This Week's News
23 September 2011
Weekly news clippings service featuring articles on the Global Health Workforce Alliance and
selection of articles from around the world on the issue of the health workforce crisis
GHWA and Partners ¦ Medical Journals ¦ Africa & Middle East ¦ Asia &
Pacific ¦ North America ¦ Europe ¦ Latin America & Caribbean
This compilation is for your information only and should not be redistributed
GHWA and Partners
Date
Headline
Publication
19.09.11
Addressing Noncommunicable Diseases – It Takes a Workforce
The Alliance
20.09.11
Scaling-up Access to Long-term Family Planning Methods in Northern
Ethiopia
UNFPA
21.09.11
Webinar Explores Models for Training Frontline Social Service
Workers
Capacity Plus
.09.11
A Nurse in the House
Capacity Plus
19.09.11
Floods return to Pakistan
Merlin, UK
20.09.11
More Bangladeshi Mothers Get Vital Care During Childbirth
UNFPA
Medical Journals
Date
Headline
Publication
20.09.11
Health Worker Crisis: Time For Action
PLoS Medicine
15.09.11
China's progress in neonatal mortality
The Lancet, UK
16.09.11
China's facility-based birth strategy and neonatal mortality: a
population-based epidemiological study
The Lancet, UK
20.09.11
Progress towards Millennium Development Goals 4 and 5 on
maternal and child mortality: an updated systematic analysis
The Lancet, UK
21.09.11
New Physician Education Initiatives Seek to Remove the Devil From
the Detailing
JAMA
Africa & Middle East
Date
Headline
Publication
20.09.11
Partnership to train skilled responsive workforce on AIDS
launched
Ghana News
Agency
20.09.11
KENYA: NCDs and HIV fight for limited resources 
IRIN PlusNews
1
20.09.11
ZIMBABWE: Aid programme dramatically improves health service
UN IRIN
20.09.11
Help Africa Fight Diseases - President Mugabe
19.09.11
Kenya: A Daily Prayer for Complication-Free Births
23.09.11
Community Health Workers to Benefit From PBF
17.09.11
Kerala tackles nurse-recruitment racket 
The Herald,
Zimbabwe
Inter Press
Service
The New Times,
Rwanda
Gulf News
Asia & Pacific
Date
Headline
Publication
21.09.11
Lack of health workers jeopardises infant survival rates
Hindustan Times
21.09.11
1 child in 11 dies before five years age
Pakistan Observer
22.09.11
Rural health care policy aims to let "barefoot doctors" have clinics
20.09.11
Afghanistan Midwives Are Key to Safe Deliveries for Afghani
Women
People’s Daily
Online
ReliefWeb
23.09.11
AMC still struggling to treat health workers stir
16.09.11
Kuwait to hire 660 nurses from PH
23.09.11
Competence of overseas GPs 'puts standards' in danger
The Times of
India
ABS-CBN News,
Philippines
The Australian
North America
Date
Headline
Publication
21.09.11
Poorest countries investing more as UN states meet pledge for
maternal, child health
Associated Press
19.09.11
Nurse Practitioners Can Help Offset Shortfall in Primary Care
Physicians
US News &
World Report
16.09.11
South Africa maternal and infant healthcare record criticized
16.09.11
A South-South Cooperation
Los Angeles
Times
Global Post
19.09.11
Demand high but medical specialists not finding work in Canada
21.09.11
Midwives push childbirth as campaign issue
National Post,
CA
Toronto Star
Europe
Date
Headline
Publication
19.09.11
350 million children will never see a health worker – report
Reuters AlertNet
16.09.11
Child death rates not falling fast enough, says report
The Guardian, UK
16.09.11
GMC says more support needed for overseas doctors in UK
BBC News, UK
20.09.11
Health unions demand pay rise for NHS staff in 2013
The Guardian, UK
20.09.11
More midwives needed for baby boom in Wales, claims RCM
BBC News, UK
21.09.11
Pay freeze is an attack too far on NHS workers
The Guardian, UK
18.09.11
Le modèle français des hôpitaux publics est-il menacé ?
Le Monde, France
Latin America & Caribbean
Date
Headline
Publication
2
15.09.11
Avance desparejo en salud
Inter Press
Service
20.09.11
MSP elabora plan ante falta de médicos en el área rural
19.09.11
Peligra la vida de niños por falta de personal médico en centro del
Ihnfa
El Espectador,
Uruguay
La Tribuna,
Honduras
22.09.11
"Estamos preocupados por la violencia laboral que sufren los
médicos"
La Capital,
Argentina
18.09.11
Ni 10 % de los médicos aprueban el examen para las residencias
22.09.11
Perú tiene un déficit de mil especialistas en cáncer
18.09.11
MPs want review of health-sector man hours
Última Hora,
Paraguay
Radio Programas
del Perú
Jamaica Observer
Back to top
GHWA and Partners
Addressing Noncommunicable Diseases – It Takes a Workforce
The Alliance
19/09/2011
Health systems with critical health workforce shortages cannot effectively respond to the growing burden of
chronic diseases. Addressing the challenges of NCDs requires concerted, comprehensive solutions developed
together by all key stakeholders.
Summary of discussions:
New York-Geneva, 19 September 2011 - The two-day UN General Assembly high-level meeting under the
theme of noncommunicable diseases (NCDs) opened in New York this week with thirty heads of state and over
one hundred senior ministers in attendance.
The Global Health Workforce Alliance (the Alliance) held a side-event: “Addressing Noncommunicable Diseases
– It Takes a Workforce” organized together with the Governments of India and Japan, Touch Foundation and
the Health Workforce Advocacy Initiative. Panelists and keynote speakers concurred that effectively addressing
the challenges posed by NCDs is dependent on the availability of a prepared, motivated, supported and wellfunctioning health workforce at all levels of care.
The session was opened by Dr. Michael Ebele Omeke (medical doctor, Uganda) who spoke of the realities on
the ground in Uganda and other developing nations, where primary care workers deal with one hundred-plus
patients a day. “Staffing levels in most public health facilities are generally less than fifty percent of the
expected numbers. Furthermore, a large proportion of these health workers were trained before the
epidemiological transition towards a mix of communicable and noncommunicable diseases. In this scenario, it
is apparent that health workers have little time and knowledge to offer preventive services for NCDs.
Dr Masato Mugitani (Assistant Minister for Global Health, Japan and Chair of the Alliance Board) spoke of the
burden and impact of NCDs on societies, and the need for an adequate number of qualified, motivated and
supported health workers. The Government of Japan has committed to training 100'000 health workers and
policy-oriented professionals.: “It is essential to ensure innovative and sustainable health systems including
[the] health workforce […] this cannot be achieved by the Global Health Workforce Alliance alone nor the
Government of Japan. It is essential to mobilize available resources from every stakeholder in global health
including donors, partner countries, civil society and the private sector.”
Public Health Foundation President Dr Srinath Reddy - moderator - underlined the importance of health
workers and urged all stakeholders to work together - “The fact that we have the government, the private
sector, and the civil society not sitting across the table, but around the table, is a symbol of hope. […] We have
a health worker, the pivotal link - the Global Health Workforce Alliance - and we hope that together they’ll be
able to carry this coalition forward into strengthening health systems.”
Panel discussion:
The panel discussion shed light to the diversity and complexity of issues emerging from the combination of an
increased NCDs burden and an insufficient workforce. Panelists included:
Dr Gustavo Gonzalez-Canali, (Head of the Health and Human Development Department of the Ministry of
Foreign and European Affairs, Government of France) spoke of the need of task-shifting and task-sharing:
“We need to have health workers able to integrate beyond a simple one-skill approach. We need to work on
the training of health workers to create a multi-skill capacity and so increase the services they are able to
provide.”
Shri. Keshav Desiraju, Additional Secretary, Ministry of Health & Family Welfare, Government of India
emphasized the importance of prevention at primary level:
3
“It’s not that we don’t have the numbers of trained health workers, we don’t have them trained in the areas we
want them trained in and we don’t have them in the places we want. One big message which has come out of
the NCD summit is that prevention of non communicable disease is best done at the primary level. Treatment
may be at the second and tertiary level but prevention is a primary level activity.”
Scott Ratazan, Vice President, Global Health, Government Affairs & Policy, Johnson & Johnson spoke about the
support the corporate sector and more specifically Johnson & Johnson can offer in terms of addressing the
growing threat of NCDs challenges, in particular in relation to its health workforce dimension.
“We’re building on what the WHO stated in 2006 a ‘strong human infrastructure’ which is fundamental to
closing today’s gap between health promise and health reality and anticipating the health challenges of the
21st century.’ We recognize that shortage of health workers and building healthcare capacity are at the heart
of our focused approach.”
Ben Phillips, Chief Campaign Officer of Save the Children UK reiterated the need for health workers to be part
of and engaged in government policies and spoke of the role of civil society in making this happen. He also
highlighted the ongoing global health worker campaign aimed at raising profile and securing commitment from
government’s and world leaders.
A lively Q&A followed, which included questions on training, task shifting, managerial skills of health workers
and migration and retention.
Dr Mubashar Sheikh (Alliance Executive Director) closed the session focusing on the need of an inclusive
approach. "We can’t have one sector versus the other: the government versus non government; the private
sector versus the non private sector. Both state and non-state leaders need to come together to avoid what we
call the “verticalization of NCDs.”
He added: “On behalf of the Global Health Workforce Alliance, we’ll keep urging the policymakers to stay
committed to ensure that we have the right kind of health workforce and the right competencies as well as the
right support mechanisms. The right tools to provide good quality chronic care must become available."
A report of the side-event will be published on this page shortly.
Related links
·
View photo gallery of the session by Touch Foundation
·
Read more about the United Nations high-level meeting on noncommunicable disease prevention and
control
2
Scaling-up Access to Long-term Family Planning Methods in Northern Ethiopia
UNFPA
20/09/2011
September 20, 2011 marks the one-year anniversary of Every Woman, Every Child, a global effort to achieve
country-led commitments to bring life-saving health care to millions of women and children in the developing
world by 2015. This series looks at maternal health in several countries with the highest number of maternal
deaths every year. UNFPA, UNICEF, WHO, the World Bank and UNAIDS – known as the Health 4+ -- are
supporting these countries to achieve their Global Strategy commitments.
ATAYE, Amhara Region, Ethiopia — On eve of Ethiopia's New Year (celebrated in mid-September), things are
slow at the Ataye Health Centre. But Hanna Kelemework, clad in her white nurse's gown, is expecting clients to
show up for family planning services on their way home after making some purchases for the holiday.
The just-ended Ethiopian year has seen a major increase in the utilization of long-acting family planning
methods at the Ataye Health Centre, and Nurse Hanna is one of medical professionals providing services. The
intra-uterine contraceptive device (IUCD), which can prevent pregnancy for 10-12 years, has now become the
second most widely used long-acting family planning method at the health centre, after Implanon, a hormonalbased contraceptive that is implanted under the skin and works for about three years.
When IUCDs were offered at the clinic five years ago, only about 16 were requested for the whole year. But as
word has spread about this method, which is cheap, reversible, safe and effective for most women, demand
has increased. Now an average of 75 women are getting IUCDs every month.
Scaling up, and offering new contraceptive options
The surge in the provision and utilization of long-acting family planning methods at the Ataye Health Centre is
part of the scale-up initiative the Ethiopian Government has been undertaking in recent years on these
methods which UNFPA has been supporting through funds secured from the Global Programme to Enhance
Reproductive Health Commodity Security.
Over the course of 2009, the Federal Ministry of Health implemented the Implanon scale-up initiative. Taking
into account the early success in this initiative and the huge demand for long-acting family planning methods in
Ethiopia, the Ministry then launched an IUCD scale-up initiative. Together, these initiatives are addressing the
4
country's large unmet needs: According to the latest DHS data (2005), one in three married Ethiopian women
would like to avoid or delay pregnancy, but is not using a modern contraceptive.
The Ataye Health Centre is applying a two-pronged approach in scaling up long-acting contraceptives. About
7,500 women in its catchment area come to the Health Center seeking services. Through an outreach
programme, Nurse Hanna and her colleagues travel periodically to the four sub-centres and Health Posts to
insert IUCDs. The outreach is coordinated with woreda (district) health officials, Community-Based
Reproductive Health agents and Health Extension Workers working at the grassroots level.
Just 35, with six children, Haregnesh welcomes a break from childbearing
Most of the clients who are benefiting from IUCD are 35 years of age and older. Woizero Haregnesh Jafer is
typical. She began childbearing early, giving birth to the first of her six children while she was just 17. Because
she experienced side effects with shorter term, she opted for IUCD after counselling with Nurse Hanna. "I
witnessed the difference in a within one month of getting the service; I now could eat very well and I see my
menstruation regularly," says Woizero Haregnesh who has been on IUCD for one year now.
The income that Haregnesh's husband earns as a cobbler was barely enough to support their large family.
Now, freed up from frequent clinic visits and the possibility of another mouth to feed, she has volunteered to
speak to other women at local gatherings about her experience. "This is working for us very well as clients like
Haregnesh are sending women to the Health Centre to benefit from the long-acting family planning methods,"
says Nurse Hanna.
Overcoming barriers to adoption of IUCDs
Still, IUCD use remains very low in Ethiopia — at about 2.1 per cent of all women. Lack of equipment and
supplies, and trained service providers at public and private or NGO-run health facilities is one persistent
barrier to the adoption of long-acting methods in this mostly rural country. Misconceptions about it are
another.
The current initiative aims to address both issues. Nurse Hanna says most of her clients first came seeking
short-term family planning methods. But offered different choices and sensitive counseling, they often switch
to longer acting alternatives.
The scale-up initiative seeks to ensure that by 2015 all hospitals and health centres will be providing IUCD
insertion and removal services as part of the comprehensive family planning services. Moreover, the initiative
is looking at increasing the users of IUCD to a total of around 1.5 million women of reproductive age by the
year 2015. Ultimately the IUCD initiative is going to be integrated into the ongoing family planning
programming.
The effort Nurse Hanna and her colleagues are putting into the initiative is already heralding an early success
for the long-term family planning method scale-up initiative. Not a single woman has come back to her Health
Centre so far seeking removal.
3
Webinar Explores Models for Training Frontline Social Service Workers
Capacity Plus
21/09/2011
Well-trained frontline health workers are essential to address the social service needs of vulnerable children
and their families. But what are the best models for providing basic skills training to this workforce, which
relies on a variety of paid and unpaid workers, including community members? More than 80 participants from
11 countries participated in a webinar hosted by the Social Service Workforce Strengthening Alliance via
CapacityPlus on September 8 to hear about and discuss three best-practice models for extending the social
service workforce.
Nathan Linsk, codirector of “twinning” partnerships between the University of Illinois at Chicago and social
service training institutions in Tanzania and Ethiopia, set the stage for the two-hour interactive session. He
explained how the webinar’s topic stemmed from the identification of training and curricula as a key priority
area during the November 2010 Social Welfare Workforce Strengthening Conference in Cape Town, South
Africa, and described some of the challenges related to expanding educational opportunities to meet the
demand for social service workers.
Kathy Scott outlined the approach of South Africa’s National Association for Child Care Workers, which uses
experiential learning methods to train unemployed rural women to provide services for youth facing hardships
in their communities, including orphans and vulnerable children. Linsk presented the model used by the
twinning partnership in Tanzania, which combines basic and follow-up coursework with a supervised six-month
field practicum to deploy community-based staff and volunteers to fill gaps in meeting the needs of children
and families. Lynette Mudekunye of the Regional Psychosocial Support Initiative (REPSSI) described an 18month certificate program for community-level social service workers—including caregivers, teachers, social
workers, and police—developed by African academics and now applied in 10 countries. Students, often from
remote areas, do not have to leave their communities to complete the course, but receive mentoring support
and submit their assignments to an academic institution for marking.
In conclusion, Linsk noted that while community-based training has enhanced the knowledge of frontline
workers, there remains a need to better establish values, ethics, and other guidelines. Courses should support
5
ongoing professional development and career paths and, as possible, be integrated into formal professional
training initiatives. Programs should also be part of overall workforce development plans that address such
issues as how graduates will be absorbed into the social service system, how policies and regulations should be
changed to accommodate these new workers, how workers will be supported (and paid, as appropriate), and
how the workforce will be sustained.
The second in a planned series funded by PEPFAR, the webinar allowed participants to ask questions and
communicate among themselves during the session via a chat function. A recording of the webinar is available
at www.ovcsupport.net.
Related items:
 Building the Workforce to Help Orphans and Vulnerable Children
 Strengthening Zimbabwe’s Social Services Workforce to Help Orphans and Vulnerable Children
 Webinar Fosters Knowledge-Sharing to Strengthen the Social Services Workforce
4
A Nurse in the House
Capacity Plus
September 2011
As a documentary filmmaker exploring the issue of untreated pain and palliative care delivery globally, I
discovered the extraordinary difference health workers make to patients facing end-of-life issues. The quality
of care a patient receives at this critical time can have a profound impact on both patients and their families.
When I learned that nurses in Uganda were able to prescribe oral morphine in the homes of patients, thereby
relieving pain and returning quality of life to many who were too sick to travel, I had to find out more.
“Many developing countries still have a real problem about the use, importation, and manufacture of
morphine,” explained Eugene Murray, former CEO of the Irish Hospice Foundation. “The second thing is having
appropriate ways to distribute it. In Uganda, they dilute powdered morphine into water which is colored with a
dye to indicate the three different strengths and is distributed by nurses in a community using recycled water
bottles. That may seem very crude but in terms of pain control that is absolutely transformational.”
In Uganda, both doctors and nurses (who have completed a nine-month clinical palliative care course at
Hospice Africa Uganda) can prescribe oral morphine. Nurses are able to travel to patients who are often too
sick to move, and prescribe and administer pain relief in their homes. Through a series of simple hand gestures
the nurses can rate the patient’s level of pain and prescribe the correct dosage. The effect for the patients is
dramatic—they are able to eat, sleep, bathe, dress, and be with their families again. In short, they regain
quality of life. Martha Rabwoni, administrator at Hospice Africa (Uganda) reflects, “The pain, if it is not treated,
the patient is in total chaos—they cannot think, they cannot do anything, they concentrate all their mind on the
pain. The relatives in that home…no one sleeps.”
Rose Kilwanuka, national coordinator at the Palliative Care Association of Uganda, explained that there are
currently 120 nurses in Uganda who are now able to prescribe morphine for patients in both metropolitan and
regional districts. However, I learned that in many other countries like South Africa, only doctors are able to
prescribe, so even if there is morphine available, there is often no one available to prescribe it. For many
people living in rural areas, or poor township areas, their first point of contact is with a nurse clinician.
Now that I have finished the documentary LIFE Before Death and 50 short films themed around pain control
and end-of-life issues I realize the journey I went on in making this film was nothing short of transformative.
To see health workers in action, the level of compassion, and the depth of care they show in their work
everyday is extraordinary. It has been one of the most rewarding projects I have ever worked on and I hope it
builds awareness of the amazing work being done by palliative care workers around the globe and
demonstrates why everyone deserves access to these essential services!
Sue Collins is a documentary film producer at Moonshine Movies in Melbourne, Australia. She is passionate
about using film as a tool to ignite social change.
Related items:
 Creating Partnerships in Support of Health Workers in Uganda
 Update on the MDGs: Where Are the Health Workers?
 Health Workers’ Role in Health Service Integration
5
Floods return to Pakistan
Merlin,UK
19/09/2011
The latest rains have claimed the lives of more than 300 people and affected more than five million others,
many of whom are still suffering as a result of last year’s monsoon that flooded an area the size of the UK.
Merlin has been in Pakistan since 2005 and was one of the first agencies to respond to people caught up in last
year’s catastrophic floods.
6
After tripling the size of its workforce, Merlin scaled up its work in Khyber Pakhtunkhwa and expanded into
Sindh and Punjab provinces, taking health care to around two and a half million people, many in inaccessible,
remote locations.
“People are in dire need”
Now, as this year’s rains claim hundreds of lives and threaten the health and livelihoods of millions more,
Merlin has expanded its emergency response to help communities in the deluged district of Badin in Sindh,
Pakistan’s worst-affected province.
Marco Aviotti, Merlin’s Country Director in Pakistan, has said that:
“Many of the people we are providing health services to are in dire need, having lost homes, livelihoods and
loved ones in last year’s floods.
“Merlin’s teams in Pakistan are committed to helping people and have, once again, reacted quickly to reach
communities in the most remote areas.”
Merlin has despatched five mobile health teams to areas where the waters have destroyed infrastructure,
making roads to existing clinics virtually impassable.
We have also launched 10 additional mobile health teams in Badin, in addition to the 25 static facilities and 8
mobile teams we have been supporting in Sindh since the 2010 floods.
All our work in Pakistan is made possible by your generous donations, so do please keep supporting Merlin's
essential and life-saving work in that region and around the world.
Find out how we've been helping people recover after last year's floods
6
More Bangladeshi Mothers Get Vital Care During Childbirth
UNFPA
20/09/2011
September 20, 2011 marks the one-year anniversary of Every Woman, Every Child, a global effort to achieve
country-led commitments to bring life-saving health care to millions of women and children in the developing
world by 2015. This series looks at maternal health in several countries with the highest number of maternal
deaths every year. UNFPA, UNICEF, WHO, the World Bank and UNAIDS – known as the Health 4+ -- are
supporting these countries to achieve their Global Strategy commitments.
MAULVIBAZAR, Bangladesh — When a woman in labour seeks her help, Kanchan Bala Roy is confident she can
oversee a safe delivery.
The rural health centre where she works was recently equipped for deliveries, as part of a broad initiative to
make childbirth in Bangladesh safer. Kanchan, a family welfare visitor, got new training: She now is better able
to manage normal deliveries at the centre or in clients' homes. And she can tell when a mother needs to be
rushed to the district hospital.
But what if the woman is powerless to heed her potentially lifesaving guidance?
Kanchan was alarmed by the case of Taslima, 18, who came to her centre one August morning after a night of
severe labour pain. Hours later, Taslima's cervix had not dilated. The clinic has no electricity, and evening was
approaching.
"The patient was suffering for a long time and there was no progress," Kanchan says. "I told her relatives this
could seriously harm mother and baby. 'She has to deliver in the hospital, not at home or in the clinic.'"
Who makes life-and-death decisions?
Despite Taslima's condition, her father-in-law took her back home rather than pay for a longer trip to the
district hospital. The fare, equivalent to two dollars, was a substantial sum for a family living hand to mouth.
"He said, 'It is the man who brings home money, so I will decide what to do,'" the health worker recalls.
Subsequently, he would claim no one told him his daughter-in-law was in danger.
When Kanchan and a medical officer showed up later at the family's home (a dark, crowded shack made of
corrugated iron and thatch), the young mother-to-be was lying unattended and in agony. After some
discussion the father-in-law relented, and once a heavy downpour subsided Taslima was put in a tricycle taxi.
Fortunately, it was not too late and the hospital emergency team was ready for her. She had a successful
Caesarean section that night.
Hospital deliveries are increasing
Surgical deliveries have doubled at the district hospital here since a United Nations project last year trained
additional doctors and nurses and built a new operation theatre that can accommodate two procedures at a
time.
7
The upgrade is part of a joint effort by UNFPA, UNICEF and the World Health Organization to help the
Government improve maternal and newborn health care. In four of the country's 64 districts, community
clinics, family welfare centres, subdistrict health complexes and hospitals have gotten new equipment and
stocks of basic drugs and supplies. Health workers at various levels have received training. Communities are
being mobilized to use the improved services.
The United Kingdom, the European Union and Canada are funding the interagency project, which will soon be
scaled up to cover 16 more districts.
Three out of four women still deliver at home
Childbirth in Bangladesh has become safer in the past 20 years, but there is a long way to go. The United
Nations estimates that every year some 12,000 die from avoidable causes related to pregnancy and delivery.
Three out of four women still deliver at home without a skilled birth attendant.
To help address this gap, free prenatal and delivery services are being offered closer to where women live. In
Maulvibazar district, 28 previously abandoned community clinics have been renovated with support from the
joint project.
The number of clients has risen steadily since the clinic in Mobarakpur village reopened last year. Roshana
Begum, a paramedic, has been trained to conduct prenatal check-ups and normal deliveries.
Malnutrition and early pregnancies increase risks…continued.
Full Text: http://www.unfpa.org/public/home/news/pid/8420
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Back to top
Medical Journals
1
Health Worker Crisis: Time For Action
PLoS Medicine
20/09/2011
by Paul Simpson
This week sees the launch of No Child Out of Reach, a Save the Children report that aims to raise awareness of
the global shortage of health workers. The message is simple; health workers are the single most important
element of any health system and the world doesn’t have enough of them. In fact, there are so few doctors,
midwives and nurses that one billion people will never see a health worker in their entire lifetime.
The report’s launch coincides with the UN general assembly in New York this week. No Child Out of Reach sets
out the case to reduce the 3.5 million health worker shortfall in the world’s 49 poorest countries and calls for
political action at both international and national levels. It is hoped that by raising the profile of the health
worker crisis this week politicians at the UN general assembly will act to address the problem.
As part of their effort to raise awareness of the health worker shortage Save the Children organised a
conference for bloggers and vloggers at their London offices last Saturday. A highlight was a talk by British
Mums who visited Mozambique with Save the Children earlier this year. Lindsey Atkin and Christine Mosler
were part of a group that followed a vaccine’s journey from a warehouse to a rural health clinic and they
documented the experience in a series of vlogs and blogs.
The conference also included a live Q&A with Lucy, a health worker in South Sudan, who joined the conference
via satellite phone. When asked what the best thing about being a health worker was she replied, “We are
always being looked at as hope, hope for better health.” However, if you consider that a child is five-times
more likely to survive to their fifth birthday if they live in a country with enough midwives, nurses and doctors,
it is plain to see that health workers are not just hope for better health. Health workers are better health.
2
China's progress in neonatal mortality
The Lancet, UK
15/09/2011
Diego G Bassania, , Daniel E Rotha
a Department of Paediatrics, Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada M5G
1X8
Available online 15 September 2011.
China's facility-based birth strategy and neonatal mortality: a population-based epidemiological
study,
Refers to:Xing Lin Feng, Sufang Guo, David Hipgrave, Jun Zhu, Lingli Zhang, Li Song, Qing Yang, Yan Guo,
Carine Ronsmans
PDF (616 K) | Supplementary content |
8
In the past two decades, important worldwide reductions in mortality in children younger than 5 years have
been accompanied by an increase in the proportion of deaths that occur in the neonatal period. [1] and [2]
Estimates indicate that, worldwide, neonatal deaths—which occur almost exclusively in low-income and middleincome countries—represent 41% of all deaths in children younger than 5 years.3 There has been increased
recognition of the need for these countries to implement public health interventions that specifically target
neonatal deaths.4 In particular, intrapartum adverse events leading to birth asphyxia (23% of all neonatal
deaths in 20083) and complications of preterm birth (29%) can be substantially averted only by increasing the
availability, quality, and demand for skilled health care before, during, and after delivery. [4] and [5]
As in Brazil and Mexico, China has accomplished substantial reductions in the mortality rate of children younger
than 5 years with socioeconomic development and targeted investments in primary health care, maternal and
child health programmes, and reproductive health. [1] and [6] China's progress is unique because the decline in
mortality rates in this age group was accompanied by a similarly marked reduction in neonatal mortality rates,
[2] and [7]
which predominantly occurred in the past decade after programmatic perinatal interventions were
introduced on a large scale.8
In The Lancet, Xing Lin Feng and colleagues' analysis9 emphasises China's success in addressing neonatal
survival over the past decade and a half. Their paper is a timely contribution, unique not only because it
reports empirical, nationally representative data for neonatal mortality rate from the most populous country in
the world, but also because the data expose large and persisting inequities in neonatal mortality across
socioeconomic strata, and in outcomes between infants born in hospital versus those delivered at home.
Feng and colleagues used district-level data from China's National Maternal and Child Mortality Surveillance
System (MCMS) to show the apparent effect of China's strategy to promote facility-based deliveries on
reductions in neonatal mortality rate between 1996 and 2008. Reductions in the rate during this period were
surprisingly uniform across diverse socioeconomic strata, which resulted in persistent inter-regional disparities
in neonatal survival. The investigators note that facility-based care might have been of lower quality and less
likely to be accessed in the poorest areas than in more developed regions. However, scarce information about
programme coverage, demand, and quality across the regions hindered a clear understanding of the
mechanisms that influenced the effectiveness of China's perinatal strategy.
Feng and colleagues show that reductions in neonatal mortality coincided with an increasing proportion of
births in hospital, an association that is central to the investigators' conclusions about the effectiveness of
China's facility-based birth strategy. However, the investigators do not present a comprehensive analysis of the
temporal association between increases in facility-based delivery and neonatal mortality rate at the district
level. Moreover, the rate and magnitude of the increase in the proportion of facility-based deliveries between
1996 and 2008 varied substantially across China's five socioeconomic strata, which contrasts with the
uniformity of the proportional decline in neonatal mortality. This finding suggests that factors other than
facility-based delivery could have been involved.
Because Feng and colleagues could access district-specific and period-specific data for neonatal mortality rate,
proportion of births in facilities, and district socioeconomic classification (and perhaps other district-level
covariates not mentioned in the paper), a longitudinal ecological (district-level) analysis, including a
combination of explanatory covariates from within the MCMS or from other sources, would have been feasible
and informative. With no such analysis, extrapolation of these findings to other settings is difficult.
Although the investigators report strong associations between neonatal mortality and place of birth (home vs
hospital), such inferences are based on a cross-sectional analysis of the 2002–08 MCMS data that did not take
account of important covariates. Many characteristics differentiate families that choose (or have access to)
facility deliveries and those who deliver at home; such differences would be expected to exist within, and not
just between, sociodemographic categories. The lack of statistical adjustment for key confounders suggests
that the estimates of preventable fractions should be cautiously interpreted.
Finally and importantly, we acknowledge the concerns about quality of the data from China's MCMS, on which
Feng and colleagues base their conclusions. Although the MCMS is a rich source of demographic data, it has
been criticised for systematically under-reporting births and deaths and for the large variation in the
distribution of surveillance sites in the past two decades. [2] , [8] and [10] Inaccurate estimation of the number of
births might have biased the analyses. For example, if home births were less likely to be reported than hospital
births, home-birth mortality rates could be spuriously inflated. Additionally, increases in the completeness of
birth reporting over time could result in apparent declines in neonatal mortality rates.
Provision of high-quality facility-based obstetric and neonatal care will undoubtedly improve neonatal survival,
and Feng and colleagues indicate how this improvement might have developed in China during the past 15
years. Nevertheless, a more complete assessment of the effect of China's national policy to promote
institutional deliveries on neonatal mortality rate is warranted. We look forward to further studies based on
MCMS data, especially with creative combinations of information from many sources 11 and analyses aimed at
untangling the complex effects of policies and interventions on maternal and child health. Studies using China's
abundant epidemiological and demographic data, and the uniqueness of its nationwide policy experiences,
could offer invaluable contributions to worldwide public health knowledge.
We thank Robert Black and Zulfiqar Bhutta for their comments and suggestions. We declare that we have no
conflicts of interest.
References
1 ZA Bhutta, M Chopra and H Axelson, et al. Countdown to 2015 decade report (2000–10): taking stock of
maternal, newborn, and child survival. Lancet, 375 (2010), pp. 2032–2044. Article | PDF (628 K) | | View
Record in Scopus | | Cited By in Scopus (31)
9
2 for the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology
Reference Group, MZ Oestergaard, M Inoue and S Yoshida, et al. Neonatal mortality levels for 193 countries in
2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med, 8
(2011), p. e1001080. Full Text via CrossRef
3 for the Child Health Epidemiology Reference Group of WHO and UNICEF, RE Black, S Cousens and HL
Johnson, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet,
375 (2010), pp. 1969–1987. Article | PDF (1712 K) | | View Record in Scopus | | Cited By in Scopus (137)
4 SN Wall, AC Lee and W Carlo, et al. Reducing intrapartum-related neonatal deaths in low-and middle-income
countries—what works?. Semin Perinatol, 34 (2010), pp. 395–407. Article | PDF (1549 K) | | View Record in
Scopus | | Cited By in Scopus (5)
5 V Kumar, A Kumar and GL Darmstadt, Behavior change for newborn survival in resource-poor community
settings: bridging the gap between evidence and impact. Semin Perinatol, 34 (2010), pp. 446–461. Article |
PDF (570 K) | | View Record in Scopus | | Cited By in Scopus (5)
6 for the Lancet Brazil Series Working Group, CG Victora, ML Barreto and M do Carmo Leal, et al. Health
conditions and health-policy innovations in Brazil: the way forward. Lancet, 377 (2011), pp. 2042–2053.
Article | PDF (170 K) | | View Record in Scopus | | Cited By in Scopus (2)
7 JK Rajaratnam, JR Marcus and AD Flaxman, et al. Neonatal, postneonatal, childhood, and under-5 mortality
for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4.
Lancet, 375 (2010), pp. 1988–2008. Article | PDF (7871 K) | | View Record in Scopus | | Cited By in Scopus
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8 for WHO/UNICEF's Child Health Epidemiology Reference Group (CHERG), I Rudan, KY Chan and JS Zhang, et
al. Causes of deaths in children younger than 5 years in China in 2008. Lancet, 375 (2010), pp. 1083–1089.
Article | PDF (802 K) | | View Record in Scopus | | Cited By in Scopus (16)
9 XL Feng, S Guo and D Hipgrave, et al. China's facility-based birth strategy and neonatal mortality: a
population-based epidemiological study, . Lancet, (2011) published online Sept 16..
10 Y Gao, S Kildea, L Barclay, M Hao and W Zeng, Maternal mortality surveillance in an inland Chinese
province. Int J Gynaecol Obstet, 104 (2009), pp. 128–131. Article | PDF (142 K) | | View Record in Scopus | |
Cited By in Scopus (4)
11 CG Victora, RE Black, JT Boerma and J Bryce, Measuring impact in the Millennium Development Goal era
and beyond: a new approach to large-scale effectiveness evaluations. Lancet, 377 (2011), pp. 85–95. Article
| PDF (282 K) | | View Record in Scopus | | Cited By in Scopus (3)
3
China's facility-based birth strategy and neonatal mortality: a population-based epidemiological
study
The Lancet, UK
16/09/2011
Xing Lin Feng PhDa, Sufang Guo ProfMDb, David Hipgrave PhDb, Jun Zhu ProfMDc, Lingli Zhang MDd, Li Song
PhDd, Qing Yang PhDd, Yan Guo ProfMPHa, ‡, Carine Ronsmans ProfMDe, ‡,
a
Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, China
b
UNICEF China, Beijing, China
c
National Office for Maternal and Child Health Surveillance of China, West China Second Hospital of Sichuan
University, Sichuan University, Chengdu, China
d
Department of Maternal and Child Health and Community Health, Ministry of Health, People's Republic of
China, Beijing, China
e
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Available online 15 September 2011.
Refers to: China's progress in neonatal mortality
The Lancet, Available online 15 September 2011,
Diego G Bassani, Daniel E Roth
Summary
Background
China's success in improving the quality of and access to obstetric care in hospitals offers an opportunity to
examine the effect of a large-scale facility-based strategy on neonatal mortality. We aimed to establish this
effect by assessing how the institutional strategy of intrapartum care has affected neonatal mortality and its
regional inequalities.
Methods
We did a population-based epidemiological study of China's National Maternal and Child Mortality Surveillance
System from 1996 to 2008. We used data from 116 surveillance sites in China (37 urban districts and 79 rural
counties) to examine neonatal mortality by cause, socioeconomic region, and place of birth, with Poisson
regression to calculate relative risks. Rural counties were categorised into types 1–4, with type 4 being the
least developed. We report attributable risks and preventable fractions for hospital births versus home births.
Findings
Neonatal mortality decreased by 62% between 1996 and 2008. The rate of neonatal mortality was much lower
for hospital births than for home births in all regions, with relative risks (RR) ranging from 0·30 (95% CI 0·22–
10
0·40) in type 2 rural counties, to 0·52 (0·33–0·83) in type 4 counties (p<0·0001). The proportion of neonatal
deaths prevented by hospital birth ranged from 70% (95% CI 59·7–77·8) to 48% (16·9–67·3). Babies born in
urban hospitals had a low rate of neonatal mortality (5·7 per 1000 livebirths); but those born in hospitals in
type 4 rural counties were almost four times more likely to die than were children born in urban hospitals (RR
3·80, 2·53–5·72).
Interpretation
Other countries can learn from China's substantial progress in reducing neonatal mortality. The major effect of
China's facility-based strategy on neonatal mortality is much greater than that reported for community-based
interventions. Our findings will provide a great impetus for countries to increase demand for and quality of
facility-based intrapartum care.
Funding
China Medical Board, UNICEF China.
Full Text:
4
Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an
updated systematic analysis
The Lancet, UK
20/09/2011
Prof Rafael Lozano MD a , Haidong Wang PhD a, Kyle J Foreman MPH a, Julie Knoll Rajaratnam PhD a, Mohsen
Naghavi MD a, Jake R Marcus MPH a, Laura Dwyer-Lindgren BA a, Katherine T Lofgren BA a, David Phillips BS
a, Charles Atkinson BS a, Prof Alan D Lopez PhD b, Prof Christopher JL Murray MD a
Summary
Background
With 4 years until 2015, it is essential to monitor progress towards Millennium Development Goals (MDGs) 4
and 5. Although estimates of maternal and child mortality were published in 2010, an update of estimates is
timely in view of additional data sources that have become available and new methods developed. Our aim was
to update previous estimates of maternal and child mortality using better data and more robust methods to
provide the best available evidence for tracking progress on MDGs 4 and 5.
Methods
We update the analyses of the progress towards MDGs 4 and 5 from 2010 with additional surveys, censuses,
vital registration, and verbal autopsy data. For children, we estimate early neonatal (0—6 days), late neonatal
(7—28 days), postneonatal (29—364 days), childhood (ages 1—4 years), and under-5 mortality. We use an
improved model for estimating mortality by age under 5 years. For maternal mortality, our updated analysis
includes greater than 1000 additional site-years of data. We tested a large set of alternative models for
maternal mortality; we used an ensemble model based on the models with the best out-of-sample predictive
validity to generate new estimates from 1990 to 2011.
Findings
Under-5 deaths have continued to decline, reaching 7·2 million in 2011 of which 2·2 million were early
neonatal, 0·7 million late neonatal, 2·1 million postneonatal, and 2·2 million during childhood (ages 1—4
years). Comparing rates of decline from 1990 to 2000 with 2000 to 2011 shows that 106 countries have
accelerated declines in the child mortality rate in the past decade. Maternal mortality has also continued to
decline from 409 100 (uncertainty interval 382 900—437 900) in 1990 to 273 500 (256 300—291 700) deaths
in 2011. We estimate that 56 100 maternal deaths in 2011 were HIV-related deaths during pregnancy. Based
on recent trends in developing countries, 31 countries will achieve MDG 4, 13 countries MDG 5, and nine
countries will achieve both.
Interpretation
Even though progress on reducing maternal and child mortality in most countries is accelerating, most
developing countries will take many years past 2015 to achieve the targets of the MDGs 4 and 5. Similarly,
although there continues to be progress on maternal mortality the pace is slow, without any overall evidence of
acceleration. Immediate concerted action is needed for a large number of countries to achieve MDG 4 and MDG
5.
Funding
Bill & Melinda Gates Foundation.
Introduction
In 2000, 189 heads of state signed the Millennium Declaration committing themselves to achieve eight goals
for development.1 The target for Millennium Development Goal (MDG) 4 was to reduce the under-5 mortality
rate by two-thirds between 1990 and 2015 and the target for MDG 5 was to reduce the maternal mortality
ratio by three-quarters during the same period.2 Progress on reducing child and maternal mortality has been
substantially slower than the target annual rates of decline of 4·4% and 5·5% for children and mothers
respectively.3, 4 In response to slow progress and the moral urgency of reinvigorating efforts to tackle child
and maternal mortality, the UN Secretary-General launched the Global Strategy for Women's and Children's
Health in September, 2010.5 Donor nations and other organisations committed US$40 billion to this effort to
accelerate progress for MDGs 4 and 5.6
To be effective, increased investment to accelerate declines in maternal and child mortality will need intense
monitoring of progress over the next 4 years. Understanding who has made progress in the recent past
11
provides opportunities for shared learning on what policies can be the most effective. Tracking progress is
crucial to sustaining increased resource mobilisation. In an era of slower growth in development assistance for
health, showing the effectiveness of aid is essential.7 Evidence of effectiveness requires robust data on recent
trends as well as accounting for broader drivers of these trends. Perhaps most importantly, data on trends are
essential for prioritising where global and national resources should go to achieve an accelerated effect. The
importance of good evidence and clear accountability for progress has been recognised by the UN SecretaryGeneral Commission on Information and Accountability for Women's and Children's Health.3, 8, 9
In 2010, several analyses were published tracking trends in maternal and child mortality.3, 4, 8, 10 Differences
between these analyses for children were mostly focused on 32 countries where differences were greater than
20% on average from 1990 to 2010. Nevertheless, there has been debate on datasets and methods.11, 12 For
maternal mortality, there were more substantial differences between estimates for many countries. New data
on maternal mortality, particularly the finding that there had been substantial progress in some countries,
generated great interest.13—16 Vigorous debate from academics, government officials, and other analysts on
a country-by-country basis has been concentrated on data, HIV-related deaths during pregnancy, and
estimation approaches.17—24 First, many data sources were not included in published analyses such as vital
registration, national surveys, censuses, and especially surveillance systems of maternal mortality.25, 26
Second, there has been substantial confusion around the MDG27 and International Classification of Diseases
(ICD)28 recommendation that all deaths due to HIV during pregnancy or within 42 days of the termination of
pregnancy be included in the computation of the maternal mortality ratio. In fact, the UN group chose to
include only half the HIV-related deaths during pregnancy in their estimation.8 Many users would prefer to
sharply distinguish obstetric causes of maternal mortality, including direct and indirect causes, from those
related to HIV or other causes.29 Third, several aspects of the estimation of maternal mortality have been
discussed including corrections for misclassification, model specification, and uncertainty analysis.24, 30, 31
The debate around these three main issues has resulted in many avenues for refining the estimation of child
and especially maternal mortality.
In our report, we update the studies of Rajaratnam and colleagues3 and Hogan and colleagues4 to produce
new estimates for under-5 mortality and maternal mortality from 1990 to 2011. Although we use their same
general approach, we incorporate into this cycle of estimation important insights that have emerged in the past
year from widespread debate. We take advantage of the many data sources revealed during the debate since
the 2010 publications that were not previously included. For maternal mortality, we include in our predictive
validity testing the modelling strategy used by the UN in 2010. By assessing evidence on both MDG 4 and MDG
5 in the same study, we are able to compare progress on the two goals country-by-country…….Continued
Full-text: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)613378/fulltext?_eventId=login
5
New Physician Education Initiatives Seek to Remove the Devil From the Detailing
JAMA
21/9/2011
JAMA. 2011;306(11):1187-1188. doi: 10.1001/jama.2011.1256
Mike Mitka
With support from recent legislation as well as advocacy from researchers, academic medicine is making
greater inroads into medical practices. But the practice known as academic detailing has prompted criticism
from pharmaceutical manufacturers and others who claim that lax oversight is opening the door to unintended
consequences such as lowering the quality of care in return for cost savings.
Academic detailing is noncommercial education of health care professionals, typically conducted by physicians,
pharmacists, and nurses, about the evidence-based efficacy, safety, and cost of therapies. It is designed to
counter detailing by pharmaceutical and device manufacturers, which critics contend can be biased because of
commercial interests.
For example, sales visits by pharmaceutical detailers for gabapentin (an anticonvulsant used to treat epilepsy
and postherpetic neuralgia) provided physicians the message about unapproved uses of the drug (Steinman
MA et al. PLoS Med. 2007;4[4]:e134). And the practice has been going on for years. In 1995, researchers
suggested that 11% of statements made by drug company detailers about drugs contradicted information
readily available to them; physicians who met with these detailers generally failed to recognize the inaccurate
statements (Ziegler MG et. JAMA. 1995;273[16]:1296-1298).
The 2009 American Recovery and Reinvestment Act gave the Department of Health and Human Services
(DHHS) $1.1 billion to conduct comparative effectiveness research designed to compare therapies for various
conditions and determine what treatments work best. The DHHS in turn is spending $300 million through its
Agency for Healthcare Quality and Research (AHRQ), in part to conduct an Academic Detailing Initiative. This
allows the AHRQ to sign 3-year contracts with organizations to carry out academic detailing activities to inform
selected health care audiences about the comparative effectiveness research program.
The AHRQ defines comparative effectiveness research or patient-centered outcomes research as providing
information that helps members of the health care community work with individual patients to select the best
possible treatment for an illness or condition. “By comparing drugs, medical devices, tests, surgeries, or ways
12
to deliver health care, patients and their families can make more informed choices,” an AHRQ publication
states.
The AHRQ has signed a 3-year $11.7-million contract with Total Therapeutic Management Inc (a quality
improvement company providing outcomes research) to provide in-person visits to clinicians and health care
system decision makers to help them understand and use comparative effectiveness research. The research to
be discussed compares treatment and diagnostic approaches for common chronic illnesses and medical
conditions, including diabetes, heart disease, mental health conditions, and muscle, bone, and joint disorders.
The AHRQ hopes to see this contract produce 9000 academic detailing visits to 1500 practices and health
systems.
In addition, the AHRQ has entered into 3-year contracts with Ogilvy Public Relations for various projects. These
efforts will involve creating a publicity center to promote the academic detailing resources and to establish
dissemination partnerships with national organizations, as well as establish regional dissemination centers to
enhance awareness and use of academic detailing. The initiative will also include Prime Education Inc, which
will provide continuing medication education to clinicians. A fourth entity, IMPAQ International, will determine
the effectiveness of the 4 projects.
After 3 years, the AHRQ hopes to have enough data to enable it to understand the impact of the academic
detailing process, the development of partnerships, the types of outcomes it can expect during different phases
of the project, and the influence of various detailing methods on health care worker behavior.
Jean R. Slutsky, PA, MSPH, director of AHRQ's Center for Outcomes and Evidence, said the initiative is targeted
at primary care physicians working in small and large practices. “We are bringing unbiased, high-quality
information to health care professionals. It is really face-to-face education with trained professionals who have
no conflicts of interest who are trained in how to discuss the information,” Slutsky said.
Based on early data collected from the field, Slutsky said, academic detailing visits last about 42 minutes and
feedback has been very positive. She noted that 91% of health care professionals say they would incorporate
the products described to them into their practices, and half request a follow-up visit. “A key message we try
to bring is the balance of benefits and harms of different health care interventions—allowing primary care
providers to understand where one option may provide more of a benefit than another option,” Slutsky said.
DIFFERING VIEWS
Not everyone sees academic detailing as a benign influence. The Pharmaceutical Research and Manufacturers
of America (PhRMA), the drug makers' trade association, addressed the issue in a statement it made last year
regarding a hearing in the Minnesota legislature about health care legislation. In the statement, PhRMA Senior
Assistant General Counsel Marjorie Powell said, “The final proposal could expand academic detailing programs
that, elsewhere, exist solely to boost the number of generic drugs that physicians prescribe. That singleminded focus raises the question of the merit of such a program in Minnesota, where generic dispensing rates
already approach 80%. Counter-detailing is not subject to rigorous federal oversight, which requires that the
information shared with physicians be accurate, fair, balanced, and reflect the federally approved medicine
label.”
Echoing the cost-pressure concern is Joshua D. Lenchus, DO, RPh, an associate professor of clinical medicine at
the University of Miami Miller School of Medicine and associate director of the University of Miami-Jackson
Memorial Hospital's Center for Patient Safety in Florida. In a legal backgrounder for the Washington Legal
Foundation, a nonprofit free-market advocacy think tank, Lenchus wrote, “Physicians and other medical
professionals are certainly conscious of the cost of drugs and medical devices, but our primary duty is to
provide each patient with the care best suited to them individually. Tools such as comparative effectiveness
research and academic detailing have been developed and applied in response to intense political and fiscal
pressure to reduce health care costs” (http://tinyurl.com/3paxzzf).
In an interview, Lenchus expanded his discussion of academic detailing and focused on the need for regulation.
“The industry has specific required regulations and policies, some self-imposed and some required by
government, that they need to adhere to when presenting information. For example, take gabapentin: the
company was fined several million dollars and one of its speakers was tossed because the information he was
presenting was off-label and incorrect, and whether the company knew or not was irrelevant. The company
had real consequences for not adhering to these policies,” Lenchus said. “And my biggest fear is that I am not
convinced the federal government will abide by the same set of rules as required for industry.”
Although academic detailing advocates point out that the programs are nonprofit, Lenchus is skeptical, saying
he could envision a system that rewards academic detailers when clinicians they visit write fewer prescriptions
or prescriptions for less costly medications, just as pharmaceutical companies reward its sales force when more
prescriptions are written for their products after they make detailing visits. But this scenario could breed some
withholding of pertinent information, perhaps withholding efficacy information favoring a higher-priced drug
over a less-costly drug, said Lenchus. He called for “a level playing field” in oversight of commercial and
academic detailing.
REGULATION NEEDED?
Jerry Avorn, MD, professor of medicine at Harvard Medical School and chief of the division of
pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital in Boston, considers the
level playing field argument misguided. “It is really specious to compare academic detailers, who are purveying
noncommercial information, often on behalf of public sector programs, to sales representatives from drug
companies,” said Avorn, who coauthored the 1983 article suggesting the concept that became academic
detailing (Avorn J and Soumerai SB. N Engl J Med. 1983;308[24]:1457-1463).
13
Avorn also takes issue with the argument to regulate both forms of detailing equally. “The reason for many
decades the courts said sales needed to be regulated and not other education forms is because it is reasonable
to see that those [are the] folks for whom there is the greatest jeopardy of bending the truth,” he explained.
There are concerns, he said, that if drug company detailers were not required to stick to the Food and Drug
Administration labeling information, they would go beyond that and persuade physicians to use the drugs for
other indications, even though there was no evidence that they would work. Avorn added that drug companies
have faced billions of dollars in fines and settlements because their representatives still apparently “say what
they want to say” to influence physicians.
“Reps get paid on how much product they move,” he said. “Academic detailers do not push a product, they are
not on commission, and they really present the best possible evidence.”
Avorn cofounded the Independent Drug Information Service, an academic detailing nonprofit that evaluates
medical journals and other data sources to put together evidence-based information about drugs commonly
used in primary care practices. He said for physicians and other health professionals, the source of information
about treatment efficacy and safety should be apparent: “It is best to get information from those without any
vested interest in those drugs.”
6
Back to top
Africa & Middle East
1
Partnership to train skilled responsive workforce on AIDS launched
Ghana News Agency
20/09/2011
Accra, Sept. 20, GNA - A two-year strategic plan to train a multidisciplinary healthcare workforce to focus on
enhancing response to HIV and AIDS treatment and prevention in Ghana was launched in Accra on Tuesday.
The training is a partnership between University of Ghana (UG) College of Health Sciences and Brown Tufts and
Yale Universities from the US.
The project has a 10-year vision to develop human resource capacity with a full set of skills to meet challenges
related to the HIV and AIDS pandemic in Ghana.
Professor Ernest Aryeetey, Vice Chancellor of University of Ghana launching the project said there was high
expectation from the partnership, especially in teaching and research and how it could be utilised in
management of HIV and AIDS in Ghana.
He said the partnership called for commitment from parties involved for it success and noted that despite the
reduction from 3.5 per cent in 2003 to 1.5 per cent in 2010 more needed to be done to stem the tide.
Prof. Aryeetey lauded the initiative and commended Brown Tufts University for partnering University of Ghana
to build capacity of health workers to manage the pandemic.
Prof. Aaron Lawson, Provost of College of Health Science stated that the launch marked a major achievement
in the College’s broader quest to be part of a more responsive, effective and efficient public health sector in
Ghana.
He explained that the partnership was intended to develop excellence in education and research by
strengthening faculty capacity at the University resulting in enhanced teaching, and applied research to
effectively address challenges of HIV and AIDS in Ghana.
“We are launching a flagship programme aimed at increasing the capacity of health professionals in Ghana and
the sub-region to respond to the HIV and AIDS pandemic,” he added.
Prof. Lawson said the Ghana Partnership Framework in support of HIV and AIDS National Response was
focused on five key goals; to reduce the number of new infections by 30 per cent by 2013, increasing antiretroviral therapy (ART) coverage from 30 per cent to 60 per cent by 2013 and strengthening health
management systems needed to achieve the prevention, treatment and care goals.
The rest are strengthening capacity of community Based Organisations (CBOs) to provide information and
services to most-at-risk population and people living with HIV.
“The College of Health Sciences has a vision to bring good health, comfort and happiness to all people including
those with HIV and AIDS,” he added.
Mr Peter Argo, Acting USAID Ghana Mission Director said the Agency was proud to be a partner to government
to help improve quality of health services and empower individuals and communities to adopt good health
practices.
14
The academic partnership, he said, provided an opportunity for shared learning and enhanced capacity building
that would empower the College of Health Sciences to be more effective in the national HIV and AIDS
response.
Mr Argo said the twining of University of Ghana and Brown Tufts University was an excellent initiative to
mobilise the unique strengths and expertise that the two institutions possessed to address developmental
issues, adding that USAID had recognised the powerful role of African higher educational institutions to foster
the development of their countries.
“Supporting strategic academic initiatives of the sort was part of how USAID was fundamentally transforming
itself from a traditional aid agency into a modern development enterprise,” he added.
Mr Argo said USAID expected to see a comprehensive curriculum that mainstreamed training in HIV and AIDS
across all health disciplines, an opportunity for faculty development in teaching and applied research,
structured mentoring of junior faculty and postgraduates at the end of the programme.
Dr Angela El-Adas, Director General, Ghana AIDS Commission (GAC) said the HIV and AIDS programme
between the two universities was a top priority for government since HIV was a major development issue.
She noted that there was the need for human resource base and capacity building in addressing the prevalence
of HIV and AIDS.
Professor Tim Flanigan, Principal Investigator, Brown Tufts University said collaboration of the two universities
started five years ago and expressed delight at the fruition of the partnership to strengthening the curriculum
and help the University of Ghana to better train the trainers as one of the effective way higher education could
attack the AIDS pandemic.
“Advancing medical education in Africa is not only important to improving health care, but also to brightening
the continent’s economic future“, he said.
2
KENYA: NCDs and HIV fight for limited resources
IRIN PlusNews
20/09/2011
NAIROBI, 20 September 2011 (PlusNews) - The crowd of health issues jostling for a share of Kenya's
inadequate health budget is expanding, with activists calling for an increase in resources for the management
of non-communicable diseases (NCDs), which account for more than 50 percent of hospital deaths and
admissions.
"We need to see more commitment in terms of resources; we have policies and guidelines for the management
of non-communicable illnesses, but we need strategic focus on operational implementation," said Andrew
Suleh, medical superintendent of Mbagathi District Hospital in the Kenyan capital, Nairobi.
According to the NGO, NCD Alliance, NCDs are responsible for more than half of all hospital admissions and
deaths; 13 percent of deaths are due to cardiovascular disease, while cancers account for 7 percent and
diabetes for 4 percent of deaths, respectively.
Scarce resources
The UN World Health Organization's 2011 World Health Statistics report, states that the Kenyan government
spends just 5.8 percent of its budget on health; this represents less than half of the 15 percent pledged by
African leaders under the Abuja Declaration of 2001.
Worryingly for health activists, government spending on health appears to be shrinking rather than growing; in
2000, health spending was 9 percent of total government expenditure and reliance on external sources for
health funding rose from 8.8 percent in 2000 to 26.8 percent, according to WHO.
"The health service is overwhelmed; at Kenyatta [National Hospital, the country's largest referral facility] we
perform open-heart surgery twice a week - our waiting list is up to 2013," said James Munene, head of the
Cardiac Unit. "We are dealing with a situation where the population has grown but we still have the same
number of facilities and the same number of qualified personnel.
"Risk reduction efforts are not working - the messages about HIV prevention and TB and other communicable
illnesses have been very clear and evident, but we don't see efforts to ensure proper nutrition, exercise - the
things that could prevent many of these NCDs," he added. "Perhaps because we have so much starvation in
parts of the country we are afraid to advise those who have food on how to eat right."
Worries over HIV funding
Against a backdrop of two consecutive rejections by the Global Fund to fight AIDS, Tuberculosis and Malaria
and flat-lined funding from the US President's Emergency Plan for AIDS Relief, HIV activists worry that any
move to increase funding for NCDs could mean less for HIV. Just 440,000 out of 1.5 million HIV-positive
Kenyans have access to treatment, and more than 100,000 new HIV infections occur annually.
15
"NCDs are sexy now, last year it was maternal health; there doesn't seem to be a genuine commitment by
government to fully address any of these issues... where are the results? The government must not forget
about people living with HIV," said James Kamau, coordinator of the Kenya Treatment Access Movement.
"Where is the 15 percent they promised - that way, we could improve treatment of all illnesses."
Kamau noted that if all Kenyans who required HIV treatment had access to it, the government would reduce
the costs of treating opportunistic infections, freeing up vital manpower and other resources to treat other
illnesses.
But boosting resources for NCDs would be beneficial to people with HIV, as studies show they are at higher risk
for conditions such as cardiovascular disease.
On the same side
According to a 2011 study of more than 12,000 HIV-positive men and women in western Kenya, there is a high
prevalence of hypertension and obesity - both linked to cardiovascular disease - among HIV-positive patients in
that part of the country. The prevalence of hypertension among men and women was 11.2 percent and 7.4
percent respectively, while 11 percent of men and 22.6 percent of women were overweight or obese.
The authors recommended that HIV care in sub-Saharan Africa should include identification and management
of cardiovascular risk factors.
"Programmes in sub-Saharan Africa that focus solely on HIV care are missing a major opportunity to improve
population health status at a substantial future cost," they said.
A 2010 study of a programme by the NGO, Family Health International, to integrate cardiovascular disease
management and HIV care in Kenya found that cardiovascular disease screening and management were
feasible in routine HIV care.
According to Mbagathi Hospital's Suleh, the demands for more health funding should not put the various health
activists at odds with each other, but rather should unite them to ensure the government fulfils its obligations.
"This should not be a competition - the same government is responsible for ensuring that HIV and NCDs are
fully funded," said Suleh. "There has been more emphasis on communicable diseases like HIV, malaria and TB;
there must be a balance and proper planning to ensure all these vital areas receive due attention."
3
ZIMBABWE: Aid programme dramatically improves health service
UN IRIN
20/09/2011
HARARE, 20 September 2011 (IRIN) - Stella Moyo lost her child three months after his birth in late 2007
because her local health facility in Chivu District, some 160km southeast of Harare, lacked antibiotics to treat
the infant’s throat infection.
“When I visited a clinic close to my home, I was referred to Chivu Hospital [50km away] because there were
no drugs at the clinic. Unfortunately, the hospital had long run out of antibiotics and I watched as my son’s
condition deteriorated, until he died,” Moyo told IRIN.
She and her husband, who survive through farming and were experiencing a lean period due to drought, could
not afford to buy the drugs from a private pharmacy. They resorted instead to traditional and faith healers who
proved ineffective.
At the time Zimbabwe’s health system was experiencing a critical shortage of not only drugs, but equipment
and trained staff, the result of an economic meltdown characterized by hyperinflation, shortages of basic
commodities and a brain drain. The impact on the country’s social services was compounded by a political crisis
which saw Zimbabwe isolated by many governments, international financial institutions and donors.
Moyo, 30, vowed not to have another child after the traumatic death of her son, but is expecting her third child
in a few weeks.
“I told myself that it was pointless to fall pregnant when there was no guarantee that my child would survive
due to poor service at clinics or hospitals,” she said. “However, I have changed my attitude because the
situation at health centres has improved.”
An elderly nurse who works at a public clinic in Warren Park, a suburb about 6km west of Harare, agreed.
“During the period of critical shortages of drugs and staff, I witnessed many children, women and other people
die because they could not get vital drugs and there was no one to attend to them. Those deaths could have
been avoided and, gladly, we can avoid them now,” said the nurse, who identified herself as Gogo Matilda.
She added that although there were still times when essential drugs, particularly antibiotics, ran out, patients
could easily get them from other health centres and “replenishments do not take too long to come”.
Multi-donor programme
16
The improved availability of essential medicines in Zimbabwe’s public health sector is largely due to a multidonor programme started in 2008 through collaboration between the government, the UN Children’s Fund
(UNICEF) Zimbabwe, the European Union (EU), the UK, Australia, Canada and Ireland.
To date, the Essential Medicines Supply Programme (EMSP) has received US$52 million in funding, according
to UNICEF. The money is used to buy drugs and medical supplies which are distributed to health centres by
Natpharm, the supply arm of the Ministry of Health and Child Welfare.
According to a survey carried out by the EU, 80 percent of essential medicines are now available at over 80
percent of health facilities compared to only 28 percent availability of vital drugs at public health institutions in
2008.
The programme recently received a shot in the arm through a $14 million grant from the EU.
“This will go a long way to ensuring that Zimbabwe stays on the path to full recovery of the health sector, in
particular to ensuring that the poor and vulnerable members of society also have access to health services,”
Peter Salama, UNICEF country representative said at the grant-signing ceremony.
Salama added that the essential medicines programme had “helped reduce the disparity in availability of
essential medicines between rural and urban health facilities” and had the potential to improve the system for
distributing drugs and medical supplies.
“Our health delivery system is on the road to recovery [and] we hope that soon, every Zimbabwean will be
able to exercise the basic human right of access to quality health care,” said Health Minister Henry Madzorera.
4
Help Africa Fight Diseases - President Mugabe
The Herald, Zimbabwe
20/09/2011
Morris Mkwate
New York — PRESIDENT Mugabe says the international community should help eradicate non-communicable
diseases in Africa by channelling more assistance to the continent.
Speaking at the High-Level Meeting on NCDs at the United Nations headquarters here yesterday, the President
said Africa was unable to deal with the diseases comprehensively owing to restricted development.
He urged developing countries to make time-bound commitments that ensured access to medicine, technology
transfer and advanced NCD training for health personnel.
"It is common cause that Africa is the least developed continent and consequently, the least able to cope with
such a scourge.
"This must be taken in the context of the devastation caused to the continent by the HIV and Aids pandemic,"
he said.
"I, therefore, call upon the international community, especially the developed countries, to increase their
assistance particularly to Africa towards preventing and controlling NCDs."
Cde Mugabe said although Zimbabwe supported a political declaration on the prevention and treatment of
NCDs that the two-day meeting was expected to endorse, there was need to fully address the major challenges
developing countries faced in dealing with the epidemic.
The declaration essentially outlines a collective attempt to finding a solution to the diseases.
"We, therefore, call upon developed countries to make concrete commitments that are time-bound so as to
ensure access to medicines, appropriate technology transfer and further training for our health personnel on
NCDs.
"My delegation is concerned that in the quest to protect trade related aspects of intellectual property rights, a
human face is lost.
"There is a tendency to forget that this is a situation of life and death to our affected people. We reiterate that
human survival must be more important than anything else.
"My delegation calls upon the international partners to grant flexibilities that will allow pharmaceutical
companies in countries of the South to manufacture generic drugs that treat NCDs just as they did for HIV and
Aids drugs in the past few years.
"We believe that this would go a long way in ensuring availability and affordability of treatment."
17
The Head of State and Government and Commander-in-Chief of the Zimbabwe Defence Forces said the latest
World Health Organisation projections that NCDs would affect 52 million people by 2030 should spur world
leaders to take mitigation measures.
The majority of new cases are likely to be recorded in the developing world, he said, adding that this would
further strain health delivery systems in the affected countries.
"As leaders, we have for a long time focused our attention on other diseases such as HIV and Aids, TB
(tuberculosis) and malaria and in the process, have overlooked the growing threat posed by NCDs to humanity.
"Our meeting today awakens us to the reality that NCDs have now surpassed HIV and Aids as the leading
cause of death worldwide. We are alarmed by the statistics from the World Health Organisation that NCDs are
expected to affect 52 million people by 2030.
". . .Undoubtedly, this will further strain our already overburdened health delivery systems in the developing
world and this, I am afraid, will scuttle the realisation of one of the main objectives of the Millennium
Development Goals.
"The scourge of NCDs in developing countries places an enormous social and economic burden on the fragile
health delivery system. Consequently, the availability of drugs to our people is compromised and inevitably,
the rate of mortality increases."
President Mugabe said while tobacco and alcohol abuse contributed to the incidence of NCDs, unbalanced diet
precipitated by poverty in developing countries, was largely to blame.
"Global food agencies such as the World Food Programme and Food and Agriculture Organisation have noted
that many families in developing countries suffer from lack of balanced diet, rendering them susceptible to
NCDs.
"Yes, many developing countries, including Zimbabwe, have had their challenges with abuse of tobacco and
alcohol, but such factors are only attributable to a small percentage of any country's population.
"The major challenge in many of our countries is to reduce poverty, which restricts many families to a rigid and
unbalanced diet."
He said that Government was already making efforts to combat NCDs through raising awareness of the
scourge. He said authorities have also put in place training programmes for NCD health services personnel,
while a second NCD risk factor surveillance would be conducted next year to augment an existing data base.
"We expect the surveillance to complement our yearly NCDs awareness campaign targeting the diseases under
the four main NCDs whose modifiable factors include; raised blood sugar level, high blood pressure, obesity,
excessive alcohol and tobacco consumption, unhealthy diets and lack of physical exercise," he said.
The high-level meeting is expected to formulate a co-ordinated global strategy to deal with NCDs, which are
defined as medical conditions that are non-infectious.
Yesterday, UN Secretary-General Mr Ban Ki-moon, said the diseases were a threat to economic development.
He said a collective global effort similar to approaches taken against HIV and Aids would ensure success in the
fight against them.
WHO director general, Dr Margaret Chan, also advocated lifestyle changes, saying conditions such as obesity
could lead to individuals developing some of the diseases.
The meeting continues today with roundtable discussions expected to tackle the rising incidence and socioeconomic impact of NCDs and their risk factors.
Also to come under the spotlight will be methods of strengthening the national capacities and policies of
member states to address their prevention and control.
The meeting is expected to ultimately adopt an action oriented outcome document. In 2008, NCDs accounted
for more than 60 percent of global deaths.
WHO projects the burden of the diseases to increase by 17 percent globally and that the greatest increase of
29 percent is expected to be in Africa.
In 2005, Zimbabwe conducted its NCD risk factor assessment, which established prevalence rates of 10 and 27
percent for diabetes and hypertension, respectively.
The WHO Global Status Report on Non-Communicable Diseases in Zimbabwe revealed "an estimated age
standardised death rate for all in 2008 to be 697, 8 per 100 000 for males and 533, 4 per 100 000 for
females".
5
Kenya: A Daily Prayer for Complication-Free Births
18
Inter Press Service
19/09/2011
By Isaiah Esipisu
DADAAB, Kenya, Sep 19, 2011 (IPS) - Dr. Beldina Gikundi's daily prayer is that the handful of malnourished
pregnant Somali women who go into labour that day at the Dadaab refugee complex do not have
complications, which might require a caesarean section. Because Gikundi knows that Somali cultural beliefs
mean that she and her staff at Hagadera Hospital will most likely not be able to immediately operate on the
women and save their lives and those of their unborn children.
"Somali women have specific people who must give consent before the procedure begins.
"We have, in the past, lost infants because of prolonged labour, which are lives we would have saved if it were
not for these cultural beliefs," said Gikundi, the doctor in charge of the maternity unit at the hospital. She said
that each day between three to five women go into labour here.
Hagadera Hospital is a fully-fledged health facility at the Dadaab refugee complex, in North Eastern Kenya.
Dadaab, the biggest refugee camp in the world, is divided into three camps: Ifo; Dagahaley; and Hagadera.
It is home to over 440,000, mostly Somali, refugees who have fled the famine and drought in their country.
According to the United Nations Refugee Agency (UNHCR), 70,000 people fled to Dadaab from Somalia in the
Horn of Africa in June and July and 1,500 arrived daily in the months to follow. The rate has since gone down.
Hagadera Hospital is run by the non-governmental organisation International Rescue Committee and has 120
beds. It provides free inpatient and outpatient services and has a 24-hour operating theatre for emergency
surgery.
But despite this, the lives of Somali women with labour complications remain at risk.
Gikundi told IPS that under normal circumstances consent is needed from a patient for a caesarean section.
But in Somali culture, this consent must come from the woman's father in-law, and if he is not available then
consent must come from the expectant woman's husband. And herein lies the complication.
A majority of the refugees at Dadaab are women, as their husbands and men-folk either remained behind in
their villages to protect their belongings, or were working in the Somali capital Mogadishu at the time the
famine struck and their families were forced to flee the region in search of aid.
Gikundi told IPS that on many occasions the hospital has had to either send someone to Mogadishu, or to the
women's villages in south Somalia, to search for their husbands or fathers-in-law for consent.
"As a result, we have seen women remain in labour for two or sometimes more days before we get the right
people to give the consent for a life-saving operation," she said.
Apart from losing the unborn infants, said Gikundi, the women run a high risk of developing vesicovaginal or
obstetric fistula.
Obstetric fistula is caused by extended pressure of the child's head against the soft tissue in the mother's
pelvis during childbirth. The tissue eventually dies from the lack of blood supply, and a hole develops between
either the rectum and vagina or between the bladder and vagina.
Women who suffer fistula are usually unable to control the flow of urine or faeces. They are often stigimatised
by their communities and families because of their condition.
"We repair an average of three cases of vesicovaginal fistula every month, which is a very high rate," said
Gikundi.
"Delay in seeking care for pregnancy-related complications and delay in consent for life-saving procedures like
caesarean sections, among other reasons, have hampered progress in reducing maternal mortality and
morbidity among refugees in Dadaab," said Ann Burton, a senior public health officer for UNHCR at Dadaab.
She said 14 women died during labour at Dadaab between January and July.
"This is a very sad situation because no woman is supposed to die while bringing forth a new life," Burton said.
Other obstacles to maternal health are the practice of female genital mutilation (FGM) and the almost nonexistent use of contraceptives.
According to public health experts at the UNHCR, almost all the Somalis at Dadaab practice FGM.
Studies in many countries have linked FGM to the increased risk of maternal and child morbidity and mortality
due to obstructed labour.
"Women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth
to a stillborn child than other women," explained Dr. Joseph Karanja, a gynaecologist in Nairobi, Kenya.
19
Burton said that FGM is an emotive subject among the Somali refugees, and it needed to be addressed with
caution.
Another obstacle to maternal health among the refugees is the failure of family planning.
The infant nutritional expert at Hagadera Hospital, Hadija Mohammed, said that many Somalis believed that
family planning and using contraception was against their religion.
"Though, the truth is that Islam clearly permits family planning," said Mohammed.
She added that many people wrongly believed that using contraceptives would cause infertility and other
health complications.
A July survey by UNCHR of the three camps that make up Dadaab: Ifo; Dagahaley; and Hagadera, found that
contraceptive uptake among refugees in the camps was two percent, three percent and one percent
respectively.
As a result, the fertility rate at Dadaab is alarmingly high. On average women here have more than nine
children in their lifetime.
"I do not have proper statistics, but the average fertility rate at the camp is likely to be more than nine
children per woman," said Gikundi.
However, UNCHR reports that there is a high attendance of antenatal care clinics.
"Between January and July, 95 percent of all pregnant women at Ifo and Hagadera camps attended antenatal
clinics four times during their pregnancies, as recommended by the World Health Organization," said Burton.
Also, between 84 to 94 percent of women at Dadaab gave birth under the supervision of a skilled birth
attendant between January and July.
Gikundi said the hospital also had a 24-hour ambulance service to transport pregnant mothers.
"We also have informants, who are equal to community health workers, who keep monitoring pregnant
women, reminding them of the importance of attending antenatal clinics. They will also call for an ambulance in
case of any complications or labour pains," said Gikundi.
6
Rwanda: Community Health Workers to Benefit From PBF
The New Times, Rwanda
23/09/2011
Community Health Works (CHWs) will soon start gaining from the Performance Based Financing (PBF) - an
initiative that offers financial incentives to medical practitioners.
With the help of the School of Public Health of the National University of Rwanda, the Ministry of Health intends
to conduct a baseline study on 4,800 health workers in 200 sectors across the country.
The study is divided into four arms of 50 sectors each, according to Dr Paulin Basinga, the Director of School of
Public Health at NUR.
"In the first arm dubbed 'demand-side incentives only', patients will receive gifts every time they visit a health
worker while in the second category, health workers will receive financial incentives if they hit the set target,"
he said.
He added that in the third category, patients will receive gifts while CHWs will also get incentives while the
fourth category is for comparison and has fewer incentives.
Meanwhile, the Ministry intends to develop a work plan with the Rwanda Cooperatives Agency through which
funds would be channelled to health workers' cooperatives and later to individuals.
Currently, there are 432 health workers' cooperatives.
The community health workers' PBF will partly be funded by the World Bank, Global Fund and the Spanish
Impact Evaluation Trust Fund.
According to the World Bank economist, Christel Vermeersch, the community PBF study will last for two years
before it extends to the rest of the country.
"The next step of when and if the program will be extended will depend on the funding of the study,"
Vermeersch.
Vermeersch, who has been representing the bank's interest in PBF in the country, noted that Rwanda is the
first country in the world to have the community PBF, adding that the initial program has been a great success.
20
Between 2006 and 2008, PBF in health centres led to a 23 percent increase in institutional delivery.
In the two years, there was also a 132 percent increase in preventive care visits for children aged between 24
and 59 months.
79
Kerala tackles nurse-recruitment racket
Gulfnews
17/09/2011
By Mahmood Saberi
Dubai: A senior official from the Indian state of Kerala has promised hassle-free staffing of nurses to the UAE
by taking measures to protect applicants from fraudulent recruitment agencies.
Kerala state minister of health, Adoor Prakash, met with senior health ministry officials in Dubai and discussed
the staffing requirements ahead of a memorandum of understanding (MOU) that will be signed in India next
week. The MOU will be signed on Tuesday during the visit of Minister of Labour Saqr Gobash Saeed Gobash to
India.
Global trend
UAE hospitals are facing a shortage of professional nurses and doctors amid an increase in the number of
health providers. The shortage reflects a worldwide trend as professionals age and retire, a senior Dubai Health
Authority official recently told Gulf News.
The Kerala ministry has set up a public sector recruitment facility to help put an end to problems many nurses
face on approaching private sector agencies. There have been cases of some nurses from Kerala who were
hired and forced into prostitution.
Prakash also held talks on the possible exchange of medical students.
Keralites constitute 60 per cent of the total Indian expatriate population of two million in the UAE. It was
reported earlier that the UAE has a plan to open a consulate in Kochi, the commercial capital of Kerala.
Prakash told Gulf News that he was grateful for the huge support from Indian doctors in the UAE. He was
speaking after the launch of a trust that will help provide treatment to patients in rural areas of Kerala state.
The trust is in the name of Dubai-based Dr K.P. Hussain, managing director of Fathima Healthcare group.
The doctor announced that he is donating 28 dialysis machines to Kerala which will help provide dialysis to
about 10,000 patients who can ill afford the twice-weekly procedure that is of critical importance.
10
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Asia & Pacific
1
Lack of health workers jeopardises infant survival rates
Hindustan Times
21/09/2011
Moushumi Das Gupta,
Children born in India are five times more likely to die before their fifth birthday because of lack of access to
trained health workers. India has a shortage of 2.6 million health workers, according to a new report released
by Save the Children, an international NGO on Tuesday. This falls way below the World Health Organization
health worker threshold of 2.3 health workers per 1000 people.
Madhya Pradesh tops the list with a shortage of 88 % health workers followed by Uttar Pradesh and Bihar at
87% and 82%.
According to the report, this shortfall means that close to 1.2 million children below the age of one die every
year in India from easily preventable diseases like pneumonia and diarrhea because of lack of access to a
trained health worker which includes doctors at primary health centres, auxiliary nurse midwives and
anganwadi workers.
“The report is cause for great concern as India has the highest number of children under 5 dying every year.
Health workers are the backbone of health care systems. Without them, millions of mothers and children have
little access to health care,” said Thomas Chandy, CEO, Save the Children. .
21
Globally there is a shortage of 3.5 million doctors, nurses, midwives and community health workers in the
world’s 49 poorest countries.
The report says that India has the highest number of children who do not receive even the most basic of
healthcare services amongst 25 developing countries. While over 55 per cent children under the age of two do
not receive comprehensive routine immunisation in India, another estimated 2.7 million children under the age
of five fail to receive treatment for diarrhea.
India along with Nigeria, Pakistan, China and Congo accounts for more than half of the world’s 3.3 million new
born deaths.
Among its other recommendations, the report has asked for an increase in per capita spending on health and
providing for additional health workers.
2
1 child in 11 dies before five years age
Pakistan Observer
21/09/2011
Islamabad—Save the Children in its report said that one child in 11 dies before the age of five in Pakistan and
half a million children die every year due to preventable causes. The report ‘No child out of reach’ which
launched on Tuesday claimed that the country is facing shortage of health staff as there is a health worker
shortage of 202,500. According to the report, the World Health Organization (WHO) has proclaimed that a
minimum number of 23 health workers per 10,000 people is required to deliver basic essential health services.
The report suggested increase in number of Lady Health Workers (LHWs) from 100,000 to 130,000 besides
increase the number of community midwives from 12,000 to 24,000 and identify women from areas where
there is little or no coverage of LHWs and train them as LHWs. It asked to ensure that community health
workers, including LHWs, carry out community case management of preventable causes of maternal, newborn
and child death, administration of vaccinations, assessment and response to malnutrition and family planning.
In a report, the provincial governments have been asked to prioritize the training and deployment of health
workers and include this in their provincial health plan and ensure that nutrition is given priority and included
as part of the provincial health plans. According to the report, Pakistan in recent years has achieved some
progress in reducing its maternal and infant mortality rates and suggested further efforts which are essential to
achieve Millennium Development Goals 4 and 5.
The current maternal mortality rate in Pakistan is 276 deaths per 100,000 live births with infant mortality rate
of 78 deaths for 1000 live births and under five mortality rate of 94 deaths. Save the Children’s experience in
Pakistan shows that it is possible to achieve improvements in household healthcare by ensuring coverage of
LHWs and giving them appropriate training, it added. Country Director, Save the Children in Pakistan David
Wright quotes, “It is simply not acceptable for a child in Pakistan, or anywhere else in the world, to die because
a midwife or a lady health visitor is out of reach.
3
Rural health care policy aims to let "barefoot doctors" have clinics
People’s Daily Online
22/09/2011
GUIYANG, Sept. 21 (Xinhua) -- Yu Bing, a 40-year-old village doctor in southwest China, is on call 24 hours a
day to provide anything from medical advice and treatment to conducting epidemic prevention checks in the
mountainous village of Shuichao.
"It isn't rare for me to be woken by patients at two or three in the morning," Yu said.
As the only doctor in the remote village in Hezhang County, Guizhou Province, Yu is constantly busy, but he
feels content when comparing his past job as a "barefoot doctor" with the present work in the village clinic.
Dr. Yu's office, a 60-square-meters cottage, is divided into a pharmacy, a diagnosis room and a therapeutic
room. It is also equipped with necessary medical instruments.
"My family used to dine, sleep and treat patients in the same cottage, and like all the other barefoot doctors, I
only had three medical instruments in the past: a sphygmomanometer, a stethoscope and a syringe," he said.
The barefoot doctor's cottage has been refurbished into a real clinic with the government's funding support for
improving the rural health care system.
Yu is one of more than 1 million village doctors providing basic medical services to nearly 700 million Chinese
farmers. A majority of them began their training as barefoot doctors.
Barefoot doctors acted as a part of an extensive health-care system promoted by late Chinese leader Mao
Zedong. The number of barefoot doctors was officially 1.46 million in 1980.
22
The name "barefoot doctor" came from their farmer-style appearance. Despite lack of professional training,
they provided the basic medical needs for China's huge rural population during the country's planned economy
era, when 90 percent of China's population enjoyed life-long, government-subsidized health care.
The system started to collapse in the early 1980s with the end of collective economy in rural areas, according
to Chen Xiwen, an expert on rural issues who serves as deputy director of the Leading Group on Rural Work of
the CPC Central Committee.
Farmers could not afford the surging medical expense as subsidies were cut and the user-pays system was
introduced. Rural medical facilities lost government financial supports and many had to close down. Thousands
of barefoot doctors lost their jobs.
As a result, rural China witnessed a vast shortage of doctors and medical facilities.
The Chinese government has been making efforts to improve health care services in rural areas through a new
program called "one clinic in each village" or "one village doctor for every 1,000 farmers," in line with a health
guideline released by the General Office of the State Council in July.
To improve village doctors' living conditions, the government has also planned to improve their subsidies and
income. A pension program is expected to be launched soon for that purpose, according to the guideline.
In addition, special funds have been established in many provinces and regions for the purchase of medical
instruments and providing professional training to village doctors.
"We farmers like village doctors because they are always there to help and are familiar to us," said Zhang
Zhihe, a farmer in Lishan Village, Nanchang County of eastern Jiangxi Province.
He said it would take him an hour to go to the township hospital if there was no village doctor.
Zhang Xingde has been practicing in Lishan Village for more than 40 years. However, the 63-year-old barefoot
doctor-turned clinic head can not figure out whether he is a private doctor or a doctor under the government
health system.
He recalled that he struggled to be an independent doctor in the village, even after the government gave up
the extensive health care system in 1980s. While in the early 1990s, village officials persuaded him to turn his
private clinic into the village clinic though the government did not invest a penny.
Zhang through his own conscientiously-driven initiatives took responsibility for providing health care and
epidemic control for the whole village.
"In the early 1970s and 1980s, many farmers volunteered to receive training to become barefoot doctors even
though medical facilities and funds were scarce. Doctors enjoyed relatively high social status," Zhang recalled.
Zhang's son Zhang Hua took after his father and gave up the opportunity to work in a city hospital and came
back to help his father in the village clinic, after he graduated from Jiangxi Medical College in 1988.
"With increasing government funding, the environment and facilities in many village clinics have begun to be
improved, and they would attract more medical students in the future," Zhang said hoping the younger
generations of village doctors would provide more professional medical care services to farmers than barefoot
doctors like him.
4
Afghanistan Midwives Are Key to Safe Deliveries for Afghani Women
ReliefWeb
20/09/2011
September 20, 2011 marks the one-year anniversary of Every Woman, Every Child, a global effort to achieve
country-led commitments to bring life-saving health care to millions of women and children in the developing
world by 2015. This series looks at maternal health in several countries with the highest number of maternal
deaths every year. UNFPA, UNICEF, WHO, the World Bank and UNAIDS – known as the Health 4+ -- are
supporting these countries to achieve their Global Strategy commitments.
KABUL, Afghanistan — Fereshta, 28, repositions herself slowly in her bed at Malalai Hospital, on the western
outskirts of Kabul. It is just a day after she has received surgery to repair an obstetric fistula, a childbirth
injury that left her incontinent after her first delivery ten years ago, when still just a teenager herself.
During the decade she lived with obstetric fistula, Fereshta gave birth to another six children. Only one
survived -- her daughter, now six years old.
Though crying moments earlier, as she recounted the years of isolation her injury caused, Fereshta stops
instantly when a doctor returns to check on her. But her reaction is one neither of relief nor celebration.
Instead, Fereshta stiffens, and with urgency in her voice asks when she will be able to go back home to
Jalalabad. "I don't want to lose my daughter, I need to see her."
23
Today, Fereshta has only one immediate concern. Her husband wishes to take another wife and have more
children – and he plans to exchange Fereshta’s daughter to pay for his new bride.
Fereshta had not sought medical treatment for her fistula until now, though she knew the treatment existed.
Her husband desired children, and a common misconception among many in this region is that the surgery
causes infertility.
Giving birth too young, too often and with too little time between pregnancies
Women’s subordinate status in the household remains as much of an obstacle to reducing maternal death and
injury in Afghanistan as geographic and conflict-related factors. Under pressure from the patriarchal society,
and without access to education and health care, women and girls like Fereshta and her daughter continue to
give birth too young, too often or with too little time between pregnancies. And when complications in
pregnancy do arise, cultural factors are among the reason they delay or are unable to seek care.
Afghan culture does not allow women to be treated by male doctors. During her first pregnancy, Fereshta went
to her mother’s house to deliver. Traditionally, Afghan women are also expected to conceal labour pain to their
families. When the pain became unbearable for Fereshta, and it was clear that she was not facing a normal
delivery, her family finally decided to bring her to the hospital. But by that time, it was too late – Fereshta
delivered in the car.
The child, which was in the difficult breech position, died before they reached hospital. Fereshta developed a
vesico vaginal fistula, a hole between the uterine wall and the bladder.
The challenges facing the Afghan health system are many – decades of conflict, cultural restrictions, poverty,
poor health education, gender inequity and a shortage of women health workers trained in midwifery all
prevent women from accessing health care. Just 14 to 24 per cent of all births are attended by skilled health
personnel (the different figures are from UN and government assessments, respectively).
It is no surprise, then, that women in Afghanistan face shocking rates of maternal death and injury. The
maternal mortality ratio is 1,400 deaths per 100,000 live births – more than four times the threshold of 300
per 100,000 live births that is generally considered ‘high’. The survival of newborns is equally tenuous: 5 out of
every 100 babies die during the first 28 days after birth.
Women, communities and policymakers forge consensus on the need to save more lives
Recently, however, there has been growing consensus in Afghanistan about the need to reduce maternal and
neonatal deaths. President Karzai included maternal, newborn and child health in his July 2010 address to the
Kabul Conference, which brought regional, international and national stakeholders in Afghanistan’s
development together to outline a roadmap forward. In September 2010, the Government of Afghanistan made
strong commitments to the Global Strategy for Women’s and Children’s Health including to:
·
Increase per capita health spending from $10.92 to $15 by 2020
·
Nearly double the midwifery workforce to increase skilled birth attendance to 75 per cent
·
Expand the proportion of women with access to emergency obstetric care, to 80 per cent
·
Strengthen health service outreach to communities
·
Increase the contraceptive prevalence rate from 15 per cent to 60 per cent
·
Expand immunization programs to cover 95 per cent of children
·
Mainstream international protocols for integrated management of childhood illness.
Since 2010, UNFPA and the International Confederation of Midwives have supported a midwifery training
programme in Afghanistan. In a society dominated by men and by a male doctor health system, the role of
these midwives is crucial for patient and care provider alike. The State of the World’s Midwifery 2011, report
released by UNFPA and partners in June 2011, found that Afghanistan needs almost 4,000 additional midwives
to attain 95 per cent skilled birth attendance by 2015.
Since January 2011, the Nursing and Midwifery Department of Ministry of Public Health has received technical
and financial support from UNFPA to develop the first National Policy and Strategy for Nursing and Midwifery
Services. The plan, approved in August, gives nurses and midwives a clear roadmap to achieve a healthier
Afghanistan for women and newborns. That same month, UNFPA’s Executive Director, Dr. Babatunde
Osotimehin, visited Afghanistan and announced additional support to raise funds for the development
Afghanistan’s health system.
Female midwives can enter doors that are closed to male doctors
Saleha Hamnawzada, 35, graduated from the Balkh Institute of Health Sciences in Afghanistan and is now the
Executive Director of the Afghanistan Midwifery Association (AMA). “In a country like Afghanistan where
women, especially in remote areas, can’t really access medical facilities because [they lack] women heath
workers, a midwife can save a woman’s life,” Saleha explains. “The midwife is the only one who can really
enter the family. She can talk with the husband and she can influence the family’s decisions.”
24
A mother of four children, Saleha faced her own uphill struggle to reach her current position. She practiced
midwifery for ten years in mobile health clinics in remote areas of Afghanistan, and later managed a
programme to train community midwives in Bamyan Province. Working in these areas, it became clear to
Saleha that cultural and gender norms are among the biggest challenges for Afghanistan today.
But she has seen examples of where this has been transformed to benefit pregnant women, mothers and
babies. She credits not only to the establishment of fully-equipped delivery rooms in remote areas, but also a
change in the general perception of a midwife in society.
Dreaming of, and working toward, a better future
“Today a midwife [who] graduates from a [community midwifery education] programme is a woman well
respected by the community,” Saleha says. “She can earn her own salary, and she represents a role model for
the future generation. A midwife is not only saving women and children’s lives, she is also bringing a huge
contribute to a more equal Afghanistan.”
Saleha Hamnawzada’s hope for the future of Afghanistan is to see a midwife leading the Ministry of Public
Health.
As for Fereshta, she hopes to have a healthy family and to keep her six-year-old daughter at home. It was her
husband’s decision to take another wife that finally pushed her to seek treatment for her fistula at the Malalai
Hospital Fistula Centre, supported by UNFPA. "Being able to have more children is my dream for the future.
After years of loneliness, I hope that this operation will help me to be part of the family again.
5
AMC still struggling to treat health workers stir
The Times of India
23/09/2011
AHMEDABAD: Though more than 1,000 malaria cases were registered in the city this month - and the toll now
stands at 15 deaths - Ahmedabad Municipal Corporation (AMC) is yet to resolve payment issues of the striking
health-link workers. And last month, two deaths occurred, one from dengue and the other from falciparum.
As for the workers, they are crucial cogs in the disease-control machinery. There are close to 1,400 link
workers employed with AMC. More than 200 link workers will gather outside AMC's central office building from
Friday to protest against low wages and stipends. Three of the workers have threatened an indefinite fast if
their demands are not met.
The kneejerk reaction from workers came when deputy municipal commissioner I K Patel sent a show-cause
notice, directing them to report for duty within 48 hours. The notice said that the workers would be heard only
after resuming duties. The workers are demanding that their salaries be raised to Rs 4,000 a month and perks
be commensurate with extra field duties.
However, a file moved by the health department has suggested only a Rs 400 rise in salaries along with some
marginal increase in perks. Akash Sarkar, the link workers union president, says that last year the state
government had given a raise of Rs 500 to every worker above the central government's stipend of Rs 1,000.
6
Kuwait to hire 660 nurses from PH
ABS-CBN News, Philippines
16/09/2011
KUWAIT – Hundreds of Filipino nurses are needed to fill in the vacancies in the public and private medical
facilities in Kuwait.
According to the Kuwaiti Ministry of Health (MOH), public hospitals and clinics are in need of 360 nurses.
However, the MOH will no longer recruit OFWs directly from manpower agencies in the Philippines.
One of the local Kuwaiti companies qualified to recruit Filipino nurses is the Medi-tech Global Technologies for
Medical Supplies and Services.
“We are one of them, Global Technologies, one of the companies qualified to recruit nurses from the Philippines
to the Ministry of Health,” said Dr. Shadya Kamal Hakeem.
The recruitment for Pinoy nurses will continue until the end of this year.
“We start issuing visas and send it to [the] Philippines so they can join us,” he said.
Although Kuwait is serious in implementing its Kuwaitization, it admits that there is still a shortage of nurses.
“Actually, the Ministry of Health, they have a great shortage of nurses and they will continue to hire more
nurses either from the Philippines or other countries,” said Abbas Yousef al Baghli, general manager of the AlBahar Medical Service.
25
Labor Attache David Des Dicang said officials and human resources directors always say that the hiring for
nurses will increase.
“Lagi sinasabi ng mga managers and HR directors, the hiring will still increase, kukuha sila nang kukuha ng
mga Pinoy. We don’t see any adverse effect on the employment sa tinatawag nating Kuwaitization,” said
Dicang.
MOH nurses will receive 600 Kuwaiti dinars or equivalent to P91,000 monthly salary, free accommodation and
transportation.
Meanwhile, aside from nurses bound for government hospitals, another 300 Pinoy nurses are needed by
private hospitals and clinics.
“Next month, we will recruit for private hospitals and private clinics 300 nurses. Prepare all your documents. All
your documents should be attested by the embassy and submit it to our agency in the Philippines,” said Dr.
Hakeem.
9
Competence of overseas GPs 'puts standards' in danger
The Australian
23/09/2011
THE competence of thousands of overseas-trained GPs has been questioned by a demographic expert, who
claims Australia's health workforce policy is founded on a false premise and standards are in jeopardy as a
result.
Monash University sociologist Bob Birrell says that far from having a shortage of GPs -- the belief of state and
federal governments for the past decade -- Australia is instead "awash with doctors wishing to become GPs",
many of whom are from non-English-speaking countries.
Yet Dr Birrell says official policies continue to encourage their recruitment, creating a "powder-keg situation"
given that many are failing fellowship exams for the national GP college but are still allowed to keep working
and "will not leave without a struggle".
In a paper to be released today, Dr Birrell says overseas-trained doctors brought in on temporary visas face
minimal testing of their skills, raising doubts about their suitability for Australian practice.
Area-of-need provisions allow them to find work more easily in rural areas but once there, they face weaker
supervision rules than home-grown trainees.
Dr Birrell told The Australian the situation was "a problem" because there were "thousands of international
medical graduates (IMGs) now in Australia -- many of them have bet their futures, and have brought their
families here in the hope of finding medical employment, but are really going to struggle (to find work)".
"All this is happening when these recruitment measures we put in place (have created a) compromise in
standards of clinical skills for these people, which could only be justified if there were a serious medical
shortage," he said.
Dr Birrell, the foundation director of the Centre for Population and Urban Research, said the preferential
arrangements encouraging the recruitment of doctors from overseas no longer made sense, because data
supplied by the Primary Health Care Research and Information Service showed most parts of Australia,
including rural areas, were "now well below" 1500 people per GP, used by the Royal Australian College of
General Practitioners as an acceptable ratio.
RACGP vice-president and Sydney GP Liz Marles agreed government policies designed to address the workforce
shortage had "allowed people to work with a lower level of qualifications", but insisted evidence showed the
shortage persisted.
"We only have to ask a member of the public, who tries to get an appointment to see their GP, whether there's
an oversupply -- they will tell you there isn't," Dr Marles said. "We have a number of GPs with closed books,
and most metropolitan practices will tell you they don't get any applications when vacancies are advertised."
A spokesman for acting Minister for Health and Ageing Mark Butler said claims there were too many GPs "will
come as perplexing news to the many parts of regional Australia where patients find it hard to find a doctor".
10
Back to top
North America
1
26
Poorest countries investing more as UN states meet pledge for maternal, child health
Associated Press
21/09/2011
Story carried by Washington Post
UNITED NATIONS — Bangladesh, Ethiopia, Nepal and some of the world’s other poorest countries delivered not
only money but new services in the year since U.N. member states pledged more than $40 billion to save the
lives of mothers and children, a new study of the spending said Tuesday.
The spending report was released at a high-level event chaired by U.N. Secretary-General Ban Ki-moon, who
has made raising money for the health of mothers and their children a special project.
Ban told a gathering at U.N. headquarters that when he was born in 1944 in South Korea, child mortality was
so prevalent that families often waited months to register births to make certain babies would survive. The
secretary-general noted that his official birth date of June 13 is several months after his actual birth.
“In our time, it is wrong to allow women and children to die when we have the tools to save them,” Ban said of
the maternal and child health initiative. “I am happy to say that one year later we are delivering.”
Norwegian Prime Minister Jens Stoltenberg told the gathering that in the past year “600,000 more children
survived to grow up and go to school,” and an additional 70,000 mothers survived childbirth. “But too many
mothers and children are still dying from preventable causes,” he said.
Dr. Julio Frenk, chairman of the World Health Organization’s Partnership for Maternal, Newborn and Child
Health, said in an earlier interview that he was especially pleased that some poorer nations are assuming more
financial responsibility for their development needs.
Frenk, who is also dean of the Harvard School of Public Health and a former health secretary of Mexico, said
those countries are “moving away from the paternalistic to a framework for shared accountability.”
Frenk said that close to $45 billion has been committed to the U.N. initiative known as Every Woman Every
Child, passing the initial pledges of $40 billion made a year ago. That includes about $11 billion from the
world’s poorer countries, and $13.7 billion from high income governments including the United States, Britain,
Canada and Norway.
“I am delighted by the progress since last year,” said pediatrician Dr. Flavia Bustreo, WHO assistant directorgeneral for family, women’s and children’s health. She added that commitments have included not only money,
but changes in policy and delivery of services.
Bustreo said more is still needed to treat severe infections in newborns and increase postnatal visits by
mothers and babies. Up to 1 million more “front-line” health workers, especially midwives, are needed to care
for mothers and their babies around the world, she added.
The report shows that Bangladesh and many of the other poorer countries that made pledges last year set
aside more funds for better health care of mothers and small children within their borders as they take more
responsibility for their own development.
As for policy changes, Bangladesh said it would train 3,000 midwives and double the percentage of births in
the country attended by a skilled health worker. Nepal began training 10,000 more skilled birth attendants.
Frenk said the collective effort is critical to meeting the U.N.’s global goal of saving the lives of 16 million
mothers and children by 2015.
Worldwide every year, an estimated 8 million children die before reaching their 5th birthday, and about
350,000 women die during pregnancy or childbirth.
In 2000, the U.N. set “Millennium Development Goals” that included reducing child mortality by two-thirds and
maternal mortality by three quarters by 2015. The goals also included cutting extreme poverty by half,
ensuring universal primary education, halting and reversing the HIV/AIDS pandemic.
On the eve of the Tuesday launch, the Secretary-General praised private companies for raising more than $1.1
billion for the initiative.
The companies include Johnson & Johnson, which is embarking on a four-year partnership with the World
Health Organization, other U.N. agencies and the World Bank to strengthen training for health workers in
Tanzania and Ethiopia.
“Every Woman Every Child has shown what can be achieved through close cooperation between the U.N.,
governments, and the private sector,” Ban said.
Another example of such cooperation is the GAVI Matching Fund for Immunization, a new private-public
initiative in which Britain’s Department for International Development and the Bill & Melinda Gates Foundation
match private sector contributions to deliver critical vaccines to the world’s poorest nations.
Copyright 2011 The Associated Press. All rights reserved
27
2
Nurse Practitioners Can Help Offset Shortfall in Primary Care Physicians
US News & World Report
19/09/2011
By Catherine Groux
As healthcare reforms give more Americans access to medical insurance, the industry needs more primary care
physicians to deal with the influx in patients. According to the Association of American Medical Colleges, by
2020 the nation will face a shortage of approximately 45,400 primary care physicians, as well as a deficit of
46,000 surgeons and medical specialists. While such a vast shortage could affect all Americans, the association
expects that underserved and vulnerable populations, such as individuals who live in rural or inner-city areas,
will suffer the most.
In order to deal with this potentially harmful shortage, many medical professionals feel it will be important to
train more nurses to become nurse practitioners. Recently, Courtney Lyder, dean of the University of California
- Los Angeles School of Nursing, expressed this opinion in a press release.
“Today’s shortage of primary care physicians will only be exacerbated unless we look to nurses and nurse
practitioners to fill the gaps in providing needed care," Lyder said in a statement.
The U.S. Bureau of Labor Statistics (BLS) notes that nurse practitioners are a type of advanced practice nurse
who are qualified to perform many of the same tasks as physicians. These healthcare professionals can
specialize in areas such as acute care, women's health, family practice and geriatrics, and must hold a master's
degree in nursing.
The BLS states that registered nurses, including nurse practitioners, are the largest healthcare occupation,
employing about 2.6 million people in 2008. Still, Lyder does not believe that most people understand just how
important these professionals are to the healthcare industry. Today, the roles of nurses and nurse practitioners
are changing, she said. These individuals are qualified to complete many more tasks and are often responsible
for implementing healthcare reforms and spearheading research.
Individuals who want to earn a master's degree in nursing have many options at schools across the country.
For example, last month, Texas' Wayland Baptist University announced the launch of an online Master of
Science in Nursing degree program, according to a press release. The course of study will begin this fall and
can be completed in 18 months. Additionally, since the program utilizes online education, officials from the
school said it can provide flexibility for students who work full time.
3
South Africa maternal and infant healthcare record criticized
Los Angeles Times
16/09/2011
By Robyn Dixon
Reporting from Johannesburg, South Africa — Bridget Moleboheng woke up at 5:45 a.m. in the hospital
operating room. Gradually her senses returned. A splitting headache. An oxygen tube in her mouth and
medical equipment attached to her body. But all of it was turned off.
"A nurse came in and said it was a miracle I was still alive."
When Moleboheng arrived to give birth the day after Christmas last year, she says, the doctors and midwives
at Sebokeng Hospital near Johannesburg told her she was behaving like an arrogant white "madam" by asking
too many questions and refusing to have a caesarean section because they wouldn't let her read the consent
form.
Moleboheng, who is black, alleges that she was left to handle a difficult breech delivery without help. She says
her baby boy was born blue, and that she had to be resuscitated after being left sitting in a pool of blood
unattended by doctors for three hours.
"I gave birth like an animal," Moleboheng said. "Their attitude to patients is very bad. But not many people
have the guts to come out and say what happened to them."
Despite boasting sub-Saharan Africa's wealthiest economy and some of the world's richest mineral resources,
South Africa has an abysmal record on maternal and infant health. About 4,500 women die giving birth each
year. The rate of such deaths has quadrupled since1998, to 625 per 100,000 live births, leaving South Africa
worse off than much poorer African countries such as Swaziland, Uganda, Ghana, Cameroon, Togo, Burkina
Faso and Mauritania.
Part of the increase is the result of South Africa's high incidence of AIDS, according to a recent report by
Human Rights Watch. But countries such as Botswana and Swaziland, with similar HIV infection rates, have
much lower maternal and infant mortality.
28
Nearly 90% of South African women give birth at medical facilities, one of the best rates on the continent. Yet
much of the maternal mortality problem is caused by poor healthcare: untrained and corrupt hospital staff
members, some of whom demand bribes before they will attend women in labor; doctor shortages; and lack of
accountability, the Human Rights Watch report says.
Women were pinched, slapped and accused of lying and in one case stabbed in the thigh with scissors while in
labor, according to the report. It documented many cases in which staff members failed to attend to women
giving birth or demanded bribes before they would offer care.
Birthing staff members interviewed by Human Rights Watch explained the slaps and pinches and other assaults
as ways to make women open their legs during birth.
"There's no excuse for abusing patients," said Liesl Gerntholtz of the rights group's Johannesburg office. "Poor
training is not an excuse for slapping patients or abusing patients or leaving women unattended for hours and
hours."
Moleboheng is suing Sebokeng Hospital for negligence. About 1,600 doctors in the public health system are
being sued, and in Gauteng, which includes Johannesburg and is the most populous state, the Health
Department paid out $88 million last year because of medical malpractice suits, putting a strain on the health
budget.
"You wonder, because so many black people were fighting for empowerment," said Moleboheng, referring to
the black struggle against the repressive apartheid system of white-minority rule. "Now we've got it, we're
abusing each other."
Another reason for South Africa's poor performance on maternal health is the legacy of apartheid, in particular
its corrosive effect on education, impairing both the quantity of trained midwives and their quality and attitude,
said Robert Pattinson of the South African Medical Research Council. In Gauteng, the number of midwives is
50% lower than the World Health Organization standard.
"Undoubtedly, there's a very severe health staff shortage," he said. "There's a problem with the caring
attitude. A lot of that will be explained by burnout of people just having too much work to do."
The hospital has conducted an internal inquiry on Moleboheng's claims, but a hospital spokesman said there
was no comment on the allegations.
A spokesman for the Gauteng health department, Simon Zwane, didn't confirm the details of the case, but said
the incident was "really regrettable."
"It's not representative. That kind of thing is not really widespread," he said. "There are isolated incidents that
happen here and there from time to time." But he announced in early August that the health department was
setting up a team to ensure improvements in service to patients.
Moleboheng says that when she arrived at the hospital entrance at 11 a.m., a doctor was yelling at a weeping
female patient, and Moleboheng's husband and sister were barred from coming in.
She says she waited seven hours to see a doctor. At 6 p.m., he examined her and prescribed pills but
explained nothing.
"Nobody explained anything," she said. "They don't explain and they get upset if you ask. It's like you know
too much."
4
A South-South Cooperation
Global Post
16/09/2011
John Donnelly
Haja Zainab Bangura, Sierra Leone's Health and Sanitation Minister, today is 4,600 miles away from home.
She’s in the middle of negotiations in Havana, Cuba, and she’s trying to seal a deal for something precious for
her country: Doctors.
Bangura isn’t stopping there. She has traveled to several countries or talked to counterparts in other ministries
of health to find more doctors and nurses. Her ports of call are not what you’d expect:
Cuba. South Africa. Nigeria. Even north Sudan.
“This is truly South-South cooperation,” Bangura said in an interview in a Washington-area hotel just before
her trip to Cuba. “Developing countries are helping us out.”
South Africa has given Sierra Leone $3 million to pay for 32 Cuban doctor specialists to work in the West
African country. Nigeria has sent 50 doctors, nurses, and midwives. Sudan is thinking about sending doctors.
29
Kuwait contributed $15 million to help upgrade three hospitals – improvements that will assist doctors and
nurses do their jobs.
While UK’s Department for International Development, UN organizations such as UNICEF, the World Bank, and,
to a lesser degree, the US Agency for International Development, all remain the country’s major donors,
developing countries are starting to give substantial sums to Sierra Leone.
“We have a huge problem with our shortage of skilled health workers,” Bangura said. “These countries are
willing to help us out."
Nearly a year and a half ago, Sierra Leone started its ambitious free health care initiative for pregnant women,
mothers who are breast feeding, and children under the age of five. The new program has increased some
hospital services by three-fold, including malaria drugs for children, showing that the most basic hurdle in
health care was that people were too poor to access services.
But free health care also has badly strained the country’s health care system, most notably exposing the
country’s lack of specialist physicians. The country of 6 million people has six gynecologists, for instance, and
only two pediatricians working for the government.
Rosann Wisman, director of the Ministerial Leadership Initiative for Global Health, a non-government group
that helps support health ministries in five countries, including Sierra Leone, said Bangura’s mission reflects
both the increased cooperation among developing countries but also the complexities of dealing with health
worker migration.
“Developing countries are helping one another because they understand the needs of one another,” Wisman
said. “On health workers, part of the issue is that major donor countries are the destination for a lot of the
health workers. Sierra Leone health workers are going to the UK, or going to the US, so it’s a very complicated
relationship. You have donor countries on the one hand providing support to help train their health workers and
at the same time they are making it very attractive for those very same health workers to migrate to that
donor country.”
Bangura is on a two-week trip out of Sierra Leone. She arrived in New York City last week. She and Sierra
Leone’s First Lady, Sia Nyama Koroma, attended a two-day high-level meeting at the UN Headquarters. The
meeting, sponsored by the UNFPA, was held to highlight the importance of reproductive health commodity
supplies, including contraceptives and medicines for safe maternal health and childbirth.
After her Cuba trip, the health minister will return to New York this weekend and attend next week’s UN
meeting on non-communicable diseases.
For Bangura, the meetings will be important. But securing the doctors in Havana today is even more critical.
“We need to get them to Sierra Leone – fast,” she said. “We need them by the end of the year at least. We
have these huge shortages of doctors, so we don’t have time to waste.”
59
Demand high but medical specialists not finding work in Canada
National Post, CA
19/09/2011
Tom Blackwell
The queues are shorter than they once were, but cancer patients in Canada can still wait close to a month to
see a radiation oncologist and weeks more to start treatment.
As newly trained doctors in the specialty have hit the job market in the last year or two, however, they have
faced an almost bizarre quandary; most cannot find work in a field that seems to urgently need them.
The oncologists are not alone. Medical organizations say physicians in a half-dozen or more specialties are
facing unemployment or underemployment, despite the country’s continuing shortage of doctors and long wait
lists for many medical services.
“It’s really frustrating,” said Dr. Shaun Loewen, 36, who recently finished his five-year residency in radiation
oncology. “I want to start working and treating patients. That’s what the public has paid me to do and that’s
what I want to do.… Unfortunatley, if I can’t find those opportunities in Canada, I’ll have to look elsewhere.”
Some of those stymied in their job search are trained in areas — like oncology and orthopedic surgery — where
governments have invested hundreds of millions of dollars in recent years to expand services and reduce
patient delays.
But while provincial governments have paid to train more specialists in those high-demand areas, hospitals and
health regions often lack the money to hire them once they hit the job market, experts say.
Others argue there is a disconnect between the divvying up at medical schools of specialty training positions,
called residencies, and the real-world patient demand for the graduates’ various services.
30
The Royal College of Physicians and Surgeons — which oversees and sets standards for medical specialties —
has already catalogued a list of high-unemployment specialties. It includes not only oncology and orthopedics
but cardiac surgery, nephrology, neurosurgery, plastic surgery, otolaryngology — the ear, nose and throat field
— and public health and preventive medicine.
“We thought, ‘Wow, this is a really surprising list,’ ” said Danielle Fréchette, the college’s health-policy director.
“It’s paradoxical to have ongoing issues with wait times and cancelled surgeries — and able-and-willing bodies
to meet those unmet needs (who can’t find work).”
The Royal College is currently surveying recently graduated residents on the issue and has so far discovered
that one in five have failed to find full-time work, prompting them to take locums — temporary fill-in jobs for
absent doctors — work part time, or return for further, sub-specialty training.
Half the 1,500 respondents to a recent survey by the residents’ association reported they were moderately to
extremely concerned about finding work, said Dr. Adam Kaufman, president of the Canadian Association of
Interns and Residents. The group has even started a program, Transition into Practice Service (TIPS) to help
get positions for newly trained specialists.
Of 35 doctors who recently completed training in radiation oncology, only a handful have found jobs in Canada
and three have already left for the United States, said Dr. Loewen.
During a typical TIPS session at Queen’s University in Kingston, Ont., one pathology trainee said he had
already been told there would be no positions in the province when he finished next year, said Bryan MacLean,
a project manager with the program.
Yet a national shortage of pathologists, resulting in heavy caseloads, is often blamed for the slew of scandals
that have cropped up in recent years over mistakes in cancer diagnoses and child-death investigations.
In another province, a health minister actually told a meeting of student doctors last year “when you finish
your training, don’t expect there to be a job,” said Mr. MacLean.
It is expected that most of the jobless doctors will get work eventually, but the delay could mean a year or two
of not applying highly-sophisticated abilities, though numerous studies have shown that the competency of
surgeons, especially, improves as they perform more of a particular procedure.
“If you’re not practising once you’ve been taught, your skills get a little rusty,” said Dr. Geoff Johnston, an
orthopedic surgeon in Saskatoon and a spokesman for his specialty’s national association. “It’s important that
one can promptly employ these people.”
While the situation varies from region to region and specialty to specialty, there is relatively little debate that
Canada needs more doctors. In 2008, it ranked 26th of 32 Organization for Economic Cooperation and
Development (OECD) countries on that front, with 2.3 physicians per 1,000 population, compared to the
average of 3.2, and 2.4 in the U.S.
In response to outcry over long wait lists, provinces have in recent years significantly boosted medical school
enrollment and the number of on-the-job training positions: two-year family-medicine residencies and fiveyear residencies in a specialty.
Once trained, family doctors and many other “primary-care” physicians, like pediatricians or psychiatrists, can
simply hang out a shingle and start billing for their services. Surgeons and others who require expensive
infrastructure like operating rooms to do their jobs, are often hired by hospitals or health regions. A cardiac
surgeon, for instance, costs a hospital $1.5 million a year, though the doctor’s income is only part of that, said
Ms. Frechette.
Physicians say the job market has been tightened in part because the expected wave of retirements has yet to
materialize, with many older doctors deciding to keep working after investment losses.
Sometimes, as well, the jobs are out there, but might require a new specialist to relocate across the country,
not always easy if they have working spouses and children, said Mr. MacLean.
Yet in areas where demand for doctors is still high, budget-constrained health institutions are often not hiring
the additional specialists recently churned out, medical leaders say.
“I don’t think there was downstream planning as to ‘How do we accommodate them once they’re finished?’ ”
said Dr. Johnson
The problems can also be traced back to medical schools, where there is scant science behind deciding how
many positions to allot to each field, said Dr. John Haggie, president of the Canadian Medical Association.
“We don’t know as a nation or a province or a jurisdiction what kind of physician population … we actually need
going forward,” he said. “As a result, people often take a fairly opportunistic, almost random career path, and
end up with skills that are fairly focused and difficult to accommodate where they want to be.”
31
Successfully predicting needs is not necessarily easy, given the five-year lag before a medical-school graduate
finishes specialty training. Ms. Fréchette said the Royal College is hoping to gather data that will contribute to
better planning in future and avoid “knee-jerk” decisions on training doctors.
In the meantime, some worry about a medical exodus like that seen in the 1990s. Even Dr. Loewen, who
wants nothing more than to work in Canada, said he may have to consider relocating to the U.S. soon.
“If recent graduates take more than a year or two to find a position in Canada, they may go to the States. If
they do go to the States, history tells us that they are not likely to come back,” said Dr. Parliament. “I would
find that to be a real shame.”
National Post
tblackwell@nationalpost.com
Physician facts
•Cost to train a family doctor in Ontario during a two-year residency: $186,000
•Cost to train a specialist during five-year residency: $514,000
•Annual salary for doctors during residency: $50,000 – $80,000
•Number of radiation oncologists who finished training in 2009 or 2010, responded to a recent survey and have
not found full-time positions: 22 out of 31
Sources: Ontario Health Ministry; Canadian Association of Interns and Residents; Loewen et al. presentation to
Canadian Association of Radiation Oncologists conference
10
Midwives push childbirth as campaign issue
The Toronto Star
21/09/2011
Andrea Gordon
Two of Ontario’s three major political parties have promised to deliver the province’s first birth centres,
according to a campaign survey by the Association of Ontario Midwives.
In the survey, to be released Thursday and obtained by the Star, both the Liberals and New Democrats say
they support the notion of freestanding birth centres. The centres would be run by midwives and give women
who have low-risk pregnancies the option of delivering babies in a more natural setting away from hospitals.
The NDP pledged outright to fund pilot projects, in response to questions posed by midwives on where the
parties stand.
The Liberals responded that they “support piloting birth centres in Ontario and are open to exploring the
possibilities for this model.”
The Conservatives did not answer repeated requests to participate, president Katrina Kilroy said Tuesday.
Midwives have long argued that birth centres would promote normal childbirth for mothers who don’t need
high-tech medical care, and reduce the climbing rates of medical interventions such as Caesarean sections,
now at an all-time high. Many women’s health advocates argue that with budgets under pressure, this would
leave hospitals with more resources for those expectant moms who require medical support.
Birth centres would also give more families access to midwifery care; demand is so high that 40 per cent of
women seeking a midwife can’t get one.
Midwives are not permitted to practice unless they have hospital privileges, which means those working in a
birth centre could move patients in labour there quickly if medical care is needed.
The NDP and Liberals also pledged to boost the pay of Ontario midwives, who argue they are significantly
underpaid relative to other health care providers. An independent report conducted for the Ministry of Health
last spring called for a pay increase to bring them into line, but the Liberal government did not respond.
The campaign pledges aren’t the first promises midwives have heard from politicians, so Kilroy is urging
mothers to speak out and keep maternal and newborn health on the radar. A commitment to birth centres
dates back to the early 1990s, but the plans never materialized.
“Women and families in Ontario care about these issues,” said Kilroy. “We’ve seen enough babies being kissed.
Now we’d like to see some action.”
The shortage of midwifery services is a key women’s health issue, says Karen Green, a founder of the Twitter
hashtag #momthevote, launched during last spring’s federal election to provoke discussion and galvanize
voters.
She said the subject was tweeted about regularly, even though midwives’ services are provincially funded.
32
“I think it will definitely gain momentum in this campaign,” said Green, a writer who lives in Chatham and
delivered her two children with a midwife.
“It’s an issue for all mothers. If we’re not the ones pushing for better access and women’s health care, who’s
going to do it?”
With the midwifery system already in place, getting a pilot birth centre up and running would only require a
minimum capital investment for the space, says Kilroy, who has estimated a cost of less than $10 million for
one or two centres.
Currently Quebec is the only province operating a network of birth centres, with a dozen in place and more
under development. Next month, Manitoba is expected to open its first, in Winnipeg.
Back to top
Europe
1
350 million children will never see a health worker – report
Reuters AlertNet
19/09/2011
By Dongwei Liu
LONDON (AlertNet) – At least 350 million children worldwide will live their whole lives without ever seeing a
health worker, resulting in millions of deaths each year from easily preventable diseases, a global children’s
charity said on Monday.
In Africa, where people shoulder a quarter of the planet’s disease burden, children have access to just 3
percent of the world’s health workers, Save the Children said in a report that highlighted a shortfall of 3.5
million health workers worldwide.
“It is simply not acceptable for a child to die because a midwife or a nurse is out of reach,” Patrick Watt,
director of policy and research at Save the Children, said in a statement.
“Training health workers is simple and inexpensive, yet their impact is immeasurable. Hundreds of children’s
lives will be saved by the vaccinations a health worker administers, or by the trained help they can give to
pregnant mothers.”
The World Health Organization considers a ratio of 2.3 health workers per 1,000 people to be the minimum
acceptable threshold.
In countries below that threshold, such as Nigeria, Ethiopia and Liberia, children are five times more likely to
die before their fifth birthday than children elsewhere, Save the Children said.
The report, “No Child out of Reach”, comes as world leaders gather at the United Nations in New York for a
two-day summit on tackling non-communicable diseases, where aid agencies will be pushing for more funding
to train health workers.
Under the U.N. Millennium Development Goals (MDGs), global leaders are committed to reducing the underfive mortality rate by two-thirds by 2015.
Save the Children said the few countries on track to achieve that goal – such as Bangladesh and Nepal – had
slashed infant mortality by investing in community health workers.
The highest child mortality rates globally are in sub-Sahara Africa, where one in seven children die before the
age of five, according to the United Nations. The area accounted for half of the 8.8 million deaths of children
under five worldwide in 2008.
Earlier this month, Save the Children released an index of the world’s worst places for a child to fall sick, which
ranked Chad, Somalia, Laos and Ethiopia as the most dangerous and Switzerland, Finland, Ireland and Norway
as the safest.
Save the Children cites a number of underlying causes for the global health worker crisis, including lack of
education in developing countries; “brain drain” of skilled health workers; ineffective funding and chronic
under-investment in health from both rich and poor countries.
In rapidly developing countries such as China, which ranks in the middle of Save the Children’s index, the
charity noted a big difference between urban and rural areas.
“Trained health workers and advanced equipment are easily accessible in big cities,” said Qian Xiaofeng, Save
the Children’s communications manager in China. “Yet in rural areas, theseresources are quite slim.”
Click
here to see more videos on Save the Children's health work in India and Nigeria.
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2
Child death rates not falling fast enough, says report
The Guardian, UK
16/09/2011
Liz Ford
About 12,000 fewer children under five are dying every day than in 1990, according to the latest estimates on
worldwide child mortality rates published this week.
The levels and trends report, published on Thursday by the UN Inter-agency Group for Child Mortality
Estimation (IGME), which is led by Unicef and the World Health Organisation, finds that over the past two
decades, the number of children under five dying each year fell from more than 12 million in 1990 to 7.6
million in 2010.
Sub-Saharan Africa remains the region with the world's highest child mortality, but the annual rate of decline
has doubled from 1.2% between 1990 and 2000 to 2.4% in the following 10 years, to 2010. But one in eight
children still does not make their fifth birthday, more than 17 times the average for developed regions – 1 in
143 – according to the IGME. The region with the second-highest death rate is southern Asia – 1 in 15 – which
it defines as Afghanistan, Bangladesh, Bhutan, India, Iran, Maldives, Nepal, Pakistan and Sri Lanka.
However, the overall pace of progress on child mortality is still not fast enough to meet the millennium
development goal, which seeks a two-thirds reduction in deaths by 2015.
The IGME report says that improved access to healthcare services, particularly for pregnant women and
newborn babies, better nutrition and more widespread coverage of immunisation programmes had all
contributed to the decrease in death rates.
Niger was hailed for making great strides in reducing child mortality rates, having cut child mortality from 311
per 1,000 live births in 1990 to 143 by 2010. It was one of five countries with the largest absolute reductions
in death of children under five – the other countries were Malawi, Liberia, Sierra Leone and Timor-Leste.
Community health workers – people who have been trained to give basic medical care in their villages, where
there are few highly educated health professionals – helped to improve the figures. All five countries had child
mortality rates of less than 100 deaths per 1,000 live births.
Somalia was found to have the highest under-five mortality rate: 180 per 1,000 live births last year. While
more than two decades of conflict and recurring drought have taken their toll,, mortality rates there are likely
to get worse since famine was declared in six regions over the past three months. One in five children died
before their fifth birthday even before the current crisis, says Unicef. In 2010, fewer than a third of one-yearolds were immunised against potentially child-killing diseases, more than 70% of the population lacked access
to safe water, and only three out of 10 children of primary school age were enrolled in school, according to
Unicef.
Among more developed countries, Russia, Albania, Romania and Ukraine still have child mortality rates that
exceed 10 deaths per 1,000 live births.
The IGME report also found that neonatal mortality rates – the number of babies who die within their first 28
days – had not declined as fast as child mortality (the under-fives). Globally, the neonatal death rate had fallen
from 32 deaths per 1,000 live births in 1990 to 23 by 2010 – an average reduction of 1.7% a year, compared
with 2.2% for under-five death rates.
The report says that to address the issue of the slsower reduction in neonatal mortality rate, "systematic action
is required by governments and partners to reach women and babies with effective care", such as early postnatal home visits. "Care at birth brings a triple return on investment, preventing stillbirths and saving mothers
and newborns," the report says.
Anthony Lake, the executive director of Unicef, said: "The news that the rate of child mortality in sub-Saharan
Africa is declining twice as fast as it was a decade ago shows that we can make progress even in the poorest
places, but we cannot for a moment forget the chilling fact of around 21,000 children dying every day from
preventable causes."
He added: "Focusing greater investment on the most disadvantaged communities will help us save more
children's lives, more quickly and more cost effectively."
The data in the report is largely drawn from household surveys conducted in developing countries. Accurate
figures are difficult to collect in countries that do not have fully functioning systems to register births and
deaths.
3
GMC says more support needed for overseas doctors in UK
BBC News, UK
16/09/2011
34
By Adam Brimelow
Health Correspondent, BBC News
The General Medical Council says some overseas doctors come to the NHS with "little or no preparation" for
working in the UK.
It says those trained under different cultural and professional standards need more support.
The GMC is planning a basic induction programme for all doctors to help them understand how healthcare is
practised in the UK.
Doctors' representatives say the scheme will help to protect patients.
More than one in three doctors registered in the UK qualified abroad. The GMC says the NHS has relied heavily
on their skills and dedication, and could not have kept going without them.
But it says they need better support in order to practise safely. The recommendation for an induction
programme comes in its first State of Medical Education and Practice report.
This presents a profile of the medical profession and outlines challenges for the future.
It says last year there were 239,270 doctors on the medical register. Just over 150,000 qualified in the UK, a
further 23,000 trained initially in the European Economic Area (EEA), and 66,000 completed their medical
undergraduate education overseas.
Cultural attitudes
Drawing on a wide range of data including doctors' surveys and patients' complaints, the report concludes that
many overseas doctors have problems adjusting to a different cultural, ethical and professional environment in
the UK. The GMC says these differences become particularly important in handling the doctor-patient
relationship.
The report also says doctors should have specific advice about what will be expected of them, how the health
service works and how they will be regulated. It recommends training in communication skills to help them
handle sensitive situations and avoid misunderstandings:
"While there are some good local schemes for supporting doctors who are new to this country, there are too
many examples of new doctors undertaking clinical practice with little or no preparation for working in the UK.
There have also been accounts of locum doctors being sent to undertake duties for which they have not been
appropriately trained."
The GMC restates its worry that it is prevented under European law from providing language checks on doctors
from the EEA. This became a central concern in the case of Dr Daniel Ubani, an out-of-hours doctor from
Germany who killed a patient, David Gray, with an overdose of a painkiller.
The report confirms that the GMC is working with the UK government to change this restriction.
The GMC's chief executive, Niall Dickson, said the regulator was preparing an induction scheme with doctors'
employers and professional bodies:
"Developing an induction programme for all doctors new to our register will give them the support they need to
practise safely and to conform to UK standards. This will provide greater assurance to patients that the doctor
treating them is ready to start work on day one."
Protection for patients
Dr Tom Dolphin from the British Medical Association's Junior Doctor Committee welcomed the move.
"Being a doctor in the UK requires much more that just clinical expertise. It is also important to have highly
developed communications skills, knowledge of UK medical ethics and culture, and an understanding of how
the NHS works.
"The development of an induction course which helps doctors coming from overseas would do much to help
them as they make the difficult transition to practise medicine in another country."
The President of the Royal College of Surgeons, Prof Norman Williams, also gave his support: "Guiding doctors
who are new to the UK on how to practise within our professional, language, ethical and legal boundaries is a
positive role for the General Medical Council to take on and one the Royal College of Surgeons would strongly
endorse.
"We want to see any potential problems headed off before situations develop that might harm patients."
Experiences of three foreign doctors
 "In my country, the doctor is a kind of king who can do everything that he wants to, so there were no
actual dilemmas because I was brought up in a way that whatever was decided was the right thing."
 "The whole approach of explaining every aspect of treatment and giving the patient the option to
actually make her own decisions, it was something totally new to me."
35

"I have come to know that that the important things in the UK which I didn't really take seriously is
confidentiality which is different… in our culture, confidentiality is important but in the UK it is very,
very important
4
Health unions demand pay rise for NHS staff in 2013
The Guardian, UK
20/09/2011
Denis Campbell
Health unions representing 1.47 million NHS staff have challenged the government's clampdown on public
sector pay by demanding salary increases once the current earnings freeze ends in 2013.
In a submission to the NHS pay review body (NHSPRB) union leaders said workers deserved a pay rise in
recognition of the erosion of their earnings during the two-year pay freeze, rising inflation and upheavals in the
health service, with shrinking budgets, rising demand and restructuring.
All NHS staff across the UK, apart from those earning less than £21,000, are in the middle of a pay freeze –
reluctantly agreed by the unions – which began in April this year and runs until 2013. Lower earners get a
£250 annual increase.
The submission says: "While staff side [unions] recognises the NHSPRB's remit, we clearly signal our
opposition to the pay freeze covering the majority of the NHS workforce and emphasise that the £250 uplift for
the remaining workforce is not sufficient. Staff side trade unions wish to set out the expectation that a fair
award is made after the pay freeze. Pay restraint has meant that NHS staff have already sacrificed a great
deal, as the gap between salaries and the cost of living continues to rise."
It adds: "We ask the review body to consider the impact of a near-total pay freeze during a period of
consistently high inflation on the declining standard of living faced by NHS staff."
A staff nurse or paramedic in band five of the NHS's pay scales, earning between £21,176 and £27,625, is
sacrificing about £1,000 in earnings this year and will see that rise to £3,000 next year, the unions claim.
The evidence to the NHSPRB does not specify how big a rise staff want. But by detailing the severe budgetary
pressure NHS staff are under because of a combination of the cap, benefits changes and the wider economic
situation, it suggests they are hoping for a substantial increase.
Unison, which represents around 500,000 NHS workers such as nurses, porters and medical secretaries, has
already asked the NHSPRB to ensure that its final recommendations "reflect the significant increase to NHS pay
rates required to protect their real value when inflation and other factors are taken into consideration".
NHS staff are under severe pressure, it says, due to "a toxic combination of increasing demand, shrinking
resources and the pay freeze", while the unions warned in a joint statement that "the impact of the proposed
pension changes and massive programme of NHS reforms in the health and social care bill are adding even
more to the stress felt by staff".
The Department of Health refused to respond directly to the unions' demand. A spokesman said: "The
government introduced a two-year pay freeze across the public sector for those earning more than £21,000 to
cut the country's deficit and to get the economy back on track.
"The pay freeze ends in April 2013. We know that NHS staff are working hard in these difficult times and the
government has again made a commitment to protect those on low incomes, and announced that those
earning basic salaries of £21,000 or less should receive uplifts of a minimum of £250."
The unions represent medical staff including nurses, midwives, therapists and paramedics, and non-clinical
employees such as cooks, cleaners and porters. Doctors and consultants hold separate negotiations.
The unions' move comes as several of them consider staging industrial action over the government's plans to
shake up the NHS pension scheme even though it generates a surplus.
Financial and other pressures affecting NHS staff, including rising workloads, are damaging employees' morale
and motivation, and a further pay freeze from 2013 onwards could make recruiting and retaining NHS staff
difficult, the unions' submission adds.
"Stability is vital in any workforce – more so during a period of change. The current turmoil in the NHS is
undermining staff morale and threatening the delivery of high-quality patient care. On top of job cuts and ward
closures, growing waiting lists and an attack on their pension, staff face a reorganisation on an unprecedented
scale," said Christina McAnea of Unison, chair of the NHS Staff Side group, which submitted the evidence on
Tuesday.
"By imposing a pay freeze for the second year running, the government is adding insult to injury. Pay has
never been generous in the NHS and, with inflation rising, many families are struggling to cover the costs of
even basic essentials."
36
Rehana Azam, a national officer at the GMB union who deals with NHS issues, said: "At a time when working
people are dealing with their own deficits as the cost of living increases, including the essentials like childcare,
fuel and food, wage stagnation and the position directed from government to pay review bodies is unhelpful
and unfair."
Josie Irwin, staff-side secretary at the Royal College of Nursing (RCN), which represents the UK's 400,000
nurses, said: "Coalition policy means that nurses face suffering a second year of pay cuts. This comes on top of
unprecedented change and upheaval in the NHS, leading to low morale, uncertainty and insecurity. The RCN
calls on the pay review body to recognise that further attacks on pay will only do more damage to recruitment
and retention in the NHS."
5
More midwives needed for baby boom in Wales, claims RCM
BBC News, UK
20/09/2011
More midwives are needed to keep up with a baby boom in Wales, according to their professional body.
The Royal College of Midwives (RCM) says an extra 10% - 136 more midwives - is needed to cope with rising
demand.
The warning comes a day after the Welsh Government published its maternity strategy, including a broader
educational role for midwives.
The government said it was "surprised", with the RCM saying last week there was no problem with midwife
numbers.
Helen Rogers, RCM director for Wales, said: "The steep birthrate rises of recent years have overtaken us."
The RCM told BBC Wales that live births in Wales had risen by 19% since 2002 to nearly 36,000 in 2010.
It said midwife numbers had kept up with the birthrate rise for most of the period before falling by 9.6% in the
last two years to the equivalent of 1,196.1 NHS midwives, resulting in a shortage.
Ms Rogers said: "Wales has done really well to maintain midwife numbers, but the steep birthrate rises of
recent years have overtaken us.
"These figures represent shortages in our maternity services that need attention. Each single number is a
midwife that should be there caring for women and their babies, but isn't."
Meeting demand
The RCM's claims of a shortage of midwives is disputed by the Welsh Government.
A spokesperson said: "We are surprised at these comments from the Royal College of Midwives who, only last
week, stated that Wales did not have a problem with midwife numbers.
"The number of midwives trained is based on what the NHS determines it will require to meet future demand.
"Since 1999 there has been an 11% increase in the number of midwives in Wales, and midwifery staffing was
not identified in the 2011 Workforce Plans as either a recruitment or a retention issue."
The warning comes after health minister Lesley Griffiths announced a strategy to improve maternity services
by focusing more directly on the needs, health and well-being of mothers and their babies.
It includes a proposal for midwives to carry out a broader educational role, although opposition parties claimed
the strategy masked a Labour administration plan for centralisation and cuts in local maternity.
6
Pay freeze is an attack too far on NHS workers
The Guardian, UK
21/09/2011
Christina McAnea
The NHS pay review body has helped to keep industrial peace in the health service over many years. Unions,
employers and the government each submit written and oral evidence that is considered, and a
recommendation made. The result is a fair, independent and well-respected system.
So it was with a heavy heart that health unions submitted their evidence again this week, against the
background of the government's pay freeze. Nurses, paramedics and therapists are among health workers
37
suffering from a freeze on pay for the second year in a row. The token £250 to those earning less than
£21,000 is small comfort to families struggling with high inflation and a decline in their standards of living.
The joint evidence submitted is a strong and compelling account of the pressures facing NHS workers both at
work and, financially, at home. The combination of increasing demand, shrinking resources and the pay freeze
is putting staff under severe stress.
As a result of rising inflation and the pay freeze, a nurse at the top of their scale has sacrificed £1,000 in
earnings in 2011. Based on inflation projections, this will rise to almost £3,000 in 2012. In real terms, the
value of an average NHS full-time salary is at its lowest level for 11 years. Continued erosion of NHS earnings
is simply unsustainable.
That is why Unison asks that the review body recommendations reflect the significant increase to NHS pay
rates needed to protect their real value when inflation and other factors are taken into account. In other words,
health workers will have a serious amount of catching up to do when the pay freeze ends.
In the meantime the impact of the proposed pension changes and the massive programme of NHS reforms in
the health and social care bill are adding even more to the difficulties. And perhaps the most damning
conclusion of the evidence is that staff express increasing concern about how they can maintain the quality of
patient care.
For any health worker, the quality of patient care has to be paramount. But it is hardly surprising that care is
being put at risk, when the government's squeeze on the NHS adds up to more than 50,000 job losses, with
many predicting that figure is the tip of the iceberg.
Nurses know there is a direct link between the quality of patient care and the number of staff on the wards.
This fact was demonstrated most starkly at Mid Staffordshire NHS Foundation Trust, where patients suffered
because of drastic cuts to staffing levels in an effort to save money and balance the books.
The latest figures also show that waiting lists are getting longer, with more patients waiting in pain for their
operations. The bottom line is that cutting staff, and closing wards and departments, puts lives at risk.
Is it any wonder then that staff morale is low? NHS workers may have been given little choice but to put up
with another year of a pay freeze, but they are angry. And that anger will find an outlet in the forthcoming
ballot for industrial action over pensions. Breaking the pensions promise to more than a million NHS workers is
a step too far.
The NHS pension scheme is cash rich – currently generating £2bn more a year than it pays out. Government
demands for a 50% contributions rise is totally unjustified. And asking nurses and paramedics to carry on
working until they are 66, 67, 68 and beyond is ludicrous.
Pay is always a massive issue for workers, and pensions are deferred pay. The government's attacks on the
NHS – cutting staff, freezing pay, rationing treatment and growing waiting lists – are fuelling widespread
anger. This toxic combination, along with the assault on pensions, is set to come back and bite the government
when the ballot for industrial action opens.
79
Le modèle français des hôpitaux publics est-il menacé ?
Le Monde, France
18/09/2011
Propos recueillis par Matthieu Aron, Luc Bronner et Gilles Leclerc
ES URGENCES
Jean-Marie Le Guen, médecin, député (PS), adjoint au maire de Paris : « Les urgences sont largement
encombrées parce que la médecine de ville ne tient plus son rôle : la permanence des soins le samedi, la nuit,
le dimanche, pendant les vacances. S'ajoutent les personnes âgées, notamment en perte d'autonomie, dont on
ne sait plus quoi faire lorsque les familles et les soignants les amènent un jour aux urgences. Et là c'est le
drame, parce que ces personnes n'ont évidemment rien à faire dans un service des urgences. Elles y perdent
leur santé, leur temps, elles sont choquées, elles sont désorientées. »
Philippe Juvin, député européen (UMP), chef du service des urgences de l'hôpital Beaujon : « L'hôpital est là
pour accueillir tout le monde. C'est vrai que les médecins de ville sont moins organisés qu'ils ne l'étaient
auparavant pour recevoir les urgences. La liste de garde des médecines de ville est plus complexe à faire
qu'elle ne l'était auparavant. Donc c'est vrai qu'aux urgences nous avons aujourd'hui des patients que nous
n'avions pas il y a 10 ou 15 ou 20 ans. »
LA RENTABILITÉ
Philippe Juvin : « Je m'inscris en faux quand on dit que l'on chercherait à rendre l'hôpital rentable. Ce n'est pas
ça le sujet. Personne ne cherche ça, ça n'a pas de sens. Ce que nous cherchons, c'est de continuer à garantir
aux Français que tous puissent avoir accès aux soins, quelle que soit leur situation sociale, qu'ils aient un
travail ou pas, ce qui n'est pas le cas aux Etats-Unis. Nous avons la chance en France d'avoir un système
hospitalier public qui donne l'excellence à tout le monde. L'hôpital, c'est le lieu de toutes les souffrances. »
38
Jean-Marie Le Guen : « On a abandonné la logique du projet médical au profit de la logique comptable. Et la
tarification à l'activité, c'est non seulement un système technique qui est assez vicieux et qui ne marche pas
bien notamment pour les disciplines les plus intellectuelles et humaines, mais c'est surtout une machine à
diminuer le budget de l'hôpital. Ce que nous connaissons, c'est en fait une pénurie de moyens donnés à
l'hôpital. »
LES FINAN CEMENTS
Philippe Juvin : « Il n'y a pas de financement idéal pour les hôpitaux. On a créé le système de tarification à
l'activité. L'hôpital est payé pour ce qu'il fait, pour l'acte qu'il fait. Auparavant, qu'est-ce qu'il y avait ? L'hôpital
recevait de l'argent en fonction du temps que le patient passait à l'hôpital. En gros, plus vous passiez de temps
à l'hôpital, même si ce n'était pas justifié, plus vous gagniez d'argent. Ce qui était aussi absurde. Et avant, il y
avait un budget global où d'année en année on vous reconduisait votre budget. Si vous étiez bon une année,
vous le gardiez définitivement.
Le financement actuel est plutôt intelligent puisqu'il paie l'hôpital pour ce qu'il fait. Simplement, on voit des
abus parce que tout système génère ses abus. C'est un système plutôt inflationniste : vous allez chercher les
actes qui rapportent de l'argent. C'est ensuite un système qui paie mieux les actes techniques que les actes
intellectuels, par exemple la psychiatrie. »
Jean-Marie Le Guen : « Le problème n'est pas là. Le problème, c'est ce qui se passe depuis 5 ans, depuis que
M. Sarkozy est au pouvoir et qu'il a décidé de s'attaquer violemment à l'hôpital. Les hôpitaux sont exsangues
et sont obligés de diminuer la masse de personnel pour pouvoir se payer les investissements. Voilà la réalité. »
10
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Latin America & Caribbean
1
Avance desparejo en salud
Inter Press Service
15/09/2011
Por Marcela Valente
BUENOS AIRES, 15 sep (IPS) - Argentina, Brasil, Bolivia, Chile, Paraguay y Uruguay registran mejoras en
materia de salud infantil. Pero mientras unos ya celebran sus éxitos, que en algunos casos son notables, otros
avanzan a paso cansino hacia la meta comprometida en 2000 en la ONU.
Ese cuadro dispar surgió de informes de los representantes de las sociedades de pediatría de los seis países del
Cono Sur de América reunidos en Buenos Aires en el marco del Congreso del Centenario organizado por la
Sociedad Argentina de Pediatría (SAP).
El encuentro que se realiza del martes 13 a este viernes 16, en el que se celebra además el centenario de la
entidad, se repasaron indicadores y buscaron maneras de mejorarlos para ayudar a cumplir con el cuarto de
los ocho Objetivos de Desarrollo para el Milenio fijados por los gobiernos en la ONU (Organización de las
Naciones Unidas), que se refiere a la reducción de la mortalidad infantil.
Aún con retos que subsisten, los países que mostraron mayores progresos en materia de combate contra la
desnutrición, reducción de la mortalidad infantil y cobertura de vacunas son Argentina, Brasil, Chile y Uruguay.
En cambio en Bolivia y Paraguay, donde la pobreza y la indigencia están en leve baja pero siguen siendo
elevadas, los indicadores arriba mencionados aún muestran enormes falencias que pesan sobre la población
infantil.
"Bolivia tiene la tasa de mortalidad infantil más alta de América Latina", afirmó el médico Darwin Martínez, de
la sociedad pediátrica de su país. "Tenemos un atraso de 50 años respecto de Uruguay", por ejemplo, lamentó
en su exposición al plenario del encuentro.
La pobreza aún afecta a 64,3 por ciento de los 10,5 millones de bolivianos, pero el porcentaje sube a 75 por
ciento entre niños hasta 13 años de edad, mientras que la desnutrición llega a 37 por ciento de los menores de
cinco años y 60 por ciento de ellos sufren algún grado de anemia, aseguró el especialista.
Agregó que la mortalidad infantil es de 50 por cada 1.000 nacidos vivos, la vacunación alcanza solo a 50 por
ciento de los niños y niñas –cinco por ciento de los menores de dos años no reciben ninguna inoculación-- y
una de cada tres menores de 20 años ya tiene al menos un hijo.
Martínez dijo a IPS que en los últimos 10 años hubo avances, como una caída de la desnutrición y mayor
inmunización. Se fomenta la lactancia exclusiva hasta los seis meses y se creó un seguro universal materno
infantil. Pero todavía no alcanza.
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Paraguay es otro país que avanza a paso muy lento. El médico Luis Moreno Jiménez recordó que 35 por ciento
de sus 6,5 millones de habitantes son pobres y 19 por ciento indigentes, la mortalidad infantil llega a 24 por
cada 1.000 nacidos vivos y la desnutrición afecta a 14 por ciento de los niños y niñas del país.
En Paraguay, con la población joven igual que Bolivia que aún no produjo la transición hacia una sociedad que
reduce el número de nacimientos, la fecundidad es de 3,5 hijos por mujer, una de las más altas de la región.
En cambio, los demás países están haciendo más rápidos progresos. Brasil, que tenía una mortalidad infantil
cercana a 80 por cada 1.000 nacidos vivos en 1983, bajó a 19 por 1.000 en la actualidad, afirmó el pediatra
Eduardo da Silva Vaz.
"La prevalencia de déficit de peso y de altura en menores de cinco años dejó de ser un problema en Brasil",
destacó el médico, aunque alertó que ahora les preocupa el sobrepeso y la obesidad creciente en niños y niñas,
un tema que atravesó todas las ponencias.
El programa de vacunación brasileño "es un éxito", pues cubre prácticamente a la totalidad de los menores,
indicó Da Silva Vaz a IPS. En tanto que los nacimientos llega casi a dos por mujer en promedio, con muchas
disparidades en este indicador según nivel educativo y social de la madre.
No obstante, el especialista se manifestó preocupado por la falta de educación preescolar, que hace que
muchos niños y niñas de hasta cinco años estén "abandonados" o sean cuidados por hermanos que no están en
condiciones de estimularlos.
También llamó la atención sobre el elevado número de muertes prevenibles en la adolescencia. Remarco que
72 por ciento de los decesos de personas entre los 15 y 19 años ocurren por causas no naturales, entre las que
prevalecen la violencia, accidentes y suicidios.
En tanto, la presidenta de la SAP, pediatra Margarita Ramonet, explicó que en Argentina la mortalidad infantil
está en 12,1 por 1.000 nacidos vivos, aunque el promedio bajo oculta fuertes contrastes. En la nororiental
provincia de Formosa, que limita con Paraguay, este indicador llega a 20,5 por 1.000, mientras que en la
ciudad de Buenos Aires cae a 8,5 por 1.000.
La población inmunizada está entre 92 y 99 por ciento, según las vacunas, y el embarazo adolescente sigue
siendo alto, ubicado en 14,5 por ciento de las mujeres de esta franja etaria, pese a la difusión de programas de
educación sexual y acceso a la anticoncepción.
Al igual que el representante de Brasil, la experta argentina se manifestó preocupada por la cantidad de
muertes de adolescentes, que en el caso de 60 por ciento de las personas entre 15 y 17 años fueron por
causas "reducibles". También alertó que a los 13 años, 46 por ciento de los menores toman alcohol.
En Chile y Uruguay también hubo notorios progresos, aunque con desafíos aún pendientes. En el primer caso,
el doctor Francisco Moraga Mardones, destacó que la mortalidad infantil llega a 7,7 por cada 1.000 nacidos
vivos y la cantidad de hijos por cada mujeres se acerca a los dos en promedio, igual que en Brasil.
No obstante, estos indicadores, similares a los de un país del Norte industrializado, ocultan serias disparidades.
"Chile es el país más desigual de América Latina", aseguró el pediatra, y dijo que entre las madres sin
instrucción la mortalidad es siete veces más alta.
También reveló que, si bien ese país se está envejeciendo y nacen pocos niños, 25 por ciento de los partos son
de mujeres menores de 20 años, 16 por ciento de las cuales tienen menos de 14 años.
La desnutrición no es ya un tema que preocupe en su país, pero sí el sobrepeso, que afecta a 30 por ciento de
los niños y niñas de hasta siete años, mientras que la obesidad alcanza a 22 por ciento de esa franja de edad.
Finalmente Alicia Fernández, presidenta de la Sociedad Uruguaya de Pediátrica, comentó que en su país la
mortalidad infantil afecta a 7,7 por cada 1.000 nacidos vivos, la más baja de la región, y la inmunización llega
a 99 por ciento del universo infantil.
Sin embargo, advirtió que uno de los principales problemas en la atención a la salud infantil en Uruguay es la
gran concentración de pediatras que hay en Montevideo, frente a la escasez que se registra en el interior del
país.(FIN/2011)
2
MSP elabora plan ante falta de médicos en el área rural
El Espectador, Uruguay
20/09/2011
El Ministerio de Salud Pública elaboró un plan para atender la falta de médicos en el medio rural, un tema que
el presidente de la República, José Mujica, definió como prioritario.
Luego de finalizado el Gabinete Social este mediodía, el subsecretario de Salud Pública, Leonel Briozzo, explicó
que la propuesta se basa en tres ejes fundamentales: mejora del salario, estimulo académico e inserción
transitoria.
40
El jerarca puntualizó que la hoja de ruta en salud rural tiene como objetivo fundamental que las personas que
viven en localidades del interior del país con menos de 5.000 habitantes, y que representan un 18,5% de la
población total del país, cuenten con servicios médicos adecuados.
El Ministerio de Salud Pública realizará un relevamiento en todo el país para saber con exactitud cuántos
médicos se necesitan para atender el déficit, pero se estima que son entre 300 y 400 puestos.
Briozzo dijo que se maneja como un elemento clave para atraer médicos hacia el medio rural la
implementación de contratos de trabajo más atractivos.
"Estamos estudiando un estímulo económico, un estímulo académico y no pensar en el afincamiento como algo
permanente sino que se dé de manera transitoria por períodos de cinco a 10 años", dijo Briozzo.
El subsecretario de Salud Pública explicó que además se está trabajando con la Facultad de Medicina para
garantizar que el trimestre de internado en el medio rural realmente se cumpla por parte de los estudiantes.
"Muchas veces se hacen guardias de dos días y se vuelve a la capital. Queremos transformar esto", dijo.
En cuanto a los plazos de implementación del plan, Briozzo informó que la idea es comenzar sobre fin de año
con los concursos de residencia de la facultad.
La primera etapa de implementación será en Artigas, Rivera, Cerro Largo y Rocha, y luego se extenderá al
resto del país. Se va a intervenir específicamente en puestos de salud, ferias rurales, policlínicas y rondas de
salud rural.
La base de planificación no estará en Montevideo, sino en las direcciones departamentales de salud del interior
del país.
3
Peligra la vida de niños por falta de personal médico en centro del Ihnfa
La Tribuna, Honduras
19/09/2011
SAN PEDRO SULA.- La Fiscalía Especial de Protección a la Niñez y Adolescencia intervino hoy el centro “Nueva
Esperanza”, donde más de 150 internos corren el peligro de enfermarse de gravedad, ante la falta de atención
del personal médico, enfermería y de aseo, el cual fue despedido por las autoridades del Instituto Hondureño
de la Niñez y la Familia (Ihnfa).
Atendiendo una denuncia, la coordinadora de dicha fiscalía, Telma Martínez, realizó una inspección a la
institución ubicada en la aldea El Carmen, donde constató la precaria y desgarradora situación en que viven los
pequeños que tienen entre uno a diez años de edad, quienes han sido rescatados de la calle, al ser
abandonados por padres abusivos y otros factores.
En el lugar se pudo comprobar que debido al hacinamiento en que viven los internos, cuatro pequeños
comparten una misma cuna, hay niños enfermos que están junto con los que cuentan con una buena salud y el
lugar es insalubre.
Asimismo, los empleados que laboran en el centro están en paro de labores, porque tienen dos meses de no
recibir el salario respectivo, lo cual agudiza la situación que ya viven los infantes.
Martínez informó que durante la supervisión, comprobó que las autoridades del Ihnfa han cancelado a dos
médicos, dos enfermeras y el personal de aseo que prestaba servicio al centro de protección de menores.
Reveló que dicho personal recibió el “sobre blanco” a inicios de septiembre, bajo las órdenes de las autoridades
de Tegucigalpa que les suspendieron el contrato de trabajo, arguyendo reducción de personal que está
llevando a cabo la institución.
“Es una situación alarmante, ya que en la institución hay unos 45 niños con problemas neurosiquiátricos que
necesitan atención en salud, por lo que hago un llamado a las autoridades del Ihnfa, a fin de que resuelvan
este problema, porque de lo contrario, interpondremos las acciones legales correspondientes”, advirtió la fiscal.
Señaló que halló a dos niñas que habían recibido una cirugía, y están aún convalecientes hasta con sondas en
su cuerpecito, pero sin la atención de un médico, por lo que se tomó la determinación de trasladar a una de
ellas al hospital “Catarino Rivas”.
Refirió que la fiscalía analizará los documentos, actas de inspección y otros que llegaron de Tegucigalpa sobre
la cancelación de los médicos, para interponer una acción de amparo para obligar al Ihnfa, a que en un término
“fatal”, contrate nuevamente el personal de salud.
“Consideramos que el Estado está vulnerando un derecho fundamental de los niños, como la salud, ya que es
el encargado de proporcionarla en los centros de protección de menores, de lo contrario un niño puede morir
hasta de una gripe”, manifestó.
41
4
"Estamos preocupados por la violencia laboral que sufren los médicos"
La Capital, Argentina
22/09/2011
Dardo Dorato, de la Asociación Médica de Rosario, dijo que ese fenómeno no es local. Según la Organización
Mundial de la Salud, el 25 por ciento de los casos de violencia laboral ocurre en el sistema de salud. Hoy, a las
19, habrá una reunión en la entidad de Tucumán y España.
Los profesionales de la salud nucleados en el Colegio de Médicos y la Asociación Médica de Rosario se reunirán
esta tarde para analizar los problemas de violencia que sufren en distintos ámbitos. Lo harán, a partir de las
19, en el auditorio de la entidad ubicada en España y Tucumán. “Hace mucho que estamos preocupados por la
violencia laboral en el sistema de salud. Este no es un tema local. Si busca literatura, la OMS (Organización
Mundial de la Salud) dice que el 25 por ciento de violencia laboral ocurre en el sistema de salud. Esto tiene su
correlato con la sociedad que es cada vez violenta”, afirmó esta mañana Dardo Doratto, secretario general de
la Asociación Médida de Rosario.
En diálogo con el programa Dos tipos audaces de La Ocho, Dorato dijo que en Rosario “hay lugares que los
hechos de violencia son más frecuentes que otros. La violencia es física, verbal o psicológica. Uno empieza
hablar en un taller con 60 médicos de diferentes áreas y todos habían sido víctima o testigos de alguna forma
de violencia”.
Doratto anticipó que lo que se presenta hoy “es un programa de trabajo con la intención de atenuar los efectos
de violencia en los diferentes lugares. Hay manuales de trabajo que hay que adaptarlos a los diferentes
lugares. No es lo mismo una ambulancia que un centro de salud barrial. Hay formas de minimizar esto con
capacitación del personal”.
El directivo de la Médica sostuvo que el problema de la violencia laboral que sufren los doctores “es un
fenómeno creciente en los últimos años. Antes, entrar o ir a un barrio con una ambulancia o portando un
maletín era casi un salvo conducto absoluto y hoy hay zonas difíciles para trabajar”.
El dirigente expuso que uno de los objetivos del encuentro de hoy “es abrir un registro para hacer un mapeo.
Los medios hablan de los que les parece, mencionan algún episodio puntual. Queremos hacer un relevamiento
lo más objetivo posible de los hechos de violencia. Es decir, saber qué contención se le dio al personal, ya sea
atención médica, legal o psicológica. Si se tomaron medidas para evitar esas situaciones, si esas medidas
fueron efectivas. Es un trabajo a largo plazo y apuntamos a prevenir este problema”.
5
Ni 10 % de los médicos aprueban el examen para las residencias
Última Hora, Paraguay
18/09/2011
El pobrísimo rendimiento que revelan desde el 2005 los egresados de Medicina en el examen de admisión a las
residencias médicas confirma la preocupación sobre la calidad académica de las universidades.
Por Susana Oviedo
Si el Examen de Admisión para las Residencias Médicas (EARM) fuera de suficiencia, basado en un nivel de
exigencia del 60 % como mínimo, más del 90 % de los egresados de Medicina no accederían a la formación de
posgrado o especialización (ver infografía).
Así lo viene advirtiendo desde el 2005 la Comisión Nacional de Residencias Médicas (Conarem) que se encarga
de organizar este examen que, además, revela la calidad de los médicos que se están incorporando al mercado
laboral del país.
"En el examen de admisión realizado en el año 2006 tan solo dos universidades han logrado superar, a duras
penas, un rendimiento del 60 % (Universidad Nacional del Este y la Universidad Nacional de Asunción). Algo
mucho peor ocurrió en el examen del año 2007. En esa oportunidad, ninguna universidad ha alcanzado
estándares mínimos de rendimiento", dice el estudio El médico paraguayo recién egresado, desde la óptica de
Conarem.
Es muy llamativo, resalta dicho documento, que el nivel actual alcanzado por los médicos recién egresados en
las tres primeras ediciones del Examen de Admisión "sea muy bajo, aún si se toman parámetros de
rendimiento de una escala del 60 %, que no es una escala exigente".
En esos tres primeros años de edición del EARM, las dos facultades de Medicina más antiguas del país: la UNA
y la Católica de Villarrica, aportaron más de la mitad de los postulantes. Las restantes facultades de Medicina,
públicas y privadas, se presentaron con un número reducido de postulantes.
Si el examen fuera de suficiencia y eliminatorio, las plazas para residencias médicas ofertadas por el Instituto
de Previsión Social y el Ministerio de Salud Pública, quedarían sin ser cubiertas.
Sin embargo, el examen es de competencia y sirve para que los postulantes con mejor rendimiento tengan la
opción de elegir la especialidad y el lugar donde seguir.
42
Lo llamativo hasta el año 2010 es que los egresados de Medicina que se presentan a esta prueba no superan
un rendimiento del 10 %. Es decir, no alcanzan siquiera el 60 % de un total de 120 puntos. Un rendimiento
que "ni siquiera es un nivel de excelencia, pero es el nivel de exigencia adoptado por todas las facultades de
Medicina del país", resalta la Conarem en el análisis del tema.
PROMEDIOS ESTO SUCEDE PESE A QUE LA MAYORÍA DE LOS POSTULANTES QUE SE PRESENTARON AL
EXAMEN DE ADMISIÓN TIENEN COMO PROMEDIO DE NOTAS DE PREGRADO ENTRE 3 Y 4, DE UNA ESCALA DE
1 AL 5. Dato que varía solamente con los que estudiaron en Cuba, cuyo promedio es de 4 a 5.
Esto hace pensar "en una falta de compromiso con la excelencia", resalta el análisis de la Conarem, sobre los
exámenes de 2005, 2006 y 2007. También debería ser un llamado de atención, agrega, el "muy pobre
rendimiento alcanzado por los médicos compatriotas que se han formado en el exterior, sobre todo aquellos
egresados provenientes de Cuba, quienes, habiendo obtenido promedios en el pregrado cercano e inclusive
superior al 4 se han ubicado en los últimos lugares en las tres ediciones del examen de admisión".
De hecho, un estudio que obra en el Ministerio de Salud Pública revela que en los planes de estudio de los
Centros de Educación Médica Superior de Cuba solo 58 % de las asignaturas alcanzan las cargas horarias y
contenidos de la Facultad de Medicina de la UNA.
UN MÉTODO EQUITATIVO DE ADMISIÓN A LAS ESPECIALIDADES
El Examen de Admisión a las Residencias Médicas (EARM) evalúa los conocimientos de los médicos recién
egresados en las áreas de cirugía, medicina interna, ginecoobstetricia y pediatría.
Consiste en un examen tipo test de selección múltiple de 120 puntos, 30 puntos por área, con penalización por
preguntas mal contestadas. Es decir, por cada tres preguntas mal respondidas, se va restando un punto.
Utilizando programas y bibliografías que corresponden a las áreas que los médicos utilizaron durante su
formación de pregrado, un equipo de médicos del Ministerio de Salud Pública y Bienestar Social y del Instituto
de Previsión Social, relacionados con la labor docente en esas instituciones, elaboraron un banco de preguntas,
que posteriormente se utilizó para la elaboración del examen único, cuya primera edición fue en el 2005. Se
rinde en febrero de cada año y la corrección informática del examen y los resultados finales están a cargo del
Centro Nacional de Computación de la Universidad Nacional de Asunción.
Con el EARM el acceso a las residencias médicas dejó de ser por "recomendaciones".
NO CONCUERDAN LOS NÚMEROS
En la página oficial de la Conarem, en la web, en un informe final sobre el Examen de Admisión a las
Residencias Médicas 2010, se incluye un cuadro con resultados desde el 2005. Los números de aprobados no
coinciden con los que están contenidos en documentos proveídos a ÚH por la Conarem. No obstante, hay
coincidencia en las siete ediciones del examen, en que ni el 10 %de los postulantes alcanzó el 60 % del
puntaje total de la citada prueba.
Desde el martes, ÚH publicará cómo funciona cada una de las 20 carreras de Medicina que hay en el país,
incluida la opinión de sus decanos.
6
Perú tiene un déficit de mil especialistas en cancer
Radio Programas del Perú
22/09/2011
Con más especialistas y equipos en cáncer, en unos 10 años se diagnosticará el mal en estadios iniciales, lo
que eleva la posibilidad de vencer la enfermedad.
El presidente de la Coalición Multisectorial Perú contra el Cáncer, Luis Pinillos, dijo que existe un déficit de
1,000 especialistas en diagnóstico y tratamiento de esta enfermedad, lo que impide extender la atención
médica al 100% de los casos reportados.
Detalló que actualmente existen en el país alrededor de 1,000 radiólogos, cirujanos oncólogos, patólogos,
oncólogos médicos y radioncólogos (para atender a una población de cerca de 30 millones de peruanos), lo que
aún resulta insuficiente.
“Hacen falta no menos de 1,000 profesionales adicionales, 100% más para los centros especializados y
unidades de oncología de los hospitales”, señaló Pinillos, tras participar en el simposio sobre oncología que
reunió en Lima a diversos especialistas en la materia.
En declaraciones a la Agencia Andina, Pinillos explicó que la capacitación de médicos en el diagnóstico y
tratamiento de cáncer era escasa por la falta de centros que permitan ejercer la profesión, además del
Instituto Nacional de Enfermedades Neoplásicas (INEN).
“Por eso en las universidades se debe estimular la especialización en oncología y áreas afines. Los cupos para
la formación de radiólogos en universidades del país son menos de 10 y se requieren ahora de 200”, expresó.
43
Explicó que el incremento del número de profesionales permitiría atender a todas las personas que sufren de
cáncer, que es considerado la segunda causa de muerte en el país. Actualmente se atiende a una de cada dos
personas con cáncer, cuando hace algunos años se atendía a una de cada tres.
7
MPs want review of health-sector man hours
Jamaica Observer
18/09/2011
Alicia Dunkley
A revelation by Ministry of Health officials that expenditure on sessional and rostered duties for doctors, nurses
and other health workers has increased by 68 per cent has prompted calls from a Parliamentary Committee for
a review of that arrangement.
Permanent Secretary for the Health Ministry Dr Jean Dixon told a meeting of the Sessional Select Committee
on Human Resources and Social Development in downtown Kingston Thursday, that while the sector was short
of health personnel needed to provide service, there was no shortage "in terms of the man hours that we are
paying for".
Sessional and rostered duties are essentially overtime where medical personnel fill gaps in regular schedules at
public health facilities which are short-staffed. Monetary incentives and allowances are paid to health sector
workers who perform these duties, which fall outside their normal rostered hours.
"One of the things it would be useful for the committee to consider is that health care is a 24/7 operation and
we really can't run it on a nine-to-five basis. We are expected to provide coverage 24 hours, but outside of the
nine to five it becomes very expensive time," Dr Dixon told the parliamentary committee.
"I think it would be very instructive to examine the Heads of Agreements we have signed over the years and I
think if we could bring some harmonisation and some sense to those agreements, that would help the
situation."
Data provided to the meeting by the ministry officials showed that expenditure for sessions/rostered duty for
nurses, doctors and other health workers increased by 41 per cent in the first year of implementation of the no
user-fee policy, moving from $2 billion the year before the policy was introduced, to $2.9 billion the year after.
More specifically, the data showed that expenditure on sessional and rostered duties for doctors, nurses and
other health workers moved from $2.051billion in 2007/08 to $3.45 billion in 2010/11, a 68 per cent increase.
Speaking on Thursday, Dr Dixon noted that the ministry's recurrent budget was $30.9 billion for 2011/12
before the recent increase in the Supplementary Budget.
"We are going to pay about $23 billion for compensation, $3.7 billion for pharmaceuticals and medical supplies,
$3 billion is left to feed the patients and so on. We have to look at compensation," she said, noting that staff
compensation was the bulk of the ministry's recurrent budget, accounting for anywhere between 75 to 80 per
cent over the years.
Commenting on the situation, committee chair, Opposition Spokesperson on Health, Dr Fenton Ferguson said
"we have to look at that", noting that while service delivery was only a quarter of the ministry's dollar, "we
have an unsustainable system of compensation".
"These extra hours, I am sure you are not happy with the monies you have to pay. We know that what is
happening as it relates to health workers, especially our doctors, is that you can't justify in many instances
their take-home salaries as a result of this doubling up and so forth. It's almost ridiculous. So we need to have
a feel as to whether there is any discussion taking place on these matters," Dr Ferguson said.
"No wonder the country has this crippling debt problem," a clearly displeased Opposition Committee member
Ronald 'Ronnie' Thwaites added.
In the meantime, committee members were also discontented with the level of attrition among health workers.
"We are training, but we are losing, and we are losing the most experienced. We need to look at the training
model in a particular way," Dr Ferguson said. He however hastened to add that "there is nothing wrong with
training for export as long as we are training enough to satisfy the local market".
"What we want is a simple thing that we have utilised for generations, a bond that committed you to work for a
certain period of time. That's not slavery," Thwaites also noted, adding that bonded health workers would work
in a location assigned by the sponsoring agency.
"What we have done is lost our nerve and our vision in respect of this. There are things we can do within our
existing resources. When I was a student I had to provide an income tax clearance before I could leave this
country to go to study.
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"Why can't we do that when a person has a student loan or a bond that's unsatisfied, to the government?" the
MP questioned.
"We are being witless, there are things that we can do now," he insisted.
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for information purposes only. The Alliance is not responsible for the content on third party web sites, and any
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