Americas & Caribbean

Salud Pública: Objeto de Conocimiento, Prácticas y Formación; Public Health: Knowledge, Practice and Training

This paper presents a discussion regarding public health’s main challenges in Latin America: knowledge of it, professional practice and training human resources. Emphasis is placed on three components: knowledge of public health, social practice and human resources training. [from abstract]

Addressing Health Worker Shortages: Recruiting Retired Nurses to Reduce Mother-to-Child Transmission in Guyana

When GHARP set out to recruit new service providers [for preventing mother-to-child transmission], it faced a dilemma. Due to the limited supply of health workers in Guyana, the project needed to avoid recruiting health care providers already working for the MOH. Hiring existing health workers away from their jobs would simple reshuffle the distribution of health workers, rather than add new ones. To address the problem, GHARP staff decided to recruit retired nurses to fill the positions. [from author’s description]

Equidad de género y calidad en el empleo: Las trabajadoras y los trabajadores en salud en Argentina

Se presentan una serie de recomendaciones de políticas y líneas de investigación que buscan instalar como “campo” de acción y de investigación la producción sistemática de información sobre recursos humanos en salud desde una perspectiva de género. [rusumen]

Output-Based Aid in Health: the Argentine Maternal-Child Health Insurance Program

The Argentine Maternal-Child Health Insurance Program uses an interesting approach of combining output-based contracting with an output-based funding mechanism. Particularly innovative is the combination of enrollment numbers and performance indicators as a way to address the trade off between quantity and quality.

Crossing Borders: International Nurses in the US Workforce

The story of the international nurse in the U.S. workforce is generally one of perserverance - not only in obtaining a visa and a state license, but in adjusting to living and working in the United States. [author’s description]

Primary Health Care in Practice: Is it Effective?

The results [of this study] combined with the small size of El Salvador suggest that alternative strategies to community health workers may be a more cost effective approach. While prevention is desirable, community health workers do not have the skills or services that the communities value, which makes them less effective in promoting prevention. Alternative modes of reaching the community could reduce costs and raise the effectiveness of public health spending. [from abstract]

Performance-Based Incentives for Health: Six Years of Results from Supply-Side Programs in Haiti

Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. [from abstract]

Guatemala, Pro Redes Salud: Rapid Scale-Up of Primary Health Care Through NGOs

Before the project began, 300,000 remote rural inhabitants in the Mayan highlands lacked basic primary care, the NGO civil society in health lacked cohesion, and the MOH NGO granting program needed revising. From 2000 to 2004, the NGO Networks Project implemented a grants program that helped form networks of NGOs, strengthening health services and testing innovations in service delivery, and improved monitoring and evaluation.

Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. [from introduction]

Nurse-Physician Relationships Solutions and Recommendations for Change

This report presents the findings of the Ministry of Health and Long Term Care (MOHLTC) directed research on the topic of nurse-physician relationships, and includes recommendations arising from the in depth literature review conducted and which are directed toward the Research Unit and Nursing Secretariat, at the MOHLTC.

Evidence-Based Standards for Measuring Nurse Staffing and Performance

Policy makers and hospital administrators are seeking evidence to support nursing staffing decisions that includes both the volume and mix of nurses required to provide efficient and effective care. The principal objective of this study was to examine the interrelationships between variables thought to influence patient, nurse, and system outcomes. The results provide quality, evidence-based standards for adjusted ranges of nursing productivity/utilization and for staffing levels for patients receiving cardiac and cardiovascular nursing care. [from executive summary]

Definition of Underserved: Policies, Issues, and Relevance

This paper begins by clarifying the terms shortage and underserviced. Provincial and federal programs for underserviced areas in Ontario are then described and considered in terms of their relevance to nursing. A discussion of the issues associated with policies addressing shortage and underserviced areas follows. The paper concludes with recommendations for change. The importance of making funding decisions based on a clear understanding of relevant concepts and models is emphasized. [introduction]

Educated and Underemployed: the Paradox for Nursing Graduands

Th is report focuses on the supply and employment of nursing graduates in Ontario and their absorption into the workforce over the two-year period from 2003/4 to 2004/5. It begins with a review of labour market trends in the health care sector and discusses nursing supply, mobility, and cross-border migration in the recent past. The major repositories of data on
nurse education are identified and an overview of the entry of new nurses into the workforce is provided. Based on a survey of new graduands, a profile of new nurses is presented.

Better Data, Better Decisions: a Profile of the Nursing Workforce

This data creates a profile of the nursing workforce, which is useful for projecting trends and estimating future requirements. At the corporate level, longitudinal examination over a series of years would demonstrate the relationship between the characteristics of the nursing workforce and the overall requirements for patient care. At the unit level, the data is helpful to examine human resource needs and fluctuations in the workforce characteristics.

Internationally Educated Nurses in Ontario: Maximizing the Brain Gain

The three sources of nursing supply in Canada are new graduates, internationally educated nurses (IENs) and nurses returning to the workforce. This report focuses on IENs. Globalization has led to high rates of migration of professionals to economically vibrant countries such as Canada. Because many skilled and educated migrants do not always realize their full potential in their new country, policies to maximize brain gain are imperative. [from executive summary]

Better Data: Better Performance: Community Health Nursing in Ontario

Understanding the supply and utilization of nurses is critical to maintaining an effective community health system. There has to be sufficient staff and a work environment that builds on the existing strengths of community health nursing to meet emerging needs. This report provides a demographic profile of community health nurses (CHNs) in Ontario and identifies enablers that support optimal practice of their competencies. [from executive summary]

New Healthcare Worker: Implications of Changing Employment Patterns in Rural and Community Hospitals

Rural health care is changing. Following restructuring in the 1990s some small hospitals remained independent, while others reorganized as amalgamations and alliances. In 2004, Ontario was divided into 14 Local Health Integration Networks (LHINs) to create accessible, quality health care at a local level. Th is study was designed to gain an understanding of the impact on nursing work and the workforce. [from executive summary]

Working Conditions of Nurses: Confronting the Challenges

This issue of the Health Policy Research Bulletin examines research on the state of working conditions facing Canada’s nurses and discusses the implications for the larger health care system. [author’s description]

Ophthalmology Human Resource Projections: Are We Heading for a Crisis in the Next 15 Years?

This manpower projection was undertaken by using the Canadian Medical Association Physician Resource Evaluation Template. This spreadsheet-based stock and flow model incorporates key parameters in estimating physician supply over the next 2 decades and enables planners to create various scenarios to test the effects on future supply. [author’s description]

Study of Health Human Resources in Nova Scotia 2003

This report provides a comprehensive picture of HRH in Nova Scotia, a snapshot of the number of people working in each health occupation and health care setting; education and training characteristics; age, gender and other demographics, and wokplace injury and illness informatio.

Creating Healthy Health Care Workplaces in British Columbia: Evidence for Action

The intent of the report is to stimulate creative discussions among [British Colubia’s] health system stakeholders about opportunities for coordinated action on employee and workplace health. The best available evidence suggests that the scope and depth of workplace health challenges today require solutions that go beyond traditional workplace health promotion programs.

Collaborative Practice Among Nursing Teams

This best practice guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was collaborative practice among nursing teams with the view that this may be a first stage in a multi-staged process that could eventually result in interprofessional guidelines. A healthy work environment for nurses is a practice setting that maximizes the health and well being of nurses, quality patient outcomes and organizational performance. Effective nursing teamwork is essential to the work in health care organizations. [from purpose]

Community-Based Approaches to HIV Treatment in Resource-Poor Settings

The main objections to the use of [antiretroviral therapies] in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere.

Losing the "Eyes in the Back of Our Heads": Social Service Skills, Lean Caring, and Violence

Violence in the social services work place in general, and the developmental services in particular, has increased in the last several years. Findings from an ethnographic study suggests that new, lean forms of work organization remove opportunities to use or learn many of the tacit or practice skills workers previously used to keep themselves and their clients safer in the work place. This article describes many of these skills and the new management schemes that remove the possibility to develop or transmit these praxis skills.

Physical and Psychological Violence in Jamaica's Health Sector

This study was done to determine the prevalence of experiences with physical violence and psychological violence that health staff have had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. [from abstract]

United States Physician Workforce and International Medical Graduates: Trends and Characteristics

International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. This article describes the historical trends and compare the characteristics of IMGs to United States medical graduates in the United States. It also recommends that policymakers consider the consequences for both the United States and source countries. [adapted from abstract]

Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention and Sustainability

This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries.

Graduates of Lebanese Medical Schools in the United States: an Observational Study of the International Migration of Physicians

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates in the US, and compared their characteristics to those of US medical graduates and other international medical graduates. [abstract]

Social Franchising of Sexual and Reproductive Health Services in Honduras and Nicaragua

This document outlines the outcome of three franchising projects implemented by Partners of Marie Stopes International (MSI) in Honduras and Nicaragua. The projects were designed to pilot full and partial social franchising models as part of an initiative to test and develop alternative forms of delivering quality sexual and reproductive health (SRH) services by a non government organisation (NGO). [abstract]

Role of Regulation in Influencing Income-Generating Activities Among Public Sector Doctors in Peru

The objective of this article is to examine in Peru the nature of dual practice (doctors holding two jobs at once - usually public sector doctors with private practices), the factors that influence individuals decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area. [from abstract]