A staff support programme for rural hospitals in Nepal

Zimmerman, Mark D.; Shah, Sharada; Shakya, Rabina; Chansi, Bal Sundar; Shah, Kashim; Munday, Daniel; Eyal, Nir; Hayes, Bruce

doi:10.2471/blt.15.153619

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…GPs can play an important role in rural Nepal by expanding surgical access [ 20 , 21 ] and access to emergency obstetric services [ 21 – 23 ]. Although Nepal’s success in reducing its maternal mortality rate by more than half in the past 15 years is commendable, a maternal mortality rate of 258 per 100 000 live births is still unacceptably high [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mirroring our experience, an intervention that deployed GPs to rural district hospitals in Nepal led to increased surgical services, deliveries, availability of emergency obstetric services, and community satisfaction compared to controls [ 21 ]. Based on these results, the Nepal government has already taken steps to increasing GP presence at district level hospitals [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Role of the general practitioner in improving rural healthcare access: a case from Nepal

Gauchan¹,

Mehanni²,

Agrawal³

et al. 2018

Hum Resour Health

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BackgroundThere is a global health workforce shortage, which is considered critical in Nepal, a low-income country with a predominantly rural population. General practitioners (GPs) may play a key role improving access to essential health services in rural Nepal, though they are currently underrepresented at the district hospital level. The objective of this paper is to describe how GPs are adding value in rural Nepal by exploring clinical, leadership, and educational roles currently performed in a rural district-level hospital.Case presentationWe perform a descriptive case study of clinical and non-clinical services offered at Bayalpata Hospital prior to and following the initiation of GP-level services in 2013. Bayalpata is a district-level public hospital managed through a public private partnership by the nonprofit healthcare organization Possible. We found that after general practitioners were hired, additional clinical services included continuous emergency obstetric care, major orthopedic surgeries, appendectomy, tubal ligation, and vasectomy. This time period was associated with increased emergency department visits, inpatient admissions, and institutional birth rate in the hospital’s catchment area. Non-clinical contributions included the development of a continuing medical education curriculum and implementation of a series of quality improvement initiatives.ConclusionsGPs have potential to bring significant value to rural district hospitals in Nepal. Clinical impact may include expanded access to surgical and emergency obstetric services, which would more fully align with local health needs, and could further reduce Nepal’s maternal mortality rate. Task-shifting and structured training programs would be required to increase orthopedic surgery capacity, but this would contribute to meeting local healthcare needs. Non-clinical impact may include supervision of health workers and leadership in continuing medical education and quality improvement initiatives. These changes can lead to improved health worker recruitment and retention in rural posts. Limitations include generalizability of our results to other district hospitals in Nepal and lack of data from control hospitals. This analysis provides an additional perspective on the potential value GPs can add in rural Nepal, through provision of a wide range of clinical and non-clinical services. It supports the expansion of GPs to additional district hospitals in Nepal’s public sector.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of the general practitioner in improving rural healthcare access: a case from Nepal

Gauchan¹,

Mehanni²,

Agrawal³

et al. 2018

Hum Resour Health

View full text Add to dashboard Cite

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“…• What are the cost-benefits of training a new worker and who will share the costs of training? (27,28,32,(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) Education and training Optimal education and training for rural practice occurs through exposure to rural and remote practice, teams, and health systems. Learning the range of skills needed is effective through distributed training systems using locally-available qualified teachers and supervisors, in the place where people are going to practice and involving of the people that the workers are going to help after they finish training.…”

Section: Selection Of Health Workersmentioning

confidence: 99%

“…• Is there rural health team cohesion? (62,(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103) Accreditation and recognition Accreditation and formal professional recognition of the worker is important for recognizing the worker's training and scope of work. It helps reinforce their investment in doing more training and supports their retention in the role and use of all their skills.…”

Section: Selection Of Health Workersmentioning

confidence: 99%

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

et al. 2020

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Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem.Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period.Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type.Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of “grow your own” strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.

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“…Mandatory rural service programs work best when combined with additional support such as comfortable housing, central personnel management, security, and a supportive working environment (1,25,26). The current program has not considered these factors even as the government enforced mandatory service for MBBS from public medical colleges from 2015 and for all specialists under government scholarships since 2018.…”

Section: Additional Supportmentioning

confidence: 99%

Medical Scholarships Linked to Mandatory Service: The Nepal Experience

Mahat

Zimmerman

Shakya

et al. 2020

Front. Public Health

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Introduction: Nepal has one of the world's lowest physician to population ratios, with a critical shortage of rural physicians. The Nepal Government uses the private sector to address this shortage of rural physicians. All private medical colleges must offer total scholarships, free of cost, to a proportion of their annual MBBS student intake. These scholarships come with a compulsory two-year service contract, which must be completed at public hospitals post-graduation. The mandatory service requirement was implemented in 2005/2006 and this paper evaluates the first decade of this scholarship program, with particular attention to the mandatory service requirement. Methods: We collected data on MBBS scholarship awardees from the Scholarship Section at the Ministry of Education, Department of Health Services, and the Ministry of Health and evaluated trends, service completion, and location. Results: Initially, because of poor monitoring, the mandatory service completion rate was low. Rates increased to 74-98% when strict rules tied service completion certificates to obtaining medical registration. In the past 4 years, three cohorts of scholarship doctors who completed their service requirements served 78% of their service-days in rural hospitals (primary healthcare centers and district hospitals). Yet, geographic inequities in physician distribution persist. Only 51% of district hospitals had at least one scholarship doctor, 31% of the district hospitals had more than 1.5 scholarship doctors, while 7% had none. The district hospitals in the Central region, which includes the capital city, had twice the number of scholarship doctors compared to the Mid-western region, which includes some of the country's most remote areas. Conclusion: The scholarship program has partially succeeded in reducing the physician shortage in Nepal's rural hospitals. To address the remaining inequities in physician distribution, efficient management systems, appropriate medical training, and support for rural practice are vital.

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A staff support programme for rural hospitals in Nepal

Cited by 8 publications

References 6 publications

Role of the general practitioner in improving rural healthcare access: a case from Nepal

Role of the general practitioner in improving rural healthcare access: a case from Nepal

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

Medical Scholarships Linked to Mandatory Service: The Nepal Experience

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