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Identifying challenges and barriers in the delivery of primary healthcare at the district level : A study in one Thai province

- Tejativaddhana, Phudit, Briggs, David, Fraser, John, Minichiello, Victor, Cruickshank, Mary

  • Authors: Tejativaddhana, Phudit , Briggs, David , Fraser, John , Minichiello, Victor , Cruickshank, Mary
  • Date: 2013
  • Type: Text , Journal article
  • Relation: International Journal of Health Planning and Management Vol. 28, no. 1 (2013), p. 16-34
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  • Description: In 2001, the universal health coverage policy was adopted by Thailand with primary healthcare (PHC) as the major focus of the policy. In order to understand the structural and institutional factors affecting the implementation of PHC in rural Thailand, a qualitative study, utilising individual interviews with national and provincial policy decision makers, community health directors, heads of hospital primary care units, chiefs of district health offices, heads of health centres and community representatives, from one rural province was undertaken. Findings showed that the sustainability of PHC service provision under the administration of community hospitals is problematic as barriers exist at the policy and operational levels and access to PHC for all citizens may not be achieved until these barriers are addressed. Furthermore, although PHC needs to be acknowledged and implemented by all stakeholders within the health industry and government, the roles and responsibilities of the stakeholders in health services management at the district level need to be clarified. Copyright © 2012 John Wiley & Sons, Ltd.

To remain, migrate abroad or resettle : a complex dynamic process affecting Pakistani physicians' career decisions

- Arif, Muhammad, Cruickshank, Mary, Fraser, John

  • Authors: Arif, Muhammad , Cruickshank, Mary , Fraser, John
  • Date: 2019
  • Type: Text , Journal article
  • Relation: Asia Pacific Journal of Health Management Vol. 14, no. 3 (2019), p.
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  • Description: OBJECTIVE This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. METHODS This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. RESULTS Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. CONCLUSIONS The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals. © 2019 Asia Pacific Journal of Health Management. All Rights Reserved.
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