Assessing geriatric capacity building needs in public hospitals in Mexico.

AIMS: To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in the care of older people. BACKGROUND: The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. METHODS: A needs assessment using a pragmatic qualitative approach structured this study. Semi-structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. RESULTS: Ninety-two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. CONCLUSIONS: This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high-income country older people care models within the Mexican healthcare context. IMPLICATIONS FOR PRACTICE: Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people.

Health Professional Education And Universal Health Coverage: A Summary Of Challenges And Selected Case Studies.

Low- and middle-income countries are experiencing serious shortages in meeting health workforce requirements for universal health coverage. We examine how national-level policies can address these deficiencies and support the development of an appropriately skilled health workforce in line with population needs. We discuss three innovative, government-led solutions that are designed to align health workforce training with the demands of universal health coverage. Specifically, we discuss two initiatives to train and retain doctors in rural areas of Thailand, the large-scale training of community health workers within multidisciplinary primary health care teams in Brazil, and the introduction of a postgraduate diploma program in primary care for nurses in India. Several positive outcomes have been associated with these initiatives, including improvements in the rural retention of doctors in Thailand and reductions in infant and child mortality rates in Brazil. However, further research is needed to assess the impact of such initiatives on the long-term retention of workers-particularly doctors-and the adequacy of the training offered to lower-skilled workers to effectively plug medical personnel gaps. Systematic monitoring of program affordability and cost-effectiveness over time must be prioritized, alongside efforts to disseminate lessons learned.

Lessons from eight countries on diffusing innovation in health care.

Health care systems are under increasing pressure to cope with shifting demographics, the threat of chronic and noncommunicable disease, and rising health care costs. The uptake of innovations to meet these challenges and to advance medicine and health care delivery is not as rapid as the pace of change. Greater emphasis on the diffusion of innovation and greater understanding of the structural and organizational levers that can be used to facilitate systemwide improvement are essential. This article describes the results of a qualitative and quantitative study to assess the factors and behaviors that foster the adoption of health care innovation in eight countries: Australia, Brazil, England, India, Qatar, South Africa, Spain, and the United States. It describes the front-line cultural dynamics that must be fostered to achieve cost-effective and high-impact transformation of health care, and it argues that there is a necessity for greater focus on vital, yet currently underused, organizational action to support the adoption of innovation.