The Abolition of User Fees in the Jamaican Public Health System: Impact on Access, Care Provided and the Work of the Professional Nurse

<p>The negative impact of user fees on the utilisation of the health services by the poor in developing countries such as Uganda and Jamaica is well documented. Therefore, various governments have been engaged in reforming public health systems to increase access by underserved populations. One such reform is the introduction of free health services. In Jamaica, user fees were abolished in the public health sector in 2007 for children under 18 years and in 2008 free health care was introduced for all users of the public health system. This study evaluated the impact of the 2008 reform on the Jamaican public health system at 1) the national level, 2) the provider level, and 3) the user level. Perspectives were sought on access to care, the care provided, and the work of the professional nurse. Participants were selected from the Ministry of Health (MOH), the four Regional Health Authorities (RHAs), and urban and rural health facilities. Data collection was done during March – August 2010, using a multi-layered mixed methods evaluation approach, incorporating both qualitative and quantitative methods. Methods included individual interviews with key policymakers (eight) at the MOH and the four RHAs, as well as a senior medical officer of health (one) and pharmacists (three); focus groups with representatives of the main practitioners in the health system including nurses (six groups), pharmacists (one group) and doctors (two groups); document reviews of the MOH and RHAs‘ annual reports, and a survey of patients (200). Views on the impact of the abolition of user charges differed across the three levels and among the health authorities, facilities, and perspectives (policymakers, practitioners and users). Patient utilisation of the public health system increased exponentially immediately following the abolition of user fees, then declined, but remained above the pre-policy level. The work of health care providers, especially the professional nurse, was affected in that they had to provide the expected and required services to the patients despite an increase in workload and constraints such as inadequate resources. The research found that, while policymakers were optimistic about the policy, providers had concerns but patients were satisfied with the increased access and the quality care they were now receiving. Users also encountered challenges that constituted barriers to access. In addition to providing further evidence about the abolition of user fees in the public health system, this research provides important new insights into the impact of the nationwide abolition of user fees, as well as the impact of the policy change on the work of the professional nurse. Equally, the findings highlighted the potential benefits, gaps, and failures of the abolition of user fees‘ policy, and will serve as a catalyst to improve the policy process regarding access to health services and the work of the professional nurse. The findings of this research will be valuable in the planning of health-related programmes for the consumers of health care in developing countries. Despite the need for further research in this area, this research has contributed to the body of knowledge regarding user fees and access to health care in developing countries.</p>

The Abolition of User Fees in the Jamaican Public Health System: Impact on Access, Care Provided and the Work of the Professional Nurse

<p>The negative impact of user fees on the utilisation of the health services by the poor in developing countries such as Uganda and Jamaica is well documented. Therefore, various governments have been engaged in reforming public health systems to increase access by underserved populations. One such reform is the introduction of free health services. In Jamaica, user fees were abolished in the public health sector in 2007 for children under 18 years and in 2008 free health care was introduced for all users of the public health system. This study evaluated the impact of the 2008 reform on the Jamaican public health system at 1) the national level, 2) the provider level, and 3) the user level. Perspectives were sought on access to care, the care provided, and the work of the professional nurse. Participants were selected from the Ministry of Health (MOH), the four Regional Health Authorities (RHAs), and urban and rural health facilities. Data collection was done during March – August 2010, using a multi-layered mixed methods evaluation approach, incorporating both qualitative and quantitative methods. Methods included individual interviews with key policymakers (eight) at the MOH and the four RHAs, as well as a senior medical officer of health (one) and pharmacists (three); focus groups with representatives of the main practitioners in the health system including nurses (six groups), pharmacists (one group) and doctors (two groups); document reviews of the MOH and RHAs‘ annual reports, and a survey of patients (200). Views on the impact of the abolition of user charges differed across the three levels and among the health authorities, facilities, and perspectives (policymakers, practitioners and users). Patient utilisation of the public health system increased exponentially immediately following the abolition of user fees, then declined, but remained above the pre-policy level. The work of health care providers, especially the professional nurse, was affected in that they had to provide the expected and required services to the patients despite an increase in workload and constraints such as inadequate resources. The research found that, while policymakers were optimistic about the policy, providers had concerns but patients were satisfied with the increased access and the quality care they were now receiving. Users also encountered challenges that constituted barriers to access. In addition to providing further evidence about the abolition of user fees in the public health system, this research provides important new insights into the impact of the nationwide abolition of user fees, as well as the impact of the policy change on the work of the professional nurse. Equally, the findings highlighted the potential benefits, gaps, and failures of the abolition of user fees‘ policy, and will serve as a catalyst to improve the policy process regarding access to health services and the work of the professional nurse. The findings of this research will be valuable in the planning of health-related programmes for the consumers of health care in developing countries. Despite the need for further research in this area, this research has contributed to the body of knowledge regarding user fees and access to health care in developing countries.</p>

An intervention for nurse wellbeing

Sam Foster, Chief Nurse, Oxford University Hospitals, considers the potential benefits of the professional nurse advocate programme and this new approach for clinical supervision and employee support

Relation between Halls’ Professionalism Scale and nurses’ demographic characteristics

Objective Nursing Professionalism was measured by Hall’s Professionalism Scale, consisting of 50 items. The scale was developed to measure the attitudes and ideologies held by professionals in various professional occupations by measuring five attitudinal constructs of professionalism, namely ‘sense of calling to the field’, ‘autonomy’, ‘using a professional organisation as a major referent’, ‘belief in self-regulation’, and ‘belief in public service’. This study focussed on determining the practically significant differences that exist between the means of the five constructs of Hall’s Professionalism Scale and certain demographic variables among nurses in South Africa. The 11-item demographic profile included the following variables: gender (1), age (2), age when becoming a professional nurse (3), undergraduate qualifications (4), marital status (5), number of children (6), employment sector (7), years’ of nursing experience (8), international experience (9), employment status (10) and satisfaction with nursing as a career (11). Results Only (7/11) demographic profile variables had an association with one or more of the five Hall’s Professionalism Scale constructs The variables included the following items: age (2), age when becoming a professional nurse (3), number of children (6), years of nursing experience (8), international experience (9), employment status (10), and satisfaction with nursing as a career (11).

Work Features that Influence the Retention of Professional Nurses in the Public Health Sector in Windhoek, Namibia

The retention of professional nurses in the public health sector is essential for maintaining quality nursing care. Effective retention strategies enhance nurses’ job satisfaction, promote professionalism, decrease organisational costs and improve patients’ care. The Namibian public health sector has, for a long time, experienced challenges in retaining professional nurses and this has affected patient care, students’ clinical practice and the facilities’ status. A qualitative descriptive design was used in this study to explore professional nurses’ perceptions of factors influencing the retention of professional nurses at a health facility in Windhoek, Namibia. Semi-structured, face-to-face interviews were conducted with 11 professional nurses. Tesch’s eight steps for data analysis generated two themes, namely: 1) Satisfaction with remuneration varied; the work environment was non-conducive and management was inadequate; and 2) Dissatisfaction resulted from negative psychological effects of the work environment and lack of career development opportunities. Remuneration packages in the public healthcare sector were regarded as inadequate compared to the private healthcare sector, which was deemed as greener pastures. The physical work environment is non-conducive and under-resourced, which has an effect on the physiological work environment when staff develop feelings of guilt, frustration, stress, feeling unsafe and uncared for—all potential catalysts for the loss of the professional nurse workforce due to resignations. In addition, career development opportunities were experienced as biased and unfair. Strategies are recommended to improve the remuneration packages and provide a well-resourced and conducive work environment, which supports the professional nurse to ensure quality patient care.

Public Reactions in Online Newspapers to Workplace Violence Against Nurses

Background Nurses frequently suffer from workplace violence, but the public is often not fully aware of the situation because many events are not widely reported. Methods This study is an attempt to describe public perceptions of and reactions to reports of incidents of violence against nurses in online newspapers. Articles about such violence in Vietnamese online newspapers published from January to December 2019 as well as readers’ comments on those articles were collected for thematic analysis. Results Nine assaults were reported in 152 articles, and 367 comments were left in the threads. The analysis found four themes: 1) proposing punishment, 2) showing sympathy, 3) being skeptical, and 4) taking gender into account. In particular, the audience called for stricter punishment of the assaulters and showed sympathy for the nurses. However, commenters’ prior experiences with poor nursing services sometimes made them skeptical about the motivations of the attackers. Additionally, commenters saw the violence as a conflict between a man (assaulter) and a woman (assaultee) rather than between a client and a professional nurse. Conclusions In general, the public showed support to nurses. Nurses should take advantage of this support to advocate improved policies and measures to protect themselves from violence at work.