Daniel H. de Vries

Should I stay or should I go? The impact of working time and wages on retention in the health workforce.

BackgroundTurnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on an employee’s intention to quit. Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee’s intention to stay.MethodsUsing data from the WageIndicator web survey (N = 5,323), three logistic regression models were used to estimate health care employee’s intention to stay for Belgium, Germany and the Netherlands. The first model includes working-time characteristics controlling for a set of sociodemographic variables, job categories, promotion and organization-related characteristics. The second model tests the impact of wage-related characteristics. The third model includes both working-time- and wage-related aspects.ResultsModel 1 reveals that working-time-related factors significantly affect intention to stay across all countries. In particular, working part-time hours, overtime and a long commuting time decrease the intention to stay with the same employer. The analysis also shows that job dissatisfaction is a strong predictor for the intention to leave, next to being a woman, being moderately or well educated, and being promoted in the current organization. In Model 2, wage-related characteristics demonstrate that employees with a low wage or low wage satisfaction are less likely to express an intention to stay. The effect of wage satisfaction is not surprising; it confirms that besides a high wage, wage satisfaction is essential. When considering all factors in Model 3, all effects remain significant, indicating that attention to working and commuting times can complement attention to wages and wage satisfaction to increase employees’ intention to stay. These findings hold for all three countries, for a variety of health occupations.ConclusionsWhen following a policy of wage increases, attention to the issues of working time—including overtime hours, working part-time, and commuting time—and wage satisfaction are suitable strategies in managing health workforce retention.Abstract in GermanHintergrundHohe Personalfluktuation und Kündigungsraten sind im Gesundheitswesen aufgrund ihres negativen Einflusses auf die organisatorische Leistung sowie die Qualität der Pflege in zunehmendem Maße ein ernstes Problem. In diesem Zusammenhang haben Studien zur Personalfluktuation vor allem den Einfluss von individuellen und organisatorischen Faktoren untersucht. Da jedoch innerhalb des Gesundheitswesens Zeitkomponenten (z.B. Dauer der für verschiedene Aufgaben verfügbaren Zeit) eine noch wichtigere Rolle spielen als die Entlohnung jedes einzelnen Arbeitsschritts, konzentriert sich der vorliegende Artikel vor allem auf den Einfluss verschiedener Arbeitszeit- und Entlohnungsfaktoren auf die Absicht von Mitarbeitern, beim derzeitigen Arbeitgeber zu verbleiben.MethodeUnter Verwendung gepoolter belgischer, deutscher und niederländischer Stichproben (2006-2012) der kontinuierlichen, weltweiten und mehrsprachigen WageIndicator- Onlineumfrage (N = 5323) untersucht die Studie anhand von drei logistischen Regressionsmodellen die Absicht von Mitarbeitern, bei ihrem derzeitigen Arbeitgeber im Gesundheitswesen zu verbleiben. Das erste Modell analysiert unter Kontrolle von soziodemographischen sowie berufs- und organisationsbezogenen Eigenschaften den Einfluss verschiedener Arbeitszeitfaktoren auf die Verbleibeabsicht. Unter Berücksichtigung der gleichen Kontrollvariablen testet das zweite Modell hingegen die Auswirkungen lohnbezogener Eigenschaften auf die Absicht zu bleiben, während das dritte Modell letztlich Arbeitszeit- und Lohnaspekte kombiniert.ErgebnisseModell 1 zeigt, dass die arbeitszeitbezogenen Faktoren die Absicht, beim derzeitigen Arbeitgeber zu verbleiben, in allen drei Ländern signifikant beeinflussen. Insbesondere Teilzeitarbeit, Überstunden sowie eine lange Anfahrtszeit zum Arbeitsplatz verringern die Verbleibeabsicht. Die Analyse zeigt auch, dass neben Einflussfaktoren wie weibliches Geschlecht, mittlere bis hohe Bildung und kürzlich erfolgte Beförderung, vor allem Arbeitsunzufriedenheit ein starker Prädiktor für die Absicht ist, den Arbeitgeber zu verlassen. In Modell 2 zeigt sich, dass lohnbezogene Merkmale, wie z.B. ein niedriger Lohn oder höhere Lohnunzufriedenheit, die Verbleibewahrscheinlichkeit von Arbeitnehmern verringert. Der starke Lohn(un)zufriedenheitseffekt bestätigt dabei, dass nicht nur die Lohnhöhe sondern vor allem auch die subjektive Lohnzufriedenheit eine zentrale Rolle spielt. Unter Berücksichtigung aller Faktoren in Model 3 bleiben die oben genannten Effekte signifikant, was darauf hindeutet, dass Arbeitszeitfaktoren (u.a. auch Anfahrtszeiten) neben Lohnfaktoren einen wichtigen Beitrag zum Verständnis von Personalfluktuation im Gesundheitswesen leisten. Diese Ergebnisse gelten für alle drei untersuchten Länder und eine Vielzahl von Gesundheitsberufen.SchlussfolgerungenDie Analyse zeigt auf, dass in der politischen Diskussion neben Lohnerhöhungen vor allem auch Themen wie Arbeitszeit (einschließlich Überstunden, Teilzeit und Anfahrtszeit) sowie die subjektive Lohnzufriedenheit in den Vordergrund gerückt werden müssen. Diese Faktoren eröffnen alternative Strategien, um das Problem hoher Personalfluktuation im Gesundheitswesen anzupacken.Abstract in SpanishAntecedentesLa rotación de personal de salud es preocupante, ya que es costoso y perjudicial para el desempeño de la organización y la calidad de atención médica. La mayoría de los estudios se han centrado en los factores a nivel individual y de organización que influyen el renunciar el empleo. Inspirado por la observación de que la prestación de atención médica se basa en la duración de las prácticas, las tareas y procesos (cuestiones de tiempo) en lugar de los valores de cambio (salarios), este manuscrito se enfoca en la influencia de las características del tiempo de trabajo y los salarios en la intención de permanecer en el empleo.MétodosUtilizando datos de la encuesta por Internet del Indicador Salarial (N = 5,323), se estimaron tres modelos de regresión logística para determinar la intención del empleado de atención de la salud a permanecer en Bélgica, Alemania y Holanda. El primer modelo incluye características de tiempo de trabajo, mientras controla por un conjunto de variables sociodemográficas, categorías laborales, la promoción y diversas características relacionadas con la organización. El segundo modelo de prueba el impacto de las características relacionadas con los salarios. El tercer modelo incluye tanto el tiempo de trabajo como los aspectos relacionados con los salarios.ResultadosModelo 1 indica que los factores de trabajo relacionados con el tiempo afectan significativamente la intención de permanecer en el empleo a través de todos los países. Las horas de trabajo a tiempo parcial o tiempo extra y un tiempo largo de trayecto al trabajo disminuyen la intención de permanecer en el mismo empleo. El análisis también indica que la insatisfacción laboral es un fuerte predictor de la intención de renunciar el empleo, también el ser mujer, ser moderadamente o bien educada y el haber sido promovido dentro de la organización actual. En el Modelo 2, características relacionadas con los salarios demuestran que los empleados con un salario bajo o un bajo nivel de satisfacción sobre el salario son menos propensos a expresar la intención de quedarse. El efecto de la satisfacción salarial no es sorprendente; confirma que, además de un alto salario, la satisfacción salarial es importante. Al considerar todos los factores en el Modelo 3, todos los efectos siguen siendo significativos, que indica que el aumentar la intención de los empleados a quedarse requiere la atención al tiempo del trabajo y del trayecto al trabajo, además de la atención sobre los salarios y la satisfacción de salarios. Estas conclusiones son válidas para los tres países y a través de una variedad de profesiones de la salud.ConclusionesCuando se implementa una política de incrementar salarios para mejorar la satisfacción salarial, también se debe considerar otras estrategias para el manejo de la retención de personal de salud, como el de trabajar horas extras, trabajo a tiempo parcial y el tiempo del trayecto al trabajo.

Health workforce remuneration: comparing wage levels, ranking, and dispersion of 16 occupational groups in 20 countries

BackgroundThis article represents the first attempt to explore remuneration in Human Resources for Health (HRH), comparing wage levels, ranking and dispersion of 16 HRH occupational groups in 20 countries (Argentina, Belarus, Belgium, Brazil, Chile, Colombia, the Czech Republic, Finland, Germany, India, Mexico, the Netherlands, Poland, Russian Federation, Republic of South Africa (RSA), Spain, Sweden, Ukraine, United Kingdom (UK), and United States of America (USA)). The main aim is to examine to what extent the wage rankings, standardized wage levels, and wage dispersion are similar between the 16 occupational groups and across the selected countries and what factors can be shown to be related to the differences that emerge.MethodThe pooled data from the continuous, worldwide, multilingual WageIndicator web survey between 2008 and 2011 (for selected HRH occupations, n=49,687) have been aggregated into a data file with median or mean remuneration values for 300 occupation/country cells. Hourly wages are expressed in standardized US Dollars (USD), all controlled for purchasing power parity (PPP) and indexed to 2011 levels.ResultsThe wage ranking of 16 HRH occupational groups is fairly similar across countries. Overall Medical Doctors have the highest and Personal Care Workers the lowest median wages. Wage levels of Nursing & Midwifery Professionals vary largely. Health Care Managers have lower earnings than Medical Doctors in all except six of the 20 countries. The largest wage differences are found for the Medical Doctors earning 20 times less in Ukraine than in the US, and the Personal Care Workers, who earn nine times less in the Ukraine than in the Netherlands. No support is found for the assumption that the ratio across the highest and lowest earning HRH occupations is similar between countries: it varies from 2.0 in Sweden to 9.7 in Brazil. Moreover, an increase in the percentage of women in an occupation has a large downward effect on its wage rank.ConclusionsThis article breaks new ground by investigating for the first time the wage levels, ranking, and dispersion of occupational groups in the HRH workforce across countries. The explorative findings illustrate that the assumption of similarity in cross-country wage ranking holds, but that wage dispersion and wage levels are not similar. These findings might contribute to the policies for health workforce composition and the planning of healthcare provisions.Abstract in SpanishAntecedentesEste artículo representa el primer intento de explorar la remuneración de los Recursos Humanos para la Salud (RHS), la comparación de los niveles salariales, clasificación, y dispersión de los 16 grupos de trabajo en 20 países (Argentina, Belarús, Bélgica, Brasil, Chile, Colombia, la República Checa, Finlandia, Alemania, India, México, los Países Bajos, Polonia, la Federación de Rusia, la República de Sudáfrica, España, Suecia, Ucrania, el Reino Unido, y los Estados Unidos de América (EEUU)). El objetivo principal es analizar en qué medida los rankings de salarios, niveles estandarizados de salarios, y la dispersión salarial es similar entre los 16 grupos de trabajo y en los países seleccionados y qué factores se puede demostrar relacionados con las diferencias que surjan.MétodosLos datos agrupados de la continua encuesta mundial, multilingüe WageIndicator por Internet entre 2008 y 2011 (para determinadas ocupaciones de RHS, n=49,687) se han agrupado en un archivo de datos con los valores de la remuneración promedio o media para 300 células de ocupación/país. Los salarios por hora se expresan en estandarizados dólares estadounidenses (USD), todos controlados por la paridad del poder adquisitivo (PPP) e indexados a los niveles de 2011.ResultadosEl ranking salarial de 16 grupos ocupacionales de RHS es bastante similar en todos los países. En general los médicos tienen los más altos y los trabajadores de atención personal los más bajos salarios medios. Los niveles salariales varían en gran medida para los profesionales de Enfermería y Partería. Los gerentes de salud tienen menores ingresos que los médicos en todos los países examinados excepto en seis. Las mayores diferencias salariales se encuentran entre los médicos, que ganan 20 veces menos en Ucrania que en los EEUU, y los trabajadores de cuidado personal, que ganan nueve veces menos en Ucrania que en los Países Bajos. No se ha encontrado apoyo a que exista la supuesta relación entre los índices de salarios más altos y más bajos de las profesiones RHS entre estos países, sino que varía de 2,0 a 9,7 en Suecia en Brasil. Además, cuando existe un alto porcentaje de mujeres en ciertas profesiones hay una baja en su rango salarial.ConclusionesEste artículo abre nuevas fronteras al investigar por primera vez los niveles salariales, la clasificación, y la dispersión de los grupos ocupacionales de la fuerza de trabajo SAR entre ciertos países. Los hallazgos exploratorios muestran que la hipótesis de la similitud en el ranking de salarios entre países se mantiene, son sólo la dispersión de los salarios y los niveles salariales que no son similares. Estos hallazgos podrían contribuir a las políticas para la composición del personal sanitario y a la planificación de las medidas de servicios de la salud.Abstract in germanHintergrundDieser Artikel stellt den ersten Versuch dar, einen Einblick in die Vergütung (Lohnniveau, -ranking und –verteilung) von 16 Berufsgruppen aus dem Gesundheitsbereich (HRH) in 20 Ländern (Argentinien, Belarus, Belgien, Brasilien, Chile, Kolumbien, Tschechien, Finnland, Deutschland, Indien, Mexiko, den Niederlanden, Polen, Russische Föderation, Republik Südafrika (RSA), Spanien, Schweden, Ukraine, Vereinigtes Königreich (UK), und Vereinigte Staaten von Amerika (USA)) zu erhalten. Hauptziel ist es, zu prüfen, inwieweit sich die 16 Berufsgruppen und ausgewählten Länder im Hinblick auf das standardisierte Lohnniveau, das Lohn-Ranking und die Lohnverteilung ähnlich sind, und welche Faktoren für die beobachteten Unterschiede verantwortlich gemacht werden können.MethodeDie gepoolten Daten der kontinuierlichen, weltweiten und mehrsprachigen WageIndicator- Onlineumfrage zwischen 2008 und 2011 (für ausgewählte HRH Berufe N = 49.687) wurden zu einer Datei aggregiert, die die Vergütung für 300 Beruf/Land-Zellen in Median- oder Mittelwert-Werten angibt. Die Stundenlöhne wurden in standardisierten US-Dollar (USD) unter Kontrolle der Kaufkraftparität (PPP) angegeben und sind auf dem Niveau von 2011 indexiert.ErgebnisseDie Analyse zeigt, dass das Lohnranking der16 HRH Berufsgruppen zwischen den Ländern vergleichbar ist. In allen Ländern haben Ärzte die höchste und persönliche Betreuungskräfte die niedrigsten mittleren Löhne. Es zeigt sich jedoch auch, dass große Länderunterschiede hinsichtlich des Lohnniveaus von professionellen Krankenpflegern und Geburtshelfern bestehen. Mit Ausnahme von 6 der 20 Länder erzielen Manager im Gesundheitswesen geringere Erträge als Ärzte. Die größten Lohnunterschiede sind für die Berufsgruppe der Ärzte zu beobachten: ukrainische Ärzte verdienen 20-Mal weniger als ihre US-amerikanischen Kollegen. Ein ähnliches Ergebnis zeigt sich auch für individuelle Pflegekräfte in der Ukraine, die 9-mal weniger verdienen als die gleiche Berufsgruppe in den Niederlanden. Die Analyse widerlegt die Annahme, dass das Verhältnis zwischen den höchsten und niedrigsten HRH-Berufen über die Länder hinweg vergleichbar ist: Der Wert variiert zwischen 2.0 in Schweden und 9.7 in Brasilien. Darüber hinaus zeigt sich,dass ein ansteigender Prozentsatz von Frauen zu einer starken Herabstufung im Lohnrang der betreffenden Berufsgruppe führt.SchlussfolgerungenDieser Artikel beschreibt zum ersten Mal die Ähnlichkeiten und Unterschiede bezüglich des Lohnniveaus, des Lohnrankings und der Lohnverteilung von 16 HRH-Berufsgruppen für 20 ausgewählte Länder. Er untersuch des Weiteren mögliche Einflussfaktoren. Die explorativen Befunde bestätigen die Annahme eines ähnlichen/vergleichbaren Lohnrankings in den untersuchten Ländern, während das Lohnniveau und die Lohnverteilung zwischen den Ländern nicht vergleichbar sind. Diese Erkenntnisse könnten dazu beitragen, Richtlinien und Politiken für die Zusammensetzung des Gesundheitspersonals sowie die Planung der Gesundheitsversorgung zu entwickeln.

Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion

BackgroundCommunity health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.MethodsAs part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.ResultsThe VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.ConclusionAs the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.

Stigma, an important source of dissatisfaction of health workers in HIV response in Vietnam: a qualitative study

BackgroundLike in many other low- and middle-income countries, the recent development of an HIV epidemic in Vietnam has led to a growing need for prevention, treatment, care, and support services for people living with HIV (PLHIV). This puts greater demands on the national HIV services, primarily on health workers, which increases the importance of their job satisfaction and working conditions. This study describes health worker perceptions and explores the factors that influence job satisfaction and dissatisfaction of health personnel working on the HIV response in Vietnam. Spector’s job satisfaction model was used as the theoretical framework for the study design and analysis.MethodsThe study employed a qualitative design with 7 focus group discussions and 15 semi-structured interviews with health workers, purposively selected from national and provincial organizations responsible for HIV services in 5 cities and provinces in Vietnam. Data were analyzed using a hybrid approach of theory-driven and data-driven coding and theme development using qualitative analysis software.ResultsHIV services are perceived by Vietnamese health workers as having both positive and negative aspects. Factors related to job satisfaction included training opportunities, social recognition, and meaningful tasks. Factors related to job dissatisfaction included unsatisfactory compensation, lack of positive feedback and support from supervisors, work-related stress from a heavy workload, fear of infection, and HIV-related stigma because of association with PLHIV. An adjusted Spector’s model of job satisfaction for HIV service health workers was developed from these results.ConclusionThis study confirmed the relationship between stigmatization of PLHIV and stigma experienced by staff because of association with PLHIV from families, colleagues, and society. The experiencing stigma results in additional work-related stress, low self-esteem, poor views of their profession, and lower income. The study shows the importance of actions to improve staff job satisfaction such as pay raises, supportive supervision, stress management, stigma reduction and workplace safety. Immediate actions could be the provision of more information; education and communication in mass media to improve the public image of HIV services, as well as improvement of workplace safety, therefore making health workers feel that their work is valued and safe.

Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital

BackgroundCommunity-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services.MethodsData were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis.ResultsThe ability of VHTs to link communities with formal health care was affected by the stakeholders’ perception of their roles. Community members perceive VHTs as working for and under instructions of “others”, which makes them powerless in the formal health care system. One of the challenges associated with VHTs’ linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not “experts”. For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health services. Having received training and initial support from an NGO, VHTs suffered transition failure from NGO to the formal public health care structure. As a result, VHTs are entangled in power relations that affect their role of linking community members with formal health care services. We also found that factors such as lack of money for treatment, poor transport networks, the attitudes of health workers and the existence of multiple health care systems, all factors that hinder access to formal health care, cannot be addressed by the VHTs.ConclusionsAs linking social capital framework shows, for VHTs to effectively act as links between the community and formal health care and harness the resources that exist in institutions beyond the community, it is important to take into account the power relationships embedded in vertical relationships and forge a partnership between public health providers and the communities they serve. This will ensure strengthened partnerships and the improved capacity of local people to leverage resources embedded in vertical power networks.

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

Background Despite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability. Methods and Findings This review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only. Conclusion Published, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sustainable (retentive) CLHW programs. Community relationships are generally seen as a “black box” represented by an interchangeable CLHW labor unit. This disconnect from community relationships and resources may have led to a systematic and chronic undervaluing of community agency in explanations of programmatic effectiveness and sustainability.

Temporal Vulnerability and the Post-Disaster ‘Window of Opportunity to Woo:’ a Case Study of an African-American Floodplain Neighborhood after Hurricane Floyd in North Carolina

After major flooding associated with Hurricane Floyd (1999) in North Carolina, mitigation managers seized upon the “window of opportunity” to woo residents to accept residential buyout offers despite sizable community resistance. I present a theoretical explanation of how post-crisis periods turn into “opportunities” based on a temporal referential theory that complements alternative explanations based on temporal coincidence, panarchy, and shock-doctrine theories. Results from fieldwork conducted from 2002 to 2004 illustrate how several temporal influences compromised collective calibration of “normalcy” in local cultural models, leading to an especially heightened vulnerability to collective surprise. Four factors particularly influenced this temporal vulnerability: 1) epistemological uncertainty of floodplain dynamics due to colonization; 2) cultural practices that maintained a casual amnesia; 3) meaning attributed to stochastic timing of floods; and 4) competitive impact of referential flood baseline attractors.

Does migration 'pay off' for foreign-born migrant health workers? An exploratory analysis using the global WageIndicator dataset.

BackgroundThis study used the global WageIndicator web survey to answer the following research questions: (RQ1) What are the migration patterns of health workers? (RQ2) What are the personal and occupational drivers of migration? (RQ3) Are foreign-born migrant health workers discriminated against in their destination countries?MethodsOf the unweighted data collected in 2006–2014 from health workers aged 15–64 in paid employment, 7.9 % were on migrants (N = 44,394; 36 countries). To answer RQ1, binary logistic regression models were applied to the full sample. To answer RQ2, binary logistic regression was used to compare data on migrants with that on native respondents from the same source countries, a condition met by only four African countries (N = 890) and five Latin American countries (N = 6356). To answer RQ3, a multilevel analysis was applied to the full sample to take into account the nested structure of the data (N = 33,765 individual observations nested within 31 countries).ResultsRQ1: 57 % migrated to a country where the same language is spoken, 33 % migrated to neighbouring countries and 21 % migrated to former colonizing countries. Women and nurses migrated to neighbouring countries, nurses and older and highly educated workers to former colonizing countries and highly educated health workers and medical doctors to countries that have a language match. RQ2: In the African countries, nurses more often out-migrated compared to other health workers; in the Latin American countries, this is the case for doctors. Out-migrated health workers earn more and work fewer hours than comparable workers in source countries, but only Latin American health workers reported a higher level of life satisfaction. RQ3: We did not detect discrimination against migrants with respect to wages and occupational status. However, there seems to be a small wage premium for the group of migrants in other healthcare occupations. Except doctors, migrant health workers reported a lower level of life satisfaction.ConclusionsMigration generally seems to ‘pay off’ in terms of work and labour conditions, although accrued benefits are not equal for all cadres, regions and routes. Because the WageIndicator survey is a voluntary survey, these findings are exploratory rather than representative.

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda

BackgroundSince the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.MethodsThis study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.ResultsContrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.ConclusionIn this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.

Crisis Discourse in Human Resources for Health: A Move Towards Securitization?

Since the 1960s, a persistent shortage of health workers has led professionals managing Human Resources for Health (HRH) to frame their field as in “crisis.” Since the HIV/AIDS epidemic, this discourse has coincided with a general securitization of global health. I explore the extent to which crisis discourse in HRH potentially signifies securitization of HRH using a narrative review of 153 articles from the PubMed database and a case study of a global, USAID-funded HRH strengthening partnership (The Capacity Project). Findings show a marked discursive shift after a 2004 collaborative report by the “Joint Learning Initiative,” which led to increased and normalized crisis discourse focusing on the threat of systemic collapse. Programmatically, this shift enabled an emergency-oriented technical approach focusing on high-level solutions that increase efficiency and surveillance and establish a new type of emergency manager: the global HRH crisis expert. I argue that the discourse of crisis may be pushing HRH towards fast-track action scenarios common to securitization, potentially closing the door to community-oriented or upstream approaches. Anthropologists or other social scientists working with local communities should monitor these developments and become active participants in HRH steering groups or political-legal bodies to support upstream and alternative (non-biomedical) solutions, such as community health resources.