Patient education is very important even in remote and rural areas. It is interesting that even those in remote and rural areas who do not know English are able to access information from internet through friends and relatives who know English.

There is a section for Patient education in the web page of MD Current India

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

and we found that even the remote rural patients from Mizoram have read and come for treatment especially after reading the following

http://mdcurrent.in/patients/prostate-surgeries-in-rural-areas/

http://mdcurrent.in/patients/small-urinary-tract-stones-the-available-options-in-rural-areas/

http://mdcurrent.in/patients/what-is-new-about-appendix-surgeries/

May God bless your efforts

J. Gnanaraj

Many thanks for stimulating this open discussion on CHWs – a critical cadre in resolving the health workforce crisis in Africa… and beyond.

In IAPB (the International Agency for the Prevention of Blindness) we have been making use of various cadres of CHWs for many years, most notably, Community Directed Distributors (CDDs) of Zithromax for trachoma control and Ivermectin for oncho/river blindness.  

Last year, as part of our comprehensive response to the  workforce crisis (ophthalmologists, optometrists, allied eye health professionals, Primary Eye Care Workers and CHWs), we undertook a situation analysis, in 23 countries in Africa, of the  role of CHWs in eye health.

The results were quite staggering as we discovered 59 different cadres playing a role, in one way or another, in promoting eye health at the community level.

The report, which has just been finalised, is attached [*] along with 2 of the most relevant appendices – on classifications and  a Ghana case study. The Report, along with all the appendices will be available in the next 2 weeks on the IAPB Africa website.  

Alongside this work,  one of  our cadre-specific Working Groups has also completed a provisional set of core competencies for the eye health component of the CHW workforce, which we are currently validating with expert groups in WHO-Afro.

In a  sense, all this is by way of background to our response to the discussion of the week – What are the most pressing challenges in the scale-up of CHW programmes today ?

Our Response = 6 Key issues:

1.       Fragmentation: Even within a hitherto vertical programme such as eye health we are constantly striving, as IAPB, to coordinate the activities of our many member agencies and to align a collective  response with existing CHW initiatives.  

2.       Comprehensiveness: According to 3 recent studies in Kenya, Cameroon and Nigeria, ocular morbidities (particularly conjunctivitis and presbyopia) account for 15-20% of all health problems faced by communities in addition to  blindness at 1%, low vision at 1% and uncorrected refractive error at 4%. In other words, eye health is a major challenge at the community level and we all need to work to ensure that any new curriculum for CHWs includes the component of eye health.  

3.       Data: While we have excellent figures for the number of CDDs due to the long-running oncho and trachoma control programmes, much less is known about the numbers, distribution, retention, training, and impact of CHWs who have been trained to deliver eye health services, as our report makes clear. Our response has been to develop a database (the IADb) of over 300  eye health indictors, aligned with DHIS2 and the African Health Observatories, to capture basic data at the community and primary levels.

4.       Funding: Various  approaches  to scaling-up the CHW workforce are being implemented but the capacity to take them to scale remains elusive.  IAPB, with 40 active members  in Africa, can play a part  in scaling-up but cannot  take on the job on its own. We need to see a greater government commitment to a comprehensive process, which must include all causes of mortality and morbidity.

5.       Disability: In eye health we would also be looking at the role of the community worker in disability  eg finding the blind child, inclusive education  of the irreversibly blind child and rehabilitation of the blind adult.

6.       Inter-sectoral collaboration: This is critical at community level with respect, in particular, to water and sanitation in trachoma control.

I do hope this contribution to the discussion is useful and we look forward to comments, constructive criticism and guidance as we move forward together.

As always

Ronnie Graham

Director, HReH,

IAPB Africa    

HIFA profile: Ronnie Graham is Director, Human Resources for Eye Health, IAPB Africa, and is based in Durban, South Africa. Professional interests: Human resources for eye health in Africa, advocacy, HMIS, research, primary health care, mHealth, Francophone and Lusophone Africa, faculty and training programmes, the GHWA-HWAI (Global Health Workforce Alliance – Health Workers Advocacy Initiative) and health economics. rgraham AT iapb.org

[*Note from HIFA moderator: HIFA does not carry attachments. Please contact Ronnie direct. Thanks, Neil PW]

Where: Pfarrkirchen, Germany

Costs: no tuition fees

Apply: https://www.th-deg.de/en/agw/courses/mi-m-en

Objectives:

The Master’s programme Medical Informatics provides bachelor or diploma graduates a theoretical basis to reinforce the knowledge they have gained thus far in order to meet the requirements of modern-day research and development tasks. The programme is offered through the faculty of Applied Health Sciences.

The Master of Medical Informatics builds on knowledge gained in bachelor or diploma programmes. Graduates will be qualified to perform evidence-based work in research and development departments in the areas of telematics, telemedicine, and eHealth, as well as in the area of service provision within the health industry at the national and international level. In addition, particularly qualified students should gain the theoretical basis needed for a promotion or for work in academic fields.

—

Anna E. Schmaus-Klughammer (LLB hons) President

HIFA profile: Anna E. Schmaus-Klughammer is president of the association “One World Medical Network”.

The goal of the association is to improve medical care in LMICs (Low and Middle Income Countries).

Our activities start from building primary and specialized health care facilities and continue to organize national cancer screening with connections to national and international expert doctors using telemedicine networks. Training of medical personnel is also an important part of the work of the association.

One World Medical Network e.V.

Ulrichsbergerstra? 17

94469 Deggendorf

Deutschland/Germany

Fon +49 991 – 99133913

Fax  +49 991 – 991339 50

info@owmn.org

www.owmn.org

Cardiff University is running a new MOOC (Massive Open Online Course) on the FutureLearn platform from Monday 7 September. It’s called The Informed Health Consumer: Making Sense of Evidence. [*see note below]

This free course is aimed at a lay audience and will be useful for people who want to find out more about a medical condition or those considering studying a health-related subject at university. It will also interest those who want to improve their knowledge of a health-related issue.

Over four weeks, the course will:

·        Look at the factors that affect the reliability of evidence;

·        Provide practical help on how to find the best evidence;

·        Improve understanding of the terminology of health research;

·        Provide some simple tools to help judge whether it’s reliable.

Thanks

Fiona Morgan  

Lecturer – School of Healthcare Sciences / Darlithydd – Ysgol Gwyddorau Gofal Iechyd

Systematic Reviewer, SURE – University Library Service / Adolygydd Systematig, SURE – Gwasanaeth Llyfrgell y Brifysgol

Cardiff University / Prifysgol Caerdydd

Check out the latest Cardiff University MOOC from 7th September: The Informed Health Consumer: Making Sense of Science https://www.futurelearn.com/courses/informed-health-consumer

Abstract

ONCE, work was a major source of friendships. We took our families to company picnics and invited our colleagues over for dinner. Now, work is a more transactional place. We go to the office to be efficient, not to form bonds. We have plenty of productive conversations but fewer meaningful relationships. In 1985, about half of Americanssaid they had a close friend at work; by 2004, this was true for only 30 percent. And in nationally representative surveys of American high school seniors, the proportion who said it was very important to find a job where they could make friends dropped from 54 percent in 1976, to 48 percent in 1991, to 41 percent in 2006…..more

CITATION: Maximizing the impact of community-based practitioners in the quest for universal health coverage

James Campbell, Kesetebirhan Admasu, Agnes Soucat & Sheila Tlou.

Correspondence to James Campbell (email: campbellj@who.int).

Bulletin of the World Health Organization 2015;93:590-590A. doi: http://dx.doi.org/10.2471/BLT.15.162198

EXTRACTS (selected by Neil PW)

‘McPake et al. report that investment in these types of health workers can be a cost-effective approach, in certain contexts and under certain circumstances…’

‘The terms “frontline health workers” and “community health workers” are often used in a non-specific way and can confuse the evidence base. The term “frontline” is not a classification recognized by the World Health Organization (WHO) or the International Labour Organization (ILO). Even the official classification of community health workers can refer to a diverse typology of lay and educated, formal and informal, regulated and unregulated, paid and unpaid health workers. Different policies relating to individual cadres, their scope of practice, education and relation to the health system undermine efforts to strengthen service delivery at community level…’

‘WHO’s Global strategy on human resources for health: workforce 2030… recognizes the potential of involving community-based, mid-level and advanced practitioners as part of a multi-disciplinary health workforce that offers people-centred, integrated primary health services.’

‘Guidelines on the role, education and integration of community-based practitioners are being prepared by WHO for publication in 2017. These guidelines will provide governments and development partners with evidence-based recommendations on community-based practitioners, including potential returns on investment. These guidelines are intended to support universal health coverage and the achievement of the Sustainable Development Goals.’

—

Best wishes, Neil

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

WHO Bulletin: Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Please find below the citation and abstract of a paper in the September 2015 issue of the WHO Bulletin. Full text is freely available here: http://www.who.int/bulletin/volumes/93/9/14-144899/en/

CITATION: Cost-effectivenesss of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Barbara McPake, Ijeoma Edoka, Sophie Witter, Karina Kielmann, Miriam Taegtmeyer, Marjolein Dieleman, Kelsey Vaughan, Elvis Gama, Maryse Kok, Daniel Datiko, Lillian Otiso, Rukhsana Ahmed, Neil Squires, Chutima Suraratdecha & Giorgio Cometto

doi: 10.2471/BLT.14.144899

Cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya

Barbara McPake, Ijeoma Edoka, Sophie Witter, Karina Kielmann, Miriam Taegtmeyer, Marjolein Dieleman, Kelsey Vaughan, Elvis Gama, Maryse Kok, Daniel Datiko, Lillian Otiso, Rukhsana Ahmed, Neil Squires, Chutima Suraratdecha & Giorgio Cometto

Objective: To assess the cost–effectiveness of community-based practitioner programmes in Ethiopia, Indonesia and Kenya.

Methods: Incremental cost–effectiveness ratios for the three programmes were estimated from a government perspective. Cost data were collected for 2012. Life years gained were estimated based on coverage of reproductive, maternal, neonatal and child health services. For Ethiopia and Kenya, estimates of coverage before and after the implementation of the programme were obtained from empirical studies. For Indonesia, coverage of health service interventions was estimated from routine data. We used the Lives Saved Tool to estimate the number of lives saved from changes in reproductive, maternal, neonatal and child health-service coverage. Gross domestic product per capita was used as the reference willingness-to-pay threshold value.

Findings: The estimated incremental cost per life year gained was 82 international dollars ($)in Kenya, $999 in Ethiopia and $3396 in Indonesia. The results were most sensitive to uncertainty in the estimates of life-years gained. Based on the results of probabilistic sensitivity analysis, there was greater than 80% certainty that each programme was cost-effective.

Conclusion: Community-based approaches are likely to be cost-effective for delivery of some essential health interventions where community-based practitioners operate within an integrated team supported by the health system. Community-based practitioners may be most appropriate in rural poor communities that have limited access to more qualified health professionals. Further research is required to understand which programmatic design features are critical to effectiveness.

—

Best wishes, Neil

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

Abstract

Abstract

Objectives: The global world of the 21 ^st century has created communities and cultures that are interconnected, thanks to the development both in the field of transportation and technology. In this global intercultural community, future physicians, and even more so future general practitioners (GPs)/family physicians (FPs), need to be clinically competent and culturally sensitive and flexible in order to adapt to different social settings while delivering holistic care in multiethnic teams and environments with professionalism. As such, exchange programs are exceptional opportunities for international collaboration and the development of personal and professional competencies of these health care professionals.

Materials and Methods: This article presents a review of the literature on the value of exchanges as well as the results of exchange programs with educational content that are aimed at junior GPs/FPs.

Results: Exchange programs have been growing in popularity, especially among junior GPs/FPs. Since its launch in 2013, The “Family Medicine 360° (FM360°) program has been receiving up to 163 inquires till date, promoting global cooperation among the World Organization of family Doctors (WONCA)’s Young Doctors’ Movementd (YDMs).

Conclusions: By participating in an exchange program, future GPs/FPs are given the chance to experience intercultural communication and peer collaboration. They also develop personal and professional skills and thus, actively contribute to the growth and development of primary care all over the world. ….more

In general practice, qualitative research contributes as significantly as quantitative research, in particular regarding psycho‑social aspects of patient‑care, health services provision, policy setting, and health administrations. In contrast to quantitative research, qualitative research as a whole has been constantly critiqued, if not disparaged, by the lack of consensus for assessing its quality and robustness. This article illustrates with five published studies how qualitative research can impact and reshape the discipline of primary care, spiraling out from clinic‑based health screening to community‑based disease monitoring, evaluation of out‑of‑hours triage services to provincial psychiatric care pathways model and finally, national legislation of core measures for children’s healthcare insurance. Fundamental concepts of validity, reliability, and generalizability as applicable to qualitative research are then addressed with an update on the current views and controversies. ….more

Nigerian President Muhammadu Buhari, who won office pledging to fight the country’s outrageous graft habit, claims to have no foreign accounts or oil concessions and only $151 000 in his local bank account. The 72-year-old military man enjoys “a spartan lifestyle”, owning five houses, a few farms and a variety of livestock, and “a number of cars”, his spokesman said in a statement listing his assets late on Thursday. His deputy, Yemi Osinbajo, appears substantially more well-heeled, according to the statement….more

Thousands of women are left to care for and support their husbands who have been left jobless and sick after contracting silicosis in the gold mines. Silicosis is a preventable lung disease that affects thousands of gold miners in South Africa. When miners are sent home, sick and unable to work, it is left to women to provide support and care in the most adverse conditions. This is their story. In October 2015, the Johannesburg High Court will decide if a group of miners and widows can file a class action lawsuit against the gold mining industry….see video

There’s a quiet revolution in one of the poorest districts in the land, where health workers have moved out of health facilities into communities to prevent rather than cure health problems. When Thandi’s* teacher noticed that the seven-year-old wet herself continually, she reported this to nurses who had started to visit schools in Umzinyathi district…..more

Tshwane has become the latest district to roll out a new programme that will let patients pick up chronic medication at community pharmacies. Tshwane recently became the latest district to pilot the National Department of Health’s Central Chronic Medicine Dispensing and Distribution Programme. As part of this programme, three companies will be distributing chronic medications to pick up points outside of local clinics. These pick up points will include private pharmacies that may be closer to patients or stay open later…..more

USAID’s flagship Maternal and Child Survival Program (MCSP) along with World Health Organization is excited to introduce our latest evidence brief, WHO Recommendations on Interventions to Improve Preterm Birth Outcomes.

This evidence brief provides highlights and key messages from World Health Organization’s 2015 recommendations on interventions to improve preterm birth outcomes. The brief summarizes the recommended practices to improve the quality of care related to preterm birth and the outcomes for preterm infants. Additionally, justifications and policy implications associated with the recommendations are outlined. This brief is intended for policy-makers, programme managers, educators and health care providers.

Find the brief here – http://bit.ly/1Vu9GhU

Full WHO Recommendations here – http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/preterm-birth-guidelines/en/

Help us spread the word to others by sharing this email with your networks and sending out a message on social media. Here are a few sample messages that you and your organizations can use:

See brief from @MCSPglobal highlighting key msgs from @WHO’s recs on interventions to improve PTB outcomes http://bit.ly/1Vu9GhU

#pretermbirth is single largest cause of perinatal & neonatal mortality & morbidity. See brief of @WHO’s recs on PTB http://bit.ly/1Vu9GhU

Please contact me if you have any additional questions. Apologies for any cross-posting.

Sincerely,

Jillian Rossman

Administrative Coordinator, Maternal and Child Survival Program

USAID Grantee, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC 20036

tel: 202.835.3112, skype: jillrossman, www.mcsprogram.org

Facebook | Twitter | YouTube | Flickr From the American People

Editorials

Monitoring inequality: an emerging priority for health post-2015

Ahmad Reza Hosseinpoor, Nicole Bergen, Veronica Magar

Bulletin of the World Health Organization 2015;93:591-591A

Published online: September 2015

The Millennium Development Goals focused on poverty and development and reducing inequalities between countries.1 Progress was monitored through national averages without adequate attention to within-country inequality. The post-2015 sustainable development goals (SDG) stress “leaving no one behind” – with goal 10 specifically calling for the reduction of inequality, within and among countries.

Monitoring of inequalities within countries focuses on indicators and dimensions of inequality that are particularly relevant to each country. Drawing upon the outputs of within-country inequality monitoring, policies can be tailored to be maximally effective in reducing inequalities.3 At the same time, having comparable disaggregated data across countries is important to track within-country inequality at a regional or global level. One of the SDG targets specifically addresses the importance of disaggregated data, calling on countries to increase “…the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts”.

Such disaggregated data are vital to identify where and why inequalities exist and ensure that policies, programmes and practices are successful in reaching the most vulnerable. Many countries have made major progress in monitoring health inequalities through household surveys such as Demographic and Health Surveys…

Keep reading / Siga leyendo: click here.

http://www.who.int/bulletin/volumes/93/9/15-162081/en/

Keywords / Palabras clave:

Inequalities; Equity in Health; Millennium Development Goals

Gas less Laparoscopic surgeries has many advantages for the rural surgeons. It is possible under spinal anesthesia. The familiar open surgical instruments could be used. The equipment is low cost and sturdy and has all the advantages of minimally invasive laparoscopic surgeries without the disadvantages like the physiological changes and complications of regular laparoscopic surgery.

The MD Current India an online Journal has kindly consented to host the course free of cost. Only those who require certification from Karunya University need to pay a nominal amount for the certificate after the contact program. For online lessons and watching live and recorded videos through LapGuru it is totally free. Those who are interested can visit the following web site register with MD Current India and enroll for the course

http://mdcurrent.in/courses/lift-laparoscopy/

Lot of doctors from Nigeria have already registered. You need not be from India to register and enroll for the online course. Another course called Minimally invasive surgery for rural surgeons would be available soon.

With warm regards

J. Gnanaraj

J. Gnanaraj MS, MCh (Urology), FARSI, FICS, FIAGES

The August map of the month depicts data from the 2013 Quality of Life (QoL) III Survey question: ‘What is the biggest problem facing your community?’. Visualising the biggest problem per ward depicts a more nuanced understanding of the developmental challenges identified by respondents in Gauteng.

This month’s map of the month depicts data collected from the 2013 Quality of Life (QoL) III survey question: ‘What is the biggest problem facing your community?’. The map is derived by calculating and plotting the most commonly identified response per ward. On the map we see that the biggest problem identified by respondents was unemployment (with 210 wards saying this was their biggest problem) and crime (with 151 wards saying this was their biggest problem). The map also depicts a more nuanced understanding of the developmental challenges evident in the GCR. For example in 55 wards,housing and a lack of basic services was the most common answer, while in 20 wards, a lack of maintenance was the most common answer. Respondents in only one ward (located in Westonaria) identified drought, flood or natural disasters as the biggest problem facing their community…..more

Tuberculosis (TB) researchers in KwaZulu-Natal have expressed concern that many people are still not tested for the disease. TB is the leading cause of death in South Africa. It’s estimated that 9 000 people around the globe miss out on being tested for TB daily…..more