Alameddine Mohamad, Khodr Hiba, Mourad Yara, Yassoub Rami, Abi Ramia Jinane
Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Department of Political Studies and Public Administration, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon.
Health Soc Care Community. 2016 May;24(3):353-62. doi: 10.1111/hsc.12210. Epub 2015 Mar 6.
The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.
全球初级卫生保健（PHC）的可持续性受到全球卫生人力资源（HRH）短缺的挑战。本研究是一次独特的尝试，旨在系统地征集和综合初级卫生保健及社区利益相关者对黎巴嫩初级卫生保健部门卫生人力资源招聘和留用策略的看法、阻碍其优化的障碍和挑战，以及克服这些障碍的建议。采用了定性设计，于2013年对黎巴嫩的22名初级卫生保健专家进行了半结构化访谈。运用Nvivo定性数据分析软件对访谈收集的数据进行主题分析。出现了五个综合主题：理解初级卫生保健范围、卫生人力资源招聘问题、卫生人力资源留用挑战、农村地区的特殊挑战以及利益相关者的建议。对利益相关者回应的分析表明，对初级卫生保健范围缺乏统一认识，影响了进行适当卫生人力资源规划的能力。确定的招聘障碍包括卫生人力资源供应不足、资金限制和管理不善。留用困难归因于工作环境差、资金限制和缺乏职业发展机会。大家一致认为，农村地区面临的卫生人力资源挑战更为严峻，危及了公平获得高质量初级卫生保健服务的机会。在许多女性更喜欢同性提供者的社会文化背景下，报告的女性卫生人力资源短缺也危及了公平获得服务的机会。该研究为扩大招聘和留用政策及做法指明了方向，方法是认可全国公认的初级卫生保健定义和范围、可持续发展初级卫生保健劳动力，并实施针对农村地区和性别平等的有针对性的招聘和留用策略。敦促决策者和规划者将卫生人力资源确定为初级卫生保健计划和干预措施取得成功的最重要投入，特别是在心理健康和老年护理等不断发展的领域。
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