PDF(Pubmed)
Abstract：
BACKGROUND: The World Health Organisation (WHO) estimates a 10 million health worker shortage by 2030. Despite this shortage, some low-income African countries paradoxically struggle with health worker surpluses. Technically, these health workers are needed to meet the minimum health worker-population ratio, but insufficient job opportunities in the public and private sector leaves available health workers unemployed. This results in emigration and un- or underemployment, as few countries have policies or plans in place to absorb this excess capacity. Sierra Leone, Liberia and Guinea have taken a different approach; health authorities and/or public hospitals \'recruit\' medical and nursing graduates on an unsalaried basis, promising eventual paid public employment. 50% Sierra Leone\'s health workforce is currently unsalaried. This scoping review examines the existing evidence on Sierra Leone\'s unsalaried health workers (UHWs) to establish what impact they have on the equitable delivery of care.
METHODS: A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included.
RESULTS: 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance.
CONCLUSIONS: Sierra Leone\'s example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone\'s efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
METHODS: A scoping review was conducted using Joanna Briggs Institute guidance. Medline, PubMed, Scopus, Web of Science were searched to identify relevant literature. Grey literature (reports) and Ministry of Health and Sanitation policy documents were also included.
RESULTS: 36 texts, containing UHW related data, met the inclusion criteria. The findings divide into two categories and nine sub-categories: Charging for care and medicines that should be free; Trust and mistrust; Accountability; Informal provision of care, Private practice and lack of regulation. Over-production of health workers; UHW issues within policy and strategy; Lack of personnel data undermines MoHS planning; Health sector finance.
CONCLUSIONS: Sierra Leone\'s example demonstrates that UHWs undermine equitable access to healthcare, if they resort to employing a range of coping strategies to survive financially, which some do. Their impact is wide ranging and will undermine Sierra Leone\'s efforts to achieve Universal Health Coverage if unaddressed. These findings are relevant to other LICs with similar health worker surpluses.
摘要：
背景：世界卫生组织（WHO）估计到2030年将有1000万卫生工作者短缺。尽管这种短缺,一些低收入非洲国家自相矛盾地与卫生工作者的盈余作斗争。从技术上讲,这些卫生工作者需要达到卫生工作者与人口的最低比例，但是公共和私营部门的就业机会不足使现有的卫生工作者失业。这导致移民和失业或就业不足，因为很少有国家制定政策或计划来吸收这种过剩的产能。塞拉利昂，利比里亚和几内亚采取了不同的方法；卫生当局和/或公立医院“招募”医学和护理毕业生不受薪，承诺最终有偿公共就业。塞拉利昂50%的卫生劳动力目前没有工资。本范围审查审查了塞拉利昂无薪卫生工作者（UHW）的现有证据，以确定他们对公平提供护理的影响。
方法：使用JoannaBriggs研究所的指导进行范围审查。Medline,PubMed,Scopus,检索WebofScience以确定相关文献。还包括灰色文献（报告）以及卫生部和卫生政策文件。
结果：36个文本，包含UHW相关数据，符合纳入标准。调查结果分为两类和九个子类别:收取应免费的护理和药物；信任和不信任；问责制；非正式提供护理，私人执业和缺乏监管。卫生工作者的过度生产；UHW政策和战略中的问题；缺乏人员数据破坏了MoHS计划；卫生部门的财务。
结论：塞拉利昂的例子表明，UHWs破坏了公平获得医疗保健的机会，如果他们采取一系列应对策略来在经济上生存，有些人这样做。它们的影响范围广泛，如果不解决，将破坏塞拉利昂实现全民健康覆盖的努力。这些发现与其他具有类似卫生工作者盈余的LIC相关。
方法：使用JoannaBriggs研究所的指导进行范围审查。Medline,PubMed,Scopus,检索WebofScience以确定相关文献。还包括灰色文献（报告）以及卫生部和卫生政策文件。
结果：36个文本，包含UHW相关数据，符合纳入标准。调查结果分为两类和九个子类别:收取应免费的护理和药物；信任和不信任；问责制；非正式提供护理，私人执业和缺乏监管。卫生工作者的过度生产；UHW政策和战略中的问题；缺乏人员数据破坏了MoHS计划；卫生部门的财务。
结论：塞拉利昂的例子表明，UHWs破坏了公平获得医疗保健的机会，如果他们采取一系列应对策略来在经济上生存，有些人这样做。它们的影响范围广泛，如果不解决，将破坏塞拉利昂实现全民健康覆盖的努力。这些发现与其他具有类似卫生工作者盈余的LIC相关。
