Stakeholders’ Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions

Abstract

BackgroundAn adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.MethodFifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.ResultsThere was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.ConclusionsBotswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Avaliação da implantação do Programa de Valorização do Profissional da Atenção Básica no estado da Bahia

“…A literatura internacional indica que as causas da escassez de médicos na Atenção Primária à Saúde estão relacionadas à formação inadequada dos profissionais, remuneração inferior a outras especialidades, distribuição desigual de profissionais entre os serviços de saúde, salários pouco atrativos, profissionais sem treinamento para atuar no nível de atenção primária, migração para outras regiões e países, inadequação da infraestrutura de unidades de saúde, precarização das relações de trabalho [5][6][7] .…”

“…Diversos estudos apontam que os gestores municipais têm enfrentado a má distribuição de médicos formulando estratégias para incentivar a ocupação dos postos de trabalho na Atenção Primária à Saúde. Contudo, a escassez de médicos parece ser mais bem enfrentada pelo nível central dos sistemas de saúde com a implementação de estratégias e incentivos monetários e não monetários por meio dos programas governamentais 6,8,9 .…”

“…Para minorar essa problemática, muitos países têm adotado incentivos monetários e não monetários, a exemplo da interiorização dos cursos de graduação em medicina e de programas de residência médica, remuneração adequada, oferta de condições satisfatórias de moradia e infraestrutura na zona rural, regulação da distribuição de médicos por região de saúde, incentivos financeiros acrescidos aos salários, redução da dívida estudantil e bônus na nota final dos processos seletivos para acesso aos programas de residência médica 5,6,[10][11][12][13][14][15][16] . No Brasil, diversas estratégias foram criadas para prover profissionais médicos para a Atenção Primária à Saúde desde a década de 1960 Em 2011, o governo brasileiro instituiu o Programa de Valorização do Profissional da Atenção Básica (Provab), por meio da Portaria Interministerial nº 2.087, cujo fundamento era apoiar e incentivar médicos, enfermeiros e cirurgiões-dentistas para atuação na atenção básica de municípios com carência de profissionais, em áreas de extrema pobreza e nas periferias das regiões metropolitanas sob supervisão presencial e à distância 15 .…”

Job retention among healthcare workers in Tabora province, Tanzania

“…3 In a study from Botswana, stakeholders' perceptions indicated that manpower shortage was perceived as being worst in primary care and rural areas. 4 Human resource development is therefore considered one of the most important elements of a health sector reform that was launched by the World Health Organization (WHO) in 2009. 5 This reform emphasizes the need for both, highquality and sufficient density of healthcare workers in rural areas.…”

The Lived Experience of Filipino Registered Nurses Seeking to Migrate Overseas

“…In 2010, African countries had one nursing or midwifery personnel per 1,000 population compared to five nursing or midwifery personnel per 1,000 population in America and eight nursing or midwifery personnel per 1,000 in Europe (Naicker, Eastwood, Plange-Rhule, & Tutt, 2010). The situation is also distressing when it is recorded that African countries have only 1.3 percent of the global health workforce but are faced with 25 percent of the global burden of disease (Nkomazana, Mash, Shaibu, & Phaladze, 2015).…”