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Assessment of HR Standards in Private and Public Hospitals in Tigray Region, Ethiopia

Sound human resources management practices are essential for retaining effective professionals in hospitals that are addressing health workforce challenges and developing the health workforce strategy of a country. The overall objective of this study is to assess human resource standards in private and public hospitals in Tigray region, Ethiopia.

INTRODUCTION

Background of the Study 

Health care can be provided through public and private providers. The government through National healthcare systems usually provides public health care. Public health is community health.  "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time. “The definition of public health is different from a person to another and from a scholar to another scholar and this is so because every person gives the meaning according to his or her field of study and perspective. Public health can be defined as the science of protecting safety and improving the health of communities through education, policy-making, and research for disease and injury prevention.

Private healthcare is healthcare and medicine provided by entities other than the government. "Private healthcare" is more common and is used to describe medical services that are not covered by the government because it is medical services provided by an entity that is not the government. Unless an individual has some form of private health insurance, the costs for private healthcare services are paid out-of-pocket; also known as "private medicine."

Private health care can be provided through “profit-making hospitals, self-employed practitioners and not profit-making non-government health providers”. There is considerable ideological debate around whether low and middle-income countries should strengthen public versus private healthcare services, but in reality, most low- and middle-income countries including Ethiopia use both types of healthcare provision. (FMOH, 2005).

STATEMENT OF THE RESEARCH PROBLEM

Global economic depression has put major constraints on government budgets recently. The major funding source for healthcare expenditures in most countries and disputes between the proponents of private and public systems has escalated. Further fueled was by the recommendation of International Monetary Fund (IMF), that countries increase the scope of private sector provision in health care as part of loan conditions to reduce government debt. However, critics of the private health sector believe that public healthcare provision is of most benefit to poor people and is the only way to achieve universal and equitable access to health care.

A review of different documents on human resources for health was undertaken. Particular attention was given to documents from Ethiopia. Generally, there is a shortage in a number of different groups of professionals, maldistribution of professionals between regions, urban and rural settings, and governmental and non-governmental/private organizations. There is no policy specific to human resource management (HRM) for health and no proper mechanism to manage the existing health workforce. A number of measures are being taken to alleviate these problems.

Research question

Do the Hospitals’ human resource combinations and quantities comply with national standards?

Objectives

  1. General objective: Assess the human resource standards on the public and private Hospitals in Tigray Region, Ethiopia.
  2. Specific objectives
  • To compare the national standards with the number of health professionals and other supportive staffs existed in public and private Hospitals
  • To identify the type and the combinations of health professionals existed in public and private Hospitals

Hypothesis

In other to achieve the objectives of this study, the hypotheses below are considered:

The Hospitals’ human resource combination and quantities do not comply with the national standards.

CONCEPT OF HRM

HRM is concerned with human beings in an organization. “Management of man is a very important and challenging job because of the dynamic nature of man”. Two people are not similar in mental abilities, tactics, sentiments, and behaviors; they differ widely also as a group and are subject to many varied influences. People are responsive, they feel, think and act, and therefore they cannot be operated like a machine or shifted and altered like a template in a room layout. They, therefore, need a tactful handing by management personnel.”  HRM is the process of managing people of an organization with a human approach. Human resources approach to labor enables the manager to view people as an important resource. It is the approach through which an organization can utilize the workforce for not only the benefits of the organization but for the growth, development, and self-satisfaction of the people concerned (Dr.S.Ganesan, 2014).

HRM in Private Hospital Facility in Tigray, Ethiopia

Mainly the government delivers health care. However, the private sector and voluntary organizations also play a significant role in general health care delivery. In Ethiopia, the growing size and scope of the private health sector, both for-profit and not-for-profit, offers an opportunity to enhance health service coverage and utilization. The health system development plan (HSDP) has explicitly recognized the complementarities between the two sub-sectors by articulating a strategy to promote the private sector in health-care delivery. The private health sector has expanded rapidly over the past 15 years in line with the government’s privatization policy. Forty (27%) of all the hospitals in Ethiopia are privately owned and 1788 private for-profit clinics are currently providing health services in the country. The majority (94%) of the health workers are in the public sector. However, high-level health professionals, and particularly specialists, are often concentrated in private health facilities. At present, the private sector and voluntary organizations also play a significant role in general health care delivery. However, efforts have been made to increase health service expansion. In Ethiopia, employment by doctors in the private for-profit sector expanded from 1 percent in 1996 to 17 percent in 2006 and in the not-for-profit sector from 8 percent to 23 percent over the same period with more experienced doctors more likely to migrate from the public to the private sector. This is one of the factors biasing staff in favor of urban placements (Ensor and Soucat et al. 2013).

HYPOTHESIS TESTING
 

H01:  THE HEALTH CARE FACILITIES’ HUMAN RESOURCE COMBINATION AND QUANTITIES DO NOT COMPLY WITH NATIONAL STANDARD

Table: Human resource combination

Correlations

Pearson Correlation

P value

 

Human resource combination with quantities with national standard

 

privet General hospitals *

.973

 

.000

Public General hospitals **

.968

 

.000

Public Primary hospitals ***

.954

 

.000

Private Primary hospitals ****

.907

.000

 

Source: Own computation (2019)
 

Direction: there is a positive correlation between privet General hospitals and Human resource combination with quantities with the national standard.

Interpretation: our significant level is less than 0.05 which is .000. So, we have evidence that to reject the null Hypothesis which means that there is a difference in   Human resource combination with quantities from national standard in privet General hospitals. *

Conclusion: privet General hospitals did not meet Human resource combination with quantities from national standards 

Direction: there is a positive correlation between Public General Hospitals and Human resource combination with quantities with the national standard.

Interpretation: our significant level is less than 0.05 which is .000. So, we have evidence that to reject the null Hypothesis which means that there is a difference in Human resource combination with quantities from national standard in Public General Hospitals.

Conclusion: Public General Hospitals did not meet Human resource combination with quantities from national standards.

Direction: there is a positive correlation between Public Primary Hospitals and Human resource combination with quantities with the national standard.

Interpretation: our significant level is less than 0.05, which is .000. Therefore, we have evidence that to reject the null Hypothesis which means that there is a difference in   Human resource combination with quantities from national standard in Public Primary Hospitals.

Conclusion: Public Primary hospitals did not meet Human resource combination with quantities from national standards.

Direction: there is a positive correlation between Private Primary Hospitals and Human resource combination with quantities with the national standard.

Interpretation: our significant level is less than 0.05 which is .000. So, we have evidence that to reject the null Hypothesis which means that there is a difference in Human resource combination with quantities from national standard in Private Primary Hospitals

Conclusion: Private Primary hospitals did not meet Human resource combination with quantities from national standards.
 

DISCUSSION OF FINDINGS

Discussion on Comparison of Health Professional´s Competence, Compliance with the National Guideline
 

General hospitals
When we see the result on the table 4.19, table4.20, and table 4.21, Staff like Accident/Emergency specialist, General practitioner, Nurse Anesthetist, Ophthalmic/Cataract nurse, Microbiologist, Environmental Health, Bio-Medical Engineer and Social workers in Private General Hospital are totally absent which means they do not have such professionals. But compared with Public General Hospitals there were 28.57% Accident/Emergency specialist, 107.14% Ophthalmic/Cataract nurse , 93.88% General practitioner, 67.86 % Environmental Health, 92.86% Bio-Medical Engineer and 42.86% Social workers.

From this finding we can realize that Public General Hospitals met the national standards specially professionals like General practitioner and Ophthalmic/Cataract nurse.

Pharmacist, Nurse (Diploma) Midwives, Radiology technologist, Nurses (BSc) and Laboratory technologist in Private General Hospital accounts from 10 to 20% meet the national standards. Whereas in Public General Hospitals 120.41% Pharmacist, 51.31% Nurse (Diploma), Midwives, 145.60% Midwives, 96.43 % Radiology technologist, 193.60% Nurses (BSc), 118.37% Laboratory technologist.

From this output, we can declare that professionals like Pharmacists, Midwives, Nurses (BSc), Laboratory technologists were overstaffed or Public General Hospitals employed more staff out of national standards during the study period. 

Health professionals like General Surgeon, Obstetrician and Gynecologist, Internist, Pediatrician, Orthopedic surgeon, Dental Specialist, Laboratory technician, Health Informatics and Supportive staff meet 38.1% from national standards in Private General Hospitals. When we see those professionals in public general Hospital General Surgeon (171.43%), Obstetrician and Gynecologist (32.14%), internist (78.57%), Pediatrician (64.29%), Dental Specialist (64.29%), Laboratory technician (119.05%), Health Informatics (90.91%) and Supportive staff (73.18%).

From this output also I can announce that General Surgeon and Laboratory technicians were employed over standard. Others like internist, Pediatrician, Dental Specialist, Health Informatics and Supportive staff met more than 60% for national standards, and I found there was no orthopedic surgeon employed in Public General hospital.

The study conducted in title of Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: Assessing for Comparative Performance of Private and Public Healthcare showed similar results with my research output that there was different about the comparison of health professional’s competence, compliance with the national guideline in the public and private health facilities. (Basu, S., Andrews, J., Kishore, S., Panjabi, R. and Stuckler, D., 2012).

Primary hospitals

When we see the result on the table 4.23, table 4.24, table 4.25 and table 4.26, Staff like Emergency surgical officer, Ophthalmic nurse, Psychiatric nurse, Dental professional, Environmental Health and Health Information in the private primary Hospitals were totally vacant. Compared with public primary Hospitals; General practitioners, Radiology professionals and Physiotherapists also were absent which means they do not have such professionals in the hospitals.

Emergency surgical officer (86.36%), ophthalmic nurse (4.55%), Psychiatric nurse (45.45%), Dental professional (9.09%), Environmental Health (95.45%) and Health Information (90.91%) staffs were employed in public primary Hospitals as per standards of National human resource guidelines.

From this finding, we can realize that Public primary Hospitals met the national standards especially professionals like an Emergency surgical officer (86.36%), Health Information (90.91%), Environmental Health (95.45%), the Laboratory technician (93.18%), Supporting staff(73.18) and BSc anesthetist/nurse anesthetist. Whereas private primary Hospitals met to the national standards like Radiology professional (100%), pharmacy technician (Druggists) (83.33%) Radiographer (83.33%), Nurses (BSc) (73.33%), Physiotherapist (66.67%), Midwives (66.67%), Nurse (Diploma) (35%), Laboratory technologist (33.33%), Supporting staff (29.17%) Health officer (HO) (33.33%), BSc Anesthetist/nurse Anesthetist (33.33%) and Pharmacist (25%).

The output of this research also showed  that professionals like health officer (HO) (268.18%), Midwives (168.18), Pharmacy technician (Druggist) (147.73%), Nurses (BSC) (133.64%), MD (Specialist (128.79%) and Nurses Diploma (112.73%) were overstaffed in Public Primary Hospitals. Whereas when we saw professionals in Primary Hospitals Private, MD specialist (188.89%) and Laboratory Technician, (116.67 %.) were overstaffed in which means they employed more staff out of the national standards during the study period. 

Discussion on Comparison of Health Professionals´ Competence, Compliance with the National Guideline in the Public and Private Health Facilities 
 

General Hospitals
When we see the result on the table 4.19, table 4.20, and table 4.21, Staffs like Accident/Emergency specialist, General practitioner, Nurse Anesthetist, Ophthalmic/Cataract nurse, Microbiologist, Environmental Health, Bio-Medical Engineer and Social workers in Private General Hospital are totally absent which means they do not have such professionals. But compared with Public General Hospitals there were 28.57% Accident/Emergency specialist, 107.14 % Ophthalmic/Cataract nurse , 93.88% General practitioner, 67.86 % Environmental Health, 92.86% Bio-Medical Engineer and 42.86% Social workers.

From this finding we can realize that Public General Hospitals met the national standards specially professionals like General practitioner and Ophthalmic/Cataract nurse.

Pharmacist, Nurse (Diploma) Midwives, Radiology technologist, Nurses (BSc) and Laboratory technologist in Private General Hospital accounts from 10 to 20% meet the national standards. Whereas in Public General Hospitals 120.41% Pharmacist, 51.31% Nurse (Diploma), Midwives, 145.60%Midwives, 96.43 % Radiology technologist, 193.60% Nurses (BSc), 118.37% Laboratory technologist

From this output, we can declare that professionals like Pharmacist, Midwives, Nurses (BSc), Laboratory technologist were overstaffed or Public General Hospitals employed more staff out of national standards during the study period. 

Health professionals like General Surgeon, Obstetrician and Gynecologist, Internist, Pediatrician, Orthopedic surgeon, Dental Specialist, Laboratory technician, Health Informatics and Supportive staff meet 38.1% from national standards in Private General Hospitals. When we see those professionals in public general Hospital General Surgeon (171.43%), Obstetrician and Gynecologist (32.14%), internist (78.57%), Pediatrician (64.29%), Dental Specialist (64.29%), Laboratory technician (119.05%), Health Informatics (90.91%) and Supportive staff (73.18%).

From this output also I can announce that General Surgeon and Laboratory technicians were employed over standard. Others like internist, Pediatrician, Dental Specialist, Health Informatics and Supportive staff were met more than 60% for national standards, and I found there was no orthopedic surgeon employed in Public General Hospital.

The study conducted in title of Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: Assessing for Comparative Performance of Private and Public Healthcare showed similar results with my research output that there was deference about the comparison of health professional’s competence, compliance with the national guideline in the public and private health facilities. (Basu, S., Andrews, J., Kishore, S., Panjabi, R. and Stuckler, D., 2012).

Primary Hospitals

When we see the result on the table 4.23, table 4.24, table 4.25 and table 4.26 (in the link at the end), Staff like Emergency surgical officer, Ophthalmic nurse, Psychiatric nurse, Dental professional, Environmental Health and Health Information in the private primary Hospitals were totally vacant. Compared with public primary Hospitals; General practitioner, Radiology professionals and Physiotherapist also were absent which means they do not have such professionals in the hospitals.

Emergency surgical officer (86.36%), ophthalmic nurse (4.55%), Psychiatric nurse (45.45%), Dental professional (9.09%), Environmental Health (95.45%) and Health Information (90.91%) staffs were employed in public primary Hospitals as per standards of National human resource guidelines.

From this finding, we can realize that Public primary Hospitals met the national standards especially professionals like Emergency surgical officer (86.36%), Health Information (90.91%), Environmental Health (95.45%), Laboratory technician (93.18%), Supporting staff (73.18) and BSc anesthetist/nurse anesthetist. Whereas private primary Hospitals met to the national standards like Radiology professional (100%), pharmacy technician (Druggists) (83.33%) Radiographer (83.33%), Nurses (BSc) (73.33%), Physiotherapist (66.67%), Midwives (66.67%), Nurse (Diploma) (35%), Laboratory technologist (33.33%), Supporting staff (29.17%) Health officer (HO) (33.33%), BSc Anesthetist/nurse Anesthetist (33.33%) and Pharmacist (25%).

The output of this research also showed  that professionals like health officer (HO) (268.18%), Midwives (168.18), Pharmacy technician (Druggist) (147.73%), Nurses (BSC) (133.64%), MD (Specialist (128.79%) and Nurses Diploma (112.73%) were over staffed in Public Primary Hospitals. Whereas when we saw professionals in Primary Hospitals Private, MD specialist (188.89%) and Laboratory Technician, (116.67 %.) were over staffed in which means they employed more staffs out of the national standards during the study period.

CONCLUSION

This research made the comparison between the National standards of health staff and the existing staff in the Hospitals in both public and private facilities. In most of the healthcare providers they were either under staff or completely vacant in both private and public Hospitals and for further comparison private Hospitals were more understaffed than the public.  Support and paramedics staff especially in the public General Hospitals were overstaffed, which means the regional health bureau has recruited more staff out of National Health Service delivery staff standards.  

Recommendation

The National human resources standard was set for better health care provision in both public and private Hospitals but the output of this research showed that there is a big gap between National human resource standard and real set up so due to such reasons I recommended the following points.

  • National health system guidelines should be inspected or revised.
  • There should be an equilibrium human resource combination and professionals competency between public and private Hospitals 
  • Further research should be conducted to strengthen the findings of this research.
     

Source: This article is a short version of an article by our student Atakilt H. Siyum. The full version with complete data can be found here. This article was supervised by our lecturer Umar Lawal Aliyu

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