The Impact of Work Environment on the
Performance of Health Workers in Sudan
Nuha Ibrahim
Centre for Global Health-Trinity College Dublin
Contents:
Background
-Sudan
-Performance of Health Workers
-Work Environment in healthcare
Research Problem
Methodology
Expected Outcomes
1-Sudan (40 million- North Sudan about 31 million)
Since1956, internal wars and conflicts have been ongoing in
different regions of the country
Disparities and inequality between rural-urban areas in terms of
their development trends
60-75 % of the population in the North and 90% of the
population in the South are living below the poverty line of less
than $1 per day
The social, economic and political situation of Sudan shapes
the health status of the country to large extent.
Challenges communicable and non-communicable
diseases
Table 2.2.1: The Status of MDGs in Sudan in 2008 (Source: UNDP Sudan 2010)
MDGs
Some of the Indicators for the MDGs
MDG 1
Estimated Poverty Incidence
Eradicate poverty
(% of total population)
MDG 2
Northern Sudan
2015 Target
50%
45%
Gross Primary Education Enrolment Ratio
62%
100%
Ratio Girls to Boys in Primary Education
88%
100 %
Under-5 Mortality Rate (per 1,000)
105
35
*MDG 5
Maternal Mortality Ratio (per 100,000 live
638
127
Improve maternal health
births)
Birth Attended by Skilled Health Staff*
57%
90%
HIV/AIDS Prevalence (% adults aged 15-49)
1.6%
-
90
-
54.2%
-
58.7%
85%
Achieve universal primary education
MDG 3
Promote gender equality and
empowering women
*MDG 4
Reduce child mortality
*MDG 6
Combat HIV/AIDS, malaria and other
diseases
Incidence of T.B (Per 100,000 per year)
Children under 5 with Fever Treated with
Anti-Malarias (%)
MDG 7
Access to Improved Drinking Water Source
Sustainable development
(% of Population)
Access to Improved Sanitation(% of
39.9%
67%
Population)
MDG 8
Develop a global partnership for
The Darfur Crisis is currently preventing progress in global partnership for development.
Examples of Health indicators
Country
No of Doctors/
Total expenditure on
Total expenditure on
Life
100,000 in
health per capita (Intl
health as % of GDP
Expectancy
population.
$, 2009)
(2009)
Population
(2008 & 2009)
Sudan
28
161
7.3
59/59
40,272,000 !
Ethiopia
***
40
4.3
53/56
82,825,000
Kenya
14 (2006)
68
4.3
58/62
39,802,000
Egypt
283
282
5
69/73
82,999,000
Jordan
245
499
9.3
69/74
6,316,000
Ireland
279
4005
9.7
77/82
4.,515,000
The increase in number of medical schools in Sudan, 1990-2001
(Source: Sudan Health System Profile 2007)
Faculty
Number
before Number
educational reform
educational
after Private
Percentage
faculties
increase
26
6
766%
Pharmacy 1
8
5
700%
Dentistry
1
8
5
700%
Nursing
1
7
2
500%
reform
Medicine
3
56% of doctors in Sudan work in Khartoum city
(pop=9 million)
Doctor/population ratio 28/100,000
Migration of doctors: 60% (12,000 of 21,000) of
those who registered in Sudanese Medical Council
are working overseas
“Osmosis Migration”
Movement rights
Push Factors
Pull Factors
Migration of Doctors from Developing to Developed countries: Supply and Demand
The global attention to deal with the HRH
crisis is focus on two important aspect
1- The retention of health workers
-The ethical recruitment by high income countries
- Retention strategies in low income countries
2-Ensuring the available workers are performing
well to provide quality of care
2-Performance of HWs
The WHO 2006:
“Performance is considered to be a combination of Staff being available
(retained & present), and staff being competent, productive and
responsive”.
Or simply (Adherence to an accepted standard or guideline)
factors influencing staff retention and mobility can be distinguished:
- Personal and lifestyle-related factors, including living circumstances;
- work-related factors, related to preparation for work during pre-service
education;
- health-system related factors, such as human resources policy and planning;
- job satisfaction, influenced by health facility factors, such as financial
considerations, working conditions, management capacity and styles,
professional advancement and safety at work.
Why it is important ?
For long time poor performance was due to lack of knowledge and
training, the reason why we had all the intervention s focusing only
on training of HWs. Which lead to disappointing long terms results
(1).
How to measure it?
“We can only be sure to improve what we can actually measure”
*Why it is important to measure performance: to support improvement
in the quality of services (2)
3-Work Environment
Definition?
The WHO report 2010 defined the supportive work
environment as
“an environment that attracts individuals into the health
professions, encourages them to remain in the health
workforce and enables them to perform effectively”.
Elements of work environments such as:
Safety
Management
Communication
Support, Supervision
Fairness and equality
Kramer & Schmalenberg (2002):
8 Essentials of the Work Environment
Interviewed 289 staff nurses in 14 Magnet hospitals
What are essential elements of the work environment to
delivery quality care (rank order)
1.
Working with clinically competent nurses
2.
3.
Good nurse-physician relationship and communication
Nurse autonomy and accountability
4.
Support nurse manager/supervisor
5.
Control over nursing practice
6.
7.
Support for education
Adequate nurse staffing
8.
Culture where concern for the patient is paramount
http://www.qdocuments.com/The-Power-of-the-Magnet-Hospital-Credential-Excellence-in-Nursing--PPT.html
Public hospitals:
"Public hospitals are asked to do more and more
with less and less, until it feels like you're doing
everything with nothing.”
Ron J. Anderson, MD President and CEO, Parkland Health and Hospital System, Dallas, TX
Aim of the research
What are the factors in the work environment
that affect the performance of doctors and
nurses in public hospitals in Khartoum?
Availability
Productivity
Responsiveness
Competence
Pre-service Training
Political Situation
In-service Training
Safety of HWs
Personal Attitude
Education
Career Development
Social Environment
Economic stability and security issues
Supportive Supervision
Cleanness
Physical Infrastructures
Availability of Data
Performance Appraisal system
The quality of available data
Managing available resources
Intention to leave
Health System Policies and Strategies
Accountability
Availability of resources; drugs, water etc.
Communication: Management, staff & Clients
Transparency
Trust
Leadership style
Respect
Clear Job Description
Recruitment & Decruitment System
Motivation & Satisfaction
Types of diseases
Teamwork
Community Participation
Methodology
-Survey (i.e. Work Environment Index+
Performance self evaluated questionnaire!..)
for Doctors and nurses
-Key informative interviews (i.e. Managers..)
- Focus Group discussion
MOH
Management
Doctors
Nurses
Data
1
What kind of
Data available
there?
11 public teaching
hospitals in
khartoum
Or maybe 1 of
them!!
Managemen
t system
Hospital Environment!!
Availability
i.e.
Teamwork
Productivity
Training&..
Attendance
Performance of
Health workers
Competence
Communication
!!
Availability of d,
w, e, etc...
Staff ratios
Responsiveness
Waiting time
Patients
Satisfaction
Communication
with patients
Job satisfaction
Intention to leave
i.e. Work Index
Expected outcomes
The expected outcomes will help to understand the
impact of work environment on the performance of health
workers in low income settings .
This will lead to designing better interventions to improve
the performance of HWs in public hospitals, to have better
quality of services and higher staff retention rate for better
health outcomes.
Having tool to measure performance and work
environment on a regular basis as a way to monitor and
improve the quality of the services
Research Plan
Research Protocol September 2011
Ethical approval December2011
Data collection by 2011_2012
Analysis and writing 2013
Finish by 2014