Factors associated with retention intentions among Isibindi child and youth care workers in South Africa: results from a national survey.

BACKGROUND: Child and youth care workers (CYCWs) are a crucial and growing component of South Africa's national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention. METHODS: This study uses data from the first nationally representative survey of CYCWs in South Africa to identify factors associated with workers' retention intentions. Data were collected in 2015 as part of a formative evaluation conducted around the mid-point of a nationwide Isibindi programme expansion. A total of 1158 CYCWs from 78 sites participated. The response rate for the sample was 87%. Questions addressed demographics, work history, retention intentions, training, mentorship and supervision experiences, workload and remuneration. Mixed effects regression models with random intercepts for project site and mentor were used to estimate factors associated with retention intentions. RESULTS: High-quality mentorship and frequent supervision support retention intentions among CYCWs. Respondents who indicated that wanting to help children or the community was their primary motivator for seeking work as a CYCW were also more likely to report intending to continue working as a CYCW. High perceived workloads and feeling threatened or unsafe on the job were negatively associated with retention intentions. As CYCWs gained experience, they were also less likely to intend to stay. CONCLUSIONS: Understanding the factors affecting retention in the CYCW workforce is vital to helping vulnerable children and families across South Africa access key social and health services. Findings highlight the importance of mentoring and supervision as part of the Isibindi model and the value of support for manageable workloads, workplace safety, and career advancement opportunities for promoting worker retention.

The 'Dream Team' for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need.

BACKGROUND: A competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on 'one size fits all' benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the 'Dream Team'). METHODS: An adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia. RESULTS: Countries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20-27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark. CONCLUSIONS: There is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker competencies represents an efficient way to allocate resources and maximise quality of care, and therefore will be useful for countries working towards SDG targets. Midwives/nurse-midwives who are educated according to established global standards can meet 90% or more of the need, if they are part of a wider team operating within an enabled environment.

A global perspective: training opportunities in Adolescent Medicine for healthcare professionals.

PURPOSE OF REVIEW: The review briefly describes the current state of adolescent health globally, and highlights current educational and training opportunities in Adolescent Medicine for healthcare providers worldwide. RECENT FINDINGS: Despite a growing body of literature demonstrating a shift toward recognizing Adolescent Medicine as a subspecialty, there are very few countries that offer nationally recognized Adolescent Medicine training programs. In recent years, several countries have begun to offer educational programming, such as noncredentialed short training programs, conferences, and online courses. Challenges, including cultural barriers, financing, and lack of governmental recognition and support, have hindered progress in the development of accredited training programs globally. SUMMARY: It is crucial to support efforts for sustainable training programs, especially within low and middle-income countries where a majority of the world's adolescent population lives. Sharing knowledge of existing curriculums, programs, and systems will increase opportunities globally to build regional capacity, increase access to interdisciplinary services, and to implement health-promoting policies for youth worldwide.

A review of generalist and specialist community health workers for delivering adolescent health services in sub-Saharan Africa.

BACKGROUND: The health of adolescents is increasingly seen as an important international priority because the world's one point eight billion young people (aged 10 to 24 years) accounts for 15.5% of the global burden of disease and are disproportionately located in low- and middle-income countries (LMICs). Furthermore, an estimated 70% of premature adult deaths are attributable to unhealthy behaviors often initiated in adolescence (such as smoking, obesity, and physical inactivity). In order for health services to reach adolescents in LMICs, innovative service delivery models need to be explored and tested. This paper reviews the literature on generalist and specialist community health workers (CHWs) to assess their potential for strengthening the delivery of adolescent health services. METHODS: We reviewed the literature on CHWs using Medline (PubMed), EBSCO Global Health, and Global Health Archive. Search terms (n = 19) were sourced from various review articles and combined with subject heading 'sub-Saharan Africa' to identify English language abstracts of original research articles on generalist and specialist CHWs. RESULTS: A total of 106 articles, from 1985 to 2012, and representing 24 African countries, matched our search criteria. A single study in sub-Saharan Africa used CHWs to deliver adolescent health services with promising results. Though few comprehensive evaluations of large-scale CHW programs exist, we found mixed evidence to support the use of either generalist or specialist CHW models for delivering adolescent health services. CONCLUSIONS: This review found that innovative service delivery approaches, such as those potentially offered by CHWs, for adolescents in sub-Saharan Africa are lacking, CHW programs have proliferated despite the absence of high quality evaluations, rigorous studies to establish the comparative effectiveness of generalist versus specialist CHW programs are needed, and further investigation of the role of CHWs in providing adolescent health services in sub-Saharan Africa is warranted.

The status of adolescent medicine: building a global adolescent workforce.

Remarkable public health achievements to reduce infant and child mortality as well as improve the health and well-being of children worldwide have successfully resulted in increased survival and a growing population of young people aged 10-24 years. Population trends indicate that the current generation of 1.8 billion young people is the largest in history. However, there is a scarcity of dedicated resources available to effectively meet the health needs of adolescents and young adults worldwide. Growing recognition of the pivotal roles young people play in the cultures, societies, and countries in which they live has spurred an expanding global movement to address the needs of this special population. Building an effective global workforce of highly-skilled adolescent health professionals who understand the unique biological, psychological, behavioral, social, and environmental factors that affect the health of adolescents is a critical step in addressing the health needs of the growing cohort of young people. In this review, we aim to: 1) define a global assessment of the health needs for adolescents around the world; 2) describe examples of current training programs and requirements in adolescent medicine; 3) identify existing gaps and barriers to develop an effective adolescent health workforce; and 4) develop a call for targeted actions to build capacity of the adolescent health workforce, broaden culturally relevant research and evidence-based intervention strategies, and reinforce existing interdisciplinary global networks of youth advocates and adolescent health professionals to maximize the opportunities for training, research, and care delivery.

Adolescent health in South America.

Since the 1950s, a significant amount of work has been done on behalf of the comprehensive health of young people in South America. This article focuses on the regional process of training health professionals to work with this age group. There are countries in which the growth of adolescent health training has been significant, others that have made progress but still have a narrower offer of teaching activities, and a few where only very basic and limited training is available. Latin American professional associations, scientific societies, and international organizations have also contributed to the education of the adolescent health work force. Although the training in the region has advanced in some countries to the point that there is specialization in adolescent medicine, much remains to be done. Certain regional conditions have contributed to the education of providers in adolescent care. The most important has been the existence of professionals who have been highly motivated to improve the health of young people. They have worked very hard and with great commitment to achieve this goal. There have also been important obstacles to educating professionals in adolescent care. Aside from the usual lack of funding, barriers have existed in the health care system and its providers, as well as the training entities and because of certain South American conditions. Finally, this article describes the regional adolescent medicine programs and the status of recognition of this specialty, and addresses the opportunities and challenges for adolescent health training.

The health of Swiss adolescents and its implications for training of health professionals in Switzerland.

Swiss adolescents generally enjoy satisfying life conditions. Nonetheless, violence, suicide and mental health are the main concerns together with injuries, chronic conditions and eating disorders. Adolescents still face barriers to access the care they need. Adequate training can improve practitioners' skills when dealing with adolescents. The last two decades have seen the development of innovative adolescent health units and networks in various regions of Switzerland as well as research and public health programmes. Training programmes in adolescent health (continuous medical education, post-graduate or pre-graduate) for physicians and nurses are developing but still patchy in Switzerland. Adolescent health is not a sub-specialty as such. Efforts have to be made in order to link with professional associations and institutions to implement adolescent health curricula more efficiently.

Schools and adolescent health: strengthening services and improving outcomes.

School-based health services have made limited contributions to the well-being of school-age children. However, they have the potential for promoting health and improving service delivery for 50 million children and adolescents enrolled in the nation's schools. Recent changes in health care, particularly the spread of managed care and development of integrated health service networks, have reawakened mainstream interest in school health and created the possibility for strengthening its efficiency and effectiveness. Two promising strategies for enabling school health programs to fulfill their potential are being implemented by the Massachusetts state government and by an Austin, Texas, hospital system. These strategies suggest measures to create either closely linked school and community health systems or fully integrated school/community child health systems that may have widespread benefit for children and their families. Barriers to fully implementing these strategies and replicating them in other communities will include the challenge of securing adequate funding, disagreements regarding the appropriate content of a school health program, and opposition to new staffing and employment arrangements from professional and union organizations. Whether this moment of opportunity yields gains for child health and school health will, for the most part, depend on forces outside school health. Success will be particularly dependent on the degree to which the managed care plans or large health care organizations see value in building more comprehensive child health systems or identify financial benefits from linking more closely with school-based services.

How one school-based clinic is meeting the challenge of adolescent health care.

Today's adolescent confronts a host of medical, social, and economic problems that have a significant impact on their lives as well as on society. The teenage population of the North Side area of the city of Pittsburgh is no exception. To address the needs of these teens a school-based clinic was established in one of the city's middle schools. It became known as the Allegheny Middle School/Allegheny General Hospital Wellness Center (AMS/AGH Wellness Center). Located on the school grounds, this clinic remained in operation during school hours. Student interest was obvious as they began using the services provided by the clinic immediately after its establishment. After only 1 school year of operation, nearly 60% of the student body was enrolled. The number of patient visits totaled 1086. Evidence from the literature attesting to the advanced skills, cost effectiveness, and holistic approach to patient care of nurse practitioners led to the selection of a family nurse practitioner as the primary health care provider for the middle school students. Other clinic staff include a part-time physician, ambulatory technician, secretary, and part-time psychiatric social worker. The establishment and operation of the Wellness Center is discussed in this article.

Açäo programática e renovaçäo das práticas médico-sanitárias: saúde e emancipaçäo na adolescência / Programmatic area and physician-sanitary practices: health and emancipation in adolescence

Analisa o Programa de Atençäo à Saúde do Adolescente (PASA), desenvolvido no Centro de Saúde Samuel B. Pessoa, o Centro de Saúde Escola do Butantä (CSEB). Sintetiza e traz ao debate a reflexäo teórica que tem sido desenvolvida a partir dessa experiência. Näo apresenta resultados práticas do programa nem desenvolve extensivamente qualquer aspecto conceitual, mas provoca a reflexäo, na mesma direçäo em que os sanitaristas têm sido provocados pela experiência de planejar e executar o programa

Reunión de expertos en desarrollo educativo para la salud de los adolescentes / Meeting on educational development for adolescent health

Apresenta proposta de desenvolvimento de recursos humanos em saúde integral dos adolescentes para a America Latina, revisando e discutindo teorias educativas, competencias necesarias para formaçäo de recursos humanos, curriculum e plano de açäo para educaçäo `a distância