Reconstruction of health service systems in the post-conflict Northern Province in Sri Lanka

Nagai, Moritaka; Abraham, Sandirasegaram; Okamoto, Miyoko; Kita, Etsuko; Aoyama, Atsuko

doi:10.1016/j.healthpol.2006.12.001

Cited by 49 publications

(45 citation statements)

References 13 publications

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“…Before the conflict, the average number of physicians per population in the NE was above the national average. However, it rapidly declined to half by 1996, while the national average continued in consistent progress [4]. Even after the peace agreement in February 2002, the number of physicians per 100,000 residents decreased from 22 in 2001 to 15 in 2003, which was one-fourth of the national average.…”

Section: Introductionmentioning

confidence: 97%

“…[1] Medical personnel flee from the affected area, and those from outside do not want to work there. Insecurity, damaged health infrastructure, work overload, and disrupted livelihood are the most common factors associated with an abrupt shortage of human resources for health (HRH) in war-torn areas [2][3][4][5]. Loss of healthcare workers, particularly physicians, leads to ineffective healthcare delivery [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…For example, the maternal mortality ratio (MMR) was 24 per 100,000 live births in 1996. [4] However, a longstanding war has affected the north-east (NE) region of the country, which had been the battlefield between a pro-independent Tamil militant organization called Liberation Tigers of Tamil Elam (LTTE) and the Sinhalese-dominant Sri Lankan government armed forces since 1983 [20].…”

Section: Introductionmentioning

confidence: 99%

“…A shortage of physicians was one of the most important and urgent healthcare problems in the NE [4]. Before the conflict, the average number of physicians per population in the NE was above the national average.…”

Section: Introductionmentioning

confidence: 99%

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Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

Gadi¹,

Higuchi²,

Warnasuriya³

et al. 2012

Health

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Background: The north-east (NE) region of Sri Lanka observed a critical health workers' shortage after the long-lasting armed conflict. This study aimed to explore medical students' attitudes towards working in the NE and to identify factors determining such attitudes. Methods: A semi-structured, self-administered questionnaire survey was conducted in two medical schools, one in the NE and the other near the capital, in October 2004. Data were qualitatively analysed using the framework approach. Results: Three main themes were identified: 1) Professional motives and career plans; 2) Students' perceptions of the healthcare situation in the NE; and 3) Students' choice of the NE as a future practice location. It was found that familiarity with the difficulties faced by the NE people was a major motivation for medical students to work in the NE in the future. For NE students, familiarity was linked to their sense of belonging. For non-NE students, their personal experience of the NE familiarized them with the difficult situation there, which positively influenced their willingness to work there. Demotivations to work in the NE were poor working and living conditions, fewer opportunities for postgraduate education, language differences, insecurity, and fear of an unpleasant social response from the NE communities. Conclusions: NE local medical students had a sense of belonging to the NE and compassion for the Tamil people as members of the ethnic group. They were willing to work in the NE if their concerns about difficult working and living conditions and postgraduate education could be solved. Non-NE students who were familiar with the NE situation through their personal experience also showed a willingness to work there; thus, early exposure programmes in medical education might help to increase the health workforce in the NE. It is also expected that non-NE physicians working for the NE people would facilitate reconciliation and the rebuilding of trust between two ethnic groups.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

Gadi¹,

Higuchi²,

Warnasuriya³

et al. 2012

Health

Self Cite

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“…However, an insufficient number and categories of HRH and their maldistribution have been common problems among countries off track of the Millennium Development Goals. These phenomena are particularly prominent in lower income countries where there is disparity between urban and rural areas in terms of socioeconomic status, including infrastructures 1 . This impedes the universal health coverage that is critically important to achieve Sustainable Development Goals, especially goal 3 health targets 2 .…”

Section: Introductionmentioning

confidence: 99%

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

Nagai¹,

Fujita²,

Diouf³

et al. 2017

Rural Remote Health

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A B S T R A C TIntroduction: Deployment and retention of a sufficient number of skilled and motivated human resources for health (HRH) at the right place and at the right time are critical to ensure people's right to access a universal quality of health care. Vision Tokyo 2010 Network, an international network of HRH managers at the ministry of health (MoH) level in nine Francophone African countries, identified maldistribution of a limited number of healthcare personnel and their retention in rural areas as overarching problems in the member countries. The network conducted this study in Senegal to identify the determining factors for the retention of qualified HRH in rural areas, and to explore an effective and feasible policy that the MoH could implement in the member countries. Methods: Doctors, nurses, midwives and superior technicians in anesthesiology who were currently working (1) in a rural area and had been for more than 2 years, (2) in Dakar with experience of working in a rural area or (3) in Dakar without any prior experience working in a rural area were interviewed about their willingness and reasons for accepting work or continuing to work in a rural area and their suggested policies for deployment and retention of healthcare workers in rural areas. In-depth interviews were conducted with policy makers in MoH, asking for their perceptions on human resource management in health and about their suggested policies for deployment and retention.Results: A total of 176 healthcare workers and eight policy makers were interviewed. The willingness to face challenges in a new place was one of the main reasons for accepting work in rural areas. The identified factors to motivate or demotivate healthcare workers in rural areas were related to pre-service and in-service education, regulatory systems, financial and non-financial incentive schemes and environmental support. Factors not included in WHO's global recommendation but highly valued in this study were (1) the fairness, transparency and predictability of human resource management by the MoH and (2) employment status, © M Nagai, N Fujita, IS Diouf, M Salla 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 ie permanent government staff versus contract staff. Financial incentive schemes were less commonly suggested. Family bonding and religious-related non-financial incentive schemes were found to be specific factors in Senegal, but would also be applicable in countries where family and religion play important roles in the values of healthcare workers. Conclusions: Improved HRH management, eg the transparency of human resource management by the MoH, was identified as a pre-condition of any policy implementation related to HRH. This factor can be considered in other countries struggling to retain healthcare workers in rural areas. The Vision Tokyo 2010 Network or HRH managers' network in Francophone Africa, Senegal MoH and the research team plan to conduct a quantitative survey to confirm the generaliz...

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Prevalence of War-Related Mental Health Conditions and Association With Displacement Status in Postwar Jaffna District, Sri Lanka

Husain

Anderson²,

Cardozo³

et al. 2011

JAMA

125

120

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Reconstruction of health service systems in the post-conflict Northern Province in Sri Lanka

Cited by 49 publications

References 13 publications

Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

Medical students’ willingness to work in post-conflict areas: A qualitative study in Sri Lanka

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

Prevalence of War-Related Mental Health Conditions and Association With Displacement Status in Postwar Jaffna District, Sri Lanka

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