The Place of Human Resource Management in Lagos State Healthcare Delivery: A Statistical Overview

Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State;numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.

Applying the workload indicators of staffing needs method in determining frontline health workforce staffing for primary level facilities in Rivers state Nigeria

Background:Nigeria faces health workforce challenges and poor population health indices resulting from disparities in health worker densities by geographical locations and levels of health care delivery.Nigeria is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs.The majority of primary health facilities in the country are staffed using perceived needs.The Workload Indicators of Staffing Need(WISN)tool developed by the World Health Organization is used to determine staffing requirements for facilities.Methods:The WISN tool was used in assessing the staffing requirements for nurses/midwives and community health practitioners in 26 primary health facilities in Port Harcourt City Local Government Area(PHALGA)and Obio Akpor Local Government Area(OBALGA).Documents were reviewed to obtain information on working conditions and staffing,and interviews conducted with key informants in 12 randomly selected facilities.We supported an expert working group that comprised of nurses/midwives and community health practitioners to identify workload components and activity standards and validate both.We also retrieved workload data from January 1-December 31,2015 from the national district health information system.Results:Findings showed varying degrees of shortages and inequitable distribution of health workers.Health facilities in PHALGA had a WISN ratio of 0.63 and a shortage of 31 nurses/midwives.There was also a shortage of 12 community health practitioners with a WISN ratio of 0.85.OBALGA had a shortage of 50 nurses/midwives and 24 community health practitioners;and WISN ratios of 0.60 and 0.79 for nurses/midwives and community health practitioners respectively.Conclusion:Our findings provide evidence for policies that will help Nigeria improve the population’s access to quality health services and reduce inequities in distribution of the health workforce.Evidence-based health workforce planning and redistribution using WISN should be institutionalized.Review of scopes of practice of health workforce should be conducted periodically to ensure that the scope of practice matches the training received by the specific cadres and those skills are used to deliver quality services.

Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.

The midwives service scheme:a qualitative comparison of contextual determinants of the performance of two states in central Nigeria

Background:The federal government of Nigeria started the Midwives Service Scheme in 2009 to address the scarcity of skilled health workers in rural communities by temporarily redistributing midwives from urban to rural communities.The scheme was designed as a collaboration among federal,state and local governments.Six years on,this study examines the contextual factors that account for the differences in performance of the scheme in Benue and Kogi,two contiguous states in central Nigeria.Methods:We obtained qualitative data through 14 in-depth interviews and 2 focus group discussions:14 government officials at the federal,state and local government levels were interviewed to explore their perceptions on the design,implementation and sustainability of the Midwives Service Scheme.In addition,mothers in rural communities participated in 2 focus group discussions(one in each state)to elicit their views on Midwives Service Scheme services.The qualitative data were analysed for themes.Results:The inability of the federal government to substantially influence the health care agenda of sub-national governments was a significant impediment to the achievement of the objectives of the Midwives Service Scheme.Participants identified differences in government prioritisation of primary health care between Benue and Kogi as relevant to maternal and child health outcomes in those states:Kogi was far more supportive of the Midwives Service Scheme and primary health care more broadly.High user fees in Benue was a significant barrier to the uptake of available maternal and child health services.Conclusion:Differential levels of political support and prioritisation,alongside financial barriers,contribute substantially to the uptake of maternal and child health services.For collaborative health sector strategies to gain sufficient traction,where federating units determine their health care priorities,they must be accompanied by strong and enforceable commitment by sub-national governments.

Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in China in 2014

Background To quantify the associations between the under-five mortality rate(U5MR)and measures of pediatric human resources,including pediatricians per thousand children(PPTC)and the geographical distribution of pediatricians.Methods We analyzed data from a national survey in 2015-2016 in 2636 counties,accounting for 31 mainland provinces of China.We evaluated the associations between measures of pediatric human resources and the risk of a high U5MR(>18 deaths per 1000 live births)using logistic regression and restricted cubic spline regression models with adjustments for potential confounders.PPTC and pediatricians per 10,000 km^(2) were categorized into quartiles.The highest quartiles were used as reference.Results The median values of PPTC and pediatricians per 10,000 km^(2) were 0.35(0.20-0.70)and 150(50-500),respectively.Compared to the counties with the highest PPTC(≥0.7),those with the lowest PPTC(<0.2)had a 52% higher risk of a high U5MR,with an L-shaped relationship.An inverted J-shaped relationship was found that the risk of a high U5MR was 3.74[95%confidence interval(CI)2.55-5.48],3.07(95% CI 2.11-4.47),and 2.25 times(95% CI 1.52-3.31)higher in counties with<50,50-149,and 150-499 pediatricians per 10,000 km^(2),respectively,than in counties with≥500 physicians per 10,000 km^(2).The joint association analyses show a stronger association with the risk of a high U5MR in geographical pediatrician density than PPTC.Conclusion Both population and geographical pediatrician density should be considered when planning child health care services,even in areas with high numbers of PPTC.