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Toolkit, Conclusions, and Recommendations

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    The Nurse Workforce in the Eastern Caribbean http://dx.doi.org/10.1596/978-1-4648-0830-2
    CHAPTER 9
    Toolkit, Conclusions, and
    Recommendations
    Toolkit
    The toolkit was developed as a way to better address the increase in noncom-
    municable diseases (NCDs). The toolkit is based on the findings of this study
    and aims to provide Eastern Caribbean countries with resources to strengthen
    the planning and management of human resources for health (HRH). It com-
    prises the following:
    • A core dataset for developing an HRH information system (appendix C)
    • A terms of reference template and discussion outline for an HRH multisector
    taskforce (appendix D)
    • A toolkit to support evidence-based medicine (appendix E)
    • A toolkit to support interprofessional team working (appendix F)
    • A toolkit to support patient-centered care (appendix G)
    • A toolkit for using informatics (appendix H)
    • A toolkit for supporting quality improvement (appendix I)
    Conclusions and Recommendations
    Eastern Caribbean countries must adopt a strategic approach if they are to cope
    with the rise in NCDs and effectively manage the region’s changing epidemio-
    logical profile. Drawing on research conducted by the Pan American Health
    Organization and the U.S. Agency for International Development (USAID), as
    well as the World Bank’s gap analysis, it can be said that the quantity of medical
    personnel, particularly of primary care nurses, in the Eastern Caribbean is gener-
    ally adequate. The gap is in the availability of nurses with specialization training.
    Closing the gap will entail managing the workforce better and improving
    access to education and training opportunities in needed specializations. It will
    also entail improving HRH governance at country and regional levels. This, in
    turn, requires that countries have an HRH strategy that aligns with their national
  • 44 Toolkit, Conclusions, and Recommendations
    The Nurse Workforce in the Eastern Caribbean http://dx.doi.org/10.1596/978-1-4648-0830-2
    health plans, so that adequate quantities and skill sets of human resources are in
    place to address national health priorities. Systems must also be established to
    effectively manage the performance of existing personnel.
    The following are recommendations for nursing education, and manage-
    ment and planning, based on the findings from the regional analysis and the four
    country case studies:
    Nursing Education
    • Better access to specialization training. This is needed to manage and combat
    NCDs. Dominica’s bachelor of science in nursing program received 60 applica-
    tions for 20–40 available positions, which highlights the challenge that Eastern
    Caribbean countries face in being able to enroll all interested students into
    specialized nursing training. Strategies to increase access can include working
    with existing nursing programs to offer specialization training at the country
    level, bringing in professionals from other countries to teach specialized areas
    to compensate for faculty shortages, and working with the University of the
    West Indies and other regional universities to make specialization training more
    affordable and accessible. East Caribbean countries are already offering incen-
    tives to encourage nurses to specialize. St. Lucia offers study leave to nurses
    pursuing a bachelor’s or master’s degree by providing 100 percent of their sal-
    ary during the first year and 75 percent during the second year; the government
    also pays for a portion of the tuition costs for students who pass the courses and
    agree to return and work in the public sector. St. Vincent and the Grenadines
    follows a similar approach, providing study leave for nurses pursuing special-
    ization training equivalent to full salary for the first year and 50 percent for the
    second year; graduates are also hired at a higher pay grade if they do specializa-
    tion training.
    • Increase educational offerings, scholarships, and incentives. To counter the high
    cost of pursuing additional education, more educational offerings should be
    available in country, scholarships should be available to make training more
    affordable, and incentives should be in place to reward nurses who invest the
    time and expense to acquire additional training. Many Eastern Caribbean
    countries already have a tuition reimbursement program for nurses seeking
    higher education (bachelor’s or master’s degrees). While this is helpful, these
    programs usually require nurses to work for five years before being eligible for
    this assistance. Many nurses have started a family by then, and the reimburse-
    ment does not cover the expense of relocating their families.
    • Include customer service skills and patient-centered care in the nursing curriculum
    to ensure that nurses are treating patients with respect. Combating NCDs requires
    that patients comply in the treatment of their disease. If they feel disrespected
    by nurses, they will be less likely to seek medical treatment, which can reduce
    country health outcomes. The University of the West Indies is the main
  • Toolkit, Conclusions, and Recommendations 45
    The Nurse Workforce in the Eastern Caribbean http://dx.doi.org/10.1596/978-1-4648-0830-2
    source of postgraduate training for NCDs. At the university’s four campuses,
    63 courses were offered in 23 subjects in the 2013/14 academic year that were
    relevant to primary and tertiary care, and NCDs.
    • Offer management and human resources training specific to health at universities
    or community colleges. The Eastern Caribbean suffers from a deficit of HRH
    management skills. Without educational offerings it will be difficult for minis-
    tries of health to find staff with the needed skills.
    • Ministries of health should track health workers attending short-term training to
    make the best use of trained personnel. In 2014, Dominica determined that
    80–100 health workers attended continuing training, which highlights the
    high demand for further training. Oversight on nurses attending training is
    needed to ensure that younger nurses, who need it most, are attending courses
    and workshops.
    Management and Planning
    • Increase control of health personnel. Ministries of health need to have greater
    control over their personnel, particularly in hiring and firing, to prevent hiring
    delays and ensure that those being hired are the best qualified candidates. The
    region’s centralized government structure, which has a separate entity (usually
    a public service commission) to manage hiring and firing, does create a system
    of checks and balances. But this also results in hiring delays and is inefficient,
    to the extent that those conducting interviews often lack the technical exper-
    tise to evaluate candidates effectively.
    • Tackle absenteeism. Absenteeism results in shortages at clinics and hospitals,
    even though the levels of HRH on the payroll may appear to be sufficient. This
    is particularly the case in Grenada. Better management of nursing staff is
    needed to ensure that absenteeism has repercussions, and that time off is han-
    dled in a way that does not jeopardize coverage at hospitals and clinics.
    • Put in place a mobility plan to encourage specialized training. A clear plan is
    needed for mobility within the clinical setting to incentivize nurses to get spe-
    cialist training. Incentives for nurses with specialized training are needed to
    encourage more nurses to incur the cost and time of further education. At
    present, nurses are not automatically given a pay increase or promotion if they
    do specialized training.
    • Put in place the core and essential components for strategic HRH management
    and planning. This includes a health information management system and a
    definite HRH plan.

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Toolkit, Conclusions, and Recommendations

Concludes that Eastern Caribbean countries must adopt a strategic approach if they are to cope with the rise in noncommunicable diseases (NCDs) and effectively manage their changing epidemiological profile. The quantity of medical personnel, particularly of primary care nurses, is generally adequate; however, there is a significant gap in the availability of nurses with specialization training. Closing this gap will entail managing the workforce better and improving access to education and training opportunities in needed specializations. Based on the findings from the four case studies, recommendations are grouped into two broad categories: nursing education, and management and planning. To better educate nurses, countries should implement strategies such as offering better access to specialization training, increasing scholarships and incentives, and improving nurses’ “customer service” and patient-centered care skills. In the area of management and planning, countries should take steps that include: increasing their ministry’s control over hiring and firing of personnel, and tackling absenteeism in a way that does not harm patient care.

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