Factors associated with the motivation and de-motivation of health workforce in Nepal.

BACKGROUND: Health workforce plays an important role in improving the health of people but its shortage is a major problem facing Nepal. This is further compounded by prolonged absence, low motivation, and improper distribution. The objective of the study is to find out the factors determining motivation of health workforce in the public sector. METHODS: A cross sectional study was conducted during September, 2012 to February, 2013. The health facilities were selected proportionately representing all the Illakas and then a simple random sampling was done to select individual facilities. Data was collected using questionnaire. The collected data was entered and analyzed in SPSS. Ethical approval was taken from the Nepal Health Research Council. RESULTS: More than a half (55%) of the health workers were satisfied with their current jobs and the financial benefits they acquired. The results revealed that higher age, higher education (OR:2.6; CI:1.414-4.660) and lower service duration (OR:2.567; CI:1.193-3.306) were significant factors for the motivation of health workers along with financial rewards (OR:4.706; CI:2.961-7.478), working environment (OR:2.344; CI:1.507-3.648) and opportunity for capacity development (OR:5.437; CI:3.344-8.840). The major de-motivational factors were: low remuneration (OR:3.215; CI:2.049-5.045), limited capacity development opportunity (OR:4.269; CI:2.672-6.821), poor working environment (OR:4.062; CI:2.528-6.526), non-recognition of performance (OR: 2.157; CI:1.389-3.350), and political interferences (OR:2.752; CI:1.754-4.320). CONCLUSIONS: Motivation of health workers is an important factor for smooth functioning of health intuitions and increased access to quality services. The good working environment, salary and other financial benefits matter greatly for enhanced performance of health workers along with additional factors.

Involving diaspora and expatriates as human resources in the health sector in Nepal.

BACKGROUND: Health professional mobility has increased in the recent years and is one of the public health concerns in the developing countries including Nepal. On the other hand, we can't ignore a positive shift of Nepali diaspora coming back to Nepal for some work related projects. The objective of this study was thus to estimate the number of Nepalese Diaspora and foreign expatriate those are coming to Nepal and explore the ways and process of their engagement in the health sector of Nepal. METHODS: Mixed method was used. In total, 13 Key Informant Interviews were conducted at the central level along with record review from professional councils. RESULTS: Nepalese Diasporas mainly come through Diaspora Volunteering Organizations, Non Resident Nepali Association and personal connections to the place of their origin. Nepalese Diasporas have supported as health specialists, health camps and project organizers, trainer and hospital promoters, supplier of equipment including ambulances etc. The Nepalese Diasporas are unrecorded with professional organizations such as NMC and NHPC. As such the real status and results of support from Nepalese Diaspora are not known. Overall, 5,120 foreign medical professionals have served to Nepal through NMC followed by 739 nursing professionals through NNC and 189 paramedical staff through NHPC as of 2012. CONCLUSIONS: Systematic information on number and characteristics of the Nepalese Diaspora and their role in the health sector of Nepal is limited. The health professional bodies have some record systems but they lack uniformity and systematic process.

Health governance at local level from human resource for health perspectives: the case of Nepal.

BACKGROUND: Evidence about effects of good governance in Human Resources for Health (HRH) is scant in Nepal. The study aimed to explore the situation of health governance at the local level and suggest measures to address the HRH challenges. METHODS: Ninety health facilities from Siraha, Bardiya and Doti districts were included in the study. Focus group discussions (N=36) with different groups and key informants interviews (33 VDC Secretaries, 76 Health Facility Management Committees and 9 central level policy makers and managers) were conducted. RESULTS: Only 49 (54%) of the health facilities have properly displayed signboard, 42 (47%) citizen charter, 36 (40%) free health services and Information on Aama program in 25 (28%) health facilities. In total 52 (58%) health facilities have not displayed names of women receiving Aama benefits. Seventy two out of 90 health facilities have not displayed social audit reports and 80 (89%) of the health facilities have not maintained complaint box. The initiative of decentralized human resource management, where implemented, has increased ownership at the local level. Staff retention has been reported well though it does not apply in case of the medical doctors. Rule of law in terms of human resource recruitment and transfer, promotion, and training were not fully implemented and were lenient in the upper level. Nepotism and power exercise was frequently reported as a hindrance in implementing the gender and social inclusion policy fully. CONCLUSIONS: Transparency, gender and social inclusion is yet to be implemented fully at the district and health facility level.

Human resource for health production capacity in Nepal: a glance.

BACKGROUND: Shortage of human resources for health is apparent in Nepal. The current HRH strategy has tried to address the demand for skilled birth attendants, MDGPs, gynecologists, anesthetists, radiologists and other health workforce. Despite the increased number of institutions, there is still shortage of health workforce due to ineffective monitoring. This study was undertaken to find out the situation of HRH production in Nepal. METHODS: This cross sectional study was conducted from September 2012 to February 2013. The primary focus was on the quantitative method by using the format for the data collection. The main study samples were the academic institutions of Nepal. The finding was analyzed and tabulated in the summary form. RESULTS: There were a total of 294 institutions to produce different cadres of health workforce in Nepal. Staff nurses (101) and CMAs (76) have been produced by the maximum number of institutions. The result revealed that the institutions were not producing the graduates upon their capacity, only 1,451 staff nurse graduated annually against the capacity of producing 4,017 per annum. Although Nepal has a capacity to produce 1,760 MBBS, 267 MD and 116 MS doctors, only 1,074 Nepali MBBS, 222 MD and 95 MS doctors graduated per year. CONCLUSIONS: The health institutions performance is lower in producing HRH compared to their capacity in the country. A long-term effort is now required to match demand and supply of the HRH in the country.

Health in Nepalese media.

BACKGROUND: Coverage of health in Nepali print media is quite a recent phenomenon despite readers' ample appetite for it. Dominated by politics, Nepal's print media has been marginally publishing news pieces, features, editorials and op-ed articles, photographs and cartoons on health, though marginally. But the media did not wake up to the issues of human resources for health until lately. METHODS: We content analysed the coverage of health issues including, human resources for health in select Nepali print media Kantipur, Nagarik and Annapurna Post of select three months in 2012 April, August and December. News pieces and their placements, Op-eds, editorials, features, letters to the editor, photos and cartoons were subjected to analysis. RESULTS: Over the study period, the papers covered 544 health news pieces, 44% of political news pieces. Health workforce news pieces contributed 24% to it. However, only 10% of the health news made to the front pages. Coverage of health in editorials, features, Op-eds, photographs, cartoons and letters to the editor is even more meager. For example, only 7% of the editorials are relating to health. CONCLUSIONS: Health is prioritized far less by the print media than politics despite the reader's appetite for it. Print media should give health a top priority, particularly in those areas that relate to health systems like human resources for health, for their massive impact on the lives of the people.

Human resources for health in major national policies and plans of Nepal.

BACKGROUND: Nepal first began planning for human resources for health forty years back. Since then a number of long-term and short-term plans, policies and acts have been introduced. This study is conducted to analyse the HRH gap in relation to objectives, guidelines, and priorities of the Ministry of Health and Population. METHODS: A combination of desk review of the HRH related policies, strategies, and plans of the government and stakeholder consultation was used for the study from October 2012 to March 2013. Ethical approval was obtained from the NHRC. RESULTS: Almost all the plans and policies highlighted human resources as central to successful health systems in Nepal. Still there are several gaps at the implementation level. The expanding health programs with increasing demand for health services has demanded more robust evidence-based planning of HRH. There are many vacant positions due to complicated health act including the issue of social inclusions of workforce due to poor implementation of program policies. CONCLUSIONS: HRH needs to be recognized as dealing with more than just health personnel, but as assets necessary for the entire health system to function, plan, and manage it. There is the need to fill vacant positions in a timely manner, and increase the participation of excluded groups.

Emerging challenges in family planning programme in Nepal.

Family planning is a priority program of the Government of Nepal. Despite political instability in the last two decades, Nepal has achieved remarkable progress in the overall status of reproductive health, including family planning. Married women of reproductive age have been increasingly using contraceptive from 1980s to 2006. However, Nepal Demographic Health Survey 2011 has shown unexpected results on contraceptive prevalence rate. There had been a notable decline in the prevalence rate between 2006 and 2011, creating concerns among various stakeholders working in family planning programs. This paper analyzes this situation and identifies possible reasons for the stagnated contraceptive prevalence rate in Nepal. High proportion of spousal separation, an increased use of traditional methods, abortion, emergency contraception, and a lack of innovative approaches to cater services to difficult-to-reach or special sub-groups are possible reasons. To improve the contraceptive prevalence, the family planning program should be implemented more strategically. Further data analysis, initiation of best practices to fulfill family planning needs of special groups, functional integration of family planning services into general health services, effective counseling and behavior change communication to prevent unwanted pregnancies, and increased access to modern family planning methods could be the stepping stones to improve contraceptive prevalence rate and the overall FP program in Nepal.