This Week's News
11-15 April 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
News from WHO and partners ¦ Africa & Middle East ¦ Asia & Pacific ¦
North America ¦ Europe ¦ Latin America & Caribbean
This compilation is for your information only and should not be redistributed
News from WHO and partners
Date
Headline
Publication
07.04.11
Ethical recruitment protects health workers’ rights and promotes
quality services
Public Services
International
07.04.11
*The training and professional expectations of medical students in
Angola, Guinea-Bissau and Mozambique
HRH Journal
07.04.11
*Improving the implementation of health workforce policies through
governance: a review of case studies
HRH Journal
07.04.11
IND 2011: Closing The Gap: Increasing Access and Equity 
06.04.11
Lao People's Democratic Republic to Implement Health Worker
Retention Tool
International
Council of Nurses
Capacity Plus
08.04.11
A month at Merlin: March 2011
Merlin, UK
14.04.11
2.6 million babies stillborn in 2009 
WHO
* All links to HRH Journal will be to an external web page - copy is not reproduced in this
document.
Africa & Middle East
Date
Headline
Publication
07.04.11
Medical aids told to shift focus to preventative care
New Age, SA
12.04.11
LES MÉDECINS RÉSIDENTS: «Nous sommes outrés et dégoûtés»
13.04.11
Benghazi Hospitals Struggle to Treat War-Wounded
L’Expression,
Algeria
UN IRIN
12.04.11
Ministry of Health to Spend U.S.$30 Million on Medicines
AIM, Mozambique
09.04.11
Mobile Phones to Offer Health Sector the Kiss of Life 
06.04.11
The Nation in Need of Systemic Implementation of Healthcare
Interventions - Osotimehin
05.04.11
Ministry to combat apathy and brain drain among health workers 
Daily Nation,
Kenya
Daily
Independent,
Nigeria
Ghana News
Agency
1
10.04.11
The nation needs new Nightingales (Editorial)
The National, UAE
11.04.11
No to private health care (Editorial) 
Haaretz, Israel
Asia & Pacific
Date
Headline
Publication
09.04.11
EDITORIAL: Many a slip
10.04.11
New MCI rule bars 6000 doctors from teaching
Daily Times,
Pakistan
Times of India
08.04.11
Challenges facing the health sector (Editorial)
07.04.11
Chinese doctors prefer public to private hospitals
The Financial
Express,
Bangladesh
Shanghai Daily
11.04.11
Number of neonatal intensive care units falls short in Korea
The Korea Times
07.04.11
‘Silent doctors’ weigh on healthcare quality
The Jakarta Post
14.04.11
Can India prevent 200 children dying every hour?
The Hindu, India
12.04.11
Australia needs physician assistants. So why aren’t we getting
them?
Crikey, AU
07.04.11
Nurses allowed to prescribe medicine for diabetics 
Radio New
Zealand
North America
Date
Headline
Publication
04.04.11
Medical tourism draws growing numbers of Americans to seek health
care abroad
The Washington
Post
11.04.11
Community health centers offer model for improving care even as
they grow
The Washington
Post
12.04.11
Hospital Is Drawn Into Bahrain Strife
12.04.11
The Quality of Medical Care in Low-Income Countries: From Providers
to Markets
The New York
Times
PLoS Medicine
14.04.11
What ‘Big Medicine’ Means for Doctors and Patients
12.04.11
Critical Shortage of Army Neurologists for U.S. Troops in Iraq and
Afghanistan
13.04.11
White House targets medical errors
14.04.11
Congress votes Thursday on cutting billions from budget before
moving to larger spending fight
08.04.11
Many doctors work into their senior years: report 
The New York
Times
ProPublica
Los Angeles
Times
Washington Post
CTV, CA

Europe
Date
Headline
Publication
09.04.11
Health-systems strengthening: current and future activities 
The Lancet, UK
09.04.11
Rational reform to medical education in India (Editorial)
The Lancet, UK
11.04.11
NHS shakeup could be biggest disaster in history of public services,
says RCN 
The Guardian, UK
08.04.11
'Foreign doctors should have English tests before being allowed to
practice in the UK'
Daily Mail, UK
2
13.04.11
Lack of specialist nurses ‘pushes patients into hospital’
Wales online
14.04.11
Leading article: The health service needs evolution, not revolution
14.04.11
Finn: wage expectations of Estonian doctors sometimes
unrealistic
The Independent,
UK
Baltic Business
News
11.04.11
La prise en charge des soins médicaux, un acquis menacé
Le Monde, France
08.04.11
Des traducteurs soutiennent les médecins en 12 langues
Swissinfo.ch
14.04.11
La opinión de los ciudadanos sobre el sistema público de salud
mejora 
El País, Spain
Latin America & Caribbean
Date
Headline
Publication
11.04.11
La salud en zona rural está en crisis, dijo Médicos Sin Fronteras en
Arauca
Meridiano 70,
Colombia
12.04.11
Desnutrición ha cobrado vidas en comunidad indígena de
Cambalache
13.04.11
Paro y reclamos
14.04.11
ANS proíbe operadoras de premiar médicos que ajudam a reduzir
custos 
Nueva Prensa de
Guayana,
Venezuela
Página12,
Argentina
Estadao, Brazil
10.04.11
CDHDF exhorta a mejorar servicios de salud en cárceles
12.04.11
La propuesta de cerrar y crear otra Caja de Salud (Editorial)
07.04.11
Muchos órganos se pierden aquí debido al alto costo del
trasplante
El Universal,
Mexico
Opinión, Bolivia
Listín Diario, DR
Back to top
News from WHO and partners
1
Ethical recruitment protects health workers’ rights and promotes quality services
Public Services International
07/04/2011
On World Health Day – 7 April 2011, Public Services International affirms the commitment of our global union
federation to support affiliates in working vigorously to strengthen the health workforce through ethical
recruitment practices. PSI recognizes that a strong workforce is key to ensuring quality public health services
and reversing the trend towards austerity, which will harm recovery from the global economic crisis.
“Governments are responding wrongly to the crisis by cutting more jobs, limiting workers’ rights and reducing
public services, such as health and social care, that provide the safety nets for a sustainable economic
recovery,” warns PSI general secretary Peter Waldorff.
Consequences of the crisis are still rolling out. According to the International Labour Organization, despite a
global economic growth rate of 4.8%, growth in employment is lagging, and the unemployment rate remains
high at 6.2%; over 205 million workers were unemployed in 2010.
Globally, health workers are inequitably distributed between urban and rural areas and between rich and poor
countries. This has contributed to a global shortage of more than four million health workers. At the same
time, ageing populations and rising care needs in industrialized countries are increasing the demand for
workers.
“Health and social care workers, a huge proportion of them women, migrate due to lack of decent work
opportunities where they live. If we are to seriously address migration and the health workforce crisis, then we
need to strengthen the workforce and invest in public health services now,” emphasizes Waldorff.
In May 2010, the World Health Assembly adopted the World Health Organization Code of Practice on the
International Recruitment of Health Personnel. The Code establishes and promotes voluntary principles and
practices for the ethical recruitment of health workers, and helps to strengthen health systems. Application of
this Code is essential to achieving quality public services.
“PSI and its affiliates, representing more than seven million workers in the medical, health and social services,
are intent on ensuring that the WHO Code is applied at national level. Only through its real application can the
3
Code become relevant to the lives of health workers and the communities that they serve. PSI’s
implementation plan for the Code, designed to promote social dialogue between governments, trade unions,
employers, recruitment agencies and other stakeholders, is well underway. We welcome on-going discussions
with the WHO in developing this joint collaboration,” says Waldorff.
Download PSI’S Ethical Recruitment campaign poster here: jpg (59KB) pdf (2MB)
Download the PSI statement
4
IND 2011: Closing The Gap: Increasing Access and Equity
International Council of Nurses
07/04/2011
International Nurses Day is celebrated around the world every May 12, the anniversary of Florence
Nightingale's birth. The International Council of Nurses commemorates this important day each year with the
production and distribution of the International Nurses' Day (IND) Kit. The IND kit 2011, contains educational
and public information materials, for use by nurses everywhere.
The IND theme for 2011 is Closing The Gap: Increasing Access and Equity. The content of this year's kit,
including the poster image are posted here as downloadable documents for use by individual nurses,
associations, health ministries and health institutions. This material has already been disseminated to national
nurses' associations worldwide. Though mainly planned around May 12 each year, IND activities continue for
much of the year by nurses and others. We encourage nurses everywhere to make extended use of the Closing
The Gap: Increasing Access and Equity kit throughout the year, through individual action and group activities.
5
Lao People's Democratic Republic to Implement Health Worker Retention Tool
Capacity Plus
06/04/2011
CapacityPlus has begun assisting the Lao People's Democratic Republic (PDR) Ministry of Health to prioritize
different retention incentive options and determine the most appropriate bundles of interventions to retain
rural health workers. The project is working in collaboration with the World Health Organization and the Lao
PDR government.
CapacityPlus will train and assist the Ministry of Health to conduct a rapid discrete choice experiment (DCE) in
May using the project’s Rapid DCE Tool. The tool is a powerful, quantitative method used to determine health
workers’ preferences regarding different employment options and to predict health workers’ decision-making
using hypothetical choice data.
The tool provides country counterparts with step-by-step directions to carry out the DCE and descriptions for
each part of the process—from choosing focus cadres to analyzing and interpreting the results. The tool also
contains sample formats for each step that can be adapted by the in-country user.
In addition, the tool allows countries to build skills to independently monitor and improve retention
interventions by:
 Maximizing country ownership
 Increasing host country capacity
 Reducing reliance on external technical assistance
 Reducing time and cost.
In Lao PDR, use of the rapid DCE and the associated Open Source costing tool—iHRIS Retain—will help the
Ministry of Health and the Government secure the evidence needed to make informed decisions about the
health workforce.
Related items:
 Retaining Health Workers: A Rapid Methodology to Develop Evidence-Based Incentive Packages
 Improving Rural Retention of Health Workers in the Lao People’s Democratic Republic
 What Brought Us Here Won’t Get Us There: Implementing Country-Level Health Workforce
Development Plans
6
A month at Merlin: March 2011
Merlín, UK
08/04/2011
With Merlin working in 14 countries around the world, there is always something new to share with you
Afghanistan
4
A Household Survey in Takhar Province has shown deliveries in clinics are higher than in the previous years.
Prenatal visits and births attended by Skilled Birth Attendants have also increased, partly due to the
recruitment of Merlin’s Community Midwife Education school graduates.
The 26 new students in Taloqan are preparing to visit communities for deployment while in Kunduz, the fourth
batch of students passed their exams with an average score of 88%.
Now qualified, they can begin providing vital maternal health services to remote communities.
Democratic Republic of Congo
On March 8, Merlin staff took part in International Women’s Day celebrations across the DRC, a country where
rape is commonplace and the risk of a women dying during childbirth is high.
The staff then spent the rest of the day talking to the public about the Merlin Hands Up for Health Workers
campaign and collected almost 500 signatures of support. For more information and photos of the day’s
events, visit the campaign website
Central African Republic
Merlin has been working with the government to provide a five day immunization campaign, providing deworming and vitamin A supplementation.
Merlin is also planning to start two six month projects, one on preventing sexual and gender-based violence
and another on child, newborn and maternal survival.
Ethiopia
Merlin is monitoring a possible outbreak of measles in Ethiopia and is managing 50 cases of reported
dysentery.
Merlin has been working in the country since 2003, providing primary health care and water and sanitation
services to vulnerable populations.
Haiti
During the traditional celebration of Kanaval, Merlin participated in a community discussion about cholera
prevention on Gamma FM radio, which is broadcast in northern Haiti.
Merlin also produced a three minute hygiene message that was broadcast on the radio channel ‘Parole de Vie’
and displayed banners with hygiene messages.
Simple public health information is crucial to prevent the spread of diseases like cholera and radio reaches a
large number of Haitians.
Kenya
Heavy rains have affected programme activities in Kenya but undeterred, Merlin supported World TB Day
activities on March 24.
Merlin has also been providing support and mentoring for staff who will be providing clinical, laboratory and
psychosocial services at five new health facilities.
Liberia
As the situation in the Ivory Coast worsens, an increasing number of refugees are crossing the border into
Liberia.
More than 36,000 refugees have entered Grand Gedeh, where Merlin supports a clinic in Toe Town but is
seeking additional funds in order to respond further.
Photos from Merlin’s work can be found on the Guardian website here and information about Merlin’s activities
in Liberia, including our appeal, can be found here.
Pakistan
Merlin opened a new maternal and child health labour room in Muzaffargarh in the Punjab province.
This is in addition to 17 mobile teams and 103 static health facilities that Merlin supports, located across 22
districts in four provinces.
South Sudan
Around 1,000 people attended World TB Day celebrations at the Pageri Primary Health Care Unit on March 24.
Merlin has also been working with local authorities to encourage local chiefs to build a new primary health care
centre.
Your support means that Merlin can work in 14 countries around the world. To read more about all the
countries we work in please visit our map and if you would like to support our work please visit our our giving
page.
7
2.6 million babies stillborn in 2009
WHO
5
14/04/2011
14 April 2011 | Geneva - Some 2.6 million stillbirths occurred worldwide in 2009, according to the first
comprehensive set of estimates published today in a special series of The Lancet medical journal.
Every day more than 7200 babies are stillborn − a death just when parents expect to welcome a new life −
and 98% of them occur in low- and middle-income countries. High-income countries are not immune, with one
in 320 babies stillborn − a rate that has changed little in the past decade.
The new estimates show that the number of stillbirths worldwide has declined by only 1.1% per year, from 3
million in 1995 to 2.6 million in 2009. This is even slower than reductions for both maternal and child mortality
in the same period.
The five main causes of stillbirth are childbirth complications, maternal infections in pregnancy, maternal
disorders (especially hypertension and diabetes), fetal growth restriction and congenital abnormalities.
When and where do stillbirths occur?
Almost half of all stillbirths, 1.2 million, happen when the woman is in labour. These deaths are directly related
to the lack of skilled care at this critical time for mothers and babies.
Two-thirds happen in rural areas, where skilled birth attendants − in particular midwives and physicians − are
not always available for essential care during childbirth and for obstetric emergencies, including caesarean
sections.
The stillbirth rate varies sharply by country, from the lowest rates of 2 per 1000 births in Finland and
Singapore and 2.2 per 1000 births in Denmark and Norway, to highs of 47 in Pakistan and 42 in Nigeria, 36 in
Bangladesh, and 34 in Djibouti and Senegal. Rates also vary widely within countries. In India, for example,
rates range from 20 to 66 per 1000 births in different states.
It is estimated that 66% − some 1.8 million stillbirths − occur in just 10 countries: Afghanistan, Bangladesh,
China, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, and the United Republic
of Tanzania.
Comparing stillbirth rates in 1995 to 2009, the least progress has been seen in sub-Saharan Africa and
Oceania. However, some large countries have made progress, such as Bangladesh, China, and India, with a
combined estimate of 400 000 fewer stillbirths in 2009 than in 1995. Mexico has halved its rate of stillbirths in
that time.
“Many stillbirths are invisible because they go unrecorded, and are not seen as a major public health problem.
Yet, it is a heartbreaking loss for women and families. We need to acknowledge these losses and do everything
we can to prevent them. Stillbirths need to be part of the maternal, newborn and child health agenda,” says Dr
Flavia Bustreo, WHO's Assistant Director-General for Family and Community Health.
Well-known interventions for women and babies would save stillbirths too
The The Lancet Stillbirth Series, shows that the way to address the problem of stillbirth is to strengthen
existing maternal, newborn, and child health programmes by focusing on key interventions, which also have
benefits for mothers and newborns.
According to an analysis to which WHO contributed in the Series as many as 1.1 million stillbirths could be
averted with universal coverage of the following interventions:…..Continued
Full-text: http://www.who.int/mediacentre/news/releases/2011/stillbirths_20110414/en/index.html
Back to top
Africa & Middle East
1
Medical aids told to shift focus to preventative care
New Age, SA
07/04/2011
Zinhle Mapumulo
Health Minister Aaron Motsoaledi has given medical aid schemes an ultimatum to change the way they function
or government will make a law that will force them to change.
At present, private doctors focus on curative health rather than preventing diseases. Motsoaledi said: “I have
warned medical aid schemes that they need to change. If they refuse, we will make a law to make them
change.” “We want a health system that prevents things from happening.
“We are no longer running a healthcare system in this country, but doing a service of procedure, for which
doctors in the private sector are being heavily rewarded. “This must change,” said Motsoaledi.
6
It is not the first time the Health Minister has criticised the private health sector, saying it was unsustainable,
destructive and very costly.
Motsoaledi had the same complaint in February. At the time, the Board of Healthcare Funders of Southern
Africa (BHF) shared the minister’s sentiments.
However, the BHF said government needed to review the legislated Prescribed Minimum Benefit (PMB)
package, which was structured around diagnosis. Motsoaledi said: “The current destructive healthcare system
cannot be allowed anymore.”
“If a young girl can stand up now and go to her medical aid and ask, ‘Can you pay for contraceptives for me?’,
they would immediately say, ‘No, you are mad. We don’t pay for such things’. The young girl will leave without
contraception and fall pregnant,” he said. “She sees a sign that says ‘safe abortion’ and she goes and does it.
“The girl ends up with septic abortion. Then she comes back to a private hospital and is admitted to the ICU for
two weeks. The bill comes to about R100000. Then the medical aid starts paying when they could have paid for
a contraceptive costing only R20,” Motsoaledi said.
The private health service caters for about 7 million people in South Africa and spends about R56bn in
operations. This was the amount spent by the provincial health departments to collectively cater for 41 million
South Africans in the 2007-08 financial year.
Dr Humphrey Zokufa, managing director at BHF, said: “The minister is correct. Private healthcare is
unsustainable in South Africa. The structure of the system definitely needs to be reviewed. Our funding method
is leading to where only the rich will be able to afford medical aid.
“We need to structure the review so that it includes preventative, curative, chronic, catastrophic and
quaternary care,” Zokufa said.
2
LES MÉDECINS RÉSIDENTS: «Nous sommes outrés et dégoûtés»
L’Expression, Algeria
12/04/2011
Walid AÏT SAÏD
Le problème des résidents en sciences médicales est loin de connaître un dénouement. Après plus d’un mois de
grève aucune solution ne se profile à l’horizon. Bien au contraire, la situation ne fait qu’empirer de jour en jour.
Et le dernier communiqué du ministère de la Santé n’est pas de nature à arranger les choses! Selon le Dr
Benhabib Amine, délégué national de la Coordination autonome des médecins résidents algériens (Camra),
cette note qui demande aux résidents de choisir de nouveaux délégués pour rouvrir les négociations, «les a
outrés, même dégoûtés».
Le Dr Benhabib, affirme que «le ministère veut nous mettre à l’écart. Or il oublie que nous avons été élus
démocratiquement par nos pairs. De ce fait, nous resterons et serons les représentants légitimes des
résidents». Il ajoute que «s’il veut dialoguer cela se fera avec nous, et il sait très bien ce qu’on demande avant
toute négociation: l’abrogation du service civil». Le Dr Benhabib assure que le Camra est un bloc solidaire et
aucune tentative de déstabilisation n’aboutira.
«On est tous déterminés à nous battre jusqu’au bout, on a tous le même but, la même volonté et rien ni
personne ne pourra changer cela», affirme-t-il. Pour ce qui est du sit-in d’hier, «il va dans la continuité de nos
actions qui ne prendront fin, qu’à la satisfaction totale de nos revendications». D’après le Dr Benhabib, «même
s’ils n’ont pas été reçus à la Présidence, tout s’est bien passé». Contrairement aux étudiants, les médecins
n’ont subi aucune violence policière.
«On s’est, comme d’habitude, organisés pour encadrer nos collègues afin d’éviter tout débordement ou
dérapage», explique-t-il. N’ayant pour le moment reçu aucune réponse convaincante, les résidents
réfléchiraient à la possibilité d’un sit-in permanent devant la Présidence. Le sit-in d’hier, tout comme celui de
mercredi, a vu la participation des internes en médecine de 7e année. «On est là par solidarité pour nos
aînés», affirme pour sa part le Dr Mokadem, délégué de ces internes.
Il insiste sur le fait que les résidents se battent pour l’intérêt de tous les médecins et futurs médecins
algériens. «Il est de notre devoir de les soutenir, leurs doléances sont pour le bien de la santé algérienne,
c’est-à-dire les patients et les praticiens», défend-il.
Toutefois, il tient à préciser que même les internes ont des doléances propres à eux et qui n’ont reçu aucun
écho de la part de leurs deux tutelles respectives à savoir le ministère de la Santé et celui de l’Enseignement
supérieur. C’est pour cette raison que les internes ont décidé de reconduire aujourd’hui et demain, comme la
semaine dernière, une grève de deux jours.
«Si personne ne prend en compte nos réclamations, on se verra contraints d’entamer, dès la semaine
prochaine, une grève illimitée», conclut le Dr Mokadem.
7
3
Benghazi Hospitals Struggle to Treat War-Wounded
UN IRIN
13/04/2011
Benghazi — Al Hawari hospital may be the most modern medical centre in the eastern Libyan city of Benghazi,
but the large number of war wounded it has received in the last two months has stretched its limited
resources.
"When the fighting began, most of the injured - both civilians and soldiers - were transferred here," said the
hospital's senior medical officer Fabri El Jroshi. "We were missing a lot of important equipment to treat them,
and we still are. We need material for fractures and fixtures and we badly need more nursing staff.
"Sometimes patients will find a doctor here, but no equipment for fixing a broken bone."
The 500-bed hospital has received 800-1,000 patients with war-related problems, El Jroshi told IRIN.
"Providing physical therapy is also difficult. Again, we just don't have the equipment. Even before the conflict
we had problems treating certain groups of patients, especially in the orthopaedic field."
Médecins Sans Frontières (MSF) emergency coordinator for Libya Simon Burroughs said: "All the doctors and
medical staff that we've met in Benghazi, Brega and Ajdabya are incredibly skilled and dedicated. Although
doctors are coping, many foreign nurses working in eastern Libya have now fled, leaving gaps in many health
facilities. Medical students are doing their best to fill some of the gaps."
At one point, MSF left Benghazi after the security situation deteriorated. It is now back and has so far provided
more than 30 tons of medical supplies to different hospitals, including surgical kits and equipment required for
the treatment of gunshot wounds.
"On a more global level, we are struggling to get a clear picture of the needs as the security situation does not
allow us to undertake even some basic assessments," Burroughs added. "When we tried to reach the town of
Ras Lanuf - 300km west of Benghazi - we had to turn back twice because of fighting and insecurity."
Transferred to Qatar
The most severely war-wounded patients have been transferred from Benghazi's hospitals to medical facilities
in Qatar. Benghazi doctors are also having to deal with cases which were rare previously, like rape and
paralysis.
Twenty-six-year-old Abdusalam* was admitted to the hospital last week, after being hit by a NATO strike that
unintentionally targeted a group of rebel fighters heading for the frontline near Ajdabiya. He fractured his thigh
and sustained bullet wounds to the lower chest. His mother and sister were not aware he was a rebel fighter,
he said.
"My mother is sick and I didn't want to worry her. My father and brothers are proud of me though... We saw
NATO planes flying above us and then suddenly, for no reason, they started to strike us... Before the revolution
began, I was sitting behind a desk. I was an employee in an office. Once my body heals, I hope to go back to
the frontline," he told IRIN.
"I would like to go to the frontline too, but I have a job. And treating the injured is just as important," El Jroshi
said.
Shortage of nurses
Nursing resources are stretched. According to the International Organization for Migration, several hundred
Filipino nurses have left eastern Libya since the unrest began.
Jeanette Calo is one of those who decided to stay. A Filipino nurse who left Manila for Benghazi a year ago, she
said there was a shortage of nurses. Seventy of her colleagues at the Al Hawiya hospital have returned to the
Philippines.
"I decided to stay because it is my job to be here to care for the patients, especially the rebel fighters injured
on the frontline. I had no experience treating gunshot wounds previously, so I had to learn quickly."
For two weeks, at the worst point, the nurses slept at the hospital. "We worked 24-hour shifts, waiting for the
injured to arrive," she told IRIN. "Things are better now but we are still lacking some equipment, and we have
to work extra hard to make up for the loss of so many nurses."
Calo added that some of her Filipino colleagues were visiting Tripoli when the unrest began. Unable to return
home to Benghazi, they were instead recruited by a Tripoli hospital that paid higher wages, she said.
One stethoscope
At the El Jalaa hospital on the other side of Benghazi, the situation is worse. Dr Nishal El Fayah said that
although stocks of medicine are sufficient, there was a severe shortage of some medical supplies.
On one of the wards, which has 38 beds, there is only one stethoscope and one blood pressure
monitor...Recently we received a patient who had hepatitis. In order to ensure that the equipment was not
8
contaminated, we decided not to monitor his vital signs.
"On one of the wards, which has 38 beds, there is only one stethoscope and one blood pressure monitor," he
said. "Recently we received a patient who had hepatitis. In order to ensure that the equipment was not
contaminated, we decided not to monitor his vital signs."
Medical students, many of whom have been working unpaid at the hospital since the conflict began, have not
been able to buy uniforms or appropriate footwear. "The shops are closed, so they have to go around in their
old shoes," he said.
Occupying one bed was Younis Abdousalam Edbeshi who was shot by pro-Gaddafi forces while fighting at the
beginning of March.
Another patient, Ed Beshi, who fractured his left thigh, was being treated for gunshot wounds, but could not be
operated on due to a shortage of medical supplies.
"I was told to go home and return in a few weeks... The hospital didn't have the supplies to help me. I was
hoping to be back on the frontline supporting the other rebels, but I'm still here, waiting for an operation... It
is frustrating, but the hospitals here were just not ready for war casualties."
Misrata
Although Benghazi's hospitals lack supplies, aid workers say needs are greater in the city of Misrata, where
doctors at the polyclinic there have recorded 257 deaths since 19 February, mostly civilians killed by snipers or
gunfire. The polyclinic said 949 people had been treated for wounds.
According to Human Rights Watch, Misrata's main hospital had been under construction for the last two years,
meaning that the seriously injured have been treated at the polyclinic instead.
"All over Libya, hospitals close for construction, often for several years," Fouad El Mabrouk, a doctor at
Benghazi's El Jawaa hospital, said. "Under the Gaddafi regime, construction would begin and then the funds
would dry up. Libya has many hospitals that could have been excellent centres for medical treatment, if only
construction had been completed."
Some of those injured at Misrata are being brought by ship to Benghazi.
"We never know who or what to expect," said paramedic Mohammed Nour. "So we have to be prepared for the
worst. All we receive is a call saying that a vessel is about to dock at the port, and we get straight down there.
Sometimes we have to deal with complicated injuries. Other times, fortunately, cases are much less serious."
*not a real name
This report does not necessarily reflect the views of the United Nations
4
Ministry of Health to Spend U.S.$30 Million on Medicines
AIM, Mozambique
12/04/2011
Maputo — Mozambique's Ministry of Health will spend 30 million US dollars on buying medicines following the
severe shortage that hit the country last year.
This was disclosed on Monday by Health Minister Alexandre Manguele, who was speaking during his ministry's
Coordinating Council meeting which is currently under way in Maputo, reports the daily newspaper "OPais".
The Minister said that there has been remarkable progress in the health sector, particularly in the reduction of
infant and maternal mortality and the number of children under five years old who are underweight.
As for progress made last year, the Minister noted that the health sector managed to exceed targets
established for institutional delivery as a result of joint efforts by health care workers and cooperation partners.
However, he acknowledged that there is still room for improvement. "It is not enough to have reports telling us
that all targets were met and that all is well and under control. The sad reality is that child mortality remains
high and maternal mortality continues to embarrass us. The prevalence of malaria and tuberculosis is still a
cause for concern. Malnutrition continues to be the main cause of illness during childhood. Health is far from
what we would like it to be in our country. It is through our effort, our intelligence and dedication that we will
reverse this situation", stressed Manguele.
The decision to spend 30 million dollars on medicines comes in the context of the recent find of large quantities
of expired medicines in a warehouse hired by the Ministry of Health in the southern city of Matola - with
nobody able to explain who was responsible for allowing drugs worth millions of dollars to deteriorate in this
way.
The medicines found in the warehouse included pain-killers (ibuprofen and paracetamol), oral rehydration
salts, anti-malarial drugs (coartem), the antibiotics ampicillin and metronizadole, and anti-retroviral drugs.
9
Health units across the country have been complaining bitterly about shortages of medicines, yet here were
box after box of medicines that had been allowed to lie in a warehouse until they passed their expiry dates. It
was found that some of the medicines had expired five years ago.
6
Mobile Phones to Offer Health Sector the Kiss of Life
Daily Nation, Kenya
09/04/2011
Sam Wambugu
Nairobi — Kenya has been in the spotlight for all its rosy news regarding the rapidly growing mobile telephony
and Internet coverage. As of last September, there were nearly nine million Internet users and over 22 million
mobile phone users, and counting.
The Kenyan population, according to last year's census is about 40 million. About 22 million or nearly 60 per
cent of Kenyans are over 15. This is roughly equal to the number of mobile phone subscriptions.
On the other hand, there are only 17 physicians for 100,000 Kenyans and 120 nurses for the same population.
These figures are even worse in the rural and hard-to-reach areas as these professionals are mostly in urban
comfort zones.
To resuscitate this sector, developing countries are starting to explore ways of tapping into the power of mobile
phones and Internet connectivity to reverse the trend of the health outcomes.
Disease prevention
Studies have shown that mobile phones can improve access to, quality of and efficiency in the delivery of
health care, as well as disease prevention and well-being.
True, telecommunications industry stakeholders are not health experts, and health experts rarely fully
comprehend the potential that technology may provide in achieving critical health objectives.
Therefore, the two groups need to work closely together to expand services using the power of mobile phones
and the Internet.
M-health, or mobile health, is a term used for the practice of medical and public health, supported by mobile
devices and has been identified as a viable solution to the ills plaguing the health sector.
While m-health certainly has application for industrialised nations, the field has emerged in recent years as
largely an application for developing countries, stemming from the rapid rise of mobile phone penetration in
these countries.
The promise of mobile health is to achieve co-location through technology, allowing patients and health
professionals to interact without the need to be in the same place.
Phones - whether they be cell phones, smart phones or mobile-enhanced diagnostic devices -- have the ability
to revolutionise several components of the health delivery system, including collecting clinical and community
health data and monitoring a patient's vital signs in real time.
This augments the direct provision of care by linking health care workers to patients, delivering health care
information to practitioners, researchers and patients, as well as addressing supply chain management
problems.
More importantly, this mobile phone-based model potentially sees the patient, not the health care provider or
the device manufacturer, footing the cost of network connectivity through a phone subscription.
Further, mobile phones could play a significant role in health financing systems, including authentication of
health insurance subscribers, monitoring of health benefits and paying for health services and products.
M-health is not new
M-health is not new in Kenya. In 2008, for example, the US Centres for Disease Control and Prevention (CDC)
funded an m-health programme in Western Kenya where HIV-positive patients were sent weekly text
messages inquiring about their well-being.
Patients responded to these message by saying everything was OK or they had a problem. If there was a
problem, a health worker would call back to assist them.
Results of this project involving 500 patients show that mobile phones can be a useful tool in supporting HIVpositive patients.
M-health has also been used at limited capacity in Kenya for education and awareness programmes largely
spreading mass information from source to recipient through short message services (SMS).
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SMSs are relatively unobtrusive and provide an avenue to reach far-reaching areas that may have limited
access to public health information, workers and clinics
Fortunately, Kenya has a database of all health professionals and health facilities complete with all services
offered in each of the facilities -- an important foundation for m-health.
7
The Nation in Need of Systemic Implementation of Healthcare Interventions - Osotimehin
The Daily Independent, Nigeria
06/04/2011
Kemi Yesufu
Interview
Recently appointed Director General of the United Nations Population Fund (UNFPA) and immediate past Health
Minister, Professor Babatunde Osotimehin, was in Nigeria on an official visit. In this interview with our
Correspondent, Kemi Yesufu, he spoke on developmental issues including girl-child education and healthcare
delivery especially in Nigeria, among other issues. Excerpts:
At an earlier forum, you asserted that for Nigeria to make headway in healthcare delivery, there must be a
systematic change, which will have the councillor in local councils executing the same programmes with the
Minister of Health. What informed this?
Yes, I made that statement in the sense that as we move forward, the way to make progress is to get the
Health Bill passed and to have co-ordination across board because when the local councils don't know what the
state is doing and the states don't know what the federal government is doing, it leads to duplication. Already,
the resources we have are not adequate, then, we are not using them efficiently to get the outcomes we are
chasing. So I believe that as we should pursue the passage of the Health Bill, we should put in place a system
that is better coordinated so that funds are properly used. This will lead to our getting better results.
You equally talked about Nigeria setting aside 15 percent of its budget for Health as proffered by the UN. What
do we do to get government to this?
As the Director General of the UNFPA, I understand that the President Goodluck Jonathan administration is
disposed to increasing funding for healthcare to 15 percent. But we must not get fixated on 15 percent because
it is the minimum not the maximum amount. We should be thinking towards a higher percentage than the
minimum. We should convince government to invest in other sectors that have direct effect on health such as
water resources. We were at the National Population Commission; they have the figures of people that have
access to clean water. It is small. There is also the issue of sanitation. We advocate that government deals
with issues that have direct consequences on health. Issues like roads, housing, have great impact on health.
This makes it pertinent that as we advocate on increased funding for health we should also focus on the allied
sectors. Beyond increasing budgetary allocation, implementation is also a major issue. We have to ensure that
budgets buy the services Nigerians need. Are children getting clean water and a good education? Are we
providing the right services because these ultimately affect the outcomes in the health sector?
With hindsight how can government remove the bottlenecks that slow down healthcare delivery?
I think that if we have the Health Bill passed and it is followed by political will from the executive arm, it will
have good effect. The Health Bill says that government should spend two percent of the budget on health and
this is huge. It says that we use majority of the funding at the primary healthcare level. It also says that we
spend on human resource development and the NHIS. The bill covers a substantial part of what I would love to
see being done for the health sector. The challenge I envisage with the passage of the Health Bill is having a
strong, well-coordinated structure to see that the Health Bill is fully in force.
Still talking about your pronouncements, you equally stated that the lopsided distribution of healthcare workers
must be addressed. How can this be done considering that many think that situation is one that will remain the
way it is for a very long time?
It is difficult because it's about people's right to choose where they want to work. With the political reality in
Nigeria the only thing I can imagine would happen is that state governments will provide professionals like
nurses, midwives and doctors the same kind of wages and welfare packages as the federal government. Some
of the strikes in recent time were based on the difference in wages at the state and federal levels. We can also
expand on the Midwives Service Scheme established during my tenure in the ministry of health. This
encourages people to go to parts of Nigeria they are not interested in going.
There are great expectations as you fully commence your tenure as UNFPA boss. What are your goals?
The UNFPA is a United Nations Organisation agency that has the responsibility of looking after issues in
population, gender equality and reproductive health/rights. Our work is determined by what was agreed to at
the international conference on population and development in Cairo. We are positioned to help governments
look after population and its dynamics, particularly among young girls. We also provide information and
services in the area of reproductive health, maternal health, family planning, Sexually Transmitted Diseases
and issues on neonatal health. My team and I are fully prepared to carry out our role to in all the countries we
are presently in.
In Nigeria girl-child education remains a major challenge, how will your agency help improve the situation?
We had a meeting with Minister of Women Affairs and Social Development. I propose to talk with Minister of
Education during my next visit. I met with the Ministers of Finance and Health. But I do know that statistics
show that girls have better access to education. The enrolment rates are on the increase, so we will continue
11
with advocating that young girls remain in school. This is because education has proven to help women make
better choices.
Reproductive health experts decry the minimal budgeting for reproductive health commodities. How will you
use your position to help remedy the situation?
We are going to be great advocates. We will carry our advocacy to the Ministers of Health, Finance and the
National Assembly. Our advocacy will not just be about providing figures. We will also have to make them see
the investments that other countries have made that make the difference in saving the lives of women and
young girls.
How can women get reproductive health commodities in the Nigerian setting where majority of them are
denied their rights to make decisions on family planning?
We just concluded a meeting before you came in. We spoke with community leaders and religious leaders. This
is one sure way of providing women with better options without offending cultural or religious sensibilities. We
know that with the kind of leaders we met today, we can penetrate communities.
Experts often talk about Nigeria having one of the best population demographics in the world. We have youths
in the majority. How can government move from stating the obvious to utilising this advantageous
demographic?
It's not just Nigeria that has this kind of population; it is a re-occurring characteristic in the developing world.
My focus in UNFPA is working with young people. We will engage young people the world over to create
programs through which they will have better access to education, credit, and employment. We will ensure that
youths are positioned in a way that they can contribute to the development of their country.
Do you agree that it is a paradox that you come from a country that the services that you mentioned constitute
a major challenge to government?
I don't think it is a paradox in the sense that I can use the office I hold now to interface with the Nigerian
government to make rapid progress along those lines. These problems are not peculiar with Nigeria. If you
follow the global trends, the Millennium Development Goals five, (MDG 5) is the least accomplished and these
issues fall under it. This has made it necessary for us in UNFPA and our partners to adjust our programs aimed
at achieving the MDG 5.
In this regard, are you satisfied with the programs designed by UNFPA and its partners?
I must say I am. We are also satisfied with our input to the National Health Framework. What we now have to
do post elections is to accelerate our interventions.
Looking back to your tenure at the Ministry of Health, what would you do differently if you were given a second
chance?
I would have worked more vigorously for the passage of the Health Bill because it is important to how we do
things. I would have begun to implement the health framework. I would also have ensured the integration of
important services at the primary healthcare level and I would have addressed the challenges of covering the
informal sector in the National Health Insurance Scheme (NHIS). A large chunk of the Nigerian population
doesn't work for government. So to improve the demand for the NHIS, we must extend its services beyond the
formal sector. Today 70 percent of what we pay for health comes from our pockets and this is not good.
Judging by the structure of health care delivery in Nigeria, do you see us achieving MDG 5 and 6?
I am an optimist. My take is that after the elections, the Health Bill will be passed and things will improve
greatly. I also want to say that some states are doing well and are meeting the MDGs 5 and 6 as we speak
because of the way there are structured. We should ensure that the central co-coordinating systems at all
levels are effective; we should encourage states doing well not to relent. This way, they serve as models for
others to emulate.
How will you use your office to assist Nigeria?
The important thing is that I have worked in Nigeria so I understand how the system works. So as we
implement our country programme I will ensure that I make an input. From experience of the immeasurable
benefits of advocacy, I will equally ensure that we carry far-reaching advocacy campaigns.
8
Ministry to combat apathy and brain drain among health workers
Ghana News Agency
05/04/2011
Accra, April 5, GNA - The Ministry of Health, in collaboration with the National Health Award Project, has
launched a Project to fight apathy and the brain drain among health workers.
The National Health Award Projects also forms part of national efforts for promoting quality and affordable
healthcare in Ghana.
The Projects come in two forms which include the "Health Legend" a television series and the National Health
Awards 2011 which comes off in September.
Speaking at the event Mr Vincent Ashong, the Medical Consultant, said the initiative would serve as a unique
stage to pursue governmental and non-governmental policies that are related to health care and medical
research.
12
He said it would offer the public the opportunity to appraise the country's healthcare services as well as help
the government in setting realistic benchmarks for the sector.
Mr Emmanuel Adusei, member of Institute of Public Relations, Ghana, said the television series was aimed at
recognising the immense achievements and contributions of Ghana's health sector and encourages health
practitioners and Service providers to be more dedicated and patriotic in discharging national duties.
"This initiative has become necessary due to the fact that the health sector needs a consistent media platform
to build on her image and serve as a resource base for discovery and innovation," he said.
He said the initiative would provide an uncommon opportunity for many young professionals to be motivated
and inspired by achievers in the sector.
Mr Baba Jamal, the Deputy Minister of Information, pledged the ministry's support to improve the health of
citizens and expressed the hope that the initiative achieved its intended purpose.
9
The nation needs new Nightingales (Editorial)
The National, UAE
10/04/2011
It was aboard a ship on the Nile where that advocate of modern, specialised nursing, Florence Nightingale,
supposedly received her calling. More than a century later, the region needs more women and men to be
struck by a similar epiphany.
As The National reported yesterday, new hospitals and clinics that are opening this year are aggravating a
nationwide shortage of nurses. Like many other countries, the UAE is seeking to recruit nurses from overseas.
But ambitious plans in national health care will depend not only on recruitment, but also on skill development
and training.
Last year, the Ministry of Health set up a Nursing and Midwifery Council to oversee the field, and recruiters
have been tasked to hire hundreds of staff from the Philippines, Lebanon, Jordan, Syria and India. A Ministry
delegation conducted interviews and tests overseas for more than 200 applicants.
That level of foresight should underpin the entire health-care project. The goal is not just to recruit nurses from
abroad, but also to encourage Emiratis to enter the profession. The effort is being held up because many
Emiratis see a lack of opportunity in the field.
Those fears are, at least in part, justified. One 23-year-old Emirati nurse expressed her disappointment: "We
were being told it is a very attractive profession and very easy to find a job and go far, but this is not what we
experienced." Another nurse knew of only one regional centre in Saudi Arabia that provided an opportunity for
nurses to specialise.
The medical profession is changing fast. Duties that were allocated to nurses in Nightingale's time are now the
province of medical assistants. A highly skilled nurse should be nearer the top of the medical profession,
having more in common with physicians than menial staff.
New specialised hospitals and clinics will need staff trained in fields as diverse as intensive care to paediatrics.
There is some recognition of this - a forum on medical specialisation at the American Hospital in Dubai
tomorrow will raise the same issues.
But there is a disconnect between means and goals. Recent cutbacks in the health-care budget will affect
recruitment and specialisation programmes, not to mention general health care, particularly in the Northern
Emirates. Nurses who have found their vocation deserve our full support.
10
No to private health care (Editorial)
Haaretz, Israel
11/04/2011
The negotiations between the Israel Medical Association and the Finance Ministry have run aground. But even if
both sides make compromises, there is one demand the government must not accept under any condition:
instituting private health care in hospitals run by the government or the Clalit health maintenance organization.
Those leading the push for private care are private insurance companies; a group of veteran doctors whose
primary concern is themselves (at the expense of their younger colleagues and specialists in fields that don't
allow for private practice ); and Deputy Health Minister Yaakov Litzman, who is behind the move because
private health care is popular among the ultra-Orthodox, whom Litzman represents as a United Torah Judaism
MK.
And now Prime Minister Benjamin Netanyahu is adding himself to the list. His position contravenes an opinion
handed down by the attorney general in 2002, which came out strongly against privatized medicine, and a
13
High Court of Justice ruling from 2009 that found that, aside from long-standing agreements with Jerusalem
hospitals, the private health care that had seeped into public hospitals during afternoon hours was illegal.
Supporters of private health care argue that it will give experienced specialists a reason to stay at hospitals
rather than work in private clinics, shorten the waiting periods for medical services, and serve as a source of
income that will be used to benefit all patients, most of whom have supplementary insurance. But the Finance
Ministry says institutionalizing private care will increase the health care budget by NIS 3 billion, make private
hospitals unnecessary, and reduce the productive competition between public and private hospitals.
The issue is even more serious when examined through the lens of social welfare. "Shortening the line for one
person," the High Court wrote in its 2009 ruling, "means making the line longer for someone else."
Indeed, many public health specialists expect an expended private health care system to increase the wait for
everyone else and make sought-after treatments more expensive. The burden on the public, which is already
high - 42 percent of the national health care expenditure comes from the public - will increase. At the same
time, health care in outlying areas of the country will be worse off and it will become more difficult to train new
doctors.
Israel's health care system is a good one, but it suffers from a shortage of doctors and resources, and it must
be shored up. Abandoning the public infrastructure for privatization will allow the state to completely ignore its
obligation to provide equal health care, and is liable to destroy the entire health care system.
Back to top
Asia & Pacific
1
EDITORIAL: Many a slip
Daily Times, Pakistan
09/04/2011
The longest strike in the country’s history by doctors in Punjab called by the Young Doctors’ Association (YDA)
came to an end after the doctors’ representatives and the Punjab government held talks and reached an
agreement. After the failure of earlier negotiations, PML-N stalwarts stepped in to persuade the doctors to call
off the strike. The government agreed to accept the doctors’ demands and reinstate the sacked protesting
doctors. The Punjab government has constituted a six-member team comprising three members each
representing the government and the doctors’ side, which will present its recommendations within 15 days.
However, judgement on this seemingly happy outcome must be reserved, as there has already been “many a
slip ’twixt the cup and the lip”. It took a complete breakdown of the health infrastructure, loss of about 500
lives due to non-availability of emergency services at public hospitals and the threat of strikes by senior
doctors in Punjab and young doctors in other provinces for the Punjab government to come down off its high
horse and finally accept the doctors’ demands for a better service structure. Regrettably, what the government
did belatedly, it could have done much earlier when the doctors first expressed disaffection with their working
conditions and salary structure over a year ago.
Chief Justice Ijaz Ahmed Chaudhry of the Lahore High Court (LHC), hearing writ petitions against the doctors’
strike has rightly taken to task the Punjab government and provincial health secretary, Fawad Hussain Fawad,
for letting things spiral out of hand. He made telling remarks about the governance style of the dispensation in
Punjab, which runs government affairs through bureaucrats and is notorious for attempting to solve problems
through removing concerned bureaucrats from their posts. However, in the present crisis, the main culprit, the
provincial health secretary, was not only allowed to continue with his job but also spoil the negotiations by
taking a hardline approach towards the doctors. For several days advertisements were published in
newspapers, first coaxing and cajoling and then warning the doctors to call off the strike or else face legal
action, which hardened positions on the other side. On March 31, the government announced a raise in the
salaries of house officers and post-graduate trainees after which the doctors ended their strike. However, no
sooner did the doctors resume their duties, the Punjab government went back on its word by stating that this
raise would be implemented through an annual raise of Rs 3,000 in the doctors’ salaries. Obviously, this ploy
did not work and the doctors immediately resumed their strike. At one point, the Essential Services Act was
evoked to take legal action against the protesting doctors and a harassment campaign was started against
them. Scores of doctors were sacked and new doctors recruited to replace them.
There is no question about the merit of both the doctors’ and the Punjab government’s stance. The doctors’
remunerations are neither commensurate with their qualification and training nor constitute a living wage. On
the other hand, it is difficult for the Punjab government to triple the salaries of young doctors overnight as per
their demand. However, the dictatorial and duplicitous manner in which the government tried to impose its
decision on doctors by painting them as the sole culprits in this crisis, and in the process prolonging the strike
by another eight days is highly condemnable. Hearing writ petitions against the doctors’ strike, the LHC has
asked the Punjab government to constitute an inquiry commission to probe the matter and fix responsibility for
the fiasco. The ‘good governance’ of the Punjab government has been exposed; the LHC should make sure that
those responsible for inducing a health crisis in the province are brought to book through an impartial judicial
process.
2
New MCI rule bars 6000 doctors from teaching
14
Times of India
10/04/2011
Mahendra Kumar Singh
NEW DELHI: A Union health ministry notification has deprived India of the services of around 6,000 doctors as
teaching faculty in medical colleges — hamstrung as it is by an acute shortage of doctors and teaching
professionals.
The ministry approved Medical Council of India's (MCI) recommendation bars Diplomate of the National Board
(DNB) degree-holders from teaching if they do not have the one-year additional teaching experience to make
them on a par with MD/MS candidates.
The directive bars around 3,000 DNB degree-holders, who have taught for several years as faculty members. It
also disqualifies another 3,000-odd doctors, who are pursuing senior residency from teaching, said an official.
According to the new rule, DNB degree-holders, who have passed out from private or non-MCI recognized
medical colleges, are required to undergo an additional year of senior residency in a teaching medical
institution.
National Board of Examination (NBE) has dubbed the move "discriminatory". Pointing out that the directive is
in direct conflict with various judgments of High Court and Supreme Court, the Board claimed that
amendments are irrational and a breach of statutory powers.
Surprisingly, the ministry revoked its own notifications of July, 2006; and February, 2009, that had done away
with the need for an additional year's teaching experience on 'unilateral' recommendation of MCI without
consultation with stakeholders like NBE.
These notifications, which had suggested that the teaching experience gained during DNB courses should be
treated as experience for teaching in medical institutions, were based on reports of expert committees and in
adherence with statutory process as prescribed by the Indian Medical Council Act.
Many within the ministry and NBE were taken aback by the move seen as a U-turn. "There is neither a cause
nor any justification at this stage to backtrack on the 2009 notification and approve these amendments," Dr K
Srinath Reddy, president, NBE, wrote in a letter to the Union health secretary. "The amended qualification
reveals that uniformity of the prestigious DNB qualifications has been breached unilaterally," the letter stated.
The ministry, in turn, has asked MCI to address NBE's demand of a rollback of the 'discriminatory' notification.
An official said MCI is dragging its feet because the Council has been asked to reconsider its own
recommendation. "Indian Medical Council Act does not empower MCI to consider or adjudicate the issue," he
added. MCI cannot regulate post-graduate courses.
3
Challenges facing the health sector (Editorial)
The Financial Express, Bangladesh
08/04/2011
The present elected government, since its assumption of office, has established a large number of community
clinics across the country. But are the preponderant rural people of the country getting significantly any extra
healthcare from their establishment? Marginally, perhaps, for the same remain understaffed. A large number of
doctors stay away from their places of duties in such public healthcare facilities, in an uninterrupted sequence
with the past, for promoting their careers in private hospitals or in private practice in cities. They are
unconscientiously taking their salaries from the government. The government has not been able to stop this
unacceptable practice. Under the present government, thus, infrastructural developments have outpaced the
availability of the people who should run the system effectively.
In this backdrop, The World Health Day was observed in Bangladesh, as elsewhere abroad on Thursday amid
different kinds of functions that were organized to mark the event and to reiterate commitment to making
sustained efforts for accomplishing the long cherished national task of ensuring the availability of healthcare
facilities to all citizens. But the same can do little to hide the fact that healthcare in the country remains in a
state which is far from being described as even reasonably satisfactory. While speaking as the chief guest in a
function to mark the World Health Day, the health adviser said regulatory reforms on health sector is needed
very much as the country now does not need mainly investment in infrastructure, rather it needs skilled
manpower. He was pointing perhaps to both not getting adequate services from the existing employed
manpower in the publicly-run healthcare system as well as the dearth of trained manpower in it.
Bangladesh, as the report said, has a staggering shortage of over 60,000 doctors, nearly 0.3 million nurses
and 0.5 million technologists. There are only about five physicians, two nurses and half technologist per 10000
people. So, a basic challenge to be overcome in the public healthcare system would be getting dedicated
service from those already engaged in it and to recruit a large number to fill the vacant slots as well as
ensuring that they are also obliged to discharge services sincerely.
15
There are also other aspects to be addressed and cured. Everyone in Bangladesh knows that most of the
medical doctors in public hospitals either own or have a contractual relationship with private clinics. For these
doctors, public service is a false identity. Their true identity is making money through their private practice or
business. They appoint public hospital staff members as brokers to bring clients to private clinics, instead of
properly treating them in public hospitals. Even if people are treated in a public hospital, they are forced to
visit private clinics for a diagnosis so that doctors can earn "commissions."
In public hospitals, from the time patients arrive for treatment, the staff encourage them and their relatives to
move to a private clinic to seek "better treatment." Simultaneously, doctors neither seriously listen to the
patients nor explain their health problems and discuss possible treatments, including the diagnosis and
medication. As a result, patients and their relatives always remain confused about the role of the doctors as
well as the possibilities for treatment for alleviating their suffering. The greed on the part of a section of
doctors is also reflected in their relationship with other healthcare professionals. They rarely delegate
responsibilities to other medical specialists, such as physiotherapists, psychologists, counselors, nurses, speech
therapists and so on, who are often looked down upon as lower class members of the health care profession in
Bangladesh.
Moreover, medical equipment in public hospitals, as the reports in the media from the countryside from time to
time do amply suggest, is intentionally kept "out of order" for years, in anticipation of increasing the business
of private clinics and earning commissions. Patients in many cases cannot expect simple pathological or
radiological tests in public hospitals. Ultimately, they are forced to go to private clinics and spend money far
beyond their financial capacities. This culture has established a new group of millionaires in Bangladesh -- the
owners of private clinics and diagnostic centres. In addition, many thousands of people who can afford to do so
-- rich and middle-class patients -- go to hospitals abroad, to avoid even the undeveloped locally available
privately offered health services, while a lack of governmental monitoring helps sustain such systems at home.
4
Chinese doctors prefer public to private hospitals
Shanghai Daily
07/04/2011
CHINA'S hospitals business is littered with the remnants of abandoned private and foreign ventures.
However, times are changing. In December, China's State Council confirmed that it foresees investors playing
a much bigger role in heath care in the country.
It's good news for the most part, according to Roberta Lipson, co-founder of Chindex International, a supplier
of US medical equipment in China. "It confirms that the Chinese government will support private investors with
preferential policies or level the playing field with public hospitals," she says.
Up until now, the record for foreign ventures in China's health care sector has been discouraging, says Sheldon
Dorenfest, president and CEO of the Dorenfest China Health care Group, a Chicago-based consultancy set up in
2006. Of the country's 20,291 hospitals, only around 4,200 (or 6.5 percent of all hospital beds) are in private
Chinese hands, and just a dozen or so are foreign joint ventures, according to an estimate by McKinsey.
Nonetheless, the government's US$125 billion health care reform launched in 2009 is making progress.
Now, an increasing number of Chinese - mostly people working for private or state-owned companies - are
eligible for Urban Employees Basic Medical Insurance, China's best established and most comprehensive health
insurance plan, and schemes have been set up for both rural and urban low-income earners.
The result: The number of China's 1.3 billion citizens who are covered by public insurance has increased to 90
percent from 45 percent in 2006.
A huge medical market indeed. But private investors face a lot of challenges, such as lack of doctors. McKinsey
estimates that there are currently 2.3 million doctors in China. One reason for the shortage is that doctors are
generally not allowed to practice at more than one hospital.
Claudia Sussmuth Dyckerhoff, McKinsey's Shanghai director, says: "Any doctor who wants career advancement
would rather stay with a public, class 3 hospital, where he or she can be more specialized, get good experience
and have a bigger case load."
She refers to thee three-tier classification system in China, with class 3 being the largest of the hospitals in
terms of beds (500 or more) and doctors, and rated the highest in terms of quality.
It is an open secret that many doctors already moonlight at other medical institutions, but that hasn't helped
private hospitals much. Many doctors are reluctant to shift to the private sector because their professional
rankings can only be enhanced by their performance at the public hospitals.
Apart from the human resource issues, private hospitals also face a huge financial handicap because they are
ineligible for social medical insurance, as the public institutions are. "If all your patients have to pay out of their
own pockets or need to have private insurance, it would have a negative affect on the overall inflow of
patients," points out Sussmuth Dyckerhoff.
16
Private hospitals, including foreign joint ventures, are now allowed to participate in the social insurance
scheme, but details, including treatment fees, are unclear and are likely to be approved on a case-by-case
basis by local heath bureaus.
Niche markets
At any rate, social health insurance reimbursements tend to be extremely low, so patients still often need
private insurance to afford the services at foreign joint venture hospitals, which are pricier than their public
counterparts.
According to Dorenfest, the greatest promise for private players is in niche markets, such as dental clinics,
obstetrics and gynecology hospitals, eye hospitals and cosmetic surgery.
Many private firms are also focusing on building their brands as superior service providers, offering access to
cutting-edge medical equipment and star doctors to patients able to pay extra.
5
Number of neonatal intensive care units falls short in Korea
The Korea Times
11/04/2011
By Kim Tae-jong
Preterm infants are more frequently being born, but neonatal intensive care units fall short of fulfilling the
increasing need.
According to Statistics Korea, the birthrate of preterm infants weighing under 2.5 kilograms account for 4.9
percent of the total births in 2009, rising from 4.3 percent in 2005 and 3.8 percent in 2000, showing a greater
need for care units.
Rural areas suffer more as experts said medical facilities and staff there still fail to effectively support preterm
infants.
“The government has been trying to increase the birthrate, but it is also important to take care of newborn
babies and help them grow healthily, which the government neglects now,” said Chang Yun-sil, a professor at
the Department of Pediatrics at the Samsung Medical Center.
A high preterm birthrate is usually seen in developed countries with low birthrates where women give birth at
comparatively older ages, she said.
“The nation’s preterm birthrate will increase to 7 to 10 percent in the future, and we have to prepare for it,”
she predicted.
But the number of neonatal intensive care units dropped to 93 in 2010 from 143 in 2005, consequently
decreasing the number of beds nationwide to 1,252 from 1,731.
Such a decrease is a major problem, especially outside of city centers. North Chungcheong Province, for
instance, has reported only one neonatal intensive care unit with four pediatrics doctors and one night-duty
doctor available.
The decrease of medical facilities for preterm infants is attributed to the fact that many hospitals suffer from a
shortage of human resources and prolonged deficits.
“For hospitals, it’s not profitable to operate a neonatal intensive care unit. It’s not fair to expect hospitals and
medical staff to take care of preterm babies, totally relying on their devotion and sacrifice,” she said.
There should be at least 200 to 600 more beds nationwide to meet the increasing need, she said, asking for
more government support.
Survival rate of preterm infants
The survival rate of low birth weight infants in the country has significantly improved over the past 50 years,
according to a recent research.
According to a journal by five pediatrics professors, the survival rate of very low birth weight infants (VLBWI)
and extremely low birth weight infants (ELBWI), whose birth weight is less than 1,500 and 1,000 grams have
been on the increase.
The survival rate of VLBWI increased to 85.7 percent in 2009 from 31.8 percent in the early 1960s and 65.8
percent in the early 1990s. The survival rate of ELBWI increased to 71.8 percent in 2009 from 8.2 percent in
the early 1960s and 37.4 percent in the early 1990s.
Titled “Recent Trends in Neonatal Mortality in Very Low Birth Weight Korean Infants,” the journal was written
by professors Hahn Won-he, Chang Ji-young, Shim Kye-shik and Bae Chong-woo of the Department of
Pediatrics at Kyung Hee University in collaboration with Chang from the Samsung Medical Center.
17
In comparison, the survival rate of VLBWI stood at 92 percent in 2008 in Japan and 92.6 percent in 2006 in the
U.S. and the survival rate of ELBWI was 85.5 percent in 2008 in Japan and 85.0 percent in 2006 in the U.S.
The better statistics are largely attributed to more advanced medical care systems in both countries, the
journal analyzed, adding the survival rates for VLBWI and ELBWI in Japan are the highest in the world and
could be achieved with its foremost perinatal care system.
To attain similar improvements in Korea, an organization of perinatal care centers, nationwide neonatal and
perinatal research networks, and regionalization of neonatal and perinatal medicine is needed, Bae said.
“We still lack neonatal intensive care units, related devices and the government’s support. Without these
things, it’s hard to make progress in the survival rates of preterm infants, especially in rural areas where only
limited facilities and medical staff are available,” he said.
6
‘Silent doctors’ weigh on healthcare quality
The Jakarta Post
07/04/2011
Tifa Asrianti
Many complaints aimed at Indonesia’s doctors concern their lack of communication skills, activists and patients
say.
Aminah, 60, who accompanied her husband Sangidun Djoefri to undergo a cardiac operation in Singapore in
2007, was impressed with the quick service in the city state as the doctors gave clear information about her
husband’s condition, the steps that needed to be taken and how much it would cost.
Farida, 31, on the other hand, experienced a major communication breakdown when she went to her doctor
recently. Her doctor stared at her X-ray and prescribed her drugs without telling her what was wrong with her.
She was left guessing and then had to ask the pharmacist when she bought the drugs.
The doctor again offered no explanation when she came for a second X-ray; he stared, nodded and told her to
go home.
She did not learn what was wrong with her until she showed her X-ray photos to another doctor, who told her
what she had — a spot on her lung. The second X-ray showed that her lung was clean, he told Farida.
Indonesian Consumers Foundation (YLKI) executive director Sudaryatmo said Indonesia’s healthcare was
hampered by a lack of communication between doctors and patients.
He said that in Indonesia, doctors and patients often had a paternalistic relationship, in which the former saw
the later as their junior.
“In other countries, doctors will tell patients about the diagnosis, what they will do to cure the disease and the
fee for the medication,” he said.
However, he added that Indonesian doctors had the same skill and knowledge — and in some cases more — as
doctors in other countries.
To solve the problem, he suggested that every hospital establish a complaint center.
Marius Widjajarta from the Indonesian Consumers Foundation for Health (YPKKI) said bad communication
between doctors and patients sometimes resulted in malpractice charges.
“The Indonesian Doctors’ Association should inform doctors that healthcare is not only about medication but
also establishing good communication between doctors and patients,” he said.
Amal M. Syaaf, a public health expert from the University of Indonesia, said that doctors in Singapore gave
information to patients because they were obliged to by a technical clinic guideline.
“The guideline has different tips on how to deliver the information for each medical case. We do not have this
in Indonesia,” he said.
Doctors Association in Asia and Oceania president Fachmi Idris said that first impressions between doctor and
patient determined how the patient would feel about the healthcare service.
He cited efforts that had been taken to improve doctor-patient communication, such as requiring medical
students to study communications and empathy, and providing doctors with a code of ethics.
“I’m sure all doctors want to give a proper explanation to their patients, but most of the time they are short on
time. If there is a doctor who is not communicative, their patients should just leave and find another doctor,”
he said.
18
Soenarto Sastrowijoto, director of the Center for Bioethics and Medical Humanities at Yogyakarta’s Gadjah
Mada University’s School of Medicine, said a doctor’s behavioral competence was important.
The center has organized two workshops for doctors on bioethics and medical humanities and doctors’ social
responsibilities.
“Competence refers not only to the students’ hands and brains but also their hearts,” he said.
Evi Mariani contributed to this report from Yogyakarta
7
Can India prevent 200 children dying every hour?
The Hindu, India
14/04/2011
Poonam Khetrapal-Singh
It is estimated that India lost 1.8 million children under five in 2008. That is more than 200 child deaths every
hour, each day, or more than three deaths every minute. Out of about 25 million babies born every year in
India, one million die. Most who survive do not get to grow up and develop well. About 48 per cent are stunted
(sub-normal height) and 43 per cent are under-weight. Additionally, about one-third of babies are born with a
low birth weight of less than 2,500 grams.
MDG target
In South-East Asia, the Maldives, Sri Lanka and Thailand have reduced newborn and childhood mortality
significantly. India has also demonstrated steady progress. Under-five mortality decreased from about 150 per
1,000 live births in 1990 to 74 per 1,000 live births in 2005-06. But at this rate of decline, India will not be
able to achieve the Millennium Development Goal 4 (MDG) target of 50 under-five deaths per 1,000 live births
by 2015. Moreover, progress has been uneven in various States in the country.
Causes
The causes of death among children are well understood in India. Newborn mortality (death within the first 28
days of life) contributes to more than half of under-five mortality. In newborns they are asphyxia (inability to
breathe at the time of delivery), infections and prematurity. After 28 days of life, they are the result of acute
respiratory infections (pneumonia) and diarrhoea. Undernutrition contributes to 35 per cent of deaths. In
addition to these, immediate causes of childhood deaths, there are several socio-cultural factors including
poverty, poor water and sanitation facilities, illiteracy (especially among women), the inferior status of women
in society, and pregnancy during adolescence (that can be attributed to early marriage). Child mortality rates
are also higher among rural populations when compared to their urban counterparts.
We know what needs to be done to save these precious lives. Newborn deaths can be prevented by ensuring
nutrition of adolescent girls; delaying pregnancy beyond 20 years of age and ensuring a gap of three-five years
between pregnancies; skilled care during pregnancy, childbirth and post-natal care; and improved newborn
care practices that include early (within first hour of birth) and exclusive breastfeeding; preventing low body
temperature and infections; and early detection of sickness and prompt treatment. Childhood deaths can be
prevented by exclusive breastfeeding for six months and complementary feeding from six months of age with
continued breastfeeding for two years; immunisation; and early treatment of pneumonia, diarrhoea and
malaria. In addition, it is important for the mother and other caretakers at home to invest in appropriate child
caring practices, right from birth to support early childhood development and lay a foundation to maximise
human potential.
India needs to provide these life-saving interventions to most, if not all, newborn and children who need them.
However, their (interventions) coverage has been quite low. For example, in 2005-06 (the National Family
Health Survey – NFHS 3 report), the rate of initiation of breastfeeding within an hour of birth was only 26 per
cent and exclusive breastfeeding at six months was just 46 per cent. Yet these two interventions have the
potential to prevent 19 per cent of deaths. The use of oral rehydration salts in cases of diarrhoea, the most
recommended treatment, was just 43 per cent and only 13 per cent cases of suspected pneumonia received
antibiotics. Immunisation coverage has been relatively better, suggesting that high coverage is achievable.
Intervention
The main causes of poor coverage of interventions include ineffective planning and implementation, mainly due
to weaknesses in the health system. To address the systemic challenges, India launched a flagship
programme, the National Rural Health Mission in 2005-06, to strengthen the health system in rural areas.
Commendable initiatives have been put in place such as training about 8,00,000 village level health volunteers
(Accredited Social Health Activist, or ASHA), hiring additional staff, strengthening the infrastructure of health
facilities, augmenting programme management capacity at State and district levels, and enhancing community
participation. However, much more needs to be done to minimise health inequities that exist among different
subpopulations in the country.
Public health expenditure in India has remained at a low — about one per cent of GDP — for quite some time.
This needs to be scaled up. Considering that about 70 per cent of health care is accessed from the private
sector in the country, better regulation and participation of private health service providers must be ensured.
Synergy between the health and nutrition sectors must be fostered through better coordination between the
Ministry of Health and the Ministry of Women and Child Development, which are responsible for the ICDS
(Integrated Child Development Services) programme.
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To reach unreached newborns and children, there is a strong case for providing home-based newborn care as
well as community-based management of non-severe pneumonia and diarrhoea in children by trained ASHAs
and other community health workers. This initiative needs to be supported by provision of incentives,
necessary drug supplies, close supervision and appropriate referral linkages. At the same time, the quality of
health services at first-level health facilities and referral hospitals must continue to be strengthened.
Fortunately, there is renewed commitment at the global and national levels towards achievement of MDG 4. To
save newborns and children, national governments, development agencies, civil society and other stakeholders
must work in close collaboration.
( Dr. Poonam Khetrapal-Singh is WHO Deputy Regional Director for South-East Asia Region.)
9
Australia needs physician assistants. So why aren’t we getting them?
Crikey, AU
12/04/2011
by Melissa Sweet
As you may have noticed, Croakey has recently been running a series of articles examining the potential of
physician assistants to improve access to health care, particularly in rural and remote areas.
These articles have been positive about the role of PAs. But we know that a number of groups are on the
record opposing or raising concerns about the introduction of PAs, including the Queensland Nurses Union, the
Australian Medical Students Association, the AMA and the 2010 Australasian Junior Medical Officer Forum. No
doubt others have been working against PAs behind the scenes.
If any of those groups – or any other PA sceptics – would like to contribute to the Croakey series, please get in
touch. It would be good to hear your responses to the pro-PA arguments that have been made.
Meanwhile, Professor Peter Brooks, director of the Australian Health Workforce Institute, explains below why he
believes that Australia needs PAs. (Incidentally, he is also due to speak at at a University of Sydney seminar on
May 3 titled “Are we training too many doctors?”.)
Professional self-interet is blocking introducton of physician assistants
Peter Brooks writes:
Well done Croakey for running these stories on Physician Assistants (PAs). The opposition to the introduction of
these health workers mirrors very much what happened in the US some 40 years ago.
Strident cries from the American Medical Association that their introduction would end life as we know it. But
interestingly – it didn’t!
Why the nurses are so actively against it is interesting but one would have to ask all opposing groups are they
interested in opposing for oppositions sake, are they interested in providing health services to patients who
currently find it difficult to access them because the workforce is not there, or are they interested in preserving
the status quo with siloed health professional practice?The health service and its constituent parts is a very
complex organism but every part of it should work together to improve patient care and not work only in the
interests of the health professional – or have I got that wrong ?
The health and social welfare workforce is currently the largest in Australia – 1.4 million – and like the rest of
the population, it is ageing.
We will need to recruit about half a million new workers at least to this sector over the next decade – a
significant challenge that policy makers and politicians do not seem to be fully accepting at present.
Where are these new workers to come from? Current recruitment will not achieve these targets so perhaps
some innovation is required. Trials of new models of care have been carried out by Queensland Health and the
South Australian Health Commission in respect to PAs.
These trials, albeit small, did suggest that these new health professionals would be useful across a variety of
health care situations. They actually assisted doctors in care delivery, worked together with Nurse Practitioners
as part of the care team, and value added to teaching of students rather than impairing it.
So why the opposition? Sad to say but may I suggest pure self interest – as always wrapped up in cries that
the introduction will impact negatively on patient safety and quality, reduce learning opportunities for medical
and nursing students and generally speed the dumbing down of health care delivery – none of which can be
supported by the many trials of PAs in Australia and overseas .
Now I have to declare my bias, having introduced the PA program at the University of Queensland in 2009.
One of the reasons was that of recruitment, the fact that in the US those joining PA programs do not want to
be doctors or nurses. So it adds to the health workforce, and that is what we have to do.
There is going to be so much work out there in health care, we need all the person power we can get.
20
Policy makers need to ensure that there is appropriate recognition of PAs and that the educational programs
are well designed and provide graduates with the right competencies for practice.
This is a time when the professional organisations and policy makers need to rise to the occasion. They need to
look outside their own silos and facilitate the introduction (and evaluation ) of new models of health care –
which will all be team based – so that we can really reform what is a very good health system, but one that
cannot cope with the challenges of an ageing and chronically diseased population as we move into the next
decade .
10
Nurses allowed to prescribe medicine for diabetics
Radio New Zealand
07/04/2011
Nurses working in specialist diabetes health care have been given the power to prescribe medicines to patients.
The move was announced by Health Minister Tony Ryall in Auckland on Thursday.
Mr Ryall says the initiative is likely to be rolled out nationally after a six-month trial involving district health
boards in Auckland, Hawke's Bay, Mid-Central in Palmerston North and Hutt Valley near Wellington.
Only registered nurses will be able to prescribe medicines under the guidance of a doctor.
Mr Ryall says registered nurses specialising in diabetes already take substantial responsibility for independently
managing patients and the extra power will result in better continuity and less complexity for patients.
The minister says diabetes is on the rise and, with growing health workforce shortages, smarter ways of doing
things are needed.
Government agency Health Workforce New Zealand says the move came from diabetes specialists, but it took
a regulation change to achieve.
Nurses see expanding role
The Nursing Council says the six-month pilot project could pave the way for a wider role for nurses generally.
Chief executive Carolyn Reed says the move will be safe for patients, who will get better access to healthcare
as a result of it, and nurses have a promising future as well.
"We have a lot of very experienced nurses who are able to take on greater roles and this pilot project will
inform us as to whether we can do something similar in other areas of health care."
The Society for the Study of Diabetes says giving nurses the power to prescribe medicines is welcome and they
for this for 15 years.
The society's medical director, Paul Drury, who also is the clinical head of the Auckland Diabetes Centre at
Greenlane Hospital, says the United Kingdom already allows the practice.
Dr Drury says diabetes is a major problem and patients will get quicker and cheaper care.
Copyright © 2011, Radio New Zealand
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1
Medical tourism draws growing numbers of Americans to seek health care abroad
The Washington Post
04/04/2011
By Manoj Jain
When my father had a toothache, he saw a dentist in Boston who recommended a root canal and dental crown
costing about $2,000. He decided to wait until he was in India, his native land, for holidays and had the
procedure done there for $200. Extremely satisfied with the service and the price, my mother decided to have
her two front teeth replaced, eliminating a wide gap that tarnished her smile, and estimated she had saved
$3,000.
According to Deloitte consulting services, 875,000 Americans like my parents were medical tourists in 2010,
traveling outside U.S. borders to receive health care: dental work, elective hip replacements, even bypass
surgery.
21
I hadn’t given medical tourism or outsourcing much thought until a few months ago, when I was at the
Narayana Hrudayalaya (NH) Hospitals in Bangalore with Devi Shetty, the founder of the medical complex and a
pediatric cardiothoracic surgeon.
Shetty told me bypass surgeries cost his patients $2,000 to $5,000, a tenth of what it would cost in the United
States. As a U.S.-educated doctor, I wasn’t sure whether I should feel threatened by or marvel at Shetty’s
setup. But I was curious, so I asked him how he was able to realize such savings.
His formula was simple: Focus on the process and on volume. “If you are investing heavily in the process, the
product naturally will be good,” he told me. Just as Wal-Mart capitalizes on the power of bulk purchasing,
Shetty has applied process and volume principles to his hospitals, using innovation and well-tested surgical
techniques developed in the United States.
Devon Herrick, a policy expert at the National Center for Policy Analysis, a think tank based in Dallas, identified
other factors that make foreign hospitals less expensive: lower labor costs certainly, but also fewer third-party
payments, price transparency, limited malpractice liability and fewer regulations.
As I spoke with Shetty, I was reminded of the epiphany Tom Friedman experienced when he conceived his
book “The World Is Flat” after meeting with the founder of Infosys. Could health care become globalized and a
level playing field, much like the software industry? Shetty’s hospitals are just a stone’s throw away from the
high-tech, oasis-like campus of Infosys, an information technology company with more than $5 billion in
annual revenue.
American health-care dollars are bound to be a prime target for providers overseas. But I was worried about
the quality of health care in a developing country where the tap water is unsafe for drinking.
Shetty, 54, wearing a surgical cap and sea-blue scrubs, had me drape on a cotton gown and surgical shoe
covers for a tour of his ICU. He told me that the Joint Commission International — a U.S.-based organization
that establishes standards for and inspects health-care providers — was coming for a review in two weeks.
I asked him a litmus-test question about quality of care delivered to critically ill patients: “What is your ICU
nurse-to-patient ratio?”
Without hesitating he said, “One to one.” The same as ours in the United States, I told him. He sent me an email in February: “We got JCI with flying colors.” More than 220 medical sites outside the United States are
JCI-certified.
I realized that Shetty was providing “value-based care,” a buzzword in today’s health-care-quality movement.
Value is defined as quality divided by cost. Shetty had maintained U.S.-standard quality in his hospital services
at a lower cost, thereby delivering better value than American hospitals do. That helps explain why the NCPA
predicts a 30 percent annual growth in the medical tourism industry over the next decade.
Though NH Hospitals caters largely to the local population, other Indian hospitals — some with Western names
such as Apollo, Escorts and Asia Heart Institute — are aggressively marketing to American patients.
But it is not an easy sell, says Arnold Milstein, a professor of medicine at Stanford University. “There are
psychological barriers to traveling overseas for health care … to countries where there is no connection,” he
says.
Indeed, even though I was born in India, I get culture shock each time I go back. If I were a Westerner
recovering from a major medical procedure in a country with a billion people with different foods, languages
and customs, I would not find it easy to have no friends or family members to visit me.
And then there is the travel and dealing with jet lag. Shetty proudly told me that his organization will soon
break ground on a $200 million, 200-bed facility that can be expanded to 2,000 beds. The location: the Britishruled Cayman Islands, an hour’s flight from Miami.
All this competition was making me a bit uneasy.
According to Milstein, though, it may not be hands-on physicians like me who should feel threatened. He
maintains that fewer than 2 percent of U.S. health-care spending can take place abroad, because so many
health conditions — a case of appendicitis, for example — require urgent attention.
What may be more significant is the potential growth of ordinary medical services, such as radiology and
laboratory tests. Ten to 30 percent of medical transcription is sent overseas, according to the American
Transcription Association, and more than 200 hospitals contract for “nighthawk” radiology reading services in
India or Australia, taking advantage of the 12-hour time difference, according to a 2006 New England Journal
of Medicine article. Many of these radiologists are U.S.-trained. Clinics from the United Kingdom send blood
tests overnight to Mumbai for cheaper processing.
On the seventh floor of one of the NH hospitals, I saw EKGs flowing across computer screens from patients
having chest pain in Africa and rural India. At the telemedicine unit, cardiologists triaged and treated patients
on whom they never laid a hand.
22
Unlike software and manufacturing, health care is highly regulated. For good or bad, protectionist policies by
state licensing boards, hospital credentialing and government legislation could require providers to be locally
based, hence limiting the flow of lab tests and patients overseas.
Regardless, medical tourism has gotten my attention, and it motivates me more than ever to do better in
providing high-quality health care at the lowest cost.
Jain is an infectious-disease specialist in Memphis and an adjunct assistant professor at the Rollins School of
Public Health at Emory University in Atlanta.
2
Community health centers offer model for improving care even as they grow
The Washington Post
11/04/2011
By Michelle Andrews
Community health centers serve 20 million people every year, and that number is expected to double by 2015,
thanks to an $11 billion infusion from the health-care overhaul and $2 billion in federal stimulus funds. If
you’re a middle-income worker with health insurance through your job, chances are these centers have been
under your radar, since their target clients are low-income and uninsured people. But as the number of
uninsured has risen to 50 million, more people than ever are struggling to get and pay for health care, and
community health centers are an affordable option. As they expand, they’re adding new services and new
locations nationwide.
Although their mission is to provide a primary-care safety net for people in underserved areas, no one is ever
turned away from a community health center. People with incomes up to 200 percent of the federal poverty
level ($44,700 for a family of four in 2011) pay on a sliding scale; uninsured people with higher incomes pay
the full cost of care, which is generally comparable to costs in the private sector. The centers accept Medicaid
and Medicare in addition to many private insurance plans.
The new health-care law is full of incentives to encourage doctors to provide “medical homes” for their
patients, with coordinated care and close patient monitoring to stay on top of necessary preventive services.
But community health centers have always taken this approach, say experts.
“It’s necessity on their part,” says Laurie Felland, a senior health researcher at the Center for Studying Health
System Change. “Because of the difficulty low-income people face in getting services … community health
centers over time have tried to add them.”
In addition to primary care, many community health centers have behavioral health providers, pharmacies,
and preventive and restorative dental services on site. Some have pediatric centers, reflecting the fact that
more than a third of their patients are children.
At the William F. Ryan Community Health Center on Manhattan’s Upper West Side, the new women and
children’s center is decorated in slate gray with bright primary color accents. The building has banks of
windows looking down on the street and is so expansive that staff members carry around tablet computers to
keep tabs on patients, says Jessica Sessions, director of pediatrics. “Patients are happier here,” she says.
A Commonwealth Fund survey of 800 community health centers last year found that 29 percent of them had all
five of the medical-home indicators it measured, among them usually providing same- or next-day
appointments, offering off-hours clinical advice, tracking test results and referring patients to specialists. An
additional 55 percent of centers had three or four indicators.
Still, arranging for specialty care can be tough, the survey found. Ninety-one percent of centers said they had
trouble getting their uninsured patients in to see a specialist, while 71 percent said that was the case for
Medicaid patients, and 49 percent reported difficulty scheduling their Medicare patients with specialists.
Wait times are another problem at many centers. In part because they don’t turn anyone away, getting an
initial appointment can take months. Once someone becomes a patient at a center, wait times for
appointments aren’t generally as long, but they still exist.
Mark Cushman says he generally waits two to three weeks for a non-urgent appointment at the community
health center near his home in Medford, Ore. Laid off from his job selling ads for a local newspaper, he has a
part-time position at a local car dealership that doesn’t provide health insurance.
Cushman, 54, recently visited the health center for blood work and to refill his prescription for a statin drug to
keep his cholesterol in check. His bill for the office visit was $28, the prescription $4, and the blood work a few
dollars more. “It’s great,” he says of the center. “What a relief to have this.”
You’d never know it wasn’t a private clinic, he says, except for the less-than-luxe waiting room. And that will
change soon, says Peg Crowley, the center’s executive director. Under the health-care overhaul, the center
received nearly $2 million. The money will allow them to not only spruce up the aged facility, but more
important, redesign it for better workflow and efficiency.
23
Continued federal funding for community health centers faces some obstacles. House Republicans have
suggested they may trim the government’s contributions as part of the party’s effort to cut federal spending.
In keeping with their focus on preventive care, an increasing number of community health clinics are
emphasizing wellness services. At the Petaluma Health Center, in California’s Sonoma County, patients are
receiving evidence-based care that melds Eastern and Western medicine. An eight-week chronic-pain group,
for example, introduces participants to a variety of integrative approaches to managing pain, including
acupuncture, meditation and Qigong, and helps show them how nutrition and sleep habits contribute to pain,
says Fasih Hameed, a physician there.
Rebecca Langenfeld participated in one of the center’s pain groups. Langenfeld, 59, has Sjogren’s syndrome,
an autoimmune condition that causes dryness of the body’s mucous membranes as well as joint and muscle
pain and fatigue. Langenfeld says the pain group and the acupuncture sessions she’s had at the clinic have
helped. “I wish that every clinic would do this stuff,” she says.
3
Hospital Is Drawn Into Bahrain Strife
The New York Times
12/04/2011
By CLIFFORD KRAUSS
MANAMA, Bahrain — A handful of soldiers, their faces covered by black masks to hide their identities, guard
the front gate of Salmaniya Medical Complex. Inside, clinics are virtually empty of patients, many of whom,
doctors say, have been hauled away for detention after participating in protests.
Doctors and nurses have been arrested, too, and the police trail ambulance drivers, health care workers said.
To the government, Salmaniya, Bahrain’s largest public hospital, and local clinics are nests of radical Shiite
conspirators trying to destabilize the country. But to many doctors at Salmaniya, the hospital has been
converted into an apparatus of state terrorism, and sick people have nowhere to go for care.
The scene is a grim sign that health care has been drawn into Bahrain’s civil conflict, which burst into violence
last month when the army and security forces cleared not only Pearl Square but also the hospital’s grounds,
which had become a hub for opposition activities.
At least a dozen doctors and nurses have been arrested and held prisoner during the last month, and more
paramedics and ambulance drivers are missing. Ambulances have been blocked from aiding wounded patients,
according to health care workers and human rights advocates.
Meanwhile, the security forces, manning roadblocks around the country, inspect drivers and their passengers
for birdshot wounds — the most common injury to demonstrators confronted by security forces — and those
with the telltale black bruises are seized and detained.
“You have an assault on the health care system and the people who practice in it,” said Dan Williams, a senior
researcher for the New York-based group Human Rights Watch, who is now investigating in Bahrain. “Hospitals
are supposed to be used for health care and not as arbitrary detention centers.”
Bahraini doctors and international human rights workers say the purpose of the crackdown appears to be to
instill terror in doctors, so they will not care for wounded demonstrators, and fear in dissidents, who might
think twice about confronting the police if they know that being injured might mark them for arrest.
Government officials say that wounded demonstrators are handed to the police only after they have been
taken care of, and reports of violations are being investigated.
At a news conference on Monday, the acting health minister, Fatima al-Balooshi, accused scores of doctors and
health care workers at Salmaniya and elsewhere of joining “a conspiracy against Bahrain from the outside” —
usually a code for Iran — to destabilize the government.
She said that 30 doctors and nurses had been suspended or otherwise kept from practicing medicine in recent
weeks, and that 150 more were being investigated.
Ms. Balooshi said doctors had deprived some people of medical care for sectarian reasons, had worsened
patients’ wounds to get stories of repression into the news media and had received overtime pay for attending
demonstrations. She also said that sophisticated weaponry had been found hidden in the hospital, and that
health care workers had set up a tent for propaganda purposes during demonstrations in Pearl Square last
month.
“They violated their duties, against international standards for health services,” Ms. Balooshi said of the
doctors. “Now, thank God, they have been stopped.”
Most doctors in Bahrain are Shiite, as is a majority of the population, in a country that is ruled by a Sunni
monarchy that now governs with the support of more than 1,000 Saudi Arabian troops. The opposition is
predominately, though not entirely, Shiite.
24
The crackdown is centered on Salmaniya, the country’s main referral hospital, ambulance depot, center for
emergency care and blood bank. But doctors at neighborhood clinics say that patients are afraid to visit them
as well, and that they do not have enough blood, antibiotics and emergency equipment to care for patients
who would otherwise go to Salmaniya.
The problems at Salmaniya began two months ago when demonstrators began using the parking lot in front of
the emergency ward for protests, and some doctors joined in while they were supposedly on duty.
When the security forces cleared Pearl Square on March 16, they also blockaded Salmaniya. According to one
doctor who was in the hospital, the staff was terrified as it watched a nurse get dragged away and beaten by
five officers after she apparently tried to escape. She said the police hauled away a paramedic and his driver,
who are still missing.
The next day, the doctor said, the security forces went to the second floor, handcuffed about 10 patients who
were wounded in the demonstrations and took them to the sixth floor for questioning under torture. Others
were taken upstairs later.
In interviews that were given on the condition that their names not be published, four doctors and nurses and
several family members of arrested health care workers said the medical community had been terrorized.
As they tell it, a pattern has emerged in which health workers are called to the Salmaniya administration
offices and then taken to a criminal investigation center. The arrested doctors and nurses are allowed to make
calls home to say they are fine. Family members then take them clothes, but rarely if ever see them.
Many of the health care workers arrested were involved in protests, but others were not. Dr. Nahad al-Shirawi
was reportedly arrested after she appeared in a published photograph weeping in the hospital over a victim
who died in a protest.
Yasser Ali Abdulla, a paramedic, and Mohsen Ashour, his driver, were dispatched on March 15 to the village of
Sitra to care for wounded demonstrators who were attacked by police. They never came home.
Mr. Abdulla’s father spotted their ambulance several days later parked at a local police station. Though the
father was not allowed to see his son, Mr. Abdulla was allowed later that day to call his wife for a few seconds
to tell her he was alive, according to a family member who spoke on the condition that she not be identified by
name or relationship.
He called a week later but has not been heard from since. “They say his crime was he stole the ambulance, but
he was on duty and in uniform,” the relative said.
Richard Sollom, deputy director of Physicians for Human Rights, said the security forces have gone so far as to
steal medical records like X-rays of people injured in demonstrations, apparently to hide human rights
violations.
“They are quite sophisticated,” said Mr. Sollom, who just completed a fact-finding trip here. “Doctors are the
one group of people who have evidence.”
A few days ago, three doctors at Salmaniya were slapped and taunted by security guards in the middle of the
night simply because they did not have a picture of the prime minister hanging on the wall of their dormitory
room.
“We were standing and shaking, and we didn’t know where this would end,” recalled one of the doctors, who
did not want to be identified for fear that he would be arrested. “Going to work every day is a calculated risk of
being beaten, harassed or even taken away.”
4
The Quality of Medical Care in Low-Income Countries: From Providers to Markets
PLoS Medicine
12/04/2011
Jishnu Das1,2*
1 World Bank, Washington, D.C., United States of America, 2 Centre for Policy Research, New Delhi, India
Citation: Das J (2011) The Quality of Medical Care in Low-Income Countries: From Providers to Markets. PLoS
Med 8(4): e1000432. doi:10.1371/journal.pmed.1000432
Copyright: © 2011 Jishnu Das. This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
Funding: The author received no specific funding to write this paper.
Competing interests: The author has declared that no competing interests exist.
Abbreviations: LMIC, low- and middle-income country
* E-mail: jdas1@worldbank.org
Provenance: Commissioned; not externally peer reviewed.
25
Linked Research Article
This Perspective discusses the following new study published in PLoS Medicine:
Berendes S, Heywood P, Oliver S, Garner P (2011) Quality of Private and Public Ambulatory Health Care in Low
and Middle Income Countries: Systematic Review of Comparative Studies. PLoS Med 8(4): e1000433.
doi:10.1371/journal.pmed.1000433.
Paul Garner and colleagues conducted a systematic review of 80 studies to compare the quality of private
versus public ambulatory health care in low and middle income countries.
It is widely believed that people in low- and middle-income countries (LMICs) are in poor health because they
cannot reach medical services on time. Predicated on this belief, much of global health policy focuses on the
physical provision of goods (clinics, equipment, and medicine) and getting doctors to “underserved” rural
areas. Yet, recent evidence shows high utilization rates, even among the poor [1],[2].
While problems of access are certainly salient for particular disadvantaged populations, quality is likely the
constraining factor for the majority.
The excellent systematic review in this week's PLoS Medicine by Paul Garner and colleagues [3] focuses
discussion on this critical issue. Their finding of poor quality in both the public and private sectors along
different dimensions (competence is similar in both, but the private sector is more patient centered) brings
much needed evidence to an ongoing debate. The review reflects a logical initial focus in the literature on
individual providers rather than the interactions between providers; going forward, broadening the discussion
on quality to health care markets can generate valuable insights for policy.
The Context: Health Care Markets in LMICs Are Incredibly Complex Top
Typically, households can access multiple providers, ranging from fully qualified public and private sector
providers to those without any formal medical training in the private sector. In Delhi, India's capital, there are
70 doctors, most in the private sector, within a 15-minute walk of every household. In the private sector,
about half are fully qualified and 10%–15% have no medical training, with a higher fraction of qualified
providers in richer neighborhoods [4].
According to a recent report, across rural India, the average household can access 3.2 private, 0.3 public, and
2.3 public paramedical staff within their village [5]. In rural Madhya Pradesh—one of the poorest states in
India—households can access 7.5 private providers, 0.6 public providers, and 3.04 public paramedical staff. Of
those identified as doctors, 65% had no formal medical training and, of every 100 visits to health care
providers, eight were to the public sector and 70 to untrained private sector providers.
Consequently, there is enormous variation in practice-quality within villages and neighborhoods. This variation
in quality has implications for a variety of policy decisions ranging from standardization and regulation to
medical training. Three steps can help bring evidence to bear on policy discussions…Continued
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000432
5
What ‘Big Medicine’ Means for Doctors and Patients
The New York Times
14/04/2011
By PAULINE W. CHEN, M.D.
A colleague described a recent meeting at his hospital by saying that five years ago, most of the physicians in
the room had been like him, independent owners of small group practices. Now a majority were employees of
the hospital.
“I’m a dying breed,” he said, “and it’s getting harder to survive.” The doctors in his own group had just spent
months wrangling over their hospital contract, installing an electronic medical record system and scrambling to
fill the void in their on-call schedule left by a colleague who went to work for another hospital.
“What’s not to like about working for a hospital,” he asked wearily, “when you can have better hours, a
guaranteed salary and no practice management hassles?”
Like wildebeests thundering across the Serengeti in search of greener pastures, doctors have been fleeing their
private practices for hospital employment. Over the last decade, there has been nearly 75 percent increase in
the number of doctors employed by hospitals. Nearly three-quarters of hospital leaders say they plan to
increase that percentage over the next three years.
How this transformation will affect patients and their relationships with doctors remains unclear. For some,
these changes represent yet another nail in the coffin of the old-fashioned patient-doctor bond.. For others,
they are a déjà vu of the last great physician migration, in the 1990s, when hospitals actively sought, bought
then let go of small practices, and doctors went from being independent practitioners to employees and back
again.
But according to a recent commentary in The New England Journal of Medicine,, there is one striking
difference: This time there may be no going back.
26
As Dr. Robert Kocher and Nikhil R. Sahni warn in their editorial, “Employment choices that physicians make
today may not be able to be undone.”
I spoke recently with Dr. Kocher. An internist by training and the director of the McKinsey & Company Center
for U.S. Health System Reform, Dr. Kocher was a member of the National Economic Council and helped shape
health care overhaul legislation as a special assistant to President Obama. The following are excerpts from our
interview.
Q.What is so unique about this point in time?
A.Change in health care is generally slow, but right now it’s accelerated relative to the last 10 years. It won’t
be as easy to undo this time because of the tremendous, simultaneous changes in the payment system and
health information technology.
In the late ’90s, doctors could go back to their practices without missing a beat because it was the same feefor-service payment environment. Now there are huge efforts to change how doctors are paid. I don’t know of
any health plan that is not experimenting with one of the newer ways of payment, like risk-based payment
approaches, accountable care organizations or patient-centered medical homes. Right now you may know how
to make money in a fee-for-service world; but you’ll have no experience in the payment system five years from
now.
Health information technology will also be increasingly important in practice. With the new standards set by the
Health Information Technology for Economic and Clinical Health Act that offers clinicians and hospitals incentive
payments to use electronic health records, doctors can begin to adopt health I.T. at any point until 2016. But
after that time, those expectations and standards are going to be cranked up every two years. If practitioners
all around you are using health I.T. at a certain level, you are going to have a hard time collaborating with your
peers if you don’t.
Q.With health care systems getting larger, should patients be concerned about pricing and possible
monopolies?
A.As hospitals become larger and control more of the doctors and specialists, they will acquire the ability to
charge higher prices. Sometimes those increased costs will lead to better care; those hospitals will be able to
afford better I.T. and bigger health care teams. No one, for example, would say that the Mayo or Cleveland
Clinic is inexpensive.
On the other hand, you could also end up with a system like Kaiser that provides the same high-quality care at
lower costs.
All of these systems exemplify quality, but the price quotients are different.
Q.What do all of these changes mean for patients and the patient-doctor relationship?
A.There’s no question that forming larger systems that are better integrated could be a really good thing for
patients. When you look at some of the best systems in the country today, places like the Mayo Clinic or
Kaiser, you see that the model of hospitals employing doctors results in fantastic care. We become a lot more
purposeful about how patients are cared for. There’s a lot more attention paid to treatment goals, more
emphasis on prevention, better communication, more efforts to standardize and use expensive supplies more
judiciously.
I’m quite confident that the employment of doctors or organizing them into larger groups could have a very
provocative and profound effect on quality. I’m less certain of the kind of effect these changes will have on
costs for patients.
Q.In your editorial, you make the point that doctors should understand the implications of their employment
choices. What should patients know?
A.Patients should realize that there could be a lot of benefits to receiving their care from a larger and more
coordinated group of providers. But most of those benefits will come from how well those providers
communicate across their system and how well their I.T. is used to guide their clinical decision-making.
Patients should ask: Are my providers being attentive to my treatment plan and goals? Am I seeing providers
who have my information? When I reach out, is there someone who knows me or is organizing my care? Is
there someone working with patients to make sure the system is actually working?
6
Critical Shortage of Army Neurologists for U.S. Troops in Iraq and Afghanistan
ProPublica
12/04/2011
by T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR
The Army is facing a "critical" shortage of neurologists, partly because of recent policy changes designed to
improve diagnosis and treatment of mild traumatic brain injuries, according to a new military medical
memorandum.
27
The policies, issued last June [1], require soldiers who have suffered three or more mild traumatic brain
injuries in a year to receive a comprehensive evaluation by a neurologist or similarly qualified doctor. The
military also set up a clinic in Afghanistan last year specifically to treat traumatic brain injury and mandated
rest periods for soldiers exposed to blasts.
The new initiatives have "increased dramatically" the need for neurologists on the battlefield, according to the
memo [2], which was issued in March and obtained recently by ProPublica and NPR.
"The shortage is far more acute than they want to admit," said one Army doctor, who did not want to be
identified for fear of damaging his career. "This is an ideal doctrine which was promulgated but not fulfilled due
to a lack of resources."
Army officials have long complained about a lack of neurologists, neuropsychologists and other medical
professionals needed to diagnose and treat mild traumatic brain injuries, also known as concussions.
At a hearing last June [3], Army Gen. Peter Chiarelli, the vice chief of staff, told Congress that the Army had a
total of 52 neurologists, though only 40 were practicing -- a figure, he said, that included child neurologists.
"I have a shortage in neurologists, a tremendous shortage," Chiarelli told NPR and ProPublica in an interview
last year. Chiarelli said the problem was not a lack of funding, but recruiting neurologists willing to be deployed
to war zones.
Also, under the military's system for deploying doctors, some neurologists act as general practitioners, serving
as the primary medical officers for combat units sent overseas rather than as specialists. The new memo aims
to stop that practice and funnel neurologists to help troops with brain injuries.
"There has always been a shortage of board certified neurologists; neurologists are in short supply in civilian
practices as well," Cynthia Vaughan, a spokesman for the Army’s Surgeon General, wrote in response to
questions. "The change was made to ensure we have neurologists who are deployed working as neurologists
and available to treat concussive injuries vs. deploying as general medical officers."
It is unclear whether other military services are having similar trouble finding neurologists to deploy abroad. A
spokesman for Central Command, which oversees the fighting in Iraq and Afghanistan, did not immediately
return a request for comment.
Official military figures [4] show that more than 155,000 troops have suffered concussions since the beginning
of the wars in Iraq and Afghanistan, many of them caused by blasts from roadside bombs, a common insurgent
weapon. Researchers outside the military say the true figure could be at least twice that number. The Pentagon
says nearly 50,000 others have suffered more severe brain injuries.
Previous ProPublica and NPR stories [5] found studies showing that as many as 40 percent of mild traumatic
injuries go undiagnosed. Such injuries do not leave visible scars and can be difficult to detect.
Most concussions heal quickly, usually within a matter of weeks. But civilian studies show that 5 percent to 15
percent of those who sustain concussions may suffer long-lasting cognitive issues, such as problems with
memory, reading, doing simple math, or following directions.
Research has shown that the danger of long-term damage increases with the number of concussions. Studies
have indicated an increased risk for a dementia-like condition among football players and other athletes who
suffered numerous mild head injuries over their careers.
7
White House targets medical errors
Los Angeles Times
13/04/2011
By Noam N. Levey
The Obama administration announced a broad new initiative Tuesday to reduce medical errors, partnering with
private insurers, business leaders, hospitals and patient advocates to tackle a problem that kills thousands of
Americans every year.
The campaign, funded by the healthcare overhaul the president signed last year, aims to cut by 40% over the
next three years the number of harmful preventable conditions such as infections that patients acquire in the
hospital.
And it seeks to cut readmissions to hospitals 20% by encouraging better care for patients after they leave.
"Those are big goals," said Dr. Don Berwick, a leading national advocate for patient safety who oversees the
federal Medicare and Medicaid programs. "But the results for patients and families will be dramatic — millions
of people … suffering less, tens of thousands of deaths averted, and anguish and worry decreased beyond
measure."
28
Concern about medical errors and the danger of hospital-acquired infections has been building for more than a
decade amid evidence that the nation's hospitals are not as safe as commonly believed.
One recent study published in the journal Health Affairs estimated that 1 in 3 hospital patients experienced an
"adverse event" such as being given the wrong medication, acquiring an infection or receiving the wrong
surgical procedure.
Though top-performing institutions across the country have made dramatic improvements in reducing errors,
many healthcare experts and patient advocates think progress has been slow.
"We can't keep going at the pace we are going," said Sorrel King, a patient advocate whose 18-month-old
daughter, Josie, died in 2001 when she was given the wrong medication at Johns Hopkins Medical Center,
where she was being treated for burns.
The new healthcare law provides billions of dollars to improve care by rewarding hospitals and physicians that
meet higher standards, such as lowering readmissions that result from poor care.
In coming months, the Obama administration plans to hand out $500 million in grants to community-based
organizations that partner with hospitals to develop programs targeting patients immediately after they are
discharged. Research has shown this is a crucial time for patients, a period in which the right follow-up care
can prevent complications that result in costly and potentially dangerous readmissions.
The administration also plans to spend $500 million to test models for reducing nine types of medical errors,
including surgical site infections, pressure ulcers and complications from childbirth.
Administration officials have been working to build a coalition of healthcare providers to support the quality
initiative, which many think will ultimately save billions of dollars.
"As business has demonstrated in various industries over the last three decades, quality costs less, not more,"
said David Cote, chief executive of manufacturing giant Honeywell, who joined Health and Human Services
Secretary Kathleen Sebelius as she announced the Partnership for Patients initiative.
The campaign has won the backing of hospital groups, leading insurers, physician groups such as the American
Medical Assn. and consumer groups such as Consumers Union.
Debra Ness, president of the National Partnership for Women and Families, a leading patient advocacy group,
said that the quality initiative was particularly important at a time when some in Congress are pushing to slash
billions of dollars in federal support for healthcare programs like Medicare and Medicaid.
"It's initiatives like this that get to the root of the problem … not cutting services," Ness said.
8
Congress votes Thursday on cutting billions from budget before moving to larger spending fight
Washington Post
14/04/2011
By Associated Press,
WASHINGTON — The House and Senate are ready to vote on legislation cutting almost $40 billion from the
budget for the current year, but President Barack Obama and his GOP rivals are both eager to move on to
multiyear fiscal plans that cut trillions instead of billions.
Lawmakers were to vote Thursday on a long-overdue spending measure funding the day-to-day budgets of
federal agencies through September. Later in the day, Republicans dominating the House will launch debate on
a 2012-and-beyond plan that promises to cut the long-term budget blueprint Obama laid out in February by
more than $6 trillion.
Obama countered Wednesday with a new call to increase taxes on wealthier people and impose quicker cuts to
Medicare, launching a roiling debate in Congress and the 2012 presidential campaign to come.
Obama fired a broadside at the long-term GOP plan, which calls for transforming the Medicare health program
for the aged into a voucher-like system for people under the age of 55 and imposing stringent cuts on
Medicaid, which provides health care to the poor and disabled, including people in nursing homes.
More immediate, however, is the 2011 spending measure. It combines more than $38 billion in cuts to
domestic accounts with changes to benefit programs, like children’s health care, that Congress’ own
economists say are illusory.
Thursday’s measure is a compromise between Obama, GOP House Speaker John Boehner of Ohio and
Democratic Senate Majority Leader Harry Reid of Nevada. As such, it’s a split-the-differences compromise that
considerably smooths a much more stringent version that passed the House in February.
The bill cuts $600 million from community health programs, $414 million from grants for state and local police
departments, and $1.6 billion from the Environmental Protection Agency’s budget. Community development
29
block grants, a favorite with mayors of both political parties, take a $950 million cut. And construction and
repair projects for federal buildings would absorb an almost $1 billion cut.
Obama, however, was able to ease cuts to favored programs like medical research, family planning programs
and education, while largely ridding the bill of conservative policy initiatives to block last year’s health care law
and new environmental regulations.
But the measure would have little direct impact on the deficit through the Sept. 30 end of the fiscal year,
according to the Congressional Budget Office, since about $8 billion in immediate domestic program cuts are
more than outweighed by increases for the Pentagon and ongoing war costs.
Later Thursday, the GOP-dominated House will kick off debate on its long-term budget plan, a measure
promising stiff cuts to domestic agency budgets that total $1.8 trillion over 10 years. The GOP measure, a nonbinding blueprint that sets a theoretical framework for future legislation, would also sharply cut Medicaid and
transform it into a block grant program runs by the states. It doesn’t touch Social Security, however, or
immediately cut Medicare.
But the GOP plan calls for transforming Medicare in the future by replacing the current system, in which the
government directly pays doctor and hospital bills, into a voucher-like program in which future retirees
purchase private insurance plans. People 55 and over would stay in the current system but younger people
would receive the insurance subsidies, which economists say would gradually lose value over time because
they wouldn’t keep up with inflating costs of medical care.
Obama and Democrats say the GOP Medicare plan, devised by Budget Committee Chairman Paul Ryan, R-Wis.,
would “end Medicare as we know it.”
On Wednesday, Obama said spending cuts and higher taxes alike must be part of any deficit-reduction plan,
including an end to Bush-era tax cuts for the wealthy.
“We have to live within our means, reduce our deficit and get back on a path that will allow us to pay down our
debt,” the president said in a speech at George Washington University, a few blocks from the White House.
“And we have to do it in a way that protects the recovery, and protects the investments we need to grow,
create jobs and win the future.”
Obama’s speech was salted with calls for bipartisanship, but it also bristled with attacks on Republicans.
“What we got was a speech that was excessively partisan, dramatically inaccurate and hopelessly inadequate
to addressing our country’s pressing fiscal challenges,” Ryan said. “What we heard today was not fiscal
leadership from our commander in chief. What we heard today was a political broadside from our campaigner
in chief.”
Obama’s plan relied on some of the same deficit-reduction measures proposed in December by a bipartisan
fiscal commission he appointed. The president is scheduled to meet Thursday at the White House with the cochairmen of the commission, Democrat Erskine Bowles and Republican Alan Simpson.
Copyright 2011 The Associated Press. All rights reserved.
10
Many doctors work into their senior years: report
CTV, CA
08/04/2011
TORONTO — More than one in 10 doctors working in Canada are aged 65 or older -- and about a third of those
continue to work full time, says a report by the Canadian Institute for Health Information.
The report, based on 2009 figures and released Thursday, found about 12 per cent of Canada's roughly 68,000
doctors -- or almost 7,900 -- were at least 65, up from nine per cent five years earlier. Those in that age
bracket who were no longer practising full time were still carrying a 40 per cent workload on average.
Unlike more traditional workers in the labour force, physicians often continue past the typical retirement age of
65, said Walter Feeney, a senior analyst for CIHI.
"Physicians aren't going to reach age 65 and drop off the map. They're not going to disappear from the
workforce," he said from Ottawa. "There are still quite a few physicians that continue working into their senior
years."
For some, that means changing their scope of practice, says the report entitled "Putting Away the Stethoscope
for Good? Toward a New Perspective on Physician Retirement."
For instance, older family doctors may no longer perform complex or delicate procedures like vasectomies or
may give up time-consuming and labour-intensive obstetrics.
"Perhaps they're complicated procedures," said Feeney, "but they could be on call and the physician could ...
say, 'I've done that for years, I want to work more regular hours. I don't want to be up at two in the morning
running to the hospital to do these deliveries."'
30
Dr. Dale Dauphinee said the report resonated with him because of his own experience and that of his medical
school classmates.
At about age 55, he decided not to return to his specialty as a gastroenterologist at a Montreal hospital after a
period in administrative leadership roles. The reason: he had developed arthritis in his hands and felt he could
no longer perform colonoscopies and other endoscopic procedures requiring manual dexterity.
"It's an example of where my life circumstances really led me to think it's time to make a shift," Dauphinee,
72, said Thursday from Montreal. So he turned to teaching medical students and consulting, instead.
At a recent reunion of his 1964 Dalhousie University graduating class, he found that classmates who had also
become surgeons often had continued in the operating room until their late 60s or early 70s, "and then they
just stopped."
"I've seen some family doctors who are older who still practise. But they don't do obstetrics anymore," he said,
adding that the report was "like looking at my class. So it rang very true to me."
While the report doesn't examine why many retirement-age doctors continue to go to their offices or hospitals,
Feeney said there are a number of possible reasons, including that physicians usually begin their careers later
in life than those in more traditional jobs, following years of medical training.
As well, physicians may tend to find their professional a calling, he added. "It's not just a Monday-to-Friday,
nine-to-five job. They find they need to provide the care for the public."
Dr. Rob Boulay, president of the College of Family Physicians of Canada, agreed that the commitment to
patients and the profession is a major driver that keeps doctors practising.
"It's almost a way of life after a while," Boulay said from Miramichi, N.B. "I think it's very hard to not have the
type of relationships that physicians develop all their lives with their patients.
"For a lot of people, it's part of their identity as well. If your identity is being a physician and that's how you're
recognized in your community, I think it might be hard to make a departure from that."
Financial reasons are also behind many doctors hanging onto their white coats and stethoscopes after they join
the ranks of senior citizens, he suggested. "I know that a downturn in the market changed a lot of physicians'
plans for retirement because we fund our own retirements, of course."
Feeney suggested that because most doctors are self-employed, they also have the flexibility to keep working
but to put in shorter hours or fewer days. "They can decide their own work-life balance."
He said the report provides important information for governments and other bodies in planning for Canada's
future health provider needs.
While a large number of Canadians are unable to find a family doctor, the country's physician workforce is
actually on the rise: not only are some retirement-age doctors staying on the job, but medical school
graduates are at a record high.
Boulay said new methods of delivering primary health care that supports family doctors is helping them to
work longer and more productively.
Team-based practices involving many types of health provider can give family physicians who may have
worked for years in solo practices a new lease on their work life, he said.
"I've heard anecdotally from physicians who've done that when they felt that they couldn't work anymore,
when they enter one of these practice models, they feel like they've been reborn. They feel like they can
continue to work."
Back to top
Europe
1
Health-systems strengthening: current and future activities
The Lancet, UK
09/04/2011
Volume 377, Issue 9773, Pages 1222 - 1223
Jesper Sundewall a, R Chad Swanson b, Arvind Betigeri c, David Sanders d, Téa E Collins e, George
Shakarishvili f, Ruairi Brugha g h
There is strong consensus in the global health community, among donors, recipient countries, and policy
makers, about the need for health-system strengthening in low-income and middle-income countries.1, 2
31
Traditional donors and new disease-specific aid initiatives, such as the GAVI Alliance, the US President's
Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are
directly or indirectly funding health-system strengthening. The need for greater capacity to produce a better
evidence-base for health-system strengthening has resulted in the first global symposium on health-systems
research, to be held in Montreux, Switzerland, in November, 2010.3 The consensus on the importance of
strong health systems is welcomed. However, without clarity on future directions, focus and energy could
dissipate. The following areas in health-system strengthening require more attention and better analysis.
First, there is lack of consensus on what health-system strengthening means, and consequently on how it
should be done and evaluated.4 As a result, efforts in health-system strengthening are fragmented. Some
commentators are enthusiastic about WHO's building-blocks model.4, 5 Others have proposed to identify
synergies for converging multiple frameworks.6 Donors have differing priorities and constraints on how they
can channel funds, which limit their adoption of a prescriptive model of health-system strengthening.7 The
efforts of PEPFAR and the Global Fund, and to a lesser extent those of the GAVI Alliance, for health-system
strengthening are generally restricted to activities related to specific target diseases, which can distort national
priorities and staff allocation.4 Consensus on health-system strengthening requires recognition of the
constraints on major donors—accountability to domestic taxpayers, domestic media, and legal frameworks—
which lead them to establish parallel systems from priority setting through to monitoring and evaluation.
However, donors need to explicitly acknowledge the pre-eminent principles of equity, universal coverage, and
the stewardship responsibilities and accountability of recipient countries to their citizens.
Second, health systems are highly contextual.8 Health problems and needs vary across countries and regions,
as do the systems to respond to these problems. Anglophone sub-Saharan African countries have seen 30
years of undermining of their health systems by structural adjustment and successive fiscal crises, contributing
to wholesale emigration of trained health workers.9 Many Asian and Latin-American health systems are tiered
and fragmented because of the unregulated growth of private health care and successive externally-driven
initiatives. Public health systems in the countries of the former Soviet Union, previously universally accessible—
albeit often inefficient—have been disrupted by reductions in funding and rapid privatisation, resulting in large
inequities. There is no magic bullet, no one size fits all. Health-system strengthening must be a long-term
iterative process in which local stakeholders, not donors or external experts, take the lead in adapting
evidence-based solutions to local political and cultural contexts, enhancing community capacities and enabling
community-based responses.
Robust, responsive, and efficient health systems are needed to reach the Millennium Development Goals. The
current surge in activities around health-system strengthening is encouraging, but focus and clarity are critical.
Some important initiatives and resources for health-system strengthening that address the challenges
described include the following. First, inter-agency consultations to jointly define the scope of health-system
strengthening and to develop a common approach to tracking investments in such strengthening are in
progress.10 Second, WHO and the World Bank have developed a toolkit for assessing health-system
strengthening.11 Third, there is the Alliance for Health Policy and Systems Research.12 Fourth, the Taskforce
on Innovative International Financing for Health Systems has recommended increased funding for healthsystem strengthening.8 Fifth, there is a consensus statement for health-system strengthening to which a
growing number of global health professionals and practitioners are contributing.13 Sixth, at the Montreux
symposium, stakeholders will “share evidence, identify significant knowledge gaps, and set a research agenda
that reflects the needs of low and middle-income countries”.3
The panel proposes areas where better evidence and capacity is needed to advance the agenda for healthsystem strengthening. The propositions encourage involvement and interactions between all levels, from local
communities to global policy makers and funders. A joint understanding of health-system strengthening and an
agenda for action with broad support across a wide spectrum of stakeholders will be central tools to improve
efforts. The period leading up to the November symposium is an opportunity to improve and refine the agenda
for research and action. ....Continued
Full-text: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)606794/fulltext?_eventId=login&elsca1=TL-080411&elsca2=email&elsca3=segment
2
Rational reform to medical education in India (Editorial)
The Lancet, UK
09/04/2011
Volume 377, Issue 9773, Page 1212
In response to The Lancet's Commission on education for health professionals, today's Correspondence section
and an online Comment discuss the contribution of ethics, social mission, primary care, and local health needs
to inform curriculum design. These themes resonate widely, but nowhere are they more relevant than in India.
As described in The Lancet's Series— India: towards universal health coverage —the country has a health crisis
exacerbated by the shortage of doctors and a mismatch between the need for basic medical services in rural
areas and the congregation of specialists in urban centres. To improve the density and distribution of doctors,
the Medical Council of India proposed wide-ranging reforms to medical education on March 29.
The recommendations, prepared over the past year by academics, will be published in a forthcoming
document, Vision 2015. The proposals aim to produce an “Indian Medical Graduate” who is reflective, socially
responsible, self-directed, and adapts to changing health circumstances in India and around the world. To
accomplish this, education begins with a foundation course that includes communication, ethics, and
32
professionalism, followed by a curriculum that reflects India's particular health burdens. At all levels, an
emphasis is placed on clinical skills. National examinations will add transparency and uniformity to medical
school admission, licensing, and postgraduate training. More postgraduate paths will be available with entry via
a 2 year MMed degree to consolidate clinical experience before specialisation, teaching, community care, or
research. And research now becomes mandatory for medical schools and for academic advancement.
The reforms will be a challenge for the country's 314 medical schools and a test of the Medical Council's
authority. Despite opposition to change from some doctors, bold changes are necessary to improve India's
disappointing health outcomes and to realise the country's research potential. A new curriculum that addresses
local health improvement is a welcome start.
3
NHS shakeup could be biggest disaster in history of public services, says RCN
The Guardian, UK
11/04/2011
Denis Campbell
The coalition government's shakeup of the NHS could easily become "the biggest disaster in the history of our
public services", the leader of Britain's 400,000 nurses has warned.
Dr Peter Carter, head of the Royal College of Nursing, made the claim in his address to the union's annual
congress on Monday as he set out a powerful critique of the planned radical restructuring in England.
While endorsing the health and social care bill's key aims, Carter said "the reforms still have a huge number of
areas that concern us", despite recent government concessions on price competition between healthcare
providers and its decision to invite a nurse to sit on the new NHS National Commissioning Board.
His comments came amid intensifying political difficulty for ministers over how meaningful the government's
rethink of the bill will be. A series of events are being held this week designed to show that prime minister
David Cameron and health secretary Andrew Lansley are genuinely listening to concerns about the bill during
the "pause" in its parliamentary progress announced last week.
"Despite the honourable principles behind the bill, it could well turn out to be the biggest disaster in the history
of our public services, if organisations like the RCN are not listened to now," Carter told about 2,000 nurses'
representatives gathered in Liverpool.
He said: "This is the most important moment in the history of our health service. Across the NHS, billions,
literally billions, of pounds are being slashed from budgets. Nurses and other colleagues are losing their jobs,
vacancies are being left unfilled and the standard of patient care is being threatened."
Hospitals, community centres, care homes, drop-in clinics and specialist services in all four countries of the UK
were struggling to cope, Carter said, casting doubt on the prime minister's pledge to "cut the deficit, not the
NHS".
Research by the RCN shows that almost 40,000 jobs have gone or are due to be shed in the NHS – including
many nurses, doctors and midwives – as healthcare organisations adjust to the leaner financial climate.
Carter said the drive to save £20bn by 2015 through efficiency savings across the NHS in England "has been
nothing but an illusion".
He claimed: "We've seen no evidence of where this money is going to be reinvested, when that's going to
happen and who decides on where it goes."
The £20bn is supposed to be generated from healthcare providers delivering care more efficiently, with savings
reinvested back into frontline services.
The British Medical Association, the doctors' union, endorsed Carter's unease about the reorganisation. "We
share the RCN's concerns that the bill, as it is currently written, represents a massive gamble. It is important
that the government not only listens to the views of nurses, doctors and other healthcare staff, but takes them
seriously and is willing to make real changes.
"The sheer size of the efficiency savings the NHS has been told to make means cuts are inevitable. Across the
country we're seeing services that patients value – things like cataract surgery – being rationed or stopped
altogether," said a spokesman.
4
'Foreign doctors should have English tests before being allowed to practice in the UK'
Daily Mail, UK
08/04/2011
The English skills of foreign doctors should be tested if they want to work in the UK.
33
NHS managers have warned the European Commission that letting them operate in places where they can't
speak the local language was putting patients' safety at risk.
Some doctors' English is so bad that they need an interpreter to tell them what is going on, the General
Medical Council warned.
Their caution comes a year after it was discovered that a third of primary care trusts are flying GPs in from
across Europe - including Lithuania and Poland - because of a shortage of British doctors willing to work at
night and weekends.
The free movement applies to other professions as well, but within healthcare it includes doctors, dentists,
nurses, midwives and pharmacists.
In 2008 Daniel Ubani, a Nigerian-born German national, arrived in the UK and started a shift three hours after
getting here.
He gave 70-year-old David Gray 10 times the maximum recommended dose of morphine, and an 86-year-old
woman died of a heart attack after he failed to send her to hospital.
The NHS European Office wrote to the European Commission saying: 'We are mindful that health care, by its
very nature, carries a high degree of serious risk to the health and safety of patients from professionals who
may lack training, clinical expertise, relevant experience or personal integrity.
'It is necessary, therefore, in this sector to balance the desire to streamline and simplify free movement with
the need to maintain minimum quality and safety standards by checking the competence and suitability of
professionals will be providing services,' according to the Daily Telegraph.
There are more than 23,000 doctors allowed to work in the UK from across the European Economic Area as
well as those from Iceland, Liechtenstein and Norway.
Currently the GMC is allowed to test neither their medical skills nor their language capabilities but potential
bosses can.
The NHS European Office added: 'Competent authorities and employers in the UK have reported concerns that
some registrants from other member states may not have the language skills necessary for pursuit of the
profession in the host member state. This has sometimes led to misunderstandings and even errors.'
5
Lack of specialist nurses ‘pushes patients into hospital’
Wales online
13/04/2011
by Madeleine Brindley
NHS spending cuts could force patients into hospitals because of a lack of specialist nurses, the Royal College
of Nursing claimed yesterday.
The concerns come as figures show Wales has just 21 nurse consultants left – less than half the 50 the nation
was promised more than a decade ago under a policy championed by then Prime Minister Tony Blair.
The decline in these specialist posts has been blamed on recruitment freezes adopted by cash-strapped health
boards.
And a survey for the RCN of 800 specialist nurses across the UK revealed almost two-thirds are seeing
cutbacks in their specialist area and more than a third are being asked to work outside their specialist area to
cover staff shortages, jeopardising their time with vulnerable patients.
One in 10 said they are now at risk of redundancy.
The RCN is worried specialist nurses will bear the brunt of cutbacks in the NHS, impacting on patient care.
It is urging NHS management to invest in nurse-led schemes which can keep people out of hospital, save
money and improve patient care.
A year after Nicola Davis-Job left her post as Wales’ only nurse consultant in stroke care, her position has not
yet been filled.
Now working as RCN Wales’ acute care and leadership adviser, she said: “There’s been no backfill and no
recognition of my role.
“I was the interface between primary and secondary care and I ran the TIA (transient ischaemic attack) clinic
at Nevill Hall Hospital, Abergavenny.
“Specialist nurses have carried on that clinic but they aren’t able to see patients in the community.
34
“Patients now have to come into the clinic, whereas I could have gone into the community and done everything
that’s done at the clinic.”
Nurse consultants were introduced in 1998 at the behest of Mr Blair and they are the most senior clinical
nurses able to run their own clinics and manage caseloads.
A total of 50 posts were approved in Wales in 2000, but only 28 nurse consultants were ever appointed. This
number has fallen by seven in the last two years.
The starting salary for nurse consultants is £45,000.
Tina Donnelly, director of RCN Wales, said: “Consultant nurse posts are central to the process of health service
modernisation, helping to provide patients with services that are fast and convenient.
“In addition, nurse consultants are responsible for developing personal practice, being involved in research and
evaluation and contributing to education, training and development.
“For the profession, a decrease in the development of nurse consultant posts in Wales leaves reduced
opportunities to retain experienced nurses in clinical practice.
“For the patient, nurse consultants provide a rich resource of high-level clinical leadership and research of
policy into practice which is unique to the role.”
She added: “Nurse consultants and clinical nurse specialists really do make a quality difference to patients.”
Charities, including Macmillan Cancer Support, Epilepsy Action and Parkinson’s UK, have also spoken of their
concern about cutbacks in the provision of specialist nurses, who play a leading role in the care of patients with
chronic conditions.
Cath Lindley, general manager for Macmillan Cancer Support in Wales, said: “We know that the NHS in Wales
is under a lot of pressure to cut costs, but NHS managers need to make good choices on how they respond to
this.
“They should ensure specialist nurses are using their skills to make patients happier and healthier so they
spend less time in hospital – therefore saving the NHS money.
“If the NHS is to deliver person-centred care and meet the financial challenges, one thing it can’t afford to do is
to cut specialist support.”
An Assembly Government spokesman said: “It is for NHS organisations to ensure that they have the
appropriate mix of staff to meet fluctuating demand.”
6
Leading article: The health service needs evolution, not revolution
The Independent, UK
14/04/2011
The Government's grand consultation exercise on NHS reform has not got off to a very good start. After much
prevarication, Andrew Lansley finally travelled to Liverpool yesterday for the Royal College of Nursing (RCN)
conference. But rather than addressing all the delegates, the Health Secretary chose to meet a select group of
just 60 nurses.
Mr Lansley explained that he wanted to listen, not lecture. But the nurses interpreted this as a way for the
Health Secretary to avoid engagement. And his reward was a resounding vote of no-confidence: 478 delegates
voted in favour of the motion, just sixz against. Such a comprehensive rejection from what is widely seen as
one of the more moderate and pragmatic health unions is a serious blow for the Heath Secretary.
Mr Lansley maintained yesterday that the RCN supports the principle of his Health and Social Care Bill, which
proposes to give consortiums of GPs the responsibility to commission care and the private sector a greater role
in the delivery of health services. And it is true that the complaints articulated by nurses in recent days have
been of a general nature, rather than related to specific details in the health Bill. Some fear the impact of more
private care on the wider NHS. Others have suspicions about Mr Lansley's motives. Many voiced concerns
about the prospect of the NHS being destabilised by the reforms.
Yet this generalised distrust among nurses of the Coalition's direction on health reform matters a great deal. It
is a feeling shared by the British Medical Association and other associations of health workers. They all
subscribe to the need for reform, but have grave doubts about what the Coalition is proposing. And these
reservations matter because Mr Lansley's reforms are not going to be successfully enacted without the cooperation of those who work in the health sector.
There is a way out of this mess for the Coalition. There need to be safeguards in the NHS reform Bill to prevent
private sector specialists cherry-picking "profitable" patients and leaving the NHS with the most expensive and
complicated cases. More work needs to be done to ensure the accountability of these new consortiums of GPs.
The Commons Select Committee's recommendation that other NHS stakeholders – hospital doctors, public
35
health chiefs, social care workers and councillors – be given a role in these consortiums seems sensible.
Further, the 2013 deadline for the implementation of GP commissioning needs to be dropped. The Department
of Health should give consortiums the right to apply to commission care when they are ready to do so, rather
than insisting on this "big bang" approach to reform. That would also give time to evaluate pilot projects – and
to see where improvements or extra safeguards are needed. What makes delay even more desirable is the fact
that the NHS, over the coming four years, is being forced to make huge efficiency savings merely to deliver the
same level of services as at present.
The Bill can be salvaged, but only if ministers are prepared to adopt a policy of pragmatic evolution, rather
than macho revolution. They also need to grasp that substantive changes are called for, not just a better public
relations exercise. David Cameron and Nick Clegg have accepted the need for an alteration of course. So the
question then becomes: is Mr Lansley capable of making the necessary changes and also convincing the health
profession and the public that he understands their concerns? The Health Secretary's woeful handling of the
early stages of this consultation process suggests that the answer might well be no.
7
Finn: wage expectations of Estonian doctors sometimes unrealistic
Baltic Business News
14/04/2011
Toomas Hõbemägi
The problem with Estonian medical doctors is that some of them want to earn too much in Finland that is
simply unrealistic, says Petri Oskari Puumalainen, CEO of Puumedi that recruits Estonian medical staff for
Finland.
Puumalainen says that while Finnish doctors working in Helsinki receive EUR 19 an hour, some Estonians who
have never worked in Finland have been demanding twice of that.
In average, doctors mediated from Estonia to Finland earn in average between 5,000 and 11,000 euros a
month. The highest monthly wage of a special doctor hired from Estonia has been 20,000 euros a month.
At the same time the number of Estonian doctors moving to Finland for work has fallen notably this year. This
is why Puumedi has this year mediated 11 Estonian and 9 Latvian doctors to Finland. Unlike Estonians,
Latvians have a language barrier and need 2 to 2.5 years to learn the Finnish language. Äripäev
8
Réguler l'installation des médecins pour en finir avec les déserts médicaux
Le Monde, France
05/04/2011
Laetitia Clavreul
En matière de santé, le PS a choisi de privilégier l'intérêt général pour contrebalancer les difficultés d'accès aux
soins. Au sujet des déserts médicaux, qui inquiètent de nombreux Français, le PS s'affiche ainsi en faveur
d'une « régulation » des installations de médecins libéraux, alors que l'UMP, en pleine tentative de
réconciliation avec la profession avant 2012, s'oppose à toute « coercition ».
L'Etat finançant leurs études, il doit avoir son mot à dire dans l'implantation des médecins libéraux sur le
territoire, estime le PS, quitte à écorner le sacro-saint principe de la liberté d'installation. Dans le cas où des
mesures incitatives ne suffiraient pas à augmenter le nombre de médecins dans les zones où il en manque, des
jeunes pourraient être obligés d'y exercer comme libéraux ou salariés quelques années. Les majors des
promotions des études de médecine choisiraient leur affectation ; les autres non ou ils devraient rembourser
leurs études.
« Il faut sortir des années de laisser-faire et avoir une approche plus courageuse. La liberté d'installation ne
doit pas être un tabou dès lors que des médecins partent et que la relève ne se fait pas », juge Christian Paul,
député de la Nièvre et président du Laboratoire des idées du PS. Un discours que ne renieraient pas les
associations de patients.
Les syndicats de médecins ne manqueront pas de rétorquer qu'avec un tel projet, le PS risque surtout de
dissuader les candidats au métier. Ils jugent que seule l'incitation peut fonctionner. Ils sont d'ailleurs en passe
d'obtenir la suppression des mesures de contraintes votées dans la loi Bachelot.
Mais M. Paul estime que sur le terrain la profession est divisée. « L'idée n'est pas de mettre fin à la liberté
d'installation mais d'adopter des solutions transitoires, le temps de retrouver un équilibre sur le territoire »,
poursuit-il. Le PS prône le plafonnement des installations de médecins libéraux dans les zones surdotées,
comme c'est déjà le cas pour les infirmières.
Il préconise aussi l'essor des aides à la construction de maisons de santé. Mais il prône également, là où les
libéraux boudent ces structures, la création de centres de santé, dans lesquels les médecins sont salariés. Un
mode d'exercice qui séduit de plus en plus de diplômés.
9
36
Des traducteurs soutiennent les médecins en 12 langues
Swissinfo.ch
08/04/2011
Par Julia Slater
Les immigrants ne parlant aucune des langues nationales n’ont pas la tâche facile lorsqu’ils doivent recourir à
un médecin. Un nouveau service leur vient désormais en aide: des interprètes sont à disposition 24 heures sur
24, dans douze langues.
Dans certains cabinets, les médecins peuvent déjà recourir à des traducteurs qui viennent assister à des
consultations et aider les patients à s’exprimer et à comprendre ce qui leur est dit. Mais désormais, une ligne
téléphonique met également à disposition des interprètes spécialement formés pour répondre aux personnes
ne parlant ni l’allemand, ni le français, ni l’italien.
Dénommé Service national d’interprétariat communautaire par téléphone (SIT), cette nouvelle prestation est
disponible dans toute la Suisse, 7 jours sur 7 et 24 heures sur 24, depuis le 1er avril. L’Office fédéral de la
santé publique (OFSP) a choisi l’organisation municipale zurichoise AOZ, spécialisée dans l’aide aux migrants,
et sa division Medios pour mener la phase pilote de cette nouvelle offre, disponible en douze langues.
«Des études scientifiques le prouvent: les personnes ne maîtrisant aucune des langues nationales sont
significativement en moins bonne santé et moins équilibrées sur le plan psychique que la moyenne», explique
le communiqué de l’OFSP. Or la Constitution fédérale prévoit que «toute personne bénéficie des soins
nécessaires à sa santé».
Une garantie dont l’application vacille lorsque le patient n’arrive pas à s’exprimer. «Des soins inadéquats
peuvent avoir des effets négatifs non seulement sur la santé de la personne, mais ils provoquent aussi, en
général, des coûts plus élevés», explique l’OFSP.
L’interprétariat communautaire, où le traducteur peut aussi, si nécessaire, fournir des explications sur les us et
coutumes du pays d’origine de la patiente ou du patient, est une profession reconnue depuis 2009. Des cours
de formation permettent d’obtenir un diplôme qui est reconnu dans toute la Suisse.
Inscription préalable
Le système est simple. Les hôpitaux désireux de recourir à un interprète peuvent s’enregistrer chez Medios, où
ils reçoivent un code de sécurité. Les médecins peuvent ensuite appeler à toute heure du jour ou de la nuit et
entrer en contact, normalement dans les cinq minutes suivantes, avec un interprète.
«Nous avons calculé que nous avons besoin de dix à douze interprètes par combinaison de langues, explique le
directeur de l’AOZ Thomas Kunz. Ainsi, nous avons 99% de chances d’en trouver un à toute heure du jour ou
de la nuit.»
L’intervention téléphonique est nettement plus astreignante pour les interprètes que les rendez-vous pris à
l’avance au cabinet. «Lorsque vous avez un appel à une heure et demie du matin et que vous devez
commencer à traduire, vous n’avez pas une minute pour vous préparer, c’est un sacré défi. De plus,
l’interprète ne voit pas le patient…», ajoute le directeur.
Cela n’effraye pas Necdet Civkin, interprète communautaire expérimenté entre le turc et l’allemand. «Je suis
préparé à intervenir n’importe quand, dit-il. Le téléphone dure entre 10 et 20 minutes mais ce ne sont pas des
cas trop complexes. C’est faisable.»
Compétences particulières
La responsable de Medios admet de son côté que tous les traducteurs ne sont pas capables de travailler de
cette façon. «Certaines personnes n’aiment pas être sollicitées en permanence, tandis que cela convient très
bien à d’autres, déclare Sanja Lukic. Ce sont des choix très personnels.»
La phase pilote débouchera sur une analyse de l’expérience. Il est possible que de nouvelles langues soient
intégrées au programme, si la demande se fait sentir. Il est en outre prévu que ce module d’interprétariat
communautaire téléphonique soit intégré au certificat professionnel.
Dans tous les cas, cette forme bien particulière de traduction requiert des qualités qui vont bien au-delà de la
«seule» connaissance de la langue. «Une personne parlera et écrira peut-être une langue couramment, mais
cela ne signifie pas qu’elle sera capable d’interpréter, explique Necdet Civkin. C’est un travail tout à fait
particulier.»
«Vous devez être capable d’écouter, d’intégrer ce qui est dit et de le transporter à tous les côtés. Il faut une
sorte d’intuition», ajoute l’interprète.
Equilibre délicat
La situation de la traductrice ou du traducteur est paradoxale. «D’un côté, vous avez une position de pouvoir,
note Sanja Lukic, puisque vous comprenez tout. Mais d’un autre côté, vous devez essayer de rester le plus
invisible et le plus discret possible. La règle veut que c’est le médecin qui dirige la conversation.»
«Il faut trouver un équilibre – délicat – entre l’empathie et la dissociation. Il n’est pas adéquat de ressentir trop
d’empathie mais si je fonctionne comme une machine, je manque de respect envers le patient», résume Sanja
Lukic.
37
Pour Necdet Civkin, il est important de rappeler que l’interprète reste le plus proche possible du patient et que
c’est au médecin de poser des questions supplémentaires si telle ou telle chose n’est pas claire.
«Par exemple, les Turcs disent souvent ‘huh, huh’ ou ils opinent du chef. Je dis alors au médecin que cela peut
vouloir dire «oui» ou «non». C’est donc au médecin de demander à la personne «qu’entendez-vous par là?»
«Ces discussions sortent du cadre normal, rappelle Thomas Kunz. Il y a un problème à résoudre.» Selon lui, les
patients et les médecins ne sont plus les seuls à avoir compris leur intérêt à bien se comprendre. Les hôpitaux
et d’autres usagers sont désormais d’accord de payer pour des services d’interprétariat communautaire.
«Beaucoup d’institutions se sont rendu compte ces dernières années qu’elles travaillent bien plus efficacement
si elles commencent par s’assurer qu’elles parviennent à communiquer.»
10
La opinión de los ciudadanos sobre el sistema público de salud mejora
El País, Spain
14/04/2011
EMILIO DE BENITO - Madrid
En líneas generales, la opinión de los ciudadanos sobre el sistema nacional de salud es cada vez mejor. Según
el Barómetro Sanitario de 2010, elaborado por el Centro de Investigaciones Sociológicas para el Ministerio de
Sanidad, le dan al conjunto un 6,57 sobre 10, una cifra que aumenta continuamente desde el 6,14 de 2005.
Este dato concuerda con el progresivo aumento de quienes piensan que funciona bastante bien o que necesita
algunos cambios, que ha pasado del 61,3% de los entrevistados en 1995 al 67,4% en 2007 y al 73,9% en
2010.
En el extremo opuesto, el de lo peor valorado, están las esperas (para ser atendido por el especialista, para ser
operado) y la coordinación entre comunidades.
El trabajo se ha hecho con 7.800 encuestas entre marzo y noviembre de 2010, y tiene un error del 1,1%, y
tiene la ventaja de que como se repite anualmente muestra fácilmente tendencias.
Muestra de esta mejor opinión está que ha bajado la proporción de quienes creen que habría que rehacer el
sistema desde el principio (del 4,7% en 2009 al 3,5% en 2010). O, como destacó la ministra de Sanidad, Leire
Pajín, que haya un continuo -aunque discreto- incremento de quienes prefieren acudir a un centro público que
a uno privado. En atención primaria, por ejemplo, el porcentaje de quienes prefieren ir al ambulatorio de su
sistema de salud es del 63,9% (en 2007 era del 61,7%), mientras que quienes prefieren ir a un médico
privado cayó al 29,8% en 2010 del 32,3% de 2007. "La rapidez de la atención y la comodidad de sus
instalaciones" son los motivos que dan, recalcó Pajín, quien insistió en que en ningún caso el motivo era que
pensaran que iban a recibir una atención de más calidad.
Esta corriente de mayor aprecio al sistema (a pesar de que el año pasado ya empezaron los recortes por la
crisis) se nota también en la valoración del personal, que sube ligeramente y en la apreciación de
prácticamente todos los indicadores, desde la cercanía de los centros y la confianza en el médico a la
tecnología y el número de especialidades.
Hasta en los aspectos peor valorados hay una ligera mejoría en el último año. Ocurre en el tiempo de demora
para un ingreso no urgente en el hospital (la nota que le dan pasa del 4,54 al 4,74), el tiempo de entrega de
resultados diagnósticos de los especialistas (del 4,72 al 4,85) y el tiempo que tarda el especialista en ver al
paciente desde que este pide cita (del 4,78 al 4,89).
Uno de los borrones de esta mejoría es que cada vez más gente va a urgencias. Lo hizo un 30,1% de los
ciudadanos. De los que fueron a un hospital, solo el 18% necesitó ser ingresado. El principal motivo es que los
ciudadanos piensan que en estos servicios hay más medios (lo dice el 37,7%).
Esta demanda excesiva de urgencias se nota en la calidad del servicio. El porcentaje de quienes afirman que
les atendieron con mucha rapidez -la clave de unas urgencias- bajó del 65,9% en 2007 al 63,8% en 2010.
La mejor opinión también llega a las listas de espera quirúrgicas. Por primera vez, menos de la mitad (el
49,7%) cree que siguen igual. En un año, la proporción de quienes piensan que han empeorado ha bajado del
13,11% al 11,7%. Esta apreciación más positiva coincide con los últimos datos (a 30 de junio de 2010), con un
descenso de las personas en espera de 10 días (de 71 a 61 días). Por cierto que al respecto la ministra de
Sanidad recordó que el Consejo Interterritorial ha acirdado que se iba a establecer un máximo por ley, aunque
no se ha elaborado todavía el real decreto correspondiente.
Hasta en uno de los aspectos peor valorados (la coordinación entre comunidades) la apreciación mejora. En
2007, un 85,83% pensaba que debía mejorar; ahora lo hace el 83,6%. En línea con ello, menos de la mitad
cree que efectivamente los servicios que dan las distintas comunidades sean los mismos, y entre 2009 y 2010
esa apreciación ha empeorado (lo que, por otra parte, no deja de ser una constatación de la realidad).
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Latin America & Caribbean
1
La salud en zona rural está en crisis, dijo Médicos Sin Fronteras en Arauca
Meridiano70, Colombia
11/04/2011
Este jueves 7 de abril, Médicos sin Fronteras, organización médica humanitaria con presencia en más de 60
países del mundo realizó en el auditorio del Hospital San Vicente de Arauca, la socialización del informe
“Acceder a la salud es acceder a la vida: 977 voces”.
El informe además de evidenciar la realidad que enfrentan cientos de colombianos para acceder a la salud,
muestra a través de diferentes voces, las mínimas oportunidades que ofrece el sistema de salud a la población
más vulnerable.
Entre los cientos de testimonios que reunió Médicos sin Fronteras para hacer el informe existe uno en
particular que reúne la problemática general que se presenta en las zonas más apartadas del país.
“Pues a veces uno está enfermo y no puede ir, la mayoría de las veces porque no tiene plata. Además eso es
muy demorado, allá le maman gallo a uno, que venga mañana, que saque esta fotocopia, que no alcanzó, que
madrugue; eso hace que uno se enferme más. Otro problema es el miedo, por allá están matando mucha
gente y además a uno le da miedo decir que va de por acá.”
El diagnóstico que fue realizado en los departamentos de: Arauca, Caquetá, Nariño, Antioquía, Norte de
Santander, Bolívar y Chocó dejó en evidencia las principales causas del por qué los colombianos no acceden a
la salud.
•· La distancia es uno de los factores que más aqueja a la comunidad porque de 977 personas encuestadas,
751 manifestaron que el problema es básicamente la lejanía, la falta de vías y la carencia de transporte. De las
977 personas encuestadas, 68 dijo que tardan una hora en llegar al centro médico, pero el 63% tarda entre
dos y ocho horas.
•· Otro de los problemas son los factores de violencia y el miedo, cuatrocientas personas respondieron que el
miedo a los grupos al margen de la ley y las minas antipersonal hace que no utilicen el sistema de salud, ya
que se les estigmatiza porque creen que pertenecen a algún grupo al margen de la ley.
•· La falta de información es otro de los indicadores para que las personas no accedan a la salud, pues muchas
personas no conocen sus derechos. El 20% de las personas no tenían conocimiento de que las urgencias no se
cobran, por lo que muchos mueren por la carencia de información.
2
Desnutrición ha cobrado vidas en comunidad indígena de Cambalache
Nueva Prensa de Guayana, Venezuela
12/04/2011
Geris Martínez
Ciudad Guayana.- La poca ingesta de alimentos en lugares muy pobres del planeta sumado a críticas
condiciones ambientales produce entre otras cosas; diarrea y deshidratación, en los casos más extremos
muerte, es la definición que internacionalmente se da a la desnutrición.
La comunidad indígena en Cambalache ha llegado a la situación más extrema según el mencionado concepto,
pues cinco menores han muerto a causa de este mal. Cuadros diarreicos y deshidratación es el origen de los
decesos.
El representante de la comunidad indígena, Antonio Valenzuela, explicó que lo que está pasando en su
comunidad es el olvido por parte de los entes gubernamentales, la falta de atención médica y el no ingreso de
bolívares fuertes para enfrentar las enfermedades.
Además de ésto, el no tener trabajo, ni ingreso alguno para alimentar a casi 300 niños que habitan en su
entorno es el problema principal.
El también conocido como Cacique de la comunidad, citó al presidente de la República, Hugo Chávez Frías,
cuando dice que las comunidades indígenas son intocables, y mencionó la ausencia del Gobernador del estado
Bolívar, Francisco Rangel Gómez, al igual que el alcalde José Ramón López en su comunidad.
Valenzuela señalando el espacio que le rodea lleno de basura, con viviendas en condiciones precarias, con
niños enfermos, preguntó: “¿Dónde está lo que hacen ellos por nosotros?”, “Yo sé lo que están sufriendo los
niños, nosotros gritamos que necesitamos ayuda y nadie nos escucha”.
Prosiguió: “Nosotros necesitamos trabajo, cuando los niños se enferman que los llevamos al médico ellos
mandan unos remedios que no podemos comprar porque no hay dinero, por eso mueren los hijos”.
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Denunció: “Una vez de la CVG nos prometieron 45 casas y sólo hicieron 15, nosotros estamos claros que el
presidente manda el dinero para los indígenas y aquí no llega nada, ni alimento”.
Agregó; “Yo tengo 11 años viviendo aquí y junto a los niños trabajamos recogiendo basura, porque no hay más
nada que hacer, vivimos en medio de la ciudad y no nos ayudan, mas bien nos engañan cuando quieren
votos”.
Cerró diciendo, “Éste Warao ha llorado y ha gritado por sus hijos y hermanos, después de los niños muertos es
que nos han escuchado”.
Jornada de emergencia
Como respuesta a las muertes que han sucedido en la mencionada comunidad el director del Distrito Sanitario
Nº 2, doctor Manuel Maurera, se apersonó al lugar con un equipo completo para atender la demanda de los
indígenas.
El mismo dijo: “Por instrucciones del Gobernador del Estado Bolívar y por la doctora Ana Ginet Morales,
presidenta del Instituto de Salud Pública, hemos venido con un equipo médico bien completo a manera de
hacer un trabajo preventivo y curativo a los niños y adultos de la comunidad indígena”.
Ésto por que a través de los medios de comunicación se ha podido detectar la situación que en el lugar ocurre,
“por eso estamos aplicando la vacuna contra la influenza estacional a los niños, ya que se manejan algunos
cuadros respiratorios incluso con complicaciones que tocan las infecciones graves”.
Maurera dijo; “La meta es garantizar la inmunización de todos los niños que habitan en la mencionada
comunidad, inmunizar a la población adulta de alto riesgo, además de ésto hacer una desparasitación a todos
tanto infantes y mayores y así hacer un trabajo preventivo y diagnóstico precoz”.
En cuanto a las declaraciones sobre la supuesta desatención médica, dijo que “el caso es todo lo contrario,
además de ésta jornada de vacunación, informamos que en la localidad existen dos consultorios populares de
Barrio Adentro donde se atiende a toda la comunidad, no solo a los criollos sino también a los indígenas”.
Resistencia a la consulta
Maurera resaltó que la población indígena asiste poco a las consultas médicas, en detalle dijo: “Los indígenas
poco acuden a las consultas voluntariamente y obviamente se necesita el apoyo de los consejos comunales y
las instituciones gubernamentales para que los casos no lleguen al extremo, y dar paso a lo que se llama la
prevención secundaria y así evitar más fallecimientos de los ya registrados.
Insistió en que se debe hacer un trabajo mancomunado para ubicar a los pacientes en los lugares donde están
radicados, que conozcan adónde deben acudir en caso de presentar malestar general y cuadros diarreicos.
Enfatizó “Estamos en el sector para dar a conocer a los medios de comunicación social que realmente sí hay
médicos en la zona, mismos que trabajan todos los días y que tienen la disposición para promover la salud en
este sector”.
La autoridad llamó a los consejos comunales y a los caciques indígenas a que se organicen y ante cualquier
síntoma o problema de salud de forma oportuna lleven al paciente a los centros de salud.
Ésto para evitar más fallecimientos como los que se produjeron en días atrás donde según él los niños
acudieron a la instancia médica cuando ya se encontraban en situaciones extremas, “las lesiones eran graves”
dijo, por lo que la muerte fue inevitable.
Por otro lado mencionó uno de los casos donde falleció un menor indígena, fue porque la madre decidió
retirarlo del hospital de Guaiparo sin permiso médico teniendo como consecuencia la pérdida de otra vida.
Desde el mismo momento de los fallecimientos el equipo epidemiológico del distrito inició una investigación de
los casos, buscando las causas de los fallecimientos y detectando los problemas que se están presentando para
poder dirigir las políticas a las acciones pertinentes, “este es parte de nuestro trabajo que es promocionar la
salud”, finalizó.
Lucia Delgado, doctora del ambulatorio tipo I ubicado en Cambalache, dijo que la problemática que
actualmente presenta la comunidad viene desde hace varios varios años donde influye principalmente la
situación ambiental combinada con el estilo de vida de los indígenas.
Dijo “toda la población de Cambalache está en riesgo por el hecho de vivir entre la basura, por tales motivos la
enfermedad en la localidad siempre han sido respiratorias, diarreicas deshidratación y desnutrición. Recomendó
la eliminación del botadero de basura o la mudanza de las comunidades aledañas.
La base alimentaria adecuada casi inexistente también influyó en la muerte de los niños, además de que no se
tienen medidas de higiene, viven en hacinamiento, y ésto debe atacarse rápidamente.
¿Cual prevención?
“Es lamentable que hayan muerto estos niños para que la comunidad contara con la asistencia médica directa”
dijo uno de los presentes, que no se quiso identificar para resguardar su nombre.
Éste agregó que no existe ningún control médico ni jornada de prevención puesto que de existir se hubiesen
evitado éstas cinco muertes, llamó a las autoridades a sincerarse y ejecutar un plan efectivo pues lo que ocurre
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en la comunidad indígena es grave y vergonzoso para el gobierno regional y municipal, cerró diciendo; “Qué
sería de ellos si el presidente se entera de lo que está ocurriendo con los Waraos”.
3
Paro y reclamos
Página 12, Argentina
13/04/2011
Informe: Soledad Arréguez Manozzo
La Asociación de Trabajadores del Estado (ATE) Capital hará hoy un paro por 24 horas, en 23 hospitales
porteños, en reclamo de insumos, nombramiento de personal y finalización de obras edilicias, demandas que el
gremio entiende como “solución integral” al problema de inseguridad en los hospitales. A su vez, los Centros
de Salud y Acción Comunitaria (Cesac) de la zona sur, ubicados en los barrios más vulnerables de la ciudad,
estuvieron ayer cerrados o con paro parcial de actividades. Frente a esta situación, vecinos, médicos y
organizaciones sociales marcharán hoy al Hospital Piñero –que ayer cumplió su séptimo día consecutivo de
paro– para exigir “la inmediata reapertura” de los servicios de salud en condiciones de seguridad, tanto para
los trabajadores como para los pacientes. A esta movilización se sumará una protesta frente a la Jefatura de
Gobierno de profesionales de la salud para que Macri se “responsabilice” por la falta de atención médica a parte
de la población.
Rodolfo Arrechea, secretario general de ATE-Capital, manifestó que “el problema no se resuelve sólo con
reponer a los policías ni con seguridad privada, porque requiere una solución integral”. La entidad, alineada con
la CTA, anunció un paro de 24 horas para hoy en 23 de los 33 hospitales, y realizarán un acto a las 10 en el
Durand, ubicado en Díaz Vélez 5044. El cese de actividades se realizará con asistencia de los trabajadores a los
establecimientos sanitarios y, según remarcó el gremialista, la atención en las guardias “será brindada con
normalidad”.
Arrechea denunció que “falta personal” en los centros asistenciales, por lo que existe “un retraso de más de
cuatro meses en el otorgamiento de los turnos” y “hay que esperar en algunos casos casi un año para
programar operaciones”. Agregó que reclamarán también un “aumento salarial de 40 por ciento” para sus
representados. El gremio exige “el aumento inmediato de nombramientos e insumos, además de la
construcción de baños públicos en los hospitales”.
El Hospital Piñero estuvo ayer con paro parcial de actividades, por séptimo día consecutivo, tanto de médicos
como del personal afiliado al Sutecba, que reclaman custodia policial, pese a que en el hospital hay seguridad
privada. Los Cesac, dependientes de ese hospital, están ubicados en los barrios de Bajo Flores, Villa Lugano,
Villa Soldati, entre otros, y desde hace una semana no brindan asistencia médica a la población. Por eso, los
vecinos de la zona junto a agrupaciones sociales y trabajadores de la salud marcharán a las 10.30, desde
Varela y Castañares, hasta el Piñero para reclamar que el Gobierno de la Ciudad “garantice” el acceso a los
servicios de salud, el ingreso de las ambulancias del SAME a los barrios carenciados y que haya profesionales
para cubrir los cargos necesarios para una adecuada atención.
“Los vecinos están preocupados por la falta de atención en estos centros y que la situación se prolongue en el
tiempo; hay turnos de cirugías que se reprogramaron, chicos enfermos y embarazadas que esperan atención”,
contó un médico del Piñero que no adhirió al paro. El Piñero, el Penna y el Santojanni son los hospitales más
afectados por las medidas de fuerza.
En tanto, profesionales de la salud harán al mediodía una protesta en la Jefatura de Gobierno, para reclamar
que se pueda volver a trabajar en condiciones seguras y dignas en los hospitales. Además, continuarán las
asambleas de trabajadores en los servicios de salud para reclamar una reforma integral. “La seguridad va más
allá de la presencia de policías. Es un problema más profundo y complejo: tener insumos es también tener
seguridad”, señaló Federico Kaski, médico residente del Piñero.
4
ANS proíbe operadoras de premiar médicos que ajudam a reduzir custos
Estadao, Brazil
14/04/2011
Lígia Formenti
Planos de saúde estão proibidos de oferecer prêmios para médicos que respeitarem uma cota mínima para
solicitação de exames ou outros procedimentos complementares. A prática, que, segundo profissionais, é
adotada por boa parte das operadoras para reduzir os custos, agora é considerada uma infração, de acordo
com instrução normativa da Agência Nacional de Saúde Suplementar (ANS) publicada ontem no Diário Oficial.
"É um avanço inegável. O que o País precisa agora é que a medida seja colocada em prática e, principalmente,
que seja fiscalizada", afirmou o vice-presidente do Conselho Federal de Medicina, Aloísio Tibiriçá. A instrução publicada dias após a mobilização de médicos por melhores condições de trabalho e de remuneração estabelece às operadoras que descumprirem a norma pena que varia de sanção a multa de até R$ 35 mil.
41
Por meio da assessoria de imprensa, a ANS informou que todas as recomendações de operadoras que
interferem na liberdade do médico já são consideradas infrações. Mas, de acordo com a ANS, as empresas se
valiam da ideia de que "gratificação" não poderia ser considerada como um interferência.
Queixas antigas. As queixas de médicos sobre abusos praticados por operadoras de saúde e, principalmente,
de interferência no exercício da profissão são antigas, destaca o presidente do Conselho Regional de Medicina
de São Paulo (Cremesp), Renato Azevedo Júnior. De acordo com ele, pelo menos desde 2003 profissionais
denunciam duas práticas comuns: a concessão de "incentivos" para aqueles que não ultrapassarem um teto de
exames e punições para quem desrespeitar os indicadores - na forma de desconto ou, até mesmo,
descredenciamento.
O presidente do Cremesp conta que a chamada "meta referencial", usada como padrão teto pelas operadoras,
era fixada por meio de critérios determinados pelas próprias operadoras. "Não há a menor condição de se
estabelecer um padrão para atendimento em consultório. Isso só prejudica o atendimento do paciente e,
sobretudo, interfere na autonomia do médico", completou Azevedo Júnior.
Demora. Para o presidente do Cremesp, embora muito importante, a medida da ANS chegou com atraso
considerável. "Além disso, há ainda outras formas de limitações à autonomia do médico impostas pelas
operadoras que precisam ser inibidas de forma mais clara pela ANS."
Entre elas, a negativa de autorização para realização de exames ou procedimentos, como por exemplo, a
videolaparoscopia. "Isso acontece muitas vezes sem nenhum tipo de justificativa, e mesmo que os
procedimentos estejam cobertos pelo contrato feito com o paciente", conta. "As normas da ANS estão aí. Mas
muitas operadoras apostam na impunidade. Não há fiscalização, não há risco de punição."
Tibiriçá afirma que médicos devem denunciar todos os casos de interferência ao exercício da profissão.
"Recebemos várias notificações. Mas profissionais ainda têm medo de represálias."
5
CDHDF exhorta a mejorar servicios de salud en cárceles
El Universal, Mexico
10/04/2011
Claudia Bolaños
La Comisión de Derechos Humanos del Distrito Federal (CDHDF) exhortó a la Secretaría de Gobierno local, de
la cual dependen los centros de reclusión, a revisar las condiciones estructurales y las prácticas
discriminatorias que se reproducen al interior de estos.
Al sobrepasar su capacidad, los penales capitalinos dan precarios servicios de salud. Internos consultados
dijeron que diariamente se dan 50 fichas para ser atendidos y generalmente hay más de 300 personas que
buscan atención en alguna de las enfermerías.
Una persona de la Secretaría de Salud adscrita a los reclusorios advirtió sobre la falta de medicamentos y de
instrumental médico.
“Hay doctores y dentistas que ellos mismos llevan su instrumental, e incluso ponen material para atender a los
internos, porque hay algunos que traen mucho dolor, incluso por semanas”, señaló una empleada.
También compran medicamentos, dijo, como aspirinas y otras pastillas que sirven como paliativos.
Destacó además que el ingreso de medicamentos requiere de un permiso especial. No obstante, hay personas
que tienen facultades para vender ese tipo de pastillas.
Para la CDHDF la protección del derecho a la salud en este grupo poblacional constituye una preocupación.
Cabe destacar que el Sistema Carcelario de Salud, a cargo de la Secretaría de Salud del Distrito Federal, brinda
servicio en ocho centros penitenciarios.
Sin embargo, este organismo observa con preocupación que el déficit en la infraestructura y la ausencia de
insumos y personal condicionan la adecuada prestación de servicios médicos.
La Comisión de Derechos Humanos local destacó que el sistema penitenciario de la ciudad no fue diseñado
para albergar al número de personas que en la actualidad tiene bajo su custodia, cifra que ya rebasa los más
de 40 mil internos, pues esta situación incide en la precaria prestación de los servicios, la insuficiencia de los
recursos clínicos, terapéuticos y de rehabilitación.
Enfatizó que el estándar internacional lo establece la propia Organización Mundial de la Salud, al considerar la
salud como el estado de completo bienestar físico, mental y social, y no sólo la ausencia de afecciones o
enfermedad.
Las personas que están en reclusión difícilmente pueden ser caracterizadas en este estado, en vista de que la
población rebasa la capacidad de los centros para proporcionarles los elementos para su bienestar en sentido
amplio.
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6
La propuesta de cerrar y crear otra Caja de Salud (Editorial)
Opinión, Bolivia
12/04/2011
Objetivos.
Cerrar la Caja no es tarea sencilla y para reemplazarla por otra, se debe conocer de qué modo se evitaría
reproducir los problemas actuales y bajo qué moldes conceptuales.
El presidente del Estado Plurinacional, Evo Morales, ha hecho referencia a dos grandes males que aquejan a las
instituciones públicas como son el nepotismo y el cuoteo. Esta alusión la formuló a tiempo de efectuar críticas
al funcionamiento de la Caja Nacional de Salud (CNS).
El Presidente ha propuesto a los dirigentes de la Central Obrera Boliviana (COB) cerrar esta entidad de salud y
crear otra institución en su lugar para que beneficie de “verdad” a los aportantes a este seguro social.
La situación de la Caja de Salud y su eficiencia en la atención de sus miles de asegurados ha sido objeto de
una serie de observaciones que tienen relación principalmente con dos aspectos que hacen al rol que debe
cumplir. El primero la atención a los asegurados y el segundo el manejo administrativo.
En cuanto al primero es evidente que existen problemas que son de larga data como por ejemplo la falta
oportuna de atención médica, de entrega de medicamentos, aunque una mayoría de los asegurados que han
recibido atención médica, si bien se quejan de estos problemas, tampoco dejan de encomiar la profesionalidad
de la planta de médicos.
La Caja en realidad es una institución que se encuentra atrapada por las propias limitaciones que tiene el país
en su generalidad. Esta institución ha servido desde su creación a miles de personas y mucha gente se
pregunta qué ocurriría con la salud de un enorme segmento de los bolivianos si no tendrían a la Caja.
La limitaciones de esta entidad que tienen que ver con aspectos médicos y administrativos, parten de
limitaciones y de métodos administrativos que no son los mejores, pero tampoco se puede desconocer que los
problemas económicos de la institución devienen porque el propio Estado le adeuda sumas importantes de
dinero que no han sido pagadas oportunamente y por el contrario, una mora que se arrastra desde hace años
afecta al desempeño de la institución.
Pero hay que preguntarse si los problemas económicos aún siendo superados podrían determinar mejores
niveles de eficiencia institucional y de prestación de servicios a los asegurados y beneficiarios. Es posible que
sí, aunque un problema central desde hace muchos años, como en muchas instituciones públicas, es
precisamente lo que ha puntualizado el presidente Morales, es decir el nepotismo, o sea la formación de
círculos donde se han formado grupos de personas que por vínculos familiares o sindicales han ocupado
determinados espacios de la entidad del seguro. El nepotismo es una tara en la administración pública que no
deja espacio a la adopción de políticas institucionales y administrativas que garanticen la eficiencia en la
gestión.
En el supuesto caso de que la Caja sea refundada o reorganizada para crear otra institución, también habría
que conocer cuáles serían los objetivos conceptuales y los métodos a emplearse para garantizar que los
problemas que enfrenta la actual entidad no se repitan, por ejemplo, con la reproducción del nepotismo y del
cuoteo político partidario.
Una de las empresas más complejas es la creación, organización y desarrollo de un seguro nacional de las
características que actualmente tiene la Caja Nacional de Salud, que como todos saben, en Bolivia tiene
características especiales porque funciona con el dinero o aporte de los trabajadores.
7
Muchos órganos se pierden aquí debido al alto costo del trasplante
Listín Diario, DR
07/04/2011
Doris Pantaleón
Aunque la lista de espera de pacientes que requieren de trasplantes de órganos es larga en el país, muchos
órganos captados por un equipo de médicos especializados para ello se pierden debido al costo del trasplante y
a la falta de recursos para cubrirlos, lamentó ayer el presidente del Instituto Nacional de Coordinación de
Trasplantes (Incort).
Fernando Morales Billini dijo que esa institución tiene en lista de espera más de 300 personas que requieren de
trasplante de hígado y cada año unos 1,500 necesitarían de riñón, pero que lamentablemente la mayoría son
personas pobres y se atienden en hospitales públicos, donde no hay recursos para costearlos y los que tienen
Seguro Médico tampoco pueden acceder porque las ARS no cubren pruebas fundamentales para ello, que son
muy costosas.
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Dijo que el programa de trasplante del país necesita financiamiento, un laboratorio de histocompatibilidad y un
banco de tejido. Un trasplante de riñón cuesta unos 860 mil pesos. Recordó que cada año en el país se
registran 170 pacientes nuevos por cada millón de población con insuficiencia renal crónica, lo que equivale a
cada año 1,500 presentan esa enfermedad, cuyo tratamiento definitivo sería el trasplante renal.
El especialista informó que con el propósito de estar preparado para expandir el trasplante, el Incort mandó
fuera del país a capacitar a 15 coordinadores de trasplantes que son los encargados de la captura de órganos y
tejidos de personas fallecidas y coordinan todo el proceso de donación, muchos de los cuales están nombrados
en diferentes hospitales.
Dijo que ahora mismo se están gestionando más donantes de lo que el país puede preparar, ya que el 70 por
ciento de los pacientes que se dializan están agrupados en hospitales de Salud Pública, no tienen
aseguramiento en su gran mayoría, son catastróficos que han quebrado ellos y sus familias, por lo que no
tienen recursos económicos para optar por el trasplante.
Explicó que actualmente en el país hay dos programas de trasplantes de donantes fallecidos, uno funciona en
el Centro Cardio-renal, Oftalmológico y de Trasplante (Cecanot) del hospital Luis Eduardo Aybar, y el otro en
el hospital General de la Plaza de la Salud, pero que para que los mismos sean sostenibles se hace necesario
que haya un financiamiento especial para trasplantes.
Entiende que el país tiene gran capacidad para recolectar órganos, ya que solamente en el Traumatológico
Darío Contreras se podrían captar 30 donantes al año, sin contar otros centros que generan donantes. Dijo que
si el donante aparece en una clínica privada su mantenimiento, el uso de sala de cirugía costaría unos 50,000
pesos, lo que no es posible disponer de inmediato dado los trámites burocráticos que eso encierra.
“Es bueno que el país sepa que los pacientes catastróficos que sufren de cáncer o necesitan un trasplante
están desamparados, porque el seguro médico se las pone en China para poder trasplantarlos y no les cubre
pruebas básicas, que cuestan unos 50,000 pesos”, señaló.
Morales Billini dijo que eso hace que no se puedan trasplantar los que no tienen seguro ni a los que lo tienen.
Destacó que cada año el país hace un promedio de 60 trasplantes de rinón, pero que el año pasado ese
promedio bajó a 46, mientrras de hígado se hacen tres y cuatro al año, costeado mayormente por el Hospital
General de la Plaza de la Salud. El Incort tiene en lista de espera a 300 pacientes con problemas hepáticos.
Morales Billini recordó que cuando una institución da informaciones sobre trasplante debe cuidar la
identificación del donante, por lo que no se deben dar detalles de la edad, características y sexo, entre otros.
Informó que Cecanot está actualmente entrenando personal para iniciar el trasplante cardíaco.
Destacó que desde el 2008 la estructura que creó la Ley 329-98 sobre Donación y Legado de ”rganos y Tejidos
para Trasplante comienza a tener presupuesto, que es cuando inicia el programa nacional de donación de
trasplante y el subprograma de donantes fallecidos.
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