2023-09-28 14:46:10 +00:00
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abstract: 'Background: Low-and middle-income countries (LMICs) are the worst
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affected by a lack of safe and affordable access to safe surgery. The
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significant unmet surgical need can be in part attributed to surgical
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workforce shortages that disproportionately affect rural areas of these
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countries. To combat this, Malawi has introduced a cadre of
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non-physician clinicians (NPCs) called clinical officers (COs), trained
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to the level of a Bachelor of Science (BSc) in Surgery. This study
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explored the barriers and enablers to their retention in rural district
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hospitals (DHs), as perceived by the first cohort of COs trained to BSc
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in Surgery level in Malawi. Methods: A longitudinal qualitative research
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approach was used based on interviews with 16 COs, practicing at DHs,
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during their BSc training (2015); and again with 15 of them after their
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graduation (2019). Data from both time points were analysed and compared
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using a top-down thematic analysis approach. Results: Of the 16 COs
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interviewed in 2015, 11 intended to take up a post at a DH following
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graduation; however, only 6 subsequently did so. The major barriers to
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remaining in a DH post as perceived by these COs were lack of promotion,
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a more attractive salary elsewhere; and unclear, stagnant career
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progression within surgery. For those who remained working in DH posts,
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the main enablers are a willingness to accept a low salary, to generate
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greater opportunities to engage in additional earning opportunities; the
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hope of promotional opportunities within the government system; and
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greater responsibility and recognition of their surgical knowledge and
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skills as a BSc-holder at the district level. Conclusion: The
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sustainability of surgically trained NPCs in Malawi is not assured and
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further work is required to develop and implement successful retention
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strategies, which will require a multi-sector approach. This paper
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provides insights into barriers and enablers to retention of this
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newly-introduced cadre and has important lessons for policy makers in
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Malawi and other countries employing NPCs to deliver essential surgery.'
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affiliation: 'Gajewski, J (Corresponding Author), Royal Coll Surgeons Ireland, Inst
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Global Surg, Dublin 2, Ireland.
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Gajewski, Jakub, Royal Coll Surgeons Ireland, Inst Global Surg, Dublin 2, Ireland.
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Wallace, Marisa, Maastricht Univ, Fac Hlth Med \& Life Sci, Maastricht, Netherlands.
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Pittalis, Chiara; Brugha, Ruairi, Royal Coll Surgeons Ireland, Div Populat Hlth
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Sci, Dublin 2, Ireland.
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Mwapasa, Gerald; Borgstein, Eric, Coll Med Malawi, Dept Surg, Blantyre, Malawi.
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Bijlmakers, Leon, Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.'
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author: Gajewski, Jakub and Wallace, Marisa and Pittalis, Chiara and Mwapasa, Gerald
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and Borgstein, Eric and Bijlmakers, Leon and Brugha, Ruairi
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author-email: jakubgajewski@rcsi.ie
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author_list:
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- family: Gajewski
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given: Jakub
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- family: Wallace
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given: Marisa
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- family: Pittalis
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given: Chiara
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- family: Mwapasa
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given: Gerald
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- family: Borgstein
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given: Eric
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- family: Bijlmakers
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given: Leon
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- family: Brugha
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given: Ruairi
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da: '2023-09-28'
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doi: 10.34172/ijhpm.2020.142
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earlyaccessdate: AUG 2020
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eissn: 2322-5939
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files: []
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journal: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
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keywords: Non-physician Clinicians; Task-Sharing; Global Surgery; Malawi
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keywords-plus: 'HEALTH-PROFESSIONALS; BRAIN-DRAIN; NONPHYSICIAN CLINICIAN; INTERNATIONAL
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NGOS; WORKFORCE; AFRICA; PROGRAM; CARE'
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language: English
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month: MAR
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number: '3'
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number-of-cited-references: '49'
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orcid-numbers: 'Brugha, Ruairi/0000-0003-0729-0197
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Bijlmakers, Leon/0000-0003-2252-0579
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Pittalis, Chiara/0000-0003-3465-9850'
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pages: 354-361
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papis_id: 23a369294e810dabcf5dbb4a7fbb4728
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ref: Gajewski2022whydo
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researcherid-numbers: 'Brugha, Ruairi/C-8420-2012
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Bijlmakers, Leon/P-6949-2015
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'
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times-cited: '5'
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title: Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in
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District Hospitals in Malawi
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000719922500001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '1'
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volume: '11'
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web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
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year: '2022'
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