Templates for reviewing the evidence and for case studies

Transcription

1 Templates for reviewing the evidence and for case studies Laura Stormont Health Workforce Migration and Retention Unit 1

2 Rationale behind the template Optimal approach would be RCTs But we can still produce STRONG recommendations based upon current evidence What is important is to have a systematic way of gathering, assessing and synthesising our evidence Need to be able to draw clear conclusions and extract any useful patterns / commonalities in our findings Complete the evidence tables for the recommendations 2

3 Use of the template 1. A tool to record existing (published/unpublished) papers, articles, or reports Will then go on to develop data extraction sheets for the construction of evidence tables 2. A draft outline for any new country case studies Main purpose is to facilitate the collection of information on contextual factors and on mechanisms used for the design, implementation and evaluation of an intervention Categorization of countries can help provide context specific recommendations 3

4 Main sections of the template Contextual analysis Country overview Health systems overview Human resources for health overview Intervention / policy analysis Recruitment and retention overview - Situation analysis - Description of intervention/policy - Implementation and evaluation - Outcomes measured - Results, conclusions and recommendations 4

5 Contextual analysis I Country overview Country socio-economic and political context Country characteristics: geographical socio-political languages and ethnic groups GDP per capita Poverty rate (urban and rural if available) Demographics and major health indicators Total population and rural-urban population ratios Life expectancy at birth 5

6 Contextual analysis II Health systems overview Priority health problems as identified by the national health policy HIV/AIDS prevalence, TB, etc Maternal mortality ratio Infant mortality rate Major drivers of the national health policy Primary health care Millennium Development Goals Financing model for the health system tax-based/social insurance Total health expenditure per capita Total health expenditure as % of GDP Decentralization policy Administrative financial Policy on public/private health care 6

7 7 Contextual analysis III Human resources overview National HRH strategic plan and policy Does an HRH strategic plan/policy exist? When was it developed/revised? How was it developed Does it cover main elements of planning, education/production, recruitment/retention, monitoring and evaluation. Has it been costed? Situation analysis Total number of health workers and health worker density by cadre; urban/rural public/private; gender; speciality What are the main HRH problems regarding the planning, education, retention, management etc Health labour market indicators related to retention (by urban/rural if possible) Vacancy rates Turn-over rates Attrition rates Absenteeism Unemployment rates (specifically highlight if there is a surplus in urban areas)

8 Intervention analysis I Recruitment and Retention overview Situation analysis of factors affecting motivation and retention of health workers, particularly in rural and remote areas Methods used for the factor analysis (discrete choice experiments, focus groups, key informant interviews, semi-structured questionnaires etc) Main factors affecting choices of location (intention to go to, stay in or leave remote and rural areas) Main factors affecting motivation of health workers in remote and rural areas Description of the existing retention policy/policies: Which category (education/regulatory, financial, management and environment support) When introduced (year) At what level was it introduced (National, district or facility etc)? Why and how was it introduced (government initiative, donor initiative, civil society push, response to strikes, part of general HRH strategy etc) Who is implementing it (government/nationwide or district level, private sector, NGOs, FBOs) What cadres are covered by the intervention Short description of the intervention(s) and of its expected outcomes 8

9 Intervention analysis II Recruitment and Retention overview Implementation issues Has it been implemented (where, to what extent) Is there a monitoring and evaluation component included Evaluation issues Evaluation methods when was the evaluation conducted (in relation to completion of intervention) study design: cross-sectional study, before and after survey data sources: documents review, satisfaction surveys for health works and patients, semi-structured questionnaires health workers Outcome measured: vacancy rates before and after the intervention changes in the density of health workers per population before and after the intervention % health workers remaining in the areas as a consequence of the intervention utilization rates in the areas of the intervention compared with non-intervention (or before and after the intervention) satisfaction of health workers within the strategy compared with those colleagues not included or of the same workers before and after the strategy patient satisfaction surveys before and after the intervention Results Conclusions Recommendations 9

10 Data extraction - context Case studies on increasing access to health workforce in remote and rural areas through improved retention Draft data extraction sheet - context Health systems overview Country overview Type of country: geographical, sociopolitical and cultural characteristics GDP per capita Poverty rate (rural/urban if available) Total population Rural/urban population ratios Life expectancy MMR, infant mortality rates Government priority health problems Any major orientations of the national health policy? If so, what? Financing model of the health system Total health expenditure per capita Total health expenditure as % of GDP Decentralisation policy - administrative Decentralisation policy - financial Policy on public / private health care Human resources for health situation analysi What are the main HRH problems? Total number of health workers by cadre rural/urban public/private gender speciality Data on (by rural/urban if possible) vacancy rates turn-over rates attrition rates absenteeism unemployment utilisation rates National HRH strategic plan and policy Does an HRH strategic plan/policy exist? If so, describe When was it developed /revised? How was it developed? Does it cover the main elements of planning production retention monitoring evaluation Has it been costed? 10

11 Data extraction intervention Case studies on increasing access to health workforce in remote and rural areas through improved retention Draft data extraction sheet - intervention Recruitment and retention policies / interventions Study Situation analysis of factors affecting motivation and retention of health workers Description of the retention policy / intervention Implementation issues Author/s, year published, title, publication Matsumoto, M., Inoue, K. & Kajii, E. 2008, 'Long-term effect of the home preference recruiting scheme of Jichi Medical University, Japan', Rural and Remote Health, vol.8, no.920, pp.1-15 Methods used for the factor analysis Main factors affecting choices of location (intention to stay or to leave) Main factors affecting motivation of health workers in remote and rural areas Category of intervention When introduced (year) Why and how was it introduced Has it been What cadres are Short description of Who is implemented? covered by the intervention and implementing it (where, to what intervention expected outcomes extent) Is there a monitoring and evaluation component included? Evaluation issues When was the Study design evaluation conducted? (in relation to completion of intervention) Evaluation methods (methodology, crosssectional study, before and after survey etc) Data sources (documents review, satisfaction Vacancy rates surveys for health works and before and after patients, semi-structured the intervention questionnaires health workers) Changes in the density of health workers per population before and after the intervention % of health workers remaining in the areas as a consequence of the intervention Outcomes measured Utilization rates in the areas of the intervention compared with nonintervention (or before and after the intervention) Satisfaction of health workers within the strategy compared with Patient satisfaction those colleagues not included or surveys before and of the same workers before and after the intervention after the strategy 11