HUMAN RESOURCE CAPACITY TO EFFECTIVELY IMPLEMENT MALARIA ELIMINATION: A POLICY BRIEF FOR ETHIOPIA

2013 ◽  
Vol 29 (2) ◽  
pp. 212-217 ◽  
Author(s):  
Adugna Woyessa ◽  
Mamuye Hadis ◽  
Amha Kebede

Objective: The aim of this study was to investigate malaria elimination in Ethiopia. Ethiopia has planned to eliminate malaria by 2015 in areas of unstable malaria transmission and in the entire country by 2020. However, there is a shortage and maldistribution of the health workforce in general and malaria experts in particular. Training, motivating, and retaining the health workforce involved in malaria control is one strategy to address the shortage and maldistribution of the health workforce to achieve the goal of elimination.Methods: Policy options include the following: (i) in-service training (educational outreach visits, continuing education meetings and workshops, audit and feedback, tailored interventions, and guideline dissemination) may improve professional practice; (ii) recruiting and training malaria specialists together with academic support, career guidance, and social support may increase the number of malaria experts; and (iii) motivation and retention packages (such as financial, educational, personal, and professional support incentives) may help motivate and retain malaria professionals.Results: Implementation strategies include the following: (i) massive training of health personnel involved in malaria elimination and malaria experts (requiring special training) at different levels (national, sub-national, District & community levels), and (ii) recruiting highly qualified health personnel and retention and motivation mechanisms are needed.Conclusions: The lack of adequately trained human resources and personnel attrition are major challenges to effectively implement the planned multi-faceted malaria elimination by 2020 strategy in Ethiopia. Although a reduction in malaria incidence has been observed in the last 3-4 years, maintaining this success and achieving the malaria elimination goal with the present human resource profile will be impossible. A clear strategy for developing the capacity of the health workers in general, and malaria experts in particular, and retaining and motivating staff are crucial for malaria control and elimination.

2020 ◽  
Author(s):  
B. Shantharam Baliga ◽  
Shrikala Baliga ◽  
Animesh Jain ◽  
Naveen Kulal ◽  
Manu Kumar ◽  
...  

Abstract BackgroundMalaria control system (MCS), an Information technology (IT)-driven surveillance and monitoring intervention is being adopted for elimination of malaria in Mangaluru city, Karnataka, India since October 2015. This facilitated ‘smart surveillance’ followed by required field response within a timeline. The system facilitated data collection of individual case and data driven mapping and strategies for malaria elimination programme. This paper aims to present the analysis of post-digitization data of 5 years, discuss the current operational functionalities of MCS and its impact on the malaria incidence.MethodsIT system developed for robust malaria surveillance and field response is being continued in the 6th year. Protocol for surveillance control was followed as per the national programme guidilines mentioned earlier. Secondary data from the malaria control system is collated and analysed. Incidence of malaria, active surveillance, malariogenic conditions and its management, malariometric indices, shrinking malaria map were also analysed.ResultsSmart surveillance and subsequent response for control was sustained and performance improved in five years with participation of all stakeholders. Overall malaria incidence significantly reduced by 83% at the end of 5 years when compared with year of digitizarion (DY) (p<0.001). Early reporting of new cases (within 48 hrs) was near total followed by complete treatment and vector control. Slide positivity rate (SPR) decreased from 10.36 (DY) to 6.5 (PDY 5). Annual parasite incidence (API) decreased from 16.17 (DY) to 2.64 (PDY 5). There was a negative correlation between contact smears and incidence of malaria. Five-year data analyses indicated declining trends in overall malaria incidence and correlation between closure by 14 days. The best impact on reduction in incidence of malaria was recorded in pre-monsoon months (~85%) compared to lower impact in July-August months (~40%). ConclusionIT System helped to micromanage control activities such as robust reporting, incidence-centric active surveillance, early and complete treatment, documentation of full treatment of each malaria patient, targeted mosquito control measures in houses surrounding reported cases. The learnings and analytical output from the data helped to modify strategies for control of both disease and the vector, heralding the city into the elimination stage.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
B. Shantharam Baliga ◽  
Shrikala Baliga ◽  
Animesh Jain ◽  
Naveen Kulal ◽  
Manu Kumar ◽  
...  

Abstract Background Malaria control system (MCS), an Information technology (IT)-driven surveillance and monitoring intervention is being adopted for elimination of malaria in Mangaluru city, Karnataka, India since October 2015. This has facilitated ‘smart surveillance’ followed by required field response within a timeline. The system facilitated data collection of individual case, data driven mapping and strategies for malaria elimination programme. This paper aims to present the analysis of post-digitization data of 5 years, discuss the current operational functionalities of MCS and its impact on the malaria incidence. Methods IT system developed for robust malaria surveillance and field response is being continued in the sixth year. Protocol for surveillance control was followed as per the national programme guidelines mentioned in an earlier publication. Secondary data from the malaria control system was collated and analysed. Incidence of malaria, active surveillance, malariogenic conditions and its management, malariometric indices, shrinking malaria maps were also analysed. Results Smart surveillance and subsequent response for control was sustained and performance improved in five years with participation of all stakeholders. Overall malaria incidence significantly reduced by 83% at the end of 5 years when compared with year of digitization (DY) (p < 0.001). Early reporting of new cases (within 48 h) was near total followed by complete treatment and vector control. Slide positivity rate (SPR) decreased from 10.36 (DY) to 6.5 (PDY 5). Annual parasite incidence (API) decreased from 16.17 (DY) to 2.64 (PDY 5). There was a negative correlation between contact smears and incidence of malaria. Five-year data analyses indicated declining trends in overall malaria incidence and correlation between closures by 14 days. The best impact on reduction in incidence of malaria was recorded in the pre-monsoon months (~ 85%) compared to lower impact in July–August months (~ 40%). Conclusion MCS helped to micromanage control activities, such as robust reporting, incidence-centric active surveillance, early and complete treatment, documentation of full treatment of each malaria patient, targeted mosquito control measures in houses surrounding reported cases. The learnings and analytical output from the data helped to modify strategies for control of both disease and the vector, heralding the city into the elimination stage.


2019 ◽  
Vol 2 (1) ◽  
pp. 10-22
Author(s):  
Hanifatur Rosyidah ◽  
Korrie De Koning ◽  
Hermen Ormel

Maternal Mortality Ratio (MMR) in Indonesia remains high, 190 per 100,000 live births in 2013. World Bank emphasizes that 60% of maternal death is contributed by poor quality of care. Lack of attitude, competence and compliance of midwives were found in Indonesia, which indicate poor quality of maternal health care. The objective of this study is to analyze factors influencing the quality of maternal health care in Indonesia. The literatures from 2004-2014 were selected and reviewed. The latest framework of 2014 on quality maternal health care by Renfrew et al. was used as a guide. The quality of maternal health care in Indonesia is influenced by lack of midwives’ competence, inadequate supervision and monitoring, lack of drugs and equipment supply, lack of community involvement in health services. In order to address the gaps in quality of maternal health care in Indonesia, six effective interventions are proposed; namely: maternal health audit and feedback, cultural competence, education, educational outreach visit, optimizing the role of lay health workers, group prenatal care and ensure adequate supply of drugs and equipment. The interventions needs to be carried out through a collaborative approach, policy change, pilot study and strengthen activities in implementation level.


BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025979 ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Rajesh Nair ◽  
Anjali Sharma ◽  
Ritika Tiwari ◽  
...  

ObjectivesWe provide new estimates on size, composition and distribution of human resource for health in India and compare with the health workers population ratio as recommended by the WHO. We also estimate size of non-health workers engaged in health sector and the size of technically qualified health professionals who are not a part of the health workforce.DesignNationally representative cross-section household survey and review of published documents by the Central Bureau of Health Intelligence.SettingNational.ParticipantsHead of household/key informant in a sample of 101 724 households.InterventionsNot applicable.Primary and secondary outcome measuresThe primary outcome was the number and density of health workers,and the secondary outcome was the percentage of health workers who are technically qualified and the percentage of individuals technically qualified and not in workforce.ResultsThe total size of health workforce estimated from the National Sample Survey (NSS) data is 3.8 million as of January 2016, which is about 1.2 million less than the total number of health professionals registered with different councils and associations. The density of doctors and nurses and midwives per 10 000 population is 20.6 according to the NSS and 26.7 based on the registry data. Health workforce density in rural India and states in eastern India is lower than the WHO minimum threshold of 22.8 per 10 000 population. More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils, while 20% of adequately qualified doctors are not in the current workforce.ConclusionsDistribution and qualification of health professionals are serious problems in India when compared with the overall size of the health workers. Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.


Author(s):  
Sooyoung Kim ◽  
Verah Nafula Luande ◽  
Joacim Rocklöv ◽  
Jane M. Carlton ◽  
Yesim Tozan

Malaria elimination and eradication efforts have stalled globally. Further, asymptomatic infections as silent transmission reservoirs are considered a major challenge to malaria elimination efforts. There is increased interest in a mass screen-and-treat (MSAT) strategy as an alternative to mass drug administration to reduce malaria burden and transmission in endemic settings. This study systematically synthesized the existing evidence on MSAT, from both epidemiological and economic perspectives. Searches were conducted on six databases (PubMed, EMBASE, CINALH, Web of Science, Global Health, and Google Scholar) between October and December 2020. Only experimental and quasi-experimental studies assessing the effectiveness and/or cost-effectiveness of MSAT in reducing malaria prevalence or incidence were included. Of the 2,424 citation hits, 14 studies based on 11 intervention trials were eligible. Eight trials were conducted in sub-Saharan Africa and three trials in Asia. While five trials targeted the community as a whole, pregnant women were targeted in five trials, and school children in one trial. Transmission setting, frequency, and timing of MSAT rounds, and measured outcomes varied across studies. The pooled effect size of MSAT in reducing malaria incidence and prevalence was marginal and statistically nonsignificant. Only one study conducted an economic evaluation of the intervention and found it to be cost-effective when compared with the standard of care of no MSAT. We concluded that the evidence for implementing MSAT as part of a routine malaria control program is growing but limited. More research is necessary on its short- and longer-term impacts on clinical malaria and malaria transmission and its economic value.


Author(s):  
Kahler W. Stone ◽  
Kristina W. Kintziger ◽  
Meredith A. Jagger ◽  
Jennifer A. Horney

While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Anup Karan ◽  
Himanshu Negandhi ◽  
Suhaib Hussain ◽  
Tomas Zapata ◽  
Dilip Mairembam ◽  
...  

Abstract Background Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India. Methods We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels. Results The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets. Conclusion India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Khurana ◽  
S Roy ◽  
M Gupta

Abstract Problem Human resources in the public health sector is of prime importance in a limited resource setting country, who at times work in a high-pressure, limited resource environment and where skilled staff continue to remain in short supply. The role of Human Resource for Health (HRH) team responsible for managing this health workforce is crucial. They play an important role in improving the human resource practices and creating an enabling organizational culture for optimal resource utilization. The paper explores the profile of the HRH teams of the states of India, their knowledge levels, and perceptions of their role. Methods The participants were HR Managers from 29 states of India who look after HRH in National Health Mission and State Health Departments. Cross-sectional survey tool was used for data collection. Quantitative data analysis included univariate and bivariate analysis. One Way ANOVA test of significance and post-hoc tests using Tukey's method was used to ascertain the groups with significant difference. Results Most of the HRH team members are postgraduates or have management background. Their experience varies from &lt;1year to &gt; 25 years. Mostly of them perceive their role to be limited to implementing bare essential HRM practices, mostly administrative. The educational qualification of the members did not have any significant bearing on their technical knowledge related to HRM practices; but their experience in public health sector showed a significant association. Lessons This study lends evidence to the principle that professionals who have been in the system for long, know about HRH and the associated policies better, and hence may be better equipped to handle HRH and establish good HR Management (HRM) systems. Better role clarity among the HRH teams, expansion of their current scope of work to include advanced practices of HRM and continuous capacity building mechanisms are needed to help strengthen the development and management of HRH. Key messages This study, a first of its kind in the country, lend evidence related to the principle for deciding the profile of team who should be entrusted with managing and development of HRH. The Study gives evidence to focus on the role clarity of HRH to zero down their knowledge and skills gaps and enhance their competencies through better capacity building.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Šantrić Milićević ◽  
N Vasilijevic ◽  
V Vasic

Abstract Background Some rich countries are actively recruiting labour from abroad for lack of health workforce. A high-level tendency for emigration among health care personnel in Serbia has attracted the attention of policymakers. In the search for evidence that can support the interventions to manage the outflow of the health workforce, the objective of the study was to obtain the opinion of medical doctors and nurses about retention factors. Methods A 65-item questionnaire was distributed to 384 hospital physicians and nurses to explore their views on fourteen aspects for labour outflow management (recruitment, training, job, salary, benefits, managers' behaviour, career development, relationships, work conditions, institutional image, organizational support, and three types of organizational commitment). Any difference between physicians and nurses and their responses' scores was assessed with Pearson Chi-Square (p &lt; 0.05) and Independent Samples t-test (p &lt; 0.05). Results Few nurses (17.8%) and physicians (13.6%) are familiar with measures taken in the country to manage the migration of healthcare workers, but most would work abroad if given such opportunities (56.8% and 63.0%, respectively). The responses of physicians and nurses differ for many aspects of management; the best scored were managers' behaviour (11.9 v 10.4, respectively, p &lt; 0.001) and organizational support (15.3 v 13.4, respectively, p &lt; 0.001), while the least scored were job benefits (4.1 v 4.0, respectively p = 0.531), salary (5.9 v 5.8, respectively p = 0.459), relationships (5.3 v 5.3, respectively p = 0.911) and performance assessment (5.3 v 4.9, respectively p = 0.008). Conclusions The study has identified success and failure factors for the outflow management of health workers in Serbia. Hospital doctors scored higher than nurses almost all retention factors. There is a space to strengthen the policy and practice to retain hospital doctors and nurses in the country. Key messages Hospital nurses are in a worse position than hospital doctors in regard to almost all aspects of outflow management. Stakeholders should invest in retaining medical doctors and nurses in the hospital.


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