planning in Malawi

Abstract Background

A well-trained and equitably distributed workforce is critical to a functioning health system. As workforce interventions are costly and time-intensive, investing appropriately in strengthening the health workforce requires an evidence-based approach to target efforts to increase the number of health workers, deploy health workers where they are most needed, and optimize the use of existing health workers. This paper describes the Malawi Ministry of Health (MoH) and collaborators’ data-driven approach to designing strategies in the Human Resources for Health Strategic Plan (HRH SP) 2018–2022.

Methods

Three modelling exercises were completed using available data in Malawi. Staff data from districts, central hospitals, and headquarters, and enrollment data from all health training institutions were collected between October 2017 and February 2018. A vacancy analysis was conducted to compare current staffing levels against established posts (the targeted number of positions to be filled, by cadre and work location). A training pipeline model was developed to project the future available workforce, and a demand-based Workforce Optimization Model was used to estimate optimal staffing to meet current levels of service utilization.

Results

As of 2017, 55% of established posts were filled, with an average of 1.49 health professional staff per 1000 population, and with substantial variation in the number of staff per population by district. With current levels of health worker training, Malawi is projected to meet its establishment targets in 2030 but will not meet the WHO standard of 4.45 health workers per 1000 population by 2040. A combined intervention reducing attrition, increasing absorption, and doubling training enrollments would allow the establishment to be met by 2023 and the WHO target to be met by 2036. The Workforce Optimization Model shows a gap of 7374 health workers to optimally deliver services at current utilization rates, with the largest gaps among nursing and midwifery officers and pharmacists.

Conclusions

Given the time and significant financial investment required to train and deploy health workers, evidence needs to be carefully considered in designing a national HRH SP. The results of these analyses directly informed Malawi’s HRH SP 2018–2022 and have subsequently been used in numerous planning processes and investment cases in Malawi. This paper provides a practical methodology for evidence-based HRH strategic planning and highlights the importance of strengthening HRH data systems for improved workforce decision-making.

Categorías: Investigaciones

Insights in interprofessional education: Dental hygiene students' suggestions for collaboration.

Search "Educación Interprofesional" - Vie, 15/04/2022 - 05:45
Background: Interprofessional education (IPE) promotes team-based approaches to professional practice and lifelong collaboration. However, there is little consensus on its "best practice" in dentistry and dental hygiene curricula. This study aimed to explore dental hygiene students' perceptions and experiences of collaboration with dentistry students in an IPE program that authentically represents private practice settings and work processes. The intent was to identify what students thought would best help prepare them to work collaboratively in an oral health team once they graduated after participating in this experience. Methods: Data were collected from 40 dental hygiene student written reflections and 6 dental hygiene students through a focus group session that was audiorecorded and transcribed. Data were examined using thematic analysis. Results: Five interrelated themes emerged: 1) understanding of roles and responsibilities; 2) hierarchical perceptions and level of experience; 3) team dynamics; 4) instructor and staff involvement and support; and 5) timing and structure of IPE activities. The findings suggest that dental hygiene students need consistent and sustained access to realistic environments in which to practise team roles and work directly with dentistry students. Opportunities to build relationships with dentistry students before working together in professional roles appear to alleviate hierarchical concerns that impede teamwork. Conclusion: IPE should occur throughout students' education as hierarchical perceptions appear to influence collaboration. Informal and/or non-clinical IPE opportunities should be introduced early in students' education to develop a foundation for team dynamics in later formal and/or clinical IPE activities. Students should collaborate in ways that will be reflected in professional expectations after graduation; the environment in which they learn their team role should provide the opportunity to authentically practise it. Contexte: La formation interprofessionnelle (FIP) favorise les approches basées sur le travail d'équipe en matière d'exercice professionnel et de collaboration tout au long de la vie. Cependant, il y a peu de consensus quant à ses « meilleures pratiques ¼ lorsqu'il s'agit de programmes de dentisterie et d'hygiène dentaire. La présente étude visait à explorer la perception et les expériences des étudiants en hygiène dentaire en matière de collaboration avec les étudiants en dentisterie dans le cadre d'un programme de FIP qui représente de manière authentique les contextes et les processus de travail en cabinet privé. L'intention était de définir ce qui, selon les étudiants, les préparerait le mieux à travailler en collaboration au sein d'une équipe de soins buccodentaires après avoir obtenu leur diplôme. Méthodologie: Des données ont été recueillies à partir de réflexions écrites par 40 étudiants en hygiène dentaire et de 6 étudiants en hygiène dentaire dans le cadre d'une séance de groupe de discussion audio enregistrée et transcrite. Les données ont été examinées par analyse thématique. Résultats: Cinq thèmes interdépendants ont été dégagés : 1) la compréhension des rôles et des responsabilités; 2) les perceptions hiérarchiques et le niveau d'expérience; 3) la dynamique du travail d'équipe; 4) la participation et le soutien des enseignants et du personnel; et 5) le moment choisi et la structure des activités de FIP. Les résultats suggèrent que les étudiants en hygiène dentaire ont besoin d'un accès constant et soutenu aux environnements réalistes dans lesquels ils peuvent assumer les rôles de l'équipe et travailler directement avec des étudiants en dentisterie. Les possibilités de tisser des liens avec les étudiants en dentisterie avant de travailler ensemble dans des rôles professionnels semblent réduire les préoccupations hiérarchiques qui font obstacle au travail d'équipe. Conclusion: La FIP doit avoir lieu tout au long de la formation des étudiants, puisque les perceptions hiérarchiques semblent influencer la collaboration. Les occasions de FIP informelles ou non cliniques doivent être introduites tôt dans la formation des étudiants afin de créer une fondation de dynamique pour l'équipe lors des activités de FIP formelles ou cliniques ultérieures. Les étudiants doivent collaborer de façons qui seront reflétées dans les attentes professionnelles après l'obtention de leur diplôme. L'environnement dans lequel ils apprennent leur rôle au sein de l'équipe devrait leur fournir l'occasion de l'exercer de manière authentique.

Leveraging interprofessional education to build high functioning teams.

Search "Educación Interprofesional" - Vie, 15/04/2022 - 05:45
As a psychologist, the author says that her role in the integrated primary care team has always been that of the behavioral health provider, serving to promote the holistic health of the patients and families with whom she works as part of the larger integrated team. Central to both Primary Care Behavioral Health and the Collaborative Care model-as well as other models of integration-is that the health care team works to address fragmented care in order to most comprehensively address patient needs. And yet we often focus on training to the model in which behavioral health providers work. As we think about the future of integrated health care workforce development, shouldn't we instead focus on training future health care professionals to develop and lead high functioning teams? As we work toward more comprehensively addressing the holistic needs of marginalized populations, it is becoming increasingly clear that we need to consider how our functions and roles be leveraged across diverse models of integration, team composition, and practice sites, while recognizing that our current educational systems might not yet adequately prepare us to do so. More widespread adoption of interprofessional education (IPE) across the educational life span may serve as one mechanism to enhance interprofessional competencies, though IPE is not without its challenges. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Simulação de alta-fidelidade na formação de uma equipa de emergência médica intra-hospitalar

Search "Educación Interprofesional" - Vie, 15/04/2022 - 05:45
O Departamento para a Qualidade em Saúde da Direção Geral da Saúde, determinou, em junho de 2010 pela Circular Normativa número 15, a criação e implementação de uma Equipa de Emergência Médica Intra-Hospitalar em cada hospital do Serviço Nacional de Saúde, recomendando um programa de melhoria contínua e ressalvando a necessidade de formação contínua da equipa. No norte do país, a Escola de Formação em Emergência de uma Unidade Local de Saúde criou um produto pedagógico destinado à formação dos enfermeiros e médicos, recorrendo à simulação como estratégia pedagógica ­ o EMI-Sim, desenvolvido com a colaboração de uma Escola Superior de Saúde. Este estudo pretendeu avaliar a experiência dos formandos com o curso EMI-Sim e tem como objetivos específicos: avaliar os ganhos percebidos, através da Escala de Ganhos Percebidos com a Simulação de Alta-Fidelidade (EGPSA); avaliar a qualidade do debriefing associado à simulação, através da Escala de Avaliação do Debriefing associado à Simulação (EADaS); avaliar a estruturação dos cenários, e a importância que os participantes lhe atribuem, através da Escala do Design da Simulação (EDS); analisar a associação entre o valor obtido em cada uma das escalas e as variáveis sexo, profissão e experiência anterior em simulação. Desenhámos um estudo transversal descritivo, de natureza quantitativa que contou com a participação de 15 profissionais (7 enfermeiros e 8 médicos), e que decorreu em março de 2021, durante 2 dias (16 horas). Para a recolha de dados utilizámos três escalas validadas (EGPSA, EADaS e EDS). Os dados foram posteriormente tratados com o software IBM® SPSS® Statistics, versão 26. Relativamente aos ganhos percebidos, foram avaliados com valor médio de 4,04 (±0,331) oscilando entre 3,46 e 4,62 numa escala de 1 a 5. Ao debriefing foi atribuído o valor médio de 4,46 ± 0,334, destacando-se o valor afetivo com média de 4,75 ± 0,256. As práticas educativas obtiveram valor médio de 4,55 ± 0,460, a importância atribuída aos itens obteve média de 4,70 ± 0,460, com 75% dos participantes a atribuir importância aos itens da escala. As escalas apresentaram correlação estatisticamente significativa, positiva, de intensidade média entre si, à exceção da sub-escala importância atribuída ao design da simulação que apenas apresenta correlação com a sub-escala práticas educativas. Em suma, os participantes perceberam os ganhos associados à SAF de forma positiva, centrando as suas respostas em melhorei consideravelmente; o debriefing associado à simulação afirmou-se como um elemento fundamental desta estratégia de educação interprofissional aprimorada por simulação; quanto às práticas educativas utilizadas no design da simulação, manifestaram, em termos médios, concordância com as afirmações apresentadas, e constatou-se que essas práticas são muito valorizadas pelos mesmos. Verificou-se a existência de diferença estatisticamente significativa, entre médicos e enfermeiros, no valor atribuído ao debriefing e na avaliação do design da simulação, sendo que os enfermeiros pontuaram com valores superiores nas duas escalas. Os instrumentos utilizados demonstraram, através da análise da consistência interna, boas propriedades psicométricas, com valores de alfa de Cronbach superiores a 0,8, constituindo-se assim como ferramentas adequadas à avaliação contínua do produto pedagógico. Seria pertinente a replicação do estudo numa amostra mais representativa, assim como a inclusão de instrumentos capazes de aferir quais os contributos que advêm da formação interprofissional. The Department for Quality in Health of the Health Coordination, determined, in June 2010 by Normative Circular number 15, the creation and implementation of an In-Hospital Medical Emergency Team in each hospital of the National Health Service recommending a program of continuous improvement and emphasizing the need for continuous training of the team. In the north of the country, the Emergency Training School of a Local Health Unit created a pedagogical product for the training of nurses and doctors, using simulation as a pedagogical strategy ­ the EMI-Sim, developed in collaboration with a Health Superior School. This study aimed to assess the experience of trainees with the EMI-Sim course and has the following specific objectives: evaluate the gains perceived, through the Scale of Perceived Gains from High-Fidelity Simulation (EGPSA); assess the quality of debriefing associated with simulation, through the Simulation Debriefing Assessment Scale (EADaS); assess the structuring of scenarios, and the importance that participants attribute to it, through the Simulation Design Scale (EDS); analyse the association between the value obtained in each of the scales and the variables sex, profession and previous experience in simulation. We designed a cross-sectional descriptive study, of a quantitative nature, with the participation of 15 professionals (7 nurses and 8 doctors), held in March 2021, for 2 days (16 hours). For data collection, we used three validated scales (EGPSA, EDaS and EDS). The data were treated with the IBM® SPSS® Statistics software, version 26. Regarding the perceived gains, these were evaluated with an average value of 4.04 (±0.331) ranging between 3.46 and 4.62 on a scale of 1 to 5. The debriefing was assigned an average value of 4.46 ± 0.334, highlighting if the affective value with an average of 4.75 ± 0.256. The educational practices had a mean value of 4.55 ± 0.460, the importance attributed to the items had an average of 4.70 ± 0.460, with 75% of the participants assigning importance to the items on the scale. The scales showed a statistically significant, positive correlation of medium intensity with each other, except the importance attributed to the simulation design sub-scale, which only presents a correlation with the educational practices sub-scale. The participants perceived the gains associated with the SAF in a positive way, focusing their responses on considerably improved; the debriefing associated with simulation asserted itself as a fundamental element of this simulation-enhanced interprofessional education strategy; for the educational practices used in the simulation design, they expressed, in average terms, agreement with the statements presented, and it was found that these practices are highly valued by them. There was a statistically significant difference between doctors and nurses in the value attributed to the debriefing and in the evaluation of the simulation design, with nurses scoring higher on both scales. The instruments used demonstrated, through the analysis of internal consistency, good psychometric properties, with Cronbach's alpha values above 0.8, thus constituting adequate tools for the continuous assessment of the pedagogical product. It would be pertinent to replicate the study in a more representative sample, as well as the inclusion of instruments capable of assessing the contributions that come from interprofessional training.

Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020.

In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as 'a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.' Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015-2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.
Categorías: Investigaciones

Improving public health sector service delivery in the Free State, South Africa: development of a provincial intervention model.

BACKGROUND: Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components. METHODS: This study describes the development of the 'Health Systems Governance & Accountability' (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton's (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization's (2007) conceptual framework for health system strengthening and reform comprised of six health system 'building blocks.' The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.'s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation. RESULTS: The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH's Strategic Transformation Plan 2015-2030. The HSGA intervention model was used as a tool to implement and integrate the Plan's programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them. CONCLUSION: The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.
Categorías: Investigaciones

Senior manager leadership competencies for quality residential aged care: an Australian industry perspective

Abstract Background

Documented poor quality and standards of care in Australia’s residential aged care (RAC) sector have highlighted a need to better understand the role of and skills required by, RAC senior management personnel to address these concerns. This study examined which senior management leadership skills and personal qualities are necessary to deliver and strengthen the quality of RAC, with the aim of improving understanding of the professional development needs of leaders in the sector.

Methods

We conducted 12 in-depth interviews with Australian aged care industry experts, including academics, and representatives from the primary health network, consumer, and provider advocate groups. Abductive, thematic analysis incorporated coding derived from existing leadership skills frameworks as well as inductively identified themes.

Results

Identified leadership skills were grouped into five domains including i) workforce development and retention, ii) governance and business acumen; iii) health systems knowledge; iv) stewardship and v) responding to regulatory and political contexts. Skills particularly emphasised by participants were those required to recruit and retain a skilled workforce, manage relationships, and promote a positive organisational culture and employee wellbeing.

Conclusions

RAC senior managers require a complex mix of business, human resource management, and clinical skills to deliver quality care in Australia’s complex RAC setting. The lack of any professional development framework to guide the acquisition or updating of those skills is a concern.

Categorías: Investigaciones

Facilitators and barriers to implementation of integrated community case management of childhood illness: a qualitative case study of Kapiri Mposhi District

Abstract Background

Zambia adopted the Integrated Community Case Management (ICCM) of childhood illness strategy in May 2010, targeting populations in rural communities and hard-to-reach areas. However, evidence suggests that ICCM implementation in local health systems has been suboptimal. This study sought to explore facilitators and barriers to implementation of ICCM in the health system in Kapiri Mposhi District, Zambia.

Methods

Data were gathered through 19 key informant interviews with district health managers, ICCM supervisors, health facility managers, and district health co-operating partners. The study was conducted in Kapiri Mposhi district, Zambia. Interviews were translated and transcribed verbatim. Data were were analyzed using thematic analysis in NVivo 11(QSR International).

Results

Facilitators to implementation of ICCM consisted of community involvement and support for the program, active community case detection and timeliness of health services, the program was not considered a significant shift from other community-based health interventions, district leadership and ownership of the program, availability of national and district-level policies supporting ICCM and engagement of district co-operating partners. Program incompatibility with some socio-cultural and religious cotexts, stock-out of prerequisite drugs and supplies, staff reshuffle and redeployment, inadequate supervision of health facilities, and nonpayment of community health worker incentives inhibited implementation of ICCM.

Conclusion

The study findings highlight key faciliators and barriers that should be considered by policy-makers, district health managers, ICCM supervisors, health facility managers, and co-operating partners, in designing context-specific strategies, to ensure successful implementation of ICCM in local health systems.

Categorías: Investigaciones

Mapping evidence of community health workers delivering physical rehabilitation services in sub-Saharan Africa: a scoping review protocol.

INTRODUCTION: Sub-Saharan Africa (SSA) is one of the low-income regions in the world which is affected by the critical shortage of human resources for health amid a high disease burden, including physical disability. Community health workers are viewed as the possible solution to increase population access to health services, including rehabilitation at the community level. The purpose of this scoping review is to map the evidence and scope of physical rehabilitation services delivered by community health workers in SSA. METHODS AND ANALYSIS: The framework by Arksey and O'Malley will be used to guide the scoping review protocol. Database searching will be conducted using PubMed, Scopus, Cochrane Central and databases within the EBSCOhost platform. Other sources of literature will include reference lists, conference presentations and publications on organisational websites such as WHO, Ministries of Health, and Non-governmental Organisations in SSA. The screening will be guided by the inclusion and exclusion criteria. Thematic content analysis aided by NVivo V.12 will be done to present the narrative account of the review. The Mixed Methods Appraisal Tool version 2018 will be used to evaluate the methodological quality of the studies. ETHICS AND DISSEMINATION: The review is part of a larger study that has received ethical clearance. The result will be disseminated using print and electronic media.
Categorías: Investigaciones

Improving public health sector service delivery in the Free State, South Africa: development of a provincial intervention model

Abstract Background

Public health sector service delivery challenges leading to poor population health outcomes have been observed in the Free State province of South Africa for the past decade. A multi-method situation appraisal of the different functional domains revealed serious health system deficiencies and operational defects, notably fragmentation of healthcare programmes and frontline services, as well as challenges related to governance, accountability and human resources for health. It was therefore necessary to develop a system-wide intervention to comprehensively address defects in the operation of the public health system and its major components.

Methods

This study describes the development of the ‘Health Systems Governance & Accountability’ (HSGA) intervention model by the Free State Department of Health (FSDoH) in collaboration with the community and other stakeholders following a participatory action approach. Documented information collected during routine management processes were reviewed for this paper. Starting in March 2013, the development of the HSGA intervention model and the concomitant application of Kaplan and Norton’s (1992) Balanced Scorecard performance measurement tool was informed by the World Health Organization’s (2007) conceptual framework for health system strengthening and reform comprised of six health system ‘building blocks.’ The multiple and overlapping processes and actions to develop the intervention are described according to the four steps in Kaplan et al.’s (2013) systems approach to health systems strengthening: (i) problem identification, (ii) description, (iii) alteration and (iv) implementation.

Results

The finalisation of the HSGA intervention model before end-2013 was a prelude to the development of the FSDoH’s Strategic Transformation Plan 2015–2030. The HSGA intervention model was used as a tool to implement and integrate the Plan’s programmes moving forward with a consistent focus on the six building blocks for health systems strengthening and the all-important linkages between them.

Conclusion

The model was developed to address fragmentation and improve public health service delivery by the provincial health department. In January 2016, the intervention model became an official departmental policy, meaning that it was approved for implementation, compliance, monitoring and reporting, and became the guiding framework for health systems strengthening and transform in the Free State.

Categorías: Investigaciones

Perspectives on deployment of humanitarian workers through operational partnerships during the acute emergency health response to the Rohingya refugee crisis in Cox's Bazar.

BACKGROUND: The unprecedented influx of Rohingya refugees into Cox's Bazar, Bangladesh, in 2017 led to a humanitarian emergency requiring large numbers of humanitarian workers to be deployed to the region. The World Health Organization (WHO) contributed to this effort through well-established deployment mechanisms: the Global Outbreak Alert and Response Network (GOARN) and the Standby Partnerships (SBP). The study captures the views and experiences of those humanitarian workers deployed by WHO through operational partnerships between December 2017 and February 2019 with the purpose of identifying challenges and good practice during the deployment process, and steps to their improvement. METHODS: A mixed methods design was used. A desktop review was conducted to describe the demographics of the humanitarian workers deployed to Cox's Bazar and the work that was undertaken. Interviews were conducted with a subset of the respondents to elicit their views relating to their experiences of working as part of the humanitarian response. Thematic analysis was used to identify key themes. RESULTS: We identified sixty-five deployments during the study period. Respondents' previous experience ranged between 3 and 28 years (mean 9.7 years). The duration of deployment ranged from 8 to 278 days (mean 67 days) and there was a higher representation of workers from Western Pacific and European regions. Forty-one interviews were conducted with people who experienced differing aspects of the deployment process. Key themes elicited from interviews related to staffing, the deployment process, the office environment and capacity building. Various issues raised have since been addressed, including the establishment of a sub-office structure, introduction of online training prior to deployment, and a staff wellbeing committee. CONCLUSIONS: This study identified successes and areas for improvement for deployments during emergencies. The themes and subthemes elicited can be used to inform policy and practice changes, as well as the development of performance indicators. Common findings between this study and previous literature indicate the pivotal role of staff deployments through partnership agreements during health emergency response operations and a need for continuous improvements of processes to ensure maximum effectiveness.
Categorías: Investigaciones

Leadership, politics, and communication: challenges of the epidemiology workforce during emergency response

Abstract Background

Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response.

Methods

We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive sampling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis.

Results

We received 166 responses from individuals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well; males who requested support were statistically more likely to receive it than females who asked.

Conclusions

Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.

Categorías: Investigaciones

Mitigating psychological distress in healthcare workers as COVID-19 waves ensue: a repeated cross-sectional study from Jordan

Abstract Background

Jordan has experienced several COVID-19 waves in the past 2 years. Cross-sectional studies have been conducted to evaluate distress in healthcare practitioners (HCPs), but there is limited evidence with regards to the impact of continuing pandemic waves on levels of distress in HCPs. We previously studied psychological distress in HCPs during the start of the pandemic (period 1, when cases were infrequent and the country was in lockdown), and demonstrated that HCPs were experiencing considerable stress, despite the country reporting low caseloads at the time. In this study, we sought to utilize the same methodology to reexamine levels of distress as COVID-19 peaked in the country and HCPs began managing large numbers of COVID-19 cases (period 2).

Methods

A cross-sectional online survey utilizing a tool previously used during period 1 was completed by HCPs working in various settings. Demographic, professional and psychological factors such as distress, anxiety, depression, burnout, sleep issues, exhaustion, and fear were assessed; and coping strategies also were measured. Items in the tool were assessed for reliability and validity. A multivariable regression was used to identify factors that continued to impact distress during period 2.

Results

Samples in both periods (n = 937, n = 876, respectively) were relatively comparable in demographic characteristics, but in period 2, a greater proportion of nurses and healthcare practitioners reported working in general hospitals. During the pandemic peak (period 2), 49.0% of HCPs reported high levels of distress (compared to 32% in period 1); anxiety and depression scores were approximately 21% higher in period 2; and 50.6% reported fatigue (compared to 34.3% in period 1). Variables significantly associated with greater distress in period 2 included experiencing burnout, experiencing sleep disturbances, being fatigued, having fatalistic fears, and having fears related to workload. Conversely, being male, reporting satisfaction at work, and using positive coping practices were associated with a significantly lower odds of being in distress.

Conclusions

Between the two periods (early pandemic and first wave), COVID-19-related mental health continued to deteriorate among HCPs, highlighting the need to do more to support HCP front-liners facing COVID-19 surges.

Categorías: Investigaciones

Online interprofessional education for in-service health-care providers improved HIV performance indicators at health facilities in Uganda: a targeted training approach.

Search "Educación Interprofesional" - Vie, 08/04/2022 - 06:35
BACKGROUND: The Makerere University Education for Interprofessional HIV Service Delivery in Uganda capacity-building programme provides online, in-service interprofessional education to HIV health-care providers through a case-based approach. We used this training to address suboptimal performance among health-care providers. METHODS: We used a multilayered integrated training and impact assessment on HIV health outcomes. In partnership with a Ugandan organisation implementing the US President's Emergency Plan for AIDS Relief, we identified health facilities underperforming on selected HIV programme indicators: pre-exposure retention at 12 months for key populations and viral load suppression and annual retention for key populations, which could be aligned with the training modules. We selected health-care providers committed to completing the interprofessional education training and application of interprofessional practice at their workstations from five health facilities. Selected health-care providers were enrolled for the Makerere University Education for Interprofessional HIV Service Delivery in Uganda online training programme. FINDINGS: Of the health-care providers enrolled (n=55), 32 (58%) were women; 17 (31%) were nurses; 9 (16%) were clinical officers; 8 (15%) were counsellors; 6 (11%) were medical officers; 5 (9%) were data clerks; 4 (7%) were laboratory personnel; and 6 (11%) included social workers, records officers, and dispensers. 45 (82%) health-care providers completed the training, and four of the five health facilities initiated quality improvement projects aligned with baseline indicators. The percentage of pre-exposure retention at 12 months improved from 4% to 80%; the percentage of viral load coverage for key populations improved from 50% to 94%; the percentage of viral load suppression improved from 80% to 96%; and the percentage of annual retention for key populations improved from 63% to 85%. INTERPRETATION: In-service and online interprofessional education training, interprofessional practice mentorship, and continuous quality improvement for HIV care improved HIV programme indicators. A multilevel stakeholder engagement strategy was associated with strengthened training and enhanced potential for sustainability and impact on patient outcomes. FUNDING: Human Resources Services Administration through award 6U1NHA31422-02-04 to University of California San Francisco and African Forum for Research and Education in Health.

Transferring interprofessional education concepts across sites - experiences and recommendations for practice.

Search "Educación Interprofesional" - Vie, 08/04/2022 - 06:35
Aim: Interprofessional education for health care professionals should be anchored at all training and study locations across Germany. In cooperation with the Medical Faculty Mannheim, an education concept trialed there, namely a longitudinal interprofessional learning sequence, was transferred and adapted to the Medical Faculty Dresden as part of the "Operation Team" support program. Here, the structured analysis and evaluation of the knowledge transfer experience is presented from the perspective of the transferee. From these findings, recommendations are derived for the planning of knowledge transfer projects. Methods: The consulting work between the two faculties was listed chronologically including knowledge transfer outcomes and was described and analyzed using the comparative categories identified in sociological systems theory and in the knowledge transfer literature. In addition, knowledge transfer outcomes were categorized according to their use and their relevance to the progress of the project was assessed. Results: The coordination teams initiated 13 consulting sessions, primarily held virtually or by telephone. From these, 36 knowledge transfer outcomes were identified, of which most were of high relevance for the transferee in all use categories. The knowledge transfer core themes were of a strategic (e.g. the consolidation of interprofessional teaching) and content-based/didactic-methodological nature (e.g. interprofessional session design, tutor training). Conclusion: The consulting sessions played a major role in facilitating the establishment of two interprofessional learning sequences and the piloting of the associated sessions at the Dresden site. The recommendations derived for a successful transfer could also be of help for other transfer projects.

Translation of an evidence-based virtual reality simulation-based interprofessional education into health education curriculums: An implementation science method.

Search "Educación Interprofesional" - Vie, 08/04/2022 - 06:35
BACKGROUND: The development of interprofessional competencies through an evidence-based program is paramount to nurture a collaborative practice-ready workforce for patient-centered care and safety. AIMS: To describe an implementation science approach for translation of an evidence-based virtual reality simulation-based interprofessional education (VR-Sim-IPE) program into medical and nursing curriculums, and to evaluate the implementation outcomes. METHODS: Implementation strategies from the "Expert Recommendations for Implementing Change" were used to support implementation of the VR-Sim-IPE program. This included recruiting and training 28 practicing clinicians as facilitators to deliver the program to 599 medical and nursing students. Proctor's conceptual framework for implementation outcomes was applied with multiple data collection methods to evaluate the VR-Sim-IPE program. An online survey was administered to measure the levels of acceptability, appropriateness, feasibility, and adoption. Forty-four sessions of structured observations were carried out to examine the facilitators' implementation fidelity. Individual interviews were conducted with 15 facilitators to identify the facilitators and barriers to the program implementation. An implementation cost analysis was also conducted. RESULTS: Both facilitators and students had positive perceptions of the acceptability, adoption, appropriateness, and feasibility of the VR-Sim-IPE program. Facilitators were observed to implement the program with high fidelity, including program adherence, dosage, quality of delivery, and student responsiveness. While opportunities to contribute and learn, as well as receiving training and support, were identified as facilitators to implementation, the lack of familiarity with the virtual environment, varying levels of student participation, and facilitating interprofessional groups were reported barriers. The implementation costs amounted to USD45,648.50. CONCLUSION: The evaluation of implementation outcomes identifies strategies for future implementation that could potentially enhance program acceptance, reduce implementation cost, improve penetration, and achieve program sustainability. These include increasing facilitation group size, preparing students to be active participants, and incorporating interprofessional facilitation skills in facilitators' training.

The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians.

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.
Categorías: Investigaciones

Medical education interventions influencing physician distribution into underserved communities: a scoping review

Abstract Background and objective

Physician maldistribution is a global problem that hinders patients’ abilities to access healthcare services. Medical education presents an opportunity to influence physicians towards meeting the healthcare needs of underserved communities when establishing their practice. Understanding the impact of educational interventions designed to offset physician maldistribution is crucial to informing health human resource strategies aimed at ensuring that the disposition of the physician workforce best serves the diverse needs of all patients and communities.

Methods

A scoping review was conducted using a six-stage framework to help map current evidence on educational interventions designed to influence physicians’ decisions or intention to establish practice in underserved areas. A search strategy was developed and used to conduct database searches. Data were synthesized according to the types of interventions and the location in the medical education professional development trajectory, that influence physician intention or decision for rural and underserved practice locations.

Results

There were 130 articles included in the review, categorized according to four categories: preferential admissions criteria, undergraduate training in underserved areas, postgraduate training in underserved areas, and financial incentives. A fifth category was constructed to reflect initiatives comprised of various combinations of these four interventions. Most studies demonstrated a positive impact on practice location, suggesting that selecting students from underserved or rural areas, requiring them to attend rural campuses, and/or participate in rural clerkships or rotations are influential in distributing physicians in underserved or rural locations. However, these studies may be confounded by various factors including rural origin, pre-existing interest in rural practice, and lifestyle. Articles also had various limitations including self-selection bias, and a lack of standard definition for underservedness.

Conclusions

Various educational interventions can influence physician practice location: preferential admissions criteria, rural experiences during undergraduate and postgraduate medical training, and financial incentives. Educators and policymakers should consider the social identity, preferences, and motivations of aspiring physicians as they have considerable impact on the effectiveness of education initiatives designed to influence physician distribution in underserved locations.

Categorías: Investigaciones

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