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      Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries: drivers, impact, and regulation

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          ABSTRACT

          Background: The paper examines external multiple job holding practices in public health training institutions based in prominent public universities in three sub-Saharan Africa countries (Rwanda, Ethiopia, Mozambique).

          Objective: The study aims to contribute to broadening understanding about multiple job holding (nature and scale, drivers and reasons, impact, and efforts to regulate) in public health training schools in public universities.

          Methods: A qualitative multiple case study approach was used. Data were collected through document reviews and in-depth interviews with 18 key informants. Data were then triangulated and analyzed thematically.

          Results: External multiple job holding practices among faculty of the three public health training institutions were widely prevalent. Different factors at individual, institutional, and national levels were reported to underlie and mediate the practice. While it evidently contributes to increasing income of academics, which many described as enabling their continuing employment in the public sector, many pointed to the negative effects as well. Similarities were found regarding the nature and drivers of the practice across the institutions, but differences exist with respect to mechanisms for and extent of regulation. Regulatory mechanisms were often not clear or enforced, and academics are often left to self-regulate their engagement. Lack of regulation has been cited as allowing excessive engagement in multiple job holding practice among academics at the expense of their core institutional responsibility. This could further weaken institutional capacity and performance, and quality of training and support to students.

          Conclusion: The research describes the complexity of external multiple job holding practice, which is characterized by a cluster of drivers, multiple processes and actors, and lack of consensus about its implication for individual and institutional capacity. In the absence of a strong accountability mechanism, the practice could perpetuate and aggravate the fledgling capacity of public health training institutions.

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          ‘Going private’: a qualitative comparison of medical specialists’ job satisfaction in the public and private sectors of South Africa

          Background There is a highly inequitable distribution of health workers between public and private sectors in South Africa, partly due to within-country migration trends. This article elaborates what South African medical specialists find satisfying about working in the public and private sectors, at present, and how to better incentivize retention in the public sector. Methods Seventy-four qualitative interviews were conducted - among specialists and key informants - based in one public and one private urban hospital in South Africa. Interviews were coded to determine common job satisfaction factors, both financial and non-financial in nature. This served as background to a broader study on the impacts of specialist ‘dual practice’, that is, moonlighting. All qualitative specialist respondents were engaged in dual practice, generally working in both public and private sectors. Respondents were thus able to compare what was satisfying about these sectors, having experience of both. Results Results demonstrate that although there are strong financial incentives for specialists to migrate from the public to the private sector, public work can be attractive in some ways. For example, the public hospital sector generally provides more of a team environment, more academic opportunities, and greater opportunities to feel ‘needed’ and ‘relevant’. However, public specialists suffer under poor resource availability, lack of trust for the Department of Health, and poor perceived career opportunities. These non-financial issues of public sector dissatisfaction appeared just as important, if not more important, than wage disparities. Conclusions The results are useful for understanding both what brings specialists to migrate to the private sector, and what keeps some working in the public sector. Policy recommendations center around boosting public sector resources and building trust of the public sector through including health workers more in decision-making, inter alia. These interventions may be more cost-effective for retention than wage increases, and imply that it is not necessarily just a matter of putting more money into the public sector to increase retention.
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            Transforming health professions’ education through in-country collaboration: examining the consortia among African medical schools catalyzed by the Medical Education Partnership Initiative

            Background African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning. Methods Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These interviews were recorded, transcribed and coded to identify common themes. Results All of the consortia have prioritized efforts to increase the quality of medical education, support new schools in-country and strengthen relations with government. These in-country partnerships have enabled schools to pool and mobilize limited resources creatively and generate locally-relevant curricula based on best-practices. The established schools are helping new schools by training faculty and using grant funds to purchase learning materials for their students. The consortia have strengthened the dialogue between academia and policy-makers enabling evidence-based health workforce planning. All of the partnerships are expected to last well beyond the MEPI grant as a result of local ownership and institutionalization of collaborative activities. Conclusions The consortia described in this paper demonstrate a paradigm shift in the relationship between medical schools in four African countries. While schools in Africa have historically worked in silos, competing for limited resources, MEPI funding that was leveraged to form in-country partnerships has created a culture of collaboration, overriding the history of competition. The positive impact on the quality and efficiency of health workforce training suggests that future funding for global health education should prioritize such south-south collaborations.
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              Case Study: A Strategic Research Methodology

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                Author and article information

                Journal
                Glob Health Action
                Glob Health Action
                ZGHA
                zgha20
                Global Health Action
                Taylor & Francis
                1654-9716
                1654-9880
                2018
                01 August 2018
                : 11
                : 1
                : 1491119
                Affiliations
                [a ] School of Public Health, University of Western Cape , Cape Town, South Africa
                [b ] Department of Community Health, Eduardo Mondlane University , Maputo, Mozambique
                [c ] School of Public Health, University of Rwanda , Kigali, Rwanda
                [d ] School of Public Health, Addis Ababa University , Addis Ababa, Ethiopia
                Author notes
                CONTACT Woldekidan Kifle Amde wamde@ 123456uwc.ac.za School of Public Health, University of the Western Cape , Private Bag X17, Bellville, Cape Town7535, Republic of South Africa
                Author information
                http://orcid.org/0000-0002-0511-4096
                http://orcid.org/0000-0003-1094-7655
                http://orcid.org/0000-0002-0778-3285
                http://orcid.org/0000-0002-2627-8954
                Article
                1491119
                10.1080/16549716.2018.1491119
                6084497
                30067152
                9446a3bb-b4ba-40c1-95e4-239fda28584e
                © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 December 2017
                : 16 June 2018
                Page count
                Tables: 2, References: 34, Pages: 10
                Funding
                The project was funded by the World Health Organization.
                Categories
                Original Article

                Health & Social care
                capacity development,case study,context,dual practice,ethiopia,higher education institutions,moonlighting,mozambique,public health,rwanda

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