Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania.

In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in professional ethics, and the way this is reinforced in practice require closer attention. The differences in the findings across the three settings underscore the importance of in-depth country-level research to tailor the development of incentives schemes

Enhancing Interdisciplinary Instruction in General and Special Education: Thematic Units and Technology

This article discusses interdisciplinary thematic units in the context of special and general education curricula and focuses on ways technology can be used to enhance interdisciplinary thematic units. Examples of curriculum integration activities enhanced by technology are provided in the context of productivity tools, presentation and multimedia tools, contextual themed software, and Web-based activities.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Physicians' migration in Europe: an overview of the current situation

<p>Abstract</p> <p>Background</p> <p>The migration of medical professionals as a result of the expansion of the European Union is cause for concern. But there is a significant lack of information available about this phenomenon.</p> <p>Methods</p> <p>Search of secondary databases about the presence of european doctors working abroad, through two search engines in the Internet (Google and Pubmed) and a survey of professional organisations and regulators in countries of the European Union.</p> <p>Results</p> <p>The United Kingdom has more foreign doctors than all other European countries for which figures are available (Ireland, France, Germany, Norway, Portugal, Italy, Austria and Poland). Some 74,031 foreign doctors are registered in the UK, 30.94% of the total. European countries with the highest percentage of doctors working abroad are Ireland (47.5%, or 10,065 doctors) and Malta (23.1%, 376 doctors). The data obtained from Norway, France and Germany do not indicate an increase in the migration of professionals from countries recently incorporated into the EU.</p> <p>Conclusion</p> <p>There is significant mobility and heterogeneous distribution of doctors within the EEA and it should be cause for concern among health care authorities. However, there is no evidence about a possible increase in this phenomenon after the recent expansion of the EU.</p

Ecosystem services of temporary streams differ between wet and dry phases in regions with contrasting climates and economies

1. Temporary streams are dynamic ecosystems in which mosaics of flowing, ponded and dry habitats support high biodiversity of both aquatic and terrestrial species. Species interact within habitats to perform or facilitate processes that vary in response to changing habitat availability. A natural capital approach recognizes that, through such processes, the ‘natural assets’ of all ecosystems deliver services that benefit people. 2. The ecosystem services of temporary streams remain largely unexplored, in particular those provided during ponded and dry phases. In addition, recent characterizations have focused on dryland systems, and it remains unclear how service provision varies among different climatic regions, or between developed and developing economies. 3. We use evidence from interdisciplinary literature to examine the ecosystem services delivered by temporary streams, including the regulating, provisioning and cultural services provided across the continuum from flowing to dry conditions. We focus on service provision during dry phases and wet–dry transitions, across regions with contrasting climates and economic development. 4. Provision of individual services in temporary streams may be reduced, enhanced or changed by surface water loss. Services enhanced by dry phases include provision of higher‐quality subsurface drinking water and unique opportunities for recreation. Shifts between dry and wet phases enable groundwater recharge that mitigates water scarcity, and grant dry‐phase access to sediments deposited during flowing phases. However, the accessibility and thus perceived value of these and other services varies considerably among regions. In addition, accessing provisioning services requires careful management to promote sustainable resource use and avoid ecological degradation. 5. We highlight the need for environmental managers to recognize temporary streams as aquatic–terrestrial ecosystems, and to take actions promoting their diversity within functional socio‐ecological systems that deliver unique service bundles characterized by variability and differing availability in space and time

Comparative Performance Measures, Globalising Strategies and Literacy Policy in Scotland

This paper explores one example of an international comparison - the OECD’s International Adult Literacy Survey (IALS) - in order to investigate the power of numbers in both the shaping and the legitimization of adult literacy policy using Scotland as a case study. It is argued that policy implementation is framed by a common assumption that the production of knowledge will increase global competitiveness leading to the prioritisation of economic objectives in education. However, despite these globalising strategies, examples are provided of how the economic discourse can be resisted, to some extent, through prioritising more social objectives at both the local and state levels

Migration of South African health workers: the extent to which financial considerations influence internal flows and external movements

Background: The loss of human resource capacity has had a severe impact on the health system in South Africa. This study investigates the causes of migration focussing on the role of salaries and benefits. Health professionals from public, private and non-governmental (NGO) health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. Methods: The study uses cross-sectional data collected in 2009. A total of 694 health professionals (430 in the public sector, 133 in the NGO sector and 131 in the private sector) were surveyed. An additional 11 health professionals were purposively selected for in-depth interviews. Odds ratios with 95% confidence intervals were calculated to determine whether salaries influenced HWs decisions to migrate. Results: HWs decision to move was not positively associated with lower salaries. It was found, instead, that the consideration to move was determined by other factors including age, levels of stress experienced and the extent to which they were satisfied at their current place of work. Conclusions: The OSD appears to have lowered the risk of HWs migrating due to low salaries. However, the results also indicate that the South African Department of Health needs to improve working conditions for HWs within the public health sector to assist in retention