How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea

From PLOS via Jisc Publications RouterSophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.Funder: World Bank Group; funder-id: http://dx.doi.org/10.13039/10000442116pubpub1

Understanding Health Workers' Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment

Background Timor-Leste built its health workforce up from extremely low levels after its war of independence, with the assistance of Cuban training, but faces challenges as the first cohorts of doctors will shortly be freed from their contracts with government. Retaining doctors, nurses and midwives in remote areas requires a good understanding of health worker preferences. Methods The article reports on a discrete choice experiment (DCE) carried out amongst 441 health workers, including 173 doctors, 150 nurses and 118 midwives. Qualitative methods were conducted during the design phase. The attributes which emerged were wages, skills upgrading/specialisation, location, working conditions, transportation and housing. Findings One of the main findings of the study is the relative lack of importance of wages for doctors, which could be linked to high intrinsic motivation, perceptions of having an already highly paid job (relative to local conditions), and/or being in a relatively early stage of their career for most respondents. Professional development provides the highest satisfaction with jobs, followed by the working conditions. Doctors with less experience, males and the unmarried are more flexible about location. For nurses and midwives, skill upgrading emerged as the most cost effective method. Conclusions The study is the first of its kind conducted in Timor-Leste. It provides policy-relevant information to balance financial and non-financial incentives for different cadres and profiles of staff. It also augments a thin literature on the preferences of working doctors (as opposed to medical students) in low and middle income countries and provides insights into the ability to instil motivation to work in rural areas, which may be influenced by rural recruitment and Cuban-style training, with its emphasis on community service.Our Research Report for 2000-2002 reflects an outstanding level of achievement throughout the institution and demonstrates once again our high level of commitment to strategic and applied research particularly in areas that enhance the quality of life.Funding: The authors thank the Australian Department of Foreign Affairs and Trade and the European Commission for their financial support.sch_iih11pub4608pub1

Reliability of infrared ear thermometry in the prediction of rectal temperature in older inpatients

To assess the capability of infrared ear thermometry accurately to predict rectal temperature in older patients. Infrared ear thermometry is now commonly used for predicting body temperature in older patients. However, ear thermometry has been insufficiently evaluated in geriatric patients. Prospective, convenience sample, unblinded study. All patients (or their guardians) gave informed consent. Patients hospitalised in a geriatric unit underwent sequential ear and rectal temperatures measurements using two different models of infrared ear thermometers (ThermoScan and Genius) and a rectal probe, respectively. After a brief otoscopic examination, ear temperatures were measured twice at both ears with each thermometer, the highest of four measurements being retained for analysis. The rectal temperature was the reference standard. Hundred patients (31 males), aged 81 (SD 7) years completed the study. The mean rectal temperature was 37.3 degrees C (SD 0.7) degrees C (range 36.3-40.7 degrees C). Eighteen patients were febrile (rectal temperature >= 37.8 degrees C). The mean bias between rectal and ear temperatures as measured with the ThermoScan was -0.20 degrees C (SD 0.32) degrees C and the 95% limits of agreement were -0.83 degrees C and 0.42 degrees C (95% CI, -0.88-0.48 degrees C). Using the Genius, the corresponding figures were -0.56 degrees C (SD 0.39) degrees C, -1.32 degrees C and 0.20 degrees C (95% CI, -1.39-0.27 degrees C). After correction for bias, the ThermoScan predicted the level of fever with a maximum error of 0.7 degrees C (mean error 0.3 degrees C). Using the Genius, the maximum error and the mean error were 1.6 degrees C and 0.4 degrees C, respectively. Infrared ear thermometry can predict rectal temperature in normothermic and in febrile inpatients with an acceptable level of accuracy. However, the predictive accuracy depends on both operator technique and quality of instrumentation. Proper technique (measuring in both ears) and optimal instrumentation (model of ear thermometer) are essential for accuracy

Aggregate economic shocks and infant mortality: New evidence for middle-income countries

We provide country-specific estimates of the effect of macroeconomic shocks on infant mortality for a sample of mainly middle-income countries. In most countries, infant mortality appears to be pro-cyclical or acyclical. Only when shocks to GDP are very deep, 15% or larger, are they consistently associated with higher mortality.Income shocks Infant mortality

Differences in follicular function of 3-month-old calves and mature cows

International audienc

Roles of KIT and KIT LIGAND in ovarian function

International audienc

Effects of Kit Ligand and anti-Kit antibody on growth of cultured mouse preantral follicles

International audienc

Correlations between complaints, inflammatory cells and mediator concentrations in nasal secretions after nasal allergen challenge and during natural allergen exposure

A quantitative determination o f the inflammatory mediators was performed and correlated with complaints and the measurement o f the inflammatory cells in nasal secretions o f 18 seasonal allergic rhinitis patients (group 1) outside the pollen season and 40 symptomatic patients (group 2) with seasonal allergic rhinitis during the pollen season. Ten nonallergic subjects (group 3) were also studied as a normal control group. In group 1, 17 (94%) out of 18 patients had an immediate response o f nasal symptoms accompanied by a significant increase o f histamine, leukotriene C4 (LTC,), and tryptase 5 min after nasal allergen challenge (NAC). One hour later, a simultaneous increase was seen both in the percentage o f the eosinophils and in the eosinophil cationic protein (ECP) concentration. The eosinophil count reached a peak 2 h after NAC with a duration o f 8 h, while the highest ECP level was reached only after 24 h with no clear-cut plateau. In group 2, a high percentage of eosinophils was observed. Mostly one observed significantly (p<0.01) higher concentrations o f ECP, LTC4 and histamine but not of tryptase than the baseline values o f group 1. The authors concluded that during the pollen season allergic rhinitis reflects mainly a chronic state o f allergic inflammation of the nasal mucosa involving various inflammatory components induced by one or more episodes of early-phase type allergic reaction. Infiltration of eosinophils and consequently release of the various late-phase inflammatory mediators into the nasal secretions are certainly believed to be the predominant pathophysiologic condition in the patients. © 1995 S. Karger AG, Basel.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Low serum bone gamma-carboxyglutamic acid protein concentrations in patients with cystic fibrosis:Correlation with hormonal parameters and bone mineral density

In 31 children and adolescents with cystic fibrosis (CF), whose bone mineral density (BMD) was determined at the level of the lumbar spine, serum bone γ-carboxyglutamine acid (GLA) protein (BGP) was measured. A standard radioimmunoassay method gave for the studied CF population a median serum BGP concentration of 9 μg/1 (range: 0.8–18.6) which corresponds to a median Z-score for age of −1.72 (range: −3.3 to +0.04). Thirteen patients presented a BGP concentration lower than 2 standard deviations (SD) under the mean for age. These patients did not differ from the others by their circulating thyroxine, triiodothyronine, 25-hydroxyvitamin D or parathyroid hormone levels. The lowering of the BGP concentration was neither related to the growth velocity nor to the severity of the lung disease, as assessed by lung scintigraphy. Six patients with a decreased BMD (<2 SD under mean for age) were found. Five of them had also a decreased BGP concentration. In conclusion, decreased serum BGP concentration was found in 42% of the studied CF patients and could not be related to hormonal abnormalities. Serum BGP had a low specificity (72%) in predicting osteopenia in young CF patients. © 1993 S. Karger AG, Basel.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Alterations in ovarian function of mice with reduced amounts of Kit receptor

International audienc