Bacteriuria in Enteric Fever

Abstract Not Provided

Human Resources and the Success of Health Sector Reform

Though reforms in the health sector have recently been common around the world, their success has, for a variety of reasons, been mixed. The paper aims to examine and explain the importance of human resources (HR) to the success or failure of health reforms using case studies from Russia, Zambia and the United Kingdom. Health sector reform often focuses on changes in financing or organisational structure, but neglects a key resource - the staff. This may result in inappropriately skilled staff for new tasks, poorly motivated staff, or even serious opposition to the reforms. Though reforms present many challenges in relation to the management of human resources, they also provide opportunities for alleviating long-standing staffing problems - such as the management of staff performance. Better staffing will contribute to the success of health reforms. The complexity of managing staff is greatly increased at times of reforms and the reasons for failure to meet challenges and take up opportunities are many. However, based on experience of reforms around the world the authors suggest that the root of the problem is in the general lack of experience and relevant skills around managing HR in the context of reforms. The priority actions proposed are: 1. Awareness raising: creating better understanding of policy makers and managers of human resource management and planning, especially in relation to reforms. 2. Capacity building: creating the structures and capacities to implement appropriate HR strategies to support health reforms. 3. Adequate preparation of the workforce for changes due to reforms - especially where conditions of employment are affected

Strengthening and facilitating the uptake of evidence into primary health care workforce policy

Australia faces a primary health care workforce shortage, exacerbated by the increase of demands from an ageing population, increasing co-morbidities and chronic disease. The Australian health system, too, is increasingly complex and fragmented. Academic research is recognising that no single profession can meet all the needs of the primary health care system. In light of this problem, a greater connection between research, practice and informed policy decision making is required to impact primary health care workforce policy reforms, and in particular to strengthen the existing evidence base of the Australian Primary Health Care Research Institute's (APHCRI's) work program. This report describes the outcomes of Professor James Buchan's visit as part of the APHCRI International Visiting Fellowship Program. The report outcomes include key findings and messages from Professor Buchan's presentations and roundtable discussions held during his visit from November 3 - 13, 2008. The report also provides implications for APHCRIs primary health care strategic work program regarding building a stronger knowledge base (Strategic goal 1) and facilitating the uptake of evidence (Strategic goal 2The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Energy incentives: evaluating government\u27s role

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Biomass energy: A New choice for America

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Developing the health workforce for universal health coverage

Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or system-wide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields.publishersversionpublishe

International recruitment of nurses : United Kingdom case study

The author acknowledges the assistance and support of staff at the Department of Health, England; Work Permits (UK); United Kingdom Central Council for Nursing Midwifery and Health Visiting (UKCC) [Note: the UKCC was reconfigured on 1 April 2002 as the Nursing and Midwifery Council- NMC]; Royal College of Nursing (RCN); NHS Professionals; the Independent Healthcare Association (IHA); An Bord Altranais; three private sector recruitment agencies; and management and nurses at three NHS trusts actively recruiting in international nursing labour markets. This paper is based on research funded by WHO, ICN, and RCN, and the support of staff at WHO and ICN is also acknowledged. The views expressed in the report are those of the author.This paper is based on research funded by the World Health Organisation, the International Council of Nurses and the Royal College of Nursing of the United Kingdom. Whilst the primary focus is on the UK, general lessons related to international recruitment and migration of nurses are also highlighted. There is general agreement amongst all stakeholders in the UK that nursing shortages have become a major factor constraining health care delivery in the National Health Service in the UK. In order to overcome these skills shortages, four areas of government initiative are underway: attracting more applicants to nurse education; encouraging returners to nursing employment; improving retention through improved career structures and flexible working practices; and recruiting nurses from abroad. NHS Plan targets for increased staffing have been one major factor in focusing attention on international recruitment. There has been a significant growth in the level on inflow of nurses from other countries to the UK. Registration data on annual admissions of nurses from non-UK sources shows a fivefold increase since the early 1990s. In 2000/01 a total of 9,694 initial entrants on the UK Register were from all overseas sources. This figure has risen to approximately 15,000 in 2001/02, which equates to almost half of all new nurses entering the UK Register in the year. Registration data highlights that a total of more than 30,000 new non-UK nurses have registered in the UK in the last three years. The Philippines, South Africa and Australia have been the main sources. The trend in significant growth of recruitment of nurses from non-EU countries has not been matched by any growth in inflow from the countries of the European Union. In recent years the EU has reduced in significance as a source of nurses entering the UK. The Department of Health in England issued guidance on ethical international recruitment practices in 1999 requiring NHS employers to avoid direct recruitment from designated countries such as South Africa and the West Indies. Registration data suggests that the 1999 guidelines may have had some short-term impact in reducing recruitment from South Africa and the Caribbean, but that this recruitment activity may have then been displaced to other developing countries. The Department has issued a strengthened Code for international recruitment in late 2001. The pull factor of meeting NHS Plan staffing targets is likely to mean that the UK, particularly England, will continue to be active in recruiting from international nursing labour markets, partly as a result of new targets having been set for 2008. UK government policy initiatives to increase the number of nursing students, and to improve retention and return rates, can have a positive effect. However, the growth in the number of UK nurses who can retire is likely to challenge the capacity of the NHS to retain the required numbers of nurses. When coupled with the likelihood of liberalisation of global labour markets, this points to a continuing high profile for the UK in international nursing labour markets.sch_nur1 For a detailed discussion on the UK nursing labour market see Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 2 See Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 3 Organisation for Economic Co-operation and Development (2001) Health Data, 2001. OECD, Paris 4 Buchan J (2001) Warning on misleading nursing ratios data. Employing Nurses and Midwives, Issue 60, p12-14. Dec 2001 5 Department of Health (2001) Review for 2002. Written Evidence from the Health Departments for Great Britain, Review Body for Nursing Staff, Midwives, Health Visitors and Professions Allied to Medicine. DH: London. 6 Wanless D (2001). Securing our Future Health: Taking a Long Term View. Interim Report. November. Public Enquiry Unit, HM Treasury, London; p183 7 Office of Manpower Economics annual survey. Published in Review Body for Nursing Staff, Midwives, Health Visitors and Professions Allied to Medicine (2001) Nineteenth Report. December 2001, London 8 see Buchan J, Seccombe I (2002) Behind the Headlines: A Review of the UK Nursing Labour Market. RCN/QMUC 9 NHS Executive (2000) The NHS Plan. DH: London 10 see e.g:Department of Health (2001) Investment and Reform for NHS Staff- Taking Forward the NHS Plan. DH: London 11 Department of Health (2002) HR Directors Bulletin, special issue. Budget 2002. 24 April 2002. DH: London 12 Department of Health (1999). Working lives DH: London 13 Home Office (2001) Control of Immigration: Statistics United Kingdom 2000. The Stationary Office, HMSO cmnd 5315 14 Mejia, A., Pizurki, H., Royston, E. (1979) Physician and Nurse Migration, World Health Organisation, Geneva 15 Buchan, J., Seccombe, I., Thomas, S. (1997) Overseas Mobility of UK Based Nurses. International Journal of Nursing Studies 34(1), 54-62 16 Department of Health (2001) Investment and Reform for NHS Staff- Taking Forward the NHS Plan. Para. 3.26. DH: London 17 Department of Health (2001) NHS Emergency Pressures: Making Progress. DH: London, p15 18 Department of Health (2002) HR Directors Bulletin, special issue. Budget 2002. 24 April 2002. DH: London 19 UKCC (2001)More countries providing more nurses and midwives. Press statement, 14 August 20 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 21 Data provided by Nurses and Midwives Council, May 2002 22 Home Office (2001) Control of Immigration: Statistics United Kingdom 2000. The Stationary Office, HMSO cmnd 5315., Table 2.1, p 32 23 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 24 UKCC. Overseas trained nurses apply to the UK in record numbers. UKCC News, website, dated 4 June 2001 ((http://www.ukcc.org.uk/cms/content/home/search.asp). This press statement quotes a figure for 2000-2001 of 7,705, and states that this financial year this figure is expected almost to double..- If doubled, this would suggest a figure of around 15,500 for 2001-2002. The UKCC subsequently increased their estimate for 2000-2001 to 8,403 from non EU sources only, (press statement on 14 August - (http://www.ukcc.org.uk/cms/content/home/search.asp)) 25 Permits waived for skilled staff-. Nursing Standard, January 9th, 2002, page 7 26 See e.g. UKCC. Spanish nurses face language barrier. UKCC News, Friday 1 March 2002 (www.ukcc.org.uk) 27 UKCC. Spanish nurses face language barrier. UKCC News, Friday March 1st, 2002 (www.ukcc.org.uk) 28 Lipley N (2002) UKCC introduces English test for non-EU applicants. Nursing Standard, 16 (26), p4. March 13th 29 Department of Health and Children (2000). The Nursing and Midwifery Resource. Interim Report of the Steering Group. Department of Health and Children, Dublin 28 International Recruitment of Nurses: UK case study July 2002 30 Letter from Executive Secretary, ICN to Chief Nursing Officer, Ministry of Health, England, 20 August, 1948. Source: Public Records Office 31 Department of Health (1999). Guidance on International Recruitment. DH: London 32 See e.g Parish C (2000) Broken Promises. Nursing Standard. 15 (3), p13 33 Department of Health (2001) Code of Practice for NHS Employers involved in international recruitment of healthcare professionals. DoH, London (http://www.doh.gov.uk/international-nurse/ ) 34 Commonwealth Secretariat (2001). Migration of Health Workers from Commonwealth Countries. Commonwealth Secretariat, London 35 Independent Healthcare Association/ Registered nursing home Association / Voices (2002). Supervised Practice Programme for Internationally Qualified Nurses: Independent Sector Rcommendations. IHA/ RNHA, London 36 International Council of Nurses (2002) available at www.icn.ch 37 Secretary for State for Health (2002).Speech to RCN Congress, 24 April 2002. Accessed at HYPERLINK http://wwwdoh.gov.uk/speeches/apr2002milburnrcnhtm http://www.doh.gov.uk/speeches/apr2002milburnrcn.htm [accessed on April 30] 38 See e.g: Sen, A. (1970) Problems of Overseas Students and Nurses. National Foundation for Educational Research (NFER), England; Mejia, A., Pizurki, H., Royston, E. 1979 Physician and Nurse Migration, World Health Organisation, Geneva; Buchan, J, Seccombe, I., Ball, J. 1994 The International Mobility of Nurses: A United Kingdom Perspective. International Journal of Nursing Studies 31(2), 143-154 Buchan, J., Seccombe, I., Thomas, S. 1997 Overseas Mobility of UK Based Nurses. International Journal of Nursing Studies 34(1), 54-62 Kingma M (2001) Nursing Migration:global treasure hunt or disaster in the making? Nursing Inquiry, 8 (4), 205-212 39 Unpublished data/ commercially sensitive. Source: recruitment agency, London 40 Pearce L (2002) World of a difference. Nursing Standard 16 (32) 14-16, April 24 41 Daniel P, Chamberlain A, Gordon F (2001) Expectations and experiences of newly recruited Filipino nurses. British Journal of Nursing, 10 (4) 254-265 42 Sawbridge Y (2001). Import Duties. Health Service Journal, 4th January, 20-21 43 See e.g War on foreign nurse abuse- Nursing Times 98 (18), p11 44 UKCC (2001) Nursing home loses right to train overseas nurses. News, Friday 10 August 2001. 45 Successful schemes helps foreign recruits adjust to life in the UK. Nursing Times, 98 92), p6. February 21, 2002 46 Successful schemes helps foreign recruits adjust to life in the UK. Nursing Times, 98 92), p6. February 21, 2002 47 UKCC unpublished analysis. See Buchan J, O'May F (1999). Globalisation and Healthcare Labour Markets: A Case study from the UK. Human Resources for Health Developments Journal. 3(3),199-209 48 Mulholland H (2002). Nurses flee UK despite efforts to raise numbers. Nursing Times. 98 (14), p4 49 In Australia there is an estimated shortfall of 5,000 out of a total workforce of 250,000. Nursing Times, 3 August 2000 50 Department of Health and Children (2000) The Nursing and Midwifery Resource- Report of the Steering Group. Dublin, September 51 Health Canada (2000) Nursing Strategy for Canada. Health Canada, Ottawa. 52 Buerhaus, P., Staiger D. and Auerbach D. (2000) 'Implications of an ageing registered nurse workforce'. Journal of the American Medical Association, 283(22), 2948-54 53 International Council of Nurses (2002) available at www.icn.ch 54 Buchan J (1999) The greying- of the UK nursing workforce: Implications for Employment Policy and Practice. Journal of Advanced Nursing, 30 (4) 818-826unpub18unpu

The financial cost of physician emigration from sub-Saharan Africa

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International recruitment of health professionals

For the United Kingdom, and some other developed countries, active international recruitment has become a solution to shortages of health professionals. issue of migration of health professionals has become an important feature of international health policy debate symbolised by the passing of a resolution at the World Health Assemblysch_nurHouse of Commons International Development Committee. Migration and development: how to make migration work for poverty reduction. Sixth report of session 2003-4. London: Stationery Office, 2004. (HC-79-1.) Physicians for Human Rights (2004). An action plan to prevent Brain drain: building equitable health systems in Africa. Boston: Physicians for Human Rights, 2004. World Health Organization. Agenda item 12.11. Fifty Seventh World Health Assembly: health systems including primary care. International migration and health personnel: a challenge for health systems in developing countries. 22 May 2004. Geneva: World Health Organization, 2004. Department of Health. Code of Practice for the international recruitment of healthcare professionals: December 2004. London. http://www.dh.gov.uk/PolicyAndGuidance/HumanResources AndTraining/MoreStaff/InternationalRecruitmentNHS Employers/CodeOfPracticeArticle/fs/en?CONTENT_ID=4043625&chk=D2OJCV (accessed 21 December 2004). Buchan J, Dovlo D. International recruitment of health workers to the UK: a report for DFID.2004. London: Department for International Development Resource Centre, 2004. www.dfidhealthrc.org/shared/publications/reports/int_rec/int-rec-main.pdf (accessed 27 Jul 2004). Commonwealth Secretariat. Commonwealth code of practice for international recruitment of health workers. London: Commonwealth Secretariat, 2003. World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. (WONCA). A code of practice for the international recruitment of health professionals: the Melbourne manifesto. 2002. World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. www.ruralhealth2002.net/melbourne_manifesto.pdf (accessed 9 Mar 04). Department of Health. International humanitarian and health work toolkit to support good practice, and compendium of the NHS's contribution to developing nations. London: DoH, 2003. Yan J. Caribbean nurses develop strategy for nurse shortages. Int Nurs Rev 2002:49: 132-4.[CrossRef]330pub17pub748

Global nursing shortages

Nursing shortages in the United Kingdom and elsewhere have been a repetitive phenomenon, usually due to an increasing demand for nurses outstripping static or a more slowly growing supply. Demand continues to grow, while projections for supply point to actual reductions in the availability of nurses in some developed and developing countries.sch_nur1. Global nursing partnerships: strategies for a sustainable nursing workforce. Atlanta: Emory University, 2001. www.nursing.emory.edu 2. Buchan J, Seccombe I, Smith G. Nurses' work: an analysis of the UK nursing labour market. Aldershot: Ashgate Press, 1998. 3. Buchan J. Nurse migration and international recruitment. Nurs Inq 2001; 8: 203-204[CrossRef][Medline]. 4. Advisory Committee on Health Human Resources, Health Canada. The nursing strategy for Canada. Ottawa: Health Canada, 2000. 5. Buerhaus P, Staiger D, Auerbach D. Implications of a rapidly aging nurse workforce. JAMA 2000; 283: 2948-2954[Abstract/Free Full Text]. 6. Buchan J. Planning for change: developing a policy framework for nursing labour markets. Int Nur Rev 2000; 47: 199-206. 7. Irvine D, Evans M. Job satisfaction and turnover amongst nurses: integrating research findings across studies. Nur Res 1995; 44: 246-253[ISI]. 8. Baumann A, O'Brien-Pallas L, Armstrong-Stassen M, Blythe J, Bourbonnais R, Cameron S, et al. Commitment and care: the benefits of a healthy workplace for nurses, their patients and the system: Final report. Ottawa: Canadian Health Service Research Foundation, 2001. 9. Aiken L, Smith H, Lake E. Lower Medicare mortality amongst a set of hospitals known for good nursing care Med Care 1994; 32: 771-787[ISI][Medline]. 10. Brown SA, Grimes DE. A meta-analysis of nurse practitioners and nurse midwives in primary care. Nurs Res 1995; 44: 332-339[ISI][Medline]. 11. Kinnersley P, Anderson E, Parry K, Clement J, Archard L, Turton P, et al. Randomised control trial of nurse practitioner versus general practitioner care for patients requesting same day consultation in primary care. BMJ 2000; 320: 1043-1048[Abstract/Free Full Text]. 12. Buchan J, Ball J, O'May F. If skill mix is the answer, what is the question? J Health Services Res Policy 2000; 16: 233-238.324pub16pub734