Human Resources for Health最新文献

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.

Background: Following completion of Higher Specialist Training (HST) in Ireland the majority of doctors pursue a fellowship abroad. Previous research has identified that while most of these doctors return to Ireland within 5 years, a substantial minority remain abroad. This paper aims to explore doctors' decision-making processes along the pathway between qualifying as a specialist and taking up a consultant post in Ireland.

Methods: For this qualitative study, 27 semi-structured interviews were conducted with doctors who qualified in Ireland as a specialist between 2016 and 2021. Maximum Variation Sampling was used to capture the perspectives of doctors across medical disciplines, genders and their current country of residence. Participants were contacted through social media, publicly available email addresses or through gatekeepers. Interviews focused on the personal and professional factors that influenced their career decisions since qualifying as a specialist.

Results: Participants went abroad after qualifying as a specialist, as this was seen as a requirement for career progression. Participants left with the intention of returning to Ireland. Personal factors, which included proximity to family, a partner's career plan and children's needs, are paramount in the decision to return to Ireland. Personal factors were identified as important both in terms of participants' decision to return to Ireland and the locations within Ireland that they considered. Professional factors acted as a barrier to returning to work in the Irish healthcare system. Participant narratives highlighted that the pathway to an attractive consultant post was not straightforward or predictable. After going abroad, intentions to return to Ireland changed due to children starting school, partners' career plans and securing a permanent consultant post abroad.

Conclusions: Policies to reduce the risk of qualified specialists becoming settled abroad include: regional strategic workforce planning; training for the correct level of specialisation; increased regional training; increasing the speed and flexibility of the consultant recruitment process; and restructuring and increasing the domestic fellowship programme.

Background: The density and distribution of Human Resources for Health (HRH) are critical to achieving universal health coverage. We aimed to study temporal trends in HRH density and state-wise inequalities in Malaysia, 2010-2022.

Methods: We obtained state-wise data on HRH (doctors, dentists, pharmacists, nurses, and assistant medical officers) from the Ministry of Health (MOH), and estimates of mid-year population, the human development index (HDI), and Gross National Income (GNI) from the Department of Statistics Malaysia. We estimated trends in HRH density per 10,000 population. Inequalities in HRH density were measured using absolute and relative gaps, and slope index inequality (SII) and concentration index (CI) across the states are ranked high, middle, and low. For geographic inequalities, we estimated absolute and relative dissimilarity indices and the Theil index.

Results: HRH density increased from 43.77 to 77.65 at an annual rate of change (ARC) of 4.89%. In absolute terms (SII), HRH density in states ranked by HDI and GNI was higher for doctors (9.77) and nurses (7.44), and in relative terms (CI), however, pharmacists (9.62), doctors (8.48), and dentists (6.30) had higher inequalities between the states, indicating higher concentration in higher-ranked states. To attain distributive equality across the states, about 13% of current doctors, nurses, and dentists, and 11% of pharmacists need to be redistributed.

Conclusion: HRH numbers and density increased across the states. Inequalities analyses showed that HRH are concentrated in higher-ranked states. Our report provides leads and directions for policymakers to achieve an equitable distribution of HRH, essential for achieving Universal Health Coverage.

Introduction: Access to safe surgery and anesthesia remains a pressing global challenge, particularly in low- and middle-income countries (LMICs). This study examines the factors influencing the worldwide availability of anesthesiologists, a critical determinant of effective surgical care.

Methods: We performed a scoping review based on the five-stage Arksey and O'Malley framework. Relevant studies were identified through systematic searches of scientific and grey literature databases, including PubMed, Scopus, Web of Science, and Google Scholar, as well as anesthesia-specific websites and journals. The review encompassed publications from May 2015 to November 2023. A multidisciplinary team conducted data extraction and thematic coding using the STEEP(Social, Technological, Economic, Environmental, Political) model, resolving discrepancies through consensus.

Results: Of the 925 screened articles, 63 met the inclusion criteria. The analysis identified 68 distinct factors organized into five STEEP areas. The most frequently cited issues in each category are as follows: (1) Political Factors: These emerged as the most frequently cited, with national and international institutional support for workforce planning identified as a cornerstone issue. (2) Social Factors: Key challenges included limited opportunities for professional development and skills evaluation, compounded by poor work-life balance. (3) Economic Factors: Financial disincentives and excessive workloads stood out as the primary barriers to anesthesiologist availability. (4) Technological Factors: Restricted access to medical training opportunities posed a significant obstacle. (5) Environmental Factors: Though less prominent, these were recognized for their potential to enhance geographical equity and resource access in anesthesia education and service delivery. High-income countries focused on optimizing performance, improving workplace quality, and strengthening retention strategies, while LMICs contended with structural challenges such as resource shortages, workforce migration, and inadequate infrastructure. Across all countries, social issues such as job burnout and work-life imbalance, alongside economic challenges like financial incentives and workload were recurring themes.

Conclusions: These findings illuminate the complex, multifaceted nature of factors affecting anesthesiologist availability. They underscore the necessity for comprehensive strategies that promote collaboration at local, national, and global levels. Addressing the political, economic, social, technological, and environmental dimensions is imperative to ensure safe and effective anesthesia care worldwide.

Mentorship plays a vital role in building research capacity, advancing evidence-based medicine, and fostering innovation in clinical practice, particularly in Africa, where Human Resources for Health (HRH) remain a persistent and complex challenge. Health mentors offer invaluable support by guiding early-career researchers in both clinical and research domains, thereby contributing to the mitigation of healthcare challenges across the continent. Effective mentorship enhances productivity, research quality, and professional networking opportunities. Africa's HRH landscape is marked by significant obstacles, including the brain drain of experienced professionals, outdated research infrastructure, limited funding, and the absence of structured mentorship programs for emerging researchers. The shortage of skilled mentors deprives young professionals of critical guidance, hindering their ability to produce high-quality research and to effectively address pressing local health issues through evidence-based practice. To address these challenges, this article proposes innovative strategies to actively engage young African researchers and establish structured, sustainable mentorship programs that empower them to participate in research-driven decision-making. It also calls on the African Union to adopt policies that prioritize research and allocate dedicated funding for mentorship initiatives. Additionally, leveraging technology such as artificial intelligence (AI) and gamification can enhance mentorship effectiveness, accessibility, and engagement. Moreover, the promotion of international exchange programs would offer young African researchers valuable exposure, broaden their technical skills, and strengthen global networks. In conclusion, strengthening mentorship frameworks, improving research infrastructure, and investing in the next generation of researchers are critical steps toward addressing Africa's health challenges and advancing its scientific leadership.

Background: Rapid economic development and urbanization in China have improved population health outcomes, but exacerbated inequalities in the allocation of public health human resources (PHHR). Existing studies largely rely on static measures and offer limited insights into the mechanisms driving these disparities. This study systematically identifies and quantifies the determinants influencing public health workforce allocation in China, aiming to provide empirical evidence to guide policy interventions.

Methods: This study analyzed the allocation of PHHR across 31 Chinese provinces from 2018 to 2022, employing four inequality indices: Gini coefficients (Gini), concentration index (CI), absolute Gini (AGini), and absolute concentration index (ACI). Two-way analysis of variance (ANOVA) and bivariate correlation analyses were used to assess temporal and regional variations. The recentered influence function-index-ordinary least squares (RIF-I-OLS) method was applied to decompose these inequality indices. This approach quantified the contributions of key factors, including the illiteracy rate among the population aged 15 years and above, government health expenditure, number of professional public health institutions (PPHI), mortality rate from Class A and B infectious diseases (IDs), and life expectancy (LE), while distinguishing between characteristic effects and coefficient effects.

Results: Between 2018 and 2019, inequity in PHHR allocation increased (Gini: 0.3792-0.3844; CI 0.0215-0.0495). In contrast, from 2019 to 2022, allocation equity improved (Gini: 0.3715; CI 0.0279). A greater number of PPHIs, a lower mortality rate of class A and B IDs, and longer LE helped mitigate inequalities, whereas a lower illiteracy rate among the population aged ≥ 15 years and increased governmental health expenditure exacerbated disparities. Inequality in PHHR allocation during 2018-2019 was primarily driven by characteristic effects, whereas in 2021-2022, coefficient effects became dominant, underscoring the role of institutional and systemic factors.

Conclusions: While the equity of PHHR allocation in China has shown modest improvement, structural and institutional factors remain key determinants of lingering inequities. This highlights the need for targeted policies to optimize the distribution of the public health workforce.

Background: Leadership is widely recognized as essential for fostering collaborative healthcare teams and improving patient outcomes. However, there is limited research on how leadership supports the development of nonclinical skills in healthcare settings in many low- and middle-income countries, including those in the Balkan region. This study addresses that gap by examining how leadership roles and practices enhance non-technical skills (NTSs)-such as communication, teamwork, and role clarity-among healthcare workers in the Balkans while also considering sustainable development, organizational values, cultural influences, and social dynamics.

Methods: A qualitative approach was employed, drawing on data collected from three workshops conducted between 2018 and 2022 in university hospital clinics in Bosnia and Herzegovina, Kosovo, and Montenegro. Data sources included observations of group discussions, focus groups, and semi-structured interviews with healthcare leaders. Reflexive thematic analysis was used to identify patterns and develop key themes.

Results: Four key themes emerged regarding the role of leadership in the development of NTSs: (1) defining roles and responsibilities, (2) fostering communication and teamwork, (3) promoting readiness for change, and (4) developing leadership competencies. The participants noted that clear role definitions enhanced team coordination, inclusive communication reduced misunderstandings, supportive leadership eased resistance to change, and mentorship served as a valuable mechanism for leadership development.

Conclusion: Leadership plays a key role in strengthening NTSs in Balkan healthcare contexts by promoting communication and teamwork within culturally and hierarchically complex environments. Role clarity, open dialogue, and shared accountability emerged as key factors for effective team performance and patient safety. These findings highlight the need for leadership development and the implementation of formal training initiatives-such as structured mentorship programs-to foster collaborative and resilient healthcare systems in low- and middle-income countries.

The shortage in medical workforce is a global health problem, and a focus of health system policy makers and organizations. Worldwide, one of the solutions for providing adequate healthcare services has been the establishment of advanced practice provider (APP) roles. Israel was a late adopter of these professions. Contrarily, a unique profession arose locally in the early 2000's, the medical student resident assistant (MSRA). Defined as a post for Israeli medical students during their clinical years, who assist physicians with their medical work during evening shifts, and under their supervision. Since, working as an MSRA has become commonplace among Israeli medical students. In an attempt to estimate MSRA workforce trends since their emergence, we screened the Sheba Medical Center's employee data from 2003 to 2023. A total of 1,423 separate employee contracts were identified, with an average employment length of 2.0 years. The majority of MSRAs worked in the adult medicine departments (849, 60%), followed by surgery (220, 15%), pediatrics (208, 15%), obstetrics and gynecology (126, 9%), and psychiatry (11, 1%). Overall, 46% of MSRAs became interns and 25% became residents at the SMC. From a total of 595 current residents in the SMC, 118 (20%) had previously worked as MSRAs. Between 2022 and 2023, 29% of students from affiliated universities who conducted clerkships in the SMC were recruited as MSRAs. MSRAs, de-facto another readily available APP role, have been an integral part of the Israeli health system workforce in the last 20 years. Paid medical student assistantship programs like MSRAs could be a true "win-win-win" situation, combining experience-based medical education (ExBL) and paid work while supporting the overstretched health workforce. The effect of this role on the patient, on the system, and on the MSRAs themselves has not been described or researched. We call for extensive research on the clinical, academic, educational, occupational, financial and workforce aspects of the MSRA entity in Israel and suggest implementation of similar roles worldwide.