ABSTRACT
The study evaluated non-financial incentive packages to retain health extension workers in the Somali Region of Ethiopia using the Discrete Choice Experiment (DCE) technique, conducted among 66 health extension workers in 3 woredas (districts). The study used a mix of qualitative and quantitative methods in sequential order. Mixed logic regression modeling was used to determine the effect of different job attributes on the retention of the health extension workers, while Preference Impact Measure (PIM) was used to determine the combinations of preferred incentive packages to retain the health extension workers in their current workplace. Opportunity for continued education ranked first, 1.009 (0.655, 1.36), P = .000, followed by career advancement/opportunity for promotion, 0.321 (0.107, 0.534), P = .003, then supportive management 0.234 (-0.395, -0.073), P = .004. in terms of impact on retention. The most preferred incentive package for retention using the PIM model was opportunities for continued education after 3 years and always good availability of and access to amenities (running water, electricity, internet), which predicted a 77% retention rate if implemented. The identified proposed retention incentive packages will help in developing evidence-based incentive policies and strategies for the future retention of health extension workers in this region.
ABSTRACT
The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.
ABSTRACT
BACKGROUND: Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery. Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population's health needs. The majority of primary health facilities in the country are staffed using perceived needs. The Workload Indicators of Staffing Need (WISN) tool developed by the World Health Organization is used to determine staffing requirements for facilities. METHODS: The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area (PHALGA) and Obio Akpor Local Government Area (OBALGA). Documents were reviewed to obtain information on working conditions and staffing, and interviews conducted with key informants in 12 randomly selected facilities. We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both. We also retrieved workload data from January 1-December 31, 2015 from the national district health information system. RESULTS: Findings showed varying degrees of shortages and inequitable distribution of health workers. Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives. There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85. OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners; and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively. CONCLUSION: Our findings provide evidence for policies that will help Nigeria improve the population's access to quality health services and reduce inequities in distribution of the health workforce. Evidence-based health workforce planning and redistribution using WISN should be institutionalized. Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.
