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  • 1
    Online Resource
    Online Resource
    Evaluation of the alignment of policies and practices for state-sponsored educational initiatives for sustainable health workforce solutions in selected Southern African countries: a protocol, multimethods study
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 4 ( 2021-04), p. e046379-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 4 ( 2021-04), p. e046379-
    Abstract: Health systems across the world are facing challenges with shortages and maldistribution of skilled health professionals. Return-of-service (ROS) initiatives are government-funded strategies used to educate health professionals by contracting beneficiaries to undertake government work on a year-for-year basis after their qualification. It is envisaged that once they have served their contract, they will be attracted to serve in the same area or government establishment beyond the duration of their obligatory period. Little is known about the processes that led to the development and implementation of ROS policies. Furthermore, there is no systematic evaluation of the strategies that demonstrate their utility. This research aims to evaluate the ROS initiatives, explore their efficacy and sustainability in five Southern African countries. Methods and analysis This study will be conducted in South Africa, Eswatini, Lesotho, Botswana and Namibia in a phased approach through a multimethods approach of policy reviews, quantitative and qualitative research. First, a review will be conducted to explore current ROS schemes. Second, a quantitative retrospective cohort study of ROS scheme recipients for the period 2000–2010 will be undertaken. Information will be sourced from multiple provincial or national information systems and/or databases. Third, we will conduct semistructured group or individual interviews with senior health, education, ROS managing agency managers (where appropriate) and finance managers and/policy makers in each country to determine managers’ perceptions, challenges and the costs and benefits of these schemes. Fourth, we will interview or conduct group discussions with health professional regulatory bodies to assess their willingness to collaborate with ROS initiative funders. Ethics and dissemination Ethics approval for this study was obtained through the Human Research Ethics Committees of the University of New South Wales (HC200519), Australia; South Africa and Lesotho (065/2020); Eswatini (SHR302/2020); Namibia (SK001); and Botswana (HPDME 13/18/1). Relevant findings will be shared through presentations to participating governments, publications in peer-reviewed journals and presentations at relevant conferences.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-046379
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 2
    Online Resource
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    Are return-of-service bursaries an effective investment to build health workforce capacity? A qualitative study of key South African policymakers
    Public Library of Science (PLoS) ; 2022
    In:  PLOS Global Public Health Vol. 2, No. 5 ( 2022-5-5), p. e0000309-
    Details
    In: PLOS Global Public Health, Public Library of Science (PLoS), Vol. 2, No. 5 ( 2022-5-5), p. e0000309-
    Abstract: Return-of-service schemes (RoS) or bursaries are used in South Africa and other nations to publicly fund the training of skilled health professionals in return for the beneficiary agreeing to return to serve in their local provinces on a year-for-year basis. This study aimed to understand insights of key policymakers in South African provinces to identify barriers and solutions to implementation of RoS schemes used to recruit and retain skilled health professionals. This research draws on the insights of 16 key South African policymakers from eight of its nine provinces through semi-structured, qualitative interviews. The respondents were interviewed through Microsoft Teams virtual platform, either in pairs (ten) or as individuals (six). Data were analysed using inductive, thematic analysis in NVIVO. The study was reported according to the consolidated criteria for reporting qualitative research. Respondents reported that the schemes had resulted in an increase in the number of skilled health professionals and had provided opportunities for study and employment for previously marginalised groups. Formal evaluations of the impact of the schemes were not reported, however, a number of shortcomings with current schemes were identified that were likely limiting their effectiveness. Respondents reported a lack of foresight in the scheme implementation including a bias in the selection of beneficiaries towards medical professionals at the expense of other health workers. Furthermore, failure to plan for practice location when beneficiaries finished training limited the capacity of the schemes to meet the needs of local populations. Monitoring of recipients was limited by loopholes in contract design, decision-making and poor coordination between departments. Between 1 and 30% of beneficiaries were reported to default their contracts with some not completing their studies, some not returning after completing their internship and others terminating their services before concluding their contracts. Return-of-service schemes have helped in overcoming health professional shortages. However, they haven’t been formally evaluated. Several planning and implementation shortcomings were identified which can be improved to enhance access to healthcare in South Africa.
    Type of Medium: Online Resource
    ISSN: 2767-3375
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pgph.0000309
    DOI: 10.1371/journal.pgph.0000309.g001
    DOI: 10.1371/journal.pgph.0000309.t001
    DOI: 10.1371/journal.pgph.0000309.t002
    DOI: 10.1371/journal.pgph.0000309.s001
    DOI: 10.1371/journal.pgph.0000309.s002
    DOI: 10.1371/journal.pgph.0000309.s003
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2022
    detail.hit.zdb_id: 3101394-6
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  • 3
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    Reformulation and strengthening of return-of-service (ROS) schemes could change the narrative on global health workforce distribution and shortages in sub-Saharan Africa
    BMJ ; 2020
    In:  Family Medicine and Community Health Vol. 8, No. 4 ( 2020-09), p. e000498-
    Details
    In: Family Medicine and Community Health, BMJ, Vol. 8, No. 4 ( 2020-09), p. e000498-
    Abstract: Despite policies for addressing shortages and maldistribution of health professionals, sub-Saharan Africa continues to experience shortages and maldistribution of skilled health professionals. Policies such as return-of-service schemes or state-funded educational initiatives do not seem to be achieving their intended objectives, potentially due to poor design, implementation; and lack of monitoring and evaluation of the strategies. A focus by global health experts on strengthening and reformulating educational initiatives offers potential for producing, retaining and recruiting health professionals.
    Type of Medium: Online Resource
    ISSN: 2305-6983 , 2009-8774
    URL: Article
    DOI: 10.1136/fmch-2020-000498
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2986753-8
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  • 4
    Online Resource
    Online Resource
    Strengthening and measuring research impact in global health: lessons from applying the FAIT framework
    Springer Science and Business Media LLC ; 2019
    In:  Health Research Policy and Systems Vol. 17, No. 1 ( 2019-12)
    Details
    In: Health Research Policy and Systems, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2019-12)
    Type of Medium: Online Resource
    ISSN: 1478-4505
    URL: Article
    DOI: 10.1186/s12961-019-0451-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2101196-5
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  • 5
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    What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India
    BMJ ; 2019
    In:  BMJ Global Health Vol. 4, No. 3 ( 2019-05), p. e001509-
    Details
    In: BMJ Global Health, BMJ, Vol. 4, No. 3 ( 2019-05), p. e001509-
    Abstract: A number of factors contribute to the performance and motivation of India’s Accredited Social Health Activists (ASHAs). This study aims to identify the key motivational factors (and their relative importance) that may help retain ASHAs in service. Methods A discrete choice experiment (DCE) survey presented ASHAs with eight unlabelled choice sets, each describing two hypothetical jobs that varied based on five attributes, specifically salary, workload, travel allowance, supervision and other job benefits. Multinomial logit and latent class (LC) models were used to estimate stated preferences for the attributes. Result We invited 318 ASHAs from 53 primary health centres of Guntur, a district in south India. The DCE was completed by 299 ASHAs using Android tablets. ASHAs were found to exhibit a strong preference for jobs that incorporated training leading to promotion, a fixed salary and free family healthcare. ASHAs were willing to sacrifice 2530 Indian rupee (INR) from their monthly salary, for a job offering training leading to promotion opportunity and 879 INR for a free family health-check. However, there was significant heterogeneity in preferences across the respondents. The LC model identified three distinct groups (comprising 51%, 35% and 13% of our cohort, respectively). Group 1 and 2 preferences were dominated by the training and salary attributes with group 2 having higher preference for free family health-check while group 3 preferences were dominated by workload. Relative to group 3, ASHAs in groups 1 and 2 were more likely to have a higher level of education and less likely to be the main income earners for their families. Conclusion ASHAs are motivated by both non-financial and financial factors and there is significant heterogeneity between workers. Policy decisions aimed at overcoming workforce attrition should target those areas that are most valued by ASHAs to maximise the value of investments into these workers. Trial registration number CTRI/2018/03/012425.
    Type of Medium: Online Resource
    ISSN: 2059-7908
    URL: Article
    DOI: 10.1136/bmjgh-2019-001509
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2851843-3
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  • 6
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    The development of an Android platform to undertake a discrete choice experiment in a low resource setting
    Springer Science and Business Media LLC ; 2019
    In:  Archives of Public Health Vol. 77, No. 1 ( 2019-12)
    Details
    In: Archives of Public Health, Springer Science and Business Media LLC, Vol. 77, No. 1 ( 2019-12)
    Type of Medium: Online Resource
    ISSN: 2049-3258
    URL: Article
    DOI: 10.1186/s13690-019-0346-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2133388-9
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  • 7
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    How Were Return-of-Service Schemes Developed and Implemented in Botswana, Eswatini and Lesotho?
    MDPI AG ; 2023
    In:  Healthcare Vol. 11, No. 10 ( 2023-05-22), p. 1512-
    Details
    In: Healthcare, MDPI AG, Vol. 11, No. 10 ( 2023-05-22), p. 1512-
    Abstract: Botswana, Eswatini and Lesotho are three Southern African countries that make use of return-of-service (RoS) schemes to increase human resources for health in their countries. These initiatives bind beneficiaries to a pre-defined period of service upon the completion of their studies based on the length of funding support received. We aimed to review the history of these policies to understand the conceptualisation, intent and implementation of these schemes. We used a multi-methods research design which consisted of a literature review, a policy review and semi-structured interviews with policymakers and implementors. All three governments have a combination of grant-loan schemes and full bursaries or scholarships. The policies have all been operating for over 20 years, with Eswatini’s pre-service policy being the oldest since it was introduced in 1977, followed by Lesotho’s 1978 policy and Botswana’s 1995 pre-service policy. These policies have never been reviewed or updated. RoS schemes in these countries were introduced to address critical skills shortages, to improve employability prospects for citizens, to have competent public sector employees by global standards and to aid the career progress of government employees. Ministries of Health are passive role players. However, these schemes can only be efficient if there is clear cooperation and coordination between all stakeholders.
    Type of Medium: Online Resource
    ISSN: 2227-9032
    URL: Article
    DOI: 10.3390/healthcare11101512
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2721009-1
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  • 8
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    It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria
    BMJ ; 2022
    In:  BMJ Global Health Vol. 7, No. 10 ( 2022-10), p. e009718-
    Details
    In: BMJ Global Health, BMJ, Vol. 7, No. 10 ( 2022-10), p. e009718-
    Abstract: Community health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery. Methods A discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated. Results About 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs. Conclusion CHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.
    Type of Medium: Online Resource
    ISSN: 2059-7908
    URL: Article
    DOI: 10.1136/bmjgh-2022-009718
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2851843-3
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