School of Health Systems and Public Health, University of Pretoria, 31 Bophelo Road, Gezina, Pretoria, South Africa.
Department of Political and Administrative Studies, University of Zimbabwe, P.O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
Hum Resour Health. 2017 Dec 16;15(1):83. doi: 10.1186/s12960-017-0260-x.
The need to understand how healthcare worker reform policy interventions impact health personnel in peri-urban areas is important as it also contributes towards setting of priorities in pursuing the universal health coverage goal of health sector reform. This study explored the impact of post 2008 human resource for health reform policy interventions on healthcare workers in Epworth, a peri-urban community in Harare, Zimbabwe, and the implications towards health sector reform policy in peri-urban areas.
The study design was exploratory and cross-sectional and involved the use of qualitative and quantitative methods in data collection, presentation, and analysis. A qualitative study in which data were collected through a documentary search, five key informant interviews, seven in-depth interviews, and five focus group discussions was carried out first. This was followed by a quantitative study in which data were collected through a documentary search and 87 semi-structured sample interviews with healthcare workers. Qualitative data were analyzed thematically whilst descriptive statistics were used to examine quantitative data. All data were integrated during analysis to ensure comprehensive, reliable, and valid analysis of the dataset.
Three main factors were identified to help interpret findings. The first main factor consisted policy result areas that impacted most successfully on healthcare workers. These included the deployment of community health workers with the highest correlation of 0.83. Policy result areas in the second main factor included financial incentives with a correlation of 0.79, training and development (0.77), deployment (0.77), and non-financial incentives (0.75). The third factor consisted policy result areas that had the lowest satisfaction amongst healthcare workers in Epworth. These included safety (0.72), equipment and tools of trade (0.72), health welfare (0.65), and salaries (0.55).
The deployment of community health volunteers impacted healthcare workers most successfully. This was followed by salary top-up allowances, training, deployment, and non-financial incentives. However, health personnel were least satisfied with their salaries. This had negative implications towards health sector reform interventions in Epworth peri-urban community between 2009 and 2014.
了解医疗工作者改革政策干预如何影响城市周边地区卫生人员非常重要，因为这也有助于确定在追求全民健康覆盖目标的卫生部门改革方面的优先事项。本研究探讨了 2008 年后人力资源卫生改革政策干预对津巴布韦哈拉雷城市周边社区埃普沃思卫生工作者的影响，以及这些干预对城市周边地区卫生部门改革政策的影响。
研究设计是探索性和横断面的，涉及定性和定量方法在数据收集、呈现和分析中的使用。首先进行了一项定性研究，通过文献检索、五次关键知情人访谈、七次深入访谈和五次焦点小组讨论收集数据。然后进行了一项定量研究，通过文献检索和对 87 名卫生工作者的半结构式样本访谈收集数据。定性数据进行主题分析，而定量数据则使用描述性统计进行分析。在分析过程中整合了所有数据，以确保对数据集进行全面、可靠和有效的分析。
确定了三个主要因素来帮助解释研究结果。第一个主要因素包括对卫生工作者影响最大的政策结果领域。其中包括与社区卫生工作者部署相关的最高相关性为 0.83。第二个主要因素包括财政激励措施，相关性为 0.79，培训和发展（0.77），部署（0.77）和非财政激励措施（0.75）。第三个因素包括城市周边埃普沃思卫生工作者满意度最低的政策结果领域。其中包括安全（0.72）、设备和工具（0.72）、健康福利（0.65）和工资（0.55）。
社区卫生志愿者的部署对卫生工作者的影响最大。其次是工资补贴、培训、部署和非财政激励措施。然而，卫生人员对工资最不满意。这对 2009 年至 2014 年期间埃普沃思城市周边社区的卫生部门改革干预措施产生了负面影响。
