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2.
Health Res Policy Syst ; 19(Suppl 3): 116, 2021 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-34641902

RESUMEN

BACKGROUND: This is the ninth paper in our series, "Community Health Workers at the Dawn of a New Era". Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. METHODS: The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. RESULTS: The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. CONCLUSION: To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.


Asunto(s)
Agentes Comunitarios de Salud , Programas de Gobierno , Fuerza Laboral en Salud , Humanos , Salud Pública , Zimbabwe
3.
Artículo en Inglés | MEDLINE | ID: mdl-34501912

RESUMEN

The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national "Containment Scout Initiative" (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an example of how solutions to address critical health system capacity issues can be implemented quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as other deficits that exist within the public health sector in Germany. This article describes the structure and process of the first phase of this initiative in order to support health policymakers, public health practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues.


Asunto(s)
COVID-19 , Pandemias , Trazado de Contacto , Alemania/epidemiología , Fuerza Laboral en Salud , Humanos , Salud Pública , SARS-CoV-2 , Recursos Humanos
6.
Med Care ; 59(Suppl 5): S420-S427, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34524238

RESUMEN

BACKGROUND: As coronavirus disease 2019 (COVID-19) rapidly progressed throughout the United States, increased demand for health workers required health workforce data and tools to aid planning and response at local, state, and national levels. OBJECTIVE: We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19. RESEARCH DESIGN: We estimated supply and demand for intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists, using Institute for Health Metrics and Evaluation projections for COVID-19 hospital care and National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, American Hospital Association, and Bureau of Labor Statistics Occupation Employment Statistics for workforce supply. We estimated contact tracing workforce needs using Johns Hopkins University COVID-19 case counts and workload parameters based on expert advice. RESULTS: The State Hospital Workforce Deficit Estimator estimated the sufficiency of state hospital-based clinicians to meet projected COVID-19 demand. The Contact Tracing Workforce Estimator calculated the workforce needed based on the 14-day COVID-19 caseload at county, state, and the national level, allowing users to adjust workload parameters to reflect local contexts. CONCLUSIONS: The 2 estimators illustrate the value of integrating health workforce data and analysis with pandemic response planning. The many unknowns associated with COVID-19 required tools to be flexible, allowing users to change assumptions on number of contacts and work capacity. Data limitations were a challenge for both estimators, highlighting the need to invest in health workforce data and data infrastructure as part of future emergency preparedness planning.


Asunto(s)
COVID-19/epidemiología , Planificación en Salud Comunitaria , Personal de Salud/estadística & datos numéricos , Fuerza Laboral en Salud/estadística & datos numéricos , Modelos Estadísticos , Regionalización , Trazado de Contacto , Humanos , Estados Unidos/epidemiología , Carga de Trabajo
7.
J Addict Nurs ; 32(3): 197-204, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34473449

RESUMEN

ABSTRACT: This article provides examples of the application of technology transfer to improve the delivery of addiction prevention, treatment, and recovery. The article describes a case example of two regional Technology Transfer Centers (TTCs) focused on addiction and mental health. It illustrates the importance of cross-regional and network-wide activities as well as meaningful collaborations with other regional networks, professional associations, and state and federal entities. This article describes a model of identifying and delivering meaningful training and technical assistance (T/TA), which also advances interprofessional collaborations and shared ownership. The described model includes collaboration in assessing behavioral health T/TA needs and preference for delivery of T/TA. The case study presents the process of engaging providers and connecting them with content experts on emerging topics in the field of addiction. This work included T/TA around integrated care, co-occurring disorders, cultural humility and inclusion, and use of data to advance system care. The case also outlines the application and use of evidence-based translation models, including Project ECHO (Extension for Community Healthcare Outcomes) and Communities of Practice.


Asunto(s)
Fuerza Laboral en Salud , Psiquiatría , Humanos , Salud Mental , Transferencia de Tecnología , Recursos Humanos
8.
Int J Public Health ; 66: 633917, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34434083

RESUMEN

Objectives: Existing evidence suggests that drug-resistant tuberculosis (DR-TB) remains a huge public health threat in high-burden TB countries such as Ethiopia. The purpose of this qualitative study was to explore the challenges of healthcare workers (HCWs) involved in providing DR-TB care in Addis Ababa, Ethiopia. Methods: We conducted in-depth interviews with 18 HCWs purposively selected from 10 healthcare facilities in Addis Ababa, Ethiopia. We then transcribed the audiotaped interviews, and thematically analysed the transcripts using Braun and Clark's reflexive thematic analysis framework. Results: We identified five major themes: 1) inadequate training and provision of information on DR-TB to HCWs assigned to work in DR-TB services, 2) fear of DR-TB infection, 3) risk of contracting DR-TB, 4) a heavy workload, and 5) resource limitations. Conclusion: Our findings highlight major human resource constraints that current DR-TB care policies need to foresee and accommodate. New evidence and best practices on what works in DR-TB care in such resource-limited countries are needed in order to address implementation gaps and to meet global TB strategies.


Asunto(s)
Personal de Salud , Tuberculosis Resistente a Múltiples Medicamentos , Etiopía/epidemiología , Femenino , Instituciones de Salud , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Recursos en Salud/provisión & distribución , Fuerza Laboral en Salud , Humanos , Masculino , Investigación Cualitativa , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/terapia
9.
BMJ Open ; 11(8): e051345, 2021 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-34452968

RESUMEN

OBJECTIVES: To scope the evidence surrounding workplace health and safety risks for the remote health workforce in Australia and to collate the recommendations to address those risks. DESIGN: A five-stage scoping review framework refined by Cooper et al was used for this review. Informit Health Collection, Ovid Emcare, Medline, Web of Science Core Collection, ProQuest and the grey literature were searched in October 2020 using a combination of key words derived from the eligibility criteria. No date restriction was placed on the search. Title and abstract screening, full-text review and data extraction were performed by three reviewers. Data were analysed by the lead author using qualitative thematic analysis. ELIGIBILITY CRITERIA: Articles were eligible for inclusion if they were published research or industry reports, focused on safety for the remote health workforce in Australia, identified hazards/safety risks or recommendations to reduce risk, and were written in English. RESULTS: The search yielded 312 articles, of which 18 met the inclusion criteria. A wide range of hazards/safety risks and recommendations were identified within the literature, which related to safety culture, isolation, safe environment, and education and training. Some recommendations, such as the use of a risk management approach, good post-incident support, safer clinics and accommodation, and improved access to education and training, had been discussed in the literature for over a decade, with a high level of agreement regarding their importance. Two articles briefly evaluated the impact of some recommendations. CONCLUSION: While many recommendations have been developed to improve the safety of the remote health workforce in Australia, there is little evidence of their implementation and evaluation. As many remote health professionals report ongoing or worsening workplace safety issues, there is an urgent need for the implementation and evaluation of the workforce safety strategies recommended in the literature and required by legislation.


Asunto(s)
Personal de Salud , Fuerza Laboral en Salud , Australia , Humanos , Recursos Humanos
10.
Medicine (Baltimore) ; 100(32): e26901, 2021 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-34397918

RESUMEN

ABSTRACT: This study aimed to investigate the time trend variation in the surgical volume and prognostic outcome of patients with lung cancer after the gradual prolonged implementation of a low-dose computed tomography (LDCT) lung cancer screening program.Using the hospital-based cancer registry data on number of patients with lung cancer and deaths from 2008 to 2017, we conducted a retrospective study using a hospital-based cohort to investigate the relationship between changes in lung cancer surgical volume, the proportion of lung-sparing surgery, and prolonged prognostic outcomes after the gradual implementation of the LDCT lung cancer screening program in recent years.From 2008 to 2017, 3251 patients were diagnosed with lung cancer according to the hospital-based cancer registry. The 5-year mortality rate decreased gradually from 83.54% to 69.44% between 2008 and 2017. The volume of total lung cancer surgical procedures and proportion of lung-sparing surgery performed gradually increased significantly from 2008 to 2017, especially from 2014 to 2017 after implementation of a large volume of LDCT lung cancer screening examinations. In conclusion, our real-world data suggest that there will be an increase in cases of operable early-stage lung cancers, which in turn will increase the surgical volume and proportion of lung-sparing surgery, after the gradual implementation of the LDCT lung cancer screening program in recent years. These findings suggest the importance of a successful national policy regarding LDCT screening programs, regulation of shortage of thoracic surgeons, thoracic radiologist workforce training positions, and education programs.


Asunto(s)
Detección Precoz del Cáncer/métodos , Fuerza Laboral en Salud/estadística & datos numéricos , Neoplasias Pulmonares/diagnóstico , Pulmón/diagnóstico por imagen , Tamizaje Masivo/métodos , Neumonectomía/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta en la Radiación , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Dosis de Radiación , Estudios Retrospectivos
11.
Worldviews Evid Based Nurs ; 18(4): 251-260, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34355844

RESUMEN

BACKGROUND: During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. PURPOSE: To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. METHODS: We conducted an integrative review of team nursing and delegation using Whittemore and Knafl's (2005) methodology. RESULTS: We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses' delegation knowledge, decision-making, and competency. LINKING EVIDENCE TO ACTION: Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.


Asunto(s)
COVID-19/enfermería , Delegación Profesional/métodos , Grupo de Enfermería/normas , Admisión y Programación de Personal/normas , COVID-19/transmisión , Delegación Profesional/normas , Fuerza Laboral en Salud , Humanos , Grupo de Enfermería/métodos
12.
Br J Nurs ; 30(15): 941, 2021 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-34379464

RESUMEN

Although the latest report on workforce equality shows positive changes, some improvements are marginal and the issue must be kept high on the agenda, says Sam Foster, Chief Nurse, Oxford University Hospitals.


Asunto(s)
Fuerza Laboral en Salud , Racismo , Medicina Estatal , Fuerza Laboral en Salud/organización & administración , Humanos , Racismo/prevención & control , Medicina Estatal/organización & administración , Reino Unido
13.
Fertil Steril ; 116(2): 292-295, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34353571

RESUMEN

The demographics of the United States are rapidly changing, and our health care workforce is not keeping pace with the population trends. The American Society for Reproductive Medicine (formerly The American Fertility Society) recognizes the need to increase diversity and is committed to promoting diversity across our membership and leadership as well as promoting equitable quality reproductive care to all patients. In the fall of 2020, the American Society for Reproductive Medicine convened a Diversity, Equity, and Inclusion Task Force to evaluate and make recommendations on the basis of findings to increase diversity to achieve equity and inclusion of reproductive and infertility services for all women. This article focuses on specific barriers that Black or African American patients face in accessing quality care and that provider's face in training and inclusion in reproductive medicine. Multiple publications have confirmed an improvement in health outcome when there is congruence between the patient and the provider. There is a stark contrast between the racial and ethnic diversity of our providers and other support personnel compared with that of our patients. Despite our best intent to minimize the effects of implicit and explicit bias, mistrust and misunderstandings when there is discordance between patients and providers negatively impacts care. To increase provider diversity, it is crucial that we prioritize pipeline programs that recruit and support underrepresented minority in medicine physicians. Specific recommendations are made to increase diversity in the pipeline to improve patient access to culturally competent quality reproductive medicine care with optimal outcomes.


Asunto(s)
Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Medicina Reproductiva/educación , Afroamericanos , Personal de Salud , Fuerza Laboral en Salud , Humanos , Mentores , Calidad de la Atención de Salud
14.
BMJ Glob Health ; 6(Suppl 5)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34353815

RESUMEN

When COVID-19 hit India, a qualitative research study had been underway the southern state of Kerala, to understand the perspectives of the front-line health workers and the Kattunayakan tribal community towards health service utilisation. This community is relatively underserved, and a great deal of our emphasis was on understanding health system barriers experienced on both demand and supply side. COVID-19 showed us that these barriers pertain not just to heath systems, but also to the conduct of health research. We completed fieldwork in one hamlet before lockdowns were announced and changed our fieldwork approach for the remaining two different hamlets. The main change was a shift to the use of mobile telephony for fieldwork. This technological shift necessitated substantial changes in the design of fieldwork, the scope of our inquiry, as well as the composition and power dynamics within our team. First, adjusting to technology-driven fieldwork posed restrictions but also enhanced the agency and comfort of participants in some ways. Study design changes attributable to COVID-19 restrictions were brought about, but also gave us critical insight into the impact of COVID-19 and related outbreaks. There was de fact greater reliance on community researchers, which meant we ceded control to the community itself, upsetting typical research power dynamics, which can be quite top-down. We present these methodological reflections for wider consideration.


Asunto(s)
COVID-19 , Control de Enfermedades Transmisibles , Fuerza Laboral en Salud , Humanos , Investigación Cualitativa , SARS-CoV-2
15.
East Mediterr Health J ; 27(7): 698-706, 2021 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-34369585

RESUMEN

Background: Despite the importance of gender and intersectionality in policy-making for human resources for health, these issues have not been given adequate consideration in health workforce recruitment and retention in Africa. Aims: The objective of this review was to show how gender intersects with other sociocultural determinants of health to create different experiences of marginalization and/or privilege in the recruitment and retention of human resources for health in Africa. Methods: This was rapid review of studies that investigated the intersectionality of gender in relation to recruitment and retention of health workers in Africa. A PubMed search was undertaken in April 2020 to identify eligible studies. Search terms used included: gender, employment, health workers, health workforce, recruitment and retention. Criteria for inclusion of studies were: primary research; related to the role of gender and intersectionality in recruitment and retention of the health workforce; conducted in Africa; quantitative or qualitative study design; and published in English. Results: Of 193 publications found, nine fulfilled the study inclusion criteria and were selected. Feminization of the nursing and midwifery profession results in difficulties in recruiting and deploying female health workers. Male domination of management positions was reported. Gender power relationship in the recruitment and retention of the health workforce is shaped by marriage and cultural norms. Occupational segregation, sexual harassment and discrimination against female health workers were reported. Conclusion: This review highlights the importance of considering gender analysis in the development of policies and programmes for human resources for health in Africa.


Asunto(s)
Fuerza Laboral en Salud , Selección de Personal , África , Femenino , Personal de Salud , Humanos , Masculino , Recursos Humanos
16.
Aust Health Rev ; 45(4): 407-410, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34334157

RESUMEN

Tooth decay and gum disease, the main dental diseases affecting Australians, can cause pain and deformity as well as affecting eating and speech. Dental practitioners are efficient and effective in relieving dental pain, and they can effectively restore oral function. There is good evidence that better health care outcomes for Aboriginal and Torres Strait Islander patients are associated with care from Aboriginal and Torres Strait Islander health professionals. Unfortunately, the representation of Aboriginal and Torres Strait Islander people within the dental practitioner workforce is very low. We argue that a strategic approach, along with additional investment, is needed to increase the number of Aboriginal and Torres Strait Islander people qualified as dental practitioners.


Asunto(s)
Odontólogos , Fuerza Laboral en Salud , Australia , Humanos , Grupo de Ascendencia Oceánica , Rol Profesional
17.
Ann Glob Health ; 87(1): 83, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34458107

RESUMEN

Background: South Africa is an upper middle-income country with inequitable access to healthcare. There is a maldistribution of doctors between the private and public sectors, the latter which serves 86% of the population but has less than half of the human resources. Objective: The objective of this study was to estimate the specialist surgical workforce density in South Africa. Methods: This was a retrospective record-based review of the specialist surgical workforce in South Africa as defined by registration with the Health Professionals Council of South Africa for three cadres: 1) surgeons, and 2) anaesthesiologists, and 3) obstetrician/gynaecologists (OBGYN). Findings: The specialist surgical workforce in South Africa doubled from 2004 (N = 2956) to 2019 (N = 6144). As of December 2019, there were 3096 surgeons (50.4%), 1268 (20.6%) OBGYN, and 1780 (29.0%) anaesthesiologists. The specialist surgical workforce density in 2019 was 10.5 per 100,000 population which ranged from 1.8 in Limpopo and 22.8 per 100,000 in Western Cape province. The proportion of females and those classified other than white increased between 2004-2019. Conclusion: South Africa falls short of the minimum specialist workforce density of 20 per 100,000 to provide adequate essential and emergency surgical care. In order to address the current and future burden of disease treatable by surgical care, South Africa needs a robust surgical healthcare system with adequate human resources, to translate healthcare services into improved health outcomes.


Asunto(s)
Fuerza Laboral en Salud/estadística & datos numéricos , Cirujanos/provisión & distribución , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sector Público , Estudios Retrospectivos , Sudáfrica
18.
J Acad Nutr Diet ; 121(7): 1379-1391.e21, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34344516

RESUMEN

Worldwide, there is a continued rise in malnutrition and noncommunicable disease, along with rapidly changing dietary patterns, demographics, and climate and persistent economic inequality and instability. These trends have led to a national and global focus on nutrition-specific and nutrition-sensitive interventions to improve population health. A well-trained public health and community nutrition workforce is critical to manage and contribute to these efforts. The study describes the current public health and community nutrition workforce and factors influencing registered dietitian nutritionists (RDNs) to work in these settings and characterizes RDN preparedness, training, and competency in public health and community nutrition. The study was comprised of a cross-sectional, online survey of mostly US RDNs working in public health/community nutrition and semistructured telephone interviews with US-based and global public health and community nutrition experts. RStudio version 1.1.442 was used to manage and descriptively analyze survey data. Thematic analysis was conducted to evaluate expert interviews. Survey participants (n = 316) were primarily women (98%) and White (84%) with the RDN credential (91%) and advanced degrees (65%). Most reported that non-RDNs are performing nutrition-related duties at their organizations. Respondents generally rated themselves as better prepared to perform community nutrition vs public health functions. Interviews were conducted with 7 US-based experts and 5 international experts. Experts reported that non-RDNs often fill nutrition-related positions in public health, and RDNs should more actively pursue emerging public health opportunities. Experts suggested that RDNs are more desirable job candidates if they have advanced public health degrees or prior experience in public health or community nutrition and that dietetic training programs need to more rigorously incorporate public health training and experience. Significant opportunity exists to improve the preparedness and training of the current dietetic workforce to increase capacity and meet emerging needs in public health and community nutrition.


Asunto(s)
Servicios de Salud Comunitaria/provisión & distribución , Dietética/estadística & datos numéricos , Fuerza Laboral en Salud/estadística & datos numéricos , Nutricionistas/provisión & distribución , Salud Pública/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
BMJ Glob Health ; 6(Suppl 5)2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34429283

RESUMEN

Mobile phones are increasingly used to facilitate in-service training for frontline health workers (FLHWs). Mobile learning (mLearning) programmes have the potential to provide FLHWs with high quality, inexpensive, standardised learning at scale, and at the time and location of their choosing. However, further research is needed into FLHW engagement with mLearning content at scale, a factor which could influence knowledge and service delivery. Mobile Academy is an interactive voice response training course for FLHWs in India, which aims to improve interpersonal communication skills and refresh knowledge of preventative reproductive, maternal, neonatal and child health. FLHWs dial in to an audio course consisting of 11 chapters, each with a 4-question true/false quiz, resulting in a cumulative pass/fail score. In this paper, we analyse call data records from the national version of Mobile Academy to explore coverage, user engagement and completion. Over 158 596 Accredited Social Health Activists (ASHAs) initiated the national version, while 111 994 initiated the course on state-based platforms. Together, this represents 41% of the estimated total number of ASHAs registered in the government database across 13 states. Of those who initiated the national version, 81% completed it; and of those, over 99% passed. The initiation and completion rates varied by state, with Rajasthan having the highest initiation rate. Many ASHAs made multiple calls in the afternoons and evenings but called in for longer durations earlier in the day. Findings from this analysis provide important insights into the differential reach and uptake of the programme across states.


Asunto(s)
Teléfono Celular , Agentes Comunitarios de Salud , Niño , Salud del Niño , Fuerza Laboral en Salud , Humanos , India , Recién Nacido
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