Purpose Resilient health facilities, particularly hospitals, are critical for a responsive local health system in post-disaster settings. The purpose of this paper is to look at the experiences of two hospitals (public and private) in Tacloban City, Philippines in the aftermath of a super typhoon and their respective delivery of health services in such setting. Design/methodology/approach It described the impact of Typhoon Haiyan on health services delivery capacity and the factors instrumental in the resilience of the case hospitals. Lessons learned from the hospitals’ experiences, both at the level of the hospital staff and the institution, were also drawn. Disaster preparedness of case hospitals were assessed along several domains of resilience. Key informant interviews among stakeholders were conducted with key themes on disaster resilience extracted. Findings Disaster preparedness scores for case hospitals were different from each other and were reflected in their experiences of health services delivery in the aftermath of the disaster. Research limitations/implications This study on hospital resilience of two case hospitals, in the aftermath of Typhoon Haiyan, is exploratory in nature. The retrospective design of the study made it prone to recall bias. Further, the use of self-report measures for hospital resilience needs to be validated by more objective measures. The lack of baseline pre-disaster resilience indicators and the unpredictability of disasters could perhaps be addressed by a longitudinal study on hospital resilience in disasters in the future. Originality/value This study revealed several key findings. Some of the themes that emerged were: public health in disaster is the responsibility of both public and private hospitals; need for flexibility in disaster preparedness and planning, disaster resilience is an emergent process not a static construct, chaos results from zeal without coordination, and the need for integration of disaster preparedness in daily processes and structures of hospital facilities.

BackgroundUnderstanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.MethodsThe Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent.ResultsFindings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.ConclusionsThese findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

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Displacement from one's home after a natural disaster results not only in physical separation from significant others but also in profound disruptions of psychological and social resources such as community support and sense of belonging. Frequent displacement can exacerbate health and mental health problems brought by the disaster, especially among lower-income families in resource-scarce regions. Objective: The present study examined the association among frequency of displacement after the disaster, health status, and psychological adjustments among survivors four years after the 2013 Super Typhoon Haiyan in the Philippines. Method: The study surveyed 345 typhoon survivors using randomized cluster samples in 13 towns in Eastern Philippines and assessed their physical and mental health status. Result: Path analysis revealed that, after controlling for age, gender, and traumatic exposure severity, frequency of displacement was a significant predictor for subjective health ratings and stress but not for posttraumatic stress symptoms, depression, and anxiety. Conclusion: These findings underscore the detrimental impact of long-term displacement on health outcomes following a disaster, especially in countries where public health resources are largely unavailable. Clinical Impact StatementThe finding that frequency of displacement predicted increased stress and decreased subjective health, over and above traumatic exposure severity, implies a need for long-term medical and psychological support for survivors who were displaced after a natural disaster. Given this evidence as to how displacement continues to impair the subjective and mental health of survivors several years after a natural disaster, public health officials could be better informed of the design of future postdisaster recovery programs.

Whether a medical school's social mission is focused on equity of access to the medical profession or on its graduates serving particular community needs, the mission principles need to be translated into practice. This translation process involves a series of externalisation and internalisation steps, each of which determines how much and what aspects of the mission are translated.

Equity in health outcomes for rural and remote populations in low-and middle-income countries (LMICs) is limited by a range of socioeconomic , cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a Johnston et al. Rural Health Workforce for LMICs significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multinational study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

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Objective: The insomnia severity index (ISI) is often used as a screening tool used with its recommended clinical cutoff scores. However, this practice presumes a single-factor structure, which has received little theoretical or empirical support. This study examined the factor structure of the ISI with the aim to validate its clinical application in postdisaster contexts. Method: One hundred sixty-eight Filipino adult survivors of the 2013 Super Typhoon Haiyan completed two waves of questionnaires that were 7 months apart. Confirmatory factor analyses were first conducted to compare models with different factor structures, followed by a test of longitudinal measurement invariance. The longitudinal interrelations among factors of the ISI as well as between insomnia and symptoms of psychological distress were then examined with path analysis. Results: Results supported a two-factor model, composed of severity and impact of insomnia, which achieved strong longitudinal invariance. The change in impact of insomnia at T2 was predicted by severity of insomnia at T1. Impact of insomnia was significantly associated with symptoms of stress but not depression and anxiety. Conclusion: We preliminarily propose a model in which the impact of insomnia mediates the influence of severity of insomnia on subsequent stress. Clinical Impact StatementThe Insomnia Severity Index is a popular assessment tool. This study suggests that the scale is better construed as a two-factor measure: severity of insomnia and impact of insomnia. The two factors are associated with different longer-term clinical outcomes; severity of insomnia predicts impact of insomnia, which, in turn, is associated with longer-term symptoms of stress.