Dataset Information

The Association between Health Workforce and Health Outcomes: A Cross-Country Econometric Study.

ABSTRACT: This study investigates the strength and significance of the associations of health workforce with multiple health outcomes and COVID-19 excess deaths across countries, using the latest WHO dataset. Multiple log-linear regression analyses, counterfactual scenarios analyses, and Pearson correlation analyses were performed. The average density of health workforce and the average levels of health outcomes were strongly associated with country income level. A higher density of the health workforce, especially the aggregate density of skilled health workers and density of nursing and midwifery personnel, was significantly associated with better levels of several health outcomes, including maternal mortality ratio, under-five mortality rate, infant mortality rate, and neonatal mortality rate, and was significantly correlated with a lower level of COVID-19 excess deaths per 100 K people, though not robust to weighting by population. The low density of the health workforce, especially in relatively low-income countries, can be a major barrier to improving these health outcomes and achieving health-related SDGs; however, improving the density of the health workforce alone is far from enough to achieve these goals. Our study suggests that investment in health workforce should be an integral part of strategies to achieve health-related SDGs, and achieving non-health SDGs related to poverty alleviation and expansion of female education are complementary to achieving both sets of goals, especially for those low- and middle-income countries. In light of the strains on the health workforce during the current COVID-19 pandemic, more attention should be paid to health workforce to strengthen health system resilience and long-term improvement in health outcomes.

Supplementary information

The online version contains supplementary material available at 10.1007/s11205-022-02910-z.

SUBMITTER: Liu J

PROVIDER: S-EPMC8919693 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundThe objective of this systematic review of diverse evidence was to examine the relationship between health system governance and workforce outcomes. Particular attention was paid to how governance mechanisms facilitate change in the workforce to ensure the effective use of all health providers.MethodsIn accordance with standard systematic review procedures, the research team independently screened over 4300 abstracts found in database searches, website searches, and bibliographies. Searches were limited to 2001-2012, included only publications from Canada, the United Kingdom, the Netherlands, New Zealand, Australia, and the United States. Peer- reviewed papers and grey literature were considered. Two reviewers independently rated articles on quality and relevance and classified them into themes identified by the team. One hundred and thirteen articles that discussed both workforce and governance were retained and extracted into narrative summary tables for synthesis.ResultsSix types of governance mechanisms emerged from our analysis. Shared governance, Magnet accreditation, and professional development initiatives were all associated with improved outcomes for the health workforce (e.g., decreased turnover, increased job satisfaction, increased empowerment, etc.). Implementation of quality-focused initiatives was associated with apprehension among providers, but opportunities for provider training on these initiatives increased quality and improved work attitudes. Research on reorganization of healthcare delivery suggests that changing to team-based care is accompanied by stress and concerns about role clarity, that outcomes vary for providers in private versus public organizations, and that co-operative clinics are beneficial for physicians. Funding schemes required a supplementary search to achieve adequate depth and coverage. Those findings are reported elsewhere.ConclusionsThe results of the review show that while there are governance mechanisms that consider workforce impacts, it is not to the extent one might expect given the importance of the workforce for improving patient outcomes. Furthermore, to successfully implement governance mechanisms in this domain, there are key strategies recommended to support change and achieve desired outcomes. The most important of these are: to build trust by clearly articulating the organization's goal; considering the workforce through planning, implementation, and evaluation phases; and providing strong leadership.

Project description:BackgroundMis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP).MethodsA cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue.ResultsWe found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination.ConclusionsDecisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.

Dataset Information

The Association between Health Workforce and Health Outcomes: A Cross-Country Econometric Study.

Supplementary information

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets