Projection of Health Sector Workforce Requirement: Vision 2025.

BACKGROUND: This study was conducted with a long-term vision (2014-2025) targeted workforce requirement projection by occupational groups in Iran's health sector. METHODS: The "modified & combined model" used including Hall Model and Australian health workforce estimation model. It was a need-based approach with three components of estimation; requirements, supply with current growth and net required workforce. Requirement estimated by three assumptions: active workforce calculation; the growth of health service delivery resources and facilities; and daily individual working hours, created eight different scenarios. Economic feasibility of each scenario determined. To forecast the supply, used accurate numbers of the existing pool of practicing workforce in addition to inflows, minus losses from the profession. To calculate total recruits required, base year stock deducted from projected requirement and by adding Net flow, recruits required calculated. RESULTS: The health sector will need 781,887 workforces to realize service's needs. Workforce supply with the existing trend in the target year was 799,347. Therefore, workforce balance would be 17,460 surpluses. Moreover, to estimate required workforce and substitution number for the exited ones during the study periods till the target year, 547,136 individuals should be recruited mostly nurses and physicians. CONCLUSION: Limiting the workforce required to economic feasibility challenge workforce accessibility in the future as it is sensed in present tense as well. Therefore, in addition augmenting GDP and health funds, it is necessary alternative policies such as increasing share of health sector from GDP, prioritization of workforce needs or moving towards other proper policies.

Human resources for health strategies: the way to achieve universal health coverage in the Islamic Republic of Iran.

BACKGROUND: It is impossible to achieve universal health coverage (UHC) without an adequate, competent and motivated workforce. AIMS: The study aimed to describe how the Iranian health sector has formulated its human resources strategies to achieve UHC. METHODS: This was a qualitative study using a conceptual framework approach to content analysis. Primary data were gathered through expert focused group discussions and document analyses. Both transcribed discussions and the selected documents were analysed using in-depth thematic analysis. A conceptual framework from the Global Health Workforce Alliance was used for content analysis and to draft and develop the strategies. The framework suggested five human resources for health (HRH) pathways to achieve UHC aspects structured according to availability, accessibility, acceptability and quality. RESULTS: Thirty strategies were formulated for Iranian HRH. Eleven of the developed strategies were related to the field of education and training, such as development of new required academic disciplines; balancing university admissions based on workforce requirements; and enrolling local students from deprived and underserved areas. Ten of the developed strategies were structured under the workforce accessibility dimension. CONCLUSIONS: Strategies for HRH were formulated by adopting a comprehensive, scientific and collaborative approach to ensure alignment with the country's health system priorities and Global Strategy on Human Resources for Health to overcome health workforce challenges.

Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016.

BACKGROUND: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. AIMS: The aim of this article is to examine the impact of DP on service delivery time by surgeons. METHODS: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. RESULTS: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (ß = 0.427). Female specialists (ß = -0.049) and full-time specialists (ß = -0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). CONCLUSIONS: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.

Factors influencing medical specialists' dual practice in the Islamic Republic of Iran.

BACKGROUND: Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery. AIMS: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran. METHODS: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln. RESULTS: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations. CONCLUSIONS: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

Factors affecting intent to immigration among Iranian health workers in 2016.

BACKGROUND: Loss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries. OBJECTIVE: The aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran's healthcare sector. METHODS: This cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18. RESULTS: Inclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12). CONCLUSION: Considering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.