Senior Managers' Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya.

Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers' experiences with health status, happiness, and motivation in hospitals and the perceived impact on the health system in Kenya. This qualitative study applied a phenomenological research design. Senior managers within the hospital management teams were selected using purposive sampling. Semi-structured interviews were carried out among senior managers across eleven hospitals in Meru County, Kenya. Among the eleven participants 63.6% were female and 36.4%, were male and the mean age was 44.5 years. The audio-taped data were transcribed and analyzed using Colaizzi's phenomenological approach. The five themes revealed were: (1) Happiness in the health system; (2) Health status in the health system; (3) Motivation in the health system; (4) Challenges in the health system; (5) Possible solutions to the challenges in the health system. This study revealed the positive and negative impact of the three domains, challenges, and solutions, from the senior managers' perspective. Healthy, happy, and motivated senior managers and healthcare workers are more responsive and perform better. Policy interventions and programs promoting happiness, health status, and motivation are necessary for strengthening the health workforce and health system.

Predictors of Health-Related Quality of Life among Healthcare Workers in the Context of Health System Strengthening in Kenya.

Kenya is among the countries with an acute shortage of skilled health workers. There have been recurrent health worker strikes in Kenya due to several issues, some of which directly or indirectly affect their health. The purpose of this study was to investigate the predictors of health-related quality of life (HRQOL) among healthcare workers in public and mission hospitals in Meru County, Kenya. A cross-sectional study design was undertaken among 553 healthcare workers across 24 hospitals in Meru County. The participants completed the EuroQol-five dimension-five level (EQ-5D-5L) instrument, which measures health status across five dimensions and the overall self-assessment of health status on a visual analogue scale (EQ-VAS). Approximately 66.55% of the healthcare workers reported no problems (i.e., 11,111) across the five dimensions. The six predictors of HRQOL among the healthcare workers were hospital ownership (p < 0.05), age (p < 0.05), income (p < 0.01), availability of water for handwashing (p < 0.05), presence of risk in using a toilet facility (p < 0.05), and overall safety of hospital work environment (p < 0.05). Personal, job-related attributes and work environment characteristics are significant predictors of healthcare workers HRQOL. Thus, these factors ought to be considered by health policymakers and managers when developing and implementing policies and programs aimed at promoting HRQOL among healthcare workers.

An Investigation of Healthcare Professionals' Motivation in Public and Mission Hospitals in Meru County, Kenya.

Strengthening health systems in developing countries such as Kenya is required to achieve the third United Nations' Sustainable Development Goal of health for all, at all ages. However, Kenya is experiencing a "brain drain" and a critical shortage of healthcare professionals. There is a need to identify the factors that motivate healthcare workers to work in the health sector in rural and marginalized areas. This cross-sectional study aims to investigate the factors associated with the level and types of motivation among healthcare professionals in public and mission hospitals in Meru county, Kenya. Data were collected from 24 public and mission hospitals using a self-administered structured questionnaire. A total of 553 healthcare professionals participated in this study; 78.48% from public hospitals and 21.52% from mission hospitals. Hospital ownership was statistically nonsignificant in healthcare professionals' overall motivation (p > 0.05). The results showed that sociodemographic and work-environment factors explained 29.95% of the variation in overall motivation scores among participants. Findings indicate there are more similarities than disparities among healthcare professionals' motivation factors, regardless of hospital ownership; therefore, motivation strategies should be developed and applied in both public and private not-for-profit hospitals to ensure an effective healthcare workforce and strengthen healthcare systems in Kenya.

Determinants of Motivation among Healthcare Workers in the East African Community between 2009-2019: A Systematic Review.

Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and sub-optimally functioning health systems. As countries globally aim to attain Universal Health Coverage and the Sustainable Development Goal 3, it is crucial that the significant role of the health workforce in this achievement is recognized. In this systematic review, we aimed to synthesise the determinants of motivation as reported by healthcare workers in the EAC between 2009 and 2019. A systematic search was performed using four databases, namely Cochrane library, EBSCOhost, ProQuest and PubMed. The eligible articles were selected and reviewed based on the authors' selection criteria. A total of 30 studies were eligible for review. All six countries that are part of the EAC were represented in this systematic review. Determinants as reported by healthcare workers in six countries were synthesised. Individual-level-, organizational/structural- and societal-level determinants were reported, thus revealing the roles of the healthcare worker, health facilities and the government in terms of health systems and the community or society at large in promoting healthcare workers' motivation. Monetary and non-monetary determinants of healthcare workers' motivation reported are crucial for informing healthcare worker motivation policy and health workforce strengthening in East Africa.

The fiscal value of human lives lost from coronavirus disease (COVID-19) in China.

OBJECTIVE: According to the WHO coronavirus disease (COVID-19) situation report 35, as of 24th February 2020, there was a total of 77,262 confirmed COVID-19 cases in China. That included 2595 deaths. The specific objective of this study was to estimate the fiscal value of human lives lost due to COVID-19 in China as of 24th February 2020. RESULTS: The deaths from COVID-19 had a discounted (at 3%) total fiscal value of Int$ 924,346,795 in China. Out of which, 63.2% was borne by people aged 25-49 years, 27.8% by people aged 50-64 years, and 9.0% by people aged 65 years and above. The average fiscal value per death was Int$ 356,203. Re-estimation of the economic model alternately with 5% and 10 discount rates led to a reduction in the expected total fiscal value by 21.3% and 50.4%, respectively. Furthermore, the re-estimation of the economic model using the world's highest average life expectancy of 87.1 years (which is that of Japanese females), instead of the national life expectancy of 76.4 years, increased the total fiscal value by Int$ 229,456,430 (24.8%).

The discounted value of human lives lost due to COVID-19 in France.

Background: This study estimates the total discounted value of human lives lost (TDVHL) due to COVID-19 in France as of 14 September 2020. Methods: The human capital approach (HCA) model was used to estimate the TDVHL of the 30,916 human lives lost due to COVID-19 in France; i.e., assuming a discount rate of 3% and the national average life expectancy at birth of 83.13 years. To test the robustness of the estimated TDVHL, the model was rerun (a) using 5% and 10% discount rates, while holding the French average life expectancy constant; and (b) consecutively substituting national life expectancy with the world average life expectancy of 73.2 years and the world highest life expectancy of 88.17 years.  Results: The human lives lost had a TDVHL of Int$10,492,290,194, and an average value of Int$339,381 per human life lost. Rerun of the HCA model with 5% and 10% discount rates decreased TDVHL by Int$1,304,764,602 (12.4%) and Int$3,506,938,312 (33%), respectively. Re-calculation of the model with the world average life expectancy decreased the TDVHL by Int$7,750,187,267 (73.87%). Contrastingly, re-estimation of the model with the world's highest life expectancy augmented TDVHL by Int$3,744,263,463 (35.7%). Conclusions: The average discounted economic value per human life lost due to COVID-19 of Int$339,381 is 8-fold the France gross domestic product per person. Such evidence constitutes an additional argument for health policy makers when making a case for increased investment to optimise France's International Health Regulation capacities and coverage of essential health services, and safely managed water and sanitation services.

The monetary value of human lives lost through Ebola virus disease in the Democratic Republic of Congo in 2019.

BACKGROUND: Between 8 May 2018 and 27 May 2019, cumulatively there were 1286 deaths from Ebola Virus Disease (EVD) in the Democratic Republic of Congo (DRC). The objective of this study was to estimate the monetary value of human lives lost through EVD in DRC. METHODS: Human capital approach was applied to monetarily value years of life lost due to premature deaths from EVD. The future losses were discounted to their present values at 3% discount rate. The model was reanalysed using 5 and 10% discount rates. The analysis was done alternately using the average life expectancies for DRC, the world, and the Japanese females to assess the effect on the monetary value of years of life lost (MVYLL). RESULTS: The 1286 deaths resulted in a total MVYLL of Int$17,761,539 assuming 3% discount rate and DRC life expectancy of 60.5 years. The average monetary value per EVD death was of Int$13,801. About 44.7 and 48.6% of the total MVYLL was borne by children aged below 9 years and adults aged between 15 years and 59 years, respectively. Re-estimation of the algorithm with average life expectancies of the world (both sexes) and Japanese females, holding discount rate constant at 3%, increased the MVYLL by Int$ 3,667,085 (20.6%) and Int$ 7,508,498 (42.3%), respectively. The application of discount rates of 5 and 10%, holding life expectancy constant at 60.5 years, reduced the MVYLL by Int$ 4,252,785 (- 23.9%) and Int$ 9,658,195 (- 54.4%) respectively. CONCLUSION: The EVD outbreak in DRC led to a considerable MVYLL. There is an urgent need for DRC government and development partners to disburse adequate resources to strengthen the national health system and other systems that address social determinants of health to end recurrence of EVD outbreaks.