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To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment.
Introduction:
Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners.
Methods:
This cross-sectional survey was conducted among 144 medical students. To estimate students’ preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed.
Findings:
All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
This chapter explores the linkages between Sustainable Development Goal (SDG) 3 ‘Health’ and SDG 5 ‘Achieve gender equality and empower all women and girls’. We argue that health equity and gender equality are ‘twin forces’ that are historically connected and cannot be separated, creating either strong co-benefits or a ‘double jeopardy’ scenario for health and gender equality. Developments at the cross-roads of SDG 3 and SDG 5 are never ‘gender neutral’ and need attention for two reasons: to strengthen the health policy co-benefits and to prevent and mitigate adverse effects if gender equality is ignored. We introduce a conceptual model of researching co-benefits that expands the focus on macro-level co-benefits towards more complex governance processes and outcomes, including gender mainstreaming approaches. Selected empirical case studies consider major targets of SDG 5 and related SDG 3 sub-goals, illustrating different scenarios of implementation of health and gender co-benefits in a range of policy and governance contexts. The empirical cases illustrate that governance actions and intersectoral structures/institutional pathways shape the ‘windows of opportunity’ for co-benefits, yet co-benefits remain contested and must be re-assured, a lesson most recently learned from the COVID−19 pandemic.
The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care.
Aim:
To explore the experiences and career development opportunities for trainee nursing associates based in primary care.
Methods:
This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically.
Findings:
Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a ‘valuable opportunity for career progression’. Trainees were frustrated by the ‘emphasis on secondary care’ in both academic content and placement portfolio requirements. They also experienced ‘inconsistency in support’ from their managers and assessors and noted a number of ‘constraints to their learning opportunities’, including the opportunity to progress to become registered nurses.
Conclusion:
This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.
To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England.
Background:
Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this.
Methods:
This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach.
Findings:
Three themes were developed: ‘Understanding the trainee role and requirements’, ‘Trainee support in primary care’ and ‘Skills and scope of practice’. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.
There is a growing recognition that the increased demand for health services brought about by population growth, aging, and economic development is putting greater emphasis on how countries train, recruit, deploy, retain, and manage their health workforce. This has resulted in an unprecedented and much-needed focus on health workforce policy, planning, production, deployment, and ongoing professional development, while taking labour market factors into account. Low- and middle-income countries (L&MICs) must develop effective strategies to optimize health workforce supply while also supporting recruitment, deployment, retention, and performance in order to address their health workforce challenges. The challenge ahead is to decide on what to do and, more importantly, how to do it. This Chapter focuses on the use of labour market dynamics concepts and frameworks in developing policies and strategies to address the current workforce challenges in L&MICs.
Health workforce development is essential for achieving the goals of an effective health system, as well as establishing national Health Emergency and Disaster Risk Management (Health EDRM).
Study Objective:
The objective of this Delphi consensus study was to identify strategic recommendations for strengthening the workforce for Health EDRM in low- and middle-income countries (LMIC) and high-income countries (HIC).
Methods:
A total of 31 international experts were asked to rate the level of importance (one being strongly unimportant to seven being strongly important) for 46 statements that contain recommendations for strengthening the workforce for Health EDRM. The experts were divided into a LMIC group and an HIC group. There were three rounds of rating, and statements that did not reach consensus (SD ≥ 1.0) proceeded to the next round for further ranking.
Results:
In total, 44 statements from the LMIC group and 34 statements from the HIC group attained consensus and achieved high mean scores for importance (higher than five out of seven). The components of the World Health Organization (WHO) Health EDRM Framework with the highest number of recommendations were “Human Resources” (n = 15), “Planning and Coordination” (n = 7), and “Community Capacities for Health EDRM” (n = 6) in the LMIC group. “Policies, Strategies, and Legislation” (n = 7) and “Human Resources” (n = 7) were the components with the most recommendations for the HIC group.
Conclusion:
The expert panel provided a comprehensive list of important and actionable strategic recommendations on workforce development for Health EDRM.
Literature investigating the change in psychological problems of the health care workers (HCWs) throughout the coronavirus disease (COVID-19) pandemic is lacking. We aimed at comparing the psychological problems and attitudes toward work among HCWs over two waves of the COVID-19 pandemic in India.
Methods:
A survey was conducted involving HCWs (n = 305, first wave, 2020; n = 325, second wave, 2021). Participants’ demographic and professional and psychological characteristics (using attitude toward COVID-19 questionnaire [ATCQ]; Depression, Anxiety, and Stress Scale – 21 Items and impact of event scale – 22) were recorded. The unpaired t-test/chi-squared test was used for comparison.
Results:
Significant improvements (χ2(1) = 7.3 to 45.6, P < 0.05) in level of depression (42.2% vs 9.6%), anxiety (41.3% vs 16.3%), stress (30.1% vs 6.7%), event-related stress symptoms (31.2% vs 27%), work-related stress (89.8% vs 76.8%), and stigma (25.9% vs 22.8, though marginally significant) were found among the participants of the second wave (vs first wave). However, on subgroup analysis, allied-HCWs (housekeeping staff and security personnel) reported lesser concerns over the domains of the ATCQ vis-a-viz frontline-HCWs (doctors and nurses).
Conclusion:
This improvement could be attributed to greater awareness about the illness, better coping skills, vaccination, and so forth; however, more research is warranted to investigate these determinants.
Health systems are fluid and their components are interdependent in complex ways. Policymakers, academics and students continually endeavour to understand how to manage health systems to improve the health of populations. However, previous scholarship has often failed to engage with the intersections and interactions of health with a multitude of other systems and determinants. This book ambitiously takes on the challenge of presenting health systems as a coherent whole, by applying a systems-thinking lens. It focuses on Malaysia as a case study to demonstrate the evolution of a health system from a low-income developing status to one of the most resilient health systems today. A rich collaboration of multidisciplinary academics working with policymakers who were at the coalface of decision-making and practitioners with decades of experience, provides a candid analysis of what worked and what did not. The result is an engaging, informative and thought-provoking intervention in the debate. This title is Open Access.
The chapter analyses the 60-year evolution of the health workforce as it responded to the evolving demands of various branches of health service delivery. The analysis encompasses the limiting and enabling factors that determined the evolution of the profile of the health workforce. This includes societal education levels, economic growth, and demographic and population behavioural patterns, as well as macroeconomic and health policies. Included also is the influence of governance measures and leadership in shaping the key characteristics of the health workforce and, in turn, the influence of the competence and mobility of the health workforce on equitable access to healthcare services and the satisfaction of clients. The complex but iterative relationship between production and utilisation of the health workforce is explored.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
Over the past 30 years, a number of national and international commission reports focus on the future of the health workforce related to availability, accessibility, acceptability and quality factors of human resources for health. Specific to a sexual and reproductive health (SRH) workforce, the World Health Organization (WHO) provides leadership for delivery of essential SRH care by competent health workers around the world. According to the WHO, SRH care goes beyond maternal child health care to include the SRH of men and women throughout their life-cycle, and adolescents of both sexes delivered as integrated services within a primary care system. SRH extends before and beyond the years of reproduction, and it is closely associated with sociocultural factors, gender roles and the protection of human rights. Global and national examples, like the US Ryan Residency Training and Family Planning Fellowship programs, described elsewhere in this book, highlight the policy interventions to align SRH practice, education, and credentialing to address challenges and progress to improving SRH workforce capacity.
International medical graduates provide a valuable service to the healthcare of their adopted countries. However, there remain a significant number of challenges in their adjustment and acculturation in the post-migration phase. We believe that the cultural capital these doctors bring with them can act as a support as well as a challenge. They are likely to face subtle and not-so-subtle, covert and overt discrimination at a number of levels. In this brief report, we highlight some of the issues faced by them and some potential solutions.
Health research remains a vital activity of Indigenous health workforces. This paper reports on the main findings of yarning interviews with 14 Indigenous researchers, that was central to a project analysing the role of research training infrastructures in strengthening the Indigenous health research workforce in Australia. The findings highlighted Indigenous researcher peers as core sources of inspiration, moral support and sustenance in academia and in life. Peer generative power arising from peer groups provide a unique enriching to the educational and research experience. Indigenous researcher peers have a strong shared aspiration to champion change to health research and higher education as a key pathway to widespread positive impacting on health and well-being. We suggest the (revived) development at a collective level of a strategic and planned approach to capitalising on the positive outcomes of peer generated leadership and support.
This study takes a retrospective look at the educational experiences of Indigenous health professionals who graduated from The University of Queensland's Indigenous Health Program between 1994 and 2005, to understand the enablers for growing an Indigenous health workforce capable of advancing the health of Indigenous peoples. Drawing on the qualitative accounts of 31 students and 9 staff members, this paper examines the enablers to educational success at this time, juxtaposed against current Indigenising agendas in higher education, of aspiration and capacity building alongside the task of embedding Indigenous knowledges within curricula. We look back not as a call to return to Indigenous-specific cohort courses but rather reconsider both the measures of and strategies for success in Indigenous higher education, within health and beyond, interrogating the ideological assumptions that inform them.
This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure.
Methods:
A review of laboratory records and regulations, interviews with key respondents, and observing work processes provided data for the World Health Organization method for determining staffing needs based on workload indicators (Workload Indicators of Staffing Need, WISN).
Results:
A total of 99 laboratory workers spend almost 70% of their available working time in undertaking core activities. Core activities per sample can take from 0.25 to 180 min. Laboratory workers are under moderate or high workload pressure (the WISN ratio from 0.86 to 0.50). The WISN difference indicates a shortage of 22.22% of laboratory analysts and 20.63% of laboratory technicians. To balance the staffing to workload, these laboratories need an additional 8 FTE analysts and 13 FTE technicians. They could also consider selectively reducing workload pressure by automating some of the additional activities while maintaining the competence of laboratory workers and opportunities for professional development.
Conclusions:
Staffing policy should account for work processes, activity standards, and workload pressure to determine necessary staffing to meet the need for laboratory services in the local context.
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