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Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study.

ABSTRACT: Background:Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the reports. We conducted a national study to explore health professional regulation practices and gaps focusing on registration, licensing, ethics, scope of practice, and continuing professional development. Methods:We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers. We used two stage stratified cluster sampling to select health professionals. The quantitative data were subjected to descriptive and multivariable logistic regression analysis. We conducted thematic analysis of the qualitative data. Results:We interviewed 554 health professionals in the quantitative survey. And 31 key informants participated in the qualitative part. Nearly one third of the respondents (32.5%) were not registered. Many of them (72.8%) did not renew their licenses. About one fifth of them (19.7%) did nothing against ethical breaches encountered during their clinical practices. Significant of them ever practiced beyond their scope limits (22.0%); and didn't engage in CPD in the past 1?year (40.8%). Majority of them (97.8%) never identified their own CPD needs. Health regulators and managers stressed that regulatory bodies had shortage of skilled staff, budget and infrastructure to enforce regulation. Regulatory frameworks were not fully implemented. Conclusions:Health professionals were not regulated well due to limited capacity of regulators. This might have affected quality of patient care. To ensure effective implementation of health professional regulation, legislations should be translated into actions. Draft guidelines, directives and tools should be finalized and endorsed. Capacity of the regulators and health facilities needs to be built. Reinstituting health professionals' council and regulation enforcement strategies require attention. Future studies are recommended for assessing effects and costs of weak regulation.

SUBMITTER: Dejene D

PROVIDER: S-EPMC6905006 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study.

Dejene Daniel D Yigzaw Tegbar T Mengistu Samuel S Ayalew Firew F Kahsaye Manuel M Woldemariam Damtew D

Global health research and policy 20191211

<h4>Background</h4>Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system. In 2010, Ethiopia established a national authority aiming to ensure competence and ethics of health professionals. Subsequently, subnational regulators were established and regulatory frameworks were developed. Although there were anecdotal reports of implementation gaps, there was lack of empirical evidence to corroborate the rep ...[more]

PMID: 31890894

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Project description:INTRODUCTION:Ethiopia is among the high-burden countries for tuberculosis (TB), TB/HIV, and drug-resistant TB. The aim of this nationwide study was to better understand TB-related knowledge, attitudes, and practices (KAPs) and generate evidence for policy and decision-making. MATERIALS AND METHODS:We conducted a cross-sectional TB KAP survey in seven regions and two city administrations of Ethiopia. Eighty kebeles (wards) and 40 health centers were randomly selected for the study. Using systematic sampling, 22 households and 11 TB patients were enrolled from each selected village and health center, respectively. Variables with a value of p = < 0.25 were included in the model for logistic regression analysis. RESULTS:Of 3,503 participants, 884 (24.4%), 836 (24.1%), and 1,783 (51.5%) were TB patients, families of TB patients, and the general population, respectively. The mean age was 34.3 years, and 50% were women. Forty-six percent were heads of households, 32.1% were illiterate, 20.3% were farmers, and 19.8% were from the lowest quintile. The majority (95.5%) had heard about TB, but only 25.8% knew that TB is caused by bacteria. Cough or sneezing was reported as the commonest means of TB transmission. The majority (85.3%) knew that TB could be cured. Men, better-educated people, and TB patients and their families have higher knowledge scores. Of 2,483 participants, 96% reported that they would go to public health facilities if they developed TB symptoms. DISCUSSION:Most Ethiopians have a high level of awareness about TB and seek care in public health facilities, and communities are generally supportive. Inadequate knowledge about TB transmission, limited engagement of community health workers, and low preference for using community health workers were the key challenges. CONCLUSIONS:Given misconceptions about TB's causes, low preference for use of community health workers, and inadequate engagement, targeted health education interventions are required to improve TB services.

Project description:ObjectivesTo provide a sociodemographic profile of students enrolled in their first year of a health professional pre-registration programme offered within New Zealand (NZ) tertiary institutions.DesignObservational, cross-sectional study. Data were sought from NZ tertiary education institutions for all eligible students accepted into the first 'professional' year of a health professional programme for the 5-year period 2016-2020 inclusive.Variables of interestgender, citizenship, ethnicity, rural classification, socioeconomic deprivation, school type and school socioeconomic scores. Analyses were carried out using the R statistics software.SettingAotearoa NZ.ParticipantsAll students (domestic and international) accepted into the first 'professional' year of a health professional programme leading to registration under the Health Practitioners Competence Assurance Act 2003.ResultsNZ's health workforce pre-registration students do not reflect the diverse communities they will serve in several important dimensions. There is a systematic under-representation of students who identify as Māori and Pacific, and students who come from low socioeconomic and rural backgrounds. The enrolment rate for Māori students is about 99 per 100 000 eligible population and for some Pacific ethnic groups is lower still, compared with 152 per 100 000 for NZ European students. The unadjusted rate ratio for enrolment for both Māori students and Pacific students versus 'NZ European and Other' students is approximately 0.7.ConclusionsWe recommend that: (1) there should be a nationally coordinated system for collecting and reporting on the sociodemographic characteristics of the health workforce pre-registration; (2) mechanisms be developed to allow the agencies that fund tertiary education to base their funding decisions directly on the projected health workforce needs of the health system and (3) tertiary education funding decisions be based on Te Tiriti o Waitangi (the foundational constitutional agreement between the Indigenous people, Māori and the British Crown signed in 1840) and have a strong pro-equity focus.

Project description:Background Knowledge and attitudes are among the key drivers of social behavioral change. We assessed employed health professionals' (HPs) knowledge, attitude, and practice regarding COVID-19 in Dessie city, northeast Ethiopia. Methods A facility-based cross-sectional study was conducted among 419 HPs working at Dessie city from 17 to 21 May 2020. The data were collected using a self-administered structured questionnaire. Knowledge, attitude, and practice are measured using 19, 16, and 8 questions, respectively. Knowledge and attitude scores are dichotomized at the 3rd quartile, while practice is using the mean value. Data entry and analysis were conducted using EpiData Manager 4.2 and SPSS 25, respectively. Three independent logistic regression analyses were carried out to determine the associated factors. We defined significant association at a p-value of < 0.05. Results Out of 419 participants, 369 (88.1%) have sufficient knowledge regarding COVID-19 (95% CI: 85–91). The mean knowledge score is 16.8 with a ± 2.1 SD. Similarly, 355 (84.7%) of the HPs have a favorable attitude toward COVID-19 (95% CI: 81–87.9). The mean attitude score is 14 with ± 2.1 SD. However, practice regarding COVID-19 is adequate only in 69.7% (292) of the HPs (95% CI: 65.2–94). The mean practice score is 5.1 with a ± 1.3 SD. Sufficient knowledge is significantly associated with the type of health facility (AOR: 4.4, 95% CI: 1.4–13.3), degree and above education (AOR: 2.6, 95% Cl: 1.4–4.9), radio availability (AOR: 2.4, 95% CI: 1.3–4.7), and social media utilization (AOR: 2.3, 95% CI: 1.1–5.1). The predictors of favorable attitude are training (AOR: 3.1, 95% CI: 1.6–6.1), sufficient knowledge (AOR: 5.2, 95% Cl: 2.6–10.4), and type of health facility (AOR: 2.3, 95% CI: 1.1–5.2). Conclusion Most HPs have sufficient knowledge and a favorable attitude regarding COVID-19. However, practice is relatively low and there remains plenty to build assertive preventive behaviors. The gap between knowledge and practice should be narrowed through an appropriate social and behavioral change communication strategy.

Project description:BackgroundA major barrier to adequate headache care is the relative lack of formal education and training of healthcare professionals. Concerted efforts should be made to pinpoint major gaps in knowledge in healthcare professionals to facilitate better educational policies in headache training. The aim of this study was to identify deficiencies and barriers in headache training among residents in neurology in Denmark.MethodsWe conducted a national cross-sectional survey of residents in neurology in Denmark from April 2019 to September 2019. The survey included questions on participant demographics, knowledge of and barriers in headache disorders, guidelines and diagnostic tools usage, contact with primary and tertiary care, medication overuse, and non-pharmacological interventions. Furthermore, respondents were asked to provide a ranked list from most to least interesting for six sub-specializations/disorders, i.e., cerebrovascular disease, dementia, epilepsy, headache, multiple sclerosis, Parkinson's disease.ResultsSixty (40%) out of estimated a population of ~ 150 resident across Denmark accepted the invitation. Of these, 54/60 (90%) completed the survey. Although two-thirds, 35/54 (65%), of the respondents had prior formalized training in headache disorders, we identified gaps in all explored domains including diagnosis, management, and referral patterns. Particularly, there was an inconsistent use of guidelines and diagnostic criteria from the Danish Headache Society (2.74 (± 1.14)), the Danish Neurological Society (3.15 (± 0.86)), and the International Classification of Headache Disorders (2.33 (± 1.08)); 1: never/have not heard of, 4: always. Headache was ranked second to last out of six sub-specializations in interest.ConclusionsOverall knowledge on headache disorders amongst neurology residents in Denmark do not meet the expectations set out by national and international recommendations. Stakeholders should make strategic initiatives for structured education in headache for improved clinical outcomes in parallel with costs reduction through resource optimization.

Project description:BackgroundHigh-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country's mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China.MethodsThis study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis.ResultsWorkforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (β = - 0.88), self-experience (β = - 0.59) and professional supervision (β = - 1.26) significantly influenced psychotherapy capacity (P<0.001).ConclusionsSustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

Dataset Information

Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study.

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Exploring health workforce regulation practices and gaps in Ethiopia: a national cross-sectional study.

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