Increasing and Retaining African Surgeons Working in Rural Hospitals: An Analysis of PAACS Surgeons with Twenty‐Year Program Follow‐Up

Essen, Caleb Van; Steffes, Bruce C.; Thelander, Keir; Akinyi, Beryl; Li, Hsin-Fang; Tarpley, Margaret J.

doi:10.1007/s00268-018-4781-9

Cited by 40 publications

(23 citation statements)

References 70 publications

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“…This is supported by research conducted in high-income countries across different rural contexts and health professions where matters relating to people and place (including supportive work environments) are often identified as being of high importance in attracting and retaining health professionals [30,32,[38][39][40]. Further exploration is needed as to whether these community/place recommendations could have relevance for rural-based health professionals from low-income countries given the differences in cultures and health and education systems [41,42]. On the other hand, the recommendations made relating to organisational/workplace and role/career domains are likely highly contextual and relate specifically to Australia's AHPs working in public sector services.…”

Section: Broader Relevance Of the Recommendationsmentioning

confidence: 99%

“…For this group, income and work conditions are major factors for attraction and retention [38,39]. In addition, recruitment of rural doctors may be influenced by financial enticements such as bonded placements, loan repayment schemes or other financial incentives, and these types of financial benefits are less commonly on offer to AHPs and nurses [41,42].…”

Section: Broader Relevance Of the Recommendationsmentioning

confidence: 99%

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Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

Cosgrave

2020

IJERPH

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Chronic health workforce shortages significantly contribute to unmet health care needs in rural and remote communities. Of particular and growing concern are shortages of allied health professionals (AHPs). This study explored the contextual factors impacting the recruitment and retention of AHPs in rural Australia. A qualitative approach using a constructivist-interpretivist methodology was taken. Semi-structured interviews (n = 74) with executive staff, allied health (AH) managers and newly recruited AHPs working in two rural public health services in Victoria, Australia were conducted. Data was coded and categorised inductively and analysed thematically. The findings suggest that to support a stable and sustainable AH workforce, rural public sector health services need to be more efficient, strategic and visionary. This means ensuring that policies and procedures are equitable and accessible, processes are effective, and action is taken to develop local programs, opportunities and supports that allow AH staff to thrive and grow in place at all grade levels and life stages. This study reinforces the need for a whole-of-community approach to effectively support individual AH workers and their family members in adjusting to a new place and developing a sense of belonging in place. The recommendations arising from this study are likely to have utility for other high-income countries, particularly in guiding AH recruitment and retention strategies in rural public sector health services. Recommendations relating to community/place will likely benefit broader rural health workforce initiatives.

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Section: Broader Relevance Of the Recommendationsmentioning

confidence: 99%

Section: Broader Relevance Of the Recommendationsmentioning

confidence: 99%

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

Cosgrave

2020

IJERPH

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“…A study from Malawi found no general surgeons, anesthetists, or biomedical technicians in 23 rural district hospitals with a catchment of about five million people as opposed to 27 general surgeons, nine anesthetists, and five biomedical technicians in urban central hospitals with a catchment of two million people [ 31 ]. This disparity is even more acute in rural West Africa than the ECSA region as decentralization of training of surgeons (using rural and district hospitals as opposed to urban teaching hospitals alone) has encouraged trainees to stay in ECSA rural areas [ 105 , 109 ]. The West African College of Surgeons relatively recently introduced a 6-month rural posting earlier in specialist surgical training [ 110 , 111 ].…”

Section: Search Resultsmentioning

confidence: 99%

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Alayande,

Chu,

Jumbam

et al. 2022

Curr Trauma Rep

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Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action.

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“…Medical schools are frequently located in the capital or other major cities, and medical students are more likely to come from urban areas as well. Multiple studies across several SSA countries reveal homogeneity in concerns about pursuing rural service: poor health facility equipment and infrastructure, lack of supervision and management support, limited career advancement opportunities, spartan living conditions, cultural and language differences, and distance from family [12]. However, there are also predictors and motivators for rural practice.…”

Section: Discussionmentioning

confidence: 99%

The Role of Family Medicine Training in Addressing Workforce Challenges in Rural Liberia – Early Implementation Experience

Sanoe¹,

Beyan-Davies²,

Anyango³

et al. 2021

Annals of Global Health

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Background: Liberia has a severe shortage in the health workforce, which is amplified in rural areas. Many talented Liberians leave the country for post-graduate education; those physicians who do stay are concentrated in Monrovia. Objective:We initiated a family medicine specialty training program (FMSTP) to increase the number of well-trained physicians who have the knowledge, skills, and commitment to meet the health needs of the Liberian people. Methods:The Liberian College of Physicians and Surgeons (LCPS) family medicine program is a three-year post-graduate course that follows the West African College of Physician (WACP) curriculum. The program has a longitudinal rural training component supported by Partners in Health in Maryland county, where residents gain experience in a remote and under-served region. The program is evaluated through resident evaluations and ultimately bench-marked by accreditation and exam pass rates. Findings:The FMSTP commenced in July 2017, and the first rural rotation was in January 2018. To-date 13 residents have completed a total of 43 rotations in Maryland. Residents surveyed highly rated the faculty and their rural rotations. They identify more hands-on involvement in patient care, exposure to community health, and one-on-one time with faculty as the greatest assets of the rural training experience. Accreditation from the WACP was granted in December 2018. One of the graduating residents from the first class in 2020 is now serving as the first Liberian family medicine specialist in Maryland County.Discussion: Investing in a strong rural training component in our FMSTP has not only strengthened the program but has also built the infrastructure to establish our rural site as an attractive teaching hospital for intern doctors and nursing students. As the program continues to grow, success will be measured by the proportion of Liberian medical students entering the family medicine training program, retention of family medicine physicians in rural areas, and ultimately progress towards universal health coverage (UHC).

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Increasing and Retaining African Surgeons Working in Rural Hospitals: An Analysis of PAACS Surgeons with Twenty‐Year Program Follow‐Up

Abstract: Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.

Cited by 40 publications

References 70 publications

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

Context Matters: Findings from a Qualitative Study Exploring Service and Place Factors Influencing the Recruitment and Retention of Allied Health Professionals in Rural Australian Public Health Services

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

The Role of Family Medicine Training in Addressing Workforce Challenges in Rural Liberia – Early Implementation Experience

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