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Overview:
Why is the integration of family planning (FP) and HIV/AIDS services important and how does it relate to the right to health?
What models of service integration are currently being implemented in Kenya?
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Why is the integration of family planning (FP) and HIV/AIDS services important and how does it relate to the right to health?
What models of service integration are currently being implemented in Kenya?
What are the successes, outcomes and lessons learned from clients and providers in Kenya?
What can you do to advocate for the integration of FP and HIV/AIDS services and halt the feminization of AIDS?
Disclaimer: While this presentation focuses specifically on the integration of family planning services and HIV/AIDS testing and counseling services, it is important to note that this is just one example that falls within a more comprehensive approach to service integration. To address the AIDS epidemic, health systems must integrate HIV/AIDS services for prevention, care and treatment with non-HIV services such as primary care, maternal and child health, and reproductive health services, including family planning. Additionally, HIV/AIDS services should be connected to social and community-based services that address underlying determinants for health such as poverty, unemployment and legal inequalities.
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Matabeleland South. The study was premised on the Health Belief Model (HBM) formulated by Hochbaum,
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HBM has 3 main components, namely individual factors, modifying factors and likelihood of action. They infer
that, an individual’s attitude determines how she/he engages in certain behaviour. Conducted over 21 days, the
study employed both qualitative and quantitative methodologies. The quantitative aspects included
questionnaires that were administered to women of child-bearing age and adolescent girls, whilst the
qualitative aspect involved secondary data review, facility assessment and focus group discussions. Purposive
and random sampling techniques were used to identify the ideal participants for the survey. The key findings
were that; Safe Motherhood was and is dependent on a lot of issues, some of which are, policies and systems,
resources (financial, material and human), community/departmental structures, infrastructure and mostly the
demography of the community including their attitudes, perceptions and beliefs. The study recommends removal
of barriers to access to health through: Resuscitation of the country’s strategy of having a health facility at
every 10 kilometre radius; Regular mobile clinics especially for reproductive health services and baby clinics to
resettlement areas that were pegged far from services; Resourcing of existing health facilities in terms of
human, material and financial resources and most of all; Change of policies, perceptions and practises that
hinder access to reproductive health services and attainment of basic health rights
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Health workforce Statistics: Current Needs and Requirements
Introduction
Trained healthcare workforce is an important determinant of efficiency and outcomes of any health system as devised by WHO health systems approach. India one of the most populous country of the world has always felt a dire need of healthcare workforce even having one of the largest medical education and capacity building system. On the other hand we have a variety of health cadre namely from an ASHA to super specialized doctors. In our presentation we have critically analyzed the distribution of health workforce in India and its impacts on health and healthcare delivery for the mass of our society.
The Health Workforce in Nutshell
India faces an acute shortage of trained health workforce. India has a large basket of interventions to improve the healthcare but they are adversely effected by shortage of trained, motivated and supported health workforce. The shortages and misdistribution of health workforce have a large contribution to inequities in health outcomes. India’s health workforce is a combination of both registered, formal health-care providers and informal medical practitioners. We have a very unique health system with a large public health system and a blanket of juxtaposed private health care system. Similar situation is also present in training and education of health workforce. There is also a lack of data on the exact number of health care providers.
Issues
Quite a percentage of Indian population is spread in the rural areas but on the other hand the concentration of health care is in the urban system. The health care providers are highly concentrated in the urban area. Health worker densities are very low in rural settings when compared with urban areas. The next issue is lack of support to the health care providers practicing in the rural area and attraction of high income, support and provisions in the urban settings for the highly specialized workforce which includes doctors, dentist etc. At the national level, the aggregate density of doctors, nurses and midwives was 2.08 per 1000 population, which was lower than WHO’s critical shortage threshold of 2.28 .
Conclusion
In a concluding remark the production of health workforce has increased too many folds which has cost increased privatization of health education. On the other hand the public medical education system has not expanded at the required level. There is need to tap the potential in the private players with keep in mind stringent control of quality and cost. The increase in production is not going to resolve the issues of health worker availability and distribution. The need of the hour is to find sustainable measures to target the acute shortfall in the trained health workforce in India.
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Challenges of Universal Health provision
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Edward Salsberg, Professor, George Washington University School of Public Health and Health Services
The moderator:
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This event took place on May 6, 2014 from 7:30-9:30 a.m. in the Pegasus Ballroom of The Magnolia Hotel Dallas, 1401 Commerce St., Dallas, TX 75202
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HPM 350 presentation_6 (1)
1. THE CURRENT AND FUTURE ADEQUACY OF
THE PUBLIC HEALTH NURSING WORKFORCE
M. BANE, A. BERNARD, E. LEE, M. HREZI & V. SIMPSON 13TH NOVEMBER, 2014
NORTHEASTERN NORTH CAROLINA PARTNERSHIP FOR PUBLIC HEALTH
2. PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
3. PRESENTATION AGENDA
• Public Health Nursing defined
• Comparison of Public Health and Non-Public Health Nursing
What is Public Health Nursing?
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
4. PUBLIC HEALTH NURSING DEFINED
Source 1: Characterization of the Public Health Nurse Workforce, Robert Wood
Johnson Foundation. (2013, June 26). http://www.rwjf.org/en/research-
publications/find-rwjf-research/2013/06/enumeration-and-characterization-of-
the-public-health-nurse-work.html
Public Health Nursing is the practice of promoting and protecting
the health of populations in addition to providing clinical services.
Public health nurses comprise 25% of the national public health
workforce, making them the largest branch.
WHAT IS PUBLIC HEALTH NURSING?
5. THE ROLE OF PUBLIC HEALTH NURSES VS. NON-PUBLIC HEALTH NURSES
Non-Public Health Nurses Public Health Nurses
Goal Direct patient care
Health education, prevention efforts, in
addition to patient care
Primary Audience Individuals Populations
Setting of Work Hospitals and health clinics
Schools, community and senior centers,
health departments
Examples
Observe, assess, and record
symptoms, reactions, and progress,
which provides the basis for care
planning and intervention
Design and implement health education
campaigns and disease prevention
activities, including:
• Immunization programs
• STD screenings and basic treatment
• Educating communities and schools
on nutrition and healthy lifestyles
Source 2: Public Health Nursing. NC Public Health Careers,
http://www.ncpublichealthcareers.com/images/Nursing.pdf
WHAT IS PUBLIC HEALTH NURSING?
6. PRESENTATION AGENDA
What is Public Health Nursing?
• National
• North Carolina
• Northeast North Carolina
• Demand
• Supply
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
7. NATIONAL SHORTAGE OF PUBLIC HEALTH NURSES
219 public
health
nurses per
100,000
people
1980
158 public
health
nurses per
100,000
people
2000
27 state
health
departments
anticipate
severe
shortage
2013
Source:. Robert Wood Johnson Foundation. Enumeration and Characterization
of the Public Health Nurse Workforce. (2013).
Source: U.S. Department of Health and Human Services Human Resources and
Service Administration Bureau of Health Professionals. NCHWA’s Nursing
Workforce Research Activities and Findings. (2013).
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
8. NORTH CAROLINA PUBLIC HEALTH WORKFORCE
Source: North Carolina Association of Local Health Directors Public Health Task Force. (2013).
Public health nurses are:
• the primary deliverers of
clinical care in the local
public health workforce;
• the first responders in
times of emergencies.
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
9. NORTHEASTERN NORTH CAROLINA
The Northeastern North Carolina Partnership for Public Health. Health in Northeastern
North Carolina: Regional Assessment of a 15-County Region. (2012).
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
10. NORTHEASTERN NORTH CAROLINA: INCREASING DEMAND
Health Risk Factors
HIV/ AIDS rate in
Northeastern NC is
75% higher than NC
Above average obesity
rate in every county in
Northeastern NC
Age
38.3% Age 50+
16.2% Age 65+
Access
Rural location
19.8% Uninsured
(2014)
“When the need for public health increases, a need for Public Health Nursing
increases”
- Susan Little, Nurse Consultant for Department of Human and Health Services
Demand for public health nurses is linked to population factors such as:
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
The Northeastern North Carolina Partnership for Public Health. Health in Northeastern
North Carolina: Regional Assessment of a 15-County Region. (2012).
11. NORTHEASTERN NORTH CAROLINA: FALLING SUPPLY
http://www.shepscenter.unc.edu/hp/longitudinal.htm
http://www.census.gov/popest/data/historical/index.html
The supply of public health nurses is declining:
General
nursing
shortage
Fewer nurses in
Northeastern
NC vs NC
Slow and unsteady
growth of supply
in Northeastern
NC
Nurses not
entering the
public health
workforce
0
100
200
300
400
500
600
700
800
900
1,000
Resistered Nurses per 100,000 (2000-2010)
North Carolina
NE North Carolina
0
5
10
15
20
25
30
35
40
45
2000 2002 2004 2006 2008 2010
Nurse Practitioners per 100,000 (2000-2010)
North Carolina
NE North Carolina
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
12. PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing
• Aging workforce
• Lack of financial resources
• Education requirements
• Exposure to public health settings
• Regional factors
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
14. AGING WORKFORCE
Retiring faster than hiring
40% of workforce age 50+
Shortage will worsen over next
decade as baby boomers retire
Age Distribution of Public Health Registered Nurses in
2000 compared to 2012
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
2000
2010
15. CHALLENGE: LACK OF FINANCIAL RESOURCES
Public Health
Nurse (Local-level)
Non-Public Health
Nurse
Difference
Nurse Practitioner 70,160 96,460 37%
Registered Nurse 49,246 65,470 33%
http://www.bls.gov/ooh/healthcare/registered-nurses.htm
http://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-
practitioners.htm
http://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf406659
http://healthyamericans.org/states/?stateid=NC#section=3,year=2014,code=undefined
http://healthyamericans.org/assets/files/TFAH2013InvstgAmrcsHlth05%20FINAL.pdf
Median Salary ($) for Nurse Positions (2013)
Severe lack of financial resources for public health programs
North Carolina health funding per capita (2012-13 FY): $12.51
Ranked 47th nationwide
Cannot afford to compete with non-public health employers
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
16. CHANGING EDUCATION REQUIREMENTS
There are not enough students graduating from Bachelor nursing programs
In Northeastern NC, most public health nurses have Associate degrees (2 years)
Shift in requirements towards Bachelor prepared nurses (4 years)
• Registered Nurse or nursing degree with enhanced
trainingRequirement
Source ###: North Carolina Association of Local Health Directors Public Health Task Force. (2013, June). A Blueprint of the Future for
Local Public Health Departments in North Carolina: 2013 Statewide Public Health Incubator Summary Report and Recommendations.
Source ###:Zahner, S. J., & Henriques, J. B. (2013). Interest in Public Health Careers Among Undergraduate Student Nurses. Journal of
Public Health Management and Practice,19(1), 62-69
Source ###: The Quad Council of Public Health Nursing Organizations (November 2006) The Public Health Nursing Shortage: A Threat
to the Public’s Health
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
17. EXPOSURE TO PUBLIC HEALTH SETTINGS
The only experience that increases interest in Public Health Nursing is
having community health exposure prior to graduation
Many nursing programs in Northeastern NC do not incorporate community
health engagement and experiential learning
Students in community colleges do not have community health rotation
Less awareness and interest
Unprepared upon graduation
• Experience in school, local health department or
community centerRequirement
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
Please cite UWM (2013)
18. UNATTRACTIVE WORK ENVIRONMENT
It is difficult to recruit and retain nurses to rural communities
Small, non-diverse population
Few amenities
Restaurants, movie theaters, arts
Few social events
Worn-out facilities
Source ###: (personal communication, September 24, 2014)
Source ###: Dingley J. and Yoder L. (2013). The public health nursing work environment: review of the research literature. Journal of
Public Health Management and Practice. 19(4) 308-321. doi: 10.1097/PHH.0b013e31825ceadc
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
19. RECRUITMENT AND RETENTION
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
RECRUITMENT RETENTION
• Education
requirements
• Exposure to
public health
settings
• Lack of
financial
resources
• Unattractive
work
environment
• Aging,
retiring
workforce
20. PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing
Challenges to Maintaining an Adequate Workforce
• Poor emergency preparedness
• Heavy burden on vulnerable population
• Reduced preventative care and health promotion
Consequences of an Inadequate Workforce
21. DECREASED PREVENTATIVE CARE AND HEALTH EDUCATION
Public Health
Nurse Roles
• Health planning
• Home health
visits
• Vaccinations
• Sexual &
Reproductive
Health Education
Affected
Populations
• Low income
• First-time
mothers
• Youth
Example: Nurse
Family Partnership
• In home
consultations
• Encourages father
participation
Outcomes of Nurse
Family Partnership
• 46% increase in
father’s presence
in household
• 79% reduction in
pre-term delivery
for women who
smoke
Decrease preventative care Increase demand of health care services
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
22. LACK OF EMERGENCY PREPARATION
Public Health Nurse
Roles
• Assess community
needs
• Operate command
center
Affected Populations
• Everyone within an
afflicted area
during a disaster
• Vulnerable
populations
Hertford County
Department of Social
Services
• Staff shelters at
local high schools in
cases of emergency
Consequence
• Poor response in
times of crisis
• Increased wait time
for medical
treatment
• Insufficient staff to
distribute supplies
• Limited facility
capacity
Lack of emergency preparation Negative impact on population health
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
23. HEAVY BURDEN ON VULNERABLE POPULATION
Public Health Nurse
Roles
• STD management,
including screening
and treatments
• Vaccinations
• Acute condition
treatment
• Physicals
Affected Populations
• Uninsured and
Medicaid patients
Enhanced Nursing
Program
• Advanced training
program
• Funded by local
health department
• Equips nurses with
skills needed for
physical
assessments and
disease treatment
Outcomes of
Enhanced Nursing
Program
• Increased access to
care for vulnerable
populations
• Better prevention
of and care for
infectious diseases
• Decreased burden
on clinicians and
emergency
departments
Few Public Health Nursing services Heavy health and financial burden on vulnerable populations
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
24. SUMMARY
• The practice of promoting and protecting the health of populations in addition to providing
clinical services
What is Public Health Nursing?
• Increasing in demand and decreasing in supply in Northeastern North Carolina
Current Adequacy of Public Health Nursing Workforce
• Aging workforce
• Lack of financial resources
• Changing education requirements
• Lack of exposure to public health settings
• Unattractive work environment
Challenges to Maintaining an Adequate Workforce
• Lack of emergency preparation
• Heavy burden on vulnerable populations
• Reduced preventative care and education
Consequences of an Inadequate Workforce
25. ACKNOWLEDGEMENTS
Susan Little
Nurse Consultant for the NC Department of Health and Health and Human Services
Diane McLawhorn
Director of Nursing, Hertford County
Julie Tunney
Coordinator of the Northeastern North Carolina Partnership for Public Health
Melanie Studer
Program Director, Course Instructor
26. REFERENCES
1. Robert Wood Johnson Foundation. (2013, June 26). Characterization of the
Public Health Nurse Workforce. Retrieved from
http://www.rwjf.org/en/research-publications/find-rwjf-
research/2013/06/enumeration-and-characterization-of-the-public-health-
nurse-work.html
2. Public Health Nursing. NC Public Health Careers. Retrieved September 30,
2014, from http://www.ncpublichealthcareers.com/images/Nursing.pdf
3. Boulton, M., & Beck, A. (2013). Enumeration and Characterization of the
Public Health Nurse Workforce. Robert Wood Johnson Foundation, 63-63.
Retrieved October 5, 2014
4. Nooney, J. (2013, May). NCHWA’s Nursing Workforce Research Activities and
Findings. U.S. Department of Health and Human Services Human Resources
and Service Administration Bureau of Health Professionals, 1-30
5. The Northeastern North Carolina Partnership for Public Health. (2012).
Health in Northeastern North Carolina: Regional Assessment of a 15-County
Region, 1-94.
Editor's Notes
The last barrier we will address today is the work and living environment in North Eastern North Carolina. Julie Tunney, the coordinator at NENCPPH, stated one reason why there are not enough nursing students going into Public Health Nursing in rural areas is because there is a lack of attraction (personal communication, September 24, 2014). She mentioned that in the town where she works, there is only one restaurant. Imagine being a college student, as you all are, having access to many social and entertainment events nearby, and then moving to a town with one restaurant and 5000 people. This barrier is exacerbated by the fact that they have fewer financial resources to attract workers in the first place.
Studies have supported this fact and found that the work environment significantly influences nurse retention and recruitment rates 29. This includes the establishment, so the fancy new building where Leah works versus an old clinic, and also the geographic job location.
Muad will now talk about the consequences of this problem.
