Search results

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

The 30 MOCHA (Models of Child Health Appraised) countries are diverse socially, culturally and economically, and differences exist in their healthcare systems and in the scope and role of primary care. An economic analysis was undertaken that sought to explain differences in child health outcomes between countries. The conceptual framework was that of a production function for health, whereby health outputs (or outcomes) are assumed affected by several ‘inputs’. In the case of health, inputs include personal (genes, health behaviours) and socio-economic (income, living standards) factors and the structure, organisation and workforce of the healthcare system. Random effects regression modelling was used, based on countries as the unit of analysis, with data from 2004 to 2016 from international sources and published categorisations of healthcare system. The chapter describes the data deficiencies and measurement conundrums faced, and how these were addressed. In the absence of consistent indicators of child health outcomes across countries, five mortality measures were used: neonatal, infant, under five years, diabetes (0–19 years) and epilepsy (0–19 years). Factors found associated with reductions in mortality were as follows: gross domestic product per capita growth (neonatal, infant, under five years), higher density of paediatricians (neonatal, infant, under five years), less out-of-pocket expenditure (neonatal, diabetes 0–19), state-based service provision (epilepsy 0–19) and lower proportions of children in the population, a proxy for family size (all outcomes). Findings should be interpreted with caution due to the ecological nature of the analysis and the limitations presented by the data and measures employed.

High turnover rates, delay and dissatisfaction among PhD students about the high efforts and low rewards are common problems in doctoral education. Research shows that many different factors are associated with the mental health crisis in graduate education, but these diverse aspects have not often been studied in relation to talent management and human resource management (HRM) strategies. Based on questionnaires and in-depth interviews, this chapter critically assesses the factors that influence doctoral students’ well-being, using as theoretical framework the self-determination theory, concerned with the social and other conditions that facilitate or hinder human well-being and flourishing, and the job demands–resources model, an occupational stress model that suggests strain is a response to imbalance between demands on the individual and the resources he or she has to deal with those demands. These theoretical frameworks help to explore the perceived job demands and resources, and motivations of a sample of 25 PhD students in the Netherlands, in order to recommend adequate talent management strategies to improve PhD work conditions at universities and reduce the increasing levels of ill-being. The study proposes a collegial model, focussing on the enjoyment of work, instead of the current managerial model, which focusses on strengthening knowledge and skills, and stimulating performance-oriented behaviour. A differentiated approach is needed, offering customized talent development for each PhD student in order to respond to his or her specific qualities, improving general well-being. This radical shift in talent management is needed to counter the mental health crisis in doctoral studies.

This chapter summarises the role of EU actions in supporting healthcare policies in the EU Member States, both looking at implemented actions and describing current priorities for the future. It argues that these coordinated actions can be beneficial for EU Member States by helping them to avoid duplication of effort and to attain economies of scale. Moreover, data sharing with proper safeguards can unleash vast amount of ‘learning what works’ both for medical treatments and for healthcare sustainability measures. The need for this common learning appears ever more urgent while facing the health and economic consequences of the present pandemic.

Here we provide a short reflection on the persistent themes from the volume and relate it to wider reproductive studies.