http://www.human-resources-health.com The latest research articles published by Human Resources for Health 2012-05-06T00:00:00Z Background: Cuba has extended its medical cooperation to Pacific Island Countries (PICs) by supplying doctors to boost service delivery and offering scholarships for Pacific Islanders to study medicine in Cuba. Given the small populations of PICs, the Cuban engagement could prove particularly significant for health systems development in the region. This paper reviews the magnitude and form of Cuban medical cooperation in the Pacific and analyses its implications for health policy, human resource capacity and overall development assistance for health in the region. Methods: We reviewed both published and grey literature on health workforce in the Pacific including health workforce plans and human resource policy documents. Further information was gathered through discussions with key stakeholders involved in health workforce development in the region. Results: Cuba formalised its relationship with PICs in September 2008 following the first Cuba-Pacific Islands ministerial meeting. Some 33 Cuban health personnel work in Pacific Island Countries and 177 Pacific island students are studying medicine in Cuba in 2010 with the most extensive engagement in Kiribati, the Solomon Islands, Tuvalu and Vanuatu. The cost of the Cuban medical cooperation to PICs comes in the form of countries providing benefits and paying allowances to in-country Cuban health workers and return airfares for their students in Cuba. This has been seen by some PICs as a cheaper alternative to training doctors in other countries. Conclusions: The Cuban engagement with PICs, while smaller than engagement with other countries, presents several opportunities and challenges for health system strengthening in the region. In particular, it allows PICs to increase their health workforce numbers at relatively low cost and extends delivery of health services to remote areas. A key challenge is that with the potential increase in the number of medical doctors, once the local students return from Cuba, some PICs may face substantial rises in salary expenditure which could significantly strain already stretched government budgets. Finally, the Cuban engagement in the Pacific has implications for the wider geo-political and health sector support environment as the relatively few major bilateral donors, notably Australia (through AusAID) and New Zealand (through NZAID), and multilaterals such as the World Bank will need to accommodate an additional player with whom existing links are limited. http://www.human-resources-health.com/content/10/1/10 Augustine Asante Joel Negin John Hall John Dewdney Anthony Zwi Human Resources for Health 2012, null:10 2012-05-06T00:00:00Z doi:10.1186/1478-4491-10-10 /content/figures/1478-4491-10-10-toc.gif Human Resources for Health 1478-4491 ${item.volume} 10 2012-05-06T00:00:00Z PDF Background: Despite working in a challenging environment plagued by persistent personnel shortages, public sector midwives in Senegal play a key role in tackling maternal mortality. A better understanding of how they are experiencing their work and how it is affecting them is needed in order to better address their needs and incite them to remain in their posts. This study aims to explore their job satisfaction and its effects on their burnout, intention to quit and professional mobility. Methods: A cohort of 226 midwives from 22 hospitals across Senegal participated in this longitudinal study. Their job satisfaction was measured from December 2007 to February 2008 using a multifaceted instrument developed in West Africa. Three expected effects were measured two years later: burnout, intention to quit and turnover. Descriptive statistics were reported for the midwives who stayed and left their posts during the study period. A series of multiple regressions investigated the correlations between the nine facets of job satisfaction and each effect variable, while controlling for individual and institutional characteristics. Results: Despite nearly two thirds (58.9%) of midwives reporting the intention to quit within a year (mainly to pursue new professional training), only 9% annual turnover was found in the study (41/226 over 2 years). Departures were largely voluntary (92%) and entirely domestic. Overall the midwives reported themselves moderately satisfied; least contented with their "remuneration" and "work environment" and most satisfied with the "morale" and "job security" facets of their work. On the three dimensions of the Maslach Burnout Inventory, very high levels of emotional exhaustion (80.0%) and depersonalization (57.8%) were reported, while levels of diminished personal accomplishment were low (12.4%). Burnout was identified in more than half of the sample (55%). Experiencing emotional exhaustion was inversely associated with "remuneration" and "task" satisfaction, actively job searching was associated with being dissatisfied with job "security" and voluntary quitting was associated with dissatisfaction with "continuing education". Conclusions: This study found that although midwives seem to be experiencing burnout and unhappiness with their working conditions, they retain a strong sense of confidence and accomplishment in their work. It also suggests that strategies to retain them in their positions and in the profession should emphasize continuing education. http://www.human-resources-health.com/content/10/1/9 Dominique Rouleau Pierre Fournier Aline Philibert Betty Mbengue Alexandre Dumont Human Resources for Health 2012, null:9 2012-04-30T00:00:00Z doi:10.1186/1478-4491-10-9 /content/figures/1478-4491-10-9-toc.gif Human Resources for Health 1478-4491 ${item.volume} 9 2012-04-30T00:00:00Z PDF Background: Migration and ethical recruitment of health care workers is receiving increased attention worldwide. Europe's aging population is creating new opportunities for medical doctors for finding employment in other countries, particularly those of a better standard of living. Methods: We conducted a survey among 1214 medical students in five out of eleven universities in Poland with medical schools in October 2008. A series of statistical tests was applied to analyse the characteristics of potential migrants. Projections were obtained using statistical analyses: descriptive, multifactorial logistic regression and other statistical methods . Results: We can forecast that 26-36% of Polish medical students will emigrate over the next few years; 62% of respondents estimated the likelihood of emigration at 50%. Students in their penultimate year of study declared a stronger desire to migrate than those in the final year. At the same time, many students were optimistic about career opportunities in Poland. Also noted among students were: the decline in interest in leaving among final year students, their moderate elaboration of departure plans, and their generally optimistic views about the opportunities for professional development in Poland. Conclusions: The majority of Polish students see the emigration as a serious alternative to the continuation of their professional training. This trend can pose a serious threat to the Polish health care system, however the observed decline of the interest in leaving among final year students, the moderate involvement in concrete departure plans and the optimistic views about the opportunities for professional development in Poland suggest that the actual scale of brain drain of young Polish doctors due to emigration will be more limited than previously feared. http://www.human-resources-health.com/content/10/1/8 Krzysztof Krajewski-Siuda Adam Szromek Piotr Romaniuk Christian Gericke Andrzej Szpak Krzysztof Kaczmarek Human Resources for Health 2012, null:8 2012-04-30T00:00:00Z doi:10.1186/1478-4491-10-8 /content/figures/1478-4491-10-8-toc.gif Human Resources for Health 1478-4491 ${item.volume} 8 2012-04-30T00:00:00Z PDF Background: Although attainment of the health-related Millennium Development Goals relies on countrieshaving adequate numbers of human resources for health (HRH) and their appropriatedistribution, global understanding of the systems used to generate information for monitoringHRH stock and flows, known as human resources information systems (HRIS), is minimal.While HRIS are increasingly recognized as integral to health system performance assessment,baseline information regarding their scope and capability around the world has been limited.We conducted a review of the available literature on HRIS implementation processes in orderto draw this baseline. Methods: Our systemic search initially retrieved 11 923 articles in four languages published in peerreviewedand grey literature. Following the selection of those articles which detailed HRISimplementation processes, reviews of their contents were conducted using two-person teams,each assigned to a national system. A data abstraction tool was developed and used tofacilitate objective assessment. Results: Ninety-five articles with relevant HRIS information were reviewed, mostly from the greyliterature, which comprised 84 % of all documents. The articles represented 63 national HRISand two regionally integrated systems. Whereas a high percentage of countries reported thecapability to generate workforce supply and deployment data, few systems were documentedas being used for HRH planning and decision-making. Of the systems examined, only 23 %explicitly stated they collect data on workforce attrition. The majority of countriesexperiencing crisis levels of HRH shortages (56 %) did not report data on health workerqualifications or professional credentialing as part of their HRIS. Conclusion: Although HRIS are critical for evidence-based human resource policy and practice, there is adearth of information about these systems, including their current capabilities. The absence ofstandardized HRIS profiles (including documented processes for data collection,management, and use) limits understanding of the availability and quality of information thatcan be used to support effective and efficient HRH strategies and investments at the national,regional, and global levels. http://www.human-resources-health.com/content/10/1/7 Patricia Riley Alexandra Zuber Stephen Vindigni Neeru Gupta Andre Verani Nadine Sunderland Michael Friedman Pascal Zurn Chijioke Okoro Heather Patrick James Campbell Human Resources for Health 2012, null:7 2012-04-30T00:00:00Z doi:10.1186/1478-4491-10-7 /content/figures/1478-4491-10-7-toc.gif Human Resources for Health 1478-4491 ${item.volume} 7 2012-04-30T00:00:00Z PDF Background: In Mexico 87% of births are attended by physicians. However, the decline in the nationalmaternal mortality rate has been slower than expected. The Mexican Ministry of Health's2009 strategy to reduce maternal mortality gives a role to two non-physician models thatmeet criteria for skilled attendants: obstetric nurses and professional midwives. This studycompares and contrasts these two provider types with the medical model, analyzingperspectives on their respective training, scope of practice, and also their perception and/orexperiences with integration into the public system as skilled birth attendants.MethodologyThis paper synthesizes qualitative research that was obtained as a component of thequantitative and qualitative study that evaluated three models of obstetric care: professionalmidwives (PM), obstetric nurses (ON) and general physicians (GP). A total of 27 individualinterviews using a semi-structured guide were carried out with PMs, ONs, GPs andspecialists. Interviews were transcribed following the principles of grounded theory, codesand categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results: All provider types interviewed expressed confidence in their professional training andacknowledge that both professional midwives and obstetric nurses have the necessary skillsand knowledge to care for women during normal pregnancy and childbirth. The three types ofproviders recognize limits to their practice, namely in the area of managing complications.We found differences in how each type of practitioner perceived the concept and process ofbirth and their role in this process. The barriers to incorporation as a model to attend birthfaced by PMs and ONs are at the individual, hospital and system level. GPs question theirability and training to handle deliveries, in particular those that become complicated, and theprofessional midwifery model particularly as it relates to a clinical setting, is also questioned. Conclusions: Hospitals in the Mexican public health sector have a heavy obstetric workload; physicianscarry the additional burden of non-obstetric cases. The incorporation of a non- physicianmodel at the primary health center level to attend low-risk, normal deliveries wouldcontribute to the reduction of non-necessary referrals. There is also a role for these providersat the hospital level. http://www.human-resources-health.com/content/10/1/6 Lisa DeMaria Lourdes Campero Marianne Vidler Dilys Walker Human Resources for Health 2012, null:6 2012-04-25T00:00:00Z doi:10.1186/1478-4491-10-6 /content/figures/1478-4491-10-6-toc.gif Human Resources for Health 1478-4491 ${item.volume} 6 2012-04-25T00:00:00Z PDF Professional dental auxiliaries emerged in the early 20th century in the United States ofAmerica and quickly spread to Europe and other regions of the world. In Brazil, however,oral health technicians (OHTs), who occupy a similar role as dental hygienists, had a longjourney before the occupation achieved legal recognition: Brazilian Law 11.889, whichregulates this occupation in the country, was only enacted in 2008. The aim of this paper is toreview the literature on the professionalization of OHTs, highlighting the triggering, limitingand conflicting aspects that exerted an influence on the historical progress of theseprofessionals in Brazil. We have tested Abbott's and Larson's theory on professionalization,against the history of OHTs. A number of different dental corporative interests exerted aninfluence over professionalization, especially in discussions regarding the permissibleactivities of these professionals in the oral cavity of patients. With primary health careadvances in Brazil, the importance of these professionals has once again come to theforefront. This seems to be a key point in the consolidation of OHTs in the area of humanresources for health in Brazil. http://www.human-resources-health.com/content/10/1/5 Carla Aparecida Sanglard-Oliveira Marcos Azeredo Furquim Werneck Simone Dutra Lucas Mauro Henrique Henrique Nogueira Guimarães Abreu Human Resources for Health 2012, null:5 2012-04-20T00:00:00Z doi:10.1186/1478-4491-10-5 /content/figures/1478-4491-10-5-toc.gif Human Resources for Health 1478-4491 ${item.volume} 5 2012-04-20T00:00:00Z PDF Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region. Methods: The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, post-graduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable. Results: Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of post-graduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation. Conclusions: The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health. http://www.human-resources-health.com/content/10/1/4 Candice Chen Eric Buch Travis Wassermann Seble Frehywot Fitzhugh Mullan Francis Omaswa S. Greysen Joseph Kolars Delanyo Dovlo Diaa El Gali Abu Bakr Abraham Haileamlak Abdel Koumare Emiola Oluwabunmi Olapade-Olaopa Human Resources for Health 2012, null:4 2012-02-24T00:00:00Z doi:10.1186/1478-4491-10-4 /content/figures/1478-4491-10-4-toc.gif Human Resources for Health 1478-4491 ${item.volume} 4 2012-02-24T00:00:00Z XML Background: Recent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.MethodA health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task. Results: We found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey. Conclusion: This study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania. http://www.human-resources-health.com/content/10/1/3 Fatuma Manzi Joanna Schellenberg Guy Hutton Kaspar Wyss Conrad Mbuya Kizito Shirima Hassan Mshinda Marcel Tanner David Schellenberg Human Resources for Health 2012, null:3 2012-02-22T00:00:00Z doi:10.1186/1478-4491-10-3 /content/figures/1478-4491-10-3-toc.gif Human Resources for Health 1478-4491 ${item.volume} 3 2012-02-22T00:00:00Z XML Background: Modern healthcare managers are faced with pressure to deliver effective, efficient services within the context of fixed budget constraints. Managers are required to make decisions regarding the skill mix of the workforce particularly when staffing new services. One measure used to identify numbers and mix of staff in healthcare settings is workforce ratio. The aim of this study was to identify workforce ratios in nine allied health professions and to identify whether these measures are useful for planning allied health workforce requirements. Methods: A systematic literature search using relevant MeSH headings of business, medical and allied health databases and relevant grey literature for the period 2000-2008 was undertaken. Results: Twelve articles were identified which described the use of workforce ratios in allied health services. Only one of these was a staffing ratio linked to clinical outcomes. The most comprehensive measures were identified in rehabilitation medicine. Conclusion: The evidence for use of staffing ratios for allied health practitioners is scarce and lags behind the fields of nursing and medicine. http://www.human-resources-health.com/content/10/1/2 Linda Cartmill Tracy Comans Michele Clark Susan Ash Lorraine Sheppard Human Resources for Health 2012, null:2 2012-02-01T00:00:00Z doi:10.1186/1478-4491-10-2 /content/figures/1478-4491-10-2-toc.gif Human Resources for Health 1478-4491 ${item.volume} 2 2012-02-01T00:00:00Z XML Background: One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia. Methods: Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need. Results: It was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities. Conclusion: Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services. http://www.human-resources-health.com/content/10/1/1 Deborah Schofield Rupendra Shrestha Emily Callander Human Resources for Health 2012, null:1 2012-01-22T00:00:00Z doi:10.1186/1478-4491-10-1 /content/figures/1478-4491-10-1-toc.gif Human Resources for Health 1478-4491 ${item.volume} 1 2012-01-22T00:00:00Z XML