Individual Responsibilities in Partial Compliance: Skilled Health Worker Emigration from Under-Served Regions

2019 ◽  
Vol 13 (1) ◽  
pp. 89-98
Author(s):  
Yusuf Yuksekdag

Abstract One of the ways to address the effects of skilled worker emigration is to restrict the movement of skilled workers. However, even if skilled workers have responsibilities to assist their compatriots, what if other parties, such as affluent countries or source country governments, do not fulfil their fair share of responsibilities? This discussion raises an interesting problem about how to think of individual responsibilities under partial compliance where other agents (including affluent countries, developing states, or other individuals) do not fulfil their fair share of responsibilities. What is fair to expect from them? Taking health worker emigration as a case in point, I discuss whether the individual health workers’ fair share of responsibilities to address basic health care needs decreases or increases when the other parties do not fulfil their share. First, I review the responsibilities that different stakeholders may hold. Second, I argue that there are strong reasons against increasing or decreasing health workers’ fair share of responsibilities in a situation of partial compliance. I also argue that it is unfair for non-complier states to enforce health workers to fulfil their fair share or take up the slack.

Author(s):  
Yusuf Yuksekdag

There is a recent interest in the ethics of high-skilled worker emigration through which the limitations of the right to exit are discussed. Insightful arguments have been made in favour of (or against) the emigration restrictions on skilled workers in order to tackle the deprivations in developing countries. However, there is still a need for clarification on how we can understand, discuss and implement limitations of a right from a normative perspective. Significantly, how we understand the limitation of a right might determine how we approach such limitations – both in terms of the process of assessing the limitations and in terms of their implications. In this paper, I identify two distinct ways to understand limitations of the right to exit with respect to losses associated with health worker emigration, while also pointing to their implications for restrictive policies: (i) as a matter of scope, and (ii) as a matter of weight or emergency, which requires a compensatory scheme for the individual right holders. While the emergency restrictions seem to be a point of convergence in the literature, what defines an emergency and the nature of the compensation still warrant exploration. To that end, I also discuss from a normative perspective what might constitute a public emergency that would give states a prima facie prerogative to regulate temporary limitations on the exercise of the right to exit. In addition, I briefly introduce the implications of emergency restrictions, with a particular focus on compensatory schemes for individual right holders.


Author(s):  
Tetiana Herliand

Relevance: in order to implement the effective personal self-realization of the future skilled worker, there is a need for the system of professional (vocational) education to follow the changes in the sphere of work, respond to the economic situation in the country, the structure of the market of professions, the demand for new competences. All this requires a significant increase in the degree of flexibility of this education system, creation of fundamentally new forms of its interaction with the labor market, employers and their active participation in its further and future development. Purpose: to carry out theoretical and methodological substantiation of the system of professional training of future skilled workers in the professional (vocational) education schools on the basis of modular competence approach. Methods: theoretical analysis, study of regulatory documents, analysis of curricula – to find out the state of development of the problem and determine the directions of research; comparison – to study different scientific perspectives on the problem; analysis and synthesis – to develop criteria and indicators of the readiness of future skilled workers to carry out professional activities on a modular basis; systematization and generalization – to formulate conclusions. Results: the essential characteristics of module competence training are revealed, its peculiarities and main aspects are characterized, which create the proper conditions for the formation of key competences and suc- cessful training of future skilled workers, the development of their creative cognitive activity and independence in terms of modular mastery of professional activity. Conclusions: in the implemented professional training of future skilled workers, based on modular com- petence, there is a complex development of skills and knowledge within the framework of formation of the specific competence of the individual, which ensures the fulfillment of the specific labor function and reflects the requirements of the modern labor market.


2019 ◽  
Vol 22 (1) ◽  
pp. 1-9
Author(s):  
Isfandari Siti

This is a review of maternal mortality risk due to preference of non skilled health worker delivery assistance among 9 ethnics applying gender analysis. Data obtained from 9 ethnograpic studies reports conducted by Pusat Humaniora. Estimation of maternal mortality rate (MMR) in Indonesia is between 305 (Supas) – 359 (Susenas) per 100.000 live birth. There is no single cause of maternal death. The greatest contributors 75% are due to direct cause namely bleeding, infection, hypertension, delivery complication and unsafe abortion. Government intervention prioritizes to prevent direct cause of maternal death through health service delivery improvement. Among them are midwives in village, PONEK, PONED. However MMR is still high. Social factors as Indirect causes such as poverty, distance, information, inadequate service and culture have not yet considered as important. In fact contribution of social factors cannot be neglected. This review explores gender dynamics of preferences on non skilled health worker delivery assistance from 9 ethnic in Sumatra, Jawa and NTT. The results showed each ethinc had different gender dynamics. Among which are gender relation in each culture. Some ethnic shows gender equity, while others believe woman have full responsibility of her pregnancy and delivery without assistance from others. Powerlessness of woman is indicated by preference of traditional birth attendant for delivery due to culture and comfort. Even the pregnant women herself did not aware that delivery is a life risk. However the studies showed there is no sharp inequity with strong preference to boy over girl. Accessibility, education, comfort perceived culture, and economy are important for delivery assisted by health providers.


2019 ◽  
Vol 21 (2) ◽  
pp. 172-174
Author(s):  
Julie Chor ◽  
Danielle Young ◽  
Michael T. Quinn ◽  
Melissa Gilliam

Young women, low-income women, and women of color make up a disproportionate share of abortion patients and experience higher rates of unintended pregnancy, maternal morbidity and mortality, and infant mortality. Furthermore, these individuals are also less likely to have access to preventive gynecologic care. Whereas lay health worker interventions have been developed to help link individuals to care in other fields, the use of such interventions to link individuals to preventive care after abortion is novel. This article describes a training protocol and curriculum that provided nonmedically trained individuals with knowledge, skills, and competency to conduct a behavioral theory–based counseling intervention to help individuals achieve self-identified goals regarding obtaining postabortion reproductive health care and contraception. When piloted with 60 patients presenting for abortion who lacked a regular health care provider and desired to delay pregnancy for at least 6 months, participants found the lay health worker skills and the counseling session highly acceptable. Specifically, participants reported feeling comfortable speaking to lay health workers about contraception and reproductive health care. These findings indicate that lay health worker interventions may present an important opportunity to help individuals address their postabortion preventive and contraceptive health care needs.


Physiotherapy ◽  
2013 ◽  
Vol 21 (4) ◽  
Author(s):  
Felicja Lwow ◽  
Małgorzata Korzeniowska ◽  
Joanna Dadacz ◽  
Ewa Hladik ◽  
Agata Łukojko ◽  
...  

AbstractThe demographic situation of Poland as well as other developed countries shows a growing number of people at retirement age. According to the data from GUS (Central Statistical Office), their number reached 6.5 mln in Poland in 2011, and the prognosis for shows 8,3 mln by the year 2035. The consequence of this fact is a necessity of including the specificity of this age group in the functioning of Polish health care as well as in preventive medicine and health promotion. Unifying the health needs of this age group would be disadvantageous due to the diversification of physical efficiency level in the psychosomatic and social aspect. Nevertheless, the key problem is to distinguish the optimal health care models which include not only chronic conditions and dysfunctions but also the quality of life and socially independent life style that guarantee the lack of isolation and social exclusion. Distinguishing the four action models, namely people considered as healthy by the system, autonomously functioning people with chronic conditions, and people who need other people or institutional care to function in a society, seems to cover the individual needs of this group. Concluding, the National Health Care needs to work out some proceeding algorithms for these models. The optimal program adjustment for the needs of the target group would most certainly improve the effectiveness of the Health Care.


2020 ◽  
pp. 026921632096759
Author(s):  
Fenella J Gill ◽  
Zahraa Hashem ◽  
Roswitha Stegmann ◽  
Samar M Aoun

Background: Provision of paediatric palliative care is complex and optimally covers meeting the individual needs of a heterogenous population of children and their parent caregivers throughout a life-limiting illness. It is unclear whether existing approaches comprehensively address parent caregivers’ needs. Aim: To examine support needs of parents caring for children with life limiting illnesses and identify specific approaches used to identify and address needs. Design: A scoping review Data sources: MEDLINE, EMBASE, PsycINFO, CINAHL and ProQuest Central, were searched for peer reviewed English language full text research published from 2008 to 2019. Study quality appraisal was undertaken. Fourteen quantitative, 18 qualitative and 12 mixed methods studies were synthesised and themed using summative content analysis and mapped to the Parent Supportive Care Needs Framework (PSCNF). Results: Themes were communication, choice, information, practical, social, psychological, emotional and physical. Communication and choice were central and additional to domains of the PSCNF. Unmet were needs for supporting siblings, for respite care, out of hours, psychological, home and educational support. Six articles reported using instruments to identify parent carer support needs. Conclusion: Support needs of parent caregivers of children with life limiting illnesses are substantial and heterogenous. While studies report evidence of burden and distress in parent caregivers, this rarely translates into improvements in practice through the development of interventions. A systematic and regular assessment of individual parent caregiver support needs is required by using instruments appropriate to use in clinical practice to move the focus to palliative care interventions and improved services for parents.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katarzyna Klasa ◽  
Stephanie Galaitsi ◽  
Andrew Wister ◽  
Igor Linkov

AbstractThe care needs for aging adults are increasing burdens on health systems around the world. Efforts minimizing risk to improve quality of life and aging have proven moderately successful, but acute shocks and chronic stressors to an individual’s systemic physical and cognitive functions may accelerate their inevitable degradations. A framework for resilience to the challenges associated with aging is required to complement on-going risk reduction policies, programs and interventions. Studies measuring resilience among the elderly at the individual level have not produced a standard methodology. Moreover, resilience measurements need to incorporate external structural and system-level factors that determine the resources that adults can access while recovering from aging-related adversities. We use the National Academies of Science conceptualization of resilience for natural disasters to frame resilience for aging adults. This enables development of a generalized theory of resilience for different individual and structural contexts and populations, including a specific application to the COVID-19 pandemic.


BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042052
Author(s):  
Jean-Baptiste Woods ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe

ObjectivesMental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.DesignSystematic literature review.Data sourcesWe searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteriaAll quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesisData were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.ResultsFifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.ConclusionsWhile there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.


2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saiendhra Vasudevan Moodley ◽  
Muzimkhulu Zungu ◽  
Molebogeng Malotle ◽  
Kuku Voyi ◽  
Nico Claassen ◽  
...  

Abstract Background Health workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices. Methods A cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection. Results A total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments. Conclusions The attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.


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