Health workforce is made up of health workers which include all people engaged in the promotion, protection or improvement of the health of the population and they play a critical role in achieving effective health care delivery. We sought to estimate the health workforce in Nigeria for 2016-2030 using the population growth rate from censuses and health workforce growth rate from data from the World health organization, World Health Organisation recommended doctors and nurses critical density and the Africa health workforce observatory database to estimate the potential supply gap. Nigeria’s population will increase from 178.5 million in 2014 to 272.5 million by 2030. We found the range of estimated doctors (physicians) and nurses & midwives required for 2016-2030 to be between 422,018 and 621,205 with mean of 515,668. The range for doctors is 101,803 to 149,862 with mean of 124,394. The range of estimated Nurses and Midwives requirement is 320,216 to 471,353 with a mean of 391,274. We found the range of deficit for doctors and nurses & midwifes to be 30.86-33.45% (average- 32.16%.) and 26.09-29.5% (average- 27.68%) respectively during the study period with actual figure for doctors ranging from 31,413-50,120 while nurses is estimated to be 83,548-137,859 if no effort is made to upscale the present supply. Nigeria needs to improve on the health workforce supply to tackle the supply deficit in order to solve the heavy disease burden and turn the tide of health indicators in the positive direction.
Factors Associated with Anemia among Pregnant Women of Underprivileged Ethnic...Prabesh Ghimire
Abstract
Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
National programme for prevention and control of cancer, diabetes, CVDs and s...Dr Lipilekha Patnaik
NCDs are surpassing the burden of communicable diseases in India, need for National Programme on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke was envisaged.
Factors Associated with Anemia among Pregnant Women of Underprivileged Ethnic...Prabesh Ghimire
Abstract
Background. This study aims at determining the factors associated with anemia among pregnant women of underprivileged ethnic groups attending antenatal care at the provincial level hospital of Province 2. Methods. A hospital-based cross-sectional study was carried out in Janakpur Provincial Hospital of Province 2, Southern Nepal. 287 pregnant women from underprivileged ethnic groups attending antenatal care were selected and interviewed. Face-to-face interviews using a structured questionnaire were undertaken. Anemia status was assessed based on hemoglobin levels determined at the hospital’s laboratory. Bivariate and multiple logistic regression analyses were used to identify the factors associated with anemia. Analyses were performed using IBM SPSS version 23 software. Results. The overall anemia prevalence in the study population was 66.9% (95% CI, 61.1–72.3). The women from most underprivileged ethnic groups (Terai Dalit, Terai Janajati, and Muslims) were twice more likely to be anemic than Madhesi women. Similarly, women having education lower than secondary level were about 3 times more likely to be anemic compared to those with secondary level or higher education. Women who had not completed four antenatal visits were twice more likely to be anemic than those completing all four visits. The odds of anemia were three times higher among pregnant women who had not taken deworming medication compared to their counterparts. Furthermore, women with inadequate dietary diversity were four times more likely to be anemic compared to women having adequate dietary diversity. Conclusions. The prevalence of anemia is a severe public health problem among pregnant women of underprivileged ethnic groups in Province 2. Being Dalit, Janajati, and Muslim, having lower education, less frequent antenatal visits, not receiving deworming medication, and having inadequate dietary diversity are found to be the significant factors. The present study highlights the need of improving the frequency of antenatal visits and coverage of deworming program in ethnic populations. Furthermore, promoting a dietary diversity at the household level would help lower the prevalence of anemia. The study findings also imply that the nutrition interventions to control anemia must target and reach pregnant women from the most-marginalized ethnic groups and those with lower education
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
National programme for prevention and control of cancer, diabetes, CVDs and s...Dr Lipilekha Patnaik
NCDs are surpassing the burden of communicable diseases in India, need for National Programme on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke was envisaged.
Maternal Health Care Services and Its Utilization in Bihar, Indiainventionjournals
ABSTRACT: The utilization of maternal health care services is a complex phenomenon and influenced by several factors. Therefore, the objective of this study is to analyze the utilization of maternal health services and its determinant that affects at community and regional levels by using DLHS-III. Bi-variate and multiple logistic regressions have been used for analyzing all these things. Home Delivery was found more in rural (74.1) than urban (46%), but maximum delivery was found normal in both rural (94.5%) and urban (85.4%) setting, birth that had been conducted by unskilled persons was also high in rural (94%) and urban (87%) settings. The utilization of any ANC, Institutional delivery and PNC was 59 percent, 28 percent and 26 percent respectively. There was also a large significant variation in utilization of ANC services and services at the time of delivery used in between rural and urban settings. Households’ socio-economic status, mother's education, caste and birth order was the most-important determinants associated with the use of any ANC and institutional delivery. Therefore, at community-levels, increase the utilization of maternal health services and there is also stable to focus on vulnerable section of the community (Poor and SC/ST groups) and regional-level awareness interventions.
Role & responsibilities of mid level healthcare providersHarsh Rastogi
Role & responsibilities of mid level healthcare providers
Mid-level health providers (MLHPs) are health workers trained at a higher education institution for at least 2-3 years.
MLHP is a health provider who:
Who is trained, authorized and regulated to work autonomously,
Who receives pre-service training at a higher education institution for at least 2-3 years, and
Whose scope of practice includes (but is not restricted to) being able to diagnose, manage and treat illness, disease and impairments (including perform surgery, where appropriately trained), prescribe medicines, as well as engage in preventive and promotive care.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
Maternal Health Care Services and Its Utilization in Bihar, Indiainventionjournals
ABSTRACT: The utilization of maternal health care services is a complex phenomenon and influenced by several factors. Therefore, the objective of this study is to analyze the utilization of maternal health services and its determinant that affects at community and regional levels by using DLHS-III. Bi-variate and multiple logistic regressions have been used for analyzing all these things. Home Delivery was found more in rural (74.1) than urban (46%), but maximum delivery was found normal in both rural (94.5%) and urban (85.4%) setting, birth that had been conducted by unskilled persons was also high in rural (94%) and urban (87%) settings. The utilization of any ANC, Institutional delivery and PNC was 59 percent, 28 percent and 26 percent respectively. There was also a large significant variation in utilization of ANC services and services at the time of delivery used in between rural and urban settings. Households’ socio-economic status, mother's education, caste and birth order was the most-important determinants associated with the use of any ANC and institutional delivery. Therefore, at community-levels, increase the utilization of maternal health services and there is also stable to focus on vulnerable section of the community (Poor and SC/ST groups) and regional-level awareness interventions.
Role & responsibilities of mid level healthcare providersHarsh Rastogi
Role & responsibilities of mid level healthcare providers
Mid-level health providers (MLHPs) are health workers trained at a higher education institution for at least 2-3 years.
MLHP is a health provider who:
Who is trained, authorized and regulated to work autonomously,
Who receives pre-service training at a higher education institution for at least 2-3 years, and
Whose scope of practice includes (but is not restricted to) being able to diagnose, manage and treat illness, disease and impairments (including perform surgery, where appropriately trained), prescribe medicines, as well as engage in preventive and promotive care.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
"The future of healthcare in Africa: progress on five healthcare scenarios", a new report written by The Economist Intelligence Unit (EIU) and sponsored by Janssen, explores Africa's recent progress on several major healthcare challenges. The report looks at the continent's increasing focus on primary and preventive care, the empowerment of communities as healthcare providers, the extension of universal healthcare, the spread of telemedicine, and the role of international donors.
"The future of healthcare in Africa: progress, challenges and opportunities", is a new report written by The Economist Intelligence Unit and sponsored by Janssen, that explores Africa's major healthcare challenges and outlook. It explores the continent's increasing focus on primary and preventive care, the empowerment of communities as healthcare providers, the extension of universal healthcare, the spread of telemedicine, and the role of international donors.
Factors Affecting Retention of Human Resources for Health in TRANS-NZOIA Coun...paperpublications3
Abstract: Retention possesses an essential spot and position inside the entire administration process. This component is utilized productively for swaying staff to make positive commitment for accomplishing organizational goals. Retention is vital, as individual temperament needs some kind of prompting, consolation or motivation to give higher execution. Over the past 5yrs, the rate of nursing staff leaving their jobs has been 40% annually and this has continued to be a problem affecting the delivery of health services. Motivation of employee's therefore, offers numerous edges to the Organization and also to the staff. Hence this study sought to establish the factors affecting retention of health workers in the health sector and especially nurses in the health department of Transnzoia County Government. The study was guided by the following objectives; - to determine the factors that affect nurse retention in the Health sector of Transnzoia County Government, to find out the effects of job satisfaction on nurse retention in the Health sector of Transnzoia County Government and to establish the effect of retention programs in the health sector of Transnzoia County Government. The design used for this study is the descriptive method. The targeted sample for this study comprised of senior management nurses as well as junior management nurses at the hospitals, health centers and dispensaries within Transnzoia County. The total population of nurses currently stands at three hundred and twenty. A sample size of one seventy five members was selected by using random sampling method. Both primary and secondary sources of data were used during the study. The procedures for collection of data for this study were basically questionnaires and interviews. Data collected using the questionnaires was edited for clarity and then frequency tables drawn to show the final results using Pearson product-Moment Coefficient correlation and Statistical Package for Social Science (SPSS) software. The SPSS was used to analyze the information gathered which was used in development of charts and graphs. It is therefore important to understand personal premises and key retention factors anchored on contemporary nursing management practices with identifiable indicators.
Analysis of Employee Retention Strategies on Organizational Performance of Ho...inventionjournals
Globally, the retention of skilled medical staff in health care sector has been a serious concern to management due to higher turnover of medics. The desired critical measures for retention strategies of medics need to be done to sustain competition among health care providers. The purpose of this study was to analyse of employee retention strategies on organizational performance of hospitals in Mombasa County. The study was guided by the following objectives; to analyse the relationship between recruitment strategies and organizational performance, to examine the extent to which supervision strategies affects organization performance,. The study employed descriptive correlational research design. Target populations of 102 respondents, the study had a sample size of 102 respondents all drawn from senior staff in the County’s ministry of health department. Sampling procedure will be census. Semi-structured Questionnaire will be used, Likert five point scale questionnaire will be used, factoring Strongly Agree to Strongly Disagree. Cronbach’s alpha coefficient was used to measure the reliability of the questionnaire. Data was analysed using descriptive statistics and regression analysis was used to measure the relationship between variables. Data was presented in cumulative frequency tables. The finding the study were The relationship between recruitment strategies and organization performance of public hospitals in Mombasa County was found to be positive and significant in that its R was 0.485 and had a p-value less than 0.05 (ε= 0.006). The regression results revealed that supervision strategies effect on performance was statistically significant (overall p-value = 0.036).The study concluded that all the employee retention strategies need to be improved because they have been found to have a positive and significant effect on organizational performance. The study recommended that the management of public hospitals in Mombasa County should improve on employee retention strategies because they have been found by this study to have a positive effect on the organizational performance
Background: Job satisfaction is a significant indicator of the way nurses feel about their profession, the efforts to perform their professional duties, or otherwise abandons it willingly. Method: cross-sectional research design approach was used to assess the job satisfaction and the associated factors among 300 hundred nurses. Data was analyzed using descriptive statistics and kruskal wallis test for association between the socio-demographic variables and job satisfaction at significance level of 0.05 Result: About 1/3 of the respondents (31%) reported gross dissatisfaction with their job, 0% reported being well satisfaction while (68.7%) respondents reported moderate satisfaction with their job. Across items on the scale, gross dissatisfaction was noted on key managerial factors and the salary of the workers. Job satisfaction was associated with specialty (p<0.018), gender (P<0.002) and age (P<0.000) of Nurses. Conclusion: majority of the respondents were moderately satisfied with their job but grossly dissatisfied with salary and administrative roles like communication flow.
The Positive Impact of Public Health Midwives for Nations Wellbeing through P...ijtsrd
For the Sri Lankan health sector, the performance management definition is relatively recent. For almost two decades, Sri Lanka has been introducing health sector reforms. The reforms included implementing public sector results oriented management and the decentralisation of health care workers management from central to local governments. However, to propose strategies for improvement, this examination analysed the application of Public Health Midwives PHM , performance management. The brief was a descriptive survey conducted in Sri Lanka and used quantitative review approach. Moreover, the review indicates that performance management is limited to the state health sector, while there have been deceptions in its application. In setting performance goals, there were inadequacies and performance management preparation were hardly performed. Although many Public Health Midwives PHM had job descriptions, both Public Health Midwives PHM and authorities were not identified and aware of the performance metrics and standards as per the WHO. Besides, the timetables for performance reviews have not always been followed. There were limited opportunities for career advancement, insufficient input on performance and inadequate mechanisms for compensation. Public Health Midwives PHM performance management is inadequately carried out in most of the district. A central component of efforts to enhance the results of the health sector is performance management. However, as Sri Lanka advances, the primary health system can provide vital health expertise in rural areas and maintain essential health workers at the grassroots level in remote parts of the country. The scheme has dramatically reduced the worlds maternal and child mortality and helped fill the rural health vacuum. However, by allocating the appropriate amount of funds through state expansionary fiscal policy, it is possible to enhance the standard of training and number of a Public Health Midwife PHM to the nations wellbeing. Pathma Kumar Wickramasinghe "The Positive Impact of Public Health Midwives for Nation's Wellbeing through Performance Management" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38389.pdf Paper Url: https://www.ijtsrd.com/management/hrm-and-retail-business/38389/the-positive-impact-of-public-health-midwives-for-nations-wellbeing-through-performance-management/pathma-kumar-wickramasinghe
13 – impact of social media on health in punjab,South India(Current), Riya(PW...ashimasahni3
A sound health and effective mental care are essential part of nation state system. In-fact
Economy and Social goal of any nation depends on the health of the people. Health is
measured by different variables like access to quality health care, genetic inheritance and the
factors comprised with the quality of water, air, environment conditions etc. However recent
researches in related filed indicates correlation between mass media and health. Mass
media plays very important role in diffusing health messages and generating awareness
about health information which guides in attitude and behavior change of the audience to
ascertain a good health. Thus, Mass media guides health officials to reach the general
people, that is very important for health communication. Hence, mass media, radio,
television, and online media are the useful ways to make up mind of the the target people to
imbibe a new life-style and to alarm them with needful information because this is the only
way which is used to pursued the public about a particular disease or epidemic. The current
study intends to find out the level of awareness of health issues among the people and to
find out the most effective mode of health communication. The present research leads to the
findings that people of Punjab are aware of health issues but not fully aware about the health
schemes initiated by government of India. The mainstream media like radio and television
are doing very good job on national level to make people aware about government related
schemes but local channels are least interested to do a job for health awareness. It has also
come into light that private media is not very serious for spreading health related information
HEALTH SITUATION The population of the country has incr.docxAASTHA76
HEALTH SITUATION
The population of the country has increased by 45.8% in the past 25 years, reaching 29.9 million in
2015. It is estimated that 17.5% of the population lives in rural settings (2012), 17.2% of the
population is between the ages of 15 and 24 years (2015) and life expectancy at birth is 76 years
(2012). The literacy rate for youth (15 to 24 years) is 99.2%, for total adults 94.4% (2013), and for
adult females 91.4% (2012).
The burden of disease (2012) attributable to communicable diseases is 12.6%, noncommunicable
diseases 78.0% and injuries 9.4%. The share of out-of-pocket expenditure was 19.8% in 2013 and
the health workforce density is 26.5 physicians and 53.73 nu rses and midwives per 10 000
population (2014).
HEALTH POLICIES AND SYSTEMS
The National Transformation Program 2020 identifies interventions for health system
strengthening, health promotion and control of noncommunicable diseases, control of
communicable diseases, health security, and improving partnerships for health development. In
addition, the National Transformation Program 2020 aims to improve the planning, production
and management of the health workforce. It has also prioritized the growing private sector with a
focus on better regulation and public–private sector partnerships. Promoting health in all policies
and greater intersectoral collaboration at national and subnational levels have been identified as
national priorities for the current planning cycle. Decentralization needs strengthening and the
strategy has identified mechanisms for empowering the subnational level. Capacity-building and
greater investments are other interventions outlined in the National Transformation Program
2020. The strategy also includes the strengthening of the monitoring and evaluation of national
health plans, using a user-friendly set of indicators. The health system is largely funded through
the government budget, which is mainly financed by oil revenues. However, due to the drop in oil
revenues, there is a risk that the decrease in national revenues will adversely affect national
expenditure on health. Identifying alternative sources of funding such as cost -sharing and
premium payments or implementation of health insurance is therefore advised. In addition, the
private sector needs to introduce some sort of social insurance.
The Ministry of Health provides primary health care services through a network of health care
centres, hospitals and primary health care facilities. The network of health infrastructure has
improved the access of populations in remote areas to health services and a referral system
provides curative care for all members of society from the level of general practitioners and family
physicians at centres to advanced specialist curative services in general and specialist hospitals.
New national policies and strategies for primary health care have been developed that are patient
centred and fo.
The delivery of these services require adequate and competent health and care workers with optimal skills mix at facility, outreach and community level, and who are equitably distributed, adequately supported and enjoy decent work.UHC strategies enable everyone to access the services that address the most significant causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.
Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.
Many countries are already making progress towards UHC, although everywhere the COVID-19 pandemic impacted the availability the ability of health systems to provide undisrupted health services. All countries can take actions to move more rapidly towards UHC despite the setbacks of the COVID-19 pandemic, or to maintain the gains they have already made. In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond to the ever-growing health needs of the populations and the increasing costs of health services.
Moving towards UHC requires strengthening health systems in all countries. Robust financing structures are key. When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness. Pooling funds from compulsory funding sources (such as government tax revenues) can spread the financial risks of illness across a population.
UHC emphasizes not only what services are covered, but also how they are funded, managed, and delivered. A fundamental shift in service delivery is needed such that services are integrated and focused on the needs of people and communities. This includes reorienting health services to ensure that care is provided in the most appropriate setting, with the right balance between out- and in-patient care and strengthening the coordination of care. Health services, including traditional and complementary medicine services, organized around the comprehensive needs and expectations of people and communities will help empower them to take a more active role in their health and health system.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
2. 10
Health workforce crisis can manifest as shortage which may be chronic or acute and misdistribution which
may be geographic or professional. This crisis is seen globally, Nigeria and Africa inclusive [15]. Currently
Nigeria is the most populous country in Africa, has the highest human resources for health in Africa
comparable only to Egypt and South Africa [15]. In 2007, there were 52,408 doctors, 128,918 nurses, and
90,489 midwives registered, which translates into about 35 doctors and 86 nurses per 100,000 populations
which was inadequate [16].This compares to a Sub-Saharan average of 15 doctors and 72 nurses per
100,000 population[6].
Inadequate health workforce would affect health status in any society; there would be ineffective tackling of
the present HIV/AIDs pandemics, emerging Non Communicable Diseases (NCDs), high maternal mortality
especially in developing countries due to inability to offer emergency obstetric care 24hours and general
obstacle to achieving good societal health indicators [1,3,9,17]. The achievement of Millennium
Development Goals (MDGs) is dependent on the availability of adequate health workforce [3]. Generally to
have access to qualitative health care an adequate and qualitative health work force is needed [5].
The health workforce status of a country is one of the indicators of the quality of health care in that country
and reflects in her rank her globally. In 49 countries identified by World Health Organisation (WHO) to be
having insufficient density of doctors, nurses and midwives, Nigeria is in sixth position [13,18]. This study
is essential to help health policy makers and planner plan health related needs of the population by
satisfying the health system needs through objective information and evidence based findings. Furthermore
the study would serve as a basis for determining the requirement for filling the potential gap for the same
period.
METHODS
We used the term “doctor” interchangeably with “physician” throughout this study. Furthermore nurses
were generally lumped together with midwives because of professionally similarity and cases of double
qualification which is popular in Nigeria.Other health workers were left out of this study.
There is strong, well and widely documented relationship between health workforce density and skill mix
involving doctors, nurses and midwives and health outcome of a community as a whole[9,14].These
quantitative requirements were derived from expected health workforce density.
The National Population Commission Census figure (2006) was extrapolated over to the study years. Other
database utilised include World Bank data base, World Health Organisation data base and African Health
workforce observatory database. The national population growth rate, physicians and nurses’ growth rate
were obtained from African health workforce observatory database and previous studies [19].
WHO expect anything short of 23 when only doctors, nurses and midwifes are counted per 10,000
population or 2.28 health care professional/1000 would be unable to achieve adequate coverage rate for key
primary health-care interventions prioritized by Millennium Development Goals(MDGs)[6,12].
Generally this is considered to be the minimum necessary to deliver essential health services [15]. This
critical number affect health outcome.
World Health Report 2006 Suggests a Minimum Worker Density Threshold or critical threshold of 2.3
Workers (Doctors, Nurses and Midwives) Per 1000 Population or 23 per 10,000 Necessary. 0.55 doctors per
1000 population while 1.73nurses midwives per 1000 population have been recommended by some studies
[21-23]. Thus the derivation of the health workforce requirement from density was used to estimate the
doctors and nurses & midwives requirement for 2016-2030. Historical workforce growth rate was use to
forecast availability in years under study.
The following terms were defined: physicians' density is the number of physicians per 10 000 population or
per 1000[22]. Nurse density is the number of nurses per 10 000 population or per 1000[22].Total number of
health workers per 10 000 or per 1000 population is the total number of physicians, nurses and midwives
[22]. Nurse-physician ratio is the ratio of the number of nurses to physicians [22].
The figures were rounded up to the nearest whole number. Average growth rate used in computing is 2.8 %
(average of 2006-2014)[24]. The last census in Nigeria put the total population (2006) at 140,431,790.
Using a growth rate of available figures would give an annualized growth rate of 2.52% of physician stock
(1960-2009). There is dearth of health statistics in Nigeria like in other third world countries. It is must be
Adebayo et al.... Int. J. Innovative Healthcare Res. 4 (1):9-16, 2016
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3. 11
said such figure would be ambitious since average figure of national medical school graduates have never
been more than 3,000/year 1991- 2008 and immigration have not demonstrate to be a significant conduit for
replenishing doctor stock in Nigeria[19].
Table 1. Historical growth rate Growth rate of health workforce [19,24-26]
Year 1960 2002 2005 2006 2007 2009
Physician 1079 22000 39210 49612 55376 59,136
Table 2. Historical growth of health workforce [19,24-26]
Year 1960 2002 2005 2006 2007 2009
Nurses and
Midwives
7,978 117,000 213,422 214,288 128,918 230,941
Using a growth rate of available figures would give an annualized growth rate of 2.48% for nurses and
midwifes (1960-2009).
RESULTS
Table 3: Population Estimate, Health Workforce & Doctors 2016-2030
Year Population estimate Estimate of Doctors
and Nurses minimum
requirement(%
Percentage of Doctors,
Nurses And Midwives
in estimated total
population)
Estimate of Doctors
requirement(%
Percentage of Doctors
in estimated total
population)
Expected new
addition to stock of
doctors to meet
requirement
2016 185,095,806 422,018(0.23) 101,803(0.55)
2017 190,278,488 433,835(0.23) 104,653(0.55) 2,850
2018 195,606,286 445,982(0.23) 107,583(0.55) 2,930
2019 201,083,262 458,470(0.23) 110,596(0.55) 3,013
2020 206,713,594 471,307(0.23) 113,692(0.55) 3,096
2021 212,501,574 484,504(0.23) 116,876(0.55) 3,184
2022 218,451,618 498,070(0.23) 120,148(0.55) 3,272
2023 224,568,264 512,016(0.23) 123,513(0.55) 3,365
2024 230,856,175 526,352(0.23) 126,971(0.55) 3,458
2025 237,320,148 541,090(0.23) 130,526(0.55) 3,555
2026 243,965,112 556,240(0.23) 134,181(0.55) 3,655
2027 250,796,135 571,815(0.23) 137,938(0.55) 3,757
2028 257,818,427 587,826(0.23) 141,800(0.55) 3,862
2029 265,037,343 604,285(0.23) 145,771(0.55) 3,971
2030 272,458,388 621,205(0.23) 149,852(0.55) 4,081
The range requirement of doctors is 101,803 to 149,862 with mean of 124,394 while nurses & midwives
required for 2016-2030(422,018 to 621,205) with mean of 515,668 (Table 3) .The expected new addition to
stock from 2017 is expected to be 2,850 new doctors based on the population addition.
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4. 12
Table 4: Population Estimate and Health Workforce (Nurses & Midwives) 2016-2030
Year Population
estimate
Estimated Nurses &
Midwives requirement
(%Percentage of total
estimated population)
Expected new addition to
stock of Nurses &
Midwives to meet
requirement
2016 185,095,806 320,216(0.173)
2017 190,278,488 329,182(0.173) 8,966
2018 195,606,286 338,399((0.173) 9,217
2019 201,083,262 347,874(0.173) 9,475
2020 206,713,594 357,615(0.173) 9,741
2021 212,501,574 367,628(0.173) 10,013
2022 218,451,618 377,921(0.173) 10,293
2023 224,568,264 388,503(0.173) 10,582
2024 230,856,175 399,381(0.173) 10,878
2025 237,320,148 410,564(0.173) 11,183
2026 243,965,112 422,060(0.173) 11,496
2027 250,796,135 433,877(0.173) 11,817
2028 257,818,427 446,026(0.173) 12,149
2029 265,037,343 458,515(0.173) 12,489
2030 272,458,388 471,353(0.173) 12,838
The range of estimated Nurses and Midwives requirement is 320,216 to 471,353. Mean -391,274 (Table 4).
The expected new addition to stock from 2017 is expected to be new 8,966 Nurses and Midwives based on
the population addition.
Table 5: Estimate supply gap of doctors
Year Population
estimate
Estimate of
Doctors
requirement
Estimate
doctors
availability
Estimated
availability
gap/deficit
Percentage
deficit
2016 185,095,806 101,803 70,390 31,413 30.86
2017 190,278,488 104,653 72,164 32,489 31.04
2018 195,606,286 107,583 73,983 33,600 31.23
2019 201,083,262 110,596 75,847 34,749 31.42
2020 206,713,594 113,692 77,758 35,934 31.61
2021 212,501,574 116,876 79,718 37,158 31.79
2022 218,451,618 120,148 81,727 38,421 31.98
2023 224,568,264 123,513 83,786 39,727 32.16
2024 230,856,175 126,971 85,898 41,073 32.35
2025 237,320,148 130,526 88,062 42,464 32.53
2026 243,965,112 134,181 90,281 43,900 32.72
2027 250,796,135 137,938 92,556 45,382 32.90
2028 257,818,427 141,800 94,889 46,911 33.08
2029 265,037,343 145,771 97,280 48,491 33.27
2030 272,458,388 149,852 99,732 50,120 33.45
The range for the estimated potential deficit of 31,413 to 50,120doctors with average deficit is 40,122
(Table 5). The average deficit of doctors over the period is 32.16%.
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5. 13
Table 6: Estimate supply gap of Nurses & Midwives
Year Population
estimate
Estimated Nurses
& Midwives
requirement
Estimated
Supply of
Nurses &
Midwives
Estimated
availability gap
Percentage of
deficit/gap
2016 185,095,806 320,216 236,668 83,548 26.09
2017 190,278,488 329,182 242,538 86,644 26.32
2018 195,606,286 338,399 248,553 89,846 26.55
2019 201,083,262 347,874 254,717 93,157 26.78
2020 206,713,594 357,615 261,034 96,581 27.01
2021 212,501,574 367,628 267,507 100,121 27.23
2022 218,451,618 377,921 274,142 103,779 27.46
2023 224,568,264 388,503 280,940 107,563 27.69
2024 230,856,175 399,381 287,908 111,473 27.91
2025 237,320,148 410,564 295,048 115,516 28.14
2026 243,965,112 422,060 302,365 119,695 28.36
2027 250,796,135 433,877 309,864 124,013 28.58
2028 257,818,427 446,026 317,548 128,478 28.81
2029 265,037,343 458,515 325,423 133,092 29.03
2030 272,458,388 471,353 333,494 137,859 29.25
The range of estimated potential deficit of nurses& midwives found was 83,548 – 137,859 and average
deficit is 27.68% (Table 6).
DISCUSSIONS
Based on this projection, Nigerian population would have increased from 178.5 million in 2014 to 272.5
million by 2030; an increase of about 93.9 million people (with health needs) over 16 years. Our calculation
was done by geometric method and the growth rate used was adopted from World Bank which has already
adjusted for fertility and death rate. We believe the projection is robust enough considering the method used
to arrive at the figure.
Using the World Health Report 2006 which suggested a minimum worker density threshold of 2.3 Workers
(Doctors, Nurses and Midwives) per 1000 Population or 23 per 10,000 the requirement of Nigeria over the
study period would be largely unmet significantly based on the current growth rate of the present stock of
doctors and nurses & midwives [20].
Nigeria will need approximately 149,852 doctors and 471,353 nurses by the year 2030. With the available
growth rate of Doctors/Nurses, by this same period only 99,120 doctors and 333,494 nurses will be
available. This implies a shortage of about 50,120 doctors and 137,859 nurses. This translates to 33.45%
gap in doctors’ supply and 29.25% gap in nurses’ supply. This figure is very far away from what is
obtainable in some Organization for Economic Co-operation and Development (OECD) countries according
to a study by Ono et al. [27].
Australia will have estimated gap of 2,701 doctors and 109,490 nurses by 2025 will have all Physicians
deficit eradicated by 2014 and by 2030 there will be surplus and Japan will have a nurse surplus of about
14,000 by 2015. Compared to these examples, the supply gap of Nigeria would be cumulatively enormous
if nothing is done.
A look at the trend in deficit shows a progressive trend with physician deficit increasing from 30.86 percent
in 2016 to 33.45 percent in 2030. Similarly Nurses deficit rose from 26.09 percent in 2016 to 29.25 percent
in 2030. With this trend if no conscious effort is made to reverse deficit, by 2030 the countries health
indices will be much worse than it is now.
Although we did not study the adequacy across the states in Nigeria, this may be necessary because
imbalance is an issue too in Nigeria particularly across the states [9, 28].
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6. 14
The study provides empirical evidence to support decision to be trained, sustained and retrained of health
workforce in Nigeria. It would help advocacy for increase investment in pre-service training (intake and
output), increase investment in training (intake and output), extension of retirement ages and possibly
recruit from abroad to help bridge the gap. It helps address national inequality derived from non-availability
of health workforce. WHO have consistently been using health workforce density to compare health work
force adequacy.
The World Health Report 2006 calls for action on a wide range of human resources issues, including higher
training output, better employment practices and the management of migration. It states that there are three
main factors at work; the number of health workers, the distribution of health workers and wider policies.
This study showed that similar demand would not change 2016-2030 if the present growth rate of available
health force continues.
Based on accredited training space for doctors (2012) by the regulatory body of 2,725 the expected
provision of doctors should be more than that figure [29]. This figure is less than the additional stock of
doctors that would be needed in any year 2016-2030. It is also observed that effort would need to be made
to keep adding to stock. As much as 4081 new doctors would be needed to cater for population growth
comparing to the preceding year. These findings further reiterate the need for more training facilities and up
scaling the present ones.
The inadequacy of medical doctors, nurse& midwives across Nigeria 2016-2030 is not likely to change and
this would most likely affect the health indicators over the same period since health work force play a
critical role in strengthening health system of any country.
RECOMMENDATIONS
Nigeria needs a well-coordinated health system reform policy if she is to meet minimally standard health.
The reform policy should be robust enough to include restructuring in pattern of admission into tertiary
institutions. This scenario whereby candidates’ get admission into various academic courses is not in any
way linked to demands of the society should cease. We recommend a central human resource planning body
which among other things will program a continuous increase in number of health care workers through
careful coordination and prediction of number of medical graduates.
The regulatory bodies should make more efforts to keep accurate records of their members, in the form of
actively practicing, travelled abroad, demised, incapacitated, retired and out of practice. This will help in
determining the exit rate of Nigerian health workers.
Also the health information system should be strengthened.
STRENGTHS AND WEAKNESSES OF THE STUDY
The figures are not corrected for possible migration however it is expected that the policy thrust of active
recruitment of health workforce from developing countries as spearheaded by UK National Health Services
may decrease the threat to manpower stock of nations like Nigeria. Although historical fraction lost to
migration is 14% [30].
LIMITATIONS
The study did not put into consideration absorptive capacity of the country health system rather it is
anticipated that the system would be scaled up to absorb this manpower requirement. Furthermore there are
no data of health professional specific death rate and other specific data that would help determine
professional stock growth rate. Population figure extrapolation was based on a single census figure
conducted in 2006. It is assumed that the Nigerian population changes year by year is progressing
constantly. These are also dearth of statistics on birth, death and migration rate to reveal the true and exact
changes in Nigerian and health workforce populations.
The study did not take into account gap in different categorises of doctors and regional variation was not
considered. The study made an assumption that no human or natural event which could interfere with
population growth will occur in this period of study. All projections were made with geometric method
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7. 15
which may exaggerate errors in population size over the years. Inflow rate and Exit rate was not calculated
because no reliable data on ground to serve as the basic for further projection.
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