OBJECTIVES To define the status of Infectious Diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery, and evaluation of postgraduate training in ID in different countries. METHODS Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses. RESULTS In responses received from 33/35 (94.3%) countries, ID is recognised as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in 8, but it is not recognised in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million. Median length of training is 5 (IQR 4.0 - 6.0) years with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75% (25/33) and assessed by final exams in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries. CONCLUSIONS There are substantial gaps in modernisation of ID training in many countries to match current European Training Requirements. Joint training with clinical microbiology and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.
Background An effective health workforce is essential for achieving health-related new Sustainable Development Goals. Odisha, one of the states in India with low health indicators, faces challenges in recruiting and retaining health staff in the public sector, especially doctors. Recruitment, deployment and career progression play an important role in attracting and retaining doctors. We examined the policies on recruitment, deployment and promotion for doctors in the state and how these policies were perceived to be implemented. Methods We undertook document review and four key informant interviews with senior state-level officials to delineate the policies for recruitment, deployment and promotion. We conducted 90 in-depth interviews, 86 with doctors from six districts and four at the state level to explore the perceptions of doctors about these policies. Results Despite the efforts by the Government of Odisha through regular recruitments, a quarter of the posts of doctors was vacant across all institutional levels in the state. The majority of doctors interviewed were unaware of existing government rules for placement, transfer and promotion. In addition, there were no explicit rules followed in placement and transfer. More than half (57%) of the doctors interviewed from well-accessible areas had never worked in the identified hard-to-reach areas in spite of having regulatory and incentive mechanisms. The average length of service before the first promotion was 26 (±3.5) years. The doctors expressed satisfaction with the recruitment process. They stated concerns over delayed first promotion, non-transparent deployment policies and ineffective incentive system. Almost all doctors suggested having time-bound and transparent policies. Conclusions Adequate and appropriate deployment of doctors is a challenge for the government as it has to align the individual aspirations of employees with organizational needs. Explicit rules for human resource management coupled with transparency in implementation can improve governance and build trust among doctors which would encourage them to work in the public sector.
BACKGROUND India faces a critical shortage of government doctors in rural and underserved areas. Several measures have been introduced to address the shortage, but significant problems still remain. The main aim of the current research was to understand the existing recruitment-related policies and systems in place for government doctors in Gujarat and to identify issues that prevent effective recruitment of doctors that could have implications for doctors' shortage in the state. The research also aims to fill the knowledge gap in the existing literature on why recruitment in civil services is an important HR function to address the shortage of doctors. METHODS The study aimed at identifying the existing recruitment policies and practices for government Medical Officers (MOs) from Gujarat state in India. The analysis is based on document review to understand the existing policies, 19 in-depth interviews with MOs to understand the systems in place for recruitment of MOs, construction of job histories from interviews to understand various nuances in the recruitment system and five interviews with Key Informants to understand recruitment policies and their actual implementation. Thematic framework approach was used to analyse qualitative data using NVivo. RESULTS While the state has general recruitment guidelines called the Recruitment Rules (RRs), these rules are very wide-ranging and fragmented. The MOs were neither briefed about them nor received copies of the rules at any time during the service suggesting that RRs were not transparent. The recruitment system was considered to be slow and very sporadic having possible implications for attraction and retention of MOs. The study results indicate several other system inefficiencies such as a long time taken by the health department to provide salary benefits and service regularization that has a negative effect over MOs' motivation. The study also found unequal opportunities presented to different categories of MOs in relation to job security, salary benefits and in recognizing their previous work experience leaving MOs unclear about their future thereby influencing the attraction and retention of MOs to government jobs negatively. CONCLUSIONS If long-term solutions are to be sought, the health department needs to have an effective recruitment system in place with the aim to (1) address the slow and sporadic nature of the recruitment system (that is likely to attract more doctors and prevent loss of any doctors during recruitment) and (2) address the job insecurity issue that MOs have which also influences their other employment benefits such as salary, pension and recognition for the years of service they have given to the health department. Addressing these issues can improve motivation among doctors and prevent loss of doctors through voluntary turnover leading to better retention.
Zimbabwe experienced a socio-economic crisis from 1997 to 2008 which heavily impacted all sectors. In this context, human resource managers were confronted with the challenge of health worker shortage in rural areas and, at the same time, had to operate under a highly centralised, government-centred system which defined health worker deployment policies. This study examines the implementation of deployment policies in Zimbabwe before, during and after the crisis in order to analyse how the official policy environment evolved over time, present the actual practices used by managers to cope with the crisis and draw lessons. 'Deployment' here was considered to include all the human resource management functions for getting staff into posts and managing subsequent movements: recruitment, bonding, transfer and secondment. The study contributes to address the existing paucity of evidence on flexibility on implementation of policies in crisis/conflict settings
The difficulties in establishing and delivering reliable clinical hematology and laboratory services in resource-limited settings are well recognized. However, much can be achieved by better use of existing resources through a concerted quality improvement approach. The recommendations of this chapter are based in part upon work in the thalassemias, inherited disorders of hemoglobin that are widely prevalent in Asia, which may serve as a model that is applicable to other common, chronic disorders in resource-poor settings. Resources are highlighted and recommendations made regarding approaches to improving services. Over the last few years, a number of low and middle-income countries, obtaining support from appropriate governmental sources, have assessed and overcome difficulties and significantly improved clinical services for patients with thalassemia.
BACKGROUND Effective performance appraisal systems can not only motivate employees to improve performance but also be important for the performance of organizations. However, the appraisal systems in civil services called the Annual Confidential Report (ACR) systems can be ineffective and do not contribute to employees' learning and development. With this background, the current study aimed at understanding the ACR system and assessing its effectiveness. The research aims to contribute in filling the knowledge gap in the existing literature on the need as to why the ACR system in civil services is an important human resource management (HRM) function. METHODS The analysis is based on policy review to understand the extant appraisal-related rules and policies. Nineteen in-depth interviews with medical officers (MOs) working with the government health department of Gujarat, India, were conducted. The main objective of the research was to assess the effectiveness of the actual appraisal system called or referred to as the ACR as perceived by MOs. Thematic framework approach was used to analyze qualitative data using NVIVO 9. Themes were built around five features of an effective appraisal system, i.e., purpose, source, feedback quality, link of the ACR system with other human resource functions, and administrative effectiveness. RESULTS The five features of the effective appraisal system studied in the current research (purpose, source, feedback quality, link of ACR system with other HRM functions, and administrative effectiveness) indicate that the overall appraisal system is ineffective. The overall appraisal system was perceived to be subjective and one directional in character by the study respondents. Furthermore, respondents perceived the appraisal system to be a ritual and where MOs hardly got to know about their performance, especially good performance. Hence, the feedback loop, an important feature for an effective appraisal system, was absent. The overall ACR system functions in isolation with no link to other HRM functions such as training and counselling, and a weak link with salary administration and promotion. CONCLUSIONS Addressing the five features or domains of an effective appraisal system can lead to improved perceived fairness MOs have on the current appraisal system which may further influence the satisfaction and motivation positively. Improved motivation and satisfaction with the appraisal system can influence two important human resource for health-related outcomes, i.e., performance and retention.
Background: Mozambique's community health programme has a disproportionate number of male community health workers (known as Agentes Polivalentes Elementares (APEs)). The government of Mozambique is aiming to increase the proportion of females to constitute 60% to improve maternal and child health outcomes. To understand the imbalance, this study explored current recruitment processes for APEs and how these are shaped by gender norms, roles and relations, as well as how they influence the experience, and retention of APEs in Maputo province, Mozambique. Methods: We employed qualitative methods with APEs, APE supervisors, community leaders, and a government official in two districts within Maputo province. Interviews were recorded, transcribed and translated. A coding framework was developed in accordance with thematic analysis to synthesise findings. Findings: In-depth interviews (n=30), key informant interviews (n=1) and focus group discussions (n=3) captured experiences and perceptions of employment processes. Intra-household decision-making structures mean women may experience additional barriers to join the APE programme, often requiring their husband's consent. Training programmes outside of the community were viewed positively, as an opportunity to build a cohort. However, women reported difficulty leaving family responsibilities behind, and men reported challenges in providing for their families during training as other income generating opportunities were not available to them. These dynamics were particularly acute in the case of single mothers, serving both a provider and primary carer role. Differences in attrition by gender were reported: women are likely to leave the programme when they marry, whereas men tend to leave when offered another job with higher salary. Age and geographic location were also important intersecting factors: younger male and female APEs seek employment opportunities in neighbouring South Africa, whereas older APEs are more content to remain. Conclusion: Gender norms, roles and power dynamics intersect with other axes of inequity such as marital status, age and geographic location to impact recruitment and retention of APEs in Maputo province, Mozambique. Responsive policies to support gender equity within APE recruitment processes are required to support and retain a gender-equitable APE cadre. Resumo O programa de saúde comunitária de Moçambique tem um número desproporcional de agentes comunitários de saúde – Agentes Polivalentes Elementares (APEs) – do sexo masculino. O governo pretende aumentar a proporção de mulheres para 60%, para melhorar indicadores de saúde materna e infantil. Este estudo explora os processos de recrutamento dos APEs e como estes são moldados por normas de gênero; e como os papéis e relações de gênero influenciam a experiência e retenção dos APEs na província de Maputo, Sul de Moçambique. Recorreu-se a métodos qualitativos para selecionar de forma propositada APEs, supervisores dos APE e líderes comunitários. As entrevistas foram gravadas, transcritas e traduzidas. Uma grelha de codificação foi desenvolvida de acordo com a análise temática para sintetizar os resultados. Realizamos entrevistas em profundidade (n=30), informante chave (n=1) e discussões em grupos focais (n=3) para captar as experiências e percepções dos processos de recrutamento. As estruturas decisórias intrafamiliares, implicam que as mulheres podem experienciar barreiras na adesão ao programa dos APE, exigindo frequentemente anuência dos esposos. Os treinamentos fora das comunidades representam aprendizagem em ambiente diferente, todavia, as mulheres relataram dificuldades em deixar as suas responsabilidades familiares, e os homens desafios em prover assistência as suas famílias. Estas dinâmicas agudizaram-se para mães solteiras com o papel de provedoras e de principais cuidadoras. A atracão do programa por gênero revelou que as mulheres tendem a abandonar o programa quando se casam, e os homens a abandonarem quando são oferecidos melhores empregos. A idade e a localização geográfica demonstram que os APEs mais jovens buscam oportunidades de emprego na vizinha África do Sul, e os mais velhos tendem permanecer no programa. Sugerimos que as normas de gênero e a dinâmica de poder se cruzam com outros eixos de desigualdade, como estado civil, idade e localização geográfica, para influenciarem o recrutamento e a retenção dos trabalhadores comunitários de saúde. O fortalecimento dos sistemas de saúde requer políticas mais equitativas e sensíveis para apoiarem a equidade de gênero nos processos de recrutamento e manter dos APEs.
Hospital accreditation has been transferred from high-income countries (HICs) to many low- and middle-income countries (LMICs), supported by a variety of advocates and donor agencies. This re-view uses a policy transfer theoretical framework to present a structured analysis of the develop-ment of hospital accreditation in LMICs. The framework is used to identify how governments in LMICs adopted accreditation from other settings and what mechanisms facilitated and hindered the transfer of accreditation. The review examines the interaction between national and inter-national actors, and how international organizations influenced accreditation policy transfer. Relevant literature was found by searching databases and selected websites; 78 articles were included in the analysis process. The review concludes that accreditation is increasingly used as a tool to improve the quality of healthcare in LMICs. Many countries have established national hos-pital accreditation programmes and adapted them to fit their national contexts. However, the im-plementation and sustainability of these programmes are major challenges if resources are scarce. International actors have a substantial influence on the development of accreditation in LMICs, as sources of expertise and pump-priming funding. There is a need to provide a roadmap for the suc-cessful development and implementation of accreditation programmes in low-resource settings. Analysing accreditation policy processes could provide contextually sensitive lessons for LMICs seeking to develop and sustain their national accreditation programmes and for international organisations to exploit their role in supporting the development of accreditation in LMICs.
Maternal and Child Health Aides are the largest nursing cadre in Sierra Leone providing maternal and child health care at primary level. Poor healthcare infrastructure and persistent shortage of suitably qualified health care workers have contributed to high maternal and newborn morbidity and mortality. In 2012, 50% of the MCHAides cohort failed their final examination and the Government of Sierra Leone expressed concerns about the quality of teaching within the programmes. Lack of teaching resources and poor standards of teaching led to high failure rates in final examinations reducing the number of newly qualified nurses available for deployment. A mixed-methods approach using semi-structured observations of teaching sessions and completion of a questionnaire by students was used. Fourteen MCHAide Training Schools across all districts of Sierra Leone, 140 MCHAide tutors and 513 students were included in the study. In each school, teaching was observed by two researchers at baseline, 3 and 6 months after the tutor training programme. Students completed a questionnaire on the quality of teaching and learning in their school at the same time points. A total of 513 students completed the questionnaire, 120 tutors took part in the training and 66 lessons across all schools were observed. There was a statistically significant ( < 0.05) improvement in mean student evaluation of teaching and learning in 12/19 areas tested at follow-up compared to baseline. Observation of 66 teaching sessions demonstrated an increase in the number of student-focused, interactive teaching methods used. Prior to the teaching and learning workshops there was little student-focused learning within the schools. Teaching was conducted predominantly using lectures even for practical sessions. Training tutors to move away from didactic teaching towards a more student-focused approach leads to increased student satisfaction with teaching and learning within the schools.
