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author:("begin, Joel")
1.  Foreign-born health workers in Australia: an analysis of census data 
Background
Provide an up-to-date national picture of the medical, midwifery and nursing workforce distribution in Australia with a focus on overseas immigration and on production sustainability challenges.
Methods
Using 2006 and 2011 Australian census data, analysis was conducted on medical practitioners (doctors) and on midwifery and nursing professionals.
Results
Of the 70,231 medical practitioners in Australia in 2011, 32,919 (47.3%) were Australian-born, with the next largest groups bring born in South Asia and Southeast Asia. In 2006, 51.9% of medical practitioners were born in Australia. Of the 239,924 midwifery and nursing professionals in Australia, 127,911 (66.8%) were born in Australia, with the next largest groups being born in the United Kingdom and Ireland and in Southeast Asia. In 2006, 69.8% of midwifery and nursing professionals were born in Australia. Western Australia has the highest percentage of foreign-born health workers. There is a higher percentage of Australia-born health workers in rural areas than in urban areas (82% of midwifery and nursing professional in rural areas are Australian-born versus 59% in urban areas). Of the 15,168 additional medical practitioners in Australia between the 2006 and 2011 censuses, 10,452 (68.9%) were foreign-born, including large increases from such countries as India, Nepal, Philippines, and Zimbabwe. We estimate that Australia has saved US$1.7 billion in medical education costs through the arrival of foreign-born medical practitioners over the past five years.
Conclusions
The Australian health system is increasingly reliant on foreign-born health workers. This raises questions of medical education sustainability in Australia and on Australia’s recruitment from countries facing critical shortages of health workers.
doi:10.1186/1478-4491-11-69
PMCID: PMC3882294  PMID: 24377370
Australia; Doctors; Health workforce; Migration; Nurses
2.  Building health systems capacity in global health graduate programs: reflections from Australian educators 
There has been increasing focus on the role of health systems in low and middle-income countries. Despite this, very little evidence exists on how best to build health systems program and research capacity in educational programs. The current experiences in building capacity in health systems in five of the most prominent global health programs at Australian universities are outlined. The strengths and weaknesses of various approaches and techniques are provided along with examples of global practice in order to provide a foundation for future discussion and thus improvements in global health systems education.
doi:10.1186/1472-698X-12-14
PMCID: PMC3489888  PMID: 22920502
3.  Brain Gains: a literature review of medical missions to low and middle-income countries 
Background
Healthcare professionals’ participation in short-term medical missions to low and middle income countries (LMIC) to provide healthcare has become common over the past 50 years yet little is known about the quantity and quality of these missions. The aim of this study was to review medical mission publications over 25 years to better understand missions and their potential impact on health systems in LMICs.
Methods
A literature review was conducted by searching Medline for articles published from 1985–2009 about medical missions to LMICs, revealing 2512 publications. Exclusion criteria such as receiving country and mission length were applied, leaving 230 relevant articles. A data extraction sheet was used to collect information, including sending/receiving countries and funding source.
Results
The majority of articles were descriptive and lacked contextual or theoretical analysis. Most missions were short-term (1 day – 1 month). The most common sending countries were the U.S. and Canada. The top destination country was Honduras, while regionally Africa received the highest number of missions. Health care professionals typically responded to presenting health needs, ranging from primary care to surgical relief. Cleft lip/palate surgeries were the next most common type of care provided.
Conclusions
Based on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed.
doi:10.1186/1472-6963-12-134
PMCID: PMC3474169  PMID: 22643123
medical missions; low- and middle-income countries; volunteer; human resources
4.  Analysis of policy implications and challenges of the Cuban health assistance program related to human resources for health in the Pacific 
Background
Cuba has extended its medical cooperation to Pacific Island Countries (PICs) by supplying doctors to boost service delivery and offering scholarships for Pacific Islanders to study medicine in Cuba. Given the small populations of PICs, the Cuban engagement could prove particularly significant for health systems development in the region. This paper reviews the magnitude and form of Cuban medical cooperation in the Pacific and analyses its implications for health policy, human resource capacity and overall development assistance for health in the region.
Methods
We reviewed both published and grey literature on health workforce in the Pacific including health workforce plans and human resource policy documents. Further information was gathered through discussions with key stakeholders involved in health workforce development in the region.
Results
Cuba formalised its relationship with PICs in September 2008 following the first Cuba-Pacific Islands ministerial meeting. Some 33 Cuban health personnel work in Pacific Island Countries and 177 Pacific island students are studying medicine in Cuba in 2010 with the most extensive engagement in Kiribati, the Solomon Islands, Tuvalu and Vanuatu. The cost of the Cuban medical cooperation to PICs comes in the form of countries providing benefits and paying allowances to in-country Cuban health workers and return airfares for their students in Cuba. This has been seen by some PICs as a cheaper alternative to training doctors in other countries.
Conclusions
The Cuban engagement with PICs, while smaller than engagement with other countries, presents several opportunities and challenges for health system strengthening in the region. In particular, it allows PICs to increase their health workforce numbers at relatively low cost and extends delivery of health services to remote areas. A key challenge is that with the potential increase in the number of medical doctors, once the local students return from Cuba, some PICs may face substantial rises in salary expenditure which could significantly strain already stretched government budgets. Finally, the Cuban engagement in the Pacific has implications for the wider geo-political and health sector support environment as the relatively few major bilateral donors, notably Australia (through AusAID) and New Zealand (through NZAID), and multilaterals such as the World Bank will need to accommodate an additional player with whom existing links are limited.
doi:10.1186/1478-4491-10-10
PMCID: PMC3447691  PMID: 22558940
5.  Anti-Retroviral Treatment Outcomes among Older Adults in Zomba District, Malawi 
PLoS ONE  2011;6(10):e26546.
Background
There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes.
Methods
A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan–Meier survival plots and Cox proportional hazards regression models.
Results
There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419) were more likely to be male (P<0.0001) and located in rural areas (P = 0.003) than those aged 25–49. Crude survival estimates among those aged 50–59 were not statistically different from those aged 25–49 (P = 0.925). However, survival among those aged 60 and older (N = 345) was worse (P = 0.019) than among those 25–59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50–59 did not differ significantly from those aged 25–49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25–49.
Conclusions
Treatment outcomes of those aged 50–59 are similar to those aged 25–49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services.
doi:10.1371/journal.pone.0026546
PMCID: PMC3198738  PMID: 22031839

Results 1-5 (5)