This Week's News
5-9 September 2011
Weekly news clippings service featuring articles on the Global Health Workforce Alliance and
selection of articles from around the world on the issue of the health workforce crisis
GHWA and Partners ¦ Medical Journals ¦ Africa & Middle East ¦ Asia &
Pacific ¦ North America ¦ Europe ¦ Latin America & Caribbean
This compilation is for your information only and should not be redistributed
GHWA and Partners
Date
Headline
Publication
07.09.11
Stopping violence
WHO
30.08.11
A journalist’s guide to reporting research findings
HIFA2015
01.09.11
Increasing Access to Care by Asking Health Workers What They
Want
Capacity Plus
06.09.11
Regional Champion of Open Source iHRIS Software Shares Successes
and Lessons Learned 
Capacity Plus
07.09.11
High-level Meeting Highlights the Importance of a Secure and
Reliable Supply of Contraceptives 
UNFPA
07.09.11
Doubling our reach in Somalia
Merlin, UK
06.09.11
Children Five Times More Likely to Die in Countries Hit by Health
Worker Crisis, Save the Children Finds
Save the Children
Medical Journals
Date
Headline
Publication
08.09.11
Prevention of torture by doctors and organisations
The Lancet, UK
06.09.11
Bahrain: continuing imprisonment of doctors
The Lancet, UK
30.08.11
Education for health professionals in Japan—time to change
The Lancet, UK
30.08.11
Neonatal Mortality Levels for 193 Countries in 2009 with Trends
since 1990: A Systematic Analysis of Progress, Projections, and
Priorities
PLoS Medicine
07.09.11
Health Care Reform and the Health Care Workforce — The
Massachusetts Experience
The New England
Journal of
Medicine
Africa & Middle East
1
Date
Headline
Publication
02.09.11
NHI 'no cure for sick public facilities'
04.09.11
Kenya needs 20,000 more doctors 
02.09.11
Neonatal deaths haunt SA
07.09.11
Kenyan nurses claim unfair treatment
05.09.11
African governments must find lasting solution to brain drain
04.09.11
Alarm over number of women relying on untrained midwives 
07.09.11
Health Ministry warns of shortage of doctors, nurses 
Mail and
Guardian, Zambia
Daily Nation,
Kenya
Mail and
Guardian, SA
The Botswana
Gazette
Daily Monitor,
Uganda
Daily Nation,
Kenya
Haaretz, Israel
05.09.11
Assault on medical personnel - a two-way street 
The Jordan Times
Asia & Pacific
Date
Headline
Publication
05.09.11
Skill development programme for nurses launched
DAWN, Pakistan
05.09.11
Govt. to hire 12,000 more health workers
04.09.11
Medicos to get 70-year-old professors
06.09.11
More mums-to-be opting for midwives at hospitals
03.09.11
Young docs wary of rural postings
02.09.11
Up-skilling AINs the key to nursing shortage
03.09.11
Rural doctors reject Government report
Philippine
Information
Agency
Deccan Chronicle,
India
Channel News
Asia
The Asian Age,
India
Nurses Careers
Allied Health, AU
ABC News, AU
31.08.11
Specialist shortage causing medical errors
New Zealand
Herald
North America
Date
Headline
Publication
06.09.11
The cost of savings
The Hill
07.09.11
Maternal Health Practioners Advocate Saving Lives at Birth
08.09.11
Physician assistants see big growth in U.S. 
07.08.11
Doctor Fees Major Factor in Health Costs, Study Says
07.08.11
Surgeon critical of wait for operations
Voice of America
News
Los Angeles
Times
The New York
Times
Telegraph
Journal, CA
Europe
Date
Headline
Publication
06.09.11
The worst country in the world to be a sick child
The Guardian, UK
04.09.11
WE MUST NURSE THE NHS BACK TO HEALTH
Express, UK
04.09.11
24 hours on a maternity ward - Sunday Mirror investigation
Mirror, UK
06.09.11
Health Minister: Ukraine faces shortage of doctors
KyivPost, Ukraine
06.09.11
6,600 patients on trolleys as beds cut back
Herald, Ireland
2
02.09.11
Foreign nurses registering in UK despite 20-year work gap
The Guardian, UK
08.09.11
An adequate health workforce
Times of Malta
10.09.11
Health care in Japan: Not all smiles
The Economist,
UK
Latin America & Caribbean
Date
Headline
Publication
08.09.11
Mujica está preocupado por la falta de médicos en la campaña 
Espectador,
Uruguay
08.09.11
Crisis en el IMSS por falta de especialistas
El Mexicano
08.09.11
El país está en el puesto 95 en cuidado infantil
08.09.11
El médico del mañana
07.09.11
Los médicos son mayoría en el país
El Comercio,
Ecuador
El Diario de
Yucatán, Mexico
La Voz, Argentina
07.09.11
Nurses walk off job due to 'unsanitary conditions'
05.09.11
Baixos salários e estrutura precária causam "apagão médico" no
Norte e Nordeste
The Tribune,
Bahamas
Rondonoticias,
Brazil
GHWA and Partners
3
Stopping violence
WHO
07/09/2011
7 September 2011 -- Violence accounts for more than 1.5 million deaths every year. Furthermore, a significant
number of women report experiencing physical and/or sexual violence by an intimate partner at some point in
their lives. Violence results in health, social and economic costs to society. To improve this situation WHO is
reviewing recent progress, including cutting-edge violence prevention programmes, within the Global
Campaign for Violence Prevention.



Find out more about the Milestones of the Global Campaign for Violence Prevention Meeting
Read the fact sheet on violence against women
See 10 facts about violence prevention
4
A journalist’s guide to reporting research findings
HIFA2015
30/08/2011
Group Discussion Forum
Posted by Neil Pakenham-Walsh
The message below is forwarded from the Knowledge Broker's Forum (KBF) - www.dgroups.org/groups/kbf - 'a
collaborative space to promote knowledge sharing and dissemination around intermediary work in international
development'. For further information on KBF, see http://www.knowledgebrokersforum.org
In my view, it is critically important to improve the quality of health reporting in the mass media. As such, this
publication is therefore welcome. However, I would like to have seen a section on the importance of systematic
reviews and cumulation of evidence. Regrettably, a great deal of health reporting seeks to sensationalise the
findings of the latest single research study without considering other research that has been conducted on the
same subject. Consequently, health reporting in the mass media leads to fear and confusion among citizens,
with conflicting stories and loss of public trust in health research.
I would be interested to hear HIFA2015 members' comments and suggestions about health journalism and
systematic reviews. What can be done to improve understanding and to reduce sensationalism in health
reporting? How widely is the concept of systematic reviews understood among journalists, among
policymakers, among health professionals?
Posted by Dr Shamprasad M. Pujar
This guide developed by Panos London provides practical tips and guidance for journalists and editors
interested in publishing stories based on development research findings. It will also be of interest to
3
communications staff in universities, think tanks, or civil society organizations responsible for promoting
research findings.
http://panos.org.uk/wp-content/files/2011/06/A-journalists-guide-to-reporting-research-findings.pdf
5
Increasing Access to Care by Asking Health Workers What They Want
Capacity Plus
01/09/2011
In Lao People’s Democratic Republic (PDR), health workers are concentrated in cities while more than 80
percent of the population lives in rural areas. As in many countries, attracting health workers to rural posts—
and retaining them—is a challenge.
“The conditions of living there [are challenging],” says Dr. Chanthakhath Papassarang, deputy chief of the
Education and Training Division, Department of Organization and Personnel in the Ministry of Health, “and the
environment for working is very poor.”
In the latest edition of CapacityPlus Voices, “Motivating health workers to serve in rural Lao PDR,” Dr.
Papassarang, Dr. Phouthone Vangkonevilay, and Dr. Outavong Phathammavong share their insights and
describe how the Ministry of Health has teamed up with CapacityPlus and the World Health Organization to
assess health workers’ preferences using the Rapid Discrete Choice Experiment Tool.
By the end of the assessment and related costing work, says Dr. Phathammavong, “we will know the most
appropriate incentive package for the health workers in Lao PDR.”
Related items:
 Motivating Health Workers to Serve in Rural Lao PDR
 Taking Steps to Retain Health Workers in Rural Areas of Lao PDR
 Improving Rural Retention of Health Workers in Lao PDR
6
Regional Champion of Open Source iHRIS Software Shares Successes and Lessons Learned
Capacity Plus
06/09/2011
Professor Kayode Odusote works with countries in West Africa to track, manage, and plan their health
workforce using CapacityPlus’s iHRIS software. Recently he traveled to the US from his home country of
Nigeria to share successes and lessons learned.
iHRIS supplies health leaders with the information they need to ensure that the right health worker is in the
right place at the right time. Because the software is open source, countries can freely customize it to meet
local needs.
Until last December, Professor Odusote was director for human resources development for the West African
Health Organization (WAHO). While working for WAHO, he adapted iHRIS Manage for a pilot in Ghana.
The success of the pilot fueled a regional movement that has resulted in an unprecedented level of country
buy-in and local stakeholder leadership. Now, as a CapacityPlus consultant, he works with other nearby
countries—including Mali, Nigeria, and Togo—to modify and implement iHRIS to address their country’s health
workforce challenges.
In August, Professor Odusote presented his work to foster independent deployment and country ownership of
iHRIS in his region at the following meetings:
 The Centers for Disease Control and Prevention’s Public Health Informatics Conference in
Atlanta, GA
 An interactive webinar with the global iHRIS community, including participants from Botswana,
Lesotho, and South Africa, fostering interregional collaboration
 A presentation and discussion at IntraHealth International in Chapel Hill, NC with guests from
Columbia University, Duke University, Family Health Ministries, MEASURE Evaluation, North Carolina
Central University, and the University of North Carolina
 A meeting with representatives from USAID, the Office of the US Global AIDS Coordinator, and
collaborating projects and organizations in Washington, DC.
CapacityPlus currently provides direct technical assistance for iHRIS implementation in Mali and Ghana with
upcoming assistance planned in Nigeria. CapacityPlus provides remote technical support for implementing
iHRIS in Togo, while WAHO provides funding support.
Related items:
 “Worth More than Any Money:” Building Local Capacity in Health Worker Information
Systems
 Mali Joins Nearby Countries in Adopting CapacityPlus’s iHRIS Software
 Partnering to Strengthen Health Information in West Africa
4
7
High-level Meeting Highlights the Importance of a Secure and Reliable Supply of Contraceptives
UNFPA
07/09/2011
UNITED NATIONS, New York –- First Ladies, health and finance ministers and parliamentarians from 12
developing countries meeting here today affirmed that voluntary family planning, secured by a steady supply
of contraceptives, is a national priority for saving women’s lives. More than 215 million women in developing
countries want to avoid or space pregnancies but are not using modern methods of contraception.
“As of October 31, the world will have 7 billion people, of which 1.8 billion are young people, and 90 per cent of
them live in developing countries. That implies that 1 billion young women are actively seeking the information
and service we are talking about here,” said UNFPA Executive Director, Dr. Babatunde Osotimehin, in his
opening remarks at the high-level meeting.
At the meeting, senior stakeholders from 12 priority countries will be showcasing their successes and
brainstorming on strategies for ensuring even greater results in the future. The 12 ‘Stream One’ countries
(Burkina Faso, Haiti, Ethiopia, Laos, Mali, Madagascar, Mongolia, Mozambique, Nicaragua, Niger, Nigeria and
Sierra Leone) are part of the Global Programme to Enhance Reproductive Health Commodity Security
programme. Launched in 2007 by UNFPA and partners, the programme supports national efforts to ensure a
reliable supply of reproductive health essentials.
“Collectively, we are changing the face of maternal and child mortality in Sierra Leone,” said the First Lady of
Sierra Leone, Mrs. Sia Nyama Koroma, during the opening session. “The high maternal mortality rate in Sierra
Leone is partly due to the weak reproductive health commodity security system, including the non-availability
of reproductive health commodities, lack of storage facilities, weak distribution systems for commodities and a
weak logistics management system.” She noted that support through the global programme has “increased the
uptake of family planning and other reproductive health programmes, such as fistula activities and the
screening of patients for breast cancer.”
Dramatic increases in the use of modern methods of contraception are widely reported by countries
participating in the global programme. In Niger, for instance, the contraceptive prevalence rate increased from
5 per cent in 2006 to 21 per cent in 2010. In Madagascar, it rose by 11 percentage points from 2004 to 2009,
when it reached 29.2 per cent.
Supplies are reaching more people in the right place at the right time. In Burkina Faso, the number of health
clinics reporting no shortfalls or stock-outs increased from 29 per cent in 2009 to 81 per cent in 2010.
Access to appropriate methods is improving. In Nicaragua, the percentage of service delivery points offering at
least three modern methods of contraception increased from 66.6 per cent in 2008 to 99.5 per cent in 2010.
Likewise in Ethiopia, the increase was from 60 per cent 2006 to 98 per cent in 2010.
Country-driven initiatives include training and computers for stronger supply delivery in the national health
system, awareness campaigns and advocacy for national policies, strategies and contraceptive budget lines.
During today’s meeting, Dr. Osotimehin called on the 12 countries to put resources in their budget to meet the
needs of their women and girls: “UNFPA will work with you to provide them with education, opportunities and
access to information and services including reproductive health commodities – so that each young girl will be
a fire, a multiplier, and will add value to the world in which she belongs,” he said.
8
Doubling our reach in Somalia
Merlin, UK
07/09/2011
As the famine spreads in Somalia, British-based health charity Merlin is stepping up its efforts to reach those
most in need.
Merlin is preparing to almost double its number of health facilities from 24 to 47 and massively scale up the
number of mobile clinics from four to 35.
Merlin’s Chief Executive Carolyn Miller says:
“Somalia is an incredibly challenging country but Merlin has been working here since 2004 with considerable
success.
“This is not a short-term crisis and we are committed to staying on as long as it takes to address the country’s
severe health needs.”
Since the beginning of the year, Merlin’s medical experts have screened over 20,000 children, pregnant women
and young mothers.
5
Merlin’s teams have also vaccinated over 3,000 children for measles, diphtheria, whooping cough and tetanus
that could prove fatal to youngsters already weak with hunger if left untreated.
In the depths of this crisis, Merlin is reaching out and making a difference.
9
Children Five Times More Likely to Die in Countries Hit by Health Worker Crisis, Save the Children
Finds
Save the Children
06/09/2011
Tanya Weinberg
WESTPORT, Conn. (September 6, 2011) — A new index by Save the Children has ranked the best and worst
countries for a child to fall sick in — with Chad and Somalia at the bottom and Switzerland and Finland at the
top.
The new analysis measures the nationwide reach of health workers and shows that children living in the
bottom 20 countries on the index are five times more likely to die than those further up the index.
“The global health worker crisis is costing children’s lives every day. All the vaccines, lifesaving drugs and
preventive care mean nothing when there are no skilled health workers to deliver them to the children who
need them most,” said Mary Beth Powers, chief of Save the Children’s newborn and child survival campaign.
The bottom-ranked countries on the new index have extreme health worker shortages – with only an average
of 7 doctors, nurses and midwives per 10,000 people. The World Health Organization says a minimum
threshold of 23 such health workers are needed for every 10,000 people in order to deliver essential maternal
and child health services. The United States has about 125 health workers per 10,000 people and ranks 15th
out of 161 countries evaluated on the index.
What does the health worker index measure?
The index measures not only how many health workers there are but also their reach and impact. It factors in
the proportion of children who receive regular vaccinations and mothers who have access to life-saving
emergency care at birth. In developed countries, almost all children and mothers are reached with these basic
services.
The World Health Organization has estimated the global health worker shortage at more than 3.5 million. In
many developing countries, there is not only a shortage of health workers, these workers are often
concentrated in urban areas and fail to reach vulnerable mothers and children in rural areas. An additional
challenge is that many existing health workers in poorer countries lack sufficient training or support to provide
basic lifesaving services.
Save the Children released the new index ahead of the United Nations General Assembly in New York later this
month. There, world leaders will review and announce new commitments on the “Every Woman Every Child”
strategy they signed onto last year in order to reduce the 8.1 million child deaths and 358,000 maternal deaths
that still occur annually.
“If world leaders truly want a more stable and prosperous world where diseases like pneumonia and diarrhea
don’t unnecessarily kill millions of children and where women don’t needlessly die in childbirth, they must act
on health workers now,” Powers said. “Working together with developing nations to put more trained health
workers on the front lines is the most cost-effective and sustainable investment wealthier nations can make.”
More about the Health Worker Index
The health worker index includes three indicators:
1.a measure of health worker density
2.the percentage of children receiving three doses of the vaccine for diphtheria, whooping cough and tetanus
3.skilled birth attendance rate
161 countries, those with accurate data available, are included in the index. Countries with a population of less
than 500,000 were not included.
0
Back to top
Medical Journals
1
Prevention of torture by doctors and organisations
The Lancet, UK
08/09/2011
doi:10.1016/S0140-6736(11)61300-7
6
Yolanda Sydney Augustin a, Marion Birch b, Chiara Bodini c, Frank Boulton b, Elicia Robertson d, Valentina
Maria Spada c, Miri Weingarten e
Emerging from World War 2 and the Nuremberg trials, societies looked to the 21st century to herald a new era
of human rights. Yet in its first decade torture has occurred in countries claiming to be global human rights
leaders, and in others an abysmal human rights record has simply continued. In 2010, George Bush defended
so-called waterboarding on the grounds that it had saved lives in the USA and UK, ignoring other legal
opinions, the unreliability of evidence gained under duress, and the banning of such practices by Barack
Obama.1 After a visit to Sri Lanka in 2007, Manfred Nowak, the UN Special Rapporteur on Torture, reported
that torture was “widely practised” and that “this practice is prone to become routine in the context of counterterrorism operations, in particular by the [Terrorist Investigation Department]”.2
Medical complicity in torture, as outlined in the World Medical Association (WMA) Declaration of Tokyo,3 occurs
when physicians willingly take part in, facilitate, or allow torture by failing to report clinical evidence of it to the
relevant authorities. Examples of direct participation in torture include provision of medical knowledge to
interrogators, disregard of medical confidentiality, force-feeding of rational people on hunger strike, and
falsification of medical records or death certificates. Tragically all these forms of unethical conduct are
represented in a new report—Preventing torture: the role of physicians and their professional organisations:
principles and practice.4
The report draws attention to the many instances of medical professionals who, often at personal risk, seek to
prevent and mitigate the effects of torture. When they do, they must receive the support and protection that
they need. Medical complicity in torture often takes place in prison and detention settings, where clinicians can
come under substantial pressure because of dual loyalty and put the perceived interests of their employers or
the state above their absolute duties to protect their patients.5
The report recommends how professional medical bodies can work more effectively towards elimination of
torture, through the support that they give their members and by tackling medical complicity. It includes case
studies from the USA, Sri Lanka, the UK, Italy, and Israel. These case studies are in no way globally
representative, and the availability of information, the existence and strength of professional bodies, and the
ability of health professionals to speak out varies widely. Readers are invited to provide additional case studies
and to consider how they can apply the report's recommendations.
There are several examples of concerns documented in the report. In the USA, reports from the International
Committee of the Red Cross, Human Rights Watch, and US military personnel showed that health professionals
falsified death certificates, failed to accurately report illnesses and injuries, and helped to design, approve, and
monitor interrogations.6 In Sri Lanka, the Judicial Medical Officers had inadequate resources to undertake most
autopsies, and obstacles to a prompt and effective examination meant that “too much evidence simply bleeds
out onto the floor”.7 In the UK, evidence to the Baha Mousa Inquiry noted that there was apparently “a
remarkable level of ignorance about the rules applicable to the health care of detainees”.8 Most submissions by
222 former inmates of UK Joint Services Intelligence Organisation facilities indicate that military doctors took
no interest in their injuries.9 In Italy, people arrested during demonstrations at the G8 summit in Genoa in
2001 suffered serious, systematic, and protracted inhumane and degrading treatment at the hands of health
personnel.10 In Israel, there is evidence that health professionals have failed to oppose, accurately document,
and report, evidence or suspicion of torture of the detainees they examine and treat.11—13…continued.
Full text: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61300-7/fulltext
2
Bahrain: continuing imprisonment of doctors
The Lancet, UK
06/09/2011
doi:10.1016/S0140-6736(11)61353-6
Eoin O'Briena,
The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4,
Ireland
a
The wave of prodemocracy protest and revolution in many Arab states—the Arab Spring—reached Bahrain in
February, 2011. The protest was soon ruthlessly suppressed with the help of forces from Saudi Arabia. 1
Bahrain's main public hospital, the Salmaniya Medical Complex, was subsequently occupied by the military.
Several independent observers recorded the brutality of the clampdown, reports of imprisonment, torture, and
extraction of confessions, and the military trials.[2], [3], [4] and [5] More than 70 medical professionals, including 47
doctors, were arrested and more than 150 medical workers have been suspended or dismissed from their
jobs.2
Ireland's close medical relation with Bahrain, which extends back many years,6 took on a new dimension when
the Royal College of Surgeons in Ireland (RCSI) invested almost €100 million to develop the RCSI–Medical
University of Bahrain. In June, 2011, when RCSI and the Royal College of Physicians of Ireland conferred joint
degrees in Bahrain, the failure of either College's president to visit the families of the imprisoned doctors, some
of whom had trained in Dublin and were fellows of RCSI, drew strong protest from the medical profession in
Ireland.[7] and [8] Subsequently the international human rights organisation Front Line Defenders organised a
delegation from Ireland to visit Bahrain to offer support to these medical personnel. The delegation comprised
two doctors, Damian McCormack and me; three politicians, Averil Power, Senator of the Irish Parliament, David
7
Andrews, former Minister for Foreign Affairs, and Marian Harkin, Member of the European Parliament; two
members of Front Line Defenders, Andrew Anderson and Khalid Ibrahim; and a photojournalist, Conor McCabe.
During a 2-day visit we met the administration of the Salmaniya Medical Complex, representatives of the
Ministry of Foreign Affairs, and Fatima Al Balushi, Minister of Human Rights and Social Development and acting
Minister of Health.9 In our preamble to these meetings we indicated that although many similarities existed
between Ireland and Bahrain, freedom of speech was a cornerstone of Ireland's democracy, and accused
persons were innocent until proven guilty. Al Balushi expressed her pride in the human rights achievements in
Bahrain, especially in furthering the rights of women and religious freedom. Al Balushi said that the Arab
Spring had brought the country to the verge of civil war. She claimed that several doctors had failed to care for
the wounded and must therefore face trial. Asked if the allegations of kidnapping, detention, and torture were
true, she answered that if such was found to be the case, the perpetrators would be duly prosecuted. She
acknowledged that mistakes had been made but said that these had been redressed by the King with the
appointment of an independent commission to investigate violations of human rights, the transfer of trials from
military to civilian courts, and the release of medical detainees who were not a threat to national security. Al
Balushi agreed to approach the King with a request on our behalf for the release of detained doctors (a request
that has not been granted to date and many imprisoned doctors are now reported to be on hunger strike); she
asked in return that I give Bahrain fair coverage in The Lancet, which she regarded as being unfairly biased
against Bahrain.10
Our delegation went to secret locations to meet members of the families of imprisoned doctors and doctors
who had been released pending trial, and to meet ambulance drivers who said they had been taken from their
ambulances, imprisoned, and tortured. Some of those who said they had been imprisoned were clearly
suffering from anxiety, emotional instability, and depression. The loyalty and affection expressed by doctors
suspended from the Salmaniya Medical Complex, where so many of them had served for many years,
contrasted strongly with their feeling of betrayal by RCSI–Bahrain. We also met Nabeel Rajab, President of the
Bahrain Centre for Human Rights, and Abdulla Al Derazi, General Secretary of the Bahrain Human Rights
Society, who have each carefully documented instances of torture for submission to the relevant international
human rights bodies.
At the end of our visit we were in no doubt that doctors and medical personnel had been subjected to human
rights abuses, including kidnapping, detention without trial in solitary confinement, and the extraction of
confessions under torture. We left Bahrain moved by their gratitude for our support and embarrassed that we
were offering so little in the face of the enormity of their suffering and courage. The medical community
worldwide needs to take notice and speak out for colleagues who are being denied basic human rights, and
who are being subjected to indignities that the medical profession should not tolerate.
My travel to Bahrain was paid for by Front Line Defenders.
References
1 J Hiltermann and T Matthiesen, Bahrain burning
http://www.nybooks.com/articles/archives/2011/aug/18/bahrain-burning (Aug 18, 2011) (accessed Aug 31,
2011)..
2 Physicians for Human Rights, Do no harm: a call for Bahrain to end systematic attacks on doctors and
patients https://s3.amazonaws.com/PHR_Reports/bahrain-22April_4-45pm.pdf (April, 2011) (accessed Aug 31,
2011)..
3 Human Rights Watch, Bahrain: systematic attacks on medical providers
http://www.hrw.org/news/2011/07/18/bahrain-systematic-attacks-medical-providers (July 18, 2011)
(accessed Aug 31, 2011)..
4 F Cunningham, Detained Bahraini medics: brutal crackdown against pro-democracy movement
http://www.globalresearch.ca/index.php?context=va&aid=24449 (April 22, 2011) (accessed Aug 31, 2011)..
5 RW Hayes, Bahrain doctors in prison for daring to speak out
http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/9521963.stm (June 25, 2011)
(accessed Aug 31, 2011)..
6 E O'Brien, The Island of Dilmun, J Ir Coll Physicians Surg 18 (1989), pp. 6–7.
7 D McCormack, Medics held in Bahrain
http://www.irishtimes.com/newspaper/letters/2011/0506/1224296280504.html (May 10, 2011) (accessed Aug
31, 2011)..
8 E O'Brien, Treatment of medics in Bahrain
http://www.irishtimes.com/search/index.html?rm=listresults&filter=datedesc&keywords=o%27brien+bahrain&
x=12&y=13 (June 23, 2011) (accessed Aug 31, 2011)..
9 E O'Brien, Hippocratic oath. Irish Examiner http://www.irishexaminer.com/ireland/kfgbcwidgboj/rss2 (Aug
31, 2011) (accessed Aug 31, 2011)..
10 S Devi, Health professionals under threat in Bahrain, Lancet 377 (2011), pp. 1733–1734. Article | PDF
(414 K) | View Record in Scopus | Cited By in Scopus (0)
3
Education for health professionals in Japan—time to change
The Lancet, UK
30/08/2011
Nobutaro Bana, and Michael D Fettersb
doi:10.1016/S0140-6736(11)61189-6
8
Department of General Medicine/Family and Community Medicine, Nagoya University Graduate School of
Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
b
Department of Family Medicine and Japanese Family Health Program, University of Michigan, MI, USA
a
Of Japan's 80 medical schools, only three—Jichi Medical University, National Defense Medical College, and
University of Occupational and Environmental Health—explicitly target physician training for rural practice, selfdefence forces, and occupational medicine, respectively. The remaining 77 medical schools (42 national, eight
prefectural or municipal, and 27 private) follow the traditional style of education to train health professionals.
Under this system, tertiary academic centres, in which university hospitals are mostly at the top of the
hierarchy, maintain power with little concern for development of secondary and primary health units in
community-based programmes. Interprofessional1 and transprofessional education2 (which includes nonprofessional health workers), are still relatively new disciplines.
Japan is known for its good health outcomes, which might indicate support from a strong primary health-care
system; however, this is not the case. Most of the country's primary-care physicians are not primary-care
physicians according to the standard definition.3 Furthermore, scarcity of gatekeepers—ie, primary-care
physicians who are not well trained as generalists allow patients to self-refer to secondary-care or tertiary-care
hospitals even when their ailments could be treated just as well, if not better, at the primary-care level.
Although other factors, such as unrestricted access to any doctor, have masked the deficit in Japan's primary
health system the inefficiency of the system is becoming recognised in view of the ageing population and
increasing costs needed for specialist care. The absence of an effective primary health-care system risks
exacerbation of the health disparities that are gradually emerging in Japan, particularly among people aged 65
years and older4 whose low income constrains them from receiving appropriate health care. Development of
primary care can relieve such inequalities.5 Reforms aimed at increasing the effectiveness and efficiency of care
recommended in other papers in The Lancet Series on Japan will be worthless if attention is not focused on
reforms to primary health care.
Historical and political issues largely account for the scarcity of specialisation in primary health-care in Japan.
There has never been a surge of popular opinion favouring an increased role for primary care in Japan because
of easy, low-cost access to most medical facilities. No groundbreaking reports have come from Japan, such as
the Millis report6 in the USA, which strongly supported the reorientation of medical education towards
physicians who would provide comprehensive and continuing health care. Although in the early 1980s the
Ministry of Health and Welfare sponsored primary care international fellowships to encourage a new
commitment to primary care, these efforts faced strong opposition from the politically influential Japanese
Medical Association, an organisation dominated by clinic-based physicians who favoured the status quo and
feared reimbursement cuts from primary-care reform. Additionally, no education system existed to train
medical students and graduates as generalists and family physicians until 2004, when the Japanese Academy
of Family Medicine—a small group of physicians attempting to introduce family medicine—launched an official
3-year training programme for specialists in family medicine. According to a survey (unpublished), only 53 of
the 80 medical schools in Japan have a department of general or family medicine that can provide an academic
headquarters for general clinical practice, education, and research in academic institutions. As of 2011, Japan
has less than 200 certified family physicians.
On a positive note, the Japan Primary Care Association (JPCA) was formed in 2010, and is now the largest
academic association of general practitioners in the country. The association formed through a merger of the
Japanese Academy of Primary Care Physicians, the Japanese Academy of Family Medicine, and the Japanese
Society of General Medicine. JPCA provides a common platform for individuals who are interested in primary
health care, and supplies certification for family physicians. Expectations are high for JPCA in the next decade:
the importance of primary care in academic medicine should be emphasised to indicate the kind of doctors
needed in Japan, and the orientation of national health policy should be changed towards primary care, in line
with a recent WHO report.7
For the Japanese medical system to be a model for other countries, recognition of a specialty of primary care
and emphasis on this specialty as a priority of national health policy are of paramount importance. To support
this policy, departments of general medicine should be established in all medical schools. Therefore, general
practitioners and family physicians will be trained to deliver first-contact care, long-term patient-centred care,
and comprehensive care in coordination with allied health personnel in the community. Such an emphasis will
help alleviate the need for self-referral to hospital-based physicians, thus easing the strains on that system and
making the Japanese health system more efficient.
Gordon Greene and Susan Hubbard provided assistance in the preparation of this manuscript. We declare that
we have no conflicts of interest.
References
1 Japan Society for Medical Education, Proceedings of the 43rd Annual Meeting of the Japan Society for Medical
Education http://www.med-gakkai.org/jsme2011 (accessed July 27, 2011)..
2 J Frenk, L Chen and ZA Bhutta et al., Health professionals for a new century: transforming education to
strengthen health systems in an interdependent world, Lancet 376 (2010), pp. 1923–1958. Article | PDF
(1695 K) | View Record in Scopus | Cited By in Scopus (41)
3 H Hashimoto, N Ikegami and K Shibuya et al., Cost containment and quality of care in Japan: is there a
trade-off?, Lancet (2011) 10.1016/S0140-6736(11)60987-2 published online Sept 1..
4 C Murata, T Yamada, CC Chen, T Ojima, H Hirai and K Kondo, Barriers to health care among the elderly in
Japan, Int J Environ Res Public Health 7 (2010), pp. 1330–1341. View Record in Scopus | Cited By in Scopus
(1)
9
5 B Starfield, L Shi and J Macinko, Contribution of primary care to health systems and health, Milbank Q 83
(2005), pp. 457–502. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (427)
6 JS Millis, The graduate education of physicians. The report of the Citizens Commission on Graduate Medical
Education, American Medical Association, Chicago (1966).
7 WHO, The world health report 2008—primary health care (now more than ever)
http://www.who.int/whr/2008/en/index.html (2008) (accessed May 28, 2011)..
4
Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis
of Progress, Projections, and Priorities
PLoS Medicine
30/08/2011
Mikkel Zahle Oestergaard1*, Mie Inoue1, Sachiyo Yoshida2, Wahyu Retno Mahanani1, Fiona M. Gore1, Simon
Cousens3, Joy E. Lawn4, Colin Douglas Mathers1, on behalf of the United Nations Inter-agency Group for Child
Mortality Estimation and the Child Health Epidemiology Reference Group
1 World Health Organization, Department of Health Statistics and Informatics, Geneva, Switzerland, 2 World
Health Organization, Department of Child and Adolescent Health and Development, Geneva, Switzerland, 3
London School of Hygiene & Tropical Medicine, London, United Kingdom, 4 Saving Newborn Lives/Save the
Children, Cape Town, South Africa
Abstract Top
Background
Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates.
Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for
about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality
rates (NMRs) and neonatal deaths for 193 countries for the period 1990–2009 with forecasts into the future.
Methods and Findings
We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 country-years of
information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical
model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data.
Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3
million babies died in the first month of life—compared with 4.6 million neonatal deaths in 1990—and more
than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8%
(19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and
Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28%
from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period
increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the
world, Africa's NMR only dropped 17.6% (43.6 to 35.9).
Conclusions
Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs.
Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4
(two-thirds reduction in child mortality) is to be achieved…continued.
Full Text: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001080
5
Health Care Reform and the Health Care Workforce — The Massachusetts Experience
The New England Journal of Medicine
07/09/2011
Douglas O. Staiger, Ph.D., David I. Auerbach, Ph.D., and Peter I. Buerhaus, Ph.D., R.N.
In 2006, Massachusetts enacted legislation to provide universal health insurance coverage that later served as
a model for the national health care reform legislation passed in 2010. Phased in during 2007, the
Massachusetts Health Care Reform Plan offered insurance subsidies for low-income individuals, expanded
Medicaid coverage, and created an individual mandate to obtain insurance, pay-or-play requirements for
employers, and a state insurance exchange through which many of the newly insured Massachusetts residents
obtained coverage. Since implementing these provisions, Massachusetts has achieved near-universal insurance
coverage but has also seen continuing growth in health insurance premiums, a net increase in state spending
on health care, and growing political pressures to control cost growth.1,2 Polls of the public and of physicians
indicate that the state’s health care reforms are generally viewed favorably, though physicians are concerned
about access to primary care and administrative burdens.3
The Massachusetts reform experience has been watched closely for indications of what might occur throughout
the country as national health care reform is implemented under the Accountable Care Act (ACA). One aspect
of the Massachusetts experience that has remained unexplored is the impact on the health care workforce,
particularly the question of whether greater numbers of health care professionals or support personnel were
needed to ensure the success of the reform in increasing access to care. If successful reform requires a larger
health care workforce, then implementation of the ACA may increase health care costs and exacerbate
expected shortages of physicians and registered nurses.
10
To examine the impact of the Massachusetts reform on the state’s health care workforce, we analyzed data on
total and occupation-level employment per capita in the health care industry and compared trends before and
after reform in Massachusetts with those in all other states. We defined health care employment as including
all employees of hospitals and ambulatory service providers, but we excluded employees of nursing and
residential care facilities, since they weren’t directly affected by reform. Data on total health care employment
came from the U.S. Bureau of Labor Statistics Quarterly Census of Employment and Wages, which publishes
monthly counts of employment reported by employers covering 98% of jobs in the United States. These data
are available at the state level by industry and are the primary data used by the U.S. government to track
trends in industry employment. Data on health care employment within major occupations were derived from
the American Community Survey, which has surveyed a nationally representative sample of nearly 3 million
households each year since 2005 and was developed by the U.S. Census Bureau to replace the long form of the
decennial census….continued.
Full Text: http://healthpolicyandreform.nejm.org/?p=15255&query=home
6
Back to top
Africa & Middle East
1
NHI 'no cure for sick public facilities'
Mail and Guardian, Zambia
02/09/2011
ILHAM RAWOOT
Doctors in the public sector say it is a far-fetched notion that the National Health Insurance scheme will work
with South Africa's public hospitals in the state that they are in.
They say that gross mismanagement and a major shortage of doctors are the biggest obstacles to the efficient
working of public hospitals.
Phophi Ramathuba is a doctor in the public sector and the chairperson of the public sector doctors group at the
South African Medical Association.
"Most issues revolve around the management of our hospitals," she says.
"We need people with the necessary skills, qualifications and capacity. I might be a doctor, but that doesn't
mean I have the skills to manage a hospital."
Hospital chief executives don't understand how a hospital's priorities differ from those of an office, she says,
and many don't even have a medical background.
Tende Makufane, the president of the Junior Doctors' Association of South Africa, says: "We have done
extensive research on the problems facing public hospitals. The reality is that most of our hospitals don't have
good managers. Some have not undergone any finance training and others have no training in healthcare."
Bad management translates into a number of tangible issues, he says.
"The infrastructure in hospitals is poorly maintained, from the physical structure down to the equipment."
Much of the equipment at public hospitals is badly maintained or not replaced timeously.
"We just keep using faulty equipment until it dies," Makufane says.
"This is the fault of poor management. It has not set up functioning systems to maintain equipment."
Makufane says public hospitals are still faced with an unreliable supply of medicines.
"It's common for our hospitals to run out of antiretrovirals or medication for diabetes and tuberculosis,
sometimes for up to six months." He blames this on a "faulty -tendering process".
Shortages
A doctor at Charlotte Maxeke Hospital in Parktown, Johannesburg, who asked not to be named, says that
underspending by management means that the anaesthetics department is often short of stock of basic
medicine such as painkillers.
He says there are no working computers to check laboratory results. "You can't check simple things like bloodtest results."
"There is a lack of ICU [intensive care unit] beds," he says, "which is a huge problem. It means that you can't
do operations. You either have to delay operations or send the patient back to their ward, which compromises
their care."
11
With only one CT scanner, he says, patients sometimes wait for up to two weeks to be scanned, costing the
health department R1 200 a day.
And doctors' rest areas need to be upgraded so that they can work better.
"At 3am, the doctors' rooms make you want to throw up. The CEOs [chief executives], the administration, the
health department don't care if I have a good working experience. There's also a serious cockroach problem
here."
Another problem is a significant shortage of hospital staff.
"The government is focusing on the production of more doctors but it is not focusing on retention," says
Makufane.
Ramathuba agrees, saying that some departments in public hospitals operate with two or three doctors when
they need 30.
According to another doctor at Charlotte Maxeke Hospital, the shortage of doctors in medical casualty means
that people often wait more than six hours to be attended to.
"There is no focus in the NHI on where the skills will come from," says the doctor. "There's no point having a
beautiful hospital with no doctors to fill it."
He says that patients are sometimes operated on by doctors who have already worked 30-hour shifts.
And the hospital is also short of administration staff….continued.
Full text: http://mg.co.za/article/2011-09-02-nhi-no-cure-for-sick-public-facilities/
2
Kenya needs 20,000 more doctors
Daily Nation, Kenya
04/09/2011
The country needs 20,000 new doctors for efficient medical services.
Medical Service Minister Prof Anyang’ Nyong’o said the country had only 5,000 doctors against the required
25,000, to serve in both private and public hospitals.
“Staff shortage in the ministry of health needs to be addressed urgently,” he said.
Speaking during the second graduation ceremony at Kendu School of Medical Sciences, the minister said that
about 17,000 nurses are in the service out of 64,000 nurses needed to meet the country’s demand.
The minister said the shortage presented his ministry with a challenge in providing effective quality service to
meet rising demand.
Colleges in the counties
Prof Nyong’o said the government was in the process of opening up more Medical Training Colleges in the
counties to solve the shortage.
Currently, there are 29 medical training schools out of 47 that should be opened up in each county.
Similarly the minister disclosed that the government plans to introduce E–Health courses where students will
learn on-line.
Prof Nyong’o said the government too has plans to update all public health facilities countrywide at the cost of
Sh85 billion in the next five years.
The minister said the public has the right to access quality care and urged health personnel to ensure they
provide it.
He asked health workers to serve faithfully saying many professionals were seeking more money from clients
at the expense of providing quality care.
“There is a disease currently eating up professionalism in the society, and that disease is the love for money,”
said Prof Nyong’o.
3
Neonatal deaths haunt SA
Mail and Guardian, SA
02/09/2011
12
SIBONGILE NKOSI
Sister Mapaseka Mokoena* holds the life of Chris Hani Baragwanath Hospital's smallest patients in her hands.
The Soweto-based nurse has worked in the hospital's busy neonatal ward for four years and she is passionate
about her job.
But she is resigning this month.
"Nothing is sadder than watching babies die," she says. "Especially when such deaths can be avoided."
Mokoena is taking her skills and her passion to the private sector. She can no longer cope with the "constant
struggle" of neonatal nursing in a state hospital. The problem: too many babies and not enough nurses.
"A neonatal ward should accommodate only 35 newborns, but we look after 45. I often have to oversee four
babies at once. The reality is that you can't offer your full attention to each child. There's just not enough
time," she says.
Mokoena feels the shortage of "simple things", such as soap and paper towels, leads to unnecessary infections.
Disposable syringes, which are meant to be used once, are routinely sterilised and recycled. This too can cause
infections, which are often fatal.
Every month nurses like Mokoena compile reports. They record how many babies have died and the reasons
for their deaths. They also suggest ways to improve the quality of neonatal care in the ward. "But no one ever
follows up on these reports," says Mokoena. "Inspectors come, but nothing gets done to improve conditions."
Since 2007 the Neonatal Nursing Association of South Africa has been trying to stem the tide of
"disillusionment and frustration" among those who care for society's "most frail and fragile".
Association director Ruth Davidge agrees that neonatal care does not receive enough attention from the health
sector, despite ongoing media coverage of infant mortality cases. She points out that HIV/Aids has had a
significant impact on the number of premature births nationally, because HIV-infected mothers are more likely
to deliver their babies preterm (before 37 weeks). Premature newborns are more vulnerable to infection and
need specialised nursing. But in South Africa, says Davidge, neonatal training is very limited.
"Hospitals often choose between inexperienced midwives, paediatric nurses and critical care nurses to work at
neonatal units," says Davidge. Junior nurses are posted to neonatal wards "against their will" and quickly
become intimidated by the demands of such a specialised form of healthcare.
In rural areas the problems are worse. Dr Richard Cooke, spokesperson of the Rural Health Advocacy Project,
points out that "many [rural] hospitals lack facilities, such as ambulances, and often don't have enough
incubators".
Cooke believes that prevention is better than cure. If mothers access quality healthcare early in their
pregnancy, many potential problems can be avoided. "We need to take healthcare systems to communities,"
he says. "Government can start by implementing mobile clinics, especially in villages, which are far from
hospitals."
Health Minister Dr Aaron Motsoaledi launched one such clinic -- funded by mining giant Kumba Iron Ore -- in
the Northern Cape in July. In his address Motsoaledi spoke frankly about the challenges facing the country's
neonatal health sector: "We have 20 000 stillbirths every year. The number of babies that die before they
reach five years has reached 75 000."
Speaking to the Mail & Guardian after the ceremony, he admitted that South Africa might not achieve the
millennium development goal of reducing child mortality by 2014, but was adamant that it remained a priority.
"If you solve the problems facing children and women, you have solved 60% of the problems facing the
healthcare system," he says.
Motsoaledi maintains that the integration of community-based health workers in hospitals is a prerequisite for
transformation. This would also involve placing paediatricians and neonatal specialists in each district "to avoid
the deaths of more children".
He says government will establish an independent "office of standards compliance" to ensure that South
Africa's hospitals and clinics meet minimum health standards.
But Mark Heywood, director of the public interest law NGO Section 27, believes it will take more than this to
transform neonatal care in South Africa. For Heywood, the key word is "accountability".
"One of the many gaps in the healthcare sector is the lack of oversight. In many cases of babies dying in
hospitals it is often unclear who should be held accountable," says Heywood.
Mokoena not only agrees with him, she also takes the argument one step further. "Nurses are not just part of
the problem, they are vital to any solution," she says.
"Government should listen more to us, not just to experts and academics. We are the ones on the ground and
we have to carry the burden. Every time a child dies, you feel you have failed. People don't understand the
13
conditions under which we work. But where does the finger point when something goes wrong? At the nurse."
* Not her real name
The morbid facts
June 2011: Five premature babies died at Jubilee Hospital in Hammanskraal, north of Pretoria, allegedly
because of broken incubators.
January 2011: Twenty-nine babies died at the Cecilia Makiwane Hospital in East London and the authorities
kept quiet, not even reporting the matter to the provincial government. An independent investigation was
conducted by the provincial department of health.
May 2010: Six babies died at the Charlotte Maxeke Johannesburg Academic hospital. The department of health
and social development established a task team to investigate the circumstances surrounding the incident. In
each case the cause of death appears to be related to a highly virulent outbreak of gastroenteritis in the
premature baby unit. The team also found the following deficiencies regarding the facility and resources: lack
of routine supplies, such as roller towels or antiseptic sprays, as well as inadequate hand-washing.
On the same day 11 babies died at the Natalspruit hospital on the East Rand. Health officials were adamant
that the Natalspruit babies had not died after contracting diarrhoea.
January to May 2010: About 200 premature babies died at the Nelson Mandela Academic Hospital in the
Eastern Cape. Deaths were blamed on poor ventilation and oxygen systems at the hospital. A task team from
the Eastern Cape department of health was established to investigate. -- Sources: www.health-e.org.za,
www.info.gov.za and www.samedical.org/newsroom
4
Kenyan nurses claim unfair treatment
The Botswana Gazette
07/09/2011
Written by ISAAC PHEKO
Nursing and Midwifery Council of Botswana says they are not qualified
Two Kenyan nurses who have been practicing in Botswana for seven years before being deregistered last year
have petitioned the Lobatse High Court alleging that they were unfairly treated by the Nursing and Midwifery
Council of Botswana.
Ruth Karikuki and Jacqueline Oniamba were deregistered as nurses and or/midwives following allegations that
they did not possess the required qualifications to practice in Botswana.
Karikuki worked for Independence surgery in Gaborone while Oniamba worked for the Ministry of Health. High
Court Judge Zibane Makhwade heard the case.
According to the papers filed in court, the de-registration followed a fact finding mission that the Council had
undertaken in Kenya, the country were the two nurses obtained their qualifications. Karikuki and Oniamba hold
the Kenya Registered Community Health Nurse qualification, referred to as KRCHN, which combines both the
nursing and midwifery programmes, and which the Botswana programme does not.
Representing the two nurses, attorney Gosego Garebamono of the Garebamono and Pillar law practice, said
that the decision to deregister the two nurses was wrongful, unlawful, unreasonable, and irrational, based on
baseless considerations; it was made in bad faith, and on those grounds should be set aside.
He added that respondent never carried out a substantive comparison of the KRCHN qualification and
Botswana’s.
Representing the Council, Gosego Lekgowe of Monthe Marumo and Company, said that submissions of lack of
comparative difference between the two programs overlook the reasons advanced by the Council in the letter
of deregistration.
He also denied that the two nurses were never told of about the results of the benchmarking exercise.
He argued that it was not the two nurses’ competency that was at issue; it was whether they held the right
qualifications.
“Their experience would not have changed the question of whether or they held the right qualifications,” he
said. A driver who drives a vehicle for ten years without a license and is found out by the authorities cannot be
heard to say, ‘but I have been driving for ten years’, attorney Lekgowe remarked.
He said that the delay in deregistering duo has been acknowledged and explained. “We submit that this does
not indicate any ill or ulterior motive on the respondent’s side.”
5
14
African governments must find lasting solution to brain drain
Daily Monitor, Uganda
05/09/2011
By Mike Mukula
Much as our continent wallows in poverty, have you readers ever pondered the number of professionals that
we (Africa) produce; professionals whose skills are on demand in various corners of the globe?
They are aplenty. However, such positive trends never make it through the news agenda in the developed
West and eastern hemispheres. That brings me to today’s discussion: brain drain in Africa. Our continent is
losing thousands of highly skilled individuals, annually, to the job market in developed countries.
But before we cry foul, let us examine the reasons why such individuals desert their mother countries. These
reasons include: lack of opportunities, low pay, political instability, and economic depression. According to
experts, Ethiopia, Nigeria, Ghana, Kenya and Uganda are the most affected countries in terms of brain drain.
Currently, more than 300,000 highly qualified African professionals, some of them with PhDs, are now working
in the Diaspora.
This brain drain, especially of medical professionals, is threatening the existence of health services in Africa.
Here are some examples: There are more Ethiopian doctors in Chicago- USA than there are back homein
Ethiopia! Partly because of political instability, Ethiopia lost an estimated 75 per cent of its professionals to
other countries, between 1980 and 1991.
Ghana is reported to have 2,000 trained doctors. The ratio of one doctor to patients 1: 11,000 patients.
However, up to 68 per cent of these doctors have relocated to other countries-- between 1993 and 2000-according to details from Ghana’s official Statistics Institute. Kenya is reported to be losing an average of 20
medical doctors every month to other countries.
According to the 1993 UNDP Human Development Report, more than 21,000 Nigerian medical doctors were
practising in the USA alone and yet their home country was suffering from an acute shortage of such
professionals! If one were to factor in the number of Nigerian medical doctors working in Saudi Arabia, other
Gulf States, Europe, Australia and other African countries, it is probable that the government in Abuja has lost
an estimated 30,000 doctors.
On the positive side brain drain can;
l Increase in the amount of financial remittances back home by such professionals. These remittances help
boost household incomes. It is estimated that the total number of Africans working abroad (both skilled and
non-skilled) do remit $45 billion annually.
l If and whenever they ever return for good, these professionals bring new skills and experience to their
mother countries.
On the negative note, while the remitted cash is something to cheer about, it does not however make up for
the social cost of losing their services back home in Africa. There are several adverse effects of losing such
skilled professionals.
Secondly, until recently, most of our senior politicians had never shown concern for the loss of such highly
skilled professionals. They regarded them as traitors or an unpatriotic lot.
Thirdly, the problem was compounded by the attitude of global lenders such as the IMF, World Bank, Usaid,
etc. These institutions would never--till now-- ask for highly professional individuals to work at high level in
their projects in Africa. Instead, they would bring in experts from more developed economies. The end result
has been the paying out of Africa-- to foreign expatriates-- an estimated $ 4billion annually. But such money
could have been paid to locals who are highly skilled.
The solution to Africa’s brain-drain perhaps lies in NEPAD’s notion of establishing a continental data base. This
might help Africa know the exact number of such professionals who are benefiting the developed West and
ignoring mother Africa.
The priority of our leaders should nonetheless be to develop our human resources and reverse the brain drain
through provision of better political, social and economic environments. They, too, must pay such professionals
a ‘deterrent’ remuneration; one that will deter them from going to greener pastures abroad. And onto such
remuneration, there should be added incentives, which will further dissuade them from fleeing into economic
exile.
For example, during dictator Idi Amin’s days, doctors were exempt from paying taxes for their vehicles. Our
governments should think up more ingenious ways of retaining these professionals.
Capt. Mukula is the chairman of the Pan African Movement, Uganda Chapter.
6
Alarm over number of women relying on untrained midwives
Daily Nation, Kenya
04/09/2011
15
By Nation Correspondent
The child mortality rate in Central Province has fallen to 52 per 1,000 live births from 77 recorded earlier in the
decade.
This is despite the continued staff shortages at hospitals.
The reduction, however, is threatened by an emerging trend where more women are visiting non-professional
birth attendants, who have limited knowledge in case of emergencies.
According to the Central provincial director of medical services, Dr Gichuiya M’Riara, expectant mothers should
ensure they visit hospitals.
Professional help
“The women ought to go to hospitals where there is professional help. In case of complications during
childbirth, the best place to be would be near a qualified doctor,” he said.
At the Nyeri Provincial General Hospital, nurses are concerned over the tendency of women only rushing to
hospital after complications arise during childbirth. They said in some cases it will be too late to help the
mothers.
Information from the provincial medical office shows that the number of births requiring surgery has gone up.
If such cases arise when the patient is seeking alternative birth assistance, there would be no way of saving
the mother and the child.
According to Central provincial medical officer Samuel Muthinji, over 50 per cent of births in the region occur
without the mother getting any assistance from a qualified helper. The women are turning to such helpers due
to lack of proper information and shortage of staff at public hospitals.
Dr Gichuiya called on the media and the public to offer support and push the government to provide more
resources to hospitals.
“The same way the country is rallying behind the hunger issue and the constitutional matter is the same way
we ought to approach understaffing and lack of equipment in hospitals. This is a matter of life and death, and
there are no shortcuts to better healthcare,” he said.
At the same time, a new study published last week in the journal PLoS Medicine says that increased focus on
maternal and child health overlooks the newborn babies, who now account for 41 per cent of child deaths.
79
Health Ministry warns of shortage of doctors, nurses
Haaretz, Israel
07/09/2011
By Dan Even
A Health Ministry report released yesterday warns of a growing shortage of doctors and nurses in Israel and
calls for immediate steps to increase the number of medical personnel.
Among the reasons listed for the predicted dwindling of doctors and nurses are physicians' aging, doctors
leaving the country or the profession, a decrease in doctors immigrating to Israel and defensive medicine
practices (designed to avert the possibility of malpractice suits ).
The report presents a plan to the tune of tens of millions of shekels to increase the number of medical
personnel and stave off the future shortage.
There are 25,542 doctors in Israel today - or 3.36 doctors for every 1,000 people. This ratio is higher than in
industrialized nations, where the average stands at 3.1 doctors to 1,000 citizens. However, Israel's ratio is
expected to fall to 3.09 doctors per 1,000 people by 2015, and to 2.69 per 1,000 people by 2025, unless
urgent steps are taken, the committee that drafted the report says.
An additional 300 students must be admitted to medical programs every year in order to reach the ratio of
2.69 per 1,000 people in 2025, the report says. It also recommends reducing the number of medical programs
available to foreign students, to allow more Israeli students into these programs.
The Health Ministry has also teamed up with the Immigrant Absorption Ministry to encourage Israeli doctors
working overseas to return to Israel.
Another idea under consideration at the ministry is raising doctors' retirement age, in coordination with the
Israel Medical Association.
The ministry's program to increase the medical personnel also includes forming a new profession in the medical
world - nursing assistants that would provide basic medical care to patients.
16
The committee that compiled the report, headed by the Health Ministry's deputy director-general for economics
and health, Dr. Tuvia Horev, also warned of a shortage in specialists, especially in the fields of anesthesiology,
intensive care, preemies' medicine, child psychology, child neurology, geriatrics and rehabilitative medicine.
A future shortage is also predicted for internal medicine specialists and general surgeons - two central fields in
hospital medicine, as well as in pathology and child surgery.
The report suggests residents be encouraged to enter these fields by offering them scholarships and grants,
while limiting places in medical fields that have a surplus of doctors, such as orthopedics and plastic surgery.
Taking careof the nurses
The current rate of nurses in Israel is 5.7 per 1,000 people, lower than the industrial states' average of 8.4
nurses per 1,000 people.
"The increase in nurses is lagging behind the population growth rate," said Health Ministry director general Dr.
Ronni Gamzu. "If we don't take measures we can expect a serious crisis."
In its report, the ministry proposes increasing the number of nursing programs so that by 2025 the country will
see 6.5 nurses per 1,000 people.
The new profession recommended by the report - nursing assistants - will require three months' training in
hospitals and nursing schools. The nurses assistants will administer basic treatments to patients such as
washing, feeding and helping them off the bed.
10
Assault on medical personnel - a two-way street
The Jordan Times
05/09/2011
By Khetam Malkawi
AMMAN - Assaults against doctors are sometimes the result of the “wrong” way doctors communicate with
patients and their families, a top government official said on Sunday.
Minister of Health Abdul Latif Wreikat said medical staff should be trained on how to deal with patients and
their families to avoid potential misunderstanding and the ensuing tension and violence.
He noted that “doctors should treat patients as they treat members of their families”, and realise that people
accompanying them are under stress and must be addressed properly.
But Wreikat stressed that the ministry will not abandon its duty to protect medical personnel and will follow
legal procedures to ensure that such incidents will not recur.
“We will not hesitate to file a lawsuit in case of an assault, in order to get to the bottom of it,” said the
minister, adding that “even if a doctor is blamed, he must be punished in accordance with the law”.
The minister made his remarks at a press meeting yesterday, during which he briefed the media on the
measures adopted by the ministry to prevent assaults against doctors.
The ministry will appoint social and psychological counsellors in emergency rooms, and will task a high-ranking
doctor to oversee this section, since the majority of attacks take place in emergency rooms.
“So far, the ministry has filed three lawsuits against citizens who assaulted doctors,” the minister said, adding
that in a fourth case, preliminary investigations revealed that the doctor was to blame because he refused to
see a patient in critical condition.
According to Jordan Medical Association figures, 13 cases of physical assaults against doctors have been
recorded since the beginning of the year.
Taking stock of medicine
Meanwhile, the minister revealed that the full computerisation of the ministry’s drug stocks will be finalised
before the end of this week.
“The computerisation of the stores will save us between JD10 million and JD15 million every year,” the minister
told reporters, adding that a daily report will be submitted to him showing the amount of dispensed medicine
and the remaining quantities.
The minister also said that there is no shortage of medicine in any of the ministry’s warehouse, countering
some media reports to the contrary.
The ministry is coordinating with the concerned parties to ensure that all guest workers are medically insured
as part of their contracts, the minister said.
17
“Usually employers do not cover medical expenses of guest workers. In case they get sick or are injured, the
employers often send them to the ministry’s hospitals and refuse to pay for their treatment,” he explained.
The health coverage should be secured by insurance companies, said the minister, adding that the cost of
conducting hepatitis and tuberculosis tests is JD65, and the ministry charges foreign workers JD20 only.
“We contemplate increasing the fees to cover part of the cost,” Wreikat said.
Back to top
Asia & Pacific
1
Skill development programme for nurses launched
DAWN, Pakistan
05/09/2011
By Ashfaq Yusufzai
PESHAWAR, Sept 4: The provincial health department has launched a five-year programme for advanced
training of the nursing staff at country`s premier health institutions to improve the patient care.
The initiative titled “Skill development programme to award scholarships in the field of nursing and
physiotherapy” would get underway from November for which an endowment fund of Rs701 million had already
been set up, said Special Secretary Health Dr Noorul Iman.
“To select nurses on merit for BSc and MSc nursing and BSc in physiotherapy has been necessitated by the
growing need for specialised nurses and physiotherapists and improve healthcare delivery,” he added.
He said that in the past they had been offering four-year BSc nursing courses to the students having secondary
school certificate (SSC) examination with pre-medical group that would stand invalid by the year 2015. “Owing
to rules of Pakistan Nursing Council (PNC) and global changes, the existing training system will stand invalid,”
he said.
“Under the new programme, trainings being imparted will include Post Registration Nurse (PRN), Bachelor of
Science in Nursing (BSN) and MSc,” he said. The male and female ratio has been fixed at 10:90 while the ratio
in physiotherapy is 50:50.
For the PRN, the candidate will be required at least two years experience from any recognised institute while
the students wanting to get BSN course will need at least 55 per cent marks in FSc.
The MSc candidates will require one year experience as BSN. Those aspiring to apply for physiotherapy courses
will need with 55 per cent marks in FSc (pre-medical).
Dr Iman said that the profession of nursing had made tremendous progress globally and it was need of the
hour to provide modern education to the students in areas of intensive and neonatal care besides other
specialised branches of medical sciences.
“A total of 330 students would be given free education along with accommodation and expenses as well as
tuition fee,” he said. A steering committee under secretary health had been formed to make final selection of
the candidates, he said.
Nurses with basic training will apply for BSc where as for MSc, those candidates, who have successfully
completed and are awarded BSc Nursing Degree by PNC after 16 years of education, will be considered.
Dr Iman said that all the nursing schools needed to be upgraded to offer bachelor degree by 2015 as per PNC
guidelines and international criteria.
The programme aimed at developing skills of medical and allied professionals and building capacity of
government to address the future challenges and contribute to the economic development through
employment generation would also give much-needed boost to 10 nursing and two postgraduate nursing
schools in the province.
All the 12 schools were on the verge of closure owing to lack of tutors, he said.
According to PNC rules all schools should have skilled faculties, three members with master degree in nursing
with three to five years experience in teaching and clinical experience for 60 students while same number of
faculty members with three years experience is required for Post Registration Nurse.
Dr Iman said that the selected nurses would get training at Agha Khan University Karachi, Shifa Institute of
Nursing Education Islamabad and Khyber Medical University Peshawar (KMU).
18
For physiotherapy, which according to him was a neglected area so far, the selected students would be sent to
College of Physiotherapy, Jinnah Postgraduate Medical Institute Karachi and KMU Peshawar.
“All the students will sign a bond that will make them bound to work for three years with the government,” he
said.
2
Govt. to hire 12,000 more health workers
Philippine Information Agency
05/09/2011
by Jerome Carlo R. Paunan
MANILA, Sept.5 (PIA) -- Government will hire some 12,000 additional nurses, midwives, and doctors, Health
Secretary Enrique Ona said over the weekend.
Ona said the program, under the Registered Nurses for Health Enhancement and Local Service (RN HEALS) of
the Department of Health (DOH), will help poor communities have access to proper healthcare.
In the last six months, government has employed some 10,000 nurses.
Ona said they will be hiring them to help improve the services at government hospitals, clinics, and rural health
units.
RN HEALS, which employs nurses in the poor communities, seeks to make essential health services available to
all Filipinos identified by the DOH in collaboration with the Department of Social Welfare and Development
(DSWD).
The program is in collaboration between the national government and local government units (LGUs). It is
expected to address the shortage of skilled and experienced nurses in 1,221 rural and unserviced or underserviced communities for one year. (DOH/RJB/JCP-PIA NCR)
3
Medicos to get 70-year-old professors
Deccan Chronicle, India
04/09/2011
By N. Arun Kumar / Janani Sampath
To tackle the huge faculty crunch in medical colleges across India, the Union health and family welfare ministry
has allowed medical colleges to recruit teachers who are 70-years-old.
The ministry has also increased the intake of students in medical colleges from 150 to 250 to augment the
number of doctors in the country.
The Centre’s announcement comes in the wake of its plan to reach a target of one doctor for every 1,000
citizens from the present ratio of 1: 2000.
Speaking to this newspaper on Saturday, dean of the Madras Medical College Dr V. Kanagasabai said,
“Every year we have only 35,000 medical graduates passing out of whom a large number go abroad. I
welcome the move and if the age criterion for faculty is relaxed, it will help us tackle the faculty shortage issue.
As the Medical Council of India (MCI) has relaxed norms for infrastructure, we are in the process of
constructing new classrooms and labs so that we can positively get the additional seats by next year,” he said.
However, Dr G.R. Ravindranath, general secretary of the Doctors’ Association for Social Equality (DASE),
opposed the Centre’s move enhancing the age of faculty from 65 to 70 years.
“As years go by we should focus on reducing the age of faculty and bring in young doctors. But doctors at 70
will be outdated and cannot perform efficiently. However, increasing the seats will help solve the issue of
dearth of medical practitioners in the country,” he said.
4
More mums-to-be opting for midwives at hospitals
Channel News Asia
06/09/2011
SINGAPORE: More mums-to-be in Singapore are opting for the services of midwives. The National University
Hospital (NUH) said the demand for such services has doubled in the past three years.
19
NUH said the increase in demand for midwives was also due to the launch of its enhanced midwifery care
scheme in February this year.
It said more than 60 pregnant women have been attracted to the scheme.
It added that midwives can provide psychological support and care, which can shorten the labour process.
NUH, which currently has three full-time midwives, said it will expand its team due to the increased demand.
5
Young docs wary of rural postings
The Asian Age, India
03/09/2011
Shruti Badyal
While most young doctors are more than happy to be serving people in urban cities, most of them are hesitant
when it comes to working in rural areas. Addressing the issue in the Rajya Sabha recently, health minister
Ghulam Nabi Azad said that despite offering several incentives young doctors are not willing to serve in rural
areas. Well, if you ask young doctors, they claim that from the lack of infrastructure, opportunities to low
salaries, there are various reasons for this growing trend.
“You still get better incentives in places like UP and Haryana but if I want to go back and serve rural areas of
my hometown in Rajasthan, I will not make any money. All you get there is `25,000 (and no incentives). Your
professional growth also stops in these areas,” says Dr Naleen Mathur, a junior doctor at a government
hospital.
The mindset of patients is a major concern for many young doctors. “Patients in rural areas are hesitant to
take medical help. Even if they do, they don’t follow the prescription given by the doctor. Many of these
patients take medicines by just consulting friends and family. This is quite discouraging for young doctors,”
says Dr Siddharth Jain, who works at AIIMS.
The problem is more deep-rooted than it seems. An intern at AIIMS tells us how there has been a 50 per cent
increase in the number of students going to the US for their Masters degree. “As a part of my 3-month
internship, I’m currently placed in Ballabgarh, Faridabad, but I can’t do this for the rest of my life. After
studying from the best medical colleges in Delhi, anyone would want a better future and a good lifestyle. The
infrastructural facilities of the hospitals in these areas is not upto the mark which makes it demoralising for a
doctor,” he says.
Devinder Narain, head, corporate relations, Shobhit University feels that lack of knowledge enhancement
makes a doctor feel stifled as there is no room for any peer discussion and there are no doctors’ forum which
can act as a consulting platform for the budding doctors in such places.
“The government should open colleges somewhere near the rural belt so that the infrastructural facilities
improve,” he suggests.
Most youngsters definitely don’t want to work for “just a cause” as a better future awaits them at the best
hospitals in the country. But is there a way to balance the two?
Answering in the affirmative, Dr Sapna (name changed on request), Medical Officer at one of the government
hospitals tells us, “I set up free camps with my friends and conduct regular check-ups at various slums in the
city. It was difficult initially, but we managed as many young doctors came forward to support us. People are
willing to work for a cause but you can’t expect youngsters to invest so much time in studies and then leave a
handsome salary and a good city to just sit and work in a rural area, where there is a lack of even the basic
facilities.”
Dr Asha, a gynecologist in West Delhi, feels the government should pay these doctors working in rural areas
higher salaries and extra perks. “Along with that, better hygiene and living conditions should also be provided
to them,” she says.
68
Up-skilling AINs the key to nursing shortage
Nurses Careers Allied Health, AU
02/09/2011
Up-skilling Assistants in Nursing will help alleviate Australia’s nursing shortage, according to an industry
expert.
Dr Mary Casey, CEO of health and nursing education organisation Casey Centre, said there was now a course
enabling AINs to work within the public health system, creating a tiered effect.
“(Having) registered nurses work at a higher level and having the AINs to do the more menial tasks would
alleviate the problem altogether,” Dr Casey said.
20
“Due to the increase in community nursing and the need for more AINs in the community, it has become a
passion (of mine) to up-skill them and train them in all areas of nursing.
“The sky is the limit for AINs these days. They are also now working in the public sector which relieves some of
the pressure in the nursing shortage.”
Dr Casey, who holds a Doctorate in Psychology, has worked in the nursing industry for more than 40 years in
areas ranging from accident and emergency to intensive care, paediatrics, medical and surgical, spending the
last eight years as Assistant Director of Nursing at a medium public hospital.
Dr Casey said the biggest challenges for nurses pursuing further education were a lack of funding and time.
“Time is also an issue in that nurses work different hours and shifts and getting them to commit to ongoing
education can be difficult,” she said.
“I have always believed that education is important and these days it is essential in getting you to where you
want to go.
“I also think that education is about gaining confidence and pursuing your goals and dreams.”
9
Rural doctors reject Government report
ABC News, AU
03/09/2011
The Rural Doctors Association of Australia (RDAA) has criticised a Federal Government report that suggests
there is no longer a shortage of doctors in rural and remote areas.
The Rural Medical Workforce and Distribution Programs and Policies report shows the ratio of doctors to
population in rural and remote areas has improved by 25 per cent.
But RDAA president Dr Paul Mara says the report is inaccurate because it relies on a system that classifies the
areas as the same as large coastal and regional cities.
"The figures that they are publishing are based on the ASGC-RA classification which we utterly reject as a
classification for rural and remote areas," he said.
"If we use the old classification it would clearly show that while we have had an increased number of doctor's
going into regional centres [and] coastal areas outside the capital cities ... they're not necessarily moving into
the smaller towns."
Dr Mara says the RDAA is sceptical about the methodology and predictive analysis used in the report.
"We're not certain that we're going to have the same number of overseas doctors into the future and we're not
certain that the number of medical students, gratefully again that the Government has increased the supply of,
are actually going to rural practices as a viable alternative."
10
Specialist shortage causing medical errors
New Zealand Herald
31/08/2011
By Paul Harper
Medical errors may be being made as a result of a shortage in specialists in New Zealand, the head of the
Association of Salaried Medical Specialists says.
Union branch representatives will meet today, and the national executive will meet tomorrow, to discuss how
to resume stalled talks with District Health Boards to address the issue.
Mr Powell said the country's medical specialist shortage was a "crisis".
"Figures released in 2009 shows that we were bottom of the OECD table in terms of the number of specialists
per head of population and that is a worry," he said.
The data showed New Zealand had 0.8 specialists for every 1000 people, while the OECD average was 1.8.
"Australia, which also has serious workforce shortages, does better than us with 1.4 specialists for 1000
people."
Alarmingly, Mr Powell said errors may be made as result of understaffing and the overstretching of staff.
21
"It's very difficult to quantify, but it is there. Often in Health and Disability Commission reports and in other
investigations, it does describe a situation of being under-resourced, of workloads being stretched too far, and
it is a common feature."
He said many specialists do not have enough time to do what is required of them.
"To give an example, the Government wants to have doctors involved more in decision making, as part of
medical leadership, but in a survey done last year of senior doctors and public hospitals through the University
of Otago, only 20 per cent of senior doctors believe have they have sufficient time to participate in activities
beyond their own clinic."
New Zealand had "become a medical training ground", he said, with the second highest emigration rate of
doctors in the OECD.
"We are increasing training registrars who become the specialists of the future - to become the specialists in
other countries. And we should be training more of them to work in New Zealand. We need to invest in a
specialist workforce and it has to be around the area of salaries."
Mr Powell said of those going abroad, an "overwhelming majority go to Australia, part of that is proximity, but
part of it is their training schemes are identical to ours". There is also more money to be made across the
Tasman.
He believed if more investment was made, it would pay for itself.
"When we have more specialists we can do things mush more cost effectively and make savings. If we had the
right number of specialists we could actually reduce the number of hospital bed days because patients could be
treated in a more timely manner than they are at the moment."
Mr Powell said the union and the DHBs agreed last year on a blueprint to address the issue, but in April the
DHBs got "cold feet" and distanced themselves from it.
Back to top
North America
1
The cost of savings
The Hill
06/09/2011
By Herbert Pardes, Peter Fine, Nick Turkal
The national debate over reducing government deficits will examine health care spending - one of the largest
items in the federal budget. Political leaders need to understand that it is wrong to claim, as some have done,
that deep, unidentified cuts will not impact patients.
Government insurance plans pay for the medical care of the elderly, the poor, children who have no other
insurance, and veterans and soldiers, among others. Our taxes also support the training of new physicians and
the world’s most successful medical research system, which has saved millions of lives.
The role of the government in healthcare is significant, successful, and expensive.
Already, some federal leaders have proposed cuts of hundreds of billions of dollars to Medicare and Medicaid as
a way to balance budgets and cut deficits. The dollar savings have been claimed before the cuts have even
been properly identified.
Inevitably, many of these cuts will impact beneficiaries. These unfocused cuts also could upset the delicate
balance of our medical system and lead to unforeseen changes in how we live our lives.
What part of government-funded healthcare should be dropped? Which patients should no longer be helped by
the taxpayers?
Our entire system of government support for healthcare is built around developing the knowledge and
expertise necessary to repair the human body. We have created science-based systems of care that prevent
and hold off disease, replace defective organs and attempt to improve our lives. We train rigorously and
prepare experts in medical care at all levels, equip hospitals with the proper tools, and fund research facilities
that continue to improve our knowledge and techniques.
Changing that equation will have inevitable impact.
If we cut Medicare funds to train doctors, as some have suggested, this country will have fewer doctors
because there is no other source to pay for training. We already need thousands of doctors to overcome a
shortage as the population continues to age.
22
To use an extreme example, the cost to provide a liver transplant to one patient starts at $500,000 for the
operation and one-year post operative care, according to the United Network for Organ Sharing. By any
measure, that’s a lot of money. Medicine has come a long way since the 1960s when the first liver transplant
was performed and into the 1970s when the one-year patient survival rate was 25 percent. Today, a liver
transplant patient has a nearly 60 percent probability of surviving 15 years.
Before a single transplant could be performed, the costs over decades were considerable in terms of research,
training, buildings, equipment, and manpower. But every family that faces an organ transplant is grateful the
investment was made.
This is the great success of American medicine. We take difficult medical problems, solve them and then make
them seem routine. People forget how important this work is until they must face illness themselves or watch
one of their family members or friends struggle with sickness.
Of course, cost savings should be explored, but it must be done with the same scientific rigor and respect for
patients that has brought us advances in medicine to improve our lives. For example, thousands of hours of
paperwork and billions in wasted dollars could be saved if insurance companies and government agencies
agreed on one format for insurance claims data.
Improving quality can lead to lower costs in hospital systems, according to government studies. Limiting
malpractice liability could reduce insurance premiums and help reduce unnecessary tests. Placing a greater
emphasis on better eating, more exercise and quitting smoking could save as much as $300 billion a year.
Greater care coordination between the ambulatory and inpatient settings will save money, as will the wider and
improved use of health information technology. Patients, too, can be a resource. With a full understanding of
the options, patients can evaluate and decide whether to seek alternatives to hospitalization such as hospice
care or even foregoing invasive and costly treatment entirely.
The difficult balance we must strike is to hold down what we spend on health care without adversely affecting
our patients. What may look good on a balance sheet can appear very different on an examination table.
Dr. Herbert Pardes, President and CEO of NewYork-Presbyterian Hospital, oversees the largest hospital system
in the New York metropolitan area. Peter Fine, President and Chief Executive Officer of Banner Health, leads
one of the largest health systems in America. Dr. Nick Turkal is the President and CEO of Aurora Health Care,
which operates hospitals and health care services in Wisconsin and northern Illinois.
2
Maternal Health Practioners Advocate Saving Lives at Birth
Voice of America News
07/09/2011
Vidushi Sinha
The World Health Organization estimates that every minute, a woman dies during pregnancy and millions of
others suffer from infections and disease associated with childbearing. To combat this global tragedy, maternal
health practitioners from around the world gathered recently at a symposium in Washington to showcase their
strategies for saving lives.
The top prize at the Saving Lives at Birth competition, the best of more than 600 international entries, went to
Dr. Michelle McIntosh and her colleagues at Monash University in Australia. They developed an inhalable spray
containing the drug oxytocin that reduces postpartum hemorrhaging, or excessive bleeding during childbirth,
that accounts for 25 percent of maternal deaths worldwide.
“We will manufacture a dry powder that will contain oxytocin that the mother could inhale into her lungs from
where that drug Oxytocin will then be absorbed into the systemic circulation into the bloodstream,” McIntosh
said.
The World Health Organization says infections, unsafe abortions and other complications account for another
70 percent of maternal deaths. That is why the presence of a skilled health worker at birth is so important,
says Dr. Joy Lawn of the private organization Save the Children.
“So a critical investment globally is (to provide) care at the time of birth: the right person with the right
equipment and the right support. And that’s the single most important thing that saves mothers' lives,” Lawn
said.
Dr. Owen Montgomery of Drexel University in Philadelphia has worked on maternal health in Tanzania,
Mozambique and Gambia. His entry in the competition detailed a program that trains experienced midwives on
how to make difficult, life-or-death decisions “...to help midwives decide when, in her hands, the best answer is
an emergency caesarean delivery. This comes with real anatomy training for women who are already
experienced midwives, and then a simulated cesarean delivery on a state of the art mannequin,” Montgomery
said.
Vishwajeet Kumar directs the Center for Maternal, Neonatal and Child Health in Shivgarh, in Uttar Pradesh,
India -- a country with the world's highest rate of maternal and infant mortality. He says maternal health
23
strategies showcased at the symposium can be effective. "Most of the innovations here, they have a lot of
potential. That can be done with the community -- it can be a game-changer. If without the community, it
might have a limited impact," Kumar said.
The World Health Organization says it is committed to achieving one of the U.N.'s so-called Millennium
Development Goals: cutting the number of maternal deaths each year by three-fourths. Health experts say
that is an achievable goal.
3
Physician assistants see big growth in U.S.
Los Angeles Times
08/09/2011
Duke Helfand
The ranks of physician assistants, who perform many duties once handled only by doctors, are rapidly growing
in the United States, allowing healthcare providers to treat more patients, say authors of a new report.
The U.S. had more than 83,000 physician assistants last year, about double the number of a decade ago,
according to the American Academy of Physician Assistants in Alexandria, Va.
The assistants perform tasks delegated by doctors -– for example, conducting physical exams, diagnosing
illnesses, and ordering and interpreting tests.
Nearly one-third of assistants work in primary care, more than in any other clinical setting. That’s important
because of a shortage of primary care doctors.
"The PA profession is growing rapidly, and it is key to expanding access to quality healthcare for millions of
Americans,” academy President Robert Wooten said.
Nearly 20,000 physician assistants provided information for the Physician Assistant Census Report.
The results showed that California had the second-largest number of assistants among all states last year, with
6,723. Only New York, with 6,989, had more.
The median age of assistants was 38, and nearly two-thirds were women.
These workers earned relatively high salaries. Their median income last year was $90,000, a 2.8% increase
from 2009.
4
Doctor Fees Major Factor in Health Costs, Study Says
The New York Times
07/09/2011
By ROBERT PEAR
WASHINGTON — Doctors are paid higher fees in the United States than in several other countries, and this is a
major factor in the nation’s higher overall cost of health care, says a new study by two Columbia University
professors, one of whom is now a top health official in the Obama administration.
“American primary care and orthopedic physicians are paid more for each service than are their counterparts in
Australia, Canada, France, Germany and the United Kingdom,” said the study, by Sherry A. Glied, an assistant
secretary of health and human services, and Miriam J. Laugesen, an assistant professor of health policy at
Columbia.
The study, being published Thursday in the journal Health Affairs, found that the incomes of primary care
doctors and orthopedic surgeons were substantially higher in the United States than in other countries.
Moreover, it said, the difference results mainly from higher fees, not from higher costs of the doctors’ medical
practice, a larger number or volume of services or higher medical school tuition.
Such higher fees are driving the higher spending on doctors’ services, the study concluded.
Ms. Glied, an economist, was a Columbia professor before President Obama named her assistant health
secretary for planning and evaluation in June 2010. She said the paper, based on academic research, did not
reflect the official views of the administration or the White House.
But the journal said the findings suggested that, as policymakers struggle to find ways to restrain health
spending, they might consider doctors’ fees. Doctors have generally been excluded from recent cost-cutting
proposals because under existing law, Medicare, the federal insurance program for older people, will reduce
their fees by 29.5 percent on Jan. 1. In addition, many states have frozen or reduced fees paid to doctors
treating poor people under Medicaid.
24
The study examined fees paid by public programs and private insurers for basic office visits and for hip
replacement surgery, and found that Americans were “very low users of office visits and relatively high users of
hip replacement surgery.”
“Fees paid by public payers to orthopedic surgeons for hip replacements in the United States are considerably
higher than comparable fees for hip replacements in other countries,” the authors found, “and fees paid by
private insurers in the United States for this service are double the fees paid in the private sector elsewhere.”
For primary care office visits, the gap between fees paid by Medicare and by public programs in other countries
was smaller. But the study found that private insurers paid more for such services here than in other countries.
“U.S. primary care physicians earn about one-third more than do their counterparts elsewhere,” mainly
“because a much larger share of their incomes is derived from private insurance,” the study said.
Ms. Laugesen and Ms. Glied said that among primary care doctors, those in the United States had the highest
annual pretax earnings after expenses — an average of $186,582 in 2008 — while those in Australia and
France had the lowest earnings, $92,844 and $95,585.
“Among orthopedic surgeons, those who had the highest annual pretax incomes, net of expenses, were in the
United States,” with an average of $442,450, the study said. In Britain, which ranked second, the comparable
figure was $324,138. Annual pretax earnings of orthopedic surgeons in the other countries were less than
$210,000.
Medical students often cite higher pay as a reason for choosing to become specialists, and the researchers said
the income gap between primary care doctors and orthopedic surgeons was larger here than elsewhere.
“In the United States, primary care doctors earned only about 42 percent as much as orthopedic surgeons
earned,” the study said. “In Canada, France and Germany, in contrast, primary care doctors earned at least 60
percent as much as orthopedic surgeons earned.”
“High physician fees in the United States may reflect the cost of attracting skilled candidates to medicine in a
society with a relatively more skewed income distribution,” the study said.
5
Surgeon critical of wait for operations
Telegraph-Journal, CA
07/09/2011
SAINT JOHN - Operating room waiting lists at the province's primary centre for acute care have increased by
10 per cent despite many meetings and plans to improve things, says a prominent longtime surgeon in the
city.
Dr. Steven Bryniak has written a letter to the Telegraph-Journal decrying the shortage of OR time at the Saint
John Regional Hospital and is outraged at Horizon Health Network's introduction of a confidentiality declaration
of understanding that threatens doctors with loss of privileges, and even firing, if they release any data or
information to a third party without authorization.
Bryniak could not be reached on Tuesday to expand on some of the points he made in his letter, but he writes
that the only change that has occurred after all of the talk about fixing operating room access is the
introduction of the policy of "muzzling" doctors in New Brunswick.
"This situation is no longer a health-care issue, but has now become a human rights issue.
"It is abundantly clear that the Horizon Network Corporation is more concerned about protecting the
corporation than protecting patients," Bryniak writes.
Regional Hospital executive-director Margaret Melanson concurs that the surgery waiting list is longer than it
was at this time last year, with 4,500 patients waiting for elective surgeries ranging from hip replacements to
some cancer procedures.
She says that, as promised last spring, six operating rooms will be in use 100 per cent of the time, Monday
through Friday, within the next two weeks; as of early April, six operating rooms were operating only 68 per
cent of the time.
"We have an aging population in our Saint John area and that has introduced the need for additional
surgeries," she said.
"We continue to have individuals added to our waiting list while we're trying as far as possible to increase the
numbers of surgeries."
By February 2012, Horizon Health hopes to have a minimum of seven operating rooms running throughout the
work week, she said.
25
Melanson says all employees across the Horizon Health Network - along with volunteers, students and board
members - have been asked to sign the confidentiality agreement.
In fact, it will be in place throughout the province, a communications officer with Horizon Health said.
"This was a policy introduced in March of 2011," Melanson said.
"It is to protect confidential information pertaining to patients and other types of sensitive information."
She said that the document does not prevent doctors from speaking to the media, but covers patient, financial,
payroll and legal information.
"This is really just a reminder for everyone of the need for confidentiality in all of our dealings with sensitive
information," she said.
Lawyers with the Canadian Medical Protective Association have advised doctors not to sign the document,
Bryniak said.
Last winter, Bryniak painted a bleak picture of a broken health-care system that is more concerned with the
bottom line than anything else and is one that puts elective surgeries ahead of emergencies.
At the same time, Dr. Donald Lalonde, a plastic surgeon at the Regional, told the newspaper that inadequate
access to operating rooms was having a destructive effect on doctors' morale.
After all of the hoopla surrounding the severe shortage of operating room time, a working group was
established to figure out how to stabilize the program.
The OR situation was made worse this summer, Bryniak writes, when the Regional closed the operating rooms
to elective surgeries for four weeks; in past years, the ORs were closed for three weeks, he said.
Bryniak has said he and his colleagues were told some years ago that it was being done as a cost-saving
measure, but Melanson says that the slowdown was spread over four weeks with an additional operating room
used. In other years, only three operating rooms were in use for the three-week slowdown, she said.
"To allow the maximum number of surgeries to continue and to allow staff to take their vacations when they
requested, having a slow-down over four weeks was preferred over the more intense slow-down of three
weeks this year," she said.
The Regional Hospital is southwestern New Brunswick's primary hospital for acute care and Atlantic Canada's
only accredited tertiary trauma centre.
In his letter, Bryniak also implores Premier David Alward to "desist in muzzling the doctors of New Brunswick"
and to remove billing numbers; New Brunswick is the last jurisdiction in Canada still enforcing a cap on the
number of doctors who can bill medicare for medical services. The caps were adopted in the belief that
restricting access to medical care would limit health-care costs.
Bryniak also asks Health Minister Madeleine Dubé to restructure the hospital system "to encourage efficiency,
save money and improve access to health care."
6
Back to top
Europe
1
The worst country in the world to be a sick child
The Guardian, UK
06/09/2011
Sarah Boseley
A league table from Save the Children establishes the safest - and most dangerous - places in the world for a
child to fall sick, which correlate closely with their chances of getting to see a health worker
Chad and Somalia are the riskiest places in the world to fall sick if you are a child. Switzerland and Finland are
the safest. That's the conclusion of an index produced by Save the Children, which ranks 161 countries based
on the availability of health workers.
There is an inevitable link, it seems. The analysis shows that children living in the bottom 20 countries – with
just over two health workers for every 1,000 people - are five times more likely to die than those further up
the index.
It stands to reason. Children die of malnutrition, of diarrhoea, of malaria, of pneumonia and many other
diseases in the poorest countries in the world. They need treatment, but often it is not just the drug or the
26
food supplement that is lacking - it is the nurse or the community health worker who can diagnose what is
wrong and do something about it. In some places, children never see a health worker in their sometimes
pitifully short lives.
The index is being published on Tuesday ahead of a UN high level meeting on non-communicable diseases in
two weeks' time, which campaigners hope will call for increases in the numbers of doctors, nurses, midwives
and community health workers for the developing world. The World Health Organisation estimates that the
world is 3.5 million short. The index not only reflects the numbers in each country, but also their success in
reaching children. It takes into account the percentage of children receiving three doses of the vaccine for
diphtheria, whooping cough and tetanus and the number of women giving birth with a skilled birth attendant.
On those measures, the worst places in the world for sick children are Chad, Somalia, Lao, Ethiopia and
Nigeria. The best are Switzerland, Finland, Ireland, Norway and Belarus. The UK comes 14th and the US 15th.
This is what Justin Forsyth, chief executive of Save the Children, says:
“A child's survival depends on where he or she is born in the world. No mother should have to watch helplessly
as her child grows sick and dies, simply because there is no one trained to help.
World Leaders must tackle the health worker shortage and realise that failing to invest in health workers will
cost lives. Even the poorest countries in Africa can make real progress if they stick to their pledge of investing
15% of their budgets in health.”
Some countries have done remarkable things in spite of the shortages, says the charity. Community health
workers are not as expensive as nurses and are more likely to stay. Bangladesh and Nepal have made strides
in bringing down children's death rates by investing in community health workers and are on track to meet
millennium development goal 4, which is to reduce mortality by two-thirds.
But more help is needed from the rich world - and only eight developing countries have met a commitment to
spend 15% of their national budgets on healthcare, Save the Children points out.
Meanwhile, Amnesty International has just published a report showing that - in spite of Sierra Leone's muchvaunted free healthcare for pregnant women and their children - mothers are still being asked to pay for drugs
they cannot afford.
Erwin van der Borght, Amnesty International's Africa programme director, says there is no monitoring or
accountability system, allowing poor practice and mismanagement to go unchallenged and allowing some
people to plunder expensive medicines. He adds:
“The healthcare system remains dysfunctional in many respects. Government figures show that since the
introduction of the initiative, more women are delivering their babies in health facilities. However, many
women continue to pay for essential drugs, despite the free healthcare policy, and women and girls living in
poverty continue to have limited access to essential care in pregnancy and childbirth.”
2
WE MUST NURSE THE NHS BACK TO HEALTH
Express, UK
04/09/2011
By Katherine Murphy, Chief Executive, The Patients Association THE Patients association was founded in 1963
by patients unhappy about the service they had received from the NHS.
Now almost 50 years later it is a national independent healthcare charity led by a simple but powerful
philosophy: “listening to patients, speaking up for change.”
We run a helpline which patients can phone to ask for advice or guidance or just to tell us about the care they
have received.
We get more than 5,000 calls a year and this number continues to grow month on month, year by year.
While the number of calls are changing, sadly we still hear similar stories about the poor care, lack of dignity
and respect that some experience.
We hear about persons being left without food or water. We hear about those being left to sit in their own
faeces and urine, with their call buzzer moved out of reach.
Last year we published a report, listen to Patients, speak up for change, detailing 17 of the worst cases of
neglect in English hospitals.
On the basis of that report we called for independent matrons in all hospitals whose sole role would be to
ensure the dignity of patients. instead the Government said that there would be 100 unannounced inspections
of hospitals in england by regulator the care Quality commission.
27
We are still waiting for its final report but it has released interim reports indicating major problems at some
hospitals.
We believe there has been a failure of the culture of care in the NHS.
Since it was founded more than 60 years ago medical science has transformed beyond recognition.
Smallpox has been eradicated and previously deadly diseases such as polio, diphtheria and tuberculosis are
increasingly rare.
This progress is incredible and nobody would deny we have come on in leaps and bounds but something is
missing.
Amid the technical jargon and science, the human aspect of the medical and caring vocations seems to have
been lost.
There appears to be a reluctance among some doctors and nurses to see the person suffering underneath the
disease.
It is also a question of taking responsibility. some healthcare workers do not seem to understand the quality of
patient care is everyone’s responsibility, not just the specific doctor and nurse looking after them.
In 2008 we published the report Preventing infection on the frontline, which found that some staff took the
attitude “infections are not my problem” and last year we conducted research on pressure sores that found a
similarly cavalier attitude.
Healthcare workers need to recognise that it is not only their problem but everyone’s problem to prevent the
spread of infection and pressure sores.
These are only two examples but they reveal what we believe to be a worrying trend.
So what is the solution? Part of it has to be reconnecting professionals to their patients.
One of the things we hear most regularly about is the lack of communication skills of doctors and a lack of
under- standing about what patients need at a personal level.
We have been working with medical schools, including the university of Birmingham and university college
london, on how to improve the training doctors get in communication skills and on giving patients a bigger
input into that training.
We hope this will give new doctors a better insight into the needs of patients and a greater understanding of
the need to treat those under their care as a personnot a statistic. in terms of nursing the major problem is a
chronic shortage of nurses, particularly on elderly wards.
Just last year the Royal college of nursing said the maximum number of patients per nurse should be six to
ensure good quality care.
The average in the NHS is eight and in elderly wards that number rises to 11.
Many nurses simply do not have the time to give the care and attention their charges deserve but the poor
culture of care that now seems endemic in the NHS is having a terrible effect.
Whether because of lack of time or the huge pressures put on them, nurses have lost the empathy they had
with patients.
We need to make sure that all healthcare professionals, not just nurses, realise that the person in front of
them is a human being not just a number.
They are someone’s mother or brother and deserve to be treated with dignity and respect.
Every year the nursing standard presents the Patient choice award to a nurse who has gone beyond the call of
duty. this year, in memory of the Patients association’s late president, it was renamed the Claire Rayner
Patient choice award and i was involved in choosing the winner.
The award was presented to Brenda somerfield, a nurse working in cornwall who truly went out of her way to
help those she looked after.
It is this type of excellent nursing care that needs to be celebrated, to make clear it is possible to provide truly
exemplary care, to act as an inspiration for nurses to work that little bit harder and go that little bit further to
ensure all patients, young and old, receive the best possible care.
3
24 hours on a maternity ward - Sunday Mirror investigation
Mirror, UK
28
04/09/2011
by Nick Owens
Britain's maternity -service is in meltdown as a chronic shortage of midwives leaves baby wards at breaking
point.
Despite a birth-rate at a 42-year high the Government is shutting labour units and failing to provide the extra
4,700 midwives experts say are needed.
The Sunday Mirror this week spent 24 hours inside the maternity unit at -Mayday Hospital in Croydon, South
London, one of the busiest labour wards in the country, criticised in a devastating report by the Care Quality
Commission over the deaths of five babies.
As our diary reveals, our investigation found that midwives trying to rebuild the ­hospital’s reputation are
crying out for more help...
Six midwives arrive to start a 12-hour shift on the 13-bed labour ward, which handles 5,000 births a year – up
10 per cent on 2008.
A consultant and surgeon are in charge and most of the staff won’t take a break until 5pm.
Other midwives are working on post-natal and ante-natal wards but one has phoned in sick.
The hospital employs 138 -midwives working across five units and out in the community. But so many babies
are being born they are advertising for more staff.
However, a lack of qualified people in the area means they are headhunting from hospitals in Scotland.
Those midwives clocking on lace up their trainers and pour a large coffee. A cleaner mops blood from one of
the labour rooms after a delivery in the early hours which one doctor called a “bloodbath”.
Four women are currently in labour and fathers-to-be pace anxiously. The phones never stop ringing.
Consultant Britt Clausson, above, who runs the unit, moves midwives into position like an air-traffic controller.
“We desperately need more,” she says. “But when you tell managers they say ‘there isn’t the money’. We try
to deliver one-to- one care, but it is not always possible.”
Screams ring out from a room where first-time mum Sarah O’Shoughnessy, 29, above, is giving birth. Her
baby’s heart rate has dipped and her midwife rings for support. Two run in and within minutes Sarah is taken
to a theatre. Husband Sean, 29, below, looks on helplessly. All he can do is wait.
The 23-bed post-natal ward, where mothers go after giving birth, is full. The three midwives each have up to
eight mothers and babies to look after.
The sound of a baby crying from the operating theatre brings tears of joy as news arrives Sarah has given birth
to a healthy boy. Proud Sean bursts in, tears streaming, to thank staff.
Surgeon Ebrahim Furough wipes sweat from his brow after performing a difficult operation to save a baby’s life
– the third caesearean section he has -performed since 9am.
Mr Ebrahim, 46, is one of thousands of foreign staff propping up Britain’s baby wards. A former child soldier in
Iran, he fled in his teens after seeing his brother executed in front of him but is now living his dream of
working in the NHS.
He says: “Thankfully mother and baby are fine. Every day we witness miracles.”…Continued
Full Text: http://www.mirror.co.uk/news/top-stories/2011/09/04/24-hours-on-a-maternity-ward-sundaymirror-investigation-115875-23393469/
4
Health Minister: Ukraine faces shortage of doctors
Kyiv Post, Ukraine
06/09/2011
Ukraine's Health Minister Oleksandr Anischenko has written a letter to regional governors and heads of regional
(town) councils, asking to approve and support the regional programs for social protection of medical personnel
and raising the prestige of the medical profession.
The minister's letter is related with "the extremely difficult situation with medical staffing," the ministry said.
Currently, Ukraine is short of 46,900 doctors (including more than 6,000 in rural areas), and almost 24,500
junior medical staff.
29
Health care institutions are seeing extremely high labor turnover rates among doctors and nurses, particularly
young specialists, the ministry said.
The Health Ministry has already drafted a Cabinet of Ministers decree about a 50% increase in wages for
doctors working in rural areas.
"However, the efforts by the Health Ministry to stabilize the human resources situation in the industry must be
reinforced by real help at a local level," the press release said.
5
6,600 patients on trolleys as beds cut back
Herald, Ireland
06/09/2011
By Conor Feehan
A record 6,600 patients were left waiting on trolleys in A&E wards last month, according to figures compiled by
the Irish Nurses and Midwives Association.
The group warned that the situation will get worse, with the closure of 2,000 beds adding to the problem of
increased demand for health services as the winter approaches.
INMO general secretary Liam Doran said it was clear the Government's current cost-cutting measures were
having "a serious negative impact upon patient care".
He also said that many hospitals were trying to deal with the crisis by placing more beds in wards that are
already cramped.
"Emergency department overcrowding and people waiting for beds on trolleys is the greatest challenge facing
the health system every day," said Mr Doran.
"It cannot be solved by hiding the problem with extra beds on wards, which compromises the care of patients,"
he added.
August saw the highest-ever levels of overcrowding in emergency departments, with INMO surveys showing a
106pc increase in the numbers on trolleys since 2007.
It found that 6,624 people were on trolleys last month, compared with 3,200 four years ago.
Last Wednesday there were 401 patients on trolleys nationwide.
As of September 1, almost 2,000 beds have been closed, including 61 in the Mater, 97 in Louth County, 86 in
the Midlands Regional in Tullamore, 62 in Cork University, and 29 in Letterkenny General.
Based on the HSE's performance system, the new figures indicate that five out of six of the main Dublin
hospitals are ranked as unsatisfactory in terms of their emergency department's performance.
The HSE has said the numbers being treated in hospitals has increased this year, and that there are more day
cases.
It added that the health system is facing increased challenges financially for the rest of the year and that
hospitals must stay in budget.
But Mr Doran called for a review of these cost-cutting measures.
"There is no other option or solution to deal with this crisis which exists every day," he said.
6
Foreign nurses registering in UK despite 20-year work gap
The Guardian, UK
02/09/2011
James Meikle
Nurses and midwives from other EU countries are being registered to work in the UK despite not having worked
with patients for 20 years, regulators have told a House of Lords inquiry.
The Nursing and Midwifery Council (NMC) is being forced to accept foreign applicants without any recent
experience to its register while British nurses without up-to-date training have had to leave the profession.
30
The council's chief executive, Dickon Weir-Hughes, said it had to operate a two-tier system because of EU rules
on the free movement of workers. The revelation came in evidence to a Lords sub-committee investigating the
mobility of healthcare professionals between member states.
In evidence to the same inquiry the doctors' regulatory body, the General Medical Council (GMC) revealed that
a foreign doctor's husband contacted them on her behalf to register her for work because she could not speak
English.
The European commission is reviewing the rules governing mutual recognition of professional qualifications.
The government and healthcare bodies have been pressing for changes for two years after the Guardian
revealed how a German doctor, Daniel Ubani, who was subsequently ruled incompetent by a coroner and the
GMC, accidentally killed a patient on his first UK locum shift by administering a massive overdose of painkillers.
The sub-committee has published written and oral evidence as it prepares what is expected to be an extremely
critical report on the current arrangements.
The NMC has a register of 670,000 professionals, with about 7,000 nurses and midwives from elsewhere in the
EU applying each year.
Weir-Hughes told peers he was concerned about the "integrity" of the register. The council required British
nurses and midwives to undergo a specific number of hours of continuing professional development (CPD) and
training every three years, he said. Nurses who did not complete this further training could no longer be
registered. However, some EU applicants had not worked as nurses in two decades.
"They make no secret of that; they simply have not practised as they have been doing other things," he told
the sub-committee. "Until fairly recently I was refusing those people entry to the register but under EU law
that was not acceptable, so our council very reluctantly decided that I had to admit them.
"We now have a situation whereby we are admitting people who literally have not been near a patient for 20
years, have done no CPD and have to be admitted to the register because they have freedom of movement
and rights. Yet if they were a UK-registered nurse or midwife, they would not be allowed to continue. Indeed,
they would have to do a return-to-practice course at a school of nursing or midwifery."
At another hearing, the GMC's chief executive, Niall Dickson, told how a member of his staff was contacted
over an EU doctor's potential application to join the UK's medical register. They realised "they were speaking to
the doctor's husband because the doctor could not speak English well enough to have a conversation with
someone in a contact centre", said Dickson.
"Our member of staff kept on saying 'I need to speak to the doctor.' The husband helpfully said, 'No, you can't
speak to her because I am busy translating for her.'"
Ubani, though struck off in Britain, is still allowed to practise in Germany. In July an administrative medical
court in Westfalen-Lippe, Germany, fined him €7,000 (around £6,000) for breaking the country's code of
conduct for doctors.
However, a ruling said his performance in the UK "cannot be seen as an expression of his indifference towards
his patients". It added: "It serves rather more to cast doubt on the professional competence of the accused
than his personal integrity and his professional ethics."
7
An adequate health workforce
Times of Malta
08/09/2011
by Joseph Cassar
The right to health has repeatedly been em-phasised in the global context over the last few decades. The 1944
Universal Declaration of Human Rights notes that “everyone has the right to a standard of living adequate for
the health, and well-being of himself and his family”. In 1966, the United Nations called for the “right of
everyone to the enjoyment of the highest attainable standard of health” in article 12 of the International
Covenant on Economic, Social and Cultural Rights. More recently, in 2000, the UN sought to further define the
right to health through extensive detailing and discussion of the characteristics of an effective health-care
system as should be provided by states and NGOs and through clearly determining that the right to health
actually extends beyond the provision of comprehensive health-care systems.
In general comment 14, the UN Committee on Economic, Social and Cultural Rights determines that other
rights and freedoms address integral components of the right to health, as are the rights to education,
housing, work and food.
It is against this backdrop that I insist that my ministry, in its central quest to address the right to health of
the people of this country, has to keep the following two items at the top of all and any of its agendas: an
effective and free health-care system and close collaboration with other ministries.
31
In turn, it is hard to argue against the fact that a good supply of human resources, that is an appropriate and
adequate workforce, is a prerequisite for both above items.
Hence, securing an adequate and appropriate workforce is a main underpinning obligation of the work of my
ministry in its quest to address the people’s right to health.
What have we done, so far? What are we doing? What are our plans? What are the main challenges?
We have primarily sought to study the nature, composition and workings of the health workforce in the specific
context of Malta and also in the context of the international scenario. The world is now increasingly looking into
and adopting integrated workforce planning and supplies, where all the different workers within a health-care
system are collectively planned for and sought. Doctors and nurses are planned for and supplied against a
wider context of plans and supplies of allied health professions and workers, as are physiotherapists and
podiatrists, the domestic staff and administrative and management members. I am confident we too are,
diligently and cautiously, moving in this more efficient direction.
Over the last few years we have worked hard at shifting the emphasis of our recruitment programme and of
our efforts at building exciting career opportunities in the health-care area away from the exclusive domains of
the medical and nursing professions. Indeed, allied health professions have increasingly received significantly
more attention. In fact, a directorate for allied health professions has recently been established within the
ministry, which seeks to secure the necessary structures for the planning and provision of all allied health
professions, in tandem with nurses and doctors and all the other essential domestic and technical staff who
work in our health-care system. The ministry has clearly understood that its workforce needs to comprise
significant administrative and management talent, potential and skills. Only then can the ministry secure a
health-care system that is effective and only when such characteristics are present can it collaborate efficiently
with other ministries in order to really address the right to health of the people.
We have also actively sought to collaborate with the main educational entities in Malta: the Malta College of
Arts, Science and Technology and the University of Malta. The cornerstone of all our collaborative work with
these entities has been the need to address the demand for a health workforce that is sufficient in terms of
both quantity and quality. Our support towards the educational initiatives of the University and Mcast, for
example by offering full cooperation to their efforts to place students needing to practise in the clinical areas,
have translated into favourable outcomes in that intakes of students to the various programmes at the
University and Mcast have been on the increase.
Last month, a record number of applicants sought to pursue programmes in health care. Surely the ministry
has been successful in its recruitment campaign but, although we are pleased with this because we
acknowledge that recruitment is indeed essential, we are fully aware that it is not sufficient for an adequate
health workforce!
Hence, we will continue to seek to maintain optimal retention and motivation across our health workforce. This
is indeed a significantly tall challenge because, in the light of pockets of skills (not necessarily staff) shortages,
both locally and internationally in view of the increasing flexibility and widening roles and remits of health-care
professionals, continuous development and advancements in health- care provision and various opportunities
for employment locally and overseas, many members of the workforce choose to move on after a while.
We are committed towards embedding measures that would accommodate retention and sustained motivation
of our workforce. The ministry takes pride in the introduction of the foundation programme for doctors, which
provided an apt vehicle to retain students who graduate from the medical school at the University. Very few
medical graduates leave the country nowadays. We are dedicating much effort in developing similar vehicles,
which will mirror the outcomes of the foundation programme for doctors, across other facets of the health
workforce. We are hoping for similar success.
Our aim is to address one’s right to health. It is a continued right of our people, hence, our efforts to ensure an
optimal workforce that can secure this right will be equally continued.
Dr Cassar is the Minister for Health, the Elderly and Community Care.
8
Health care in Japan: Not all smiles
The Economist, UK
10/09/2011
THE Japanese spend half as much on health care as do Americans, but still they live longer. Many give credit to
their cheap and universal health insurance system, called kaihoken, which celebrates its 50th anniversary this
year. Its virtues are legion. Japanese people see doctors twice as often as Europeans and take more lifeprolonging and life-enhancing drugs. Rather than being pushed roughly out of hospital beds, they stay three
times as long as the rich-world average. Life expectancy has risen from 52 in 1945 to 83 today. The country
boasts one of the lowest infant-mortality rates in the world. Yet Japanese health-care costs are a mere 8.5% of
GDP.
Even so, the country’s medical system is embattled. Although it needs a growing workforce to pay the bills,
Japan is ageing and its population is shrinking. Since kaihoken was established in 1961, the proportion of
people over 65 has quadrupled, to 23%; by 2050 it will be two-fifths of a population that will have fallen by
32
30m, to under 100m. “The Japanese health system that had worked in the past has begun to fail,” Kenji
Shibuya of the University of Tokyo and other experts write in a new issue of the Lancet, a British medical
journal, devoted to kaihoken. “The system’s inefficiencies could be tolerated in a period of high growth, but not
in today’s climate of economic stagnation.”
By 2035 health care’s share of GDP will roughly double, according to McKinsey, a consultancy. The burden falls
on the state, which foots two-thirds of the bills. Politicians are unwilling to raise taxes, so they squeeze
suppliers instead: more than three-quarters of public hospitals operate at a loss.
Like other service industries in Japan, there are cumbersome rules, too many small players and few incentives
to improve. Doctors are too few—one-third less than the rich-world average, relative to the population—
because of state quotas. Shortages of doctors are severe in rural areas and in certain specialities, such as
surgery, paediatrics and obstetrics. The latter two shortages are blamed on the country’s low birth rate, but
practitioners say that they really arise because income is partly determined by numbers of tests and drugs
prescribed, and there are fewer of these for children and pregnant women. Doctors are worked to the bone for
relatively low pay (around $125,000 a year at mid-career). One doctor in his 30s says he works more than 100
hours a week. “How can I find time to do research? Write an article? Check back on patients?” he asks.
On the positive side, patients can nearly always see a doctor within a day. But they must often wait hours for a
three-minute consultation. Complicated cases get too little attention. The Japanese are only a quarter as likely
as the Americans or French to suffer a heart attack, but twice as likely to die if they do.
Some doctors see as many as 100 patients a day. Because their salaries are low, they tend to overprescribe
tests and drugs. (Clinics often own their own pharmacies.) They also earn money, hotel-like, by keeping
patients in bed. Simple surgery that in the West would involve no overnight stay, such as a hernia operation,
entails a five-day hospital stay in Japan.
Emergency care is often poor. In lesser cities it is not uncommon for ambulances to cruise the streets calling a
succession of emergency rooms to find one that can cram in a patient. In a few cases people have died
because of this. One reason for a shortage of emergency care is an abundance of small clinics instead of big
hospitals. Doctors prefer them because they can work less and earn more.
The system is slow to adopt cutting-edge (and therefore costly) treatments. New drugs are approved faster in
Indonesia or Turkey, according to the OECD. Few data are collected on how patients respond to treatments. As
the Lancet says, prices are heavily regulated but quality is not. This will make it hard for Japan to make
medical tourism a pillar of future economic growth, as the government plans.
The Japanese are justly proud of their health-care system. People get good basic care and are never
bankrupted by medical bills. But kaihoken cannot take all the credit for the longevity of a people who eat less
and stay trimmer than the citizens of any other rich country. And without deep cost-cutting and reform, the
system will struggle to cope with the coming incredible shrinking of Japan.
9
Back to top
Latin America & Caribbean
1
Mujica está preocupado por la falta de médicos en la campaña
Espectador, Uruguay
08/09/2011
El presidente de la República, José Mujica, manifestó este jueves su preocupación por la falta de médicos en la
campaña uruguaya, tema que el primer mandatario ha planteado al Ministerio de Salud Pública y que generó
críticas desde el Sindicato Médico del Uruguay.
En este sentido, destacó que hay familias de compatriotas perdidos en pueblitos y en la inmensidad de la
campaña, con caminos muy poco transitables, que suelen no tener un médico en 50 o 100 kilómetros a la
redonda.
Sin embargo, agregó el presidente, estas personas cumplen funciones fundamentales en un país agroexportador, dado que en esos lugares está la masa de los trabajadores rurales con sus familias y los primeros
escalones de la humilde clase media rural. “Ni mejores, ni peores, pero insustituibles”, expresó Mujica.
Para el presidente estas personas constituyen la última reserva humana de población rural en un mundo que
cada vez se urbaniza más.
“Parece que no los podemos perdonar. Tienen que estar ahí, Con caminos poco transitables, a veces, con lo
mínimo para luchar por la vida. ¿Podemos ser tan egoístas de no ver esto que se puede ver a pocos kilómetros
de Montevideo? ¿Podemos ser tan ciegos? ¿No nos damos cuenta que hay que luchar por mejorar la suerte de
esa gente que a veces está en peor condiciones que la gente más humilde que viven en una ciudad porque por
lo menos se sale a la calle y se consigue una asistencia pública? ¿Podemos no darnos cuenta que mandar a un
niño a la escuela a veces en ciertos lugares del interior es arrancar de madrugada porque hay un ómnibus que
33
va y el mismo ómnibus vendrá casi en la noche?. Esto lo he visto en pueblos en los que he parado en mí país.
¿Por qué no vemos estas cosas? El peor ciego es el que no quiere ver”, afirmó Mujica.
Mujica sostuvo que poner un médico joven funcionario de Salud Pública, que reciba un sueldo para poder vivir
y que haga su peripecia un par de años, “parece un imposible o una condena”.
“Tampoco faltan algunos que dicen que no tienen experiencia”, dijo el presidente, pero sentenció que “peor es
que no tengan nada”.
“¿Los médicos jóvenes que se reciben no pueden dar una mano por un tiempo?”, se preguntó el mandatario.
“Va a ser mejor que tener un curandero”, agregó.
“¿Por qué esa manía de hacerlo todo imposible, todo difícil y todo de entrada? ¡Qué barbaridad! Barbaridad es
tener un callo en el corazón, esa es la barbaridad. No podemos tener desgraciadamente un hospital en cada
pueblito, no podemos tener una posada cinco estrellas, no podemos. Tenemos que hacerlo como se ha hecho
siempre. Los jueces en este país arrancan su carrera sirviendo en el interior y van lentamente moviéndose, los
funcionarios de la seguridad van a trabajar donde les toca y a cumplir un servicio que es fundamental y van a
veces hasta los del sistema financiero y allá van con sus petates y están un tiempo por acá y por allá. La vida
está llena de estas cosas. Por qué creernos que estas cosas son imposibles cuando en todas partes a veces hay
que hacerlas por razones elementales y humana, solidaridad”, afirmó Mujica.
Mujica puso como ejemplo de la misma actitud a los grandes propietarios de tierras rurales.
En este caso, el primer mandatario destacó que estos productores “han hecho una fortuna”, pero “se le enojan
porque le está pidiendo unos pesitos para atender la caminería rural profunda”.
“La peor ceguera de la sociedad es la que no quiere ver”, reiteró el presidente, quien dijo que “en la vida todos
tenemos derecho a exigir, y está bien, pero también tenemos responsabilidad y algo que dar por los demás”.
Mujica dejó en claro que no se le está pidiendo -en el caso de los médicos- trabajo social o voluntario.
“Hoy estamos a voluntad, si quieren ir pueden ir, totalmente voluntario, y no van. Estoy hablando de trabajo
profesional, pero con algún margen de obligación por algún tiempo. Esto se practica en muchos países, ¿no
será posible? Tal vez yo sea a mis 76 años un tonto idealista en este mundo moderno. Primero, no puedo creer
que la muchachada de este país no tenga gestos de sensibilidad para los que están más olivados y más
necesitados”, reflexionó Mujica.
En otros asuntos, Mujica reconoció que “falta mucho en materia de enseñanza” en Uruguay y que “hay que
invertir más”, pero puntualizó que para obtener recursos se debe seguir el actual rumbo de la economía.
El presidente explicó que “el rumbo es muy sencillo”, pero que “no es tan fácil concretarlo”. Puntualizó que la
base del desarrollo económico de la sociedad está en acentuar la inversión y aprovechar lo que más se pueda
los recursos para aumentar los bienes materiales de la sociedad.
Mujica explicó que la reforma de la salud va a llevar un esfuerzo grande y que hay que comprometer
cuantiosos recursos en esto, dado que la preocupación en este caso es prolongar la vida humana.
Pero también se refirió a la enseñanza como una de las cuestiones sociales en las que hay que invertir.
“Cada vez para progresar económicamente tendremos que multiplicar la capacidad de nuestra gente y eso
significa invertir, invertir mucho en la enseñanza. Y claro que nos falta, y que nos falta siempre y que faltará
siempre. Por eso lo primero el rumbo de la economía porque si de allí no salen semillas no habrá aceite, no
habrá harina, no habrá pasta, no habrá con qué. Y en la vida no solo es querer, lo sustantivamente es poder y
lo poder en gran medida va de la mano de la marcha de la economía. No se puede separar una cosa de la
otra”, enfatizó Mujica.
Por este motivo, agregó el presidente, se busca siempre mejorar la relación internacional para vender y
comprar mejor.
2
Crisis en el IMSS por falta de especialistas
El Mexicano
08/09/2011
Juan Salazar García / El mexicano
Ciudad Juárez, Chihuahua.- El Instituto Mexicano del Seguro Social actualmente tiene una carencia de 129
médicos de distintas especialidades, y en el estado 162 médicos, lo que impacta fuertemente en la atención a
la población derechohabiente. Debido a ello se ha hecho necesario que algunas de las cirugías se tengan que
programar fuera de la ciudad, como son en Monterrey, Nuevo León, y Torreón, Coahuila, dio a conocer el
doctor Huberto Fabela Rey, secretario general del Sindicato Nacional de Trabajadores al Servicio del Seguro
Social, sección VIII (SNTSS).
34
Tan sólo para urgencias 48 médicos, cardiólogos 5 cirujano general 2 endocrinólogos 1, gastroenterología 3,
ginecología 8, medicina interna 16, nefrología 3 neumología 1, pediatría médica 2, neonatología 1, psiquiatría 5
cirugía pediátrica 1, ontología medica 3, cirugía plástica y reconstructiva 1, terapia intensiva 6, ontología
quirúrgica 2, anestesiología 4, endoscopia 1, medicina física y rehabilitación 1, radiología 6 entre otras
especialidades hasta sumar el déficit de 129.
La convocatoria que se ha hecho de estas especialidades es en todo el país, si un medico llega a solicitar
trabajo con algunas de las especialidades de la medicina inmediatamente es contratado ya con sus base dijo
Favela Rey.
Dijo que no son médicos que se hayan retirado, lo que sucede que la producción de especialistas en la
medicina, son pocos los que egresan de las universidades, cada año es mas toda la republica mexicana acude a
invitar a, los recién egresados de las especialidades a irse a sus estados esta petición se hace en forma
conjunta tanto el IMSS como el SNTSS, para invitara a los profesionistas para que se vengan al estado de
Chihuahua.
El impacto en la salud implica el aplazamiento en la atención en todos los sentidos, subrayó que todas las
especialidades en la medicina todas son importantes, pero hay otra que requieren de mayor urgencia,
obviamente aquellas donde la patología o la enfermedad, como son medicina interna que abarca varias
especialidades entre ellas las enfermedades crónico degenerativas como la diabetes, la nefrología y la diabetes
nos llega dijo, después a la insuficiencia renal, cardiología en algún momento se hizo la petición en hospital 66,
se pusiera una unidad de hemodinamia, se pudiera tener facultativos de corazón abierto, pero los programas
institucionales en cuanto a obras esto no nos ha beneficiado, dijo Huberto Favela Rey ya que se le da atención
a otros estados.
3
El país está en el puesto 95 en cuidado infantil
El Comercio, Ecuador
08/09/2011
Ecuador está en el puesto 95 de 161 naciones en el cuidado de niños enfermos.
La ONG Save The Children presentó un estudio en el que analizó la proporción de médicos, enfermeros,
comadronas y otros trabajadores del sector salud por cada 1 000 habitantes.
También se evaluó la proporción de niños vacunados contra la difteria, el tétano y la tosferina, y la proporción
de mujeres que dan a luz con una comadrona.
El mejor país para el cuidado de los niños es Suiza y el peor Chad. Ecuador está en el puesto 95. El ex ministro
de Salud y actual miembro del Foro Permanente de la Salud, Francisco Andino, reconoce que en el país hace
falta especialidades médicas.
Cree que las universidades deben responder a las necesidades del sistema sanitario y no espontáneamente
como lo hacen ahora en cuanto a la formación.
Solo si se toma en cuenta a la enfermería existe una deficiencia extrema porque no hay lugares de formación.
Según Andino, en Ecuador existen siete veces menos profesionales de enfermería de los que debería haber.
En el informe, la ONG insiste en la penuria de más de 3,5 millones de médicos, enfermeras, comadronas y
agentes de salud comunitarios en todo el mundo. “Sin agentes de salud no se puede administrar ninguna
vacuna, ni recetar ningún medicamento y las mujeres no pueden recibir ayuda durante su parto. Enfermedades
como la neumonía y la diarrea, que son fáciles de curar, se convierten en mortales”, añade.
El asambleísta Leonardo Viteri, de la Comisión de Salud de la Asamblea Nacional, afirma que un 40% de las
causas de morbilidad y mortalidad infantil es evitable. Por esto enfatiza que se debe dar mayor importancia a
la prevención y no solo al tratamiento para la enfermedad.
“Seguimos mirando al enfermo y no al sano, debemos dirigirnos a lo clave que es el niño y la mujer
embarazada”, opina Viteri. Debe existir atención primaria y fomentar la educación en salud.
Andino añade que si no existe control prenatal habrá más mujeres desnutridas, de bajo peso, que viven en
ambientes contaminados. “Las consecuencias obviamente serán las muertes de niños porque tienen bajo peso
al nacer, incluso infecciones porque ha existido muchas veces la automedicación. Estos niños están propensos
a morir rápidamente”.
Uruguay ocupa el puesto 31, inmediatamente por delante de España, y Brasil el 35. México (65), Chile (80),
Colombia (85), Panamá (88), El Salvador (89), Costa Rica (90), Venezuela (93), Perú (99) y Bolivia (107) son
los otros países latinoamericanos considerados en la clasificación.
La ONG hace un llamado de atención a los países ricos a “aumentar su financiación en favor de la salud” , y
subraya que “en el plano mundial faltan dos terceras partes de los medios necesarios para alcanzar el acceso
universal a los cuidados de salud para todas las madres y los niños ” .
35
Andino concluye que para mejorar el sistema nacional y abandonar el puesto 95 hay que apuntar a la
prevención.
4
El médico del mañana
El Diario de Yucatán, Mexico
08/09/2011
Jorge Carlos Bolaños Ancona
Conceptos relevantes del discurso del doctor Jorge Carlos Bolaños Ancona, director de la Escuela de Ciencias
de la Salud de la Universidad Marista, en la ceremonia de inauguración de nuevas carreras, de lo que
informamos en Imagen
Nos han pedido hablar del médico del mañana, de cómo vislumbramos al médico que egresará de nuestras
primeras generaciones y, para hablar de ese médico, primero nos tenemos que preguntar: ¿cómo queremos
formarlo?
Pensamos que el médico debe exhibir ante todo solidez académica y para lograr esto iniciaremos transmitiendo
las enseñanzas que nos dejaron nuestros maestros: Todo buen diagnóstico se inicia con una buena historia
clínica. Por eso el médico de hoy y mañana no debe abandonar nunca la clínica y el estudio de las materias
básicas.
Al mismo tiempo, la medicina avanza a pasos agigantados, los recursos médicos son ahora invaluables y
necesitamos a un médico joven informado de todos los adelantos y, como escuela de Medicina, debemos
facilitarles la información médico-científica que continuamente se genera, sobre todo en el campo
biotecnológico, haciendo particular hincapié en la inmunología, la biología molecular y la genética.
Creemos que la enseñanza y el aprovechamiento de la medicina genómica debe acompañarse de una reflexión
sobre los derechos del hombre, ya que la tecnología se adelanta y nos invita a transitar aceleradamente a un
mundo de fantasía y soberbia donde jugamos a ser dioses. Es la reflexión sostenida en la dignidad y la
trascendencia del ser humano la que nos obliga a no rebasar los límites de la ética en pro del conocimiento.
Al joven médico le espera otro reto, el de capacitarse en utilizar las herramientas para el diagnóstico y el
tratamiento de las enfermedades, que incluso le piden un esfuerzo extra para comprender complicados
programas de computación... Complementariamente, será necesario inculcar en los alumnos el interés por la
investigación.
Queremos pues, un médico bien formado académicamente, con sólidas habilidades diagnósticas y terapéuticas,
proclive a la investigación, que impulse la medicina de nuestro estado y por ende la de nuestro país. Pero
también entendemos que México es un crisol de contrastes, donde conviven la riqueza y la pobreza extrema,
en la cual todavía se mueren niños producto de la desnutrición y al mismo tiempo ocupamos los primeros
lugares en obesidad infantil, donde se siguen muriendo mujeres por una mala atención del parto en sus lugares
de origen y por otro lado contamos con hospitales de alta especialidad donde se pueden atender los embarazos
de alto riesgo.
Por eso, a nuestras aspiraciones de formar médicos con solidez académica debemos agregarle la de tener un
médico con sensibilidad. Sí, sensibilidad social para entender a nuestro país y a nuestro Estado con sus
carencias y dificultades; sensibilidad para establecer programas de apoyo a los más necesitados; sensibilidad
para cooperar con las autoridades en programas de atención prioritarios para la sociedad; sensibilidad para
optimizar y aprovechar los grandes recursos tecnológicos y diagnósticos.
Pero también creo que debemos tener sensibilidad para reconocer el esfuerzo que hacen otros, el valor de
quienes como nosotros se involucran en la formación de los jóvenes, y en esto creo que ha llegado el momento
de impulsar nuevas estructuras que permitan profundizar mejor nuestra relación institucional entre las
escuelas de Medicina del Estado y las autoridades de Salud.
Creemos que las escuelas de Medicina, y hago énfasis en esto ante los representantes de la Uady y la
Universidad Anahuac Mayab, debemos encontrar momentos de encuentro y reflexión conjunta para conocernos
mejor, profundizar en nuestra realidad y fortalecer nuestros programas, estableciendo estrategias de
cooperación.
Cada escuela tiene o tendremos nuestra propia historia, pero ninguna puede dar la espalda a la historia de la
salud en nuestro Estado. Estamos para sumar voluntades, no para polarizar nuestras diferencias. No olvidemos
que uno de los retos de las universidades lo constituye la formación de ciudadanos capaces de valorar y
enriquecer los esquemas sociales, en la búsqueda de proyectos comunes.
Creo que con ese perfil -un médico con solidez académica y sensibilidad social- se cumplirían los
requerimientos de un buen profesional, pero ¿realmente cumpliría nuestras expectativas? ¿Sería para ustedes
como pacientes el ideal de un médico completo?En nuestro caminar dentro de la medicina creo que todos los
que la ejercemos nos hemos enfrentado al reto más difícil de un médico y ése es, sin temor a equivocarme,
cuando el paciente pierde la vida en nuestras manos... Pienso que todos los médicos que estamos esta noche
aquí podríamos describir ese sentimiento en una sola palabra: impotencia.Sí, es la impotencia de fracasar para
lo que fuimos educados, que es preservar la vida; es la impotencia que sentimos al perder a un paciente que
36
se vuelve familia. Pero la grandeza de ese momento radica en hacernos ver lo pequeño que somos. Por eso, si
esa impotencia se traduce en humildad, si esa impotencia nos hace perder la soberbia, si nos hace mucho más
humanos y menos "divinos", ese sentimiento nos estará enseñando a ser mejores médicos y mejores
personas.Por eso a la solidez académica y a la sensibilidad social nos falta agregar la sencillez, ésa que nos
hace ponernos en el lugar del otro, ésa que entiende que al hombre cuando sufre no se le mira el color de su
piel, no sabe de ideologías, de partidos, religión o posición económica... Esa misma sencillez que nos hace
reconocer que sólo somos instrumentos imperfectos de quien verdaderamente decide sobre la vida y la
muerte.
Solidez, sensibilidad y sencillez... Las tres comienzan con "S", como con "s" también se inician los sueños. Y
así, con esas características, tenemos hoy el sueño de formar un médico marista.- Mérida, Yucatán.
5
Los médicos son mayoría en el país
La Voz, Argentina
07/09/2011
En la Argentina hacen falta más de 80 mil enfermeras y sobran médicos, a la vez que persiste una enorme
desigualdad en la distribución de recursos humanos en el sistema de atención médica, ya que gran parte de los
200 mil médicos y la tecnología de avanzada se concentran en áreas metropolitanas.
El diagnóstico surge de estudios elaborados con vista al XIV Congreso Argentino de Salud, que se realizará en
Mar del Plata el 15 de este mes, donde se abordará esta temática.
El encuentro es organizado por la Asociación Civil de Actividades Médicas Integradas (Acami), que nuclea a 27
prestadores sin fines de lucro como la Fundación Favaloro, Fleni, y los hospitales Alemán, Británico e Italiano,
entre otros.
La Argentina, con algo más de 40 millones de habitantes según el último censo, es el segundo país con más
médicos por habitante después de Italia (180 habitantes por médico) al contar con un profesional cada 200
personas. Pero mientras en la ciudad de Buenos Aires, hay un médico cada 30 habitantes, en provincias como
Santiago del Estero, Formosa, Misiones o Chaco, sólo hay un profesional cada 700 habitantes.
A su vez, por año 14 mil alumnos se inscriben en alguna de las 24 universidades que dictan la carrera de
medicina.
Con casi 200 mil profesionales, la medicina es hoy la disciplina matriculada con mayor cantidad de egresados
en el país, seguida por derecho con 148.306. El promedio argentino de un médico cada 200 habitantes
cuadruplica el de Chile (uno cada 900).
“En el país hay al menos el doble de los médicos necesarios, y sólo el 38 por ciento de las enfermeras
requeridas”, advirtió el titular de Acami, Marcelo Mastrángelo.
Según datos oficiales, en la Argentina hay sólo un enfermero cada cuatro médicos, una relación inversa a la
que existe en otros países como Canadá y muy alejada a la recomendada por OPS: tres por médico. Y por año,
egresan sólo mil.
6
Nurses walk off job due to 'unsanitary conditions'
The Tribune, Bahamas
07/09/2011
By SANCHESKA BROWN
THE MARSH Harbour clinic in Abaco suspended health services yesterday after the nursing and line staff walked
off the job due to "unsanitary conditions."
The nurses say they are on strike and will continue to strike until the government takes them seriously. They
claim they are working in conditions not fit for animals, having to endure the scorching heat and lack of
resources day after day.
One nurse who wanted to remain anonymous said they are fed up with being left in the heat and treated like
second-class citizens.
She said: "We are protesting the conditions at the Marsh Harbour Government Clinic. We will no longer work
like this. We are begging and crying out for help. There is no AC in this entire building. Even the cooling unit in
the morgue has stopped working. The roof is leaking, the tiles are coming loose, the toilets are backed up and
there is mould in the building. The conditions are hazardous.
"We are not taking any patients. We are turning everyone away. We cancelled the general clinic and the
antenatal clinic today. Anyone who knows anything about health care knows you need a cold environment. The
windows don't even open to allow circulation and ventilation. The fan is only blowing hot stink air. This is
ridiculous. We will not work like this."
37
According to the nurses, they had a meeting with Health Minister Dr Hubert Minnis and representatives from
the National Insurance Board last year to discuss their issues. They say they were promised the clinic would be
renovated, but eight months later nothing has happened.
Despite the strike, doctors are still working but are only taking patients in emergency situations. There are two
doctors at the clinic. All other patients are being referred to the clinic in Sandy Point, which is 45 miles away,
or the one in Coopers Town 40 miles away.
The only other option for residents in Marsh Harbour is to attend a private doctor.
Island Administrator Cephas Cooper said as far as he knows the nurses are not striking but are simply sitting
under the tree outside to cool off in the heat. He would not make any further statement.
Dr Minnis was not available for comment.
7
Baixos salários e estrutura precária causam "apagão médico" no Norte e Nordeste
Rondonoticias, Brazil
05/09/2011
FLORÊNCIO MESQUITA
Segundo o CFM (Conselho Federal de Medicina), existem 334 mil médicos atendendo aos 185 milhões de
brasileiros. Os números são de 2010 e apontam para uma média de um profissional para cada 578 habitantes,
bem acima do mínimo preconizado pela OMS (Organização Mundial da Saúde), que indica um médico para
grupos de 1.000 pessoas.
A situação é ainda mais grave quando confrontados dados regionais. No interior de Estados como Amapá,
Amazonas e Roraima, essas médias caem a índices inferiores a um médico para cada 8.000 habitantes, abaixo
de Guiné Bissau (que tem um profissional para cada 8.333 pessoas), país subdesenvolvido da África.
Se divididos índices das capitais e do interior, o percentual mais baixo de médicos é registrado longe da capital
de Roraima, Boa Vista. Com uma população de 166 mil pessoas, os 14 municípios do interior do Estado contam
com apenas 15 médicos –o que dá uma média um profissional para cada 11.077 pessoas. Amapá (um médico
para cada 9.290 habitantes), Amazonas (8.940) e Maranhão (6.437) também têm índices similares ao de
países africanos.
Procurada pelo UOL Ciência e Saúde, a Secretaria de Saúde de Roraima informou que o Estado tenta dar
melhores salários aos profissionais que escolhem o interior para trabalhar. “Uma alternativa encontrada é fazer
concursos públicos direcionados aos municípios, com uma proposta salarial diferenciada, a fim de que os
profissionais possam se sentir motivados e valorizados, no intuito de não requererem transferência de local”,
informou.
Ainda segundo o órgão, os 14 municípios são atendidos não só pelos 15 profissionais que moram no interior,
mas também por outros 56 contratados. “Em média, a maioria dessas localidades conta com dois médicos
atendendo, mas esse número pode chegar a oito, como em Mucajaí e seis em Pacaraima”, afirmou.
para o movimento sindical médico, a interiorização está se tornando mais difícil a cada dia por conta dos baixos
salários ofertados e das más condições de trabalho. Segundo o 1° vice-presidente da Fenam (Federação
Nacional dos Médicos), Wellington Moura Galvão, os médicos sofrem pelo atual “sub-financiamento da saúde”,
que é um problema nacional, com reflexos mais graves nas pequenas cidades.
“O que falta é uma valorização da atividade médica. Hoje se paga a um médico no Nordeste, por exemplo,
uma média de 10 salários mínimos (R$ 5.450) no PSF, quando o pactuado no programa era de 30 salários (R$
16.350). Querem pagar mixaria sem dar condições éticas de trabalho. Assim, não vão interiorizar nunca”,
alegou Galvão.
Regionalidades
A distribuição dos médicos esconde distorções regionais significativas. A média de profissionais cai na medida
em que se sobe no mapa, variando entre índices europeus nas capitais, e africanos no interior do Norte e
Nordeste, onde se enfrenta um verdadeiro "apagão médico".
O CFM diz que, entre 2000 e 2010, o número de médicos no país aumentou 28%. O problema está na
distribuição desses profissionais. O Sudeste é a região mais bem servida e concentra 55% dos médicos
brasileiros. Na região, existe um médico para cada 422 habitantes. No Nordeste, essa média cai para 888 e no
Norte, fica no mínimo de 1.000 habitantes para cada profissional.
Os índices começam a fugir da referência da OMS quando observada a distância das cidades mais longes dos
centros de referência. Cerca de 56,3% dos médicos estão nas capitais dos Estados, contra 43,7% dos que
atuam no interior. O índice é proporcionalmente inverso à população do país, que está concentrada
basicamente no interior. O IBGE (Instituto Brasileiro de Geografia e Estatísticas) mostra que dos 185 milhões
de brasileiros, apenas 23% estão nas capitais.
38
O resultado dessa distorção é que o Brasil possui, ao mesmo tempo, índices de países ricos e miseráveis.
Enquanto nas capitais existem um médico para cada 238 habitantes --média superior a de países como
Alemanha, Bélgica e Suíça--, no interior a média é de um para cada 1.051 pessoas.
Municípios fazem “leilão” por médicos
Mas encontrar um médico para trabalhar no interior não é uma tarefa simples. Médica e ex-presidente da
diretora de Saúde da Associação dos Municípios Alagoanos, a prefeita de Santana do Ipanema Renilde Bulhões
afirma faltam médicos. Por conta disso, os gestores do interior do Norte e Nordeste são obrigados a ofertar
cargas horárias menores, salários maiores que a média, combustível e hospedagem. Apesar disso, a maioria
das vagas está desocupada por falta de profissionais, especialmente para o programa de saúde da família.
Segundo ela, o Ministério da Saúde repassa apenas R$ 6 mil para pagamento de médicos, o que está abaixo da
média de mercado. “Vivemos hoje uma espécie de leilão. O município que der mais, ganha o médico. Pagamos
aqui, por exemplo, R$ 7 mil ao médico. Mas têm municípios vizinhos, aqui no sertão, que pagam até R$ 9 mil,
mais gasolina. Trabalhamos no limite financeiro do município. Essa é a realidade do Norte e Nordeste, que são
regiões pobres”, contou.
Outro problema apontado pela prefeita é que dos nove profissionais que trabalham em Santana do Ipanema,
apenas dois moram na cidade. “Como gestores, não conseguimos segurar o profissional no município. Hoje os
médicos preferem passar apenas uma temporada no interior. Quando fazem seu pé-de-meia, voltam para os
grandes centros para fazerem suas especialidades médicas”, afirmou Bulhões.
Falta incentivo, dizem profissionais
O vice-presidente da Fenam confirmou que, para “ter uma remuneração mais ou menos digna”, o médico que
opta por trabalhar no interior é obrigado a ter vários empregos. “Eles reduzem a carga horária para poder
trabalhar pelo que recebem. O médico é hoje um caixeiro viajante. Sem contar a precarização. Um médico
hoje no interior do Nordeste é contratado com salário-base de R$ 1.000, que chega no fim a R$ 5 mil, R$ 6 mil
por gratificações. Mas quando entra em férias, se acidenta, recebe o 13° salário é apenas R$ 1.000. Não existe
um plano de cargo e salário”, afirma.
Além da falta de altos salários e de bons hospitais, o interior ainda sofre com problemas políticos, que
interferem no exercício médico. “Em muitos casos, o médico é refém do prefeito. Às vezes, se ele fizer uma
denúncia, ele é tirado de uma comunidade pra outra. Acontece de vereadores quererem que médicos façam
coisas-extras, trabalhem fora de horário. Falta de um carreira de Estado. E isso é muito mais grave no Norte e
Nordeste, onde o coronelismo ainda impera em muitos locais".
Novas medidas
Para tentar mudar o mapa de distribuição, o governo federal anunciou medidas que pretendem interiorizar a
atuação dos médicos. Na terça-feira (30), a presidente Dilma Rousseff prometeu, durante aula inaugural do
curso de medicina em Garanhuns (PE), criar 4,5 mil novas vagas em cursos de medicina por ano para atender
à população do interior.
No último dia 25, o Ministério da Educação publicou edital anistiando do pagamento do empréstimo do Fies
(Fundo de Financiamento Estudantil) os médicos recém-formados que aceitem trabalhar em uma das 2.219
cidades consideradas prioritárias do país, todas no interior dos Estados. Cada mês trabalhado abaterá 1% da
dívida total. Ao todo a medida vale para 19 especialidades médicas, além de quatro áreas de atuação
prioritárias para o PSF.
8
Back to top
----------------------------------------------------------------------The weekly news is a compilation of selected articles on the issue of the health workforce crisis, and is provided
for information purposes only. The Alliance is not responsible for the content on third party web sites, and any
link to external web sites does not imply any endorsement by the Alliance. If you wish to receive the Alliance
weekly news compilation in your e-mail, please send a request to ghwa@who.int. You can also suggest or
contribute articles that should be in the compilation, by writing to ghwa@who.int, for inclusion in the next
distribution.
39