Are we powerless to effect change? It’s a notion that’s been popular for many election cycles. But just try telling a local community group that’s just rallied for a new service or program, that they are powerless. The truth is, there are some very achievable changes we can make to the Canadian democratic system, to get everyone a lot more engaged…..more

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For the next 15 years, the newly adopted Sustainable Development Goals will guide what donors fund and what countries push – and the world may just take a page from Africa’s playbook as it pursue universal health coverage…..more

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‘The main causes of maternal and newborn mortality are well-known and many can be prevented by relatively simple and inexpensive interventions… many of the resulting maternal and newborn deaths are at least partly due to simple oversights and a lack of consistency early on in the treatment process… community midwives and staff in primary care facilities sometimes are too slow to make referrals or fail to recognise problems and carry out basic diagnostic tests…

‘The WHO Safe Childbirth Checklist… aims to help health care workers to improve the quality of care around childbirth and minimise complications and deaths. For Dr Haroon, the benefits are clear. “Most of the time I lack the information that I need” she explains. “Implementing the Checklist will help to identify problems early on and make sure that the right decision is taken at the right time.”…

‘In 2008 the World Health Organization (WHO) started to develop a checklist-based tool to address these difficulties. The resulting Safe Childbirth Checklist (http://www.who.int/patientsafety/implementation/checklists/childbirth/en/) translates a range of known best practices into a simple format that health workers can use in their daily work. The Checklist is still in development, however, the pilot edition contains 29-items that address the main causes of morbidity and mortality around the time of childbirth. Each item on the list prompts the health worker to consider a critical action that, if missed, could lead to complications or death.’

Full text here

Best wishes, Neil

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

CHINA’s one-child policy, instituted in 1978, slowed population growth to 0.47% last year, with the country’s total population now standing at 1.376-billion. The demographics have had a limited effect on the economy, which has slowed from a growth rate of about 10% per annum a few years ago to 7% today. The latter is a rate that most nations would die for, but for the Chinese it has been a bit of a disappointment. One reason the economy is doing relatively well is that people of 65 and over represent 9.4% of the population, much lower than America’s 14.5%. But this is about to change. Look at projections of China’s demographics to 2030 and an extraordinary thing happens…..more

The International Classification of Diseases (ICD) is the system for describing and coding mortality and morbidity incidents, implemented by most WHO member states. As of Oct 1, 2015, the USA formally transitioned to the updated codes, although they have already been in use in 117 other WHO member states (such as China and Canada) since release in 1992. The directive by the US Federal Government for ICD-10 compliance has been a major and controversial administrative and financial undertaking for health-care professionals, hospitals and health centres, and insurance companies…..more

Last week, WHO expedited release of their Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, ahead of the updated comprehensive guidelines scheduled for publication later this year. The early-release guideline recommends immediate initiation of antiretroviral therapy (ART) for all individuals living with HIV, irrespective of age and CD4 cell count. Previously, ART has been recommended only for individuals with CD4 cell counts less than 500 cells per μL (in addition to pregnant women, discordant partners, and those with other conditions such as active tuberculosis)…..more

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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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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.’

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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

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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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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