Context counts: training health workers in and for rural and remote areas

Strasser, Roger; Neusy, André-Jacques

doi:10.2471/blt.09.072462

Cited by 146 publications

(143 citation statements)

References 24 publications

(21 reference statements)

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“…Thus, it could never supersede the focused learning and teaching of on-site training or the concentrated attention of face-to-face supervision, but should be conceived as an additional layer. Nevertheless, the provision of an additional space for problem solving and knowledge sharing is certainly of value in the context under investigation, in a typical sub-Saharan African setting where health workers have limited access to knowledge resources [29], peers and supervisory support.…”

Section: Discussionmentioning

confidence: 99%

Mobile instant messaging for rural community health workers: a case from Malawi

Pimmer

Mhango

Mzumara

et al. 2017

Global Health Action

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Background: Mobile instant messaging (MIM) tools, such as WhatsApp, have transformed global communication practice. In the field of global health, MIM is an increasingly used, but little understood, phenomenon. Objectives: It remains unclear how MIM can be used by rural community health workers (CHWs) and their facilitators, and what are the associated benefits and constraints. To address this gap, WhatsApp groups were implemented and researched in a rural setting in Malawi. Methods: The multi-site case study research triangulated interviews and focus groups of CHWs and facilitators with the thematic qualitative analysis of the actual conversations on WhatsApp. A survey with open questions and the quantitative analysis of WhatsApp conversations were used as supplementary triangulation sources. Results: The use of MIM was differentiated according to instrumental (e.g. mobilising health resources) and participatory purposes (e.g. the enactment of emphatic ties). The identified benefits were centred on the enhanced ease and quality of communication of a geographically distributed health workforce, and the heightened connectedness of a professionally isolated health workforce. Alongside minor technical and connectivity issues, the main challenge for the CHWs was to negotiate divergent expectations regarding the social versus the instrumental use of the space. Conclusions: Despite some challenges and constraints, the implementation of WhatsApp was received positively by the CHWs and it was found to be a useful tool to support distributed rural health work.

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Section: Discussionmentioning

confidence: 99%

Mobile instant messaging for rural community health workers: a case from Malawi

Pimmer

Mhango

Mzumara

et al. 2017

Global Health Action

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“…When compared with their metropolitan counterparts, rural health workers are "extended generalists" who provide a wider range of services and carry a higher level of clinical responsibility in relative professional isolation (25). In the context of large distances, geographical factors, transport links, communications and so forth, small communities in rural or remote areas may require a larger number of generalist health-care providers that would not be justified in an urban context.…”

Section: Focus On Health Equitymentioning

confidence: 99%

Geographical mobility of general practitioners in rural Australia

McGrail

Humphreys

2015

Medical Journal of Australia

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Objective: To describe the geographical mobility of general practitioners in Australia, both within rural areas and between rural and metropolitan areas. Design and participants: Annual panel survey of GPs between 2008 and 2012. Main outcome measures: Work location, categorised by a typology based on geographical location and community size; frequency of mobility (change of location category); and characteristics of those who moved. Results: There were 3906 participants in 2008 (representative cohort, 19% of Australia's GP workforce) and 3502, 3514, 3287 and 3361 in subsequent years. 1810 GPs participated in all 5 years, and 10 900 origin–destination pairs were observed after removing GP registrars from the dataset. A total of 133 GPs moved from rural to metropolitan locations, 103 moved from metropolitan to rural locations, and 271 observed location changes were within rural areas. Annual location retention rates were 95% in regional centres, 90% in small rural towns and 82% in very remote areas. GPs in small towns of < 5000 residents had the highest risk of leaving rural practice. Mobility rates were significantly higher for GPs who had worked in a location for under 3 years and those working as either contracted or salaried employees, and somewhat higher for international medical graduates. Younger age was a small predictor of increased mobility, while sex and family status had no association with mobility. Conclusion: GPs working in small communities and those in a rural location for less than 3 years are most at risk of leaving rural practice.

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“…Evidence shows that curricula should be linked to the local context in which students will practice. Although evident, this approach was not applied (Strasser and Neusy 2010). Community-based training, socially responsive education, and a range of apprenticeship models are being tested in a number of countries to reach rural areas.…”

Section: Promising Government and Institutional Interventionsmentioning

confidence: 99%