Kisakye Angela N, Tweheyo Raymond, Ssengooba Freddie, Pariyo George W, Rutebemberwa Elizeus, Kiwanuka Suzanne N
Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Healthc Leadersh. 2016 Nov 9;8:81-94. doi: 10.2147/JHL.S107746. eCollection 2016.
A systematic review was undertaken to identify regulatory mechanisms aimed at mitigating health care worker absenteeism, to describe where and how they have been implemented as well as their possible effects. The goal was to propose potential policy options for managing the problem of absenteeism among human resources for health in low- and middle-income countries. Mechanisms described in this review are at the local workplace and broader national policy level.
A comprehensive online search was conducted on EMBASE, CINAHL, PubMed, Google Scholar, Google, and Social Science Citation Index using MEDLINE search terms. Retrieved studies were uploaded onto reference manager and screened by two independent reviewers. Only publications in English were included. Data were extracted and synthesized according to the objectives of the review.
Twenty six of the 4,975 published articles retrieved were included. All were from high-income countries and covered all cadres of health workers. The regulatory mechanisms and possible effects include 1) organizational-level mechanisms being reported as effective in curbing absenteeism in low- and middle-income countries (LMICs); 2) prohibition of private sector activities in LMICs offering benefits but presenting a challenge for the government to monitor the health workforce; 3) contractual changes from temporary to fixed posts having been associated with no reduction in absenteeism and not being appropriate for LMICs; 4) multifaceted work interventions being implemented in most settings; 5) the possibility of using financial and incentive regulatory mechanisms in LMICs; 6) health intervention mechanisms reducing absenteeism when integrated with exercise programs; and 7) attendance by legislation during emergencies being criticized for violating human rights in the United States and not being effective in curbing absenteeism.
Most countries have applied multiple strategies to mitigate health care worker absenteeism. The success of these interventions is heavily influenced by the context within which they are applied.
开展了一项系统评价，以确定旨在减少医护人员旷工的监管机制，描述这些机制在何处以及如何实施及其可能产生的影响。目的是为低收入和中等收入国家解决卫生人力资源旷工问题提出潜在的政策选择。本评价中描述的机制涉及当地工作场所和更广泛的国家政策层面。
使用MEDLINE检索词在EMBASE、CINAHL、PubMed、谷歌学术、谷歌和社会科学引文索引上进行全面的在线检索。检索到的研究上传到文献管理软件中，由两名独立的评审人员进行筛选。仅纳入英文出版物。根据评价目的提取并综合数据。
在检索到的4975篇已发表文章中，有26篇被纳入。所有文章均来自高收入国家，涵盖了所有医护人员类别。监管机制及其可能的影响包括：1）据报道，组织层面的机制在低收入和中等收入国家有效遏制旷工；2）低收入和中等收入国家禁止私营部门提供福利的活动，但这给政府监测卫生人力带来挑战；3）从临时岗位改为固定岗位的合同变更与旷工率未降低相关，且不适用于低收入和中等收入国家；4）大多数情况下实施了多方面的工作干预措施；5）低收入和中等收入国家有可能采用财务和激励监管机制；6）健康干预机制与锻炼计划相结合时可减少旷工；7）美国因违反人权而批评紧急情况下通过立法出勤的做法，且这种做法在遏制旷工方面无效。
大多数国家已采用多种策略来减少医护人员旷工。这些干预措施的成功很大程度上受到其应用背景的影响。
