Factors behind job preferences of Peruvian medical, nursing and midwifery students: a qualitative study focused on rural deployment

Background: Deployment of health workforce in rural areas is critical to reach universal health coverage. Students? perceptions towards practice in rural areas likely influence their later choice of a rural post. We aimed at exploring perceptions of students from health professions about career choice, job expectations, motivations and potential incentives to work in a rural area. Methods: In-depth interviews and focus groups were conducted among medical, nursing and midwifery students from universities of two Peruvian cities (Ica and Ayacucho). Themes for assessment and analysis included career choice, job expectations, motivations and incentives, according to a background theory a priori built for the study purpose. Results: Preference for urban jobs was already established at this undergraduate level. Solidarity, better income expectations, professional and personal recognition, early life experience and family models influenced career choice. Students also expressed altruism, willingness to choose a rural job after graduation and potential responsiveness to incentives for practising in rural areas, which emerged more frequent from the discourse of nursing and midwifery students and from all students of rural origin. Medical students expressed expectations to work in large urban hospitals offering higher salaries. They showed higher personal, professional and family welfare expectations. Participants consistently favoured both financial and non-financial incentives. Conclusions: Nursing and midwifery students showed a higher disposition to work in rural areas than medical doctors, which was more evident in students of rural origin. Our results may be useful to improve targeting and selection of undergraduate students, to stimulate the inclination of students to choose a rural job upon graduation and to reorient school programmes towards the production of socially committed health professionals. Policymakers may also consider using our results when planning and implementing interventions to improve rural deployment of health professionals

Enabling reproductive, maternal, neonatal and child health interventions:Time trends and driving factors of health expenditure in the successful story of Peru

We compared expenditure trends for reproductive, maternal, neonatal and child health (RMNCH) with trends in RMNCH service coverage in Peru. We used National Health Accounts data to report on total health expenditure by source; the Countdown database for trends in external funding to RMNCH, and Ministry of Finance data for trends in domestic funding to RMNCH. We undertook over 170 interviews and group discussions to explore factors explaining expenditure trends. We describe trends in total health expenditure and RMNCH expenditure in constant 2012 US$between 1995 and 2012. We estimated expenditure to coverage ratios. There was a substantial increase in domestic health expenditure over the period. However, domestic health expenditure as share of total government spending and GDP remained stable. Out-of-pocket health spending (OOPS) as a share of total health expenditure remained above 35$ 1.0 in 2002 to US$6.3 in 2012. Expenditure on maternal and neonatal health per pregnant woman increased from US$ 34 in 2000 to US$512 in 2012, and per capita expenditure on under-five children increased from US$ 5.6 in 2000 to US$ 148.6 in 2012. Increased expenditure on RMNCH reflects a greater political support for RMNCH, along with greater emphasis on social assistance, family planning, and health reforms targeting poor areas, and a recent emphasis on antipoverty and crosscutting equitable policies and programmes focused on nutrition and maternal and neonatal mortality. Increasing domestic RMNCH expenditure likely enabled Peru to achieve substantial health gains. Peru can provide useful lessons to other countries struggling to achieve sustained gains in RMNCH by relying on their own health financing

[Association between exclusive breastfeeding and obesity in children: a cross-sectional study of three Latin American countries].

OBJECTIVE: To determine if breastfeeding for at least the first six months of life is associated with overweight and obesity in children 2 to 5 years old. METHOD: Cross sectional analysis of data from national demographic and health surveys conducted in Bolivia, Colombia and Peru. Overweight and obesity were defined using World Health Organization standard definitions. Odds ratios (OR) were calculated using multinomial logistic regression. RESULTS: The prevalence of obesity in children 2 to 5 years old was 10.4% (95% confidence interval [95%CI]: 8.2-12.6) in Bolivia, 4.9% in Colombia (95%CI: 4.0-5.8), and 6.4% (95%CI: 5.2-8.0) in Peru. Prevalence of exclusive breastfeeding for at least the first 6 months in the study population was 89.9% (95%CI: 87.8-91.9) in Bolivia, 73.9% (95%CI: 72.2-75.6) in Colombia, and 92.8% (95%CI: 91.2-92.4) in Peru. Exclusive breastfeeding was associated with a decreased risk of obesity in children as compared to no breastfeeding or breastfeeding for less than 6 months in Bolivia (OR = .30; 95%CI: .16-.57) and a marginal association in Colombia (OR = .71; 95%CI: .47-1.06) and Peru (OR = .49; 95%CI: 0.23-1.04). No association between breastfeeding and overweight was found. CONCLUSION: Exclusive breastfeeding for at least the first six months of life decreases the risk of obesity in children 2 to 5 years old in Bolivia. A similar but weaker pattern was observed for children in Colombia and Peru

Factors behind the success story of under-five stunting in Peru: a district ecological multilevel analysis

Background: Stunting prevalence in children less than 5 years has remained stagnated in Peru from 1992 to 2007, with a rapid reduction thereafter. We aimed to assess the role of different predictors on stunting reduction over time and across departments, from 2000 to 2012. Methods: We used various secondary data sources to describe time trends of stunting and of possible predictors that included distal to proximal determinants. We determined a ranking of departments by annual change of stunting and of different predictors. To account for variation over time and across departments, we used an ecological hierarchical approach based on a multilevel mixed-effects regression model, considering stunting as the outcome. Our unit of analysis was one department-year. Results: Stunting followed a decreasing trend in all departments, with differing slopes. The reduction pace was higher from 2007–2008 onwards. The departments with the highest annual stunting reduction were Cusco (−2.31%), Amazonas (−1.57%), Puno (−1.54%), Huanuco (−1.52%), and Ancash (−1.44). Those with the lowest reduction were Ica (−0.67%), Ucayali (−0.64%), Tumbes (−0.45%), Lima (−0.37%), and Tacna (−0.31%). Amazon and Andean departments, with the highest baseline poverty rates and concentrating the highest rural populations, showed the highest stunting reduction. In the multilevel analysis, when accounting for confounding, social determinants seemed to be the most important factors influencing annual stunting reduction, with significant variation between departments. Conclusions: Stunting reduction may be explained by the adoption of anti-poverty policies and sustained implementation of equitable crosscutting interventions, with focus on poorest areas. Inclusion of quality indicators for reproductive, maternal, neonatal and child health interventions may enable further analyses to show the influence of these factors. After a long stagnation period, Peru reduced dramatically its national and departmental stunting prevalence, thanks to a combination of social determinants and crosscutting factors. This experience offers useful lessons to other countries trying to improve their children’s nutrition.Revisión por pare

Mercado de formación y disponibilidad de profesionales de ciencias de la salud en el Perú

Objectives. To describe the availability and demand of professional training programs for eight health science professions in Peru. Study the profiles of the physicians, nurses and midwives that these programs train and their competencies to work at the primary health care level. Materials and methods. Cross-sectional study using data on the volume of applicants, students and graduates of these eight professional training programs during the period 2007 - 2011. In addition, the curricula of professional training programs for physicians, nurses and midwives from public and private universities were analyzed, along with competency profiles developed by Professional Colleges and the Ministry of Health. Results. Admission rates in public and private universities vary by program: 4% and 28% respectively for medical schools, and 18% and 90% for nursing. Graduation rates were estimated at approximately 43% and 53% of students entering medicine and nursing training programs respectively. Contrasting the profiles of recently graduated professionals in medicine, nursing and midwifery, with the skills required by the Ministry of Health for professionals working in primary care the first level of care, indicate that these recently graduated professionals are not necessarily or specifically trained to work in primary care. Conclusions. Demand for professional training in health sciences exists and its supply is met predominantly by private universities. Competency profiles developed by the MOH for the basic professional health team in primary care shows a clear disconnect regarding the current supply of trained professionals.Objetivos. Describir el mercado de formación y la disponibilidad de profesionales de ocho carreras de ciencias de la salud en Perú. Además, examinar los perfiles de los médicos, enfermeros y obstetras que se forman y sus competencias para trabajar en el primer nivel de atención. Materiales y métodos. Estudio transversal utilizando datos de volumen de postulantes, ingresantes y graduados de ocho profesiones durante el periodo de 2007–2011. También se analizaron los planes de estudio de programas de formación de médicos, enfermeros y obstetras de universidades públicas y privadas, y los perfiles de competencias elaborados por los colegios profesionales y el Ministerio de Salud (MINSA). Resultados. Las tasas de ingreso en universidades públicas y privadas varían según la carrera: 4 y 28% respectivamente para Medicina Humana, y 18 y 90% para Enfermería. Además, se estima que se gradúan aproximadamente 43 y 53% de los estudiantes que ingresan a Medicina y Enfermería, respectivamente. El análisis del perfil de los profesionales recientemente graduados en Medicina, Enfermería y Obstetricia, al ser contrastados con el perfil de competencias priorizadas para los profesionales que laboran en el primer nivel de atención elaborado por el MINSA, indican que no están necesariamente ni específicamente formados para trabajar en este nivel de atención. Conclusiones. Existe demanda de formación para profesionales de ciencias de la salud y predomina la oferta por parte de universidades privadas. Los perfiles de competencias desarrollados por el MINSA muestran un claro divorcio con respecto a la oferta actual de profesionales formados

Parity and Overweight/Obesity in Peruvian Women.

INTRODUCTION: The rise in noncommunicable diseases and their risk factors in developing countries may have changed or intensified the effect of parity on obesity. We aimed to assess this association in Peruvian women using data from a nationally representative survey. METHODS: We used data from Peru's Demographic and Health Survey, 2012. Parity was defined as the number of children ever born to a woman. We defined overweight as having a body mass index (BMI, kg/m2) of 25.0 to 29.9 and obesity as a BMI ≥30.0. Generalized linear models were used to evaluate the association between parity and BMI and BMI categories, by area of residence and age, adjusting for confounders. RESULTS: Data from 16,082 women were analyzed. Mean parity was 2.25 (95% confidence interval [CI], 2.17-2.33) among rural women and 1.40 (95% CI, 1.36-1.43) among urban women. Mean BMI was 26.0 (standard deviation, 4.6). We found evidence of an association between parity and BMI, particularly in younger women; BMI was up to 4 units higher in rural areas and 2 units higher in urban areas. An association between parity and BMI categories was observed in rural areas as a gradient, being highest in younger women. CONCLUSION: We found a positive association between parity and overweight/obesity. This relationship was stronger in rural areas and among younger mothers

Mercado de formaci?n y disponibilidad de profesionales de ciencias de la salud en el Per?

Objectives. To describe the availability and demand of professional training programs for eight health science professions in Peru. Study the profiles of the physicians, nurses and midwives that these programs train and their competencies to work at the primary health care level. Materials and methods. Cross-sectional study using data on the volume of applicants, students and graduates of these eight professional training programs during the period 2007 - 2011. In addition, the curricula of professional training programs for physicians, nurses and midwives from public and private universities were analyzed, along with competency profiles developed by Professional Colleges and the Ministry of Health. Results. Admission rates in public and private universities vary by program: 4% and 28% respectively for medical schools, and 18% and 90% for nursing. Graduation rates were estimated at approximately 43% and 53% of students entering medicine and nursing training programs respectively. Contrasting the profiles of recently graduated professionals in medicine, nursing and midwifery, with the skills required by the Ministry of Health for professionals working in primary care the first level of care, indicate that these recently graduated professionals are not necessarily or specifically trained to work in primary care. Conclusions. Demand for professional training in health sciences exists and its supply is met predominantly by private universities. Competency profiles developed by the MOH for the basic professional health team in primary care shows a clear disconnect regarding the current supply of trained professionals.Objetivos. Describir el mercado de formaci?n y la disponibilidad de profesionales de ocho carreras de ciencias de la salud en Per?. Adem?s, examinar los perfiles de los m?dicos, enfermeros y obstetras que se forman y sus competencias para trabajar en el primer nivel de atenci?n. Materiales y m?todos. Estudio transversal utilizando datos de volumen de postulantes, ingresantes y graduados de ocho profesiones durante el periodo de 2007?2011. Tambi?n se analizaron los planes de estudio de programas de formaci?n de m?dicos, enfermeros y obstetras de universidades p?blicas y privadas, y los perfiles de competencias elaborados por los colegios profesionales y el Ministerio de Salud (MINSA). Resultados. Las tasas de ingreso en universidades p?blicas y privadas var?an seg?n la carrera: 4 y 28% respectivamente para Medicina Humana, y 18 y 90% para Enfermer?a. Adem?s, se estima que se grad?an aproximadamente 43 y 53% de los estudiantes que ingresan a Medicina y Enfermer?a, respectivamente. El an?lisis del perfil de los profesionales recientemente graduados en Medicina, Enfermer?a y Obstetricia, al ser contrastados con el perfil de competencias priorizadas para los profesionales que laboran en el primer nivel de atenci?n elaborado por el MINSA, indican que no est?n necesariamente ni espec?ficamente formados para trabajar en este nivel de atenci?n. Conclusiones. Existe demanda de formaci?n para profesionales de ciencias de la salud y predomina la oferta por parte de universidades privadas. Los perfiles de competencias desarrollados por el MINSA muestran un claro divorcio con respecto a la oferta actual de profesionales formados

Incremento en el gasto por inversión en el sector salud: ¿eficiencia y efectividad en el gasto?

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