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Background: While previous studies have examined various platforms that enable providers to connect, Virtual Hallway (VH) stands out with its unique features. The value add is that this online platform connects primary care providers and specialists for synchronous phone-based conversations and aims to reduce referrals and enhance the quality of referrals. VH allows providers to easily log in, select the required specialty, book call times, receive reminders, and have calls documented, ensuring a high connection rate. In May 2022, the provincial health authority in Nova Scotia, a Canadian province, and VH initiated a feasibility study facilitated through the Health Innovation Hub in Nova Scotia. The goal was to enable primary care providers to connect with specialists, thereby reducing wait times and unnecessary referrals, and facilitating timely access to relevant clinical direction for patients. The current evaluation assessed utilization, value for money in economic analysis, and consultation experiences., Methods: The study used post, cross-sectional, and cost-benefit study designs. We collected data through various methods, including administratively recorded utilization, theory-driven surveys, and cost data. Utilization was measured by the number of completed consults and the number of healthcare professionals using the VH platform. We analyzed the data using a combination of descriptive statistics and a cost-benefit analysis, which also involved conducting probabilistic sensitivity analysis., Results: The study found that approximately 84% of the VH consultations avoided needing in-person specialist referrals. The return on investment was 1.8 (95% CI: 0.8 to 3.0), indicating that the monetary value of the measurable benefits associated with VH exceeded the value of the resources invested. The provider experience survey revealed high satisfaction levels with VH across user groups, with 92% of specialists and 96% of primary care providers reporting being satisfied or highly satisfied with their experience. These positive indicators of provider experience were further supported by the fact that 97% of respondents agreed or strongly agreed that they intended to continue to use VH in their practice, and 97% of respondents agreed or strongly agreed that they would recommend VH to a colleague., Conclusions: The study suggests that VH was well-received by users, with high levels of satisfaction reported and a reduced need for in-person referrals. It also represented value for money. Further research could explore how the availability of virtual health services can lead to reduced utilization of healthcare resources among different groups of patients., (© 2024. The Author(s).)

Objective: The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity., Introduction: To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system., Inclusion Criteria: This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies)., Methods: This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format., Results: Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems., Conclusions: Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally., Review Registration: DalSpace dalspace.library.dal.ca/handle/10222/80835., Competing Interests: The authors declare no conflict of interest., (COPYRIGHT © 2024 THE AUTHORS. PUBLISHED BY WOLTERS KLUWER HEALTH, INC. ON BEHALF OF JBI.)

Objective: The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program., Methods: This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years., Findings: Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival., Key Conclusions: Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Paynter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.

In April 2019, the province of Nova Scotia became the first jurisdiction in North America to pass legislation that incorporated deemed consent for deceased organ donation. The reform included many other important updates, including the hierarchy for consent, enabled donor and recipient contact, and mandatory referral of potential deceased donors. Additionally, system reforms were implemented to improve the deceased donation system in Nova Scotia. A collection of national colleagues identified the magnitude of the opportunity to develop a comprehensive strategy to measure and evaluate the impact of the legislative and system reforms. This article describes the successful development of a consortium from both national and provincial jurisdictions that included experts from a variety of backgrounds and clinical and administrative disciplines. In describing the creation of this group, we hope to offer our case example as a model for the evaluation of other health system reforms from a multidisciplinary perspective.

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

Objectives: To (1) compare changes in parenting self-efficacy, social support, postpartum anxiety, and postpartum depression in Canadian women before and during the early COVID-19 pandemic; (2) explore how women with a newborn felt during the pandemic; (3) explore ways that women coped with challenges faced., Methods: A cross-sectional design was used. Prior to the pandemic, an online survey was conducted with women who an infant 6 months old or less in one of the three Eastern Canadian Maritime provinces. A similar survey was conducted during the pandemic in mid-2020., Results: Pre-COVID, 561 women completed the survey, and 331 women during the pandemic. There were no significant differences in parenting self-efficacy, social support, postpartum anxiety, and depression between the cohorts. Difficulties that women reported because of COVID-19 restrictions included lack of support from family and friends, fear of COVID-19 exposure, feeling isolated and uncertain, negative impact on perinatal care experience, and hospital restrictions. Having support from partners and families, in-person/virtual support, as well as engaging in self-care and the low prevalence of COVID-19 during the summer of 2020 helped women cope., Clinical Relevance: Women identified challenges and negative impacts due to the COVID-19 pandemic, although no differences in psychosocial outcomes were found. Consideration of public health policy during the postpartum period for the ongoing COVID-19 pandemic is needed., Conclusion: While there were no significant differences in psychosocial outcomes, there were still challenges and negative impacts that women identified., (© 2022 Sigma Theta Tau International.)

Background: The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women., Purpose: To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers., Methods: Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses., Results: A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4  or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery., Conclusion: There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.

Background: Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania., Methods: The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the 'Big Results Now' star-rating assessments and a team-developed survey for health providers/managers. The 'Big Results Now' star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings., Results: Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building., Conclusion: Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision., (© 2022. The Author(s).)

Introduction: In Tanzania, inadequate access to comprehensive emergency obstetric and newborn care (CEmONC) services is the major bottleneck for perinatal care and results in high maternal and perinatal mortality. From 2015 to 2019, the Accessing Safe Deliveries in Tanzania project was implemented to study how to improve access to CEmONC services in underserved rural areas., Methods: A five-year longitudinal cohort study was implemented in seven health centres (HCs) and 21 satellite dispensaries in Morogoro region. Five of the health centres received CEmONC interventions and two served as controls. Forty-two associate clinicians from the intervention HCs were trained in teams for three months in CEmONC and anaesthesia. Managers of 20 intervention facilities, members of the district and regional health management teams were trained in leadership and management. Regular supportive supervision was conducted., Results: Interventions resulted in improved responsibility and accountability among managers. In intervention HCs, the mean monthly deliveries increased from 183 (95% CI 174-191) at baseline (July 2014 -June 2016) to 358 (95% CI 328-390) during the intervention period (July 2016 -June 2019). The referral rate to district hospitals in intervention HCs decreased from 6.0% (262/4,392) with 95% CI 5.3-6.7 at baseline to 4.0% (516/12,918) with 95% CI 3.7-4.3 during the intervention period while it increased in the control group from 0.8% (48/5,709) to 1.5% (168/11,233). The obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6-3.1) at baseline to 1.1% (95% CI 0.7-1.6) during the intervention period (not statistically significant). Active engagement strategies and training in leadership and management resulted in uptake and improvement of CEmONC and anaesthesia curricula, and contributed to scale up of CEmONC at health centre level in the country., Conclusions: Integration of leadership and managerial capacity building, with CEmONC-specific interventions was associated with health systems strengthening and improved quality of services., Competing Interests: The authors have declared that no competing interests exist.

This paper documents Nova Scotia Health's progress in operationalizing integrated needs-based workforce planning as part of its ongoing response to the pandemic. A multidisciplinary workforce planning team with representation spanning key portfolios was created to facilitate the organization's response to the pandemic. Analyses applied early in Wave 3 of the pandemic showed large projected shortages in several professions and identified which services would likely be scarcest among the available workforce relative to patient need. Based on these results, the workforce planning team recommended and supported operational teams in implementing a multi-faceted set of interventions aimed at increasing the availability of individuals with these competencies. These interventions collectively yielded an adequate supply of additional competent personnel to meet the needs of COVID-19 inpatients across the province through the third wave of the pandemic. Lessons learned are proving critical to maintaining core operations during Wave 4 of the pandemic.

Objective: To determine the effectiveness of the Essential Coaching for Every Mother program on maternal self-efficacy, perceived social support, postpartum anxiety, and postpartum depression at six-weeks postpartum., Methods: Participants from Nova Scotia were randomized, stratified by parity, to receive either the Essential Coaching for Every Mother postpartum text-message program or usual care, from birth to six-weeks postpartum. Participants completed surveys at enrollment (after birth) and at 6 weeks. Differences between groups were analyzed using analysis of covariance, considering parity and group allocation., Results: Of the 171 participants recruited (53% primiparous), 150 completed the baseline survey (intervention n  = 78, control n  = 72). At baseline, newborns were on average 4.4 days old (SD: 3.9) and mothers 31.4 years old (SD: 4.5). Controlling for maternal age, primiparous women in the intervention group had a greater increase in maternal self-efficacy than primiparous women in the control group (mean difference [MD] = 4.84 (standard error [SE] = 0.75) vs. MD = 2.13 (SE = 0.81), p  = 0.034). Women allocated to the intervention group had a greater reduction in postpartum anxiety symptoms than women in the control group for both multiparous and primiparous women (MD = -3.91 (SE = 1.82) vs. 2.81 (SE = 1.86), p  = 0.011). There was no significant change in postpartum depression scores or perceived social support for either group., Discussion: This study presents the results of the first Canadian postpartum text message program, which found improved psychosocial outcomes for postpartum women. Given the potential to reach numerous women at a low cost across geographical locations, the scalability of this intervention can improve maternal self-efficacy and reduce postpartum anxiety., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objectives: The primary objective of this project was to evaluate the preliminary impact of Essential Coaching for Every Mother on maternal self-efficacy, social support, postpartum anxiety, and postpartum depression. The secondary objective was to explore the acceptability of the Essential Coaching for Every Mother program provided during the COVID-19 pandemic., Methods: A prospective pre-post study was conducted with first-time mothers in Nova Scotia, Canada, between July 15 and September 19, 2020. Participants completed a self-report survey at enrollment (after birth) and 6 weeks postpartum. Various standardized measures were used, and qualitative feedback on the program was also collected. Paired t tests were carried out to determine changes from baseline to follow-up on psychosocial outcomes, and qualitative feedback was analyzed through thematic analysis., Results: A total of 88 women enrolled. Maternal self-efficacy increased between baseline (B) and follow-up (F) (B: 33.33; F: 37.11, P = 0.000), whereas anxiety (STAI) declined (B: 38.49; F: 34.79, P = 0.004). In terms of acceptability, 89% of participants felt that the number of messages was just right, 84.5% felt the messages contained all the information they needed relative to caring for a newborn, and 98.8% indicated they would recommend this program to other new mothers., Conclusions: Essential Coaching for Every Mother may play a role in increasing maternal self-efficacy and decreasing anxiety, although future work with a control group is needed to delineate the true effects of the program. Overall, mothers were satisfied with the Essential Coaching for Every Mother program and would recommend it for other mothers, during the COVID-19 pandemic and beyond., (© 2021 Wiley Periodicals LLC.)

Background: "Essential Coaching for Every Mother" is a Canadian text message-based program that sends daily messages to mothers for 6 weeks after they give birth. There is a need to explore the program's effectiveness in terms of the participants' experience to guide refinement and modification., Objective: This study aimed to describe the process evaluation of the Essential Coaching for Every Mother randomized controlled trial through an evaluation of the research implementation extent and quality., Methods: Participants were recruited from Nova Scotia, Canada, between January 5 and August 1, 2021. Enrolled participants were randomized into the intervention or control group. Participants randomized to the intervention group received standard care along with the Essential Coaching for Every Mother program's text messages related to newborn and maternal care for the first 6 weeks after giving birth, while the control group received standard care. Usage data were collected from the SMS text message program used, and participants completed web-based questionnaires at 6 weeks after birth. Quantitative data and qualitative responses to open-ended questions were used to triangulate findings. Quantitative data were summarized using means, SDs, and percentages, as appropriate, while qualitative data were analyzed using thematic analysis., Results: Of the 295 unique initial contacts, 150 mothers were eligible and completed the baseline survey to be enrolled in the study (intervention, n=78; control, n=72). Of those randomized into the intervention group, 75 (96%) completed the 6-week follow-up survey to provide feedback on the program. In total, 48 (62%) intervention participants received all messages as designed in the Essential Coaching for Every Mother program, with participants who enrolled late missing on average 4.7 (range 1-12) messages. Intervention participants reported an 89% satisfaction rate with the program, and 100% of participants would recommend the program to other new mothers. Participants liked how the program made them feel, the format, appropriate timing of messages, and content while disliking the frequency of messages and gaps in content. Participants also provided suggestions for future improvement., Conclusions: Our process evaluation has provided a comprehensive understanding of interest in the program as well as identified preference for program components. The findings of this study will be used to update future iterations of the Essential Coaching for Every Mother program., Trial Registration: ClincalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570., (©Justine Dol, Megan Aston, Douglas McMillan, Gail Tomblin Murphy, Marsha Campbell-Yeo. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.05.2022.)

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VIOA and EE are board members of the GPEF, a not-for-profit organization involved with the design of Text4HealthyAging program. All other authors declare no conflicting interests., (© The Author(s) 2022.)

Objective: The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities., Introduction: Achieving food security is of global importance to meet the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts more than 4 million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians., Inclusion Criteria: Sources were considered for inclusion if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security., Methods: This scoping review was conducted in accordance with JBI methodology. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. No restrictions were placed on date of publication. Language restrictions were limited to English and French. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to their article. Data were extracted independently by two team members, and are presented narratively and in tabular format., Results: The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded for not meeting the inclusion criteria, leaving five articles that underwent data extraction. All five included studies involved African Canadian participants in Canada. All studies focused on adults; one study included women and men participants, while four focused exclusively on women. One study involving women participants included cisgender and transgender women as well as those identifying as queer. Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs., Conclusions: This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings and predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. The urgent need to collect race-disaggregated data in Canada is evident., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 JBI.)

Background: After giving birth, women experience significant changes related to maternal self-efficacy and social support and are at risk of experiencing postpartum anxiety and depression., Problem: No studies have focused on the relationship between parity and infant age and their impact on psychosocial outcomes, particularly in a Canadian context., Aim: To explore the relationship between parity and infant age on perceived maternal self-efficacy, social support, postpartum anxiety, and postpartum depression., Methods: Women from three Canadian provinces within the first 6 months postpartum completed standardized online questionnaires. Multivariate analysis of covariance was used to examine the primary aim., Findings: A total of 561 women (56.5% primiparous, 55.1% infant 0-3 months) participated. There were significant main effects for both parity (P < .001) and age of infant (P < .001), but no significant interaction (P = .463). Primiparous women had lower maternal self-efficacy (P = .004) and higher postpartum anxiety (P = .000) than multiparous women. Women with younger infants had more perceived social support (P = .002). Women with older infants had higher levels of postpartum anxiety (P = .003) and depression (P = .000)., Discussion: The transition that women experience, independent of parity, within the first six months is dynamic with women of older infants experiencing more postpartum mental health concerns and less perceived social support. Our findings emphasize that postnatal support should extend beyond the typical six-week follow-up period., Conclusions: Additional studies are warranted to determine ways to provide ongoing support throughout the first six months and beyond to improve maternal well-being and address postpartum needs., (© 2021 Wiley Periodicals LLC.)

Purpose: Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health., Design/methodology/approach: This was a mixed-methods study that targeted nurses ( N  = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level., Findings: Most participants were female ( n  = 112), had 15 or more years' experience ( n  = 71) and an associate degree/diploma in nursing ( n  = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles., Research Limitations/implications: Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected., Practical Implications: The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional., Originality/value: This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders., (© Emerald Publishing Limited.)

Background: The transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging., Objective: To describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother., Methods: First time mothers (n=11) and postpartum healthcare providers (n=18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers., Results: Three cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers., Conclusion: Essential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education., (Copyright © 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Background: Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum., Objective: The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program., Methods: This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant's age and the woman's self-selected preference for breastfeeding or formula feeding and tailored with the infant's name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant's date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention., Results: Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022., Conclusions: This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program., Trial Registration: ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570., International Registered Report Identifier (irrid): DERR1-10.2196/27138., (©Justine Dol, Megan Aston, Douglas McMillan, Gail Tomblin Murphy, Marsha Campbell-Yeo. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.03.2021.)

The levels and types of oral health problems occurring in populations change over time, while advances in technology change the way oral health problems are addressed and the ways care is delivered. These rapid changes have major implications for the size and mix of the oral health workforce, yet the methods used to plan the oral health workforce have remained rigid and isolated from planning of oral healthcare services and healthcare expenditures. In this paper, we argue that the innovation culture that has driven major developments in content and delivery of oral health care must also be applied to planning the oral health workforce if we are to develop 'fit for purpose' healthcare systems that meet the needs of populations in the 21st century. An innovative framework for workforce planning is presented focussed on responding to changes in population needs, service developments for meeting those needs and optimal models of care delivery., (© 2020 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Aim: To explore perspectives of nurse managers about their preparation for transitioning into positions of leadership., Background: There have been serious concerns about the level of preparation as well as availability of support systems for transitioning of nurses into positions of authority., Methods: This was a quantitative study conducted in four Caribbean countries targeting nurses promoted to leadership positions within the last 5 years. Data were collected using a 30-item questionnaire. Ethical approvals were received from the University of the West Indies and the participating countries., Results: Most participants were female, had 15 or more years' experience and an associate degree/diploma in nursing. They felt prepared through training and acting opportunities although many were not preceptored/mentored into the position. Preparation by training was positively correlated to acting opportunities, preceptorship programme and having a preceptor., Conclusion: Transitioning into positions of leadership requires readiness from a personal as well as an organisational perspective. There must be investment in the development opportunities to support nurses' transition into leadership positions., Implications for Nursing Management: Organisational continuity and effectiveness will be dependent on a balance between investing in experienced nursing personnel while encouraging personal development of less-experienced nurses. Peer mentorship must be utilized to facilitate nurse transition., (© 2020 John Wiley & Sons Ltd.)

Objective: The objective of this study is to synthesize and describe the evidence relating to food security among African Canadian communities to inform future research and health policy concerning people of African descent., Introduction: Food security denotes the timely access to nutritionally and culturally appropriate foods by individuals, families, groups, and communities. In Canada, there are vulnerable groups who experience higher rates of food insecurity, including immigrant and senior populations as well as Indigenous communities. While there is evidence describing food security among these vulnerable groups, food security among African Canadian communities remains poorly understood. The African Canadian community is an integral component of the Canadian population, yet there is a limited understanding of food security among this group., Inclusion Criteria: This review will focus on the African Canadian population and food security, which encompasses food access, nutrition, and culturally appropriate foods. Evidence obtained from qualitative, quantitative, mixed methods studies, as well as dissertations and gray literature will be considered for inclusion., Methods: This scoping review will be conducted in accordance the JBI scoping review methodology. A comprehensive search strategy developed by a librarian scientist will be used to locate and retrieve relevant sources. A screening tool will be used to screen titles and abstracts as well as the full text of included sources. Data will then be extracted by two independent reviewers, synthesized, and presented narratively, including tables and figures where appropriate.

Aim: This paper examines the possibility of including families, particularly mothers, within the health workforce using the human resource for health planning model to improve newborn outcomes., Background: In many low- and middle-income countries, there is a critical shortage of healthcare providers which impacts care for the neonatal population. A maternal and newborn health need that is prevalent in such countries is the care available between pregnancy and the postnatal period, where significant maternal and newborn deaths occur., Sources of Evidence: Using the population health need of the neonatal population in Tanzania, this paper explores the opportunity to include mothers as an additional human resource for health within the Needs-Based Health Human Resources and Health Systems Planning model., Discussion: In relation to educating and engaging family caregivers, the possible extension of the health workforce to include mothers as a response to meeting the healthcare needs of the neonatal population has yet to be explored. Through mothers and healthcare providers working together to address the population health need of essential newborn care, it offers a way forward for planning the resources needed in a health system. If utilized, mothers offer the opportunity to supplement the demand for human resources for health in the provision of newborn care, without replacing healthcare providers., Conclusion: Mothers as potential members of the health workforce furthers the health system as a whole whereby population health needs are addressed and newborn mortality declines., Implications for Health Policy: To solve the critical gap based on the supply of and demand for providers including doctors, nurses and midwives, a broader look at innovative solutions is essential., Implications for Nursing Practice: Mothers offer the opportunity to supplement the available human resources for health in the provision of newborn care, thus helping to close existing gaps., (© 2020 International Council of Nurses.)

Objective: This review aims to evaluate the effectiveness of mother-targeted mobile health (mHealth) education interventions during the perinatal period on maternal psychosocial outcomes in high-income countries., Introduction: Mobile health (i.e. mHealth) is defined as the use of mobile devices to transmit health content and services. The use of mHealth to provide education and support to mothers is a growing field of health innovation. Mothers seek health information online during the postpartum period to learn about health concerns and get advice and support. Despite the potential benefits of mHealth, the potential impact on maternal psychosocial outcomes requires further evaluation., Inclusion Criteria: The review will consider studies that include mHealth interventions targeting mothers in high-income countries. The mHealth education interventions must occur during the antenatal or postnatal period. This review will consider studies that compare the intervention to any comparators. Studies published in English from 2000 will be included., Methods: The search strategy will aim to locate both published and unpublished studies. Following the search, all identified citations will be collated and duplicates removed. Titles and abstracts will be screened and full text of selected citations will then be assessed in detail against inclusion criteria. The results of the search will be reported in full in the final systematic review. Eligible studies will be critically appraised by two independent reviewers. Data extracted will include specific details about the interventions, populations, study methods and outcomes. Studies will be pooled in statistical meta-analysis or presented in narrative form including tables and figures.

Background: Previous studies in Tanzania have shown that mothers do not often receive the recommended number of postnatal contacts, which limits their ability to not only have health checks but also to be provided with sufficient and quality postnatal education. Educating mothers while in the hospital is important yet there remains a paucity on the experiences of mothers in a hospital setting related to newborn care education. Therefore, the objective of this study was to explore the experience of newborn care discharge education at a national hospital in Dar es Salaam, Tanzania from the perspective of mothers and nurse midwives., Methods: Using convenience sampling, participants were recruited from Muhimbili National Hospital. Eight mothers who recently gave birth and eight nurse midwives working on the postnatal and labour ward participated. In-depth semi-structured interviews were conducted in Swahili and transcribed and translated into English. Interviews were analyzed using thematic coding., Results: Most mothers were multiparous (75%) and averaged 29.6 years of age (SD = 5.1). Nurse midwives had an average of 10 years of experience (SD = 7.5). The primary themes identified included barriers, facilitators, and opportunities related to newborn care discharge education. Barriers included lack of standard postnatal education guidelines; community norms against hospital teaching; gaps in hospital care; and expectations of mothers' previous knowledge. Facilitators identified were that education was already being provided on some relevant newborn care topics; nurse midwives desired to teach; and mothers desired to learn and build on their previous knowledge and confidence. Opportunities to improve included developing standardized guidelines related to postnatal discharge education; training nurses how to engage mothers and families; and engaging mothers through varied learning methods., Conclusion: While mothers received some education prior to discharge and nurses expressed a desire to teach, challenges remained in receiving sufficient education on all recommended postnatal education topics. Opportunity to improve postnatal education can be addressed through the development of standardized education and engaging mothers through preferred learning methods., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: The primary objective of this review was to determine the impact of mother-targeted mobile health (mHealth) educational interventions available during the perinatal period in low- and middle-income countries (LMICs) on maternal and neonatal outcomes., Introduction: There has been significant growth of mHealth projects in LMICs. The use of mHealth interventions across the perinatal period offers the ability to share information with mothers about essential newborn care and to encourage mothers to attend perinatal clinics to obtain additional in-person support as needed. The impact of perinatal mHealth educational interventions on maternal behavior change and early neonatal mortality and morbidity outcomes in LMICs is unknown., Inclusion Criteria: This review considered studies that included mHealth educational interventions targeting mothers living in LMICs during the antenatal or postnatal period using mobile devices. The intervention must have been initiated during the antenatal period (conception through birth) through six weeks postnatally. All experimental study designs were included. Outcomes included maternal knowledge, maternal self-efficacy, antenatal/postnatal care attendance and newborn early morbidity and mortality., Methods: PubMed, Embase and CINAHL were searched on March 19, 2018 for studies published in English. The search was updated on June 7, 2018. Critical appraisal was undertaken by two independent reviewers using standardized critical appraisal instruments. Quantitative data were extracted from included studies independently by two reviewers using a standardized data extraction tool. All conflicts were resolved through consensus with a third reviewer. Quantitative data were, where possible, pooled in statistical meta-analysis. Where statistical pooling was not possible, the findings were reported narratively., Results: A total of 1514 articles were screened, and 71 full-text papers were assessed for eligibility, with 23 articles critically appraised. Following appraisal, three articles were excluded due to poor quality. Of the 20 articles included, 16 were peer reviewed articles and four were gray literature reports. Eight papers targeted antenatal education, eight covered postnatal education and four covered both antenatal and postnatal education. Studies varied in terms of design, country, approach, frequency and content. Mothers who received an mHealth intervention attended a significantly greater number of antenatal care contacts (mean difference = 0.67, 95% confidence interval, 0.35 to 0.99, P = 0.0001) and were significantly more likely to have at least one postnatal care contact between six and eight weeks (odds ratio = 1.36, 95% confidence interval, 1.00 to 1.85, P = 0.05). Maternal knowledge, self-efficacy and neonatal mortality and morbidity were inconsistently reported across studies., Conclusions: mHealth education interventions are associated with increased maternal contact antenatally and postnatally in LMICs. Due to heterogeneity of studies among country of implementation, approach, frequency and content of the mHealth interventions, the impact on other maternal and neonatal outcomes is inconclusive. Future work using mHealth to target maternal education during the perinatal period should focus on standardization of content and outcome evaluations.

Providing quality health care is the core purpose for health systems, and it is only possible with adequate capacity among the workforce to provide the required services. Addressing the requirements for, and supply of, the health workforce (workforce planning) is essential for strengthening health systems. There is a global recognition that interprofessional education (IPE) is critical to achieving universal health care. In this introductory paper we discuss how IPE is a key factor within needs-based health systems strengthening and Human Resources for Health (HRH) planning. This perspective is illustrated through six case studies from countries around the globe which provide discourse on how the integration of IPE/IPC with needs-based workforce planning can contribute to strengthening the health systems. Three key learnings arise from the case studies - 1) IPE is important to meet health care needs of populations efficiently and effectively; 2) integrated needs-based planning provides a framework within which IPE has an integral role, and 3) stakeholders from both health and education are critical to the process of seamless integration of IPE across the continuum of health systems.

Background: As population health needs become more complex, addressing those needs increasingly requires the knowledge, skills, and judgment of multiple types of human resources for health (HRH) working interdependently. A growing emphasis on team-delivered health care is evident in several jurisdictions, including those in Canada. However, the most commonly used HRH planning models across Canada and other countries lack the capacity to plan for more than one type of HRH in an integrated manner. The purpose of this paper is to present a dynamic, multi-professional, needs-based simulation model to inform HRH planning and demonstrate the importance of two of its parameters-division of work and clinical focus-which have received comparatively little attention in HRH research to date., Methods: The model estimates HRH requirements by combining features of two previously published needs-based approaches to HRH planning-a dynamic approach designed to plan for a single type of HRH at a time and a multi-professional approach designed to compare HRH supply with requirements at a single point in time. The supplies of different types of HRH are estimated using a stock-and-flow approach., Results: The model makes explicit two planning parameters-the division of work across different types of HRH, and the degree of clinical focus among individual types of HRH-which have previously received little attention in the HRH literature. Examples of the impacts of these parameters on HRH planning scenarios are provided to illustrate how failure to account for them may over- or under-estimate the size of any gaps between the supply of and requirements for HRH., Conclusion: This paper presents a dynamic, multi-professional, needs-based simulation model which can be used to inform HRH planning in different contexts. To facilitate its application by readers, this includes the definition of each parameter and specification of the mathematical relationships between them.

Objectives: To identify and map existing postnatal educational interventions targeting parents in low and middle-income countries. A secondary objective is to conduct a critical analysis of the strengths and limitations of the educational strategies used for parent-targeted postnatal education. Design & data sources: Using scoping review methodology, MedLine, CINAHL, and SCOPUS were searched in October 2017., Review Methods: All studies published after 2000 reporting on educational interventions that targeted parents from the period of birth to 6 weeks postnatally in low and middle-income countries were included. Studies were excluded if they targeted healthcare professionals or were community interventions that spanned antenatal to postnatal care. Title, abstract and full-text screening was conducted by two reviewers., Results: We initially identified 9284 articles with 77 articles included after title, abstract and full-text screening. Most of the studies were quantitative (94%) with over half published after 2014. Most studies (61%) targeted a single newborn care education intervention, of which 75% targeted breastfeeding. Interventions used on average three different methods of implementation (e.g., verbal, written information, counselling). Interventions were provided in the hospital (76%), at home (23%), at a clinic/hospital (8%), and/or virtually through an eHealth intervention, including phone or text messages (12%). Maternal outcomes primarily included knowledge, self-efficacy, anxiety and stress while newborn outcomes primarily included exclusive breastfeeding, weight gain at follow-up, and morbidities. Positive changes were found to occur for reported maternal outcomes (89%) and newborn outcomes (56%)., Conclusions: Parent-targeted education varied in terms of educational topics covered, method and location of intervention, and outcomes examined. While the best strategies of implementing postnatal education interventions to parents in low and middle-income countries is yet to be determined, evidence suggests that current interventions had a positive impact on parents' outcomes using a combined approach. Further work is needed to evaluate the impact on newborn outcomes and to identify the most effective methods and timing of the interventions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Review Question: The objective of this review is to determine the impact of mother-targeted mobile health (mHealth) education interventions available during the perinatal period in low- and middle-income countries on maternal and newborn outcomes. Thus, the review questions are: what is the impact of mother-targeted mHealth education interventions on.

Aim: This paper explores the invisibility and underrepresentation of Black nurses in formal and informal leadership roles using a Black feminist poststructuralist framework. The paper describes historical and contemporary challenges experienced by Black nurses throughout their nursing education and in practice. It also highlights how social and institutional discourses continue to marginalise and oppress Black nurses as leaders and render them invisible., Background: Diversity among nursing leaders is essential to inform health care delivery, develop inclusive practices and provide culturally sensitive care. Despite this glaring need for diversity within nursing in Canada, there remains a significant underrepresentation of Black nurses in the workforce and as leaders., Design: This is a discursive paper on Black nurses in nursing education and the workforce as well as their location as leaders in health care through a critical analysis using Black feminist poststructuralism., Methods: A review of the literature involved searching electronic databases CINAHL, NovaNet, PubMed and Google Scholar using keywords including: Black; African; Nurses; Leaders; Feminism; Poststructural. Articles were screened by titles and abstracts before accessing full-text for relevant articles., Results: Black feminist poststructuralism uncovers how power, language, subjectivity and agency are constructed by the historically ingrained social and institutional discourses of everyday life for Black nurses. Experiences of discrimination and oppression were common throughout nursing education and practice for Black nurses, resulting in feelings of marginalisation and isolation., Conclusion: The invisibility of Black nurse leaders is the result of generational oppression and discrimination manifested through discourses. Systemic, institutional and historical discourses perpetuate barriers for Black nurse leaders, resulting in their invisibility or absence in practice., Relevance to Clinical Practice: This paper is designed to generate discussion related to the invisibility of Black nurse leaders by providing an understanding of the historical experiences of Black people, their entry into the nursing profession and the present day challenges they face. This discussion will inform health care practice, policy, and structuring by identifying the barriers to leadership for Black nurses., (© 2018 John Wiley & Sons Ltd.)

The postpartum period is an exciting yet stressful time for first-time mothers, and although the experience may vary, all mothers need support during this crucial period. In Canada, there has been a shift for universal postpartum services to be offered predominantly online. However, due to a paucity of literature, it is difficult to determine the degree to which mothers' needs are being effectively addressed. The aim of this study was to examine and understand how first-time mothers accessed support and information (online and offline) during the first 6 months of their postpartum period. Using feminist poststructuralism methodology, data were collected from focus groups and e-interviews, and analyzed using discourse analysis. Findings indicate that peer support is greatly valued, and mothers often use social media to make in-person social connections. Findings highlight how accessing support and information is socially and institutionally constructed and provide direction for health professionals to provide accessible postpartum care.

Postpartum education can save lives of mothers and babies in developing countries, and the World Health Organization recommends all mothers receive three postpartum consultations. More information is needed to better understand how postpartum education is delivered and ultimately improves postpartum health outcomes. The purpose of this qualitative study was to examine how postpartum care was delivered in three postnatal hospital clinics in Dar es Salaam, Tanzania. Semistructured interviews with 10 nurse-midwives and three obstetricians were conducted. Feminist poststructuralism guided the research process. Postpartum education was seen to be an urgent matter; there was a lack of supportive resources and infrastructure in the hospital clinics, and nurse-midwives and obstetricians had to negotiate conflicting health and traditional discourses using various strategies. Nurse-midwives and obstetricians are well positioned to deliver life-saving postpartum education; however, improvements are required including increased number of nurse-midwives and obstetricians.

Basu and Pak (2014) argue that need-based workforce planning models would not maximize social welfare, and use of need-based models would result in inefficiency. They propose that planning be based on service utilization to incorporate preferences or other socioeconomic factors. We show that the analysis is based on inappropriate considerations of the nature of healthcare demand, a misrepresentation of need-based approaches and misunderstanding publicly funded healthcare system objectives. We explain how current levels of utilization emerge from workload and income interests of providers that underlie utilization-based models and are incompatible with public goals of maximizing health gains. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Review Objective/question: The objective of this review is to evaluate the impact of the Helping Babies Survive program on neonatal outcomes and healthcare provider knowledge and skills. This quantitative review will aim to answer the following question: What is the impact of the Helping Babies Survive modules (Helping Babies Breathe, Essential Care for Every Baby and Essential Care for Small Babies) on neonatal outcomes and health provider knowledge and skills?

Background: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study., Methods: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically., Results: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration., Conclusions: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

Background: As part of efforts to inform the development of a global human resources for health (HRH) strategy, a comprehensive methodology for estimating HRH supply and requirements was described in a companion paper. The purpose of this paper is to demonstrate the application of that methodology, using data publicly available online, to simulate the supply of and requirements for midwives, nurses, and physicians in the 32 high-income member countries of the Organisation for Economic Co-operation and Development (OECD) up to 2030., Methods: A model combining a stock-and-flow approach to simulate the future supply of each profession in each country-adjusted according to levels of HRH participation and activity-and a needs-based approach to simulate future HRH requirements was used. Most of the data to populate the model were obtained from the OECD's online indicator database. Other data were obtained from targeted internet searches and documents gathered as part of the companion paper., Results: Relevant recent measures for each model parameter were found for at least one of the included countries. In total, 35% of the desired current data elements were found; assumed values were used for the other current data elements. Multiple scenarios were used to demonstrate the sensitivity of the simulations to different assumed future values of model parameters. Depending on the assumed future values of each model parameter, the simulated HRH gaps across the included countries could range from shortfalls of 74 000 midwives, 3.2 million nurses, and 1.2 million physicians to surpluses of 67 000 midwives, 2.9 million nurses, and 1.0 million physicians by 2030., Conclusions: Despite important gaps in the data publicly available online and the short time available to implement it, this paper demonstrates the basic feasibility of a more comprehensive, population needs-based approach to estimating HRH supply and requirements than most of those currently being used. HRH planners in individual countries, working with their respective stakeholder groups, would have more direct access to data on the relevant planning parameters and would thus be in an even better position to implement such an approach.

Background: Recognition of the importance of effective human resources for health (HRH) planning is evident in efforts by the World Health Organization (WHO) and the Global Health Workforce Alliance (GHWA) to facilitate, with partner organizations, the development of a global HRH strategy for the period 2016-2030. As part of efforts to inform the development of this strategy, the aims of this study, the first of a pair, were (a) to conduct a rapid review of recent analyses of HRH requirements and labour market dynamics in high-income countries who are members of the Organisation for Economic Co-operation and Development (OECD) and (b) to identify a methodology to determine future HRH requirements for these countries., Methods: A systematic search of peer-reviewed literature, targeted website searches, and multi-stage reference mining were conducted. To supplement these efforts, an international Advisory Group provided additional potentially relevant documents. All documents were assessed against predefined inclusion criteria and reviewed using a standardized data extraction tool., Results: In total, 224 documents were included in the review. The HRH supply in the included countries is generally expected to grow, but it is not clear whether that growth will be adequate to meet health care system objectives in the future. Several recurring themes regarding factors of importance in HRH planning were evident across the documents reviewed, such as aging populations and health workforces as well as changes in disease patterns, models of care delivery, scopes of practice, and technologies in health care. However, the most common HRH planning approaches found through the review do not account for most of these factors., Conclusions: The current evidence base on HRH labour markets in high-income OECD countries, although large and growing, does not provide a clear picture of the expected future HRH situation in these countries. Rather than HRH planning methods and analyses being guided by explicit HRH policy questions, most of the reviewed studies appeared to derive HRH policy questions based on predetermined planning methods. Informed by the findings of this review, a methodology to estimate future HRH requirements for these countries is described.

The WHO Global Code of Practice on the International Recruitment of Health Personnel was implemented in May 2010. The present commentary offers some insights into what is known about the Code five years on, as well as its potential impact, drawing from interviews with health care and policy stakeholders from a number of 'source' and 'destination' countries.