March 29, 2020

Mode of Production of Human Resource for Health


Pre-Service Training — Pre-service training is a process through which individuals are made ready to enter a certain kind of professional job like as medicine, engineering, etc. The prerequisite training which people undertake in order to get a service job. The training is given before requirement. VHW, ANM, AHW, computer, driving are the examples of pre-service training. This type of training is also considered as technical education and/or vocational training which focus more in practical or skill development. In this type of training, individuals have to attend regular classes in a formal institution and need to complete a definite curriculum and courses successfully to receive a formal degree or diploma. They are not entitled to get a professional job unless they can earn a certificate, diploma, or degree from the recognized institution. Pre-service training contents emphasize mostly technical subject matter such as medical, nursing, laboratory, etc.

In-service training — It is a process of staff development for the purpose of improving the performance of an incumbent holding a position with assigned job responsibilities. It promotes the professional growth of individuals. "It is a program designed to strengthen the competencies of extension workers while they are on the job". In-service training is problem-centered, learner-oriented, and time-bound series of activities which provide the opportunity to develop a sense of purpose, broaden perception of the clientele, and increase capacity to gain knowledge and mastery of techniques. This training is short term for personnel involved in the job. The focus of in-service training is usually on a single course. In-service training may broadly be categorized into seven different types — Induction or Orientation Training, Basic Training, On-the-Job Training, Refresher or Maintenance Training, Career Development Training, Specialized Training, and Training of Trainers. All of these types of training are needed for the proper development of employees throughout their service life. In-service training is most effective in a real situation if possible (e.g., in clinical settings for clinical training, MRT, CAC, PAC).

Basic Training: This is long term training given just after the recruitment of a group of persons to a job. The training intends to develop the KSA (knowledge, skills, and abilities) of person who is responsible to perform certain activities. Minilap, Norplant, IUD are examples for first time. This training is also appropriate for newly recruited personnel. Besides technical competence and routine instruction about the organization, every staff member needs some professional knowledge about various rules and regulations of the government, administrative capability, communication skills, leadership ability, coordination and cooperation among institutions and their linkage mechanism, report writing, and so on. This type of training is made available to employees to strengthen the foundation of their service career. This training is usually provided at an early stage of service life.

Refresher training: This is short term training aims to refresh the learning in the basic training and to learn new things that is changed for immediate application and practice of the knowledge, skills (May be new) and attitude which is very needful to perform certain job. This type of training keeps the concerned personnel updated and enables them to add to the knowledge and skills they have gained already.  Thus, this training is also known as maintenance training. Minilap, Norplant, IUD are examples. 

On the Job Training (OJT): This training is imparted by the supervisor in the job situation of an employee or a person. It helps the worker in correcting minor mistakes during job performance.
Field Training: This is a part of all types of training. It has a job oriented focus used during training relating to theory and practice. It helps in getting situational experiences in the field setting. This is a very effective part of any training program and it gives an opportunity to learn from practical situation.

Formal academic training:  Formal academic trainings are these trainings which are qualified as academic career. Certificate trainings like SN, HA, Lab Tech are examples.

Formal non academic training: Formal non-academic trainings are these trainings which are not qualified as academic career.  ANM, CMA, Lab assistant are examples.

Orientation training: This training gives introductory information and skills for some services offered for new employees to start the job. The orientation training is given to the persons who have been recruited for a particular job.

Forecasting of HRH, Demand Supply, and Gap Analysis


Forecasting the need of human resources
Forecasting implies the identification of number and types of human resources for particular period of time (i.e. how many will be required, by when and of what types). Forecasting uses information from the past and present to identify expected future conditions. In HR planning, forecasting consists of estimating demand and supply, and analyzing the gap between demand and supply.

a. Estimating/forecasting demand
Forecasting is the estimation of human resource requirement in terms of quality and quantity (i.e. people with right quality and right number) with time demarcation. Demand forecasting is affected by a number of external and internal factors. External factors may consist of environmental aspects like economical, technological, political, legal, and social. Internal factors like growth, expansion and restructuring of organization; introduction of new technology; initiation of new program; nature of the job; employees productivity, turnover and absenteeism; and replacement need of employees due to resignations, retirement and termination, are the relevant factors for human resource forecasting.
Demand forecasting can be used by using mainly two methods viz. qualitative/judgmental and quantitative/statistical. The qualitative/judgmental method includes Delphi technique, nominal group technique and managerial estimate whereas quantitative/statistical methods include ratio-trend analysis, and simple and multiple linear regression analysis. In context of health, methods like need based approach, service target approach, health demand approach, population-personnel ratio, and managed health care system are used to estimate demand of health manpower.

b. Estimating/forecasting supply
Forecasting human resources supply is the estimation of human resource availability in terms of quality and quantity, from internal and external sources (i.e. within the organization and from outside the organization). Like as demand, supply estimation is also affected by some of the external and internal factors. Forecasting external supply of human resources can be predicted on the basis of global, national, regional and local level; the affecting factors may be — supply & demand of jobs or skills, educational attainment levels within a region, compensation pattern, market competition, technological development patterns, and legislative measures. Internal supply can be estimated by reviewing the data in HRIS. The supply of internal supply is affected by movement, absence and turnover of employees which are often associated with compensation and benefits, promotional opportunities, and scope for personal growth and development.
There are a variety of methods to forecast HR supply. Judgmental/qualitative methods include skills competency inventories, replacement charts, staffing tables and succession planning; and similarly statistical/quantitative methods include ratio-trend analysis, gain & loss analysis and Markov analysis.

c. Gap analysis (comparison between demand and supply)
Gap analysis identifies the differences between the forecasted HR demand and forecasted HR supply, and determines the future human requirements (number and characteristics of employees needed). Ideally, the estimation of demand and supply could balance out (i.e. identifying no gap in both the forecast), but this is a rare situation. Most likely, either HR supply exceeds demand or demand exceeds supply. When supply exceeds demand, HR surplus is identified and when demand exceeds supply, HR shortage is identified. The closer the gap between demand and supply, the better for the organization to goes into human resource procuring.
The comparison of demand and supply, if create differences between the two, organization need to choose an appropriate action designed to eliminate the gap. For e.g. in case of demand exceeds supply (i.e. shortage of human resources), organization might choose the options like — overtime work with current employees, providing extra compensation and benefits, increase training and promotions of current employees, or recruit new employees. Similarly, in case of supply exceeds demand (i.e. surplus of human resources), organization may opt the alternatives like — attrition, early retirements, demotions, layoffs, and terminations. These types of alternatives of fulfilling the gap (between demand and supply) come under the activities designed by HR action plans.



March 28, 2020

Qualitative Data Analysis

Qualitative data is an iterative process of individual and group level review and interpretation.
There are mainly three steps of qualitative data processing and analysis:

  1. Data Collection
  2. Process Data
  3. Analyse Data

Introduction of Qualitative Research

Qualitative Research is a phenomenon which cannot have numbers assigned. It is a strategy for systematic collection, organization and interpretation of textual information. Qualitative research uses inductive approaches to generate novel insights into phenomena that are difficult to measure quantitatively. For e.g. Barriers and facilitators of institutional delivery practice...Read More...

Distinction between Public health, Community Health, Social Medicine and Community Medicine

First and foremost, among these four terms the words ‘Health’ and ‘Medicine’ used should be distinguished. We define health as “a complete state of physical, mental, social and (newly added) spiritual well-being not merely absence of disease or injury” and medicine as “the science or practice of the diagnosis, treatment, and prevention of disease”. Thus, these two words separate the meaning of ‘public health’ and ‘community health’ with ‘social medicine’ and ‘community medicine’....Read More...

Nepal Initiatives on Nutrition

Implementation of nutrition programmes and interventions have historically been led by the health sector. The health sector in Nepal is guided by the Interim Constitution, which has provisioned health as the fundamental right for every citizen...Read More...

Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases (2014-2020)

There is no exact national policy related to Non-Communicable Diseases (NCDs), however, there is Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2014-2020)...Read More...

Sources of Water Pollution

With the speedy growth of population, urbanization and industrialization environmental pollution has greatly increased. The main sources of water pollution arise from many activities. The sources of water pollution can be classified as natural and anthropogenic (human-made), and on basis of source identification...Read More...

Epidemiology Relation with Public Health

Public health has itself defined epidemiology and epidemiology can be said as a key discipline of public health. It is also known as one of the core sciences of Public Health. It is also considered as the foundation methodology of Public Health Research...Read More...

Historical Evolution of Epidemiology

Disease prevention and health promotion are the main goals of public health, a multidisciplinary field that focuses on populations and communities rather than separate individuals. Epidemiology, one of the basic sciences of public health, is defined as “the study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems.” Epidemiology has played an important role in public health achievements of the last 400 years. Key historical figures and studies have included...Read More...

Scale Construction

The scale construction is viewed as a specialized area of survey design. Its main purpose is designing a questionnaire, which provides a quantitative measurement of a hypothetical variable. However, not all surveys are scales, so...Read More...

Formative Research and Its Importance

Formative Research is a research conducted during the development of a program or intervention to help decide on and describe the target audience, understand the factors which influence their behavior and determine the best ways to reach them. It looks at behaviors, attitudes, and practices of target groups; it involves exploring behavioral determinants and uses a myriad of methods to collect data...Read More...

Literature Review and Its Importance in Research

A literature review in a research is a critical discussion and summary of scholarly articles, research papers, literature that is relevant to particular area or topic under study. Literature survey or literature review is important in research with following major considerations...Read More...

Eleven Strategic Policies for Prevention and Control of Non Communicable Disease (NCDs) in Nepal

Multisectoral Action Plan for the Prevention and Control of NCDs (2014-2020) by Government of Nepal has highlighted eleven strategic policies for prevention and control of NCDs....Read More...

Public Health Ethics: Social Health Justice

Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information...Read More...

Introduction to Research

The word research was coined from a French word “CERCHIER” meaning “to seek or to search”. Thus, research is an attempt to solve or gain a solution to a problem. Research is “the process of systematically obtaining accurate answers to significant and pertinent questions by the use of the scientific method of gathering and interpreting information”.....Read More...

Types of Research

There are different types of research methods that can be classified into several categories according to the nature and purpose of the study and other attributes....Read More...

Selection of Research Problem

A research problem, in general, refers to some difficulty which a researcher experiences in the context of either a theoretical or practical situation and wants to obtain a solution for the same. Research Problem is an unanswered question that a researcher might encounter in the context of either a theoretical or practical situation.....Read More...



Reviewing the Literature

Once the problem is formulated, the researcher should undertake extensive literature survey connected with the problem and perform critical review of previous studies. Reviewing the literature expands upon the reasons for selecting a particular research question and allows the researcher to.... Read More...

Research Objectives

Research objectives describe what will be demonstrated, tested, evaluated, confirmed or compared. The objectives of a research project summarize what is to be achieved by the study. Objectives should be closely related to the statement of the problem. The formulation of objectives will help to:...Read More...

Research Hypothesis

Based on the experience with the study problem, it might be possible to develop explanations for the problem, which can then be tested. If so, hypotheses can be formulated in addition to the study objectives.

A HYPOTHESIS is a prediction of a relationship between...Read More...

Research Protocol


Research Designs

A research design is the set of methods and procedures used in collecting and analyzing measures of the variables specified in the problem research. There are different types of research designs... Read More...

Sampling and its Types

Sampling means selecting a given number of subjects from a defined population as representative of that population. The main objective of sampling is to get a representative sample of the population by minimizing time, cost and human resources, and help to estimate and test the validity of the estimated population parameter. Read More...

Data Collection Techniques and Tools

Data collection technique is a process of gathering information on targeted variables in an established systematic fashion, which then enables one to answer relevant questions and evaluate outcomes. Data collection instrument/tool refers to the device or guideline used to collect data, such as a paper questionnaire or computer-assisted interviewing system, etc. Read More...

March 24, 2020

Data Management and Analysis

After data collection, the data should be managed and processed in a systematic order to obtain valid results through appropriate analysis techniques. There are certain data processing operations before the data go through analysis procedure....Read More...

Survey

Making a single observation to measure and record something is a survey. Surveys are usually rapid, cross-sectional and mostly descriptive, one-shot (Usually not continuous) study....Read More...

Long-term Outbreak Management Approaches

Epidemics arise massively because the national health services and infrastructures fail. Due to a lack of information, people don’t know how to protect themselves. Well-run education systems and health services, as well as functioning infrastructures, are the best protection against epidemics...Read More...

Long-term Outbreak Management Approaches


Integration of Epidemic Preparedness into National and International Development and Health Policies 
Epidemics arise massively because the national health services and infrastructures fail. Due to a lack of information, people don’t know how to protect themselves. Well-run education systems and health services, as well as functioning infrastructures, are the best protection against epidemics. 
However, the path towards this ambitious goal is long and costly. A faster and more effective intervention would be the integration of epidemic prevention into all areas of development aid. In regions particularly affected by outbreaks many small and simple measures can be implemented that contribute to the protection against dangerous pathogens. 

Early Warning System for Emerging Pathogens 
Newly-emerging pathogens almost always jump from animals to humans. Ebola virus came from fruit bats or some other, yet unknown reservoir; HIV-1 from chimpanzees, swine flu from pig, etc. Strengthening the capacity of Early Warning and Reporting System (EWARS) can be one of the major long term approaches to tackle outbreak potential diseases. 

Strengthening Epidemiology and Disease Control Division 
The prevention, early detection and control of outbreaks are managed by Epidemiology and Disease Control Division (EDCD) in Nepal. EDCD should strengthen the quality and capacity of laboratories and intervention teams. 

Preparedness of Adequate Medical Response Unit 
The fast setup of medical response unit and treatment centers, in sufficient numbers, is crucial for the early containment of an outbreak. The necessary technical equipment is not a challenge. Mobile units in tents or containers have proved to be superior to fixed buildings. The provision of consumable materials (e.g., protection suits, disinfectants) should be secured through supply contracts or stockpiling, respectively. 
A far greater challenge than equipment is the personnel. The outbreak investigation team should be adequately available and prepared through continuous education (disaster medicine, languages, etc.) and, when necessary, through special field training. The Medical Response Unit should as a rule act in conjunction with aid organizations in the affected region, which in particular provide the necessary field staff. 

Development of Outbreak manuals, protocols 
The outbreak plan should clearly document or identify locally appropriate protocols for outbreak management. Outbreak protocols should encompass the entire outbreak management process. Outbreak protocols should suggest thresholds for each stage of the outbreak investigation and response. 

Research & Development (R&D) Blueprint for action to prevent epidemics 
It is a global strategy and preparedness plan that allows the rapid activation of R&D activities during epidemics. Its aim is to fast-track the availability of effective tests, vaccines and medicines that can be used to save lives and avert large scale crisis. 

Long-term substantial investments should be made to strengthen health systems so they are able to provide safe, effective and qualitative health services before, during and after epidemics. 

Others: 
  • Training to front-line responders to prepare them for emergency. 
  • Health screening of travelers especially foreigners, refugees at cross borders, airport. 
  • Maximum coverage of vaccination, especially in the unreached areas 
  • Regular surveillance of areas with past outbreak records, high risk areas

National Population Policy – 2071

Nepal has its first National Population Policy embraced by the Cabinet. The approach was highlighted when world pioneers had quite recently consented to handle rising populace and development needs taking after the fruitful consummation of 20 years of Program of Action of the International Conference on Population and Development (ICPD), Cairo, 1994....Read More...

Introduction to Community Diagnosis

According to WHO definition, it is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action”.....Read More...

Process of Community Diagnosis

There are several steps of Community diagnosis process, which are....Read More...

Micro Health Project

Micro Health Project is the implementation part of any community health diagnosis. It helps to mitigate the community health needs through community participation and maximum utilization of the community resources. The micro-health project is conducted on the prioritized real need(s).
Micro Health Process....Read More...

What is Public Health?

In 1920, Charles Edward Amory Winslow built up a fitting meaning of Public Health: “The science and art of preventing disease and promoting health and efficiency through organized community effort.”
Public health is about taking the responsibility for improving the health of the public, our community’s health. Doctors treat individual patients for a specific disease or injury. Public health professionals monitor and diagnose the health concerns of entire communities and promote healthy practices and behaviors to assure that populations stay healthy.....Read More...

A Short History of Public Health

Although medicine and public health share a lot of the same concerns relating to human health, the two disciplines approach the problem differently. Public health primarily focuses on treating the population, but these concerns about the population are tempered by concerns about the individual, the emphasis is on prevention and health promotion for the entire community and the intervention is in the areas of the environment, human behavior and medical care. Medicine focuses on the treatment of the individual, the emphasis is on diagnosis and treatment of the patient and the predominant emphasis is on medical care.....Read More...

Short-term Outbreak Management Approaches

The degree of urgency and priority placed on outbreak control depends on several factors, including the incidence and severity of disease (morbidity and mortality), whether or not the outbreak is continuing or likely to recur, the degree of public concern, and the effectiveness or practicality of the control measures themselves. 
Control measures may be considered under three areas aimed at:
  1. Outbreak source
  2. Contaminated vehicles of infection transmission
  3. Susceptible humans.
The choice of control measure within these three areas is...Read More...

Short-term Outbreak Management Approaches

The degree of urgency and priority placed on outbreak control depends on several factors, including the incidence and severity of disease (morbidity and mortality), whether or not the outbreak is continuing or likely to recur, the degree of public concern, and the effectiveness or practicality of the control measures themselves. 
Control measures may be considered under three areas aimed at:
  1. Outbreak source
  2. Contaminated vehicles of infection transmission
  3. Susceptible humans.
The choice of control measure within these three areas is dictated by factors such as whether the outbreak source is known, whether a suspected vehicle has been identified and whether a vaccine or prophylactic treatment is available for susceptible humans.

Examples of control measures aimed at the outbreak source

Outbreaks associated with food, water or environmental sources 
  • Closure of premises or site of outbreak (e.g., food premises closure) 
  • Modification of procedures (e.g., swimming pool filtration) 
  • Cleaning or disinfecting contaminated equipment or fittings (e.g., cooling towers) 
Outbreaks associated with animal contact
  • Removal from contact, treatment, isolation, immunization or destruction of animal reservoirs (e.g., immunization of cattle to prevent human leptospirosis) 
Outbreaks associated with human sources 
  • Treatment of cases and carriers (e.g., treatment of individuals with tuberculosis disease or infection) 
  • Exclusion or restriction of activities (e.g., temporary restrictions placed on food handlers or health care workers with gastroenteritis symptoms) 
  • Isolation (e.g., use of universal precautions to manage hospital in-patients infected with or carrying MRSA) 
  • Quarantine (e.g., people arriving in the country with viral hemorrhagic fever, close contacts of a confirmed case of measles) 
  • Education (e.g., advising individuals with STIs to use condoms during sexual contact) 

Examples of control measures aimed at contaminated vehicles and vectors

Outbreaks associated with contaminated food or water
  • Removal or recall of contaminated product (e.g., packaged food contaminated with Listeria) 
  • Treatment, pasteurization or sterilization of contaminated material (e.g., use of boiled or treated water) 
Outbreaks associated with vectors
  • Application of insecticides, setting traps, eliminating breeding habitats, improving management of solid waste (e.g., application of insecticide to breeding areas to control mosquito vectors) 

Examples of control measures aimed at susceptible humans

Outbreaks associated with food, water or environmental sources
  • Education to change behavior associated with food preparation or hygiene (e.g., education to improve food safety, implementation of a food safety plan) 
  • Instructions to treat or sterilize contaminated material (e.g., issuing ‘boil water’ notices) 
  • Education to reduce contact with vectors (e.g., use of screens, bed nets, long-sleeved shirts and insect repellents to reduce risk of vector borne disease) 
Outbreaks associated with human sources
  • Administration of chemo-prophylaxis (e.g., isoniazid for tuberculosis) 
  • Administration of active and passive vaccines (e.g., immune globulin and vaccine for hepatitis A) 
  • Advice on physical barriers (e.g., use of condoms to prevent STIs) 
  • General improvement in host resistance (e.g., correct malnutrition or vitamin deficiency to reduce the effects of measles)