Low-wage migrant workers in Singapore are legally entitled to healthcare provided by their employers and supported by private insurance, separate from the national UHC (universal health coverage) system. In practice, they face multiple barriers to access. In this article, we describe this policy-practice gap from the perspective of HealthServe, a non-profit organisation that assists low-wage migrant workers. We outline the healthcare financing system for migrant workers, describe commonly encountered barriers, and comment on their implications for the global UHC movement’s key ethical concepts of fairness, equity, and solidarity.
PurposeThe aim of this study was to determine the effectiveness of promoting peer support to reduce depression, anxiety and stress among migrant construction workers in Singapore.Design/methodology/approachThis longitudinal study drew participants from migrant workers of various nationalities in the construction sector in Singapore. Baseline data pertaining to depression, anxiety and stress was established using the DASS-21 questionnaire, and salient covariates such as demographic factors and work environment factors recorded using suitable questionnaires. Intervention was training of participants on peer support techniques, supplemented by episodic support by trained counsellors. At the end of 6 months, DASS-21 was again deployed to obtain the post-results. Comparison of baseline with post-results data was performed to evaluate effectiveness of the peer support intervention.FindingsStatistically significant reduction was observed in measures of all the three parameters studied, namely, depression, anxiety and stress. A decrease of 3.3 (95% CI:2.3 to 4.3) points in mean depression score, a decrease of 2.6 (95% CI: 1.6 to 3.7) points in mean anxiety score and a decrease of 2.7 (with 95% CI: 1.6 to 4.0) points in mean stress scores on the DASS-21 scale were recorded. Conclusions: Peer support is effective in improving mental health of migrant workers in the construction sector in Singapore. This intervention should be considered among other measures to improve their welfare.Originality/valueThis is the first paper that talks about the mental health of migrant workers pre-COVID and hence would be a strong paper for the future comparative studies for pre-and post-COVID periods. This is the first paper that addresses the benefits of peer-support among migrant workers to improve their mental wellbeing.
BackgroundSierra Leone is pursuing multiple initiatives to establish in-country postgraduate medical education (PGME), as part of national efforts to strengthen the health workforce. This paper explored the career preferences of junior doctors in Sierra Leone; and the potential benefits and challenges with regards to the development of PGME locally.MethodsJunior doctors (n = 15) who had graduated from the only medical school in Sierra Leone were purposively sampled based on maximum variation (e.g. men/women, years of graduation). In-depth interviews were conducted in October 2013, and digital diaries and two follow-up interviews were used to explore their evolving career aspirations until November 2016. Additionally, 16 semi-structured interviews with key informants were held to gather perspectives on the development of PGME locally. Results were thematically analysed.ResultsAll junior doctors interviewed intended to pursue PGME with the majority wanting primarily a clinical career. Half were interested in also gaining a public health qualification. Major factors influencing career preferences included: prior exposure, practical (anticipated job content), personal considerations (individual interests), financial provision, and contextual (aspirations to help address certain health needs). Majority of doctors considered West Africa but East and South Africa were also location options for clinical PGME. Several preferred to leave the African continent to pursue PGME. Factors influencing decision-making on location were: financial (scholarships), practical (availability of preferred specialty), reputation (positive and negative), and social (children). Key informants viewed the potential benefits of expanding PGME in Sierra Leone as: cost-effectiveness (compared to overseas specialist training), maintaining service delivery during training years, decreasing loss of doctors (some decide not to return after gaining their specialist degree abroad), and enhancing quality control and academic culture of the local medical school. Major perceived challenges were capacity constraints, especially the dearth of specialists required to achieve training programme accreditation.ConclusionsThis study has provided an insight into the career preferences of junior doctors in Sierra Leone. It is timely as there is increasing political and professional momentum to expand PGME locally. Findings may guide those involved in this PGME expansion in terms of how possibly to influence junior doctors in their career decision-making.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1292-1) contains supplementary material, which is available to authorized users.
Despite their economic contributions to both receiving and sending countries, low-wage international migrant workers tend to experience suboptimal access to healthcare. 1 Health research related to this migrant group remains relatively limited even though they constitute the majority of international migrants and are likely to face various health threats in their migration journey. 2 Singapore, for example, is a country that has relied on low-and semi-skilled migrant workers on work permits to supplement its local labour for decades, 3 and a number of recent studies have led to an increased understanding of the health seeking behaviors of these guest workers, the increased health risks associated with their migrant status, and the barriers they face in accessing healthcare. 4 Arguments have also been advanced for the improvement of healthcare access for these 1
BackgroundAlthough peer assessment has been used for evaluating performance of medical students and practicing doctors, it has not been studied as a method to distribute a common group work mark equitably to medical students working in large groups where tutors cannot observe all students constantly.MethodsThe authors developed and evaluated a mathematical formulation whereby a common group mark could be distributed among group members using peer assessment of individual contributions to group work, maintaining inter-group variation in group work scores. This was motivated by community health projects undertaken by large groups of year four medical students at the National University of Singapore, and the new and old formulations are presented via application to 263 students in seven groups of 36 to 40 during the academic year 2012/2013.ResultsThis novel formulation produced a less clustered mark distribution that rewarded students who contributed more to their team. Although collusion among some members to form a voting alliance and ‘personal vendettas’ were potential problems, the former was not detected and the latter had little impact on the overall grade a student received when working in a large group. The majority of students thought the new formulation was fairer.ConclusionsThe new formulation is easy to implement and arguably awards grades more equitably in modules where group work is a major component.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-0987-z) contains supplementary material, which is available to authorized users.
Whereas some medical missionaries may already have moved away from “traditional” models of medical mission, in the experience of the authors from the Asia-Pacific region, many potential medical missionaries in the region still imagine a stereotypical generalist medical missionary who runs a mission hospital. The authors argue that with the economic and socio-political development of low- and middle-income countries (LMICs) in recent decades, the landscape for medical missions has changed. Hence, contemporary medical missionaries should be well-advised to have specialist qualifications and be more likely to teach, mentor, and do research rather than only doing hands-on clinical work. Professionalism and quality, rather than “make-do,” should be the norm. There are more opportunities to partner with and strengthen existing local institutions rather than setting up a Christian health service. Furthermore, mission opportunities may be available in academia, government, or secular organisations, including places where Christianity has a hostile reception. Multi-disciplinary expertise and collaboration within health services are increasingly important and provide another opportunity for missions. Medical missionaries may also come from other LMICs, or from within the same country. Job-sharing, self-funding, or fly-in-fly-out, may be a viable and legitimate means of sending more medical missionaries. These non-traditional models of medical mission that incorporate a diversity of approaches, but without sacrificing the “traditional” missional values and practices, should allow even more people to serve in medical missions. The purpose of this paper is to survey this topic in hope of stimulating discussions on non-traditional medical mission opportunities in the Asia-Pacific region and beyond.
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