Wednesday, September 1, 2010

[EQ] Increasing access to health workers in remote and rural areas through improved retention

Increasing access to health workers in remote and rural areas through improved retention

Global policy recommendations

World Health Organization WHO - 2010  - ISBN: 9789241564014

Available online PDF [80p.] at: http://bit.ly/bw3qy9

‘’…….Globally, approximately one half of the population lives in rural areas, but less than 38% of the nurses and less than 25% of the physicians work there. While getting and keeping health workers in rural and remote areas is a challenge for all countries, the situation is worse in the 57 countries that have an absolute shortage of health workers.

After a year-long consultative effort, this document proposes sixteen evidence-based recommendations on how to improve the recruitment and retention of health workers in underserved areas. It also offers a guide for policy makers to choose the most appropriate interventions, and to implement, monitor and evaluate their impact over time….”

Tables of contents

Executive Summary

1. Introduction

1.1 Rationale

1.2 Objective

1.3 Target audience

1.4 Scope

1.4.1 Types of health workers targeted

1.4.2 Geographical areas covered

1.4.3 Categories of interventions covered

1.5 Process for formulating the global recommendations

1.6 Dissemination process

1.7 Methodology

1.8 Structure of the report

2. Principles to guide the formulation of national policies to improve retention of health workers in remote and rural areas

2.1 Focus on health equity

2.2 Ensure rural retention policies are part of the national health plan

2.3 Understand the health workforce

2.4 Understand the wider context

2.5 Strengthen human resource management systems

2.6 Engage with all relevant stakeholders from the beginning of the process

2.7 Get into the habit of evaluation and learning

3. Evidence-based recommendations to improve attraction, recruitment and retention of health workers in remote and rural areas

3.1 Education

3.1.1 Get the “right” students

3.1.2 Train students closer to rural communities

3.1.3 Bring students to rural communities

3.1.4 Match curricula with rural health needs

3.1.5 Facilitate professional development

3.2 Regulatory interventions

3.2.1 Create the conditions for rural health workers to do more

3.2.2 Train more health workers faster to meet rural health needs

2 3.2.3 Make the most of compulsory service

3.2.4 Tie education subsidies to mandatory placements

3.3 Financial incentives

3.3.1 Make it worthwhile to move to a remote or rural area

3.4 Personal and professional support

3.4.1 Pay attention to living conditions

3.4.2 Ensure the workplace is up to an acceptable standard

3.4.3 Foster interaction between urban and rural health workers

3.4.4 Design career ladders for rural health workers

3.4.5 Facilitate knowledge exchange

3.4.6 Raise the profile of rural health workers

4. Measuring results: how to select, implement and evaluate rural retention policies 35

4.1 Relevance: which interventions best respond to national priorities and the expectations of health workers and rural communities?

4.2 Acceptability: which interventions are politically acceptable and have the most stakeholder support?

4.3 Affordability: which interventions are affordable?

4.4 Effectiveness: have complementarities and potential unintended consequences between various interventions been considered?

4.5 Impact: what indicators will be used to measure impact over time?

5. Research gaps and research agenda

5.1 Research gaps

5.1.1 Study all types of health workers

5.1.2 More research in low-income countries

5.1.3 More well-designed evaluations

5.1.4 Quality of the evidence – not only “what works”, but also “why” and “how”

5.2 Research agenda

6. Deciding on the strength of the recommendations

Methodology

List of participants
References

Annexes

:: Annex 1 – Grade evidence profiles [pdf 151kb]
:: Annex 2 – Descriptive evidence profiles [pdf 220kb]

Executive summary :: Download [pdf 37kb]

Related link

:: WHO Global Code of Practice on the International Recruitment of Health Personnel
Resolution WHA63.16 is included as Annex 3 in the CD attached to the printed version of the global policy recommendations.

 *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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[EQ] The Emergence of Translational Epidemiology: From Scientific Discovery to Population Health Impact

The Emergence of Translational Epidemiology:
From Scientific Discovery to Population Health Impact

Muin J. Khoury, Marta Gwinn, and John P. A. Ioannidis

American Journal of Epidemiology - August 5, 2010
Am. J. Epidemiol. 2010 172: 517-524; doi:10.1093/aje/kwq211


Available online at: http://bit.ly/c2skoq

 

“……In a recent editorial launching the new journal Science Translational Medicine, Dr. Elias Zerhouni, former director of the National Institutes of Health, remarked that despite decades of advances in our understanding of human biology and the emergence of powerful new technologies, such as genomics, the transformation of scientific discoveries into effective health interventions continues to elude us (2).


There is daunting complexity when applying basic discoveries and experimental approaches to treating and preventing human disease, requiring a strong translational research (TR) agenda. He stressed the need for ‘‘more and better TR, both for the sake of our patients and because much of the research funding comes from the primary expectation of the public that such scientific investigations will reduce the burden of disease’’ (2, p. 1)…..”

“….Knowledge synthesis methods, such as meta-analysis, are becoming standard in developing evidence-based recommendations for practice (T2 research).

The Cochrane Collaboration (51), an international not-forprofit and independent organization founded in 1993, produces and disseminates systematic reviews of health-care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. It continues to play a pivotal role in developing and promoting quantitative synthesis of evidence of what works and what does not work in health-care interventions. Increasingly, other independent groups, such as the US Preventive Services Task Force, are adopting similar methods (33, 52). In human genomics, knowledge synthesis plays a key role in T1 epidemiologic research….”

More at:

Robert A. Hiatt
Invited Commentary: The Epicenter of Translational Science
American Journal of Epidemiology - August 5, 2010
Am. J. Epidemiol. 2010 172: 525-527; doi:10.1093/aje/kwq212

Muin J. Khoury, Marta Gwinn, and John P. A. Ioannidis
Respond to "The Epicenter of Translational Science": Crossing All the T's
American Journal of Epidemiology - August 5, 2010
Am. J. Epidemiol. 2010 172: 528-529; doi:10.1093/aje/kwq214

 *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho






IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.

[EQ] The Emergence of Translational Epidemiology: From Scientific Discovery to Population Health Impact

The Emergence of Translational Epidemiology:
From Scientific Discovery to Population Health Impact

Muin J. Khoury, Marta Gwinn, and John P. A. Ioannidis

American Journal of Epidemiology - August 5, 2010
Am. J. Epidemiol. 2010 172: 517-524; doi:10.1093/aje/kwq211

Available online at: http://bit.ly/c2skoq

 

“……In a recent editorial launching the new journal Science Translational Medicine, Dr. Elias Zerhouni, former director of the National Institutes of Health, remarked that despite decades of advances in our understanding of human biology and the emergence of powerful new technologies, such as genomics, the transformation of scientific discoveries into effective health interventions continues to elude us (2).


There is daunting complexity when applying basic discoveries and experimental approaches to treating and preventing human disease, requiring a strong translational research (TR) agenda. He stressed the need for ‘‘more and better TR, both for the sake of our patients and because much of the research funding comes from the primary expectation of the public that such scientific investigations will reduce the burden of disease’’ (2, p. 1)…..”

“….Knowledge synthesis methods, such as meta-analysis, are becoming standard in developing evidence-based recommendations for practice (T2 research).

The Cochrane Collaboration (51), an international not-forprofit and independent organization founded in 1993, produces and disseminates systematic reviews of health-care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. It continues to play a pivotal role in developing and promoting quantitative synthesis of evidence of what works and what does not work in health-care interventions. Increasingly, other independent groups, such as the US Preventive Services Task Force, are adopting similar methods (33, 52). In human genomics, knowledge synthesis plays a key role in T1 epidemiologic research….”

 

 *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho





IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission.

Thank you.

[EQ] Budget crises, health, and social welfare programmes

Budget crises, health, and social welfare programmes

BMJ 2010; 340:c3311 doi: 10.1136/bmj.c3311 (Published 24 June 2010)

BMJ 2010; 340:c3311

David Stuckler, researcher 12, Sanjay Basu, physician3, Martin McKee, professor of European public health4

1 Department of Sociology, Oxford University, Oxford

2 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London UK

3 Department of Medicine, University of California San Francisco and Division of General Internal Medicine, San Francisco General Hospital

4 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine

Available at: http://bit.ly/ddkipc

"…..Governments may feel they are protecting health by safeguarding healthcare budgets, the authors argue that social welfare spending is as important, if not more so, for population health

 

The recession of 2008 has had profound economic consequences for many countries. How and when to reduce budget deficits was a major focus in the recent general election in the United Kingdom and continues to make headlines around the world. The new government has already begun to make large cuts in public expenditure,1 2 even though the UK's projected underlying debt, as a share of gross domestic product (GDP), is less than that of other industrialised countries, it has longer than many other countries before it is required to refinance loans (table 1), and the actual deficit in 2009-10 was considerably less than expected.

Leading economists have widely divergent views about whether the cuts will aid or hinder economic recovery,3 4 but have paid scant attention to the potential effects of reductions in health and social expenditure on population health.5 We examine historical data for insights into how lower levels of public spending might affect health….."

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
------------------------------------------------------------------------------------
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IMPORTANT: This transmission is for use by the intended
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in error, please dispose of and delete this transmission.

Thank you.