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‘This Global Communication Strategy Development Guide for Maternal, Newborn, Child Health and Nutrition Programs Guide has been conceived as a step-by-step tool for MNCH program managers, program planners, and communication specialists to use when conceptualizing, writing, implementing and assessing their programs.

‘The Guide consists of modules that address the various steps in developing a communication for development strategy, with an example of how to develop a strategy specifically for Maternal, Newborn, Child Health and Nutrition (MNCHN) programmes.’

Content of this Guide

‘This Guide is divided into Modules.  Module 1 provides a description of the Social Ecological Model (SEM) and communication for development (C4D), and the importance of social norms.  Module 2, presents the 5-step evidence-based model for developing a strategic plan for MNCH or any program area.  Module 3 shows how to use the model to develop a strategic plan for MNCH programs.  Each Module includes hyperlinks to documents that provide further information, examples and/or references.’

Freely available here:

http://www.unicef.org/cbsc/index_65738.html

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Sustainable Development Goals kick off this month. Francis Omaswa welcomes the SDGs, but wonders if they are a bit too wide-ranging to capture the imagination of politicians and the community at large? Francis Omaswa. Africa Health (September 2015) p7

http://www.africa-health.com/articles/sept_2015/Francis’%20Opinion.pdf

SELECTED EXTRACTS (selected by Neil PW)

‘The challenge that I see facing us, the techno-professionals in Africa is how to simplify and sell this message to our political leaders and the general populations. As I see it, African countries can achieve UHC, provided that we move from thinking of health as treating illness and preventing disease by designated health workers.’

‘Embedding health in the routine governance of society will ensure that the laws that we make provide populations to live pro-health lives. This calls for law enforcement arms of governments and society to give priority to ensuring that laws that protect and promote health are complied with by individuals and communities.’

‘Healthcare and health services will of course be needed and the scope will be determined by the resources available, and the priorities set with active participation of the populations. These priorities define the affordable Basic Health Packages for countries and communities. Here the roles of community health workers will deliver UHC that leaves no one behind and the level of sophistication will grow over time.’

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

Sustainable Development Goals kick off this month. Francis Omaswa welcomes the SDGs, but wonders if they are a bit too wide-ranging to capture the imagination of politicians and the community at large? Francis Omaswa. Africa Health (September 2015) p7

http://www.africa-health.com/articles/sept_2015/Francis’%20Opinion.pdf

SELECTED EXTRACTS (selected by Neil PW)

‘The challenge that I see facing us, the techno-professionals in Africa is how to simplify and sell this message to our political leaders and the general populations. As I see it, African countries can achieve UHC, provided that we move from thinking of health as treating illness and preventing disease by designated health workers.’

‘Embedding health in the routine governance of society will ensure that the laws that we make provide populations to live pro-health lives. This calls for law enforcement arms of governments and society to give priority to ensuring that laws that protect and promote health are complied with by individuals and communities.’

‘Healthcare and health services will of course be needed and the scope will be determined by the resources available, and the priorities set with active participation of the populations. These priorities define the affordable Basic Health Packages for countries and communities. Here the roles of community health workers will deliver UHC that leaves no one behind and the level of sophistication will grow over time.’

—

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

CITATION: Mind the gap: knowledge and practice of providers treating uncomplicated malaria at public and mission health facilities, pharmacies and drug stores in Cameroon and Nigeria

Lindsay Mangham-Jefferies, Kara Hanson, Wilfred Mbacham, Obinna Onwujekwe and Virginia Wiseman.

E-mail: lindsay.mangham-jefferies@lshtm.ac.uk

Full text freely available here:

http://heapol.oxfordjournals.org/content/30/9/1129.abstract

ABSTRACT

Background: Artemisinin combination therapy (ACT) has been the first-line treatment for uncomplicated malaria in Cameroon since 2004 and Nigeria since 2005, though many febrile patients receive less effective antimalarials. Patients often rely on providers to select treatment, and interventions are needed to improve providers’ practice and encourage them to adhere to clinical guidelines.

Methods: Providers’ adherence to malaria treatment guidelines was examined using data collected in Cameroon and Nigeria at public and mission facilities, pharmacies and drug stores. Providers’ choice of antimalarial was investigated separately for each country. Multilevel logistic regression was used to determine whether providers were more likely to choose ACT if they knew it was the first-line antimalarial. Multiple imputation was used to impute missing data that arose when linking exit survey responses to details of the provider responsible for selecting treatment.

Results: There was a gap between providers’ knowledge and their practice in both countries, as providers’ decision to supply ACT was not significantly associated with knowledge of the first-line antimalarial. Providers were, however, more likely to supply ACT if it was the type of antimalarial they prefer. Other factors were country-specific, and indicated providers can be influenced by what they perceived their patients prefer or could afford, as well as information about their symptoms, previous treatment, the type of outlet and availability of ACT.

Conclusions: Public health interventions to improve the treatment of uncomplicated malaria should strive to change what providers prefer, rather than focus on what they know. Interventions to improve adherence to malaria treatment guidelines should emphasize that ACT is the recommended antimalarial, and it should be used for all patients with uncomplicated malaria. Interventions should also be tailored to the local setting, as there were differences between the two countries in providers’ choice of antimalarial, and who or what influenced their practice.

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We thank MD Current for having such work from rural areas in one site

http://mdcurrent.in/camps-and-rural-healthcare/

and especially for the ones related to patient education

http://mdcurrent.in/patients/healthcare-in-rural-areas/

and online courses

http://mdcurrent.in/courses/

These resources could be used all over the world

With regards

J. Gnanaraj

2014 WHO African Regional Report http://apps.who.int/iris/bitstream/10665/137377/4/9789290232612.pdf

‘Overall, health workers felt abandoned and lost within an unsupportive system they serve…’ This is the key finding of a new paper from Tanzania.

‘Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers’ knowledge and skills necessary for providing quality maternal health care.’

CITATION: “Once the government employs you, it forgets you”: Health workers’ and managers’ perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania

Dickson Ally Mkoka, Gladys Reuben Mahiti, Angwara Kiwara, Mughwira Mwangu, Isabel Goicolea and Anna-Karin Hurtig.

Human Resources for Health 2015, 13:77  doi:10.1186/s12960-015-0076-5

Corresponding author: mkokamalinga@yahoo.co.uk

ABSTRACT

Background: In many developing countries, health workforce crisis is one of the predominant challenges affecting the health care systems’ function of providing quality services, including maternal care. The challenge is related to how these countries establish conducive working conditions that attract and retain health workers into the health care sector and enable them to perform effectively and efficiently to improve health services particularly in rural settings. This study explored the perspectives of health workers and managers on factors influencing working conditions for providing maternal health care services in rural Tanzania. The researchers took a broad approach to understand the status of the current working conditions through a governance lens and brought into context the role of government and its decentralized organs in handling health workers in order to improve their performance and retention.

Methods: In-depth interviews were conducted with 22 informants (15 health workers, 5 members of Council Health Management Team and 2 informants from the District Executive Director’s office). An interview guide was used with questions pertaining to informants’ perspective on provision of maternal health care service, working environment, living conditions, handling of staff’s financial claims, avenue for sharing concerns, opportunities for training and career progression. Probing questions on how these issues affect the health workers’ role of providing maternal health care were employed. Document reviews and observations of health facilities were conducted to supplement the data. The interviews were analysed using a qualitative content analysis approach.

Results: Overall, health workers felt abandoned and lost within an unsupportive system they serve. Difficult working and living environments that affect health workers’ role of providing maternal health care services were dominant concerns raised from interviews with both health workers and managers. Existence of a bureaucratic and irresponsible administrative system was reported to result in the delay in responding to the health workers’ claims timely and that there is no transparency and fairness in dealing with health workers’ financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers’ concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers’ knowledge and skills necessary for providing quality maternal health care.

Conclusion: Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers’ financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.

SELECTED EXTRACTS (selected by Neil PW)

“There is nowhere to speak out our problems. Nowhere! How can you do that? We are afraid and decide to be silent and continue working with our problems. May be we can say this to people like you but otherwise we are avoiding victimization. But for us who are working in the remote areas, they need to find a way to listen to us a bit.” (Nurse, Dispensary H).

Inadequacy of facility infrastructure and unavailability of resources reported in this study played a key role in affecting health workers’ performance. Lack of running water and a reliable source of light in health facilities increased chances of cross infection putting health workers and women using these facilities at risk. This, along with an excessive workload as a result of shortage, unavailability of material resources and lack of supervision further handicapped health workers’ capacity leading to provision of suboptimal maternal care that leave women unsatisfied with the type of care they receive. Mistrust towards health workers and the health system in general become an outcome, and with continued blames received from the community, health worker morale decreased further.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

In a recent HIFA message I wrote: “It seems to me that one of the biggest challenges facing scale-up of CHWs and their integration into the formal health system will be: How to integrate CHWs while maintaining their trust, accountability and sense of ownership to and by the communities they serve. I look forward to hear your views.”

(Neil PW, UK – 20 Sept – CHW Data for Decision Making – Challenges for scale-up of CHW programs (23) Selection and performance of village health teams (VHTs) in Uganda).

I was therefore very interested to see this new paper from the open-access journal BMC Human Resources for Health. ‘From the health sector side, top-down supervision and inadequate training possibilities hampered relationships and demotivated HEWs… Expectations from the community and health sector regarding HEWs’ tasks sometimes differed, negatively affecting motivation and satisfaction of HEWs.’

CITATION: A qualitative assessment of health extension workers’ relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance

Maryse C. Kok, Aschenaki Z. Kea, Daniel G. Datiko, Jacqueline E.W. Broerse, Marjolein Dieleman, Miriam Taegtmeyer and Olivia Tulloch.

Human Resources for Health 2015, 13:80  doi:10.1186/s12960-015-0077-4

http://www.human-resources-health.com/content/13/1/80

ABSTRACT

Background: Health extension workers (HEWs) in Ethiopia have a unique position, connecting communities to the health sector. This intermediary position requires strong interpersonal relationships with actors in both the community and health sector, in order to enhance HEW performance. This study aimed to understand how relationships between HEWs, the community and health sector were shaped, in order to inform policy on optimizing HEW performance in providing maternal health services.

Methods: We conducted a qualitative study in six districts in the Sidama zone, which included focus group discussions (FGDs) with HEWs, women and men from the community and semi-structured interviews with HEWs; key informants working in programme management, health service delivery and supervision of HEWs; mothers; and traditional birth attendants. Respondents were asked about facilitators and barriers regarding HEWs’ relationships with the community and health sector. Interviews and FGDs were recorded, transcribed, translated, coded and thematically analysed.

Results: HEWs were selected by their communities, which enhanced trust and engagement between them. Relationships were facilitated by programme design elements related to support, referral, supervision, training, monitoring and accountability. Trust, communication and dialogue and expectations influenced the strength of relationships. From the community side, the health development army supported HEWs in liaising with community members. From the health sector side, top-down supervision and inadequate training possibilities hampered relationships and demotivated HEWs. Health professionals, administrators, HEWs and communities occasionally met to monitor HEW and programme performance. Expectations from the community and health sector regarding HEWs’ tasks sometimes differed, negatively affecting motivation and satisfaction of HEWs.

Conclusion: HEWs’ relationships with the community and health sector can be constrained as a result of inadequate support systems, lack of trust, communication and dialogue and differing expectations. Clearly defined roles at all levels and standardized support, monitoring and accountability, referral, supervision and training, which are executed regularly with clear communication lines, could improve dialogue and trust between HEWs and actors from the community and health sector. This is important to increase HEW performance and maximize the value of HEWs’ unique position.

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‘What began as a movement to make research accessible and free now provides millions of readers around the world increasing opportunities to make important, positive impacts on global health, scientific discovery and science education.’ So comcludes the foreword to the PLOS Progress Update 2014-2015.

The full Update may be downloaded here:

https://www.plos.org/wp-content/uploads/2015/09/Progress-Update_FINAL_LO_RES_Update-9.15.15.pdf

Extracts (selected by Neil PW):

‘An influential venue for research and commentary on the major challenges to human health worldwide, PLOS Medicine publishes articles across all areas of medical science with potential to directly and substantially inform clinical practice or health policy, including research that provides mechanistic insights into disease processes. The journal emphasizes work that advances understanding of conditions or risk factors impacting human health through clinical, epidemiological or translational research.’

‘The first journal devoted to chronic infectious diseases that primarily occur in rural and poor urban areas of low- and middle-income countries, PLOS Neglected Tropical Diseases (PLOS NTDs) is dedicated to advancing research in pathology, epidemiology, treatment, control and prevention of NTDs, as well as public policy. The journal promotes the eorts of scientists, health practitioners and public health experts from endemic countries, building capacity in the areas most in need.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

Please see below a news release from the WHO website. This emphasises again the central importance of health systems, and in particular the health workforce, in achieving the new global health targets. ‘A strong and motivated health workforce is key to a resilient, integrated and people-centred health system. Without a fit for purpose workforce the world put’s itself at risk of not only failing to meet the ambitious targets of the SDGs, but of even reversing progress in the face of population growth and unexpected challenges such as the Ebola outbreak.’

INVESTING IN HEALTH WORKFORCES: THE PATH TOWARDS THE SDGS STARTS HERE

By Jim Campbell, Director, Health Workforce Department (WHO), Executive Director, Global Health Workforce Alliance.

http://www.who.int/hrh/news/2015/path-towards-SDGs/en/

This week marks a transition from one era of global health and development to the next. Seventeen Sustainable Development Goals (SDGs) will be agreed by 193 Heads of State and Government at the UN General Assembly in New York this week. As with the Millennium Development Goals (MDGs), health is rightly recognized as a fundamental human right and driver of development

Closing the gaps

Since 1990 we have seen unprecedented progress in improving global health outcomes, thanks in part to the priority given to health in the MDGs (3 out of 8 MDGs are focused on health). A 47% reduction in maternal mortality, and a 49% reduction in child mortality are just two of the extraordinary achievements of the past generation.

As we move now into the Post-2015 era, we know that to sustain and build upon on these past successes we must do more to address inequities in access to quality health care. Progress in achieving the MDGs has been uneven with the poorest and most marginalized people still being denied the most basic heath services. That is why SDG 3 – as with all the goals – moves away from targets that can be met whilst leaving the poorest behind, and instead calls on governments and other partners to ensure healthy lives and promote wellbeing for all.

Renewed focus on health systems

The quantity, skills and geographic distribution of the health workforce have long been recognized as factors that have held back even greater, and more equitable progress on the health-related MDGs. A strong and motivated health workforce is key to a resilient, integrated and people-centred health system. Without a fit for purpose workforce the world put’s itself at risk of not only failing to meet the ambitious targets of the SDGs, but of even reversing progress in the face of population growth and unexpected challenges such as the Ebola outbreak.

The need for greater priority to be given to health systems and human resources for health (HRH) is recognized in the new SDG targets. For example there are new targets to ‘achieve universal health coverage’ and to ‘substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries’.

A number of new strategies are also being launched in New York this week that will help translate the SDG goals into action. Two in particular have a focus on human resources for health –

Securing a Healthy Future: Resilient Health Systems to Fight Epidemics and Ensure Healthy Lives

“Roadmap: Healthy Systems – Healthy Lives”, a global initiative to strengthen health systems will be launched at a high-level side event on September 26, hosted by the Governments of Germany, Ghana and Norway. The Roadmap will be developed through a multi-stakeholder process that intends to facilitate a comprehensive understanding of health systems strengthening and agree on principles and approaches that will help countries build strong and resilient health systems. This process will be facilitated by Germany and the WHO, with a target date of completion for mid-2016.

A bold agenda for women’s, children’s and adolescents’ health

A new Global Strategy for Women’s, Children’s and Adolescents’ Health which will be launched on September 26, calls for an even more ambitious agenda of ending all preventable deaths within a generation by expanding equitable coverage of a broader range of reproductive, maternal, newborn, child, and adolescent health services.

As a recent paper, Improving the resilience and workforce of health systems for women’s, children’s, and adolescents’ health, published in the British Medical Journal highlighted, the updated Every Woman, Every Child Strategy must place health systems – and health workforces – at its heart, as their performance will decide success or failure for reproductive, maternal, newborn, child, and adolescent health in the next fifteen years. Clear guidance should be developed for countries so that they can build integrated and resilient healthcare delivery systems that meet the needs and expectations of all women and children.

The Global Strategy on HRH: building health workforces fit to deliver the SDGs

An extensive, global consultation on HRH has just been completed and the results are currently being translated into an updated draft of WHO’s Global Strategy on Human Resources for Health: Workforce 2030. This strategy will provide essential guidance for all partners looking to improve health outcomes related to the SDGs.

The Strategy highlights the increasing evidence that HRH offers a triple return on investment:

It drives improvement in population health outcomes;

It triggers broader socio-economic development with positive spill-over effects on the attainment of the SDGs, including education, gender equality and on the creation of decent employment opportunities and sustainable economic growth;

It serves as a first line of defense for individual countries to meet the International Health Regulations (2005) and promote global health security.

This week, we all have an opportunity to set off on the right path towards the achievement of the SDGs in 2030. Ensuring that we create the conditions for employment in the health and social sectors, addressing global deficits and improving access to care is surely the smartest place to start the journey.

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org

ABSTRACT: The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).

KEY MESSAGES

– The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries (LMIC).

– There is a compelling need to shift what has been an inordinate emphasis on reducing financial risk burden towards policy and increased coverage to expand quality of services.

– As the SDG era emerges onto the global scene, countries will be increasingly called upon to address long-standing challenges.

SELECTED EXTRACTS:

In contrast to common perceptions, quality usually means basic services and interventions, not high tech/high cost care. Poor hand hygiene is rampant among health workers in lower- and middle-income countries and is a grossly underestimated cause of deaths of babies and mothers alike. For simplicity, quality means providing an appropriate health-care service in the right quantity and at the right time.

The Know-Do gap, i.e. what health workers know vs what they do, is large. Clinicians in Delhi, India were found in public clinics to practice just over one-tenth what they described as their standard practice. The same clinicians practiced one-third what they described in private clinics (Das and Hammer 2014).

Meanwhile, overuse of technology often increases the risk of death. For example, keeping a stable pre-term baby in an incubator doubles the risk of death compared with in direct skin contact with the mother (‘Kangaroo Mother Care’)

In the context of our current discussion on Achieving the new global health targets, I was interested to read this paper, which argues for a shift of emphasis from coverage to quality and ‘methodologies to improve health worker competencies’.

CITATION: Quality at the centre of universal health coverage

Howard L. Sobel, Dale Huntington and Marleen Temmerman

Health Policy Plan. (2015) doi: 10.1093/heapol/czv095

First published online: September 29, 2015 The full text is freely available here:

http://heapol.oxfordjournals.org/content/early/2015/09/28/heapol.czv095.full?papetoc

Contact E-mail: sobelh@wpro.who.int

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

One of the fundamental requirements for rapid progress is the ability to measure such progress. In no area is this more important than in maternal, newborn and child health.

‘Although the Millennium Development Goals (MDGs) sparked an increase in data collection, most countries still do not have timely data about how many of the women, adolescents, children, and newborns who need effective interventions are receiving them. This is unacceptable, and the global health community can do better…’

This is the key message of a Comment in next week’s issue of The Lancet (16 October 2015). The authors say: ‘What is needed is a core set of coverage indicators (ie, about 15) that are informative, feasible, and cost effective to collect, to continue the work of Countdown and the independent Expert Review Group of the Commission on Information and Accountability for Women’s and Children’s Health. Each indicator must be accompanied by standard measurement methods, and the whole package should be agreed on by global normative agencies including the UN, major donors, and national governments.’

CITATION: Maternal, newborn, and child health and the Sustainable Development Goals—a call for sustained and improved measurement

John Grove, Mariam Claeson, Jennifer Bryce, Agbessi Amouzou, Ties Boerma, Peter Waiswa, Cesar Victora, Kirkland Group

The Lancet, Volume 386, No. 10003, p1511–1514, 17 October 2015

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00517-6/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This paper in The Lancet is a reminder that indicators for the health-related SDGs have not yet been agreed. Christopher Murray of the Institute for Health Metrics notes that ‘the indicators chosen for each Sustainable Development Goal (SDG) target will probably determine the amount of action and attention each target receives’.

Christopher J L Murray. Choosing indicators for the health-related SDG targets. The Lancet, Vol. 386, October 3, 2015

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00382-7.pdf

‘In the era of the Millennium Development Goals (MDGs), regular reporting of specific health indicators drew public and policy attention, and ultimately resources, to causes such as maternal and child health. On the basis of the lessons learned from the MDGs, the indicators chosen for each Sustainable Development Goal (SDG) target will probably determine the amount of action and attention each target receives. Shortening the long lists of proposed indicators for various targets will be a challenging task; for good reasons, advocacy groups will want their component of the target reflected in the selected indicator.’

SELECTED EXTRACTS (selected by Neil PW)

‘What basic properties should be fulfilled by the high-level indicators for the health-related SDGs? First, the indicators should not only measure the intended effect of a target but should also be important for population… Second, any indicator should be easily interpreted and communicated… The meaning and value of

the indicator should also be clear to the public, decision makers, and the scientific community. Third, it should be affordable to produce valid, timely, local, and comparable measurements of an indicator. Fourth, wherever possible and relevant indicators should be disaggregated…’

‘The table [see article] shows a list of the health-related SDG targets and the indicators that I propose for them.’

[for example, against Target 3.4 ‘Achieve universal health coverage…’, Chris Murray recommends ‘(a) % of households with catastrophic health

expenditures in a year; and (b) % of the population with effective coverage of a package of basic health care’]

‘Irrespective of the indicators selected for the health-related SDGs, monitoring the indicators will benefit from publicly available data, pluralistic data synthesis and analysis, and vigorous public debate about the findings.’

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

‘Universal health coverage — the widely accepted quest of health systems — must include access to pain control and palliative care with financial protection as a fundamental goal.’ An editorial in The Lancet (26 August) makes me wonder if universal health coverage (global health target 3.8) has been fully defined and agreed, or if countries are free to interpret the wording as they wish: “Target 3.8 – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. I would be interested to hear from any HIFA members who can shed any light on this.

Currently, ‘most of the world’s population has little or no access to pain control and palliative care, forcing patients and families to endure a tremendous burden of avoidable suffering’, says the editorial. ‘High-income countries account for less than 15% of the world’s population and 94% of global morphine consumption.’

‘In clinical medicine, the obsession with extension of life and treatment of disease, at any pecuniary or emotional cost, displaces adequate attention to human dignity and quality of life.11, 12 Terminal illness is stigmatised, and dying patients are too often expelled or excluded from health-care systems.’

CITATION: Closing the divide: the Harvard Global Equity Initiative–Lancet Commission on global access to pain control and palliative care.

Felicia M Knaulemail, Paul E Farmer, Afsan Bhadelia, Philippa Berman, Richard Horton.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60289-6/fulltext

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

Further to Chris Zielinski’s message (13 October) on the Know-do gap, and Richard Smith’s earlier message (PACK: A package to improve primary care in underserved areas) I was interested to read an editorial in the BMJ (16 October). Below are extracts. The full text is restricted-access.

‘The sustainable development goals launched last month commit the world to achieving universal health coverage by 2030. Achievement will depend on providing high quality primary healthcare… We need better integrated, concise, and user friendly materials that can help health workers manage the wide range of problems seen in primary care.’

‘The most widely implemented of these tools, the Integrated Management of Childhood Illness, covered the five commonest life threatening conditions in children under 5 years and has been adopted in more than 100 countries… two decades on the integrated management booklet remains the main resource for primary care workers caring for children in low and middle income countries.’

‘An example of a programme with wider coverage is the Practical Approach to Care Kit (PACK) developed over the past 15 years in primary care health services in South Africa.13 It is based on a concise (100 page) set of algorithms and checklists for the commonest 40 symptoms and 20 chronic conditions among adults presenting to primary care facilities in low and middle income countries. It integrates content on communicable diseases, non-communicable diseases, mental illness, and women’s health and uses short (1.5 hour) onsite training sessions to familiarise health workers with its content and to support scalable implementation.’

‘The studies also show that health workers use the tools regularly and feel empowered by them. Recently, the University of Cape Town and BMJ have partnered to address some of the shortcomings of such programmes… The partnership will also test new models for adapting PACK for sustainable use in other countries. Work is under way in Brazil, Nigeria, Uganda, and Bangladesh. It may even be useful in high income countries struggling with staff shortages in primary care.’

It is unclear whether PACK will be made available on an open access license, thereby allowing others to freely use, reproduce, adapt and translate the package as needed. If so, it could be a game-changer. If not, its impact will be limited.

CITATION: Lara Fairall, Kieran Walsh. Practical tools for improving global primary care

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h5361 (Published 13 October 2015)

Cite this as: BMJ 2015;351:h5361

http://www.bmj.com/content/351/bmj.h5361

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Sustainable Development Goals: commendable but pie-in-the-sky

Médecins Sans Frontières (MSF), 25 September, 2015

https://www.msf.org.za/msf-publications/sustainable-development-goals-commendable-pie-sky

‘The aspirations of the SDGs are commendable, but Doctors Without Borders (MSF) is concerned that they lack a concrete plan to accelerate progress and address existing gaps in healthcare. Daily MSF medics witnesses the real world outcomes of government policy decisions, actions and inactions on people’s health. From our perspective there is a disconnect between the SDGs and people’s health needs, context and country variations and a serious lack of political will and leadership to make health central among other concerns in the SDGs.’

‘MSF’s Key Concerns:

– The SDG ambitions are at odds with the reality of the people. Significant gaps in health care provision continue to destroy lives and cripple communities.

– Health gains of the last 15 years are at risk.

– Inadequate support for research and development (R&D) and lack of access to vaccines and medicines.

– Funding for health care is being reduced.         

– Lack of political will and leadership on health…’

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The UN Sustainable Development Summit formally agreed the Sustainable development Goals, and this summary provides a record of the contributions made by heads of state worldwide. With thanks to HESP Newsletter.

Summary of the UN Sustainable Development Summit: 25-27 September 2015

by Rishikesh Bhandary, Faye Leone, Leila Mead et al.

International Institute for Sustainable Development (IISD), 30 September 2015

http://www.iisd.ca/download/pdf/enb3224e.pdf

‘From the speeches at the UN Sustainable Development Summit, it was clear that the implementation of the Sustainable Development Goals (SDGs) has already begun; the sense of ownership over the negotiated outcome has extended into stakeholders’ commitment to implement the 2030 Agenda. Governments reported that they have taken steps to assess how the SDGs will be implemented within their ministries. Others said they had referred to the SDGs while developing their intended natio

ally determined contributions (INDCs) to address climate change. Intergovernmental and nongovernmental organizations enumerated the SDGs addressed in their mandates. And representatives from the pbility assessments.’

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Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

This new paper is from Australia but the approach potentially has wide applicability. The authors conclude: ‘Communities of practice can offer an effective workforce development strategy for rural and remote practitioners and should be considered by employers and workforce planners as a way of developing the public health nutrition workforce to more effectively manage population nutrition and health issues into the future.’

CITATION: Citation: Holden S, Ferguson M, Brimblecombe J, Palermo CE.  Can a community of practice equip public health nutritionists to work with remote retail to improve the food supply? Rural and Remote Health 15: 3464. (Online) 2015. Available: http://www.rrh.org.au

Full text is freely available here: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=3464

ABSTRACT

Introduction:  This study aimed to determine the influence on practice of a community of practice designed for public health nutritionists who work with retail stores in remote Indigenous communities in Australia.

Methods:  A descriptive evaluation of the community of practice participants’ perspectives using the most significant change technique and individual in-depth interviews was conducted. Data were analysed using thematic and content analysis with a focus on answering the evaluation questions.

Results:  Twelve public health nutritionists employed to work with remote Indigenous community stores were involved. The community of practice was reported to develop competence through problem solving, knowledge sharing and building confidence for innovative work. Building competence was achieved through accessible and timely professional support. Sharing stories and being encouraged to reflect on practice was valued and supported the participant’s practice. Working to improve the food supply is challenging but there is value in being supported by like-minded colleagues to stay focused on this work.

Conclusions:  Most participants perceived the community of practice intervention to be an effective strategy to improve their work. These findings provide evidence of a promising intervention for building the public health nutrition workforce in remote Indigenous community store retail settings.

SELECTED EXTRACTS

‘Participants believed that they were equipped to ask the right questions of the right people with power and influence to make change. They explained that this was a difference in their thinking that could not be found by reading the literature alone.’

“I think, without being … involved in the community of practice, I probably would never have been able to get to where I am now.” (Quote from participant)

‘The community of practice assisted practice through the following four key functions:

– Shared problem solving, knowledge sharing…

– Building confidence for practice…

– Accessible professional support through sharing and reflective practice…

– Support by like-minded colleagues to stay focused…’

‘The participants described feeling more valued for the work they do through connecting with others.’

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Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org