Human Resources for Health最新文献

Background: Physician migration is a known global phenomenon, with the migration intention of medical students serving as early indicators of the trends in workforce mobility. Understanding the factors influencing their decision to migrate is crucial in the planning of human resources for health in a country and the sustainability of a healthcare system, particularly in low- and middle-income countries (LMIC). This scoping review synthesises current available evidence on the trends, determinants, and implications of medical student international migration.

Methods: A systematic search was conducted on PubMed, Scopus, and Proquest from July 2013 to May 2025, following the PRISMA for Scoping Reviews framework. The selected articles included primary research investigating factors influencing migration intention among medical students. Articles were excluded if the study only explored on perception of migration. Included studies were assessed for quality according to Joanna Briggs Institute (JBI) Critical Appraisal tool, and extracted factors were reclassified and regrouped into domains of Academic and Personal Development, Economic and Working Conditions, and Social and Living Environment factors.

Results: 517 articles were screened, of which 33 articles were included, covering medical students from diverse geographical locations. Migration intentions were varied across regions, with studies from 6 countries each reporting that over 80% of sampled medical students intended to migrate. The most common push factors included income, working culture and environment, and career progression. The most frequently cited stay factors were family, financial, and patriotism.

Conclusion: Migration intentions were widely reported among medical students across different regions, though the proportions varied by country. This serves as a predictor and could indicate the evolving global trend of physician migration in the years to come. Financial prospects, career opportunities, and working conditions play critical roles in determining the migration intentions of medical students. Targeted retention strategies should be implemented especially in resource-limited settings to address brain drain, although at the same time achieving balance in ethical recruitment practices in high-income countries. Future research is warranted to study the longitudinal trends of migration intention and assess the impact of policies on retention.

Background: The competence of public health workers is crucial for grassroots public health service capabilities. This study aimed to establish a competency model for public health workers and to test the reliability and validity of the model.

Methods: An evaluation indicators scale of competency of public health workers in Shanghai community health service centers (CHSCs) was constructed through a literature review, expert consultation, behavioral event interviews and questionnaire surveys. A questionnaire survey was carried out with 3809 public health workers from 249 Shanghai CHSCs to test the reliability and validity of the constructed scale.

Results: Exploratory factor analysis identified 5 common factors: comprehensive ability, professional spirit, professional knowledge, professional skills, research and development ability. The cumulative variance contribution rate was 62.241%. The factor load for each item ranged from 0.495 to 0.868. The overall Cronbach's alpha coefficient for the questionnaire was 0.985, for the five dimensions ranged from 0.916 to 0.969. The overall split-half reliability of the questionnaire was 0.842, and that of the five dimensions ranged from 0.913 to 0.952, with the Guttman split-half reliability coefficient ranging from 0.912 to 0.949. The correlation coefficients for all scale items with the total score ranged from 0.591 to 0.854 (p < 0.01). The correlation coefficients between each item and each dimension ranged from 0.434 to 0.925. Confirmatory factor analysis showed that the model had a good fitting effect (χ²/df = 2.288, TLI = 0.943, CFI = 0.957, IFI = 0.958, NFI = 0.928, RMSEA = 0.081). Using self-efficacy, self-esteem, work pressure, work motivation, and job satisfaction as benchmarks, all dimensions of the scale demonstrated significant positive correlations with the total scores of various benchmark questionnaires.

Conclusions: The constructed scale of competency of public health workers in Shanghai CHSCs has good reliability and validity and can be used as a tool to evaluate the competency level of public health workers.

Background: Nonphysician healthcare workers play a crucial role in patient care, often under challenging conditions. Workplace violence puts professionals such as nurses and emergency medical service (EMS) workers at risk for (emotional) stress. This study comparatively analyzed the burden of workplace violence, burnout risk, and their associations among nurses and EMS workers.

Methods: Two surveys were conducted using (i) a paper-pencil questionnaire for nurses and (ii) an online questionnaire for EMS workers in 2015. The surveys assessed experiences of workplace complaints, violence, and burnout risk measured by the Maslach Burnout Inventory (MBI). Data were analyzed descriptively (frequencies, means, percentages, Pearson correlation coefficients). Associations between workplace violence and burnout were estimated using binary logistic regression, adjusting for gender, employment status, work experience, education, and working conditions.

Results: Data from 3,169 nurses (84.7% female) and 1,024 EMS workers (13.6% female) were analyzed. Frequent verbal abuse-ranging from daily incidents to several times a month-was reported by 44.7% of nurses and 59.9% of EMS workers, while 12.2% and 23.5%, respectively, experienced physical violence from patients or their families. Overall, a large proportion of employees in both professions have a moderate to high risk of burnout in the dimension of emotional exhaustion (EE) (nurses: 58.1%, EMS workers: 56.3%) and in the dimension of depersonalization (DP) (nurses: 58.4%, EMS workers: 74.4%). Logistic regression revealed that physical violence was significantly associated with a high risk of burnout in the dimensions EE and DP in nurses, and EE in EMS workers. Verbal abuse by patients was significantly associated with EE and DP in nurses, and with DP in EMS workers. In addition, an increased risk of burnout in both MBI dimensions was significantly associated with variables of working conditions and work experience for both professions.

Conclusions: This is the first comparative study to examine the association between workplace violence and the risk of burnout among nurses and EMS workers. These findings highlight the need for strengthened measures to address workplace violence, prevent burnout among employees, and support staff in coping with these challenges. Improvements in working conditions must also be considered.

Background: Infectious diseases pose significant challenges to global public health security, which necessitates robust prevention and control capabilities within national public health systems. This study aimed to assess the infectious disease control competencies of provincial and prefecture-level public health professionals in China and investigate their willingness and demand for professional training to inform future training plans.

Methods: A cross-sectional survey was conducted from June 2023 to December 2023 among public health professionals from 15 provinces in China. The infectious disease control competency scale was utilized to evaluate professionals' competencies across four dimensions: knowledge, practical skills, leadership, and personal qualities. Descriptive statistics and multivariable analyses were performed.

Results: Among 883 participants enrolled in the study, the median total competency score was 74.70 (IQR 67.97-81.00) out of 100. The most deficient areas identified were scientific research abilities (scoring rate 63.76%), knowledge of public health emergency management (65.35%), and skills in infectious disease prevention and emergency preparedness (70.15%). Higher education level (OR 1.565; 95% CI 1.137-2.153), longer work experience (OR 2.448; 95% CI 1.354-4.427), more frequent outbreak response involvement (OR 3.931; 95% CI 2.517-6.141), continued professional development through training (OR 4.100; 95% CI 2.096-8.019), and higher job satisfaction (OR 6.199; 95% CI 3.659-10.502) were all associated with enhanced competency scores. Most participants (87.5%) expressed willingness to participate in future training, with preferences for case analysis, scenario simulations, public health response to infectious diseases, research design, and report and paper writing.

Conclusions: This nationwide survey revealed moderate infectious disease control competencies among Chinese public health professionals, with specific areas for improvement. Tailored training initiatives focusing on identified gaps and preferred topics, coupled with strategies to foster continuous professional development, are crucial for enhancing the public health workforce's capabilities.

Background: Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment.

Methods: In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019-March 2021) and mid-2023 HFAs, and quarterly QI processes. The unit of analysis was the neonatal unit with day and night staff-to-baby ratios calculated. Ratios were aggregated overall, by country, by hospital level, and by neonatal unit occupancy rates. Staff coverage and skill-mix were also analysed for nurses, doctors, clinical officers, laboratory technicians, data clerks, biomedical technicians, and engineers.

Results: For 65 neonatal units, the median time between baseline and 2023 HFAs was 31 months (Interquartile Range (IQR) 29-34 months). In 2023, only 3 (5%) neonatal units had zero neonatal ward-specific nurses compared to 8 (12%) at baseline during the day. Between baseline and 2023 HFAs, median nurse-to-baby ratios were 1:6 (IQR 1:3-1:11) during the day and 1:10 (IQR 1:6-1:17) at night, with consistency over time. At baseline, only one third of neonatal units had a doctor providing care, or on-call coverage, at all times of day and night (n = 20, 31%), and half of hospitals lacked 24 h laboratory coverage (n = 25, 45%) with no change over time. There were improvements in neonatal data clerk (n = 32, 49% to n = 58, 89%) and biomedical technician (n = 45, 69% to n = 56, 86%) coverage between baseline and 2023 HFAs.

Discussion: Evaluation revealed variability by country and hospital level, and important shortfalls remain in the number of staff providing care. Neonatal survival in hospitals requires better staff-to-baby ratios and more skilled staff. To meet the projected shortfall in the health workforce, governments must invest in training more health workers for neonatal care.

Introduction: Türkiye has been among the most welcoming for Syrian healthcare workers who have been forced from their homes due to the protracted conflict in Syria. It provides two main routes for work in Türkiye: one through formal accreditation processes to work in jobs equivalent to Turkish doctors and another through retraining as generalists to work in the Migrant Health Centres which cater to Syrian refugees across Türkiye. The aim of this study is to explore the experiences of Syrian physicians living or working in Türkiye.

Methods: We used purposive and snowball sampling to identify Syrian physicians who were living or working in Türkiye at the time of the study. Interviews were conducted remotely in Arabic between February and August 2021 then transcribed and thematically analysed using a deductive approach to identify themes and subthemes.

Results: Twenty three physicians were interviewed; 6 were female. Most resided in Gaziantep (15 of 23). The main themes are grouped as 1. Bureaucratic and academic challenges 2. Language, culture, and integration and 3. Personal impacts and future intentions. Many participants spoke of the prolonged journeys and challenges they faced whichever paths they chose; for many, obtaining ratifications of their certificates from the Syrian ministries was not possible, limiting their options. Themes around integration-related to language and culture (both in healthcare and in the community) also emerged.

Discussion: Though Türkiye has provided the most favourable circumstances for Syrian physicians in the region, many personal and structural challenges remain; these impede successful career progress and integration. The interviews were conducted in 2021, during the COVID-19 pandemic. Since then, economic and political upheavals and natural disasters have affected perceptions towards Syrian refugees in Türkiye, including for physicians. In early December 2024, the fall of Syria's regime will also likely have important impacts on physician intentions for remaining in Türkiye, return to Syria or migrate elsewhere. Further exploration of the impact of such changes is required to better understand the current experiences and intentions of Syrian physicians in Türkiye.

Background: The COVID-19 pandemic has substantially increased burnout and psychological distress among frontline health professionals. Although this issue has been widely recognized, limited research has explored specific work arrangements during the Omicron epidemic and the associations with burnout and psychological distress among frontline healthcare professionals.

Methods: We conducted a citywide, multicenter cross-sectional survey from July 12 to 26, 2022, during the Omicron outbreak in Shenzhen, China. Participants included physicians, nurses, and health technicians from public hospitals and community health centers. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), and psychological distress was assessed using the Depression Anxiety and Stress Scale (DASS-21). Multinomial logistic regression models were constructed to examine associations of specific work arrangements with burnout and psychological distress.

Results: Among the 3158 respondents, 85.5% reported high levels of burnout and 50.4% reported psychological distress. Over one-third were consistently assigned to nucleic acid sampling (33.1%) or worked more than 5 days per week on containment tasks (32.0%), in addition to routine duties. Frequent assignments to sampling and extended working days were significantly associated with high emotional exhaustion, depersonalization, depression, anxiety, and stress. For example, those always assigned to sampling had higher risks of emotional exhaustion (RRR = 1.95, 95% CI 1.20-3.15) and depression (RRR = 2.01, 95% CI 1.16-3.48). Negative emotions during work and dissatisfaction with current work arrangements were also strongly associated with poor mental health outcomes.

Conclusions: This study highlights the burnout and mental health burden among frontline health professionals linked to specific emergency work arrangements during COVID-19 containment. Our findings underscore the need for targeted institutional design in future health emergencies. Future preparedness planning should integrate psychological sustainability into emergency protocols, including rotational deployments, support measures, and workload balancing strategies.

Background: In Canada and internationally, health systems have experienced rising healthcare staffing shortages in recent years. Specifically, this study seeks to analyse evidence on the causes and effects of hospital nursing shortages, to consider whether shortages may be self-reinforcing. It complements an existing linear healthcare workforce logic model (Sonderegger et al., 2021) by considering whether there may be evidence that implies the existence of feedback loops (a form of system dynamics).

Methods: An umbrella review was undertaken to identify both causes and effects of hospital nursing shortages. A two-phase approach was undertaken: first, a review of all articles to identify a common list of factors, and second, a subsequent line-by-line review to ensure comprehensive coding.

Results: The umbrella review identified several specific issues which were both causes and effects of nursing shortages, across a number of articles. This suggests that shortages could be self-reinforcing. For policymakers, the implication is that early intervention is likely to support the resilience and retention of hospital nurses. For researchers, this study highlights the risk of biased coefficients within econometric analysis and provides a testable cross-country hypothesis for the impacts of early intervention.

Conclusions: Overall, this study contributes to existing academic literature and practical policymaking by identifying evidence that nursing shortages may be self-reinforcing. Through proactive intervention to restrain the growth of workforce shortages, policymakers can support the welfare of healthcare service users and nurses themselves.

Background: Complementary and alternative systems of medicine, which include Ayurveda, Yoga, and Naturopathy, Unani, Siddha, Sowa Rigpa, and Homoeopathy (AYUSH), play a significant role in the Indian healthcare system. Despite many efforts to integrate and mainstream AYUSH, there are significant inequities that disadvantage AYUSH doctors compared to their allopathic counterparts. In this paper, we examine the recruitment-related experiences of contractual AYUSH doctors and make some side-by-side comparisons with those of contractual allopathic doctors from two Indian states.

Methods: This study, on which this paper reports, is set within a larger qualitative study conducted in India to examine the experiences of public sector doctors with Human Resource Management systems. We conducted semi-structured interviews with 61 participants, including 33 frontline doctors and 28 policy actors. We employed purposive sampling to select doctors from two states. Data collection occurred from February to October 2019. Thematic analysis, utilizing the Framework Approach, was applied to organize and synthesize qualitative data based on themes identified from the data. We also developed job histories from the interviews with the doctors to explore their experiences with the recruitment system. The quantitative data gathered through job histories were analysed using frequencies and triangulated with the narrative accounts provided by the doctors.

Results: The paper reports the discontent of AYUSH and allopathic doctors with the recruitment, but this was consistently worse for AYUSH, especially in State 1, in several ways. One, there were significant discrepancies in salaries and allowances between AYUSH and allopathic doctors. Two, AYUSH doctors experienced stagnated career progressions and high job insecurity. Three, the system sabotaged AYUSH doctors' expectations of progressing to regular recruitment in State 1. And four, AYUSH doctors perceived the system to be highly inequitable and unresponsive towards their concerns, particularly in State 1, with critical implications for health services.

Conclusion: This paper highlights the extreme form of inequity perceived and experienced by the contractual AYUSH doctors. The policy and institutional environment surrounding AYUSH integration is weak, and there is a significant failure of institutions to meet the expectations of these doctors. Additionally, there are insufficient translations between policy and practice, leaving larger questions about holistic integration and the inclusion of AYUSH unresolved. Our findings suggest that the subtle nuances discussed in the paper indicate a bias toward allopathic doctors, which may further lead to the marginalization of AYUSH.

Objectives: We studied the association between GPs' characteristics and the places they practise, in terms of the supply and demand for primary care and of the registration of new patients for ongoing care at the office or for house calls.

Study design: An exhaustive simulated patient survey enabled us to determine the GPs practising in the Paris metropolitan region who were accepting new patients for registration for continuing care at their office and/or for house calls.

Methods: We studied the associations between the characteristics of GPs who were accepting new patient registrations and those describing their office location.

Results: In 2017-2018, we contacted 8171 physicians (87.6% of the GPs in the region), 49.70% were willing to register a new patient for office visits and 18.7% for house calls. In both situations (office and visit), doctors who most frequently agreed to register new patients were men in solo practices, who had no secretary and did not practise alternative medicine. GPs in areas with low levels of deprivation and relatively few individuals with costly chronic diseases agreed more frequently than those elsewhere to register new patients. No characteristic describing the supply of primary care was associated with agreement to register new patients.

Conclusions: The difficulties of finding a GP in the most deprived areas and with the most people with chronic diseases suggest the need to develop policies facilitating the settlement of new doctors in such areas.