The Impact of Work Environment on the Performance of Health Workers in Sudan

1. The Impact of Work Environment on the Performance of Health Workers in Sudan Nuha Ibrahim Centre for Global Health-Trinity College Dublin

2. Contents: • Background -Sudan -Performance of Health Workers -Work Environment in healthcare • Research Problem • Methodology • Expected Outcomes

3. 1-Sudan(40 million- North Sudan about 31 million) • Since1956, internal wars and conflicts have been ongoing in different regions of the country • Disparities and inequality between rural-urban areas in terms of their development trends • 60-75 % of the population in the North and 90% of the population in the South are living below the poverty line of less than $1 per day • The social, economic and political situation of Sudan shapes the health status of the country to large extent. • Challenges communicable and non-communicable diseases

4. Table 2.2.1: The Status of MDGs in Sudan in 2008 (Source: UNDP Sudan 2010)

5. Examples of Health indicators

6. The increase in number of medical schools in Sudan, 1990-2001 (Source: Sudan Health System Profile 2007)

7. 56% of doctors in Sudan work in Khartoum city (pop=9 million) • Doctor/population ratio 28/100,000 • Migration of doctors: 60% (12,000 of 21,000) of those who registered in Sudanese Medical Council are working overseas

9. The global attention to deal with the HRH crisis is focus on two important aspect 1- The retention of health workers -The ethical recruitment by high income countries • Retention strategies in low income countries 2-Ensuring the available workers are performing well to provide quality of care

10. 2-Performance of HWs • The WHO 2006: “Performance is considered to be a combination of Staff being available (retained & present), and staff being competent, productive and responsive”. • Or simply (Adherence to an accepted standard or guideline) • factors influencing staff retention and mobility can be distinguished: - Personal and lifestyle-related factors, including living circumstances; - work-related factors, related to preparation for work during pre-service education; - health-system related factors, such as human resources policy and planning; - job satisfaction, influenced by health facility factors, such as financial considerations, working conditions, management capacity and styles, professional advancement and safety at work.

11. Why it is important ? For long time poor performance was due to lack of knowledge and training, the reason why we had all the intervention s focusing only on training of HWs. Which lead to disappointing long terms results (1). • How to measure it? “We can only be sure to improve what we can actually measure” *Why it is important to measure performance: to support improvement in the quality of services (2)

12. 3-Work Environment • Definition? The WHO report 2010 defined the supportive work environment as “an environment that attracts individuals into the health professions, encourages them to remain in the health workforce and enables them to perform effectively”.

13. Elements of work environments such as: • Safety • Management • Communication • Support, Supervision • Fairness and equality

14. Kramer & Schmalenberg (2002):8 Essentials of the Work Environment • Interviewed 289 staff nurses in 14 Magnet hospitals • What are essential elements of the work environment to delivery quality care (rank order) • Working with clinically competent nurses • Good nurse-physician relationship and communication • Nurse autonomy and accountability • Support nurse manager/supervisor • Control over nursing practice • Support for education • Adequate nurse staffing • Culture where concern for the patient is paramount http://www.qdocuments.com/The-Power-of-the-Magnet-Hospital-Credential-Excellence-in-Nursing--PPT.html

15. Public hospitals: "Public hospitals are asked to do more and more with less and less, until it feels like you're doing everything with nothing.” Ron J. Anderson, MD President and CEO, Parkland Health and Hospital System, Dallas, TX

16. Aim of the research What are the factors in the work environment that affect the performance of doctors and nurses in public hospitals in Khartoum?

17. Availability Productivity Responsiveness Competence Pre-service Training Political Situation Social Environment In-service Training Safety of HWs Personal Attitude Education Economic stability and security issues CareerDevelopment Supportive Supervision Cleanness Availability of Data Physical Infrastructures Performance Appraisal system The quality of available data Managing available resources Intention to leave Health System Policies and Strategies Availability of resources; drugs, water etc. Communication: Management, staff & Clients Accountability Trust Transparency Respect Teamwork Leadership style Clear Job Description Community Participation Recruitment & Decruitment System Motivation & Satisfaction Types of diseases

18. Methodology -Survey (i.e. Work Environment Index+ Performance self evaluated questionnaire!..) for Doctors and nurses -Key informative interviews (i.e. Managers..) - Focus Group discussion

19. MOH Management Doctors 1 Nurses Data

20. What kind of Data available there? 11public teaching hospitals in khartoum Or maybe 1 of them!! Hospital Environment!! Management system i.e. Staff ratios Attendance Waiting time Patients Satisfaction Communication with patients Job satisfaction Intention to leave Availability Teamwork Productivity Training&.. Competence Performance of Health workers !! Communication Responsiveness Availability of d, w, e, etc... i.e. Work Index

22. Expected outcomes • The expected outcomes will help to understand the impact of work environment on the performance of health workers in low income settings . • This will lead to designing better interventions to improve the performance of HWs in public hospitals, to have better quality of services and higher staff retention rate for better health outcomes. • Having tool to measure performance and work environment on a regular basis as a way to monitor and improve the quality of the services

23. Research Plan • Research Protocol September 2011 • Ethical approval December2011 • Data collection by 2011_2012 • Analysis and writing 2013 • Finish by 2014