Transcript The impact of the work environment on the performance of health
The Impact of Work Environment on the Performance of Health Workers in Sudan
Nuha Ibrahim Centre for Global Health-Trinity College Dublin
Contents:
Background -Sudan -Performance of Health Workers -Work Environment in healthcare Research Problem Methodology Expected Outcomes
1-Sudan
( 40 million- North Sudan about 31 million) Since1956, internal wars and conflicts have been ongoing in different regions of the country Disparities and inequality between rural-urban areas in terms of their development trends 60-75 % of the population in the North and 90% of the population in the South are living below the poverty line of less than $1 per day The social, economic and political situation of Sudan shapes the health status of the country to large extent. Challenges communicable and non-communicable diseases
Table 2.2.1: The Status of MDGs in Sudan in 2008 (Source: UNDP Sudan 2010) MDGs MDG 1 Eradicate poverty MDG 2 Achieve universal primary education MDG 3 Promote gender equality and empowering women * MDG 4 Reduce child mortality * MDG 5 Improve maternal health Some of the Indicators for the MDGs Estimated Poverty Incidence (% of total population) Gross Primary Education Enrolment Ratio Ratio Girls to Boys in Primary Education Under-5 Mortality Rate (per 1,000) Northern Sudan 50% 62% 88% 105 45% 100% 100 % 35 2015 Target * MDG 6 Combat HIV/AIDS, malaria and other diseases MDG 7 Sustainable development MDG 8 Develop a global partnership for development Maternal Mortality Ratio (per 100,000 live births) Birth Attended by Skilled Health Staff* HIV/AIDS Prevalence (% adults aged 15-49) 638 57% 1.6% Incidence of T.B (Per 100,000 per year) Children under 5 with Fever Treated with Anti-Malarias (%) Access to Improved Drinking Water Source 90 54.2% 58.7% 127 90% 85% (% of Population) Access to Improved Sanitation(% of 39.9% 67% Population) The Darfur Crisis is currently preventing progress in global partnership for development.
Examples of Health indicators
Country No of Doctors/ 100,000 in population. (2008 & 2009) Total expenditure on health per capita (Intl $, 2009) Total expenditure on health as % of GDP (2009) Life Expectancy Population Sudan Ethiopia 28 *** Kenya Egypt Jordan Ireland 14 (2006) 283 245 279 161 40 68 282 499 4005 7.3
4.3
4.3
5 9.3
9.7
59/59 53/56 58/62 69/73 69/74 77/82 40,272,000 !
82,825,000 39,802,000 82,999,000 6,316,000 4.,515,000
The increase in number of medical schools in Sudan, 1990-2001 (Source: Sudan Health System Profile 2007) Faculty Medicine Number before educational reform Number educational reform after Private faculties 3 26 6 Pharmacy 1 8 5 Dentistry 1 Nursing 1 8 7 5 2 Percentage increase 766% 700% 700% 500%
56% of doctors in Sudan work in Khartoum city (pop=9 million) Doctor/population ratio 28/100,000 Migration of doctors: 60% those who registered in Sudanese Medical Council are working overseas (12,000 of 21,000) of
“Osmosis Migration”
Movement rights Push Factors Pull Factors Migration of Doctors from Developing to Developed countries: Supply and Demand
The global attention to deal with the HRH crisis is focus on two important aspect
1 The retention of health workers -The ethical recruitment by high income countries - Retention strategies in low income countries 2-Ensuring the available workers are performing well to provide quality of care
2-Performance of HWs
The WHO 2006: “Performance is considered to be a combination of Staff being available (retained & present), and staff being competent, productive and responsive”.
Or simply (Adherence to an accepted standard or guideline) factors influencing staff retention and mobility can be distinguished: - Personal and lifestyle-related factors, including living circumstances; - work-related factors, related to preparation for work during pre-service education; - health-system related factors, such as human resources policy and planning; - job satisfaction, influenced by health facility factors, such as financial considerations, working conditions, management capacity and styles, professional advancement and safety at work.
Why it is important ?
For long time poor performance was due to lack of knowledge and training, the reason why we had all the intervention s focusing only on training of HWs. Which lead to disappointing long terms results (1
)
. How to measure it?
“We can only be sure to improve what we can actually measure” *Why it is important to measure performance: to support improvement in the quality of services (2)
3-Work Environment
Definition?
The WHO report 2010 defined the supportive work environment as “an environment that attracts individuals into the health professions, encourages them to remain in the health workforce and enables them to perform effectively”.
Elements of work environments such as:
Safety Management Communication Support, Supervision Fairness and equality
Kramer & Schmalenberg (2002): 8 Essentials of the Work Environment Interviewed 289 staff nurses in 14 Magnet hospitals What are essential elements of the work environment to delivery quality care (rank order)
5.
6.
7.
8.
1.
2.
3.
4.
Working with clinically competent nurses
Good nurse-physician relationship and communication
Nurse autonomy and accountability Support nurse manager/supervisor
Control over nursing practice Support for education
Adequate nurse staffing
Culture where concern for the patient is paramount
http://www.qdocuments.com/The-Power-of-the-Magnet-Hospital-Credential-Excellence-in-Nursing--PPT.html
Public hospitals: " Public hospitals are asked to do more and more with less and less, until it feels like you're doing everything with nothing.” Ron J. Anderson, MD President and CEO, Parkland Health and Hospital System, Dallas, TX
Aim of the research
What are the factors in the work environment that affect the performance of doctors and nurses in public hospitals in Khartoum?
Availability Productivity Competence Responsiveness Pre-service Training In-service Training Education Career Development Physical Infrastructures Political Situation Personal Attitude Supportive Supervision Cleanness Performance Appraisal system Social Environment Safety of HWs Economic stability and security issues Availability of Data Managing available resources The quality of available data Intention to leave Health System Policies and Strategies Availability of resources; drugs, water etc.
Accountability Communication: Management, staff & Clients Trust Transparency Leadership style Respect Teamwork Clear Job Description Recruitment & Decruitment System Community Participation Motivation & Satisfaction Types of diseases
Methodology
Survey (i.e. Work Environment Index+ Performance self evaluated questionnaire!..) for Doctors and nurses -Key informative interviews (i.e. Managers..) - Focus Group discussion
1 MOH Management Doctors Nurses Data
Managemen t system Teamwork Training&..
Communication Availability of d, w, e, etc...
What kind of Data available there?
Hospital Environment!!
Performance of Health workers !!
11
public teaching hospitals in khartoum Or maybe
1
of them!!
Availability Productivity Competence Responsiveness i.e. Staff ratios Attendance Waiting time Patients Satisfaction Communication with patients Job satisfaction Intention to leave i.e. Work Index
Expected outcomes
The expected outcomes will help to understand the impact of work environment on the performance of health workers in low income settings .
This will lead to designing better interventions to improve the performance of HWs in public hospitals, to have better quality of services and higher staff retention rate for better health outcomes.
Having tool to measure performance and work environment on a regular basis as a way to monitor and improve the quality of the services