医改前后乡镇卫生院资源配置与利用情况比较分析

为进一步了解医改给山东省乡镇卫生院带来的变化,通过对医改前后山东省乡镇卫生院的机构设置、人力资源、物力资源、财力资源和业务量情况等进行比较分析发现,医改后山东省乡镇卫生院布局更加合理,服务数量有所增加,服务效率得到提高,但乡镇卫生院卫生人力数量和质量仍有待增加和提高,农村居民就医流向不合理现象仍较为严重.建议通过进一步整合农村地区卫生资源,增加农村地区卫生人力数量,提高卫生人力质量,以提高乡镇卫生院资源利用效率,扭转农村居民就医流向不合理的现象.     

Is Health Insurance Enough? A Usual Source of Care may be More Important to Ensure a Child Receives Preventive Health Counseling

Despite the promise of expanded health insurance coverage for children in the United States, a usual source of care (USC) may have a bigger impact on a child’s receipt of preventive health counseling. We examined the effects of insurance versus USC on receipt of education and counseling regarding prevention of childhood injuries and disease. We conducted secondary analyses of 2002–2006 data from a nationally-representative sample of child participants (≤17 years) in the Medical Expenditure Panel Survey (n = 49,947). Children with both insurance and a USC had the lowest rates of missed counseling, and children with neither one had the highest rates. Children with only insurance were more likely than those with only a USC to have never received preventive health counseling from a health care provider regarding healthy eating (aRR 1.21, 95% CI 1.12–1.31); regular exercise (aRR 1.06, 95% CI 1.01–1.12), use of car safety devices (aRR 1.10, 95% CI 1.03–1.17), use of bicycle helmets (aRR 1.11, 95% CI 1.05–1.18), and risks of second hand smoke exposure (aRR 1.12, 95% CI 1.04–1.20). A USC may play an equally or more important role than insurance in improving access to health education and counseling for children. To better meet preventive counseling needs of children, a robust primary care workforce and improved delivery of care in medical homes must accompany expansions in insurance coverage.     

Human resources for health planning and management in the Eastern Mediterranean region: facts, gaps and forward thinking for research and policy

Background  

The early decades of the 21^st century are considered to be the era of human resources for health (HRH). The World Health Report (WHR) 2006 launched the Health Workforce Decade (2006–2015), with high priority given for countries to develop effective workforce policies and strategies. In many countries in the Eastern Mediterranean Region (EMR), particularly those classified as Low and Low-Middle Income Countries (LMICs), the limited knowledge about the nature, scope, composition and needs of HRH is hindering health sector reform. This highlights an urgent need to understand the current reality of HRH in several EMR countries.     

The health-related quality of life of children and adolescents in home-based foster care

Objective To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6–17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6–17 years living in the community in Australia. Method In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13–17 year olds. Results Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL. Conclusion The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care. All results of the analyses discussed in this paper are available upon request.     

Health workforce development planning in the Sultanate of Oman: a case study

Introduction  

Oman's recent experience in health workforce development may be viewed against the backdrop of the situation just three or four decades ago, when it had just a few physicians and nurses (mostly expatriate). All workforce categories in Oman have grown substantially over the last two decades. Increased self-reliance was achieved despite substantial growth in workforce stocks. Stocks of physicians and nurses grew significantly during 1985–2007. This development was the outcome of well-considered national policies and plans. This case outlines how Oman is continuing to turn around its excessive dependence on expatriate workforce through strategic workforce development planning.     

Behavioral Health Problems as Barriers to Work: Results from a 6-year Panel Study of Welfare Recipients

Over the course of welfare reform, behavioral health problems have emerged as significant issues. Welfare time limits have added urgency to recipients’ efforts to obtain economic self-sufficiency and have raised new concerns about mental health and substance abuse problems as barriers to work. However, there is limited research on how behavioral health problems operate to impede the employability of welfare recipients. This analysis draws on data from a 6-year panel study of welfare recipients (n = 341) to examine how a broad spectrum of mental health and substance abuse problems impact efforts to obtain work while on aid and subsequent transitions from welfare to work. Recipients who reported symptoms of depression at baseline were less likely to actively search for work while on aid compared to others. However, they were no less likely to leave welfare for work within a 2-year time frame. In contrast, other problems – including hostility, interpersonal sensitivity, psychoticism, and heavy drug use – had significant effects on work exits from welfare but little association with job search activities. Overall, these results suggest that behavioral health problems do not operate in the same manner to inhibit transitions from welfare to work. Welfare-to-work programs should direct interventions towards the unique constellations of problems that recipients face. This study was made possible by grants from the U.S. National Institutes on Health, National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group, Public Health Institute, including: Center Grant (AA-05595), R01 Project Grant (AA-10015), and R21 Grant for Secondary Analysis of Existing Health Services Data (AA-12159). A previous version of this paper was presented at the National Institutes of Health, “Complexities of Co-Occurring Conditions,” Washington DC, June 23–25, 2004.     

Occupational health needs in small industry in New Zealand: preferred sources of information

An audit of occupational health needs assessment and serviceutilization was carried out in a survey of small industry. Fifteenper cent of the workforce considered that working conditionswere poor, and 8 per cent considered that their health had beenaffected by work. The proportions were highest in manual workers,rising to 31 per cent and 18 per cent respectively. Thirty-eightper cent of the workforce had needed occupational health informationor advice in the past, particularly amongst manual workers (53per cent). The ‘boss’ was the commonest source ofinformation, followed by the general practitioner. These findingshave important implications for planners of occupational healthservices who need to ensure that these two groups have accessto high quality information. Fifty-nine per cent of those whohad needed information had not actually sought and obtainedit. This suggests that information needs are not being met.Information which was received, however, generally met the requester'sneed.     

Tracking and monitoring the health workforce: a new human resources information system (HRIS) in Uganda

Background  

Health workforce planning is important in ensuring that the recruitment, training and deployment of health workers are conducted in the most efficient way possible. However, in many developing countries, human resources for health data are limited, inconsistent, out-dated, or unavailable. Consequently, policy-makers are unable to use reliable data to make informed decisions about the health workforce. Computerized human resources information systems (HRIS) enable countries to collect, maintain, and analyze health workforce data.     

常州市卫生人力资源配置现状及发展对策

目的调查了解常州市卫生人力资源配置存在的问题，以提出相应对策。方法分析卫生人力的数量和专业、年龄、学历、职称构成，以及近10年卫生人力资源及利用效率的动态变化。结果卫生人力总量充足，城乡差别不大，专业分布不平衡，年龄呈中青年化，结构不尽合理，农村卫生人力素质及利用率较低。结论合理规划卫生人力资源，使各专业协调发展，加强高层次人才培养，进行城乡合理资源调整。     

Addressing the health workforce crisis: towards a common approach

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents – and invites comments on – a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level.     

Health workforce policy and Turkey's health care reform

The health care industry is labor intensive and depends on well-trained and appropriately deployed health professionals to deliver services. This article examines the health workforce challenges in the context of Turkey's recent health reform initiative, Health Transformation Program (HTP). Reformers identified shortages, imbalances in the skills-mix, and inequities in the geographical distribution of health professionals as among the major problems. A comprehensive set of policies was implemented within the HTP framework to address these problems. The article argues that these policies addressed some of the health workforce challenges, while on the other hand exacerbating others and hence may have resulted in increasing the burden on the workforce. So far HTP's governance reforms and health human resource policy have not encouraged meaningful participation of other key stakeholders in the governance of the health care system. Without effective participation of health professionals, the next stages of HTP implementation that focus on managerial reforms such as restructuring public hospitals, improving the primary care system and implementing new initiatives on quality improvement could be very difficult.     

Deteriorating health status in Stockholm 1998–2002: results from repeated population surveys using the EQ-5D

Rationale, aim and methodology In order to measure the change in health status in Sweden, the generic health-related quality of life instrument, the EQ-5D, was included in the 1998 (n = 4,950) and 2002 (n = 49,914) cross-sectional postal Public Health Surveys, a representative sample (21–84 years) of the Stockholm County population, with response rates about 63% in both years. The EQ-5D provides data on five dimensions of health as well as an overall index value (1 = full health; 0 = dead). Results Over time the health index decreased statistically significantly from 0.858 to 0.841 for men and from 0.833 to 0.797 for women. Women had significantly more health problems in 2002 in four out of the five dimensions, with the largest increase in the dimensions anxiety/depression (33–43%) and pain/discomfort (47–53%). The health index was significantly lower in all age-groups for women. Men had significantly more health problems 2002 in two dimensions, and the largest increase in anxiety/depression (24–31%). The health index decreased significantly over time for younger men. Conclusion The observed deterioration in health status over time gives reason for concern. Investigation of reasons for the declining health status should be a research priority. The 1998 and 2002 Public Health Surveys in Stockholm County     

The African Health Profession Regulatory Collaborative for Nurses and Midwives

Background

More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives.

Discussion

The African Health Profession Regulatory Collaborative for Nurses and Midwives convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa. It provides a high profile, south-to-south collaboration to assist countries in implementing joint approaches to problems affecting the health workforce. Implemented in partnership with Emory University, the Commonwealth Secretariat, and the East, Central and Southern African College of Nursing, this initiative also supports four to five countries per year in implementing locally-designed regulation improvement projects. Over time, the African Health Regulatory Collaborative for Nurses and Midwives will help to increase the regulatory capacity of health professional organizations and ultimately improve regulation and professional standards in this region of Africa. The African Health Regulatory Collaborative for Nurses and Midwives will measure the progress of country projects and conduct an annual evaluation of the initiative??s regional impact, thereby contributing to the global evidence base of health workforce interventions.

Conclusion

The African Health Regulatory Collaborative for Nurses and Midwives is designed to address priority needs in health workforce development and improve regulation of the health workforce. This model may assist others countries and regions facing similar workforce challenges.     

Quality of life domains in the healthy public: A trial investigation using attendants for an annual health checkup

A trial investigation of subjects gathered for annual health checkups was performed to detect domains of quality of life in the healthy public, and to explore the changes of their demographic characteristics for the possibility of engaging them in health service activities in the community. The eligible 1,096 subjects aged 30–79 years were investigated. The period of this survey was from September to December, 1997. The subjects were questioned using ten quality of life domains which were preliminarily prepared and had been assumed to be most important in the subjects’ lives in relation to the order of priority, importance, and satisfaction levels. The first most important domain in both the male and female subjects’ lives was personal health, followed by relationships with family, though the mean importance scores for their personal health and relationships with family were almost equivalent. The mean scores for work abruptly decreased in males over 60 years of age. Also, the first large and the second relatively small principal components were extracted through principal components analysis. The proposed ten domains of quality of life are most likely valid and reliable in terms of the results analyzed and the comparison with a referred study. Relationships with family is an effective cue for health service activities in the community, and the significance of work on quality of life in the healthy public will have to be taken into account separately, especially in males.     

National Disparities in the Quality of a Medical Home for Children

Objectives To examine socio-demographic disparities associated with a quality medical home. Methods A nationally representative sample of children ages 0–17 years (n = 102,353) from the 2003 National Survey of Children’s Health. Risk factors including non-white race/ethnicity, income <200% of the federal poverty level (FPL), uninsured, parent education lesser than high school, and non-English primary household language, were examined in relation to a quality medical home separately and together as a “profile” of risk. Fourteen questions were used to measure five medical home features: access, continuity, comprehensiveness, family-centered care, and coordination. Quality was defined as a value greater than median for each feature and for an overall score. Results Before and after adjustment for child demographics and health status, all studied risk factors were associated with poorer quality medical home features. Uninsured [odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.40–0.47] and low-income children (OR = 0.65, CI: 0.62–0.69) had among the lowest odds of a quality medical home overall and across most features, except coordination that showed an opposite trend. Summarized through risk profiles, children experiencing all five risk factors had 93% lower odds of a quality medical home overall (OR = 0.07, CI: 0.04–0.25) compared to zero risk children. Conclusion This study demonstrates large national disparities in the quality of a medical home for children. That disparities were most prevalent for the uninsured and those in or near poverty, both modifiable risk factors, suggests that reforms to increase coverage and to lift families out of poverty are essential to assuring that children have access to the full complement of appropriate health care services including a quality medical home.     

潍坊市坊子区城乡卫生机构一体化实践探索

为统筹城乡卫生事业发展,整合卫生资源,尽快提高农村基层卫生服务水平,保证基本医疗卫生服务的均等化,潍坊市坊子区开展了城乡卫生机构一体化管理改革。通过实施城乡卫生机构一体化改革,城乡卫生资源配置趋于合理,居民就医经济负担降低。     

An evaluation of stress education in the Royal Navy

Background Psychoeducational programmes aim to reduce the morbidityassociated with exposure to stressful events. Although theyare widely used, there are conflicting views as to how or whythey might be effective. Aim To examine exposure to ‘stress’ education withinthe Royal Navy (RN) and ascertain any links between stress educationand mental health status. Methods In all, 1559 RN personnel were surveyed using a studyquestionnaire which asked about exposure to and quality of anystress education provided during service. Participants alsocompleted two measures of psychological health, the GeneralHealth Questionnaire (GHQ)-12 item and the Post-Traumatic StressDisorder Checklist. Odds ratios (ORs) were calculated and 95%confidence intervals were computed using multivariable logisticregression adjusting for socio-demographic variables. Results The response rate was 70%; 47% of the sample reportedhaving received a stress brief during service. Those who reportedhaving received a brief had better general mental health (measuredby the GHQ) than those who had not [adjusted, OR = 0.76 (0.59–0.98)].When brief quality was taken into account, only those who receiveda brief and considered it ‘useful’ were significantlyless distressed [adjusted, OR = 0.65 (0.49–0.86)]. Poor-qualitybriefs were no better than having had no brief at all [adjusted,OR = 1.04 (0.74–1.47)]. Conclusions Our data indicate that only educational stress briefswhich are relevant for the target audience may be beneficial.Simply providing stress briefings, without thought to theirquality, may constitute a waste of resources.     

High-quality healthcare workplaces: a vision and action plan

Looking into a future marked by intense competition for talent, growing numbers of employers are striving to create "workplaces of choice." Yet, despite the consensus that health human resources are a vital piece of the healthcare reform puzzle, few health service organizations have developed comprehensive strategies to address work environment issues. The cumulative impact of years of cost-cutting, downsizing and restructuring have left Canada's healthcare workforce demoralized, overworked and coping with working conditions that diminish both the quality of working life and organizational performance.     

A cross-country review of strategies of the German development cooperation to strengthen human resources

Background  

Recent years have seen growing awareness of the importance of human resources for health in health systems and with it an intensifying of the international and national policies in place to steer a response. This paper looks at how governments and donors in five countries – Cameroon, Indonesia, Malawi, Rwanda and Tanzania – have translated such policies into action. More detailed information with regard to initiatives of German development cooperation brings additional depth to the range and entry doors of human resources for health initiatives from the perspective of donor cooperation.