Preparing for Paediatric Service Redesign (PREPARE) in a Low-Income Country: exploring the needs and capacity of producing paediatric workforce in Bur

背景尽管布隆迪渴望实现全民健康覆盖议程，但卫生工作者的严重短缺和分布不均阻碍了这一目标。1例如，在关注训练有素的卫生人员数量的情况下，每10000人中的医生人数确实从2010年的0.28人增加到2017年的1.00人，但仍然很低。特别是在布隆迪，到2030年实现儿童和青少年健康目标需要重新设计卫生系统，以满足所有儿童的需求。4任何重新设计的一个支柱是发展一支适合于环境和所经历的主要卫生挑战的儿科工作队伍。3本研究旨在审查布隆迪儿科工作队伍的现状和发展计划，以及如何作为全民健康覆盖的一部分，可以满足当前和未来的人口需求。此外，它将审查生产和雇用不同类型的儿科卫生工作者的成本，并探讨未来的专业技能组合可能既满足优先儿科服务提供的需求，同时促进公平的机会。研究结果将为儿科劳动力发展政策和服务重新设计提供信息，作为实现全民健康覆盖愿望和实现2030年全球目标的一部分。研究问题RQ 1。国家战略和政策文件表明，在儿科专业人员及其作用的数量和组合方面有哪些计划，目前的政策中明确或暗示了不同专业人员之间的任务分担形式？RQ 2.目前儿科专业人员的数量、作用、分布和组合是否符合国家战略和区域/全球政策文件中规划的需求？ RQ 3.培养和雇用不同的专业卫生工作者骨干的财务成本是多少？根据国家或全球政策建议扩大劳动力队伍可能产生的预算影响或负担能力如何？RQ 4.作为全民健康覆盖的一部分，国家优先儿科服务一揽子计划应包括哪些内容，可采用哪些替代的专业技能组合模式来提供此类一揽子计划，以及替代的技能组合模式在健康成果和公平获得方面可能有哪些权衡？第一个问题将通过对有关儿科人员配备的国家政策文件进行审查来回答（数量、分布和技能）、他们的角色和任务分担安排的形式，并辅以关键线人的采访。在第二阶段，对数量进行横截面描述性映射，将利用卫生部和劳动部提供的二级数据5确定儿科专业人员的作用和组合。此外，鉴于布隆迪卫生工作人员规模小，而且该国是一个领土，因此有可能进行初级数据收集。上述两个目标的结果将用于估计实时儿科劳动力缺口。将从提供者（政府）的角度评估培训的财务费用，方法是查看培训的实际预算加上受训者的直接付款。将对不同医疗干部的教育财政总费用6进行分析。我们将继续使用卫生劳动力市场分析框架对卫生劳动力市场进行分析。7 -10其次，将使用基于性别的数据估计雇用不同儿科干部的实际年度财务成本。最后，将召集一个由选定的儿科卫生专业人员组成的专家/决策者小组，以确定/优先考虑最重要的儿科服务或一揽子服务以及应提供这些服务的卫生系统级别。基于专家共识和情景权衡，我们将开发经济情景/模型，为政策制定提供信息。

Background Despite Burundi aspiring to deliver on a universal health coverage agenda, this is undermined by severe shortage and maldistribution of health workers.1 With attention to the quantity of trained health personnel, for instance, the number of medical doctors per 10 000 population did increase from 0.28 in 2010 to 1.00 in 2017 but remains low.2 Achieving neonatal, child, and adolescent health targets by 2030 especially in Burundi requires the redesign of health systems to meet the needs of all childern.3,4 One pillar of any redesign is development of a paediatric workforce that is appropriate for the context and the major health challenges experienced.3 This study aims to examine the current status and plans for development of the paediatric workforce in Burundi and how it might meet current and future population needs as part of universal health coverage. Further, it will examine the costs of producing and employing different types of paediatric health workers and explore what future professional skill-mix might both meet priority paediatric service delivery needs while promoting equity in access. The study findings will inform paediatric workforce development policy and services redesign as part of delivering on the aspirations of universal health coverage and meeting the 2030 global targets. Research questions RQ1. What do national strategy and policy documents indicate is planned in terms of numbers and mix of paediatric professionals and their roles and what forms of task-sharing across different professionals are either explicit or implicit in current policies? RQ2. Do the current number, roles, distribution and mix of paediatric professionals respond to the needs as planned in national strategy and regional / global policy documents? RQ3. What are the financial costs of producing and employing different cadres of professional health workers and what is the likely budget impact, or affordability, of expanding the workforce in line with national or global policy recommendations? RQ4. What should be included in a priority national package of paediatric services as part of universal health coverage, what alternative models of professional skill-mix might be used to deliver such a package and what trade-offs might alternative skill-mix models have in terms of health outcomes and equity of access? MethodsThe first question will be answered by conducting a national policy document review in relation to paediatric staffing (numbers, distribution and skills), their roles and the forms of task-sharing arrangements complemented with key informants interviews.In the second stage, a cross-sectional descriptive mapping of the number, roles and mix of paediatric professionals will be done using secondary data from the Ministry of Health and the Ministry of Labour5. Also, given the small size of Burundi's health workforce and the country as a territory, it may be possible to conduct primary data collection. Findings from the above two objectives will be used to estimate the real-time paediatric workforce gap. Financial costs of training will be assessed using a provider perspective (government) by looking at the actual budget going into training plus direct payments from trainees. Total educational financial costs6 will be analysed for different medical cadres. We will continue with the analysis of the health labour market using the framework for analysis of the health labour market.7-10 In the second instance, the actual annual financial costs of employing different paediatric cadres will be estimated using employee-based data. Finally, an expert / policy maker panel supplemented with selected paediatric health professionals will be convened to define / prioritise the most important paediatric services or packages and level(s) of the health system they should be provided at. Based on expert consensus and scenario trade-offs, we will develop economic scenarios / models to inform policy making.