The nature of armed conflict is changing, putting health workers increasingly in harm’s way. A new campaign by the Red Cross, the Health Care in Danger strategy, aims to raise awareness and improve conditions on the ground for health workers and facilities in conflict zones. The harm done when health workers are attacked is not limited to the assault itself, but has a knock on effect that can deprive patients of treatment. The intensity of attacks on health care workers has increased, according to Physicians for Human Rights, but they acknowledge there is a lack of reliable data. Because of the blurred nature of contemporary war, health facilities find themselves providing services to both sides of a conflict and exposing themselves in doing so. According to this article, it has become more common for soldiers to enter a hospital to settle scores, for example, or indeed for government forces to come looking for insurgents and prevent doctors from treating opponents. Médecins Sans Frontières (MSF), recommends negotiating what may be called the “parameters of intervention” before starting operations, which requires communicating and negotiating with all the relevant military and paramilitary actors to create the neutral space in which medical services can be offered.
Human Resources
The Kenya Medical Association (KMA) received a copy of a petition to the Minister for Health from its members who have been on internship. The immediate consequence to this is that the concerned doctors will have their salaries stopped and asked to vacate their stations as they wait for the positions of medical officers to be advertised. This letter states expands on how and why KMA fully support the petition by the medical officer interns.
Miriam Ahmed's face contorts in pain as her frail and bony fingers clutch her stomach. A sweat breaks on her head as she writhes in pain on her bed. The 16-year-old girl is the latest patient to be admitted to Mandera District Hospital following an outbreak of cholera in the area. The District Medical Officer of Health, Dr Boniface Musila, says the situation is under control. But Mandera District Hospital Medical Superintendent, Dr Muktar Omar, said there was a shortage of nurses at the facility.
Kenyatta National Hospital, which has over the years solely depended on government budgetary allocations, is now making a huge effort to be self-sufficient. At the same time, KNH chairman, Prof Alfred Mutema, disclosed that the board plans to raise the annual basic salaries for its workers by 15 per cent subject to approval by the Government.
The doctors’ strike now in its third month in Kenya has caused great suffering to the majority poor people who cannot afford medical care in private hospitals. The author writes that the strike is not merely about the welfare of the healthcare workers, but about a public health system crumbling under deliberate state neglect and corruption. By mid-February Kenyan doctors had been on strike for over two months. They have made several demands including: better remuneration, availability of more doctors in public hospitals, better equipment and availability of drugs in these facilities, and more allocation of funds to health research. They are, according to the author, demanding better healthcare for all Kenyan citizens. The author comments that the doctors’ demands have been spurned by government, and the media to some extent, in what is part of a wider effort to portray the doctors as greedy individuals. The negotiation process has been long and tortuous, with the government side not keen on implementing a Collective Bargaining Agreement (CBA) it signed with the doctors in 2013. Private healthcare providers on the other hand are argued to stealthily lie like vultures – waiting for the public healthcare system to implode so they can expand their ‘investments’ in Kenya, a country that’s been described as ‘a lucrative market for private healthcare service provision’. One can almost imagine that this is part of a wider scheme to privatise the Kenyan healthcare system, a move which would drive the cost of treatment beyond reach of the majority. Kenya was ranked 145 out of 176 in Transparency International’s corruption perception index in 2016. The author writes that it is no longer possible to stand by and watch as up to a third of the Kenyan budget is lost to corruption, and disappears into the pockets of a select few. Kenyans can no longer stand by and watch the state audaciously claim it cannot pay their doctors. Kenyans just cannot afford to be spectators in such a matter of life and death.
This is a time of unprecedented change in medical education globally. Medical schools, postgraduate bodies and other organisations are responding to rapid advances in medicine and changes in health care delivery. New education approaches are being adopted to exchange information. This enables the institutions to produce relevant health professionals. There are a number of innovations and models that are being explored to improve the learning of students studying medicine and public health. This Kenyan case study reports on how partnerships between the higher education institution and the community are working. It gives an account of the Moi University community programme that uses adaptive instruction for health trainees in the schools of medicine and public health. Adaptive instruction is a student centred approach where they are given real life cases to solve health problems theoretically as tutorial cases. This discussion, with the guidance of a tutor, promotes active learning. The model encourages active learner participation in the provision of health services. It introduces the students to a community health framework where they work in rural health facilities as part of their continuous assessment. It means that graduates entering the profession are able to apply and practise knowledge and skills beyond the theory learnt at the university. The students diagnose issues affecting the local community, develop a research proposal, work with district health management teams and implement activities. They conduct surveillance and monitor diseases and in the event of an epidemic, they are expected to respond effectively. They master the principles of how rural health facilities are run. The programme is divided into five phases: Introduction to the community, Community diagnosis, Writing a research proposal, Investigation executing the research plan, District health service attachment. The research projects designed and implemented in phase three and four have produced fascinating reports with research topics that address issues affecting the communities. It takes 20% to 30% of curriculum content and makes the graduand socially responsible and accountable team players in health care delivery. The authors hope that other tutors in Kenya, Eastern Africa and beyond the continent will benefit from this model. The experience provides tutorial guidance towards building a resilient and experienced crop of health professionals at par with global health training standards.
The World Health Organization (WHO) and the Office of the US Global AIDS Coordinator (OGAC) convened representatives from HIV Programmes and Human Resources for Health Departments from Ministries of Health, Professional Associations, Academic Institutions and representatives from workers associations in Geneva for a two day technical consultation about the need for a regulatory framework in support of Task Shifting. The meeting signaled the beginning of a new expert partnership for driving forward the Task Shifting Project in the context of the wider HIV/AIDS and health workforce plan “Treat, Train, Retain”.
This qualitative study was undertaken to understand how practising doctors and medical leaders in Ghana describe the key factors reducing recruitment and retention of health professionals into remote areas, and to document their proposed policy solutions. In-depth interviews were carried out with 84 doctors and medical leaders, including 17 regional medical directors and deputy directors from across Ghana, and 67 doctors chosen to represent progressively more remote distances from the capital of Accra. All participants felt that rural postings must have special career or monetary incentives given the loss of locum (i.e. moonlighting income), the higher workload, and professional isolation of remote assignments. Career 'death' and prolonged rural appointments were a common fear, and proposed policy solutions focused considerably on career incentives, such as guaranteed promotion or a study opportunity after some fixed term of service in a remote or hardship area. Short-term service in rural areas would be more appealing if it were linked to special mentoring and/or training, and led to career advancement.
In recognition of the critical shortage of human resources within health services, community health workers in Ethiopia have been trained and deployed to provide primary health care in developing countries. In this study, researchers investigated the knowledge and performance of these health extension workers (HEWs) on antenatal and delivery care, as well as the barriers to and facilitators for the provision of maternal health care. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Almost half of the respondents had at least five years of work experience as a HEW. More than half (54%) of the HEWs had poor knowledge on contents of antenatal care counseling, and most (88%) had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructure like water supply, electricity, and waiting rooms for women in labour. On average, within six months, a HEW assisted in only 5.8 births. Only a few births (10%) were assisted at the health posts, most (82%) were assisted at home and only 20% of HEWs received professional assistance from midwives. Based on these findings, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their knowledge and competencies, while creating appropriate working conditions.
The South African Department of Health publishes annual guidelines identifying priority groups, including immunosuppressed individuals and healthcare workers (HCW), for influenza vaccination and treatment. How these guidelines have impacted HCW and their patients, particularly those infected with HIV, remains unknown. The authors aimed to describe the knowledge, attitudes and practices regarding influenza and the vaccine among South African HCW. Surveys were distributed by two local non-governmental organisations in public health clinics and hospitals in 21 districts/municipalities (5 of 9 provinces). There were 1164 respondents. One-third (34%) of HCW reported getting influenza vaccine and most (94%) recommended influenza vaccine to patients infected with HIV. The ability to get vaccine free of charge and having received influenza government training were significantly associated with self-reported vaccination in 2013/2014. Self-reported vaccination and availability of influenza vaccine during the healthcare visit were significantly associated with recommending influenza vaccine to patients infected with HIV/AIDS. Free and close access to influenza vaccine were associated with a higher likelihood of getting vaccinated. HCW who reported getting the influenza vaccine themselves, had vaccine to offer during the patient consult and were familiar with guidelines and training were more likely to recommend vaccine to HIV-infected patients.