What do health workers in Timor-Leste want, know and do? Findings from a national health labour market survey

Human Resources for Health

Research

Estanislau Saldanha¹  Fernanda Julia¹  Tomas Lievens²  Rashid U. Zaman²  Kay Engelhardt²  Sophie Witter³  Firdaus Hafidz⁴  Toomas Palu⁵  Eileen B. Sullivan⁵  Xiaohui Hou⁵  Christophe Lemiere⁵ 

[1] Dili Institute of Technology, Dili, Timor-Leste;Oxford Policy Management, Oxford, United Kingdom;Oxford Policy Management, Oxford, United Kingdom;Queen Margaret University, Edinburgh, United Kingdom;Oxford Policy Management, Oxford, United Kingdom;Universitas Gadjah Mada, Yogyakarta, Indonesia;World Bank, Washington, DC, United States of America;

关键词: Health workers;    Doctors;    Nurses;    Midwives;    Motivation;    Competence;    Performance;    Timor-Leste;   

DOI  :  10.1186/s12960-016-0164-1

 received in 2016-02-29, accepted in 2016-11-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe objectives of this study were to understand the labour market dynamics among health workers, including their preferences and concerns, and to assess the skills, competence and performance (i.e. the ‘know–do gap’) of doctors working in Timor-Leste.MethodsThis cross-sectional survey was implemented in all 13 districts of Timor-Leste in 2014. We surveyed 443 health workers, including 175 doctors, 150 nurses and 118 midwives (about 20% of the health workers in the country). We also observed 632 clinical consultations with doctors, including 442 direct clinical observations, and tested 190 vignettes.ResultsThe study highlights some positive findings, including the gender balance of health workers overall, the concentration of doctors in rural areas, the high overall reported satisfaction of staff with their work and high motivation, the positive intention to stay in the public sector, the feeling of being well prepared by training for work, the relatively frequent and satisfactory supervisions, and the good attitudes towards patients as identified in observations and vignettes. However, some areas require more investigations and investments. The overall clinical performance of the doctors was very good in terms of attitude and moderate in regard to history taking, health education and treatment. However, the average physical examination performance score was low. Doctors performed better with simulated cases than the real cases in general, which means they have better knowledge and skills than they actually demonstrated. The factors that were significantly associated with the clinical performance of doctors were location of the health facility (urban doctors were better) and consultation time (cases with more consultation time were better). Regression analysis suggests that lack of knowledge was significantly associated with lack of performance, while lack of motivation and equipment were not significant.ConclusionsThe survey provides essential information for workforce planning and for developing training policies and terms and conditions that will attract and retain health workers in rural service. Improving the work environment and performance of doctors working in rural health facilities and ensuring compliance with clinical protocols are two priority areas needed to improve the performance of doctors in Timor-Leste.

【 授权许可】

CC BY   
© The Author(s). 2016