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ObjectiveTo assess the impact of an interprofessional case-based training programme to enhance clinical knowledge and confidence among clinicians working in high HIV-burden settings in sub-Saharan Africa (SSA).SettingHealth professions training institutions and their affiliated clinical training sites in 12 high HIV-burden countries in SSA.ParticipantsCohort comprising preservice and in-service learners, from diverse health professions, engaged in HIV service delivery.InterventionA standardised, interprofessional, case-based curriculum designed to enhance HIV clinical competency, implemented between October 2019 and April 2020.Main outcome measuresThe primary outcomes measured were knowledge and clinical confidence related to topics addressed in the curriculum. These outcomes were assessed using a standardised online assessment, completed before and after course completion. A secondary outcome was knowledge retention at least 6 months postintervention, measured using the same standardised assessment, 6 months after training completion. We also sought to determine what lessons could be learnt from this training programme to inform interprofessional training in other contexts.ResultsData from 3027 learners were collected: together nurses (n=1145, 37.9%) and physicians (n=902, 29.8%) constituted the majority of participants; 58.1% were preservice learners (n=1755) and 24.1% (n=727) had graduated from training within the prior year. Knowledge scores were significantly higher, postparticipation compared with preparticipation, across all content domains, regardless of training level and cadre (all p6 months, knowledge and self-reported confidence scores were greater compared with precourse scores (all p

Byline: David. Campbell, Susan. Williams, Jill. Konkin, Isabella. White, Ian. Couper, Ruth. Stewart, Lucie. Walters Introduction: Rural doctors typically work in low-resource settings and with limited professional support. They are [...]

The 21st century presents significant global health challenges that necessitate an integrated health workforce capable of delivering person-centered and integrated healthcare services. Interprofessional collaboration (IPC) plays a vital role in achieving integration and training an IPC-capable workforce in sub-Saharan Africa (SSA) has become imperative. This study aims to assess changes in IPC confidence among learners participating in a team-based, case-based HIV training programme across diverse settings in SSA. Additionally, it sought to examine the impact of different course formats (in-person, synchronous virtual, or blended learning) on IPC confidence. Data from 20 institutions across 18 SSA countries were collected between May 1 and December 31, 2021. Logistic regression analysis was conducted to estimate associations between variables of interest and the increases in IPC confidence. The analysis included 3,842 learners; nurses comprised 37.9% (n = 1,172) and physicians 26.7% (n = 825). The majority of learners (67.2%, n = 2,072) were pre-service learners, while 13.0% (n = 401) had graduated within the past year. Factors significantly associated with increased IPC confidence included female gender, physician cadre, completion of graduate training over 12 months ago, and participation in virtual or in-person synchronous workshops (p <.05). The insights from this analysis can inform future curriculum development to strengthen interprofessional healthcare delivery across SSA. [ABSTRACT FROM AUTHOR]

The maldistribution of health workers between urban and rural areas is a policy concern in virtually all countries. It prevents equitable access to health services, can contribute to increased health-care costs and underutilization of health professional skills in urban areas, and is a barrier to universal health coverage. To address this long-standing concern, the World Health Organization (WHO) has issued global recommendations to improve the rural recruitment and retention of the health workforce. This paper presents experiences with local and regional adaptation and adoption of WHO recommendations. It highlights challenges and lessons learnt in implementation in two countries--the Lao People's Democratic Republic and South Africa--and provides a broader perspective in two regions--Asia and Europe. At country level, the use of the recommendations facilitated a more structured and focused policy dialogue, which resulted in the development and adoption of more relevant and evidence-based policies. At regional level, the recommendations sparked a more sustained effort for cross-country policy assessment and joint learning. There is a need for impact assessment and evaluation that focus on the links between the rural availability of health workers and universal health coverage. The effects of any health-financing reforms on incentive structures for health workers will also have to be assessed if the central role of more equitably distributed health workers in achieving universal health coverage is to be supported. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] La mauvaise repartition des travailleurs de la sante entre les zones urbaines et rurales demeure une preoccupation politique dans pratiquement tous les pays. Elle empeche l'acces equitable aux services de sante, elle peut contribuer a une augmentation du cout des soins de sante et de sous-utilisation des competences des professionnels de la sante dans les zones urbaines, et elle represente un obstacle a la mise en place d'une couverture maladie universelle. Pour repondre a cette preoccupation qui existe depuis longtemps, l'Organisation mondiale de la Sante (OMS) a emis des recommandations visant a ameliorer le recrutement et la retention des travailleurs du secteur de la sante en milieu rural. Ce document presente differentes experiences locales et regionales concemant l'adaptation et l'adoption des recommandations de l'OMS. Il souligne les defis et les lecons tirees de mises en oeuvre dans deux pays--en Republique democratique populaire lao et en Afrique du Sud--et il offre une perspective plus vaste dans deux regions--en Asie et en Europe. Au niveau des pays, l'application des recommandations a permis un dialogue plus structure et plus cible sur les reglementations, qui a abouti a l'elaboration et a l'adoption de politiques plus pertinentes basees sur les faits. Au niveau regional, les recommandations ont suscite un effort plus soutenu en ce qui concerne l'evaluation des politiques entre les pays et leur apprentissage commun. Il faut evaluer l'impact des liens qui existent entre la disponibilite des travailleurs de la sante dans les zones rurales et la couverture maladie universelle. Les effets de toutes les reformes flnancieres sur les structures d'incitation des travailleurs de la sante devront egalement etre evalues si le but principal est de repartir plus equitablement les travailleurs de la sante et d'atteindre une couverture maladie universelle. [TEXT NOT REPRODUCIBLE IN ASCII] La distribucion ineficaz del personal sanitaria entre las zonas urbanas y rurales constituye una preocupacion politica en casi todos los paises, pues impide el acceso equitativo a los servicios sanitarios, puede contribuir al aumento de los castes de atenci6n sanitaria y la infrautilizacion de las capacidades profesionales sanitarias en las zonas urbanas, y obstaculiza la cobertura sanitaria universal. Para solucionar este problema de larga data, la Organizacion Mundial de la Salud (OMS) ha publicado una serie de recomendaciones generales para mejorar la contratacion a nivel rural y la conservad6n del personal sanitaria. Este informe presenta las experiencias en relacion con la adaptacion local y regional, y la adopcion de los recomendaciones de la OMS. Ademas, subraya los desafios y las lecciones aprendidas de la aplicacion en dos paises, la Republica Democratica Popular Lao y Sudafrica, y proporciona una perspectiva mas amplia en dos regiones, en concreto, Asia y Europa. A nivel nacional, el usa de las recomendaciones facilito un dialogo politico mas organizado y especifico, lo que permitio el desarrollo y la adopci6n de politicas mas relevantes con base empirica. A nivel regional, las recomendaciones motivaron un esfuerzo mas firme para evaluar los politicas entre los poises y el aprendizaje conjunto. Es necesario realizar una evaluacion y una valoracion del impacto que se centren en la relacion entre la disponibilidad de personal sanitaria en zonas rurales y la cobertura sanitaria universal. Asimismo, deben evaluarse los efectos de las reformas financieras en asistencia sanitaria sabre las estructuras de incentivos para el personal sanitaria con miras a promover el papel central del mismo, distribuido de forma mas equitativa, en la consecucion de la cobertura sanitaria universal., Introduction Any shortage of health workers can prevent good access to health services and is a barrier to universal coverage. When such shortages are accompanied by an unequal distribution of [...]

District health managers (DHMs) lead and manage Ministry of Health programmes and system performance. We report on the acceptability and feasibility of inter-related activities to increase the agency of DHMs in Kenya, Nigeria, South Africa and Uganda using a cross-sectional rapid appraisal with 372 DHMs employing structured questionnaires. We found differences and similarities between the countries, in particular, who becomes a DHM. The opportunity to provide leadership and effect change and being part of a team were reported as rewarding aspects of DHMs' work. Demotivating factors included limited resources, bureaucracy, staff shortages, lack of support from leadership and inadequate delegation of authority. District managers ranked the acceptability of the inter-related activities similarly despite differences between contexts. Activities highly ranked by DHMs were to employ someone to support primary care staff to compile and analyse district-level data; to undertake study tours to well-functioning districts; and joining an African Regional DHM Association. DHMs rated these activities as feasible to implement. This study confirms that DHMs are in support of a process to promote bottom-up, data-driven, context-specific actions that can promote self-actualisation, recognises the roles DHMs play, provides opportunities for peer learning and can potentially improve quality of care. [ABSTRACT FROM AUTHOR]