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Descriptive exploratory research in a Public University in Curitiba. The population was composed of 173nursing workers of the night shift. The goal was to identify the main health problems of workers of the night nursingshift. The questionnaire was answered by 66,5% workers, being 84% of them females. The process of morbidity expressedby employees of the night shifts shows the wear process in health and disease. The most significant ones were varicoseveins, fatigue, irritability and cervical injuries above 50%. The symptoms recorded after the work rest confirm that theemployee still feels tired and discouraged and remain excessively sleepy, confirming that the employee returns to workin a state of fatigue. The consequences entailing health are seen as a major problem and the intervention measuresshould be considered to intervene in the health disease process of nursing workers.

Realiza-se uma breve discussão da introdução das noções de raça/etnia e etnicidade no campo da saúde pública no Brasil, destacando-se a emergência dessa questão no contexto da universalização das políticas públicas sociais e tendo como pano de fundo a experiência de realização de cursos de extensão na área de saúde pública.This report discusses the introduction of the conceps of race, ethnics and ethnicity in Brazilian public health policies highlighting the relationships between ethnicity and universal social policies, departing from universities extension courses in public health.

O artigo revisita o processo histórico de construção do modelo de educação profissional de nível médio vigente no Brasil, procurando identificar aspectos que auxiliem na compreensão de questões pertinentes a essa modalidade de ensino. Aborda a dualidade do ensino médio, a associação entre discriminação social e ocupações técnicas, a contenção de demanda ao nível superior de ensino, a formação integral do cidadão e a formação para o mundo do trabalho, situando a educação profissional na área da saúde nesse contexto. Foram utilizados, como fontes, a legislação brasileira para a educação, além de referenciais, diretrizes e documentos técnicos do Ministério da Educação. O artigo ressalta a importância que o conceito de terminalidade adquiriu nas propostas para a educação profissional, apontando a politecnia como alternativa à formação escolar e profissional, assinalando as peculiaridades da área da saúde que a afastam do modelo de educação profissional de nível médio com caráter de terminalidade.El artículo revisita el proceso histórico de la construcción del modelo de educación profesional del nivel medio en Brasil, buscando identificar los aspectos que ayuden a la comprensión de las cuestiones pertinentes a esta modalidad de educación. Aborda aspectos como la dualidad de la educación media, la asociación entre la discriminación social y las ocupaciones técnicas, la contención de la demanda a la universidad, la formación integral del ciudadano y la formación para el mundo del trabajo, precisando la educación profesional en el área de la salud en este contexto. Han sido utilizados, como fuentes, la legislación brasileña para la educación, además de los referenciales, las directrices y documentos técnicos del ministerio de la educación. El artículo resalta la importancia que el concepto de término de formación adquirió en las propuestas para la educación profesional, señalando la politecnia como alternativa a la formación propedéutica y profesional, señalando las particularidades del área de la salud que la separan del modelo de la educación profesional de nivel medio con carácter de término de formación.This paper argues the historical process of professional education models construction in the Brazilian high schools to help the understanding of this education modality questions. It approaches the high schools ambiguity, the association between social discrimination and technical occupations, containment of demand to the Universities, citizen's integral formation and formation to the work, pointing out the health area in this context. It had been used, as sources, the Brazilian legislation for the education and other governmental technical documents. The article intends to show the importance that the finish point concept acquired in the professional education proposals, pointing the politecnia as alternative to the school and professional formation, designating the peculiarities of the health area.

In Ontario, maternal health systems are changing, with an increasing variety of childbirth options being offered to low-risk pregnant women. Midwifery became a regulated profession in the province in 1994: providing primary care throughout pregnancy, labour and for up to six weeks postpartum. Currently there are three midwifery-led birth centres operating in Ontario, two of which opened in early 2014. The Ministry of Health and Long-Term Care (MoHLTC) has launched these new birth centres in order to offer women more choice in health care provider and birth setting. This shift is representative of the MoHLTC’s push to move services out of hospitals and into community-based settings. While the birth centre initiative is in its early stages and a formal program evaluation is needed, it has the potential, if scaled up, to decrease the need for hospital beds as well as reduce health care costs through more appropriate care for low-risk pregnancies, leading to fewer interventions. L'accroissement de l'éventail des choix pour l'accouchement offerts aux grossesses à bas risque est en train de faire évoluer les systèmes de santé maternelle en Ontario. La profession de sage-femme est régulée en Ontario depuis 1994. Les sages-femmes fournissent les soins primaires pendant la grossesse, l’accouchement et dans les six semaines post-partum. Il existe aujourd'hui trois centres de naissance dirigés par des sages-femmes en Ontario, dont deux ont ouvert au début de 2014. Le Ministère de la santé et des soins de longue durée (MSSLD) a créé ces centres de naissance afin d'offrir aux femmes un plus grand choix de types d'accouchement (personnels et lieux). Ce changement est représentatif d’un virage ambulatoire du MSSLD. Bien que l'initiative des centres de naissance n'en soit qu'à ses débuts et qu'une évaluation officielle du programme soit encore à venir, elle est susceptible, si généralisée à l'ensemble de la population, de diminuer la demande pesant sur les lits d'hôpitaux et de réduire les coûts des soins en fournissant des soins appropriés aux grossesses à bas risque nécessistant moins d'interventions.

In July 2014, the Ontario Ministry of Training, Colleges and Universities (MTCU) released the Personal Support Worker (PSW) Program Standard. Prior to this, there were three educational standards, inconsistently applied across a multitude of education and employment settings, governed by three distinct pieces of legislation. The primary goal of the reform is to address variance in available educational options in which one can receive a certificate or diploma as a PSW. The decision emerged in response to a growing group of unregulated workers providing care for an increasingly complex long-term and community care population. The reform was achieved through a small consultation led by the Ministry of Health and Long-Term Care (MOHLTC). A technical working group at the MTCU was responsible for developing the standard. The PSW Program Standard has the potential to simplify a complex educational landscape through standardization but is only the first step in addressing broader health workforce problems facing the long-term care sector in Ontario. En juillet 2014, le Ministère de la Formation et des Collèges et Universités (MFCU) a établi le Cahier des Normes pour le Programme des Préposés aux Services de Soutien à la Personne (PSSP). Avant ce cahier trois normes existaient, appliquées de manière non uniforme à une grande variété d'établissements de formation et de travail, et gouvernées par trois textes de loi différents. Le principal objectif de la réforme est de résoudre ce problème de variabilité dans l'offre de formation délivrant un grade ou un certificat de PSSP. La décision a été prise en réponse à la croissance du nombre de préposés non régulés devant fournir des services à une population elle aussi croissante et aux besoins de plus en plus complexes, en institutions aussi bien que dans la communauté. La réforme a été promue après une courte consultation menée par le Ministère de la Santé et des Soins de Long-Terme (MSSLT). Un groupe de travail technique au MFCU a pris la responsabilité de développer le cahier des normes. Le Cahier des Normes pour les PSSP peut standardiser et donc simplifier un paysage de formation complexe mais ne représente qu'un premier pas vers la solution des problèmes généraux liés à la main d'oeuvre dans le secteur des soins de long-terme de l'Ontario.

Introduction: Forecasting the demand and supply of health manpower in an accurate manner makes appropriate planning possible. The aim of this paper was to review approaches and methods for health manpower forecasting and consequently propose the features that improve the effectiveness of this important process of health manpower planning. Methods: A literature review was conducted for studies published in English from 1990-2014 using Pub Med, Science Direct, Pro Quest, and Google Scholar databases. Review articles, qualitative studies, retrospective and prospective studies describing or applying various types of forecasting approaches and methods in health manpower forecasting were included in the review. The authors designed an extraction data sheet based on study questions to collect data on studies' references, designs, and types of forecasting approaches, whether discussed or applied, with their strengths and weaknesses Results: Forty studies were included in the review. As a result, two main categories of approaches (conceptual and analytical) for health manpower forecasting were identified. Each approach had several strengths and weaknesses. As a whole, most of them were faced with some challenges, such as being static and unable to capture dynamic variables in manpower forecasting and causal relationships. They also lacked the capacity to benefit from scenario making to assist policy makers in effective decision making. Conclusions: An effective forecasting approach is supposed to resolve all the deficits that exist in current approaches and meet the key features found in the literature in order to develop an open system and a dynamic and comprehensive method necessary for today complex health care systems. [ABSTRACT FROM AUTHOR]

Objectives. This paper will explore the social history of the transnational migration of foreign-trained doctors to western countries in the post-WWII era, by examining, as a case study, South Asian-trained doctors who were first licensed in the Canadian province of Nova Scotia between 1961 and 1971.Design. This article draws on both quantitative and qualitative primary sources. First, we analyzed the 1966 and 1971 copies of the Canadian Medical Directories (CMD), the annual compendium of all licensed practitioners in the country (over 20,000 practitioners). These CMD entries were supplemented by the annual returns of ‘intended occupation’ (those designated as ‘physician’ or ‘surgeon’) of landed immigrants to Canada, as compiled by the federal Department of Manpower and Immigration. Secondly, we analyzed testimony of 26 oral histories and narrative accounts of foreign-trained doctors being compiled as part of an ongoing multiyear program of research on the immigration of foreign-trained doctors to Canada. We have interviewed 14 doctors who, at one point in their career, practiced in Nova Scotia, 8 of whom were South Asian-trained medical practitioners. These oral interviews provide personal reflections on the process of professional and social acculturation that occurred as these foreign doctors settled in Canada.Results.The results of this paper indicate that the social history of the immigration of South Asian-trained doctors to Canada in the 1960s must be seen within a larger and more complicated pattern of the international migration of health care professionals. Indeed, the demand for foreign-trained doctors in Britain was in part a reflection of the out-migration of British-born doctors who were leaving the National Health Service for Canada, the USA, and Australia. And the demand in Canada for doctors was itself a reaction to the drift of a certain number of Canadian-trained doctors for advanced training in the USA.Conclusions. In this way, this article sheds important historical perspectives on the globalization of health human resources and the complicated, multiple migrations that continue to animate international health human resources today. [ABSTRACT FROM AUTHOR]

Background: It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. Methods: A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. Results: Overall, a 96 % response rate was achieved (n =438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. Conclusions: This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective. [ABSTRACT FROM AUTHOR]

Introduction: Amidst concerns about the capacity to meet the needs of older adults requiring home-based palliative care in Ontario, Canada, one regional organization that coordinates home care services implemented a new model of home care delivery called ‘eShift’. The eShift model of home-based palliative utilizes point-of-care technology along with remotely located registered nurses and personal support workers in the client's home to provide palliative care to clients who wish to die at home. Methods: For this pilot study, an interpretive description methodology with semi-structured interviews was conducted to examine the experiences of eight informal caregivers who cared for a family member who received palliative care as part of the eShift model of home care. Results and discussion: Four themes were identified: the health care family; making the invisible visible; there's no place like home; and burden of love. Overall, informal caregivers indicated that they were very satisfied with care delivery, felt supported by health care providers, and were able to support their family member to die at home. Findings from this study contribute a greater understanding of the experiences of informal caregivers caring for a family member receiving care in a technology enhanced palliative care model. [ABSTRACT FROM PUBLISHER]

Recently, the emphasis on health human resources (HHR) planning has shifted away from a utilization-based approach toward a needs-based one in which planning is based on the projected health needs of the population. However, needs-based models that are currently in use rely on a definition of 'needs' that include only the medical circumstances of individuals and not personal preferences or other socio-economic factors. We examine whether planning based on such a narrow definition will maximize social welfare. We show that, in a publicly funded healthcare system, if the planner seeks to meet the aggregate need without taking utilization into consideration, then oversupply of HHR is likely because 'needs' do not necessarily translate into 'usage.' Our result suggests that HHR planning should track the healthcare system as access gradually improves because, even if health care is fully accessible, individuals may not fully utilize it to the degree prescribed by their medical circumstances. [ABSTRACT FROM AUTHOR]

Objective: To understand the knowledge and services of informal providers and to explore their role in addressing the human resource gap in Uttar Pradesh, India, within the context of maternal health. Materials and methods: The study is exploratory in nature, conducted in four blocks of four districts of Uttar Pradesh state, India. Semi-structured interviews were conducted with 114 informal providers. Results: More than one-third (38%) providers have some formal education and unrecognized degrees. Approximately three-fourths (74%) of them have more than 5 years of work experience. They also provide delivery and in-patient services and have basic equipment available. However, they lack essential knowledge about maternal health. They have mixed opinion about their contribution towards maternal health but the only ones available. Therefore, despite lacking requisite knowledge, training and services, they become indispensable due to lack of emergency and timely public health services, and being the only ones existing in the community. Conclusion: Informal sector practitioners are a critical link in reaching out to population for health services in developing countries. As opposed to the general notion, they possess years of formal education, experience, informal trainings along with trust of communities. Thus, it becomes important to accept their presence and manage them to the best of their abilities even for specialized care like maternal health.

Aim To identify and report on the relative importance of factors influencing nurse managers' intentions to stay in or leave their current position. Background Effective nurse managers play an important role in staff nurse retention and in the quality of patient care. The advancing age of nurse managers, multiple job opportunities within nursing and the generally negative perceptions of the manager role can contribute to difficulties in retaining nurse managers. Methods Ninety-five Canadian nurse managers participated in a web survey. Respondents rated the importance of factors related to their intent to leave or stay in their current position for another 2 years. Descriptive, t-test and mancova statistics were used to assess differences between managers intending to stay or leave. Results For managers intending to leave ( n = 28), the most important factors were work overload, inability to ensure quality patient care, insufficient resources, and lack of empowerment and recognition. Managers intending to leave reported significantly lower job satisfaction, perceptions of their supervisor's resonant leadership and higher burnout levels. Implications for nursing management Organisations wishing to retain existing nurse managers and to attract front-line staff into leadership positions must create and foster an environment that supports nurse managers. [ABSTRACT FROM AUTHOR]

In 2006, the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced Physician Assistants (PAs) through the announcement of demonstration projects, education and training programs, and subsequent funding. PAs are directly supervised by physicians and act as physician extenders by performing acts as delegated to them by their supervising physicians. PAs were proposed as a potential solution to help improve access to health care and reduce wait times throughout the province. Prior to the 2006 Ministry announcement, there was little public discussion regarding the acceptance of the PA role or its sustainability. Opposition from nursing and other groups emerged in response to the 2006 announcement and flared again when stakeholder comments were solicited in 2012 as part of the PA application for status as regulated health professionals. As a health reform, the introduction of PAs has neither succeeded nor failed. In 2013, the majority of PA funding continues to be provided by the MOHLTC, and it is unknown whether the PA role will be sustainable when the MOHTLC withdraws salary funding and health system employers must decide whether or not to continue employing PAs at their own expense. Le ministère de la santé et des soins de longue durée de l’Ontario (MSSLD) a introduit les Adjoints au Médecin (AM) en 2006 en annonçant des projets expérimentaux, des programmes de formation et d’éducation, ainsi que des financements à venir. Les AMs sont placés sous la direction directe des médecins et agissent comme des prolongements des médecins en effectuant des actes qui leur sont délégués par leur médecin superviseur. Les AMs ont été vus comme une solution possible aux problèmes d’accès aux soins et de délais d’attente dans la province. L’acceptabilité et la pérennité du rôle des AMs n’avaient pas vraiment été discutées publiquement avant cette annonce du ministère en 2006. Les infirmières, ainsi que d’autres groupes, ont marqué leur opposition en réponse à l’annonce de 2006, et de nouveau en 2012 lorsque des commentaires des parties prenantes ont été sollicitées dans le cadre d’un dépôt de demande de régulation en profession médicale par les AMs. L’introduction des AMs ne peut être qualifiée de succès ou d’échec. La majeure partie du financement des AMs est toujours assurée par le MSSLD en 2013 et il est impossible de savoir si le rôle des AMs sera pérennisé lorsque le MSSLD arrêtera de financer leur salaires, laissant les employeurs au sein du système de santé décider par eux mêmes s’ils veulent ou non continuer à employer des AMs sur leur propre budget.

Introduction: An unbalanced geographical distribution of physicians leads to important differences in healthcare outcomes and difficulties in accessing healthcare services in rural areas. As in many other countries in the world, the geographical distribution of physicians in Turkey is unbalanced. Although there has been an increase in the number of physicians in the rural areas of Turkey since the introduction of the Health Transformation Program in 2003, health statistics indicate that significant differences still exist between regions in terms of the population-to-physician ratio. The aim of this study was to determine the factors that affect physicians’ decisions about working in rural areas in Turkey. Methods: Overall, 1340 physicians working in urban areas constituted the sample group of this study. A survey method was used to collect the data. The questionnaire, which was used as a data collection tool, included nine questions to gather the opinions of physicians regarding working in rural areas. Variables such as occupational group and financial incentives affecting the physicians’ willingness to work in rural areas were analyzed with descriptive statistics, and the answers given according to these variables were compared via t-test and one-way analysis of variance. Results: Of the sample, 59.9% of the participant physicians were men, and 36.9% were specialists. Opinions of the physicians about working in the rural areas differed significantly by occupational group, marital status and income. Medical residents and general practitioners were more willing to work in rural areas than other profession groups. In addition, single physicians were more open to working in rural areas than were married physicians. An increase in physicians’ income reduced their willingness to work in rural areas. The developmental level of the region where they worked was found to be a very important variable affecting their preferences. Participants working in developed regions are reluctant to work in the rural areas. Conclusions: Specific occupational groups, young and single physicians, and physicians working in underdeveloped regions were found to be the groups that can more easily be motivated to work in rural areas. To encourage physicians to work in rural areas, monetary and non-monetary incentives should be considered. [ABSTRACT FROM AUTHOR]

Aims The aims of this paper are to: (1) describe work characteristics that nurse faculty report encourage them to remain in or leave their academic positions; and (2) determine if there are generational differences in work characteristics selected. Background Nurse faculty play key roles in preparing new nurses and graduate nurses. However, educational institutions are challenged to maintain full employment in faculty positions. Design A cross-sectional, descriptive survey design was employed. Methods Ontario nurse faculty were asked to select, from a list, work characteristics that entice them to remain in or leave their faculty positions. Respondent data ( n = 650) were collected using mailed surveys over four months in 2011. Results While preferred work characteristics differed across generations, the most frequently selected incentives enticing nurse faculty to stay were having: a supportive director/dean, reasonable workloads, supportive colleagues, adequate resources, manageable class sizes and work/life balance. The most frequently selected disincentives included: unmanageable workloads, unsupportive organizations, poor work environments, exposure to bullying, belittling and other types of incivility in the workplace and having an unsupportive director/dean. Conclusion This research yields new and important knowledge about work characteristics that nurse faculty report shape their decisions to remain in or leave their current employment. Certain work characteristics were rated as important among all generations. Where similarities exist, broad strategies addressing work characteristics may effectively promote nurse faculty retention. However, where generational differences exist, retention-promoting strategies should target generation-specific preferences. [ABSTRACT FROM AUTHOR]

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to identify the association between nursing staffing and indicators of healthcare quality in intensive care units. Materials and Methods: A descriptive study was done using a correlational component in which 4006 work shifts were observed and staffing variables (structure) and results were analyzed in terms of cases of shock or arrest, infections associated with health care, number of deaths, and all adverse health events. Findings: The findings show nurses conduct a limited number of activities involving direct patient care. These focus on administering medication, supervising transfusions and other administrative tasks, while assistant nurses handle direct patient care, including complex activities. The average patient-to-nurse ratio was 5.4 patients per nurse available during the shift, while the average patient-to-nursing assistant ratio was 2.4. The correlations are inconclusive. Conclusions: It is suggested the skill mix be explored further as a more sensitive measure of staffing, and recommendations are made on differentiating activities between nursing professionals and assistant nurses. Several considerations are raise concerning staff allocation. [ABSTRACT FROM AUTHOR]

Background: Planning for human resources for health (HRH) is central to health systems strengthening around the world, including in the Caribbean and Jamaica. In an effort to align Jamaica's health workforce with the changing health needs of its people, a partnership was established between Jamaican and Canadian partners. The purpose of the work described in this paper is to describe the development and application of a needs-based HRH simulation model for pharmacists in Jamaica's largest health region. Methods: Guided by a Steering Committee of Jamaican stakeholders, a simulation modelling approach originally developed in Canada was adapted for the Jamaican context. The purpose of this approach is to promote understanding of how various factors affect the supply of and/or requirements for HRH in different scenarios, and to identify policy levers for influencing each of these under different future scenarios. This is done by integrating knowledge of different components of the health care system into a single tool that shows how changes to different parameters affect HRH supply or requirements. Data to populate the model were obtained from multiple administrative databases and key informants. Findings were validated with the Steering Committee. Results: The model estimated an initial shortage of 110 full-time equivalent (FTE) pharmacists in the South East Region that, without intervention, would increase to a shortage of about 150 FTEs over a 15-year period. In contrast to the relatively small impact of a large enrolment increase in Jamaica's pharmacy training programme, interventions to increase recruitment of pharmacists to the public sector, or improve productivity - through, for example, the use of support staff and/or new technologies - may have much greater impact on reducing this shortage. Conclusions: The model represents an improvement on the HRH planning tools previously used in Jamaica in that it supports the estimation of HRH requirements based directly on measures of population health need. Both the profession (pharmacists) and country (Jamaica) considered here are under-studied. Further investments by Jamaica's MoH in continuing to build capacity to use such models, in combination with their efforts to enhance health information systems, will support better informed HRH planning in Jamaica. [ABSTRACT FROM AUTHOR]

Objective: To understand the knowledge and services of informal providers and to explore their role in addressing the human resource gap in Uttar Pradesh, India, within the context of maternal health. Materials and methods: The study is exploratory in nature, conducted in four blocks of four districts of Uttar Pradesh state, India. Semi-structured interviews were conducted with 114 informal providers. Results: More than one-third (38%) providers have some formal education and unrecognized degrees. Approximately three-fourths (74%) of them have more than 5 years of work experience. They also provide delivery and in-patient services and have basic equipment available. However, they lack essential knowledge about maternal health. They have mixed opinion about their contribution towards maternal health but the only ones available. Therefore, despite lacking requisite knowledge, training and services, they become indispensable due to lack of emergency and timely public health services, and being the only ones existing in the community. Conclusion: Informal sector practitioners are a critical link in reaching out to population for health services in developing countries. As opposed to the general notion, they possess years of formal education, experience, informal trainings along with trust of communities. Thus, it becomes important to accept their presence and manage them to the best of their abilities even for specialized care like maternal health. [ABSTRACT FROM AUTHOR]

The principal problems of healthcare services in China are “difficulty in seeing a doctor”and “high expense of getting medical service” (commonly known in Chinese as “kan bing nan, kan bing gui”). The central Chinese government has already launched the bottom-up cascading medical system and two-way referral system recently in order to solve these problems (1). Only when patients go to medical institutions in an orderly fashion, can we see the hope of breaking the kan bing nan, kan bing gui (2). However, we face a number of obstacles when implementing the referral policies. The biggest obstacle is the lack of Human Resource (HR) for primary care both in capacity and volume (3). The central Chinese government has launched a series of policies to deal with the shortage of HRs in rural areas. Profound measurements involve postgraduate training for General Practitioner (GP) (a three-year plan beginning in 2010 for producing health professionals for rural areas and improving rural retention), “3+2” medical education model (3-year diploma education and 2-year postgraduate GP training), and in-service training for physicians in rural areas (4). It is not the time to assess their effectiveness, however, these measurements are certain to improve the capacity of Community Health Service (CHS) institutions.

The lack of health human resources is a global issue. China also faces the same issue, in addition to the equity of human resources allocation. With the launch of new healthcare reform of China in 2009, have the issues been improved? Relevant data from China Health Statistical Yearbook and a qualitative study show that the unequal allocation of health human resources is getting worse than before.

In response to the growing role of personal support workers (PSWs) in the delivery of health care services to Ontarians, the Ontario government has moved forward with the creation of a PSW registry. This registry will be mandatory for all PSWs employed by publicly funded health care employers, and has the stated objectives of better highlighting the work that PSWs do in Ontario, providing a platform for PSWs and employers to more easily access the labour market, and to provide government with information for human resources planning. In this paper we consider the factors that brought the creation of a PSW registry onto the Ontario government’s policy agenda, discuss how the registry is being implemented, and provide an analysis of the strengths and weaknesses of this policy change. Prenant acte du rôle de plus en plus important joué par les préposés aux services de soutien à la personne (PSSP) dans les soins fournis aux Ontariens, le gouvernement de l’Ontario a décidé de créer un registre des PSSP. L’inscription dans ce registre sera obligatoire pour tout PSSP travaillant pour des employeurs financés sur fonds publics et les objectifs suivants sont poursuivis : mettre en valeur le travail des PSSP en Ontario, fournir un point d’accès au marché du travail pour les PSSP et leurs employeurs, et fournir au gouvernement l’information nécessaire pour planifier les ressources humaines dans ce domaine. Dans cet article, nous décrivons les facteurs expliquant comment la décision politique de créer un registre des PSSP a été prise, nous discutons la façon dont celui-ci est mis en place, et nous proposons une analyse des forces et limites de cette décision politique.