Results from the AIDS Treatment for Life International Survey (ATLIS 2010), a multi-country survey of more than 2,000 people living with HIV/AIDS (PLWHA), were presented at the International AIDS Conference in Vienna, held from 19–23 July 2010. The results revealed a significant gap in patient-physician dialogue about critical health-related conditions that may negatively impact patients’ overall long-term health, quality of life, and treatment outcomes. While the ATLIS 2010 findings showed a high degree of patient satisfaction with HCPs globally (97%), and the majority of patients believe they are being treated according to their individual needs (84%), some respondents claim to have never engaged in important discussions related to their long-term wellness, such as health history, present medical conditions, treatment side effects, new treatment options, or how all of these factors may impact their overall health and treatment outcomes. The report calls for more in-depth discussions to reinforce the importance of adherence to HIV medicines and avoidance of HIV drug resistance. The main findings were that co-morbid conditions are increasingly affecting PLWHAs, there is a critical need for patient literacy in treatment adherence and drug resistance, and that side effects caused by anti-retrovirals need to be monitored closely.
Human Resources
Rene Loewenson. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
Increased world trade has generally benefited industrialized or strong economies and marginalized those that are weak. This paper examines the impact of globalization on employment trends and occupational health, drawing on examples from southern Africa. While the share of world trade to the world’s poorest countries has decreased, workers in these countries increasingly find themselves in insecure, poor-quality jobs, sometimes involving technologies which are obsolete or banned in industrialized countries. The occupational illness which results is generally less visible and not adequately recognized as a problem in low income countries. Those outside the workplace can also be affected through, for example, work related environmental pollution and poor living conditions. In order to reduce the adverse effects of global trade reforms on occupational health, stronger social protection measures must be built into production and trade activities, including improved recognition, prevention, and management of work-related ill-health. Furthermore, the success of production and trade systems should be judged on how well they satisfy both economic growth and population health.
The debate on the 'brain drain', or the emigration of skilled workers, is not new but it has taken on greater urgency in the context of a globalizing economy and ageing societies. Today, the developed world is perceived as poaching the best and the brightest from the developing world, thus prejudicing those countries of their chance of development. This paper starts with two guarded caveats: first, that any brain drain is as much internal within any country as it is among countries and, second, that the skilled migration system should not be seen in isolation from other types of migration. The paper reviews the data available for the analysis of skilled migration and identifies the main global trends. It goes on to examine the globalization of education and of health as reflected in the movement of students and health personnel.
Dixon Chibanda developed the Friendship Bench approach to mental health care in Zimbabwe. In this interview he tells Fiona Fleck how he is taking the innovative approach to other countries. The idea of the Friendship Bench arose when he lost a patient to suicide in 2005. After identifying a large burden of mental health conditions, Chibanda talked to the authorities, but they had no money, staff or facilities to offer. So in 2007 he worked with 14 grandmothers in Mbare, a suburb of Harare that was badly affected by the clearance operation of informally built suburbs in the city. The grandmothers were from the community and already doing community work and the friendship bench formalized their role. The first four years were focused on developing a culturally appropriate evidence-based intervention that they could deliver. They developed a problem-solving therapy in the local language drawing on familiar concepts in the local culture while incorporating elements of cognitive behavioural therapy. Together with the grandmothers, they came up with key terms – kuvhura pfungwa, which means opening the mind, kusimudzira, (uplifting), and kusimbisa(strengthening) – that formed the basis of the Friendship Bench approach. The benches are outside each health facility, initially they were set apart, but now they are quite public, because the programme is widely accepted in the communities. Harare has more than 53 primary health care facilities, each with one to four of these benches. When people come to these facilities seeking mental health services, they are screened with the Shona Symptoms Questionnaire 14 to determine the level of mental health disorders and referred to the grandmothers –lay health workers who have been trained and who are supervised by health professionals. Chibanda’s own grandmother lived in Mbare and – although she was not one the therapists – she was instrumental in coming up with the income generating component of the approach, which is an important part of the group peer support. After finishing sessions on the bench, the grandmothers sit in a circle and share the challenges they face with their colleagues, while crocheting bags with recycled plastic to sell. Now, after completing therapy, the grandmothers give their patients further support and show them how to make the bags, as a forum for problem solving and income generation. In Zimbabwe, the approach has been scaled up in more than 70 communities in Harare, Chitungwiza and Gweru and further roll out is taking place, with a component for adolescents under development. The approach is being rolled out in Tanzania, the USA, Canada, Australia and New Zealand.
The growing gap between the supply of health care professionals and the demand for their services is recognised as a key issue for health and development worldwide. Policy-makers, planners and managers continue to seek effective means to recruit and retain staff. One way to achieve this is to develop and implement effective incentive schemes. The World Health Organization report Working together for health (2006a) estimated a global shortage of 4.3 million health workers, including 2.4 million physicians, nurses and midwives. Translated into access to care, the shortage means that over a billion people have no access to heath care. Many countries are affected by the shortage and 57 have been identified as ‘in crisis’. An effective workforce strategy will address the three core challenges of improving recruitment, improving the performance of the existing workforce, and slowing the rate at which workers leave the health workforce. Incentives can play a role in all these areas, providing a means by which health systems can attract and retain essential and highly sought-after health care professionals. Effective incentive schemes also help build a better motivated, more satisfied and better performing workforce.
Harare City Council has recruited 100 nurses to beef up its depleted nursing staff following the departure of several health personnel for greener pastures within the region and overseas. According to the latest full commission minutes, the nurses filled in all the vacant positions for State Registered Nurses. Harare has been losing nurses on a monthly basis to other more paying institutions outside the country.
Many countries have created community-based health worker (CHW) programs for HIV, often through national and non-governmental initiatives, raising questions of how well these different approaches co-ordinate. The authors conducted a literature review on the harmonisation of CHW programs, defining harmonisation, and identifying and describing the major issues and relationships surrounding the harmonisation of CHW programs, including key characteristics, facilitators, and barriers for each of the priority areas of harmonisation. The authors found a large number and immense diversity of CHW programs for HIV. This includes integration of HIV components into countries’ existing national programs along with the development of multiple, stand-alone CHW programs. While harmonisation is likely a complex political process, with in many cases incremental steps toward improvement, a wide range of facilitators are available to decision-makers. They can be categorised into those involved in the intervention itself, in relation to stakeholders, health systems, and the broad context.
In a move to curb Xhosa initiate deaths and mutilations the Health Department would employ experienced iincgibi (traditional surgeons) to perform circumcisions said Eastern Cape Health Department spokesperson Mahlubandile Magida yesterday.
On the occasion of World Health Day 2009, the Global Health Workforce Alliance has underlined the important and critical role played by health workers at times of disaster and emergency. At the heart of making hospitals safer are the people responsible for saving lives - the health workers. And when an emergency strikes - health workers are on the frontline. Often 'first on scene', health workers are tragically also often the first casualties themselves - there are many examples around the work where health workers have been killed in large numbers in the early instances of disaster. Added to this, health workers - like all members of populations in crisis zones - lose family members, friends, colleagues and others close to them.
Progress toward universal health coverage in many low- and middle-income countries is hindered by the lack of an adequate health workforce that can deliver quality services accessible to the entire population. The authors used a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudan, and Zambia, and identified the main policies implemented in these countries in the past ten years to address shortages and maldistribution of health workers. Despite increased availability of health workers in the four countries, major shortages and maldistribution persist. Several factors aggravate these problems, including migration, an aging workforce, and imbalances in skill mix composition. In this paper, the authors provide new evidence to inform decision-making for health workforce planning and analysis in low- and middle-income countries. Partial health workforce policies are not sufficient to address these issues. It is argued top be crucial to perform a comprehensive analysis in order to understand the dynamics of the health labour market and develop effective polices to address health workforce shortages and maldistribution as part of efforts to attain universal health coverage.