Explore the vast range of titles available.

Background Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. Methods We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion. Results Stability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. Conclusions This study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.

ObjectivesThis study examined the impact of hospital readiness on patient safety from the healthcare workers’ perspective.DesignThe study employed a mixed-methods explanatory sequential design, with the quantitative phase taking precedence. We conducted an online survey of 235 healthcare workers at COVID-19 referral hospitals, followed by an interview with 11 participants from various hospital types.SettingCOVID-19 referral hospitals in Indonesia.ParticipantsHealth workers working at COVID-19 referral hospitals.MeasuresHospital ownership; hospital accreditation status; hospital readiness including incident management system, surge capacity, infection control and prevention, and human resource management; patient safety incident.ResultsAccording to the survey, 66.4% of the participants worked at a hospital owned by the provincial or district government, and 69.4% worked at a hospital which had received an excellent status accreditation. More than 80% of the hospitals scored well in the categories of the incident management system (86%), surge capacity (80.9%), infection control and prevention (97.9%), and human resource management (84.7%). However, only 50.6% of the hospitals scored well in managing patient safety incidents. Hospital ownership, accreditation status and hospital readiness all have an impact on patient safety incidents, which were reported in all types of hospitals by both studies.ConclusionsThis study provides significant results for Indonesia in terms of hospital preparedness and patient safety for the COVID-19 pandemic. The accreditation and ownership status of the hospital have aided hospital readiness. Despite the fact that no hospital in the world was prepared for the COVID-19 pandemic, hospital readiness has improved a year later; however, patient safety has not improved. Patient safety incidents occurred regardless of hospital status, with the most common occurrence being delayed treatment. Administrative errors were also recorded in COVID-19 field hospitals that were not accredited. Future research should focus on improving pandemic care quality and implementing initiatives that are applicable to all types of hospitals.

In many Indian states, public health programs are led by clinicians without formal training in leadership and management, limiting their effectiveness. To tackle this, Uttar Pradesh's Department of Medical, Health, and Family Welfare initiated a Public Health Management and Leadership (PHML) training program for the Level 4 (mid-career) medical officers. This program aims to enhance the leadership and management skills necessary for these officers to support them transitioning to administrative roles. The training focused on essential competencies such as leadership, communication, team building, fiscal management, and public health problem-solving. It included in-person sessions and mentored practicum, utilizing experiential learning and problem-solving group projects. Kirkpatrick's model was used to evaluate participants' reactions, learning outcomes, and behavior change. Feedback was analyzed using descriptive statistics across 12 training domains, while pre- and post-training test scores were compared using paired t-tests in Stata 18 to measure learning improvements. Participant interviews provided additional insights. Participants reported high satisfaction with the learning environment and methods but faced challenges in applying management concepts, citing limited contextual input and faculty interaction. Learning outcomes showed moderate improvement, with average test scores rising from 53.3 to 59.6 (p = 0.003). They successfully applied a structured problem-solving framework in practicum projects and created action plans for public health challenges. Participants recommended adding topics on financing, procurement, human resources, and hospital management to support them in performing their core functions. Barriers to applying learned concepts included human resource constraints, limited autonomy, gender stereotypes, and lack of recognition. Emphasizing leadership competencies, experiential learning, and mentored practicum holds promise. However, customizing the curriculum to UP's specific context, ensuring sufficient training time, focusing on core management functions, and addressing organizational barriers are vital. Integrating these recommendations into blended training that enhances core managerial skills and leadership development can strengthen workforce capabilities.

IntroductionAfghanistan’s health system has faced considerable challenges since the Taliban takeover in 2021, leaving the population vulnerable to an increased risk of morbidity and mortality. Research to illuminate the current functioning of the health system and approaches for strengthening its key components is critically needed to address imminent and evolving health needs of the Afghan people.MethodsA health systems’ research agenda for Afghanistan that uses a systematic and evidence-based wisdom of the crowds’ approach has yet to be developed. Using the Child Health and Nutrition Research Initiative methodology, this study identifies the top 20 health systems’ research priorities among experienced Afghanistan health researchers. Priorities were also considered when disaggregating data by subgroups, such as Afghan versus non-Afghan respondents and those from low- and middle-income versus high-income settings.ResultsA total of 303 researchers were invited to score the research questions; 86 responded to the scoring survey and 55 completed it (60% were of Afghan origin). The highest priority questions were relatively diverse in terms of topic area, with questions spanning system-level factors, healthcare quality, community-based healthcare, improvements in the pharmaceutical sector, epidemiological trends, health management information systems and surveillance, access to care and approaches to improving service delivery in Afghanistan, among many others. ‘Delivery’-focused and ‘development’-focused questions were prioritised, demonstrating that participants assigned greater importance to more practical research questions that would explore features of and approaches to improving existing health system structures within the current Afghan context. Results were consistent across subgroups.ConclusionThis research prioritisation exercise fills a gap by generating consensus and establishing a research agenda for strengthening Afghanistan’s health system.

The need for emergency preparedness training for healthcare administration professionals has increased significantly with more frequent weather and man-made disasters throughout the United States disrupting the continuity of healthcare organizations' operations. This paper explores the current state of emergency management education since Houser and Houser's 2006 groundbreaking study of bioterrorism and mass-casualty management education in healthcare administration programs more than a decade ago. A survey of undergraduate and graduate healthcare management programs was conducted in the spring of 2014 to collect information on the extent of coursework and/or instruction about emergency preparedness and the healthcare executive's role. Findings from the survey strongly echo those from Houser and Houser's study, suggesting relative stability in the scope and focus of healthcare administration emergency management education. However, the new national disaster mentality \"reality\" identified by these authors has not driven healthcare management curricular augmentation or sharp increases in academic engagement, and gaps in emergency management education for healthcare administration faculty continue to exist.

Background: National Public Health Institutes (NPHIs) are government agencies that provide science‑based leadership and coordination for public health functions. They are often formed by merging existing public health entities and functions found across and beyond the health sector, seeking to reduce fragmentation and enhance national preparedness and response. Their effectiveness depends on scientific rigor and sustainable capacity that can endure fluctuations in funding and priorities. Objective: To present the NPHI Organizational Strengthening Module (OSM) framework—a practical, adaptable set of tools designed to strengthen organizational design and performance management of NPHI’s to institutionalize core public health functions and improve resilience and responsiveness to emerging health threats. Methods: The OSM framework originates from the field of organizational development (OD) and builds on approaches validated in business and public sectors. The framework is tailored to meet the specific OD needs of NPHIs and was developed through reviewing and adapting tools, combined with piloting of each module. Findings: The OSM framework includes a foundational public health function mapping activity and has six independent modules: strategy, partnerships, communication, workforce, finance, and governance—supported by a cross‑cutting change management workstream. Each OSM consists of 3–4 concrete steps, beginning with a domain‑specific assessment, followed by guided actions and best practices. OSMs are delivered through 3–6‑month sprints, typically culminating in a 2–5‑year strategy. Designed to engage senior leadership, the tools can be implemented virtually or in‑person by internal staff or external facilitators. Conclusions: The OSM framework provides a systematic, evidence‑informed approach to organizational strengthening for NPHIs. By focusing on strengthening the strategic and operational capacity of the organization, this approach supports NPHIs in becoming more effective and resilient stewards of national public health, capable of anticipating and responding to emerging health threats.

Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan. Contracts to NGOs were made to deliver a common set of primary care services in each province, with the funding agencies determining contract terms. The contracting approaches could be classified into three contracting out types (CO-1, CO-2 and CO-3) and a contracting-in (CI) approach based on the contract terms, design and implementation. Exit interviews of patients attending randomly sampled primary health facilities were collected through systematic sampling across 28 provinces at two time points. The outcome, the odds that a client attending a health facility is poor, was modelled using logistic regression with a robust variance estimator, and the effect of contracting was estimated using the difference-in-difference approach combined with stratified analyses. The sample covered 5960 interviews from 306 health facilities in 2005 and 2008. The adjusted odds of a poor client attending a health facility over time increased significantly for facilities under CO-1 and CO-2, with odds ratio of 2.82 (1.49, 5.36) P-value 0.001 and 2.00 (1.33, 3.02) P-value 0.001, respectively. The odds ratios for those under CO-3 and CI were not statistically significantly different over time. When compared with the non-contracting facilities, the adjusted ratio of odds ratios of poor status among clients was significantly higher for only those under CO-1, ratio of 2.50 (1.32, 4.74) P-value 0.005. CO-1 arrangement which allows contractors to decide on how funds are allocated within a fixed lump sum with non-negotiable deliverables, and actively managed through an independent government agency, is effective in improving equity of health services provision.

Abstract Medical injury consistently ranks among the most expensive hospital stay diagnoses and represents a frequent cause of hospital readmission. Although older adults are at greater risk of medical injury, in part, because of greater incidence of comorbidity and increased medical complexity, little is known about the burden of medical injury leading to ED use or the costs and outcomes associated with these events among older adults. In response, this study used nationally representative data from the 2014 Nationwide Emergency Department Survey to examine the epidemiology of older adult ED-visits for medical injury. Principal diagnosis codes were grouped using AHRQ’s Clinical Classification Software to identify medical injury-related visits. Results indicated that in 2014, 506,466 ED-visits for medical injuries occurred, comprising 2% of all older adult ED-visits. Leading causes of medical injury included malfunction of device, implant and grafts (24%); infection and inflammation of internal prosthetic device, implant, and graft (16%), and other complications of surgical and medical procedures (15%). Risk factors for medical injury included being male, Medicaid as primary payor, and number of chronic conditions. Multinominal logistic regression and multivariate regression results indicate that Medical injury-related ED visits were associated with higher hospitalization risk (RRR=2.08, p<0.000), 27% longer hospital stays, and 24% higher total charges relative to non-medical injury related visits. However, medical injury was not associated with risk of death after adjustment. Study findings suggest that ED-visits for medical injury occur frequently among older adults and are associated with significant burden and cost.

Abstract Previous studies reported that high Nursing Home Administrator (NHA) turnover correlates with low staff morale and poorer care outcomes. The purpose of this study was to assess how NHA job satisfaction (JS) (in five subscales: job content, coworkers, work demands, work load, work skills, and rewards) interacts with role conflict and ambiguity, autonomy, work conflict, and influence and to estimate the odds of having NHA’s intent to quit by degree of job satisfaction. A total 208 responses were collected from the online survey in 2017 among NHAs currently working in nursing homes in 5 states. We analyzed the data using descriptive statistics and ordinal logistic regression models. The findings suggested that NHAs were generally satisfied in all JS subscales and expressed moderately high levels of autonomy, neutral levels of work conflict, role conflict and role ambiguity. NHAs with good coworker relations (adjusted odds ratio [AOR]=0.67), fair job demands (AOR=0.68) and rewards (A0R=0.8), were less likely to harbor quitting intents. Interestingly, NHAs reporting higher job skills were more likely to consider leaving nursing homes (AOR=1.46). Overall, study findings are consistent with previous JS research with the exception that higher perceived skill efficacy was found to be associated with greater likelihood of quitting in the near future. This suggests perhaps that more highly skilled NHAs may now have less tolerance for work discomfort. These findings are presented in the context of earlier studies on NHA turnover as well as likely implications of changing market conditions.