Human Resources for Health最新文献

Background: Village Health Support Groups (VHSGs) are pivotal in delivering maternal, newborn, and child health (MNCH) in underserved Cambodian regions. However, their work performance is influenced by multifaceted determinants, hampering capacity in service delivery. While mobile health applications (mHealth apps) offer a promising avenue to overcome some of these challenges, research on mHealth apps in Cambodia remains scarce. Therefore, this study aims to explore the sociocultural and environmental factors influencing VHSGs' work performance and assess the dynamic influencing their willingness to adopt mHealth apps.

Methods: A qualitative study was conducted in Battambang province in May 2023. 38 stakeholders engaged in MNCH service planning and provision were interviewed. We collected data on the factors influencing VHSGs' work performance in delivering MNCH services and examined how these factors impact the potential adoption of mHealth apps. Data were analyzed according to reflexive thematic approach.

Results: Findings demonstrated that work performance is influenced by factors spanning all five domains of the socio-ecological model. At the micro-level, intrinsic motivation, strong interpersonal relationships and adequate working knowledge were identified as key enablers. However, main challenges remained at the meso and macro-level, including manpower and resources shortages, limited community trust and the absence of a sustainable financial framework to support VHSGs operations. While stakeholders recognized the potential of mHealth apps as handy job aids to improve work performance, a digital divide exists due to uneven digital literacy, immense workload, and poor digital infrastructure, hampering intention to use.

Conclusion: Our findings highlight the pressing need for a stepwise reevaluation of VHSGs employment model to address existing challenges in work performance. This three-pronged approach entails a gradual transition to remunerated positions, accreditation and opportunities for professional development, implemented in successive phases. Additionally, to further boost VHSGs' work performance through mHealth apps, strategies such as cultivating a digitally competent workforce and strengthening digital infrastructure can collectively reduce barriers to adoption and sustain long-term engagement.

Background: Many low- and middle-income countries (LMICs) lack instruments to measure gaps in the public health competency of health professionals. The objective of this study is to develop a validated and reliable Core Public Health Competency (COPHEC) index by assessing the knowledge, skills, abilities, and attitudes of senior and mid-level public health professionals with supervisory and management responsibilities in Uttar Pradesh (UP), India.

Methods: Using the Core Competency framework that was developed in UP, we generated a draft COPHEC tool with 37 items, measured on a four-point Likert scale. We administered the tool to a total of 166 public health professionals that included two samples-84 senior and 82 mid-level public health professionals. To extract factors and assign factor scores to the instrument, we performed an exploratory factor analysis (EFA) using principal component analysis (PCA). Content and face validities were assessed by examining the steps used for the construction of the draft tool. Construct validity was measured by assessing the average factor loading of the items onto the component extracted from EFA. Internal consistency was used as a measure of reliability.

Results: The final COPHEC index had 37 items loaded on one factor in the sample. Content and face validities were assured through a participatory process with relevant stakeholders who identified the initial set of items as part of a Core Competency framework. Construct validity of the COPHEC scale was confirmed by the high average factor loading of components ranging from 0.58 to 0.81. The final index showed adequate reliability with Cronbach's alpha (α) = 0.97.

Conclusions: The COPHEC index is a valid and reliable measure of core competencies in public health in UP. We recommend that governments adapt the index in LMICs to conduct assessments of health workers to identify training needs, evaluate the effectiveness of training programs through participants' competency acquisition pre- and post-training, and inform workforce development efforts in recruitment and performance management.

Background: The COVID-19 pandemic posed unprecedented challenges for frontline healthcare professionals (HCPs), leading to high rates of burnout and decreased work motivation. Limited ability to provide adequate end-of-life (EOL) care caused moral distress and ethical dilemmas. However, factors that prevent burnout, reduce intent to leave, and enhance professional fulfillment remain underexplored. This study aimed to explore HCPs' perceptions of work motivation during the pandemic, seeking insights to support their continued dedication.

Methods: A qualitative descriptive study was conducted through online semi-structured interviews (from August to December 2021) with HCPs who provided EOL care, working at intensive care units, specialized COVID-19 wards, and general wards across Japan. Aiming for a diverse sample in terms of gender, occupation, hospital size, and location, interviewees were recruited via the network of the Department of Health Informatics, School of Public Health, Kyoto University. Inductive thematic analysis was applied to interpret the data semantically.

Results: The study participants were 33 HCPs (15 physicians and 18 nurses) from 13 prefectures. The following four main themes with 13 categories were revealed: Developing proficiency in COVID-19 EOL care through HCP experiences, Unity as a multidisciplinary COVID-19 team, Managerial personnel who understand and support staff in fluctuating work, and Social voices from outside of hospitals. These themes uncovered possibilities beyond the personal traits of HCPs and influenced their motivation by incorporating factors associated with healthcare teams, organizations, and wider societal contexts.

Conclusion: In this study, four themes, including the importance of organizational management to prevent isolation, maintaining connections among colleagues, and the need for supportive social voices from outside the hospital, emerged from interviews regarding HCPs' work motivation during the pandemic. These findings highlight the complex interplay of individual, organizational, and societal factors in shaping HCPs' motivation during pandemic waves.

Background: The health workforce or human resources for health (HRH) is the bedrock of an efficient healthcare system, and the consequences of HRH shortage are evident in poor health service delivery. Many low- and middle-income countries (LMICs) have a suboptimal HRH density, far from the Sustainable Development Goals (SDG) target of 4.45 doctors, nurses, and midwives per 1000 population. Despite income levels influencing HRH density, variations in the number of health workers per capita and their performance highlight the need to optimize HRH within any economic context. This study presents a practical framework for optimizing the health workforce in LMICs, using Nigeria as a case study.

Methods: This research introduces a comprehensive HRH optimization framework derived from a strategic blend of existing frameworks, mainly the International HRH Action Framework, the WHO HRH Assessment Guidelines, and the WHO Health System Governance Action Plan for UHC. The study used a qualitative approach to apply this framework in assessing the HRH challenges and potential optimization strategies in Nigeria using data from a review of relevant documents and key informant interviews at the national and state levels.

Results: The study reveals a complex HRH landscape in Nigeria, where policies such as Task Shifting and National HRH Policy coexist with challenges in implementation, funding, and political interference. Institutional arrangements show potential for HRH optimization in states such as Gombe and Kaduna but face staffing and funding limitations. Data utilization for HRH decision-making is hindered by integration issues, while political dynamics influence policies and practices, leading to disparities in healthcare access. Challenges in workforce planning, recruitment, administration, and motivation underscore the need for targeted interventions and systemic reforms to optimize HRH density, distribution, skill mix, performance, service coverage, quality of care, and equity of access, crucial for improving healthcare delivery and ensuring equity nationwide.

Conclusion: As demonstrated in Nigeria, the HRH optimization framework effectively assesses and plans HRH optimization strategies. LMICs facing HRH shortages can use this framework to identify HRH optimization opportunities within their health systems, leading to improved health service.

Background: Little attention has been paid to quantifying job precariousness among health workers in low- and middle-income countries. Analytical models of human resources for health omit work precarity as a relevant phenomenon. However, analysing job precariousness is critical to improving health systems' performance.

Methods: We analysed pooled cross-sectional population-based data from Mexico's National Occupation and Employment Survey for 31,394 physicians and nurses between 2005 and 2022, representing almost 7, 8 million nationally throughout the study period. We used a pooled state and year fixed-effects multiple logistic regression to estimate the likelihood of having precarious employment for each survey year in both groups and according to the private/public employment sector. We conducted post hoc comparisons of quintiles of changes (2005-2022) in the adjusted percentage of labour precariousness according to the employment sector and of the private-public labour precariousness gap by state.

Findings: There was sustained growth in labour precariousness (from 58.7 and 49.0% in 2005 to 75.5% and 67.3% in 2022 among physicians and nurses, respectively). In both groups of professionals, labour precariousness was steadily higher in the private sector. However, the private-public gap narrowed to a greater extent and more accelerated among physicians than among nurses. The reduction in the private-public precariousness gap was not territorially random either (range - 39.5% to - 46.9%), with higher levels of convergence between both labour sectors, especially in the poorest socioeconomic regions.

Conclusions: The differences in the nursing and medical labour market composition have exposed the latter to the growth of precariousness due to their historical link with the private sector. The closing of the gap between public and private is a result of the recent expansion of precarious work in the latter. It is essential to develop regulatory policies to reduce precariousness and its effects on the health system applicable to both sectors.

Introduction: HIV care providers are often overworked and suffer from burnout and low job satisfaction. Differentiated service delivery (DSD) models for HIV treatment aim to decongest clinics and improve providers' quality of professional life by reducing the client/provider ratio and allowing for more time with clients in need. We investigated current job satisfaction and perceived changes in job satisfaction among HIV care providers in Malawi, South Africa, and Zambia after the adoption of DSD models of care in each country.

Methods: We conducted a concurrent, cross-sectional mixed methods survey with clinical and non-clinical HIV care providers between April 2021 and January 2022 at public sector clinics in Malawi (n = 12), South Africa (n = 21), and Zambia (n = 12). Questions investigated the effect of DSD models on provider responsibilities, work burden, time allocation, and job satisfaction. We conducted a principal components analysis of survey responses to create a job satisfaction index and estimated odds ratios (OR) using logistic regression for associations between key variables and low reported job satisfaction. We reported emerging qualitative themes. We used Herzberg's two-factor theory to organize and interpret results, identifying motivating factors (which lead to job satisfaction) and hygiene factors (which we refer to as maintenance factors, that lead to dissatisfaction if lacking).

Results: Providers had generally high job satisfaction. Providers from Malawi were more likely to report lower job satisfaction than those from South Africa or Zambia (adjusted OR (aOR) 4.56; 95% confidence interval (CI) [2.12-9.80]). Providers who believed that their jobs became harder after the introduction of DSD models (2.82; [1.14-6.96]) or that their jobs did not change (6.50; [2.50-16.89]) were more likely to report lower job satisfaction than those who believed their jobs became easier. Qualitatively, providers felt DSD models improved their working conditions by easing clinic congestion and allowing them to spend more time on other tasks. Providers were particularly motivated when they could spend more time with clients.

Conclusion: Findings highlight the importance of DSD models in maintaining or improving healthcare providers' quality of professional life and underscore the need for continued monitoring of the impact of these models on job satisfaction among HIV care providers in resource-constrained settings.

Background: The English National Health Service (NHS) strives for a fair, diverse, and inclusive workplace, but Black and Minority Ethnic (BME) representation in senior leadership roles remains limited. To address this, a large multi-hospital acute NHS Trust introduced an inclusive recruitment programme, requiring ethnically and gender diverse interview panels and a letter to the Chief Executive Officer (CEO) explaining hiring manager's candidate choice. This generated large amount of valuable structured and free-text data, but manual analysis to derive actionable insights is challenging, limiting efforts to evaluate and improve such equality, diversity, and inclusion (EDI) recruitment initiatives.

Methods: Using this routinely collected recruitment data from the programme between September 2021 to January 2024, we used natural language processing artificial intelligence techniques, triangulated with secondary data analysis, to evaluate the programme's effectiveness in increasing the number of BME appointees to senior leadership roles. Multivariate logistic regression identified recruitment factors that influence the odds of BME candidates applying, being shortlisted or offered a role compared to white candidates. Topic and sentiment analysis revealed thematic trends and tone of candidate assessments, stratified by hiring manager and candidate characteristics. Normalised average interview scores were also compared by job grades and candidate characteristics.

Results: The requirement for hiring managers to write a letter to the CEO explaining recruitment decisions raised the odds of a BME candidate being offered a role by 1.7 times [95% CI 1.2-2.3] compared to white candidates. However, white candidates still had higher overall odds of being offered senior roles. BME candidates scored lower in interviews, with BME women twice as likely (p < 0.05) to receive negative assessments compared to white women.

Conclusions: The Letter to the CEO component of the inclusive recruitment programme increased BME representation in senior leadership roles, but inequities still persist in the recruitment process, reflecting national NHS recruitment trends. While the initiative marks progress, further strategies are needed to ensure equitable recruitment, career development, and retention. Artificial intelligence tools, such as natural language processing, provide effective methods to evaluate and enhance EDI recruitment initiatives by analysing routinely collected recruitment data to identify areas for improvement and establish best practices.

Background: The shortage of nurses has been an ongoing issue for many decades. An important contributing factor is voluntary turnover. Especially in intensive care (ICU) and critical care units (CCU) with high workloads, high mortality rates and stressful working conditions, the phenomenon has serious consequences. In addition, the COVID-19 pandemic has exacerbated the problem. This review examines the factors influencing the intention to leave (ITL) and intention to stay (ITS) among intensive care and critical care nurses and the influence of the COVID-19 pandemic.

Methods: A scoping review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed, Wiley, Scopus, APA PsycNet and Web of Science were searched. In addition, a forward search using Google Scholar was carried out. Empirical studies reporting on factors influencing the intention to stay or leave among ICU nurses published from 2000 to 2022 were included. The factors were qualitatively coded in MAXQDA, resulting in an inductive coding frame.

Results: Fifty-four studies, including 51 quantitative, one qualitative, and two mixed methods studies, were included in the review. The analysis of factors influencing the intention to either leave or stay in intensive care can be systematically classified into two categories: organisational factors and individual factors. The category of organisational factors encompasses factors, such as commitment and integration, leadership, professional collaboration and communication. Conversely, the category of individual factors comprises factors, such as professionalism, job satisfaction, mental health and social reasons. The pandemic has exacerbated certain aspects within individual and organisational factors, influencing the intention to leave intensive care. Notably, despite the significant impact of COVID-19, no "new" themes are directly attributable to it.

Conclusions: The results can help practitioners meet future challenges (maintaining adequate staffing levels in view of the existing shortage of nurses). It is the responsibility of nursing and hospital management to capitalise on the insights of this review. Future research should focus on longitudinal, interventional and qualitative study designs to understand voluntary turnover among ICU nurses.

Background: Turnover intention (TI) is significant for stabilizing the pediatric healthcare workforce and ensuring sufficient pediatric healthcare human resources. This study focuses on the impact and potential mechanisms of person-organization fit (POF), hierarchical plateau (HP), and person-group fit (PGF) on TI.

Methods: The data set was collected from the Children's Hospital of Hebei Province on the Wenjuanxing online platform using the convenience sampling method in September and October 2023. 546 questionnaires were collected, with 371 valid questionnaires (effective rate: 67.95%). Model 4 and Model 14 of the PROCESS macro (version 3.3) in SPSS were used to construct mediation and moderated mediation models, respectively, and the significance of mediation and moderation effects in the theoretical model was verified using the Bootstrap method (sample size = 5000).

Results: The results of Model 4 indicate that POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = - 0.3616, p < 0.001), while the HP has a positive impact on TI ( B = 0.2528, p < 0.001), and HP can mediate the relationship between POF and TI (B = - 0.0358, 95% CI [- 0.0678, - 0.0049]). The results of Model 14 show that the POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = - 0.2827, p < 0.001), while the HP has a positive impact on TI ( B = 0.2747, p < 0.001), and index of moderated mediation shows that the PGF can moderate the indirect effect of POF on TI (Index = 0.0305, 95% CI [0.0020, 0.0582]).

Conclusions: This study constructed a moderated mediation model and found that POF can negatively affect the TI of pediatric healthcare workers, the HP can mediate the relationship between POF and TI, and PGF can moderate the second part of this mediating process. This emphasizes the important role of employee fit with the organization and group, as well as the significant impact of employee career development on TI.

Background: The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world's leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.

Methods: We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We transcribed and translated the focus group discussions and key informant interviews and analyzed it thematically.

Results: Workforce factors at entry, current employment, and exit hinder the implementation of UHC. Factors at entry include: poor preparation of graduates in school for implementing UHC; difficulty in recruitment due to restrictive government hiring policies; and government budget caps for personnel services. Factors at the current employment include: poor working conditions; uncompetitive salaries; lack of trained personnel for financial management; exorbitant fees for trainings; lack of job security for nationally deployed personnel; and lack of integration of some barangay health workers and community health volunteers. Factors at exit include the pull of migration overseas and poor crisis management. Some recommended practices to recruit and retain health workforce include scholarships and return service programs; free tuition for dependents of health workers; opportunities for postgraduate degrees and specialist training overseas, and onboarding UHC training for new hires.

Conclusions: To address the health workforce issues hindering the effective implementation of UHC in the Philippines, there is a need for reforms in the country's healthcare sector and beyond. Specifically, there is a need to revisit the country's Local Government Code, integrate further health professions education institutions and healthcare facilities, implement reforms in its basic, higher, and health education, and the civil service, revisit training costs, and training programs for specialists, and design and implement more sustainable and equitable bilateral labor agreements to keep health workforce in the Philippines and engage them as partners for optimal implementation of UHC in the country.