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

尽管布隆迪渴望实现全民健康覆盖议程，但由于卫生工作者严重短缺和分布不均，这一目标受到了破坏例如，考虑到训练有素的卫生人员的数量，每万人口中的医生人数从2010年的0.28人增加到2017年的1.00人，但仍然很低到2030年实现新生儿、儿童和青少年健康目标，特别是在布隆迪，需要重新设计卫生系统，以满足所有儿童的需求2 .任何重新设计的一个支柱是发展一支适合具体情况和面临的主要卫生挑战的儿科工作队伍本研究旨在审查布隆迪儿科劳动力的现状和发展计划，以及作为全民健康覆盖的一部分，儿科劳动力如何满足当前和未来的人口需求。此外，它将审查培养和雇用不同类型儿科保健工作者的成本，并探讨未来何种专业技能组合既能满足儿科优先服务提供需求，又能促进公平获得服务。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RQ1。就儿科专业人员的数量和组合及其作用而言，国家战略和政策文件表明计划了什么？当前政策中明确或隐含了哪些不同专业人员之间的任务分担形式？RQ2。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/全球政策文件所规划的需求？RQ3。培养和雇用不同专业卫生工作者骨干的财务成本是什么？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是什么？RQ4。作为全民健康覆盖的一部分，国家儿科一揽子优先服务应包括哪些内容？可采用哪些专业技能组合替代模式来提供这种一揽子服务？在健康结果和公平获取方面，替代技能组合模式可能会有哪些权衡？方法通过开展国家政策文件审查来回答第一个问题，审查内容涉及儿科人员配备（人数、分布和技能）、他们的作用和任务分担安排的形式，并辅以对关键举报人的访谈。在第二阶段，将利用卫生部和劳工部提供的二手数据，对儿科专业人员的数量、作用和组合进行横断面描述性绘图5。此外，鉴于布隆迪的卫生人力规模较小，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儿科劳动力的实时差距。培训的财务成本将从提供者（政府）的角度进行评估，方法是查看用于培训的实际预算加上学员的直接付款。分析了不同类型医务干部的教育财务总成本。我们将继续利用卫生保健劳动力市场分析框架分析卫生保健劳动力市场。7-10在第二种情况下，将使用基于雇员的数据估计雇用不同儿科干部的实际年度财务成本。最后，将召集一个专家/决策者小组，由选定的儿科卫生专业人员补充，以确定/优先考虑应在卫生系统中提供的最重要的儿科服务或一揽子服务和级别。在专家共识和情景权衡的基础上，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.