As the population ages, policymakers struggle to cope with the increasing demands for home care and institutional long-term care. This thesis project focuses on factors associated with the transition from home to institutional care for people with dementia. Using health administrative data at a population level, we construct a multivariable model that estimates the time between home care initiation after dementia diagnosis and placement in a long-term care home. From the model, we identify protective factors that allow people with dementia to remain at home for longer, with a particular emphasis on the health workforce and the contribution of formal and informal caregivers to delaying the transition from home to institutional care. Together, these results inform policymakers in capacity planning and in determining where investments should be targeted to maintain people with dementia at home, along with the associated health workforce implications.

Philosophiae Doctor - PhD / Health system in Sub-Saharan in Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Wide-ranging capacity development interventions exist to address these limitations. however, failure to take into account complexity into planning and implementation in the practice and research of these capacity development intervention predominate , hindering understanding and learning, and resulting in poor implementation or lack of sustainability of the capacity gains.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: The U.S. is faced with a primary care (PC) workforce shortage; an estimated 43 percent of the population has unmet health care needs and 18.2 percent of the adult population lacks a usual source of care (USC) provider. The workforce shortage limits even those with a USC from receiving the full scope of recommended clinical services. One promising solution is reforming scope-of-practice (SOP) policies for PC nurse practitioners (NPs). Objectives: The primary objective of this dissertation was to assess the impact of NP SOP policy implementation on NP practice patterns and patient access to PC by evaluating NP time spent delivering patient care, NP role as USC providers, patient travel times, and appointment availability. Methods: The studies discussed in this dissertation leveraged cross-sectional data from the National Sample Survey of Nurse Practitioners (NSSNP), time-series data from the Medical Expenditure Panel Survey (MEPS), and the Nurse Practitioner Professional Practice Index (NPPPI) to quantify variations in state policy environments. We used generalized mixed effects models to examine relationships in the cross-sectional data analyses and two-way fixed effect models to evaluate longitudinal data. Results: Our analyses revealed several key findings: NP SOP policies do impact the percentage of time NPs spend providing direct patient care; the NP workforce role as USC providers has increased as SOP policies have changed; states with supportive reimbursement policies have more NPs working as USC providers; and states with fewer NP supervision requirements have shorter patient travel times to USC providers. Conclusion: The U.S. health care system must continue to evolve to address the growing demand for PC services. While strategies to increase the supply of PC providers may be an effective long-term solution, our findings suggest that NP SOP reform may be a viable and complementary strategy to increasing the capacity of the PC workforce, providing more immediate relief. / 2 years

A caracterização dos recursos humanos na odontologia no serviço público é importante para avaliar as discrepâncias de contratação e remuneração, colaborando com a elaboração de políticas públicas que permitam um adequado recrutamento e fixação de profissionais, garantindo equidade no acesso aos serviços. Tanto o problema das relações de trabalho quanto o de distribuição dos profissionais de saúde, estão diretamente relacionados com as barreiras de desenvolvimento de um sistema de saúde eficiente e efetivo. O objetivo desse estudo foi caracterizar e analisar aspectos da contratação, recrutamento e remuneração dos profissionais de odontologia no serviço público. Foram utilizadas três estratégias: i) revisão de escopo, ii) análise de mecanismos de recrutamento de recursos humanos em saúde para o serviço público (concursos públicos e processos seletivos do ano de 2013) e iii) análise dos dados do PMAQ-AB II e PMAQ-CEO I, referentes ao agente contratante, vínculo e mecanismo de ingresso de dentistas no serviço público. A revisão de escopo mostrou que os estudos de recursos humanos em odontologia são escassos, especialmente em países de baixa e média renda, e apresentou opções de remuneração e inserção dos profissionais de odontologia no mercado de trabalho público, privado e misto. As formas de remuneração apresentadas foram: pagamento por taxa de serviço, salário fixo, captação, ou modelos mistos. Os editais de concursos públicos e processos seletivos do Brasil no período avaliado mostraram dados imprecisos com ausência de informações sobre as vagas, salários e benefícios oferecidos, tipo de vínculo e perfil profissional exigido para trabalhar no serviço público. Observou-se importantes diferenças salariais entre dentistas, médicos e enfermeiros, além de maior concentração de vagas oferecidas na região sudeste do país, evidenciando a falta de um planejamento estratégico da distribuição geográfica desses recursos humanos e cobertura do cuidado. Quanto ao PMAQ-AB, observou-se que 80% dos dentistas que trabalham na atenção básica foram contratados por administração direta, mas apenas 45% estão sob regime estatutário como vínculo. A indicação política como forma de ingresso foi relatada por 23% dos entrevistados. Entretanto, no PMAQ-CEO, 80% dos dentistas foram contratados pela administração direta e 58% possuem vínculo estatutário. O mecanismo de ingresso de 65% desses profissionais foi o concurso público, enquanto que no PMAQ-AB os concursados somam aproximadamente 50%; portanto, nos CEO há maior proporção de profissionais concursados em relação à atenção básica, demonstrando que o processo de terceirização da gestão está mais avançado na atenção básica do que na secundária. Concluindo, políticas públicas informadas por evidências científicas são importantes para oferecer equidade no acesso aos serviços melhorando a distribuição dos profissionais, oferecendo incentivos e condições de trabalho adequadas, com processos de seleção de pessoal eficientes. Os estudos sobre a relação entre o vínculo do profissional com o serviço público e os impactos na quantidade e qualidade de serviços oferecidos aos usuários também são igualmente importantes para que o Brasil possa alcançar os princípios da estratégia global para recursos humanos em saúde da Organização Mundial de Saúde, oferecendo disponibilidade, acessibilidade, aceitabilidade e qualidade da força de trabalho. / The profile of the human resources in dentistry in the public service is important to evaluate the discrepancies between hiring and remuneration, collaborating with the elaboration of public policies that allow an adequate recruitment and fixation of professionals, guaranteeing equity in the access to the health services. Labor relations and the health professionals\' distribution issue are directly related to barriers to the development of an efficient and effective health system. The objective of this study was to characterize and analyze aspects of contracting, recruitment and remuneration of dentistry professionals in the public service. Three strategies were used: i) scoping review, ii) human resources recruitment mechanisms for public service analysis (2013 public tenders and selective processes), and iii) PMAQ-AB II and PMAQ-CEO I analysis to the contracting agent, bond and mechanism of dentists\' entry into the public service. The scoping review showed that human resources studies in dentistry are scarce, especially in low- and middle-income countries, and presented options for the remuneration and insertion of dentistry professionals in the public, private and mixed labor market. The forms of remuneration presented were: fee-for service, fixed salary, capitation, or mixed models. The calls for public selection processes evaluated showed inaccurate data with no information about the vacancies, salaries and benefits offered and professional profile required to work in the public service. Significant salary differences were observed among dentists, physicians and nurses, as well as a greater concentration of vacancies offered in the southeastern region of the country, evidencing the lack of a strategic planning of the geographic distribution of these human resources and care coverage. Regarding PMAQ-AB, it was observed that 80% of dentists working in primary care were contracted by direct administration, but only 45% are under servant regime. The political indication as a form of admission was reported by 23% of respondents. However, in the PMAQ-CEO, 80% of the dentists were hired by direct administration and 58% had a public servant relationship. The admission mechanism of 65% of these professionals occurred by public tender, while in PMAQ-AB the number was 50%; therefore, in the CEO there is a greater proportion of professionals in the field of primary care, demonstrating that the outsourcing process is more advanced in primary care than in secondary care. In conclusion, public policies informed by scientific evidence are important in order to offer fair access to services by improving the distribution of professionals, providing incentives and adequate working conditions, and efficient personnel selection processes. Studies on the relationship between the professional\'s link to the public service and the impacts on the quantity and quality of services offered to users are equally important so that Brazil can achieve the principles of the global strategy for human resources in health of the World Health Organization, offering availability, accessibility, acceptability and quality of the workforce.

Maintaining the health of Tennesseans depends heavily on a well-trained, efficient public health workforce that can work effectively in a complex environment. In order to assess the training needs of this group, the Tennessee Public Health Training Center-LIFEPATH administered a survey to all governmental public health employees in Tennessee during the summer of 2012. This instrument was modeled after previous assessments conducted by health agencies outside of Tennessee which utilized as their rubric the Core Competencies for Public Health Professionals developed by the Council on Linkages between Academia and Public Health Practice. The goal of this research was to inform and streamline educational efforts of the Tennessee Department of Health (TDOH), LIFEPATH and their partners across the state by identifying specific competency driven training opportunities within the workforce. Participants were recruited via email and directed to SurveyMonkey, an online survey toolkit, where they could complete the questionnaire. Of the 5178 TDOH employees who received the recruitment email, 3086 individuals completed at least one of the competency questions for a response rate of 59.6%. The survey assigned questions pertinent to the eight core competency areas to respondents based on one of three Tiers – Tier 1: Entry Level, Tier 2: Management Level, Tier 3: Leadership Level. Once the data were collected, responses from all three tiers were dichotomized to generate a “Needs Score” which when summarized represented the percentage of responses indicating a lack of knowledge or proficiency in a competency area. Tier 1 respondents had an average needs score of 60.46% in each of the eight core competency areas. Tier 2 had an average needs score of 49.50%, and Tier 3 respondents had an average needs score of 28.91%. This trend shows that individuals in leadership positions within TDOH were more likely to be knowledgeable or proficient in the eight core competency areas. Prior to administering the survey, TDOH job classifications were submitted to an expert panel within the health department. This body was tasked with assigning tiers to specific job classifications. Previous needs assessments that used the eight core competencies had respondents self-select their tier. As a test of validity the LIFEPATH survey asked TDOH employees to select their job classification in addition to tier. A Kappa test of agreement between self-selection of tier and their actual tier determined by TDOH leadership showed moderate agreement (Kappa=0.5089), suggesting that while most respondents selected the correct tier; there remained some confusion regarding tier definitions. This must be considered when evaluating the results of previous studies that utilize only the self-selected tiers to drive their survey. This data has already begun to direct training goals at the state, regional and local levels across Tennessee and will serve as a baseline measure for future evaluations of educational programing’s impact on workforce competency.

yes / Between 2008 and 2011 academic teaching staff from Leeds Beckett University (UK) and Chainama Hills College of Health Sciences (Zambia) worked together on a Development Partnership in Higher Education (DelPHe) project funded by the Department for International Development (DFID) via the British Council. The partnership focused on “up-scaling” the provision of mental health education which was intended to build capacity through the delivery of a range of workshops for health educators at Chainama College, Lusaka. The project was evaluated on completion using small focus group discussions (FGDs), so educators could feedback on their experience of the workshops and discuss the impact of learning into their teaching practice. This chapter discusses the challenges of scaling up the mental health workforce in Zambia; the rationale for the content and delivery style of workshops with the health educators and finally presents and critically discusses the evaluation findings. / Department for International Development (DFID) via the British Council

Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs'€™ integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-17T10:45:41Z No. of bitstreams: 1 DISS MP Luciano Moura. 2014.pdf: 12456929 bytes, checksum: 4c323db95b4e904c2baeb5a6cb2cd2e9 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-20T11:01:09Z (GMT) No. of bitstreams: 1 DISS MP Luciano Moura. 2014.pdf: 12456929 bytes, checksum: 4c323db95b4e904c2baeb5a6cb2cd2e9 (MD5) / Made available in DSpace on 2015-04-20T11:01:09Z (GMT). No. of bitstreams: 1 DISS MP Luciano Moura. 2014.pdf: 12456929 bytes, checksum: 4c323db95b4e904c2baeb5a6cb2cd2e9 (MD5) / O estudo analisa a produção científica sobre o planejamento da força de trabalho em saúde no período entre 1964 a 2013, ao tempo em que busca identificar critérios utilizados, métodos e as categorias de trabalhadores da saúde tomadas como objeto de estudos no Brasil. Realizou-se um levantamento de artigos nacionais selecionados nas bases de dados bibliográficas Lilacs e Scielo. Foram incluídos 58 trabalhos, analisados a partir das conjunturas políticas brasileiras em três momentos distintos, 1964 a 1979, 1980 a 1989 e 1990 a 2013. Observa-se uma tendência na utilização dos métodos normativos, iniciadas desde 1964 permanecendo ao longo de todo o período analisado. A centralização política no primeiro momento direcionou a prática do planejamento no setor saúde, com forte viés econômico, influência das organizações internacionais e foco na categoria médica. O momento seguinte, de intensa movimentação e proposta de reformulação das políticas de saúde no país é dada maior nitidez e visibilidade a estruturação da área de Recursos Humanos em Saúde. Nota-se que, embora influenciados pelo pensamento estratégico, o planejamento permaneceu com práticas e métodos normativos, voltados para os profissionais da área de enfermagem, incluindo o nível médio, técnico e universitário. Já o período entre 1990 a 2013, marcado pelo processo de implementação do SUS, caracteriza-se pela influência das políticas neoliberais, com redução do papel do Estado e forte processo de privatizações, levando ao pouco investimento no planejamento da força de trabalho em saúde (PFTS). Mesmo em um contexto preocupado com as questões sociais e de ampliação do acesso aos serviços de saúde, a preocupação com as questões referentes a força de trabalho permaneceram em respostas as discussões inerentes ao mercado de trabalho. Conclui-se que mesmo em diferentes contextos políticos e sociais, o planejamento da força de trabalho permaneceu voltado a responder as questões econômicas e com forte concentração no setor hospitalar.

Interprofessional education (IPE) is essential for enhancing students’ critical thinking skills and ability to integrate other professionals’ knowledge to ensure mutual respect and shared values for patient-centered care. The needs of medically underserved populations (MUPs) to receive behavioral health and nutritional care integrated with primary care services are significant. This research highlights the data outcomes from six offerings of a graduate IPE course on integrated health care. Funding from a Health Resources and Services Administration (HRSA) Behavioral Health Workforce and Education Training (BHWET) grant provided stipends for graduate social work and school counseling students in their final year of field working with MUPs in integrated care settings. Findings indicate significant increases in integrated care knowledge from pre- to post-course. Students reported appreciating the social justice framework of the course including food security and access to care. Students suggest that the course be required of all, not just stipend recipients. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Behavioral Health Workforce Education and Training Program Grant No. M01HP313900100. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.