Sample attrition analysis in a prospective cohort study of medical graduates in China

Background A major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described status of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures. Methods The cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015 and 2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into ‘always-out’, ‘rejoin’ and ‘other’. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development. Results 2364 (65.3%) participants completed all follow-up surveys. For those with incomplete follow-up, 520 (14.4%) were ‘always-out’, 276 (7.6%) rejoined in the 2020 survey. Willingness to participate in residency training (OR=0.80, 95%CI[0.66 - 0.98]) and willingness to provide sensitive information in the baseline survey predicted a lower rate of attrition (providing scores for university entrance exam OR=0.82, 95%CI[0.69 - 0.97]]; providing contact information (OR=0.46, 95%CI[0.32 - 0.66]); providing household income (OR=0.60, 95%CI[0.43 - 0.84]). Participants with compulsory rural service (OR=1.52, 95%CI[1.05 - 2.19]) and those providing university entrance scores (OR=1.64, 95%CI[1.15-2.33)) were more likely to rejoin in the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development. Conclusions Graduates who were unwilling to participate in residency training or not providing sensitive information should be targeted early in the cohort study to reduce attrition. More information about the study should be provided to those graduates early to facilitate their understanding of the meaning in participation. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The research team should invest more effort in contacting those graduates and returned them to the cohort.

How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea

Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.

Interventions in increasing availability of skilled healthcare providers in rural areas: A Case Study of Bihar (India)

Population of rural areas face distinct health challenges due to economic conditions, cultural/behavioural factors, and health provider shortages that combine to impose striking disparities in health outcomes among them. The process of recruitment takes about four to six months for Recruitment of Medical officers and paramedics. The number of applicants is quite limited because of dearth of doctors and paramedics in the State. It was felt that the health staffs incentives will help to increase the turnover of health staffs to some extent in the rural and remote areas. Monitoring cell has been constituted at the state level. The trainings are being monitored at regular intervals of time. The motivational level of health staff at all levels seems to be low. Continuous communication and feedback by state level programme officers is needed on regular basis. Placement of the suitable trained personnel is needed at those health facilities where sufficient infrastructure is available. Since 2010-11, there has been a continuous focus on the capacity building of the existing manpower in the state. Trainings as per GOI guidelines on Immunization, IMNCI, EmOC, LSAS, SBA and Minilap/MVA etc. have been taken up with full strength. In addition, the State wide training on immunization for Medical Officers, IPC skills for breast feeding and basic training in neonatal resuscitation also has been taken up at various levels. More than four-fifth of the total staffs in the health facilities were agreed on all the educational interventions for retention of health staffs in rural areas. For the regulatory interventions such as enhanced scope of practice, different types of health workers; multi skilling of alternate service providers, compulsory rural service which may be mandatory for obtaining license to practice or can be a prerequisite for entry into specialization and subsidized education in return of assured services were agreed by four-fifth of the total staffs. For the interventions related to professional and personal support such as better living conditions (water, sanitation, electricity, telecommunications, schools, etc.), safe and supportive working environment, outreach activities to facilitate cooperation between health workforce from better served and underserved areas; use of tele-health, designing career development programmes linked with rural service: more senior posts in rural areas and professional networks for rural areas such as rural health professional associations, rural health journals, etc. about 88 percent of the HR categories of Staffs were agreed in the health facilities

Sample Attrition Analysis in a Prospective Cohort Study of Medical Graduates in China

Background: A major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described patterns of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures. Methods: The cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015-2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into ‘always-out’, ‘rejoin’ and ‘other’. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development. Results: 2364 (65.3%) participants completed all follow-up surveys. For those with incomplete data, 520 (14.4%) were ‘always-out’, 276 (7.6%) rejoined in the 2020 survey. Unwillingness to participate in residency training (OR=1.311, 95%CI[1.028-1.672]) and unwillingness to provide sensitive information in the baseline survey predicted a higher rate of attrition (providing scores for university entrance exam (OR=1.313, 95%CI[1.064-1.620]; providing contact information (OR=2.762, 95%CI[1.660 - 4.593]; providing household income (OR=1.679, 95%CI[1.122-2.512]). Participants with compulsory rural service (OR=1.516, 95%CI[1.050-2.190]) and those providing university entrance scores (OR=1.639, 95%CI[1.152-2.334)) were more likely to rejoin the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development. Conclusion: Graduates who were unwilling to participate in residency training or not providing sensitive information were associated with higher attrition and should be targeted early in the cohort study to reduce attrition. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The overall attrition is unlikely to affect the estimates of outcome measures.

How to attract and retain health workers in rural areas of a fragile state: findings from a labour market survey in Guinea

Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak.The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts.We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training.Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.

Hospital practice in COVID-19 times: Perceptions of the midwifery interns in Peru

Objective: To evaluate the perception of midwifery interns regarding hospital practices during COVID-19. Material and methods: Study of qualitative approach, of phenomenological design, where 80 obstetric interns from the different regions of Peru participated, who are also representatives of their hospital headquarters. An in-depth interview was applied where the perception of hospital practices was addressed according to: i) current problems and ii) solution proposals. Results: Midwifery interns have been removed from hospital practices, mainly due to the absence of personal protective equipment and health insurance, financially affecting those who must continue to make rent and food payments; Likewise, a large part of the universities have not offered proposals for solutions to the delay in internships, raising concerns about delays in administrative procedures, even more so for students from non-licensed universities. Among the proposals, those who are close to graduating suggest being exempted from the months when there were no activities, so as not to delay future processes such as tuition and rural service; likewise, suspend payment for these months and strengthen knowledge through the discussion of clinical cases, which could be virtual. Conclusions: The cessation of hospital practice responds to a lack of guarantees in the health care of the student, generating economic repercussions and a negative perception regarding university management. Finally, solutions that could be considered for the next decisions made by the institutions are reported.