This Week's News
18-22 January 2010
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
The Global Health Workforce Alliance ¦ Africa & Middle East ¦
Asia & Pacific ¦ North America ¦ Europe ¦ Latin America & Caribbean ¦
News from WHO and partners
This compilation is for your information only and should not be redistributed
Global Health Workforce Alliance
Date
Headline
Publication
15.01.10
Crisis in Haiti: The Alliance calls for health workforce support 
The Alliance
20.01.10
Medicus Mundi, World Health Professional Alliance and Health
Workforce Advocacy Initiative urge for discussion of the Code of
Practice at the next World Health Assembly 
The Alliance
Africa & Middle East
Date
Headline
Publication
16.01.10
Second cardio centre for Ghana 
Ghanaian Times
17.01.10
Nigeria's Problematic Health Insurance Scheme (Op-Ed)
14.01.10
Malaria Consortium to improve community health workers
performance in Africa
The Guardian,
Nigeria
Afrique en ligne
14.01.10
Kaduna Health Workers Give Govt Ultimatum 
18.01.10
Babies Dying From Poor Care After Delivery
20.01.10
Brain Drain, Funding, Bane of Health Sector
16.01.10
Un départ massif des sages-femmes en retraite pénaliserait le métier

Daily Trust,
Nigeria
New Vision,
Uganda
Daily Champion,
Nigeria
Algérie Focus
Asia & Pacific
Date
Headline
Publication
15.01.10
Govt. planning medical degree course to produce rural doctors 
14.01.10
High-strung city has only 400 psychiatrists 
14.01.10
Innovative and affordable 
NetIndian News
Network
Hindustan Times,
India
Hindustan Times,
India
20.01.10
India to turn out 1,750 mental health workers a year 
1
Sify News, India
14.01.10
An Area Health Centre with lack of water and space 
Solomon Star
19.01.10
Rural doctor warning
15.01.10
SA-based national health agency under fire 
16.01.10
Minister happy with healthy new year 
Weekly Times
Now, Australia
Adelaide
Independent
Weekly, Australia
PS News,
Australia
North America
Date
Headline
Publication
15.01.10
In Haiti, aid workers face a dual challenge
Los Angeles
Times
04.01.10
Will IT change how doctors treat you in 2010?
Computer World
12.01.10
Health Reform Revisionism 
Newsweek
12.01.10
For Severely Ill Children, a Dearth of Doctors 
08.12.09
The Need for Management Capacity to Achieve VISION 2020 in SubSaharan Africa 
Wall Street
Journal
PLoS Medicine
15.01.10
Broad Demand for Healthcare Workers Seen in Most US Markets
15.01.10
Closing the Health Care Workforce Gap 
14.01.10
Nurse shortage replaced by job shortage 
16.01.10
Personnel infirmier dans l'Est-du-Québec: pénurie majeure en vue
17.01.10
'Serious threats to jobs' fuel health negotiations 
Health Leaders
Media
Center for
American
Progress
Carin’s New
York Business
Le Soleil,
Canada
Victoria Times,
Colonist,
Canada
Europe
Date
Headline
Publication
16.01.10
Busy maternity units turn away hundreds of women in labour
The Times, UK
15.01.10
Baby boom causes midwife shortfall
Morning Star, UK
12.01.10
The Accelerated Child Survival and Development programme in west
Africa: a retrospective evaluation
The Lancet, UK
17.01.10
40 per cent more nurses join dole queue 
The Mirror, UK
16.01.10
Fears for health service as cuts loom 
18.01.10
Rising birth rate is leading to a shortage of midwives, report
warns
Belfast
NewsLetter, UK
Daily Mail, UK
19.01.10
Governo admite contratar mais médicos estrangeiros em 2010
15.01.10
Trabajadores del Hospital de A Coruña denuncian la falta de
personal
18.01.10
Health workers on national strike today
18.01.10
L’hôpital, le grand raté des 35 heures 
Latin America & Caribbean
2
RCM Pharma,
Portugal
La Opinión
Coruña, Spain
Hürriyet Daily
News, Turkey
Le Parisien,
France
Date
Headline
Publication
13.01.10
Reconocen labor de enfermeras 
11.01.10
Honduras: Ampliar cobertura el reto en salud 
11.01.10
Enfermeras mantendrán sus medidas por conflicto con ASSE
16.01.10
Hospitales dominicanos, repletos de haitianos 
17.01.10
Fies poderá ser pago com trabalho 
15.01.10
Falta de médicos retrasa atención a damnificados: ONG
18.01.10
"Machadadas" no SNS levam profissionais a fugir para privados
14.01.10
Novos empreendimentos na Amazônia ameaçam sobrevivência dos
índios 
El Informador,
Mexico
La Prensa,
Honduras
El Espectador,
Uruguay
El Universal,
Mexico
Tribuna do Norte,
Brazil
El Financiero,
Mexico
Rádio
Renascença,
Brazil
Terra Brazil
News from WHO and partners
Date
Headline
Publication
14.01.10
PAHO/WHO Coordinating Regional Efforts to Assist Haiti after
Earthquake 
PAHO/WHO
18.01.10
Overcrowded Hospital Wards: Performing Caesarean Sections on a
Park Bench 
UNFPA
11.01.10
Survey Shows Attention Required to Keep Ugandan Nurses in the
Profession 
ICN
15.01.10
Merlin joins call to address critical health worker shortages
Merlin, UK
15.01.10
Haiti: The health issues right now
Merlin, UK
18.01.10
Field Hospital Supported by the Government of Canada now
Deployed in Haiti
CIDA
19.01.10
*Scaling up proven public health interventions through a locally
owned and sustained leadership development programme in rural
Upper Egypt 
HRH Journal
* All links to HRH Journal will be to an external web page - copy is not reproduced in this document.
Global Health Workforce Alliance
Crisis in Haiti: The Alliance calls for health workforce support
The Alliance
15/01/2010
15 January 2010 - Following the catastrophic earthquake in Haiti on 12 January, the Global Health Workforce
Alliance appeals to all members and partners to provide urgent support to the country's health workforce, to
enable help and aid the population.
"Haiti is one of the 57 countries with crisis-level shortages of health workforce and a weak health system. Due
to this terrible disaster, people are in urgent need of help from health care workers to treat their injuries. We
hope our partners and members will act to aid Haiti in building and strengthening its health workforce in the
coming period," said Dr Mubashar Sheikh, Executive Director of the Alliance.
Merlin, an international charity for emergency medical help and a member agency of the Alliance is already on
the ground in Haiti. "Haiti's health system was in a fragile state before the disaster and Merlin will be working
closely with the Ministry of Health to train and retrain local health workers and will look to stay on as long as
we are needed," Merlin said on its website.
WHO and other partners are spearheading action to coordinate immediate health response. "At least eight
health facilities have been damaged or destroyed. Many people are unaccounted for underneath rubble, a large
number of survivors suffer from severe trauma injuries," said WHO.
3
Countries with chronic shortages of health personnel face devastation of unimaginable proportions when hit by
disasters and emergencies. The Alliance and its members and partners are committed to intensifying action to
improve health workforce planning and management in countries to enable decent health services for all.
Related links:
Follow WHO updates on relief efforts for Haiti
Donate to Merlin's Haiti Emergency Earthquake appeal
2
Medicus Mundi, World Health Professional Alliance and Health Workforce Advocacy Initiative urge
for discussion of the Code of Practice at the next World Health Assembly
The Alliance
20/01/2010
20 January 2010 - Coalitions of the Alliance member civil society organizations have released statements and a
public letter, responding the WHO Executive Board (EB) discussions on the draft global code of practice on
international recruitment of health personnel.
The public letter signed by 25 international NGOs and released by the Health Workforce Advocacy Initiative
(HWAI) stressed the importance of the Global Code of Practice and urged the EB to submit the Code for
discussion at the 63rd WHA in May 2010.
The letter reads: "The Code is necessary to (1) respond to the critical HRH shortages and (2) ensure the full
realization of the right of everyone to the enjoyment of the highest attainable standard of health – “the right to
health” – in all contexts. While recognizing the importance of respecting the right of health professionals to
migrate, we also support strong language to set clear boundaries and expectations on State and non- State
actors on recruiting HRH, particularly from developing countries, and to prioritize health systems
strengthening."
The HWAI signatories also stressed the need for improvements of the current Draft of the Code, including the
need for "provision on abstaining “from active recruitment of health personnel from developing countries
unless” equitable agreements (or other arrangements) supporting that recruitment are in place."
Anke Tijtsma of Wemos read a statement by Medicus Mundi International Network, highlighting the need to
further strengthen the ability of State and non-State actors to adhere to the Code and enhance its overall
impact. She said, "while the Code refers to the right and responsibility of all States to progressively achieve full
realization of the Right to Health, it needs to explicitly incorporate that the right to health entails
both the obligation of countries to strengthening their own health systems and the obligation of international
cooperation and assistance." She also mentioned the importance of participation of non-State actors in the
implementation and monitoring processes of the Code.
The World Health Professional Alliance (WHPA) is an umbrella body of organizations such as the International
Council of Nurses, International Pharmaceutical Federation, World Dental Federation and World Medical
Association. The WHPA also supported the revised global draft code of practice and its submission to the World
Health Assembly. Its statement said, that "the balance between the individual rights of health personnel and
the right to the highest attainable standard of health of the populations of source countries is clearly a priority
issue which has been addressed in the Code. It is important that the Code applies globally, to private as well as
public sectors, temporary as well as permanent workers."
The WHO Executive Board comprises of 34 members and acts as a decision-making body to advise on the
policies of the World Health Assembly.
Back to top
Africa & Middle East
1
Second cardio centre for Ghana
Ghanaian Times
16/01/2010
A second cardiothoracic centre in the country is to be established within the next six months at the 37 Military
Hospital Post-graduate centre to train doctors for the diagnosis and treatment of heart-related diseases.
Lieutenant-Colonel Dr. Sunny Mante, Head of Surgery, and Cordinator of the 37 Military Hospital Post-graduate
College, disclosed this at a press conference in Accra on Friday ahead of the African Heart Summit on
Saturday.
The four-day Heart Summit is a collaboration between the 37 Military Hospital and the German Heart Institute,
Berlin. It is aimed at creating awareness of cardiovascular diseases in African society besides forging capacity
building in cardiovascular medicine in Africa.
4
About 50 resource persons across the world will forge partnership with Ghanaian doctors at the workshop to
promote cardiovascular health service delivery.
Throwing more light on the Summit, Professor Charles Yankah, Course Director at the German Heart Institute,
said to improve upon the country’s health workforce, it must take cardiovascular diseases more seriously.
The World Health Organisation and World Bank Statistics have indicated that by 2025, cardiovascular diseases
would surpass HIV/AIDS infections to be the leading cause of death in Africa.
He said between two and three per cent of Ghana’s estimated 23 million population has cardiovascular related
diseases.
Professor Yankah said the ideal situation was to have at least two physicians in the regional hospitals
specialised in the diagnosis and treatment of heart related diseases to ease off the load at the Korle-Bu
Teaching Hospital.
Prof. Yankah said the German Heart Institute was working with the Ghanaian authorities to have more
cardiovascular surgeons, cardiologists, nurses, and physicians trained in the country to improve the wellbeing
of the workforce.
He said the cardiovascular physicians would be trained to diagnose and treat people who suffer from heartrelated diseases but do not necessarily require operation.
The Course Director said the society should be more scientific to recognise and seek early treatment for heartrelated diseases rather than to be superstitious about such conditions.
Prof. Yankah advised people to check their diet and undertake regular medical checkups.
Dr. Edward Asumanu, Deputy Coordinator, Postgraduate College of the 37 Military Hospital, said the heart
summit sought to deepen the awareness of cardiovascular diseases among the medical community to carry the
message to the wider society.
He said cardiovascular diseases which were categorised under non communicable disease were gradually
emerging as major killers but the awareness was very low.
Dr. Asumanu said medical examination should be made mandatory in the country.
2
Nigeria's Problematic Health Insurance Scheme (Op-Ed)
The Guardian, Nigeria
17/01/2010
By Reuben Abati
One of the major fall-outs of President Umaru Yar'çdua's prolonged absence from the country and his seeming
"incarceration" in a Saudi Hospital has been the protest that if the Nigerian health care system were developed
and well managed, the President not to talk of ordinary citizens would not have cause to travel abroad for
medical treatment. Meaning: if President Yar'çdua had been in a Nigerian hospital receiving treatment, the
noise about his health would have been less strident. But unfortunately, Nigeria runs a healthcare system that
is worse than what they have in Haiti where tragedy has currently assumed its original human form. The
seriousness of this matter was conveyed afresh only a few days ago, I guess inadvertently, through an
advertorial in The Guardian newspaper placed by the management of the NHIS (Thursday, January 14 at page
62). In it, the NHIS says it is suspending a number of HMOs and HCPs. The import of that advert is that the
National Health Insurance Scheme is not working. It has failed. This is the simple fact.
When the NHIS was introduced by the Obasanjo government, the expectation was that it would help to
improve access to healthcare for the majority of Nigerians, particularly persons in the public service and the
private sector. In typical Nigerian style, the scheme began to die slowly a-borning. Many Nigerians depend on
out of pocket spending for healthcare. With widespread poverty in the land, this creates special difficulties;
unable to spare an extra Naira on healthcare, many Nigerians patronise quacks, or they make compromises
with their health with tragic consequences. Even the educated, acting out of ignorance or expediency make
uninformed choices. The NHIS as conceived was meant to bridge an existing gap and widen opportunities for
access to qualitative healthcare with strong private sector participation, and with government defining policy
and framework.
Nobody had any illusions that a national health insurance scheme would solve all of Nigeria 's problems, surely
a strong primary healthcare system would still be required to care for the usually marginalised segments of the
population. But through insurance a sizeable and strategic segment of the population would have been
captured. In the United States , health care reform remains a major issue, but despite the controversies, the
national health insurance scheme works. The British NHIS is also so attractive that many Nigerians travel
regularly to take advantage of it, even when they are not resident in the United Kingdom . I hope I am not
revealing any secret among the immigrant community but I understand there is a way around these things to
enable even ordinary visitors masquerading as residents to have good medical attention in the UK . Britain has
been running a health insurance system since 1911; Germany since 1883.
5
As ever, the Nigerian system needed to be strengthened. In 2005, when the NHIS was officially launched, the
then President Olusegun Obasanjo had uttered the following words: "with the start of the National Health
Insurance Scheme, (NHIS), we see a future of opportunity to improve our health indicator which is related to
our poverty index. The scheme will never go the way of other government programmes. The scheme will prove
to Nigerians, our administration is serious and sincere about the reform agendas." Four years later, nothing
has been proved. The poverty index has risen, and so have the country's poor health indicators. Initially,
Nigeria 's NHIS had faced problems arising from what was defined as "global capitation"; in layman's terms
that came across as rivalry among several professionals and service providers within the health sector but it
was all the more about how to share revenue.
Nevertheless, this was the least of the problems. Managing a health care system for results and actual
difference requires leadership, careful management, and capacity building. As at 2005, average expenditure on
healthcare as measured through GDP was 4.6; Federal Government average expenditure on health was about
1.5 %. Very poor you would say, but state and local governments fared worse. And yet ensuring the well-being
of all Nigerians is part of government's constitutional mandate. Not doing so is a violation of the rule of law.
Nigerian governments have voted for the latter, indeed the failure of the NHIS is a comment on the failure of
governance.
In the advertorial under review, the management of the NHIS claims inter alia,, that HMOs have not lived up to
expectations, they have not made "sufficient progress" and that further re-accreditation of HMOs will be
necessary. It is not impossible that certain HMOs have not been so efficient. The irony though is that HMOs
have long been in the business of health insurance in the private sector before the same policy was formally
adopted. What happened to the pool of knowledge that had been acquired? The NHIS advertorial does not tell
the full story, but it also does in a way through the caveat that it provides rather conclusively. According to the
NHIS, "the suspension shall not affect the following categories of providers: i. Providers in states folding into
the Community Health Insurance Programmes for the Maternal and Child Health Project. ii. Providers in states
folding into the NHIS Formal Sector Programme where additional facilities would be required." Our straight
interpretation is that the big problem with Nigeria 's NHIS is the ambition of the Federal Body to seize control
of it. This does not serve the purpose of efficiency rather it satisfies the urge of a cabal for power and profit.
The NHIS in its concluding paragraphs uses the phrase "fold into", that is, the states folding into the NHIS
formal sector programme. We are confronted here, therefore, with the original problem with Nigerian
federalism. We run an over-centralised state. The centre would rather dictate what happens in other parts of
Nigeria in scandalous breach of the law!
The management of the NHIS needs to be told a few truths. One, health is on the concurrent list. The states
don't have to fold into the Federal NHIS programme. They can set up their own management and
administrative systems and accredit their own HMOs. Two, at the root of the Federal NHIS office's territorial
aggression is money. NHIS wants subscription from the states. At least two states have hurriedly co-operated
(Bauchi and Cross River states, but even that is not working). The states can have their own separate NHIS
programmes which will not run contrary to the national NHIS. This allows for variety and diversity rather than
over-centralisation. HMOs can then operate independently at various levels, they do not have to be under the
control of a Federal Government that is widely regarded to be absent-minded.
Three, our fear is that when civil servants seek to over-centralise everything as the NHIS authorities are
struggling to do, they are not interested in the public good, they are more interested in creating a large pot
from which they hope to draw honey until the pot is bankrupted. There have been integrity questions in the
past about the management of the NHIS. Even now, there are questions about premiums paid. The NHIS
insists that premiums are non-refundable. But when they are non-refundable, where do they go? To what
purpose are they put? Four, our biggest concern is that the NHIS authorities in Abuja , talking about regulation
and accreditation, are only interested in the collection of premiums. They seem to have abandoned regulation
the object of which should be to make sure that the stakeholders do their job, a point that is only faintly, albeit
cleverly referred to in the advertorial under review.
On December 4, 2009, ThisDay newspaper at page 50 published an interview with the Director-General of the
NHIS, Dr Dogo Muhammad titled "Why NHIS may not achieve universal coverage." The DG provides a selfindicting explanation that he should be ashamed of. He says in simple terms that the only reason the NHIS is
not growing is because some states have refused to place their health schemes under the umbrella of the
Federal Government. Why should they do so in a federal system, and in a matter that is concurrent? Dogo
Muhammad wants the enabling law changed. What he really wants is more powers for the Federal NHIS. He is
wrong. Universal coverage will be better achieved through decentralisation and greater investment in primary
health care targeted at the poor. I admit that there are countries in the world where healthcare insurance is
completely public sector driven as part of an overall reform framework, but it is a model that is ill-suited to
Nigeria , given government's record of performance.
What Nigerians need is a healthcare system that guarantees access to qualitative medicare at affordable price.
There is no denying the fact that Nigeria 's healthcare index is very poor, and that the people are suffering.
Today, this country has one of the highest maternal morbidity and infant mortality rates in the world. Public
hospitals are grossly under-equipped. Private hospitals provide cash and carry services, and take-away medical
services too, a sign of the intrusion into the medical sector of the fast food phenomenon. Self-medication is on
the increase just as the market for quackery has blossomed. Governments at all levels provide little support for
the medical sector. There is a yawning gap between promises and actual performance. When Nigeria 's big
men fall ill, they jump onto the next available aircraft to seek help abroad.
Without any doubt, the NHIS over which so much air has been split is a programme for the elites. Providing a
non-discriminatory, broad-based healthcare opportunity for all Nigerians should be the overriding objective.
There is a lot to be done. Health workers need to be motivated to take their jobs more seriously and to be
6
interested in serving Nigeria, not a foreign land whose attraction are the better conditions that it promises.
Governments at all levels must assign more funds to the growth of the health sector with international
standards in mind. Special attention must be paid to colleges of medicine, teaching hospitals and health related
institutions to ensure quality training of medical personnel. A lot more energy should also be devoted to public
enlightenment and the creation of social safety nets. People need to know what health insurance is all about:
are they entitled to discounts? Is there a linkage between lifestyle choices and health insurance packages? Can
they make choices and if so, what kind of choices?
In March 2007, the following memorable statement was made by President Umaru Yar'çdua: "My personal
experience demonstrated clearly the inadequacies of the Nigerian healthcare system. When I become the
President of the Federation, I will fight to ensure that no Nigerian travels beyond the shores of the country to
seek or obtain medical care" (ThisDay, March 20, 2007, p. 19). When the same man became President two
months later, he forgot to include health in his famous seven-point agenda. He has since then travelled in and
out of the country for foreign medical care! For the past 50 days, he has been in Saudi Arabia in a hospital. I
doubt if the President is on the NHIS. So, who is picking up the bills for his long stay in a Saudi Arabian
hospital? The same funds should be more than enough to set up a world-class hospital to take care of his
health problem.
Nigeria is losing all that. In real terms, the entire nation is sick. When the opportunity arises, someone should
calculate and announce how much it is costing Nigeria to keep the President in a five-star hospital in Jeddah ,
Saudi Arabia for such a prolonged period. The short of it on all fronts is good governance which Nigeria lacks. I
recommend a review of the NHIS and a decentralisation of the health insurance system in law and operation.
The role of government should be restricted to regulation and monitoring and no more. Finally, a point of
information: much better progress is being made with the NHIS in Ghana next door.
3
Malaria Consortium to improve community health workers performance in Africa
Afrique en ligne
14/01/2010
Limited community involvement, shortages of medicines and shortfalls in training materials are among factors
severely hampering the effectiveness of community based agents (CBAs) in the treatment of malaria and other
communicable diseases in resource-poor countries, according to the UK-based Malaria Consortium.
While there are many advantages in using CBAs, evidence to date has revealed that their effectiveness was
also prevented by lack of refresher training and supervision, while the data collected by CBAs remained underutilised, the Consortium said in a statement Thursday after receiving a US$10 million grant from the Bill &
Melinda Gates Foundation.
The grant is intended to demonstrate how government-led integrated community case management (iCCM)
programmes can be scaled-up, leading to a sustained increase in the proportion of children with diarrhoea and
other common diseases receiving appropriate treatment.
'Malaria Consortium is excited to have secured this important grant from the Bill & Melinda Gates Foundation,'
said Dr James Tibenderana, Director, Case Management for Malaria Consortium. 'We estimate that each year
diarrhoea causes about 30,000 and 36,000 deaths in children aged under five years in Mozambique and
Uganda respectively, where this project will be implemented. This grant will give us the opportunity to prevent
some of these deaths which is a responsibility we take very seriously.'
A crucial element in attaining this goal is to gain a better understanding of the CBAs motivation and attrition,
and find workable solutions to their retention and performance.
According to the Malaria Consortium, this is essential if iCCM implementation is to be successful on a national
scale.
Health systems in resource-poor countries are often unable to scale up essential child health interventions.
Many are strengthening their human resource capacity by investing in CBAs to deliver lifesaving treatment to
children suffering from common but deadly diseases.
As the lead agency, Malaria Consortium said it would build on established operations and excellent relations
with the health ministries in Mozambique and Uganda, as well as other key national and international partners.
It will manage a partnership combining expertise in research, communications and information technology,
including the London School of Hygiene & Tropical Medic i ne, University College London Centre for
International Health and Development, Strai ght Talk Foundation, N'Weti and Software Factory.
'This five-year project will complement the work recently started by Malaria Consortium through a Canadian
International Development Agency (CIDA) funded project in four countries, including Uganda and Mozambique.
'While the CIDA project will carefully measure the impact of interventions, the Bill & Melinda Gates Foundation
funded programme will add implementation research and activities to promote uptake of iCCM to 50 percent
coverage in both countries,' the statement added.
7
Malaria Consortium works in partnership with communities, health systems, government and non-government
agencies, academic institutions and local and international organisations to ensure good evidence supports
delivery of effective services.
Dar es Salaam - Pana
4
Kaduna Health Workers Give Govt Ultimatum
Daily Trust, Nigeria
14/01/2010
Ismail Mudashir
Health workers in Kaduna State yesterday gave an ultimatum to the state government to abide by the
agreement reached last November or face an indefinite industrial action.
The state government had promised to meet the requirements of the union after a three-day warning strike
over improved welfare package by the workers in November.
Addressing newsmen in Kaduna yesterday, the state chairman of the Association of Resident Doctors Dr.
William Ayet said the workers would resume the suspended strike if the government failed to take appropriate
action to address the issues affecting the workers.
He said the state government had failed to implement the agreement of the Memorandum of Understanding
(MOU) on the acceptance and implementation of their demands in November last year.
"We suspended the three-day strike following a memorandum of understanding signed by the consultative
health workers and the Head of Service to reach an agreement before the passage of the 2010 budget. They
promised to address our demands before the presentation of the budget to the House of Assembly but now
they have violated the agreement reached by presenting it before addressing our demands," he said.
The chairman noted that the 350 per cent increase approved for the health workers was to enable them catch
up with other states which goes to show how poor the state's health workers' salaries had been in recent years
5
Babies Dying From Poor Care After Delivery
New Vision, Uganda
18/01/2010
Frederick Womakuyu
Kampala — AT Kwirot Village, on the fringes of Mt. Elgon, Kapchorwa district, a Traditional Birth Attendant
(TBA) battles in vain to save a life, but the three-year-old infant dies before he can reach the health centre
40km away.
This is not an isolated issue. According to the 2007 new born health report by the child and reproductive health
division of the Ministry of Health, Uganda's infant and child mortality rates are still high, with six out of 10
children dying annually before the age of one. Of these deaths, four out of 10 are newborn deaths. This is
equivalent to 45,000 a year, an equal number of babies being born dead.
The mothers are not spared either. At the annual conference of gynaecologists and obstetricians last year, Dr.
Romano Byaruhanga of Nsambya Hospital, noted that 16 mothers also die per day due to pregnancy and birthrelated complications.
Health experts say the major cause of mothers dying is excessive bleeding after delivery. This is defined as
blood loss greater than 500 millilitres during vaginal delivery or greater than 1,000 millilitres during caesarean
delivery.
In a paper entitled "Hurdles and Opportunities for newborn care in rural Uganda," Dr. Byaruhanga noted that
Uganda may not be able to achieve the Millennium Development Goal 4.
In the year 2000, UN member states agreed that by the year 2015, child mortality should be reduced by twothirds or 4.1 per 1,000 live births.
Dr. Jessica Nsungwa, co-presenting the report, blamed the high deaths on poor health seeking behaviour by
mothers and staffing shortages in Uganda's health facilities.
"In Uganda, about 59% of the babies are born outside a formal health facility. In addition, only 45% of the
women attend four antenatal visits (during their pregnancy) and of these, 38% of deliveries are performed by
skilled attendants," Dr. Nsungwa revealed.
Dr. Byaruhanga says delivering at home is very risky. "The society does not adhere to guidelines on newborn
care. Some have negative perceptions of practices on newborns." He adds that 80% of babies born in Uganda
8
suffer from hypothermia (extreme cold), because they are bathed immediately after birth. He cautions that this
is very risky because the baby may die, develop pneumonia, feeds less and the amount of glucose or sugar in
the blood decreases. This affects the baby's brain and increases risk of infection.
He says the baby may develop infections like diarrhoea, tetanus and failure to breathe.
The Ministry of Health report reveals that only three out of 10 mothers and babies born in a health facility,
receive check-ups and support during the first 24 hours after childbirth.
"The health facilities discharge the mother and the new born, usually after six hours when the mother and the
baby are still at risk of ill health and death," the report reveals.
Dr. Juliet Kiguli, a gynaecologist who attended the conference, noted that health facilities lack equipment and
staff to support the mother and baby beyond 24 hours.
According to the Ministry of Health, only 51% of health worker positions are filled in the country and of these,
20 % of the health facilities meet midwife staffing levels.
Interventions
The National Situation Analysis of newborn health recommends that health centres and communities recognise
and refer newborn illnesses through community health workers during the infant period, to save their lives.
Dr. Kiguli called for the training of health workers and health facility support in dissemination of guidelines,
service standards for post-natal care, especially the policy on timing and service package for post-natal care
within the first seven days after birth.
The report called for health workers to sensitise the community about seeking formal health care with an aim
of increasing the number of mothers who deliver in the health facility. The report also called for the
Government to review the essential drug list for inclusion of pre-referral drugs for lower level health units.
The essential drug policy should be reviewed to include availability of priority drugs for newborns at lower
levels (healthcentre IIs and IIIs), including gentamicin and injectable ampicilin.
But what is the Government doing?
According to the Department of Human Resource in the Ministry of Health, in the next five years, they will
recruit health workers countrywide to a staffing level of 71%.
"However, health worker shortages increase outwardly from the urban, to the rural areas because of lack of
staff housing, with some having as low as 36% staff positions filled," says a source in the department who
preferred anonymity.
Proper Care fr Newborns
Dr. Byaruhanga says when a child is born, the amniotic fluid should be wiped off with a cloth, not water (even
warm water) and the baby should be wrapped in a dry sheet and covered before the umbilical cord is cut off.
The report also called for initiating early breastfeeding to keep the baby warm. "Warmth through skin-to-skin
contact for low birth weight and premature babies should be encouraged," the report says, adding that proper
cord care should be undertaken by a trained health worker to avoid unnecessary bleeding of the baby."
6
Brain Drain, Funding, Bane of Health Sector
Daily Champion, Nigeria
20/01/2010
Florence Udoh
Nigeria's plan to attain the health goals of the Millennium Development Goals (MDGs) by 2015 may be a mere
dream as the country has only one doctor to over 5,000 patients.
World Health Organisation (WHO), however, stipulated ratio of one doctor to 30 patients.
Former National Secretary of the Nigerian Medical Association(NMA), Dr Kayode Akinlade said though
thousands of medical doctors are trained in the country annually, only 25,000 are available to serve 150 Million
Nigerians.
"Funding is not the only constraint in the health sector. There is also capacity by which I mean the health
workforce. Nigeria has produced well over 25,000 doctors because in the register we have about 50,000
doctors but many have gone outside the country," he said.
Akinlade, who said doctors should not be blamed for their migration to other countries because of their high
demand abroad. "For instance, there is this attraction in salaries. Here an average nurse is paid about N40,000
per month, whereas abroad, a nurse can earn as high as US$3,000. So there is a lot to gain. Why won't they
run away if they have the opportunity?, he said.
9
He blamed the problem in the health sector on political environment, saying nobody seemed ready to address
the problems in the health sector or the demands of health workers.
"Abroad when something like this happens, the Minister will resign, Commissioners will resign. Political
consideration is another factor. Maybe also the godfather syndrome. Somebody puts you there and therefore
you cannot be removed and the masses are suffering. So, how will our health indices improve?
"I am aware of parts of the country where there are no doctors, other categories of health personnel carry out
surgical procedures and consultation with all kinds of complications. Nigeria needs to train more doctors to be
able to take care of the health of the populace," he said.
10
Un départ massif des sages-femmes en retraite pénaliserait le métier
Algérie Focus
16/01/2010
Poste par Sat
[Aps 16/1/10] ALGER – La secrétaire générale de l’Union nationale des sages-femmes, Akila Guerrouche, a
affirmé samedi à Alger qu’un départ massif des sages-femmes en retraite pénaliserait ce métier. S’exprimant
lors d’une rencontre de concertation avec le ministère de la Santé, de la Population et de la Réforme
hospitalière autour du statut particulier de ce corps paramédical, Mme Guerrouche a relevé qu’un nombre
considérable de sages-femmes, sur l’ensemble du territoire national, ont atteint l’âge légal de la retraite. Elle a,
à cet égard, averti contre le « manque flagrant » de sages-femmes dans les services de santé dû à un départ
massif en retraite en dépit du programme de formation tracé par le ministère de tutelle.
Mme Guerrouche a saisi cette rencontre pour souligner l’urgence de revaloriser le métier de sage femme,
plaidant pour une protection contre d’éventuelles poursuites judiciaires suite à des erreurs médicales « dans la
plus part du temps non commises ». Elle a appelé aussi au renforcement de la formation continue des sagesfemmes et à une mise à niveau de leur cursus professionnel afin qu’elles puissent être en amont avec
l’évolution que connaît le secteur de la santé et assurer ainsi de bonnes prestations.
Pour Mme Guerrouche, une formation de qualité des sages femmes « ne peut être garantie que par la
réouverture de l’Ecole nationale des sages femmes qui a fonctionné en Algérie depuis 1825″, la prolongation de
la durée de formation à cinq années et l’introduction d’un module sur l’examen par échographie.
Concernant la prévention contre la grippe A/H1N1, Mme Guerrouche a déploré la non participation des sages
femmes à la campagne de sensibilisation sur cette pandémie, alors que la sage femme, a-t-elle dit, « est
présente dans toutes les maternités et fait partie du corps médical et paramédical à la tête des campagnes de
vaccination ».
De son coté, la chargée du dossier formation et suivi des statuts particuliers des corps médicaux et
paramédicaux au ministère de la Santé, a affirmé que le statut particulier des sages femmes et à l’ordre du
jour au ministère. Sur la formation de ce corps paramédical, elle a expliqué que le ministère a tracé un plan
consacré à ce volet, dont certains points relèvent des prérogatives du ministère de l’Enseignement supérieur et
de la Recherche scientifique.
Back to top
Asia & Pacific
1
Govt. planning medical degree course to produce rural doctors
NetIndian News Network
15/01/2010
Union Minister for Health & Family Welfare Ghulam Nabi Azad today said the Government was planning to
introduce a three-and-a-half year medical degree course to meet the shortage of doctors in rural areas.
This would be a course leading to a Bachelor's degree in Medicine and Surgery to produce doctors who would
work in rural areas and district hospitals with specified bed capacities could be utilised as medical schools, he
said at a meeting of State Health Secretaries.
Mr Azad said the expansion of health services under the National Rural Health Mission (NRHM) and emergence
of non-communicable diseases had resulted in a high demand for specialists and doctors.
He said the Government had, therefore, initiated various reforms in medical education to increase the intake at
the level of post-graduation and also rationalise the process of setting up new medical colleges in deficient
States and regions.
He pointed out that the Post-Graduate Medical Education Regulations, 2000 had been amended recently,
wherein the teacher-student ratio had been revised from 1:1 to 1:2.
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He said the Medical Council of India (MCI) Regulations were amended in order to enable medical colleges to
increase seats in post-graduate medical courses. He said the Ministry and the MCI had requested all the State
Governments to instruct the Government Medical Colleges in their States to send the information with regard
to availability of teaching faculty.
Mr Azad said the Government had so far received information from 64 Government Medical Colleges from 14
states only.
He said the MCI had, after considering the information furnished by these States, recommended to the Central
Government for increase of approximately 1100 seats in various post-graduate medical courses.
He urged State Governments to send the details of teaching faculty in Government Medical Colleges in their
states at the earliest so that they could be considered for increase of post-graduate seats in the light of the
amended post-graduate regulations.
He said the Government had also formulated a scheme for strengthening and upgradation of the State
Government Medical Colleges to increase the number of post-graduate seats and start new post-graduate
courses.
He urged the State Governments to be pro-active in availing these benefits and take measures to increase the
availability of human resources in their States.
The two-day meeting, being attended by senior health officials from the Union and the State Governments as
well as various health agencies, will discuss disease control programmes, maternal and child health,
immunisation, medical education and various new initiatives of the Government and chalk out action plans to
take them forward.
He said the NRHM had helped improve the health infrastructure facilities and the availability of human
resources. He said reports had shown encouraging trends in many states, such as increasing in-patient and
out-patient cases, institutional deliveries, availability of drugs, provision of diagnostic facilies and availability of
transport systems.
Mr Azad said people living in the most difficult and remote areas should also be able to access public health
facilities easily and receive quality health care.
"We also have a long way to go, in achieving our goals relating to MMR, IMR, TFR, universal immunization and
reduce the disease burden on account of malaria, T.B. and other infectious diseases," he said, adding that he
had asked his Ministry to identify backward districts with poor health parameters for focused attention.
States have also been asked to identify health facilities in remote areas, especially in the hilly States, northeastern States and tribal pockets so that a comprehensive package of additional incentives for doctors and
health workers could be considered for encouraging them to work in these places.
The Minister said reproductive and child health was a key area and required focused attention. He said the
percentage of fully immunised children in the country was not satisfactory called for close monitoring of the
routne immunisation programme.
He said he had asked the Ministry to develop a system, for tracking pregnant mothers and children, to
ascertain the status of ante-natal and post-natal care and institutional delivery and immunization of the
children.
Mr Azad said vector borne diseases, particularly malaria, continued to be a major public health problem in the
country, both in terms of mortality and morbidity. He said there was an increase in the burden of noncommunicable diseases, such as cancer, cardiovascular diseases and diabetes.
He said the Government was in the process of formulating specific schemes to address these concerns. For
diabetes, it was working out a strategy for checking all people in the age group of 30-40 years in the rural
areas for diagnosing potential cases, he said.
He noted that, in Pune, the local authorities have decided to take up such an exercise in the entire district to
diagnose people sufering from diabetes and blood pressure and urged all States to follow this example.
2
High-strung city has only 400 psychiatrists
Hindustan Times, India
14/01/2010
Naziya Alvi, Hindustan Times
Despite its high-pressure life, Mumbai is facing severe shortage of psychiatrists.
With a population of more than a crore, the city has only 400 trained psychiatrists registered with the Bombay
Psychiatrists’ Association.
11
The Association has on its rolls another 350 mental health workers which include psychologists and counsellors,
who are not doctors. They conduct counselling sessions but cannot prescribe medication.
“There is a severe dearth of psychiatrists not only in Mumbai but across India,” said Dr Harish Shetty, a senior
psychiatrist.
The shortage of psychiatrists is alarming in the wake of the World Health Organisation predicting depression to
be the second largest disease by 2015.
While in Mumbai, one psychiatrist has to cater to approximately 2.25 lakh people, the United States has 17
psychiatrists per lakh population, informed Dr Meera Narasimhan, Vice Chairman Research and Scientific
Initiatives, University of South Carolina School of Medicine.
“With growing urbanisation and major lifestyle disorders the demand for psychiatrists is bound to go up,” said
Dr Yusuf Matcheswala, a senior psychiatrist with JJ Hospital and former President of Bombay Psychiatrists
Association. In the past decade, Matcheswala has seen a 15 to 20 per cent rise in the number of new patients
every week.
The reasons for the shortfall in the number of psychiatrists are varied. Brain drain is one of the most prominent
problems.
“More Indian psychiatrists are found outside India,” said Dr Anjali Chhabaria, who runs a private clinic at Juhu.
“Last year I trained four psychiatrists of whom three went abroad soon after the course was over,” said Dr
Shubhangi Parker, head of psychiatry department at KEM Hospital.
Also, the numbers of seats available to study psychiatry in city medical colleges are only four to six. This is
because there aren’t enough senior psychiatrists in the city to teach the subject. In 1985, when Matcheswala
had joined JJ Hospital, he recalled there were eight psychiatry teachers in the department.
“Today, the hospital has only four faculty members in the psychiatry department,” he said.
3
Innovative and affordable
Hindustan Times, India
14/01/2010
Sanchita Sharma, Hindustan Times
Doctors can now diagnose heart disorders with a simple one-touch operation on a small, handheld device called
the MAC i.
Within minutes, the machine conducts and prints results of an ECG — short for electrocardiogram — used to
measure the heart’s electrical activity and evaluate heart problems such as heart attacks, irregular heart
rhythms and heart failure.
Developed at General Electric (GE) Healthcare’s R&D centre in Bangalore as part of the company’s “reverse
innovation” strategy to rapidly accelerate growth in low-end emerging markets, the MAC i costs just Rs 25,000.
The device brings down the cost of an ECG test to Rs 9, as compared to Rs 300 it costs in most private
hospitals in India.
“Any para-health staff or physician can use the MAC i anywhere with just a few minutes of training,” said V.
Raja, president and CEO, GE Healthcare, South Asia.
GE is one of the multinationals reversing their traditional business models by shifting from developing high-end
products to adapting them for emerging markets and developing local technologies, which are then distributed
globally.
“As part of GE Healthcare’s Rs 28,000-crore Healthy Imagination, global initiative project, we are developing
at least 100 innovations that will reduce the cost of procedure, increase access and improve quality,” said Raja.
With close to 70 per cent of India’s 1.2 billion people living in villages and 80 per cent of doctors clustered in
and around urban areas, rural areas require innovative medical solutions. “Affordable technology without frills
has helped us increase the number of free camps in villages from two to six times a week, reaching one lakh
(100,000) people a year,” said Dr Naresh Trehan, chairman, Global Health, which runs Medanta – The Medicity
in Gurgaon.
CX 50, a Philips mobile echocardiography device, for instance, helps diagnose rheumatic heart disease early
enough for it to be treated using penicillin. “If diagnosed late, it needs valve replacement,” said Dr Trehan.
It’s not just the private sector that is taking advantage of the new affordable technology. The Centre’s efforts
to reduce neonatal deaths that constitute 45 per cent of India’s under-five mortality — under the Navjat Shishu
Suraksha Karyakram, which trains health workers in basic new-born care and resuscitation — have got a boost
with innovations such as the Lullaby Incubator XP and Lullaby Incubator TR. Designed for neonatal care in
12
semi-urban and rural clinics and during transport, these easy-to-use incubators are priced 70 per cent lower
than the average price of current warmers.
“Under the National Rural Health Mission, some states such as Maharashtra, Karnataka, Andhra Pradesh,
Kerala and Tamil Nadu have already installed basic stabilisation units and incubators at some community and
primary health centres to provide specialised care,” said a health ministry official. “We plan to expand it to
train all health workers to ensure newborn care goes beyond home-based care.”
Efforts such as these are showing impact. Infant mortality in the country has dropped from 58 per 1,000 live
births in 2005 to 53 per 1,000 live births in 2009, data from the Sample Registration System, shows.
The Apollo group’s telemedicine initiative helps it reach out to people in 200 centres in small towns and
villages. “Our network of telemedicine centres and mobile vans with uplinking facilities and basic ECG and Xray machines help in instant diagnosis, online consultation and referrals,” said Dr Anupam Sibal, group medical
director, Apollo Hospitals, which run 46 hospitals, including a 50-bed charity one at Aragonda village in Andhra
Pradesh
4
India to turn out 1,750 mental health workers a year
Sify News, India
20/01/2010
IANS - The central government Wednesday announced a health scheme to address the problem of acute
shortage of doctors and health workers for mental health disorders, saying India will produce 1,756 such
practitioners, including 520 doctors, every year.
'We know there is an acute shortage of human resource and we are putting in place a mental health scheme.
The outcome of this scheme is 1,756 mental health professionals annually, which includes 104 psychiatrists
and 416 clinical psychologists,' Health Minister Ghulam Nabi Azad said.
He said the above list also has 416 psychiatric social workers and 820 psychiatric nurses for handling mental
disorder patients.
Azad said nearly seven percent of Indians face common mental health problems but only two percent face
acute problem needing proper medical treatment.
He said under the mental health scheme worth Rs.1,000 crore, 11 existing mental health hospitals are being
upgraded and strengthened to produce qualified manpower.
'Rs.30 crore per centre will be given for academic block, library, hostel, laboratories, supportive departments
and lecture theaters,' the minister said.
An additional 44 post-graduate seats in psychiatry, 176 M.Phil seats in clinical psychology and psychiatric social
work and 220 seats in diploma in psychiatric nursing will be available every year, he added.
Azad also said that assistance would be provided for setting up and strengthening of 30 units of psychiatry, 30
departments of clinical psychology, 30 departments of psycho-social worker and 30 departments of psychiatric
nursing. The central government will provide Rs.5.1 million to Rs 10 million per PG department for the
purpose.
7
An Area Health Centre with lack of water and space
Solomon Star
14/01/2010
EMU Harbour Area Health Centre is the only health outlet that serves people in the central and north Ranoggah
for many years.
But for nearly 20 years water and lack of space are problems that affected the services being provided at the
health centre.
Area Health Supervisor Lawrence Tonowane has been there for the last five years.
He told the Solomon Star last week the health centre is in dire need of reliable water supply.
He said there’s piped water that supplies the Emu Harbour community.
But because the pressue was too weak, it was unable to reach the health centre.
The health centre had proper plumbing inside.
"But due to poor pressure no water is coming through," he said.
Mr Tonowane said even a water tank to supplement the water shortage is not able to be provided for the past
years despite appeals to leaders.
"A water tank is our immediate need now," he said.
13
Mr Tonowane has three other staff – a mid-wife and two assistant nurses – working at the health centre.
He said the centre sees between 20-25 patients on average on a daily basis and attend to general medical
health services to emergency cases.
Malaria tests are also being conducted with a full time Malaria lab techicians working with them.
There are students on practical attachments every year and that has also helped ease their demand.
The centre operates a 24 hour service and acts as a mini-hospital.
It caters for patient admissions.
If cases get worse they refer them to Gizo.
Birth deliveries are also being done at the centre, Mr Tonowane said.
Last year about 33 births were recorded.
Mr Tonowane said the figure is small compared to the two previous years, where they recorded around 50.
He said they referred delivery cases of mothers who have twins or any suspected complications to Gizo.
They have a nurse on call after hours.
Water problem
But fetching water from the nearby stand pipe through kettles and bucket is a hurdle for the health workers.
"We have to collect water in kettles and bucket daily to do general clean up and also wash up the linens which
have blood stains," he said.
He said at most times washing of linens are done at the nearby stand pipe, which is several metres away.
"This is not healthy at all because the stand pipes are being used by the community too," he said.
During deliveries, water had to be collected from buckets to help the mother wash up.
"It’s time-consuming for us to fetch water and this affects our services here," he said.
He said the facilities aren't up to standards and it affects their quality of service delivery at the centre plus lack
of water.
Lack of Space
Emu Health Centre has also space problem because in the last decade there was no expansion.
The Health Centre was established as an aide post by the Emu Harbour Community before being upgraded to
Rural Health Centre.
In 1996 it was upgraded to an Area Health Centre status.
But then there was no expansion over the years, while the population continues to increase.
Currently, the centre has a general outpatient area, an office, a general ward, a post and anti-natal ward and
delivery ward.
Mr Tonowane said that in most cases, female and male are sharing one ward which is not right.
He said malaria lab technician had to share a room with the dressing room and consultation area and there was
no privacy for the patient because the technician can hear the conversations between nurses and patients.
The supervisor said there are still enough land infront of the centre and expanding the current building is
urgent.
"Funding is a problem but I hope the relevant authorities will see the need to expand," he said.
As the population increases, the need for expansion is important for the people, he added.
Apart from Emu, there are three rural health centres and two nurse aide posts around Ranoggah.
But Mr Tonowane said there should be other health centres built on the island.
"Not only that we need more medical workers because this is not like in the past where the demand for medical
services is required in the rural areas," he said.
Currently the Emu Harbour community is supporting the Area Health Centre through the construction of
homes.
He said the community is responble for building homes for the nursing staff and also maintenance of the
centre.
"It’s a struggle by the community but they hav done their part," he said.
Fundraisings are currently underway to build additional staff houses.
There are two permanent staff houses and a semi-permanent one.
For Mr Tonowane, he is living in a house left by the Area Assembly Officer (AAO), which was renovated.
One house which was built was not completed due to lack of funding.
14
"The community is currently raising funds to complete it," he said.
As for general patients, whenever they visited the clinic they also make freewill donations towards the health
centre.
Mr Tonowane said the donation meets the stationary requirements of the clinic and other basic needs.
The Western Provincial Health Division only provides medical stock and fuel.
He said there was no actual budget allocation for the health centre.
"Therefore we have to support ourselves where possible," he said.
Mr Tonowane is hoping that some donors or the government see their need to upgrade the centre to a mini
hospital to serve the growing population on Ranoggah.
Ranoggah/Simbo is under the Parliamentary care of Minister of Commerce Francis Billy who also came from
Emu Harbour.
By MOFFAT MAMU
8
Rural doctor warning
Weekly Times Now, Australia
19/01/2010
AAP - THE peak body which promotes the recruitment of rural GPs says many remote areas would go without if
the federal government changed the rules affecting overseas-trained doctors.
The Australian Medical Association this week called for an end to the "10 year moratorium" rule, which requires
foreign-trained doctors to first take up a hard-to-fill posting when they start work in Australia.
Dr Kim Webber, chief executive of Rural Health Workforce Australia, said the rule was vital to staffing the
nation's regional and remote areas and it could not be dropped.
"Our workforce in the country would be decimated if you got rid of it and the AMA needs to be careful that it
doesn't throw the baby out with the bathwater on this issue," Dr Webber said.
"If that policy was unilaterally dropped, I don't know how places like the Kimberley and Brewarrina would ever
be staffed.
"These communities understand this and greatly appreciate the work these doctors do there."
Dr Webber said rural Australia was now reliant on overseas-trained doctors and this would not change until
there were sufficient numbers of new medical graduates trained in Australia.
It would take "several years" before the recent expansion of medical schools and undergraduate places would
fill this gap, she said.
New rural relocation incentives for doctors, which take effect from July 1, should also help to attract GPs to
regional areas, she said.
Rural Health Workforce Australia is the peak body for the not-for-profit Rural Workforce Agencies, which recruit
and support rural and remote GPs in each state and the Northern Territory.
The AMA this week said the rule was "discriminatory", and it ensured newly arrived and recently graduated
doctors were sent to challenging postings where they had limited resources and professional suppor
9
SA-based national health agency under fire
The Adelaide Independent Weekly, Australia
15/01/2010
DANIELLE FORSYTH
A key Federal Government health initiative to be based in Adelaide has been dismissed as a rushed-through,
bureaucratic agency which will not address the country’s health crisis.
The $1.5 billion Health Workforce Australia (HWA) will officially open its doors in Adelaide on January 27, more
than eight months later than originally planned.
It will attract more than 100 jobs to the city, but the federal shadow health minister Peter Dutton says the
HWA will not help those who need it most.
“The Rudd Government promised to ‘fix’ hospitals by mid-2009, but instead all we have seen to date is the
creation of more agencies and jobs for bureaucrats,” he said.
“Kevin Rudd has added another layer of health bureaucrats, and that won't help patients, doctors or nurses.”
15
Announced in November 2008 by the Coalition of Australian Governments, the HWA is the centrepiece of the
Federal Government’s response to health issues and is the largest investment in the health workforce ever
made by Australian governments.
The HWA has been assigned the tasks of supporting research, training and workplace reform. It will also advise
health ministers.
However, Mr Dutton said the agency was ill-planned and not equipped to deal with the problems facing the
health system.
“Health workforce training and planning is important, but once again the Rudd Government rushed through
legislation without proper consultation and without clearly defining the responsibilities of the new agency,” he
said.
“This agency alone will have administration costs of $125 million over four years, at a time when the
government has cut Medicare rebates for a range of procedures because of pressure on the health budget.
“Kevin Rudd needs to start actually fixing our health system rather than just adding more pressure by spending
scarce dollars on more bureaucracy.”
The State Government enticed the HWA to SA with offers to contribute towards office rental costs.
Health Minister John Hill said cabinet approved $300,000 this financial year and $590,000 for the agency’s first
full year of operation.
"It's expected that these initial set-up costs will be easily outweighed by the predicted wider and long-term
economic benefits, as the HWA’s Adelaide location will raise the national profile of SA and offer the opportunity
to attract new business and national organisations to the state," he said.
Federal Health Minister Nicola Roxon did not respond by deadline.
Ms Roxon has previously promised the agency would provide “more effective, streamlined and integrated
clinical training arrangements and support workforce reform initiatives”.
10
Minister happy with healthy new year
PS News, Australia
16/01/2010
The Minister for Health has hailed the new year as another important one for reform of Australia’s health
system, setting out a number of new arrangements coming into effect or planned for 2010.
The Minister, Nicola Roxon, said a particular highlight was the establishment of the first national Agency
dedicated to the country’s health workers, Health Workforce Australia, which commenced on 1 January.
“HWA is set to provide national planning and support for Australia’s health professionals,” Ms Roxon said.
“Health Workforce Australia will produce more effective, streamlined and integrated clinical training
arrangements and will support workforce reform initiatives.”
She said the new Agency would become operational from 27 January, with Mark Cormack appointed as CEO.
Ms Roxon said a national approach was needed to building up Australia’s health workforce, and that the HWA
was a centrepiece of the Council of Australian Governments’ $1.6 billion health workforce reform package.
In other measures, nurses and allied health professionals would be eligible to able to apply for more than
$118 million in a revised scholarships and support program and individuals with Epidermolysis Bullosa, which
leaves sufferers with skin as delicate as butterfly wings, will have access to a new program that provides
dressings that can cost up to $5,000 a month.
In addition, she said Australians accessing medicines on the Pharmaceutical Benefits Scheme would benefit
from a new HIV medication being added to the Highly Specialised Benefits Scheme at an additional cost of $15
million over four years.
She said the Government would also improve the operation of the Medicare Benefits Schedule (MBS),
providing $93 million over two years to develop and implement a new evidence-based framework for managing
the MBS into the future.
“A new listing process will ensure a more robust evaluation process for decisions relating to the listing of MBS
items,” Ms Roxon said.
She said the Government-funded seasonal influenza program has been extended, which includes pregnant
women, Aboriginal and Torres Strait Islander people aged between 15 and 49, and people aged six months to
64 years who were at greater risk of severe influenza because of chronic conditions.
Ms Roxon said a major reform planned for 2010 that was not commencing was the Preventative Health
Agency, which was set to be running from 1 January but which has been held up in the Senate.
“[The Preventative Health Agency] was to be a key weapon in the Government’s fight against obesity,
chronic disease and alcohol and tobacco addiction,” Ms Roxon said.
She expressed the hope it would be passed without too much further delay.
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Back to top
North America
1
In Haiti, aid workers face a dual challenge
Los Angeles Times
15/01/2010
In Haiti, average life expectancy is 53, three-quarters of women give birth without a health attendant,
diarrheal illnesses are the second-leading cause of death and 30% of children younger than 5 have stunted
growth.
And that was before Tuesday's magnitude 7.0 earthquake.
This time, emergency medical responders will have to provide much more than the usual food, water, latrines
and bandages to stop the spread of disease, said Dr. Christina Catlett, associate director for health
preparedness at the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore. They'll
also have to create a public health system on the fly.
It's not clear yet whether aid workers will have enough resources to meet all needs, Catlett said. Haitians are
in desperate need of clean water, and there was a stampede Thursday when a rumor spread that water was
available, she said. One person needs about four gallons of clean water for drinking and hygiene per day to
limit disease.
"My heart absolutely broke when I heard about [the quake]," she said. "Haiti had significant health problems
prior to the earthquake: HIV, tuberculosis, severe malnutrition, intestinal parasites, anemia and a host of other
problems."
In the Western Hemisphere's poorest nation, with a population of about 9 million, only $96 per person is spent
on healthcare, compared with $6,090 in the United States and $3,040 in France. Half of all Haitian families live
in a single-room dwelling. About 8% of newborns and children younger than 5 die of malnourishment each
year. One-quarter of adult women are anemic. There are roughly three doctors in Haiti for every 10,000
people, according to the World Health Organization.
"This would be a disaster anywhere," said Dr. Alina Dorian, assistant director of the UCLA Center for Public
Health and Disasters. "However, when you're starting with pretty much zero infrastructure, this really
overwhelms everything."
Haiti will challenge the record of the global public health response to natural disasters, said Dr. Georges
Benjamin, executive director of the American Public Health Assn. Such responses have been generally
effective, with successful efforts to curtail disease outbreaks and deaths after the Indian Ocean tsunami of
2004 and Hurricane Katrina.
"We know how to do this. That's not an issue," he said.
But humanitarian support systems, such as the World Health Organization and non-governmental
organizations, have been crippled by the disaster. According to news reports, only one hospital in Port-auPrince, the capital, is functioning.
Clean water is the most crucial need. Diseases such as cholera and dysentery may break out if people drink
contaminated water.
But food is also more crucial than in most other disasters. Many Haitians are already underweight and won't be
able to survive as long as a healthy person without food, Dorian said. Emergency health responders may need
to set up therapeutic feeding stations to care for people who are in danger of starving.
There is also the risk that people could resort to eating contaminated food, making food-borne illness likely.
"When you're hungry, you'll eat whatever you can find," Benjamin said. "People may eat food that's not safe
and we'll have water- and food-borne illnesses like E. coli and salmonella."
If Haitians flock to shelters, which seems likely considering their limited options, crowding will increase the
threat of disease. Haiti already has high rates of communicable diseases such as tuberculosis and measles.
"You have worry about hand-washing and hygiene and roaches and vermin that carry disease," Benjamin said.
"Waste disposal is so important. Anyone who has ever been on a cruise ship knows how easily a
gastrointestinal illness like norovirus can spread."
These threats are much more real than those posed by the many corpses lying in the streets, Dorian said.
"Dead bodies transmit disease less than a live body," she said.
Chronically ill Haitians are likely to be hit especially hard. The number of Haitians infected with the human
immunodeficiency virus, which causes AIDS, is estimated to be at least 200,000 and it could be as high as
17
600,000. Haiti has about 30,000 new cases of tuberculosis each year, according to WHO. People taking daily
medications for HIV or tuberculosis may be cut off from their supplies, Dorian said. Already weakened, they'll
be less able to withstand new illnesses.
Diseases such as tetanus and diphtheria -- much more common there because of low rates of childhood
vaccination -- could spread easily. And people injured in the quake may be susceptible to infections, such as
tetanus, sepsis and meningitis, which would be fatal if untreated.
"The baseline health conditions and health status of Haitians is going to make responding more challenging,"
Catlett said. "There was no margin for error in the first place."
The tragedy will cause an immediate deterioration of public health delivery in Haiti, but it also could focus longterm attention on the nation's desperate medical needs.
"Haiti has gone through so much for the past decade; flood after flood and disaster after disaster and coup
d'etat after coup d'etat, and the international community only responded on the surface," said Ulrick Gaillard,
chief executive of the Batey Relief Alliance, a nonprofit agency that provides assistance in Haiti. "Right now you
have a country completely destroyed. The only way the international community can respond to Haiti is by
rebuilding Haiti."
shari.roan@latimes.com
Copyright © 2010, The Los Angeles Times
2
Will IT change how doctors treat you in 2010?
Computer World
04/01/2010
By Lucas Mearian
Computerworld - With the federal government aggressively pushing for electronic health records (EHR), 2010
could be the year telehealth technology finally allows doctors to monitor their patients' health wirelessly in real
time -- no matter where the patient is.
Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic
illnesses such as diabetes, heart disease, asthma and Alzheimer's Disease, according to Dadong Wan, who
leads the health innovation program at Accenture Technology Labs.
Monitoring a patient's condition in real time and using the information to develop a more detailed medical
history could eliminate the need for some emergency treatment or hospital re-admissions by heading off health
problems early.
According to a recent report from Accenture (download PDF), the rise of inexpensive Internet connectivity and
smaller, cheaper and "smarter" health electronics should deliver better, more efficient health care.
Wireless health monitoring
The emergence of consumer health electronics such as portable ECG devices, blood pressure monitors or
weight scales can allow the seamless capture and sharing of patient information from home, at work or even
on the road. Portable ECGs, for instance, weigh just 3.5 ounces and allow outpatients to record electrical heart
signals and transmit the results to doctors who can monitor them for trouble down the road. Advances in
microprocessors will allow such devices to connect wirelessly with home computers, mobile phones or even
remote Internet applications.
Other technologies expected to emerge include bandages or bracelets that monitor and transmit vital signs and
patient locations as well as blood sugar monitors that -- after taking their readings -- transmit the data to
central databases. Database-enabled tools can then alert doctors and their patients to improve treatment of
chronic illnesses.
In addition, patients will soon be able to carry a USB stick or other electronic device that provides access to an
online database detailing their medical history, as well as X-rays, recent test results or prescriptions. The
patients can then make that information available to hospitals, doctors and emergency services.
For example, the the American Ambulance Association (AAA) announced last month that it will back a virtual
medical ID system that allows paramedics to access a patient's health history in an emergency. The medical
alert technology would also send a text message to the patient's relatives informing them that medical care is
under way.
InvisibleBracelet.org is a Web registry that started in Oklahoma, where the local government made it available
as a health benefit for state employees. The ambulance group plans to begin training medical crews on the use
of the bracelets later this month.
Personal health records
"I'm a big proponent of finding out as much health information as we can and keeping on top of," said Christine
Chang, a Health IT analyst with research firm Ovum. "Personal health records are just starting to be adopted
now, so not many people know about them. But in the heat of an accident, they'll be invaluable."….Continued
Full-text:
http://www.computerworld.com/s/article/9142843/Will_IT_change_how_doctors_treat_you_in_
2010_?taxonomyId=15
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18
Health Reform Revisionism
Newsweek
12/01/2010
By Mary Carmichael | Newsweek Web Exclusive
Health-care reform is largely about everyday concerns—making sure more people are insured and have regular
access to primary care to treat acute illnesses like the flu in proper settings, instead of emergency rooms, and
helping to keep chronic illnesses such as diabetes in check. What it doesn't explicitly tackle is how the medical
industry's response to unexpected public health crises and epidemics would differ. There's little in either the
House or Senate bills that would result in more intense surveillance of outbreaks, for instance, and there's
nothing in either bill that can prevent the criminal activity that led to two of the most alarming health stories of
the past few decades—the Tylenol tampering scare and the anthrax attacks of 2001.
So, it's worth pondering if the current bills could have changed how some of the other big public-health crises
of the past few decades would have played out: does having a more comprehensive health-care plan in place
make a nation less prone to various epidemics and illnesses? We asked several experts to "run back the clock"
(as one of them put it) and assess whether reform would have made any difference or saved any lives. Many of
them agree that although it wouldn't have averted any crises, they may have been easier to bear. Here's a
look at three health crises and how they may have fared under a comprehensive health-care-reform plan.
Could guaranteed health insurance have slowed the spread of AIDS?
Under both bills, health insurance companies will be barred from discriminating against people with preexisting
conditions or rescinding people's insurance because of anything other than documented fraud. Both of those
provisions could have made a tremendous difference in how AIDS was initially dealt with in the U.S., says
Wendy Parmet, a prominent lawyer who argued the first Supreme Court case applying the Americans with
Disabilities Act to AIDS victims.
As HIV began to spread in the early '80s, so did fear. Many people worried (sometimes rightly) that they would
lose their insurance if they were found to be HIV-positive—either because insurance companies would deem
them a bad risk and drop them, or because they'd lose their jobs (and thus their insurance) if their status
became known. As a consequence, some of them avoided testing, and were at more risk to passing the disease
to partners unwittingly.
Eventually, says Parmet, policymakers responded in a way that was "highly driven by the fact that people could
lose their insurance"—they created a network of confidential testing centers, so people could find out their
status without having it automatically reported to insurers. Those centers wouldn't have been necessary under
health-care reform, since no one would have had to worry about losing his insurance or being unable to get
any in the first place, and presumably more people would have gotten tested earlier in conventional settings.
The insurance dilemma created one silver lining for HIV/AIDS patients who couldn't afford treatment for their
disease, either through insurance or out-of-pocket—they ended up getting the bulk of their AIDS care paid for
by a different mechanism than the rest of their health care. (The act helps over 500,000 people a year with
AIDS-related expenses.). AIDS advocates developed "a whole separate system of financing for HIV care"
through the Ryan White Care Act, Parmet notes. Centers that received funding from the federal legislation
became de facto hubs for treatment. This allowed institutions that applied for Ryan White funding to develop
extraordinary expertise in treating the disease. It also gave AIDS advocates extra motivation to make sure
their cause wasn't ignored, marginalized, or underfunded just because it was treated through a separate
system. "If the funding had been more mainstream, if more of it had run through our typical health-insurance
programs, would that specialization and skill have been lost? Maybe," says Parmet. "And the community
mobilization around the disease might have been very, very different."
An interesting side note: Parmet says that many experts in the '80s believed the AIDS epidemic "might finally
cause us to get universal health insurance, because private insurance at the time just couldn't deal with it." At
least one book made the same case.
Could electronic health records have red-flagged the spread of SARS, bird flu, or the swine flu? What about
West Nile?
Most would agree that America's system for identifying outbreaks early is in need of improvement. A recent
report, issued by the health advocacy organization Trust for America's Health and the Robert Wood Johnson
Foundation, found "serious underlying gaps in the nation's ability to respond to public health
emergencies…[including] a lack of real-time coordinated disease surveillance and laboratory testing, outdated
vaccine production capabilities, limited hospital surge capacity, and a shrinking public-health workforce.
And electronic medical records, as they're currently provided for in the health-care-reform bills, aren't likely to
change much of that—and they wouldn't have helped experts track most of the exotic pathogens that have
cropped up in the last few years.
In the case of West Nile, says Dr. Gerald Keusch, professor of international health and medicine at Boston
University, the problem wasn't a lack of information about increases in illness and deaths. The information
existed, and federal agencies had access to it. They just didn't know what to do with it. The CDC knew about
rising cases of encephalitis in humans. It also knew about a Bronx Zoo veterinarian who was seeing similar
fatal cases in birds. But it didn't investigate the link until months after it first came to light, and "by the time an
effort was made to prevent [the] spread, by insecticide treatment to kill the mosquitoes, it was too late, and
the infection was in the birds and silently spreading from the epicenter in New York."
19
As for the other pathogens—SARS, bird flu, swine flu—electronic medical records alone wouldn't have made
much difference. That's because they're portable (meaning doctors and hospitals can share them with each
other) but not searchable—there's no huge proposed database of everyone's medical data being updated in
real time. "Electronic medical records alone, without a system to aggregate information to look for unusual
trends, would have done nothing" to stop those diseases, says Keusch. To "pick out anomalous events," he
says, you'd need "some algorithm-driven system accessing clinical information without identifiers other than
perhaps age, gender, and geographic location."
It's technically possible to create such a system. But, says Keusch, "I fear there is insufficient trust of
government or private sector groups like Google, with the capacity to do it, to give public endorsement for the
effort." In other words, for most people, pathogens aren't the biggest concern—privacy is.
Could more comprehensive primary care have kept people alive during the 1995 Chicago heat wave?
More than 600 people died in 1995's infamous five-day heat wave, when temperatures topped out at 106 with
a heat index (the warm-weather counterpart of wind chill) of 125. As soon as the mercury fell back to normal,
doctors in Chicago started trying to figure out how they could have helped prevent so many deaths. Terry
Vanden Hoek, who had just started as an attending physician in emergency medicine at the University of
Chicago, was one of those doctors. . "There were a lot of questions about what we could have done better," he
says. "The thing about heat waves is that they're pretty predictable. We knew this heat wave was coming. Yet
we really didn't prepare for it as well as we could have." Neither did many of the city's elderly poor, who were
afraid to go outside because of crime. They found themselves trapped in their own apartments and many died
for lack of air conditioning
Several provisions in the health-care-reform bills might have saved those people, says Vanden Hoek. The
Senate bill calls for "community preventive services" grants—pilot programs that work to overcome health
disparities rooted in poverty. Patient advocates and medical homes, or team-driven primary-care centers that
coordinate all of a patient's medical needs, might have helped the Chicago doctors "keep track of who's elderly,
who's by themselves, who's got diabetes and is especially vulnerable," says Vanden Hoek. "We could have
called people and asked if they had air conditioners, or if they knew about the cooling centers we had set up.
We could have arranged for transportation to get them out."
Still, a health system that pays special attention to tracking the poor and elderly wouldn't have managed to
save everyone—at least if the European heat wave of 2003 is any indication. In France, even under
comprehensive universal health care, almost 15,000 people died that summer from overheating. "You can have
a very different health-care system [from what we currently have in the U.S.]," says Vanden Hoek, "and still be
unprepared for this kind of emergency."
© 2010
4
For Severely Ill Children, a Dearth of Doctors
Wall Street Journal
12/01/2010
A growing shortage of pediatricians trained in specialties such as neurology, gastroenterology, and
developmental and behavioral medicine is threatening timely access to care for children, according to pediatric
medical groups.
As the House and Senate intensify the process of melding their two health bills, pediatric groups are lobbying
to secure more funding for training and higher reimbursement for pediatric sub-specialties, in the hope of
encouraging more doctors-in-training to enter the field. Specialization typically requires up to three years of
training beyond a general pediatrics residency and can pay salaries less than half the rate of adult specialty
medicine. At present, 17 states lack at least one physician in one of 13 sub-specialties.
Wednesday, in a briefing for members of a congressional caucus on children's health, the National Association
of Children's Hospitals and Related Institutions, known as Nachri, will present results of a December survey. In
it, members said that shortages of doctors across a multitude of pediatric sub-specialties are forcing 90% of
hospitals to delay appointments, lose patients or refer them elsewhere.
Of particular concern, given the rise in autism-related disorders, is a shortage of development-behavioral
experts; half of hospitals in the survey reported that it takes more than three months to see a developmental
pediatrics specialist, one of the longest wait times.
Jim Kaufman, Nachri's vice president for public policy, says its 200 members on average devote half their
caseloads to children from low-income families who are covered by the federal Medicaid program, which
reimburses pediatric sub-specialists on average at 30% below what the Medicare program reimburses adult
specialists. The group is counting on a provision in the House bill that would require Medicaid to pay Medicare
rates for office visits to most providers, which could boost subspecialist pay.
Thanks to advances in medicine such as better care of premature infants, many children are alive who may
have died in the past. "We've done a good job of caring for kids with complex medical problems, but we've
created a generation of kids who need ongoing and continuing care for serious issues," says Arthur Pickoff,
chairman of pediatrics at Children's Medical Center of Dayton, Ohio. His hospital has struggled to fill jobs in
gastroenterology, neurology and pediatric surgery and is looking at ways to raise more money for training,
such as reducing spending on urgently needed capital projects.
20
Nachri says 44 hospitals employing 3,000 sub-specialists responded to the survey, representing about 40% the
children's hospitals that train half of all pediatric sub-specialists. The hospitals also reported that jobs for the
top specialties are going unfilled for a year or longer; nearly half reported vacancies in pediatric-rehabilitation
medicine, hematology and oncology, and cardiology.
For families, that often means waiting for months to see a specialist and incurring heavy travel costs, often to
another state. Three-year old Kenneth Jones, for example, was born in Alaska with a rare gastrointestinal
disorder that made him unable to absorb protein. He had to travel three hours to see one pediatric GI specialist
in the state—a doctor who left a year later. The family moved to Oregon for work-related reasons and found a
clinic that could provide complete care for the disorder—in Ohio, at a Cincinnati Children's Hospital clinic where
they had to wait seven months for Kenneth's first appointment.
"There are so few pediatric GIs out there and so many children that need to be seen that you just have to wait
in line," says Kenneth's mother, Lauren Jones. "That's the hardest thing to endure for a parent with a sick child
who needs help right away."
For example, nearly 300,000 children suffer rheumatic diseases such as rheumatoid arthritis, characterized by
inflammation of joints, muscles or tendons. Pediatric rheumatologists have been trained to treat the complex
and sometimes life-threatening diseases, but fewer than 200 are in practice in the U.S.; 13 states lack a
pediatric rheumatologist, and children on average travel 57 miles to the nearest one, according to the federal
Department of Health and Human Services. Pay for the specialists is even lower than other pediatric subspecialists; in 2007, salaries averaged $115,022, compared with $144,000 for pediatric cardiology, neonatal
medicine and pediatric critical care.
The Senate bill contains a measure that would fund a loan-forgiveness program for pediatric sub-specialists,
easing the financial burden of medical-school costs. "While most of us are driven into this profession because
we love kids, the vast majority leave training with huge debt and the prospect of not making very much money
at the end," says John McBride, a pediatric pulmonologist at Children's Hospital Medical Center of Akron, Ohio,
who cares for children with a number of diseases including cystic fibrosis.
The federal Medicare program funds training programs for adult medicine. Congress five years ago authorized
funding for pediatric specialty training, but the funds must be re-authorized every year. Nachri is asking for
$330 million for funding for fiscal 2011, up from the $317.5 million appropriated for fiscal 2010.
The American Board of Pediatrics currently certifies or jointly certifies 20 pediatric subspecialties, not including
neurology and surgical subspecialties. In 2008, there were close to 19,000 certified pediatric sub-specialists,
compared to about 15,000 five years earlier. But while there has been an increase in the number of pediatric
residents choosing to enter sub-specialty programs, fewer are finishing the training, leading to an overall
decline in the number of doctors who chose pediatric specialties. And while the pipeline of trainees is increasing
in some specialty areas, large gaps still exist between demand and supply in many pediatric specialty areas,
according to James Stockman, president and chief executive of the American Board of Pediatrics.
"We are really in a crisis mode" says Beth Pletcher, a professor at New Jersey Medical School who chairs a
committee on work-force issues for the American Academy of Pediatrics. When Dr. Pletcher recently tried to
refer a patient to a pediatric endocrinologist, she learned that there was a six-month waiting list—and the
doctor wasn't taking any new patients.
One problem is that specialists tend to cluster close to large academic medical centers, in areas where there is
a population large enough to sustain a practice. But in a survey of its members, to be published later this year,
the American Academy of Pediatrics found that while the greatest shortages are in rural areas, the majority of
general pediatricians in all geographic areas considered wait times to be excessive when referring patients to
sub-specialists.
To cope with the problem, many hospitals are turning to strategies such as telemedicine—remote consultations
using two-way video systems—and mobile vans that may drive hundreds of miles to set up clinics in underserved areas. Hospitals are also more often turning to adult specialists to treat children, though not all are
willing to do so. Surgeons, for example, may refuse to operate on children, because they aren't trained to deal
with the differences in their physiology.
"Children are not just small adults, they have unique characteristics and different responses to medications and
side effects," says Dr. Pletcher. "Given the choice, you want your child to see a pediatric sub-specialist."
Write to Laura Landro at laura.landro@wsj.com
5
The Need for Management Capacity to Achieve VISION 2020 in Sub-Saharan Africa
PLoS Medicine
08/12/2009
Susan Lewallen1*, Amir Bedri Kello2
1 Kilimanjaro Centre for Community Ophthalmology, Good Samaritan Foundation, Moshi, Tanzania, 2 Light for
the World, Addis Ababa, Ethiopia
Citation: Lewallen S, Kello AB (2009) The Need for Management Capacity to Achieve VISION 2020 in SubSaharan Africa. PLoS Med 6(12): e1000184. doi:10.1371/journal.pmed.1000184
21
Copyright: © 2009 Lewallen, Kello. This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
Funding: No specific funding was received for this piece.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: slewallen@kcco.net
Provenance: Commissioned; externally reviewed.
Summary Points
Sub-Saharan Africa has the highest regional burden of blindness and visual impairment in the world.
More clinically trained manpower alone will not be sufficient to meet eye care needs and will not guarantee
productive services.
Management systems run by professional nonclinical personnel are needed to support clinical personnel so that
they can be productive.
There is currently a lack of such systems and personnel and without a change, VISION 2020 goals in Africa will
not be realized.
Globally, there are 314 million people with vision impairment, of whom 269 million people have low vision and
45 million are blind [1],[2]. The geographic distribution of visual impairment is not uniform and more than
90% of the world's visually impaired live in developing countries. Sub-Saharan Africa, with around 11% of the
world's population, has about 20% of the world's blindness [1]. This represents the highest regional burden of
blindness in the world. VISION 2020: The Right to Sight is a broad initiative whose goal is to eliminate
avoidable blindness by the year 2020 (see Box 1). Whether this initiative goes the way of other unrealized
slogans of the past, or whether it can actually be met still remains to be seen. In sub-Saharan Africa, there are
still vast populations with limited or no access to eye services. Progress has been made in some places,
however, and there are lessons we can learn from these that will help us come closer to realizing VISION 2020
goals. In this article, we examine the need for dedicated managers if VISION 2020 goals are to be achieved in
Africa.
The Lack of Comprehensive Eye Services
Inadequate human resources have long been noted among the constraints to better eye health care [3]; the
ophthalmologist-to-population ratio for much of sub-Saharan Africa countries is usually accepted to be around
1:1,000,000 [4]. Therefore, one of the three prongs of the VISION 2020 strategy is human resource
development, including the training of more personnel. This goal usually seems to be interpreted as a need for
more personnel with clinical training. While the inadequate numbers of doctors and nurses providing eye care
in Africa is indisputable, sheer numbers, either trained or working, should not be the main indicators of
progress. What happens after training? Is the training applied effectively? How productive are workers and
what factors influence this?
Although there is increasing awareness throughout Africa of the complex but interrelated problems in human
resources for health, including attrition, absenteeism, and productivity [5],[6], there is little specifically related
to eye health workers. One study of cataract surgeons (a mid-level cadre) demonstrated that, on average,
these surgeons performed fewer than 250 cataract surgeries per year with a median of 113 [7]. This number is
very low, considering that even operating on ten cases twice a week (not a heavy burden) for 40 weeks would
result in 800 surgeries in a year. Interestingly the variation in productivity was extreme, ranging from less than
50 to 750 surgeries per year. The factors significantly associated with higher productivity included adequate
equipment (microscope and surgical instruments), enough support staff, and a supporting outreach program
that provided transportation for patients to get to the hospital [7]. The study did not attempt to measure all of
the critical but more subjective factors that are associated with productivity, such as leadership. A study of
trichiasis surgeons (another mid-level cadre) found again that productivity was associated with having an
outreach programme and having adequate equipment and, in this study, knowing who one's supervisor was
[8].
The VISION 2020 initiative advocates for planning for comprehensive eye services at the level of 1–2 million
people—referred to as a “district” (although populations of 1–2 million are often comprised in a “Region” or
“Province”). This population-based approach is a change from the old model, which was based on services
provided at a given hospital, regardless of where patients came from. The new model calls for much more
coordination and linkages of services among all the eye care providers and donors to eye care in a district,
whether they be government, private, or mission based. Our experience in observing and mentoring
programmes as they plan and implement VISION 2020 programmes has led us to recognize that successful
programs include a specific management component, consisting of management systems and skills in the
broadest sense while less productive programs lacked this component. We divide this management component
into several categories for discussion, recognizing that management issues cut across many areas.
Human Resources Management
Eye care, like much medical care, must be delivered by a team effort. The best trained ophthalmologist still
needs a team to be effective. An eye care team usually comprises the ophthalmologist, ophthalmic nurses (a
role sometimes served by ophthalmic technicians or ophthalmic assistants depending on the country),
refractionist or optometrist, and other support staff (cleaners, security personnel, and drivers). However,
ideally it should also include an eye care manager, patient counselor, equipment and instrument maintenance
technician, and community eye care coordinator. The roles and responsibilities of these team members have
been described [9]. Teamwork requires management of people, with every team member knowing his or her
22
job, showing up to work, and performing satisfactorily [10]. Management at this level involves a wide range of
issues including skills development, routine monitoring of output, assessment of the quality of outcomes,
supportive supervision, conflict resolution, and effective systems for performance appraisal. Workers must
know what their tasks are and when they are performing well and receive help when they are not. When a
worker is absent, someone needs to be deputized to take his place. Team workers need motivation, not just by
increased salaries, which is often temporary [11], but by an organizational culture built on shared values and
maintained through good leadership [12]. This latter should come from the clinical head of a service, but he or
she can get tremendous support from a well-trained nonclinical manager who is empowered to deal with many
details. It is unrealistic to expect the clinical head to provide all the human resource management needed.
Continued
Full-text:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000184
6
Broad Demand for Healthcare Workers Seen in Most US Markets
Health Leader Media
15/01/2010
John Commins, for HealthLeaders Media
The demand for healthcare workers appears to be accelerating in most areas of the nation, a new study shows.
Labor trends in 30 markets tracked by the consulting firm Health Workforce Solutions LLC found demand
growing fastest in Sacramento, Riverside/San Bernardino, Pittsburgh, Cleveland, and Dallas for the fourth
quarter of 2009. The New York/Northern New Jersey area ranked at the bottom of the 30 markets tracked.
"After several slow quarters, we are now seeing notable movement across a number of markets as healthcare
employers begin to ramp up again," said David Cherner, managing partner of San Francisco-based HWS. "With
the healthcare reform picture finally becoming clearer, many forward-thinking organizations appear to be
refocusing back on their hiring needs at an opportune time before the competition for key clinical and ancillary
personnel undoubtedly returns."
HWS' Labor Market Pulse Index also found that:
•Much of the growth is being fueled by newly announced expansion plans and larger facility openings at
organizations, such as Mercy San Juan Medical Center in Sacramento, the University of Pittsburgh Medical
Center, the Cleveland Clinic and University Hospitals in Cleveland, and Texas Health Resources in Dallas.
•Of the 30 major markets tracked, the slowest area for the quarter, the New York metro/Northern New Jersey
area, remained relatively flat, dropping 4% from the prior quarter.
•The Labor Market Pulse Index composite index, a representative basket of the 30 largest markets, posted a
19.5% increase in the fourth quarter of 2009 from the third quarter of 2009 and was up 17.3% compared to
the fourth quarter of 2008.
•For the fourth quarter of 2009, 21 markets of the 30 tracked by the LMPI showed signs of accelerated
demand, up from 16 in the third quarter.
-------------------------------------------------------------------------------John Commins is an editor with HealthLeaders Media. He can be reached at
jcommins@healthleadersmedia.com.
7
Closing the Health Care Workforce Gap
Center for American Progress
15/01/2010
By Daniel J. Derksen, Ellen-Marie Whelan
America’s five million health care professionals directly influence the cost and quality of health care through
their diagnoses, orders, prescriptions, and treatments. These primary care and specialist physicians, dentists,
nurses, and other medical and dental assistants labor every day to take care of their patients, but experts say
there are too few of them today, and by 2020 there will be a shortage of up to 200,000 physicians and 1
million nurses. Rural Americans and those living in other underserved areas across the country are especially
vulnerable to these current and growing health workforce shortages.
As our nation grapples with reforming the U.S. health care system to cover the uninsured, improve the quality
of health care, and cut overall costs in the long term, we must consider provisions to assure an adequate
health care workforce. Primary care clinicians—those providing the most basic, frontline health services—
continue to decrease in numbers and there are many pockets around the country without enough health care
providers overall. Researchers estimate that policies to expand coverage to all Americans would increase
demand for physician services by 25 percent. Our nation already suffers from a long-standing shortage of
nurses—the U.S. Bureau of Health Professionals estimates today’s shortage to be over 400,000 nurses. And
23
the American Hospital Association calculates 116,000 registered nurse positions are unfilled at U.S. hospitals
and 100,000 jobs are vacant in nursing homes. Some expect the shortage to worsen as 78 million baby
boomers6 begin to hit retirement age in 2011 and require more care for chronic illnesses.
This is an especially important time to examine these shortages as Congress considers expanding access to
health care to the entire nation and the jobless rate in our country hovers at 10 percent. Congress and the
Obama administration have a historic opportunity to prepare to the nation for health care reform in 2010 as
well as solve several long-standing problems in the way federal subsidies support health care workforce
training programs.
But what to do? There remain some questions whether the problem is a shortage of health professionals
overall or just with the distribution of particular types of health professionals in certain areas of need, such as
by geography or by profession. Assessing health workforce needs is difficult because there are many variables
that determine its adequacy and no single entity in the United States is in charge of workforce planning.
Variables that make workforce planning difficult to estimate include regional maldistribution of health
professionals, overspecialization of physicians, and the current and expected demographics of the health
workforce and the population they serve, among others. Few models are available to accurately predict what
an adequate ratio of health professionals should be to the population served in a given area.
Still, several remedies that can be acted upon now are clear. First and foremost, training a high-performing
health workforce will enhance the success of policy reforms directed at health insurance coverage, access to
quality care, and controlling costs. The United States lacks a cohesive approach to workforce shortages,
modern training of health professionals across disciplines, and distribution of health professionals to areas of
need. Reliable access to quality, affordable care is not available in many areas and for certain populations.
Rational reform of the federal support for health workforce training and distribution will create a more efficient,
higher quality health system.
Federal funding, including subsidies from the federal government’s Medicare program and the joint federalstate Medicaid program, for physician training has not been overhauled for decades. The federal government
pays for health care workforce development in two broad categories. The largest is payment to teaching
hospitals to train physicians in residency programs and for the higher costs associated with their teaching
mission. The payments to these hospitals are based on complex formulas paid through Medicare and Medicaid,
totaling about $12 billion per year.
The second bucket of funding for the health workforce is through Health Resources and Services Administration
programs, about $530 million allocated at the discretion of Congress. HRSA funding supports primary care,
general dentistry, nursing, and grants and incentives for providers to work in medically underserved
communities and in shortage specialties such as primary care. For every dollar spent on HRSA’s programs,
teaching hospitals are paid $24 by Medicare and Medicaid to subsidize physician training. Funding of teaching
hospitals is the bulldozer to the HRSA rake in reshaping the health workforce landscape.
Alas, there is little relationship between what the federal government funds and the quality of education or
even the costs of educating physicians and other providers. This paper offers the following mix of
recommendations to fiscal, legislative, and regulatory policies to assure the balance, mix, and distribution of
health professionals necessary for a well-functioning, cost-efficient U.S. health system in the 21st century. In
the pages that follow, we identify numerous recommendations to alleviate these problems, but broadly our
proposals fall into three general areas.
Better align federal payment policies for health professions
With so many moving parts and so many different programs in different federal agencies, there needs to be a
body specifically assigned to examine and make decisions about the U. S. health workforce. The best way to
accomplish this realignment is by creating a permanent National Health Workforce Commission.
This new commission would make recommendations to Congress and appropriate agencies to design funding
and incentives, and to evaluate the implementation and revision of programs, grants, and regulations related
to the nation’s health workforce. The commission’s recommendations would assist Congress and federal
agencies address the long-term heath care workforce needs for our nation and help to better allocate funding.
In addition, we recommend new federal support for graduate school-level nursing education to ensure there
are enough nursing teachers to train the millions of nurses we need in the coming decade. Today, the number
of nursing faculty at our universities is insufficient to address current shortages, let alone those projected in 10
years. Improving the nursing workforce must include hiring more faculty, creating loan programs to help
nursing students, and redirecting Medicare subsidies to nursing specialties who provide care to Medicare
beneficiaries.
Lastly, payment of primary care providers needs to be enhanced and new payment methodologies developed
to reward prevention, coordination of care, and management of chronic diseases such as diabetes. If Medicare
leads the way by increasing the rates primary care clinicians are paid in the current reimbursement system and
developing new ways of paying for care that reward outcomes that typically come from better delivery of
primary care, then private payers will likely follow. Innovative payment models include paying for better
coordinated care and improved outcomes through so-called Medical Homes and Accountable Care
Organizations, which treat patients for “episodes” of care rather than on a per-visit basis, and coordinate care
as patients are discharged from the hospitals to prevent rehospitalizations.
Support for health care workers in high-need specialties and underserved areas
24
Definitions of health care workforce shortage areas include primary care, mental and behavioral health, dental,
and other specialties, as well as geographic and population designations. Enhanced funding for the National
Health Service Corps would help fill vacancies in these areas, and should include scholarship and loan
repayment programs to help recruit and retain an adequate health care workforce.
Increasing funding for nursing workforce programs is necessary to expand nursing faculty to train enough
nurses to meet the nation’s needs. Special programs to encourage low-income, rural, and minority students to
pursue health careers, such as the Health Careers Opportunities Programs and Centers of Excellence funded
through the Health Resources and Services Administration, also would help assure a diverse health professions
workforce and reduce health disparities due to socioeconomic, geographic, race, and ethnicity factors.
Reform the training of health professionals
Training reform can be accomplished by enhancing and modernizing subsidies for the education of health care
professionals of all stripes. This can be accomplished in several ways, by balancing the current emphasis on
training in highly subspecialized “tertiary care” hospitals with training outside the hospital in outpatient, rural,
and community sites, and changing the content of education to include the provision of health care in teams
and coordinated across disciplines, both inside and outside the hospital. These changes will mean increasing
the necessary faculty to provide interdisciplinary and team-based training to teach the skills needed to work in
a reformed health system.
To achieve these ends, we recommend that current federal dollars now spent on training physicians in hospitals
also be available for spending in community-based sites. Currently the funding for medical residents does not
allow reimbursement for training in community-based sites. This ban must be lifted. Since most of the health
care Americans receive occurs outside the hospital, there needs to be more of an investment in nonhospitalbased training for physicians. This could be done through hospitals to expand training locations or with
payments directly to community-based sites, a provision known as Teaching Health Centers.
Federal funding also should be expanded to provide grants and loans for the start-up costs associated with
developing new community-based training sites in underserved communities. And in addition to new locations,
the content of the training must be revamped. Training should be more interdisciplinary and move toward a
more team-based approach.
All these reforms, taken together, can prepare our country for the steep health care challenges we face as the
baby boom generation enters retirement in force and as health care reform increases demand and further
propels us to grow our health care workforce. After reading our paper, we’re confident you’ll agree that
demonstrable steps can be taken by Congress and the Obama administration in league with health training
institutions to ensure America boasts the best, deepest, and most diversified health care workforce in the
world.
Read the full report (pdf)
Download the executive summary (pdf)
8
Nurse shortage replaced by job shortage
Crain’s New York Business
14/01/2010
By Gale Scott
For years, health planners have lamented a shortage of nursing school graduates and poured funds into jobtraining programs. Those efforts have been successful, according to a recent survey by the Center for Health
Workforce Studies in Albany. But there is an unanticipated snag: Many of the jobs seem to have disappeared.
Though it is seen as a temporary setback, for now the job market for registered nurses has tightened, the
survey found.
The center's researchers report that the percentage of RN program directors surveyed who said their region
has a strong job market for nurses dropped to 42% in 2009 from 95% in 2006. For hospital jobs, the
percentage of program directors saying there are a lot of jobs plummeted to 38% from 95%.
"Significantly fewer nursing education program directors reported many available job opportunities in their
region for newly trained RNs," the researchers report. The study blamed the economic downturn for the
decline.
At Montefiore Medical Center, Joanne Ritter-Teitel, senior vice president and chief nurse executive, agreed with
the findings. She says the Bronx hospital system currently has about 80 to 90 vacancies for RNs, down from
about 200 two years ago.
"We've definitely had fewer openings lately," she said. "Nurses used to work on average 17 years, now they
are staying longer," she added. "Nurses have their own economic concerns."
Montefiore employs about 3,000 nurses.
25
The Albany study found that 9,300 people graduated from RN education programs in New York in 2009, an
increase of nearly 81% since 2002. That total is expected to reach nearly 10,000 nurse graduates this year.
But the newly minted nurses will face a competitive job market.
At the New York State Nurses Association, a spokeswoman said, "This is a blip. There is no question there is a
serious long-term nurse shortage."
But the Albany researchers warn that the current job shortage could discourage people from entering training
programs. "The perceived lack of available RN positions may result in a leveling off of RN graduations in the
future," the report said.
9
Personnel infirmier dans l'Est-du-Québec: pénurie majeure en vue
Le Soleil, Canada
16/01/2010
Carl Thériault, collaboration spéciale, Le Soleil
(Rimouski) Les mises à la retraite chez les infirmières et le départ d'effectifs des régions du Bas-Saint-Laurent
et de la Gaspésie vers les grands centres urbains depuis cinq ans engendreront une importante pénurie
d'infirmières dans le réseau de la santé du Bas-Saint-Laurent et de la Gaspésie.
Le Syndicat des infirmières, infirmières auxiliaires et inhalothérapeutes de l'Est-du-Québec (SIIEQ - 1650
membres) estime que, si rien n'est fait, la pénurie d'infirmières atteindra une période critique dans deux ou
trois ans.
«Entre 2013 et 2017, il y aura 20 % du personnel qui sera apte à la retraite sur le territoire du Bas-SaintLaurent et de la Gaspésie. Ce qui est inquiétant, ce qu'actuellement, on ne réussit pas à embaucher
suffisamment de personnel pour remplacer les départs à la retraite. Si rien n'est fait, on risque d'être en
rupture de services dans les prochaines années», soutient Micheline Barriault, présidente du SIIEQ. «Nous
voulons lors de la négociation de la prochaine convention collective, par exemple, améliorer les conditions de
travail des infirmières qui travaillent le soir et la fin de semaine, diminuer la charge de travail, avoir plus de
pauses pour attirer les jeunes dans cette profession qui veulent aussi de bonnes garanties d'emploi. On
pourrait donner des bourses d'études, comme 5000 $ par année, mais avec un engagement des finissantes de
rester dans la région pendant cinq ans.»
Le syndicat donne aussi comme exemple de solution la formation, dans la Baie-des-Chaleurs, sur deux ans des
infirmières auxiliaires pour devenir des infirmières. «Ce personnel qui est déjà installé dans la région a un très
grand potentiel de rétention. Cette formation se donne aussi dans la région de Matane et d'Amqui, mais les
personnes n'ont pas de salaire comme dans la Baie-des-Chaleurs. Il faut que les établissements aient la
volonté de régler le problème.»
Les effectifs sont aussi en baisse dans l'Est-du-Québec en faveur de la grande région métropolitaine de
Montréal. Depuis 2004-2005, les quatre régions en périphérie de Montréal enregistrent une hausse de leur
effectif infirmier de 8 à 13 %, selon les données de l'Ordre des infirmières et infirmiers du Québec (OIIQ).
Toutefois, les régions du Bas-Saint-Laurent, de la Gaspésie-Îles-de-la-Madeleine ainsi que de l'Outaouais ont
enregistré des diminutions.
Selon l'OIIQ, près de 15 000 infirmières sont potentiellement admissibles à la retraite au Québec, qui compte
plus de 70 000 infirmières. En effet, 21 % de l'effectif a 55 ans ou plus, comparativement à 17 % il y a cinq
ans. Onze mille infirmières, qui sont actuellement dans la classe d'âge des 50 à 54 ans, peuvent s'ajouter à ce
nombre.
10
'Serious threats to jobs' fuel health negotiations
Victoria Times Colonist, Canada
17/01/2010
By Cindy E. Harnett, Times Colonist; - With files from Canwest News Service
Bargaining to protect about 40,000 public-sector jobs and benefits in the midst of an economic slump is as
difficult as it gets, says the business manager for the Hospital Employees Union.
"It's one of the toughest rounds of bargaining I've ever been involved in," Judy Darcy said this week from
Vancouver, where she is in negotiations.
About 180 collective agreements in seven sectors for more than 220,000 public-sector workers are set to
expire this year, most on March 31. That number doesn't include nurses or teachers.
The government has vowed there will be no money for wage increases, although it has also said wage rollbacks
aren't being considered.
26
In its throne speech in August, the government said its focus will be on protecting jobs to preserve services
"while our workforce strives to rejuvenate its ranks for the future, in the face of its aging profile."
The union claims the downturn in the economy is not an excuse to do nothing, however. Darcy said negotiating
to keep jobs and introduce innovative solutions has been extremely difficult.
The HEU is demanding greater job security for its 40,000 health-care workers, protection of wages and
benefits, and wage compensation for workers who have been given added responsibilities -- for example,
licensed practical nurses.
"These are very complex negotiations with some very serious threats to jobs," said Darcy.
"We're going to make sure government keeps its word and won't lay off more health-care workers in this time
of economic difficulty."
Major threats to jobs include contracting out, contract flipping -- where a contract is repeatedly turned over to
new management, forcing employees to reapply for their jobs in some cases -- restructuring and
amalgamation of services, giving way to "huge instability" in health care, Darcy said.
Meanwhile, negotiations are going more smoothly for the B.C. Government and Service Employees' Union.
Almost 14,000 community health workers across the province -- the majority of whom are represented by the
BCGEU, with the balance represented by nine other unions -- have been urged to accept a two-year agreement
that offers more job security, some benefit improvements, but no general wage increases.
BCGEU president Darryl Walker said recently that in a year of tough negotiating, the bargaining committee was
able to find under-utilized benefits and rework them into a range of improvements accessible to a broad crosssection of the membership.
This week, Finance Minister Colin Hansen said fair agreements can be achieved while not increasing wages, and
pointed to the tentative agreement with community health workers as a positive sign in the current round of
talks.
The BCGEU will try to reach deals for about 53,000 employees.
"You have to be hopeful as a negotiator, otherwise you couldn't go to the table every day," Darcy said.
ceharnett@tc.canwest.com
© Copyright (c) The Victoria Times Colonist
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Europe
1
Busy maternity units turn away hundreds of women in labour
The Times, UK
16/01/2010
David Rose, Health Correspondent
Women in labour are being turned away from overstretched maternity units amid Britain’s continuing baby
boom.
Hospitals across the country closed their doors to expectant mothers on more than 350 occasions last year
because they could not cope with demand, sending women to other units to give birth.
Reasons for the temporary closure or suspension of services included shortages of midwives or beds, despite
government pledges to improve staffing levels and choice for women giving birth. Maternity wards in at least
six out of ten regions in England closed at some point in 2008-09, figures reported to the Nursing and
Midwifery Council (NMC), the independent regulator, showed yesterday.
The NMC warned that staffing levels of midwives were “still playing catch-up” with the rising birthrate, now
higher than it has been for more than 36 years. Increasing numbers of complicated births, because of
problems such as obesity, substance abuse, domestic violence or mothers not speaking English as a first
language also placed a strain on services, the watchdog said.
The Government promised in 2007 that all pregnant women in England would have a choice of where to give
birth. Campaigners said that in many cases this choice could not be guaranteed and that it could be terrifying
for women to be turned away at the last minute by a hospital or maternity unit.
Reports submitted to the NMC by Local Supervising Authorities, which oversee the work of all registered
midwives, found that units in the North West of England closed on more than 219 occasions last year.
27
There were also 60 closures or suspensions in the East of England, 46 suspensions or attempted suspensions in
London, 15 in the South East and 13 in the East Midlands.
Jay Francis, of the National Childbirth Trust, said that the Government’s choice guarantees were “clearly not
being met”. “It is terrifying for a woman to go into her chosen unit in labour and to find the doors are closed,”
she said. “While temporary closures may occasionally be necessary on the grounds of safety these should be
rare events. Women rely on maternity services being open for them 24 hours a day, seven days a week.”
Anne Milton, the Conservative health spokeswoman, said: “The Government have not adequately planned for
the rising birthrate. The Government claims it has increased maternity funding yet it appears that more units
are closing.”
The Department of Health said that funding for maternity services had almost doubled since 1997 to just under
£2 billion and that it had set a goal to recruit an extra 4,000 midwives by 2012.
Case Study
When Kate Goode, 31, went into labour at 35 weeks at 10pm on July 3, 2006, her husband Jack took her to
The Grange Birth Centre in Petersfield.
The couple knew that the centre was due to close the following day, but it was officially still open. Nurses
advised them to go home and relax but when Mrs Goode returned five hours later, 7cm to 8cm dilated, she
was turned away.
Because she was a first-time mother, they were told to drive 20 miles to St Mary’s Hospital, Portsmouth, where
her son Jacob was born three hours later. The Grange reopened in 2007 but was too understaffed to be the
choice when her daughter, Maisie, was born a year later.
2
Baby boom causes midwife shortfall
Morning Star, UK
15/01/2010
by Will Stone
A report highlighting a shortfall of midwives due to Britain's rising birth rate has been welcomed by the
profession.
The Nursing and Midwifery Council called on health authorities to act on the concerns raised in its Supervision,
Support and Safety report, which revealed midwife shortages in many areas of the country faced with a
spiralling number of births.
A rising number of complex births, plus potential challenges including substance abuse and obesity, were also
placing a strain on existing midwifery services, according to the report's findings.
Council chief executive and registrar Professor Dickon Weir-Hughes said: "Although successful efforts have
been made to boost the numbers of midwives in many regions, others are still lagging behind and this problem
could worsen as a significant proportion of experienced midwives and supervisors of midwives are now
approaching retirement age."
Commenting on the council's findings, Royal College of Midwives general secretary Cathy Warwick said many
areas were being forced to play catch-up.
She said: "This is a welcome report that identifies encouraging progress in maternity services, but also
highlights the challenges facing maternity services of rising birth rates and more complex births.
"There is no doubt that the government is committed to increasing the number of midwives and this is
happening. However, we are still playing catch-up and there is still a long way to go to match midwife numbers
to birth rates and take the pressure off the system."
But head of nursing at health union Unison Gail Adams said there has long been a serious shortage of midwives
across Britain.
"If there is a rising birth rate, then this can only get worse. Threats to impose pay freezes in the public sector
will do nothing to encourage more people to go into midwifery training," she said.
The Department of Health said funding for maternity services had almost doubled since 1997 to just under £2
billion.
A spokesperson said: "We have set a goal to recruit an extra 4,000 midwives by 2012 and the NHS has already
exceeded an interim target to recruit 1,000 by September this year, which shows the high priority being given
to maternity services."
3
28
The Accelerated Child Survival and Development programme in west Africa: a retrospective
evaluation
The Lancet, UK
12/01/2010
Dr Jennifer Bryce EdD a , Kate Gilroy PhD a, Gareth Jones PhD a, Elizabeth Hazel MHS a, Prof Robert E Black
MD a, Prof Cesar G Victora MD a b
Summary
Background
UNICEF implemented the Accelerated Child Survival and Development (ACSD) programme in 11 west African
countries between 2001 and 2005 to reduce child mortality by at least 25% by the end of 2006. We undertook
a retrospective evaluation of the programme in Benin, Ghana, and Mali.
Methods
We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys to compare
changes in coverage for 14 ACSD interventions, nutritional status (stunting and wasting), and mortality in
children younger than 5 years in the ACSD focus districts with those in the remainder of every country
(comparison areas), after excluding major metropolitan areas.
Findings
Mortality in children younger than 5 years decreased in ACSD areas by 13% in Benin (absolute decrease 18
deaths per 1000 livebirths, p=0·12), 20% in Ghana (21 per 1000 livebirths, p=0·10), and 24% in Mali (63 per
1000 livebirths, p<0·0001), but these decreases were not greater than those in comparison areas in Benin
(25%; absolute decrease 36 deaths per 1000 livebirths, p=0·15) or Mali (31%; 76 per 1000 livebirths,
p=0·30; comparison data not available for Ghana). ACSD districts showed significantly greater increases than
did comparison areas in coverage for preventive interventions delivered through outreach and campaign
strategies in Ghana and Mali, but not Benin. Coverage in ACSD areas for correct treatment of childhood
pneumonia, diarrhoea, and malaria did not differ significantly from before to after programme implementation
in Benin and Mali, but decreased significantly in Ghana for malaria (from 78% to 53%, p<0·0001) and
diarrhoea (from 39% to 28%, p=0·05). We recorded no significant improvements in nutritional status
attributable to ACSD in the three countries.
Interpretation
The ACSD project did not accelerate child survival in Benin and Mali focus districts relative to comparison
areas, probably because coverage for effective treatment interventions for malaria and pneumonia were not
accelerated, causes of neonatal deaths and undernutrition were not addressed, and stock shortages of
insecticide-treated nets restricted the potential effect of this intervention. Changes in policy and nationwide
programme strengthening may have benefited from inputs by UNICEF and other partners, making an
acceleration effect in the ACSD focus districts difficult to capture.
Funding
UNICEF, Canadian International Development Agency, Coordenação de Aperfeiçoamento de Pessoal do Nível
Superior (Brazil), and Fulbright Fellowship.
Introduction
UNICEF implemented the Accelerated Child Survival and Development (ACSD) programme in 11 countries in
west and central Africa between 2001 and 2005, at a cost of about US$27 million, more than half of which was
provided by the Canadian International Development Agency (CIDA). UNICEF reported in 2005 that the
programme had reduced mortality in children younger than 5 years by 20% in programme areas compared
with comparison areas by increasing coverage for highly effective interventions, on the basis of modelling and
estimation.1
The ACSD programme aimed to accelerate reductions in mortality in children younger than 5 years by
increasing coverage with three packages of interventions that are known to reduce child mortality (panel).
Cost-effective interventions for reducing neonatal deaths had not yet been defined at the time when UNICEF
designed ACSD, and were therefore not included. In four countries, 16 focus districts worked to deliver all
three packages; in the remaining countries, ACSD focused on the delivery of vaccines, vitamin A supplements,
and insecticide-treated nets (ITNs) for the prevention of malaria. UNICEF and its country partners report that
they designed ACSD to reinforce activities in child survival that were already under way rather than create a
new programme, with a strong focus on strengthening of service delivery by health workers in communities.1
4
40 per cent more nurses join dole queue
The Mirror, UK
17/01/2010
By Nick Owens
Record numbers of nurses are being forced to sign on the dole because of a shortage of jobs.
New figures show 1,225 nurses registered for benefits last month - up 40 per cent on the 875 in the previous
December.
29
Experts blame the surge on the fact most vacancies are for experienced staff - and that hospitals are hiring
part-time agency workers to save money. NHS Trusts have been ordered to make cuts of £20billion in five
years.
Nursing leaders warned the situation is getting staff down.
Josie Irwin, of the Royal College of Nursing, said: "All the signs are that workload is increasing... and morale is
being affected."
The data - obtained in an investigation by the Nursing Standard journal - shows London, Manchester and
Glasgow are hardest hit.
Lib Dem health spokesman Norman Lamb said: "If hospitals do need to cut back, they should be looking at
how much they're spending on bureaucracy, management consultants and management, not frontline staff."
PINTS OF ALE, NOT BLOOD
New nurse Denise Black has been forced to take a job as a barmaid after her year-long search for a job ended
in frustration.
Denise, 29, has ap plied for dozens of jobs in the NHS. But, in almost every case, she has been told she is
under-qualified. Denise, from Forfar in Angus, said: "I am now won deringwh ether to continue my dream. I
feel I have wasted my time training."
5
Fears for health service as cuts loom
Belfast NewsLetter, UK
16/01/2010
HEALTH workers and the public are bracing themselves for the effect of cuts demanded in the revised Stormont
budget announced this week.
Under-pressure Finance Minister Sammy Wilson wants the health department to cut more than £113 million off
its annual spending, including £92 million out of its budget and £21.5 million in capital spending.
The cuts, if agreed by the Assembly, will take effect from April.
Mr Wilson's demand quashed hopes that the already under-pressure service may have escaped any further
cuts - and he in fact handed it the largest cut of all in pure cash terms.
Making his announcement on Tuesday, he said: "Unfortunately, the level of savings required meant that it was
simply not possible to exempt entire departments from the process, although I would expect that my
ministerial colleagues would seek to reduce the costs of bureaucracy in the first instance."
Health Minister Michael McGimpsey publicy declared last year that the service was already 'cut to the bone' so
fears are growing that the latest savings demanded will have a significant impact on frontline staff and
services.
Mr McGimpsey has already said he is "disgusted" at the latest cuts and has vowed to resist them.
Unions representing ancillary staff, nurses, medics and the voluntary sector have also all expressed fears about
the effect of cuts on their staff and the delivery of health services to patients.
The health department has by far the largest budget in the Executive and every single person will at some
stage need medical care, so the public is also waiting with bated breath to see where the cuts will be made and
how they will affect the service.
The Royal College of Nursing said it is worried about the effect of cuts on its members and the knock-on effect
on patients.
RCN director Janice Smyth said: "An effective, productive health service depends on there being enough nurses
and health care staff with the necessary skills and training to meet patients' needs.
"Cuts on this scale could mean cuts in frontline staff which we have been opposing for some time.
"Patients want to see more nurses, not fewer."
The voluntary sector is also on the alert to see which way the axe will fall.
Andrew Dougall of the NI Chest, heart and Stroke charity says some good could come of the cuts.
He says voluntary organisations can help provide services at a lower cost.
Mr Dougall also wants the Government to look at targeting illnesses like heart disease and stroke to save
money in the future.
30
"It is essential that all waste and inefficiencies are eliminated before there is a cut in any front line services.
"If there was a campaign on preventing stroke, this could save the Health Service and the economy huge
amounts of money."
6
Rising birth rate is leading to a shortage of midwives, report warns
Daily Mail, UK
18/01/2010
By Daily Mail Reporter
The rising birth rate across Britain is leading to a shortage of midwives, a report warned today.
The Nursing and Midwifery Council (NMC), the organisation responsible for regulating the profession, found
midwife shortages in many areas of the country faced with a spiralling number of births.
The council called on health authorities to act swiftly on concerns raised in its report
A rising number of complex births, plus potential challenges including substance abuse and obesity, were also
placing a strain on existing midwifery services, the report found.
NMC chief executive and registrar Professor Dickon Weir-Hughes said: 'Our report has raised a number of key
concerns about the future of maternity services in the UK.
'An increasing birth rate was reported from all (26) local supervising authorities (LSAs) bar one, and this has
had a significant impact on midwife-to-birth ratios in several areas.
'Although successful efforts have been made to boost the numbers of midwives in many regions, others are still
lagging behind and this problem could worsen as a significant proportion of experienced midwives and
supervisors of midwives are now approaching retirement age.
'The NMC urges maternity service providers, related health authorities and the UK health departments to
monitor the situation and act swiftly if LSAs raise concerns about the quality of care provided to mothers and
babies.'
The report, entitled Supervision, Support and Safety: An Analysis Of The 2008 To 2009 Local Supervising
Authorities' Annual Reports To The NMC, also posed questions about the rising numbers of midwives
recommended to undertake a spell of supervised practice.
It outlined worries over the number of midwives and supervisors of midwives who may leave the workforce as
they approach retirement, plus the quality of maternity data used to monitor trends.
However, it identified that progress had been made in the development of services for the most vulnerable
families.
The Department of Health said funding for maternity services had almost doubled since 1997 to just under
£2billion.
A DoH spokesperson said: 'We have made it clear that maternity services should remain a priority for the NHS
and have invested an additional £330m, however, ring-fencing funding is out-dated and prevents the local NHS
from spending budgets as it sees fit to meet the needs of local communities.
'We have set a goal to recruit an extra 4,000 midwives by 2012 and the NHS has already exceeded an interim
target to recruit 1,000 by September this year which shows the high priority being given to maternity services.'
Cathy Warwick, general secretary of the Royal College of Midwives, said the profession was 'still playing catchup' as birth rates rose.
She said: 'This is a welcome report that identifies encouraging progress in maternity services, but also
highlights the challenges facing maternity services of rising birth rates and more complex births.
'There is no doubt that the government is committed to increasing the number of midwives, and this is
happening.
'However, we are still playing catch-up and there is still a long way to go to match midwife numbers to birth
rates, and take the pressure off the system.
'The RCM is working with the government to increase midwife numbers.
'It is encouraging that supervisors of midwives to midwife ratios have improved in some areas.
'I would want to see concerted action to meet the recommended ratio in areas that are falling short.
'This is a key role that contributes to the protection of women and helps midwives to maintain high standards
of practice.
31
'This is a central role not an add-on and trusts and health boards should see it as a priority.'
7
Governo admite contratar mais médicos estrangeiros em 2010
RCM Pharma, Portugal
19/01/2010
O Ministério da Saúde admite fazer novas contratações no estrangeiro, mas só depois de serem colocados os
250 médicos portugueses que concluem a sua especialidade em Medicina Geral e Familiar, este ano, avança a
Rádio Renascença. Os cerca de 400 mil portugueses sem médico de família ainda vão ter de aguardar mais
alguns meses até terem o seu problema resolvido.
“Procederemos à homologação atempada desses médicos portugueses e verificaremos depois quais são as
necessidades que temos e quais são as possibilidades de recrutamento de médicos no estrangeiro para suprir
situações onde se revelem carências”, disse o secretário de Estado da Saúde.
Em entrevista à Renascença, Manuel Pizarro, admite novas contratações no Uruguai e em Cuba para reforçar
os serviços das áreas metropolitanas de Lisboa e do Porto, mas também do Ribatejo, Braga e Barlavento
algarvio
8
Trabajadores del Hospital de A Coruña denuncian la falta de personal
La Opinión Coruña, Spain
15/01/2010
REDACCIÓN | A CORUÑA La Comisión del Centro de Atención Especializada del Hospital de A Coruña denunció
ayer, a través de un comunicado, la supuesta "inoperancia" de la Gerencia del centro con respecto al aumento
de la plantilla de personal en los turnos de noche de la unidad de Rehabilitación, del hospital de Oza, y de los
servicios de Otorrinolaringología y Máxilo-facial, del Teresa Herrera.
La Comisión critica que cada una de estas unidades sea atendida "por una sola enfermera", que debe
encargarse de las 42 camas de Rehabilitación, las 30 de Otorrinolaringología y las 22 de Maxilofacial,
respectivamente. Además, hace hincapié en que "la mayoría de los pacientes son altamente dependientes".
Por su parte, la Dirección de Enfermería, en reunión paritaria con los representantes sindicales, anunció, según
el comunicado, la reestructuración de diferentes servicios. En este sentido, la Comisión del Centro exige que
este personal "sirva para reforzar las unidades más deficitarias".
9
Health workers on national strike today
Hürriyet Daily News, Turkey
18/01/2010
ISTANBUL - Patients, except in emergency cases, will not be able to receive medical attention at public and
university hospitals around Turkey, due to the one-day national strike protesting the new law for healthcare
workers.
Healthcare workers will only be at hospitals Tuesday for emergency cases and they will not see other patients,
even if they have appointments. Hüseyin Demirdizen, head of Istanbul Chamber of Physicians, told the Hürriyet
Daily News & Economic Review that they expected widespread participation across the whole country.
However, Demirdizen said he does not expect great participation from private hospitals since the healthcare
workers in the private sector are not well organized. “Emergency cases such as childbirth, cancer treatment,
and chronic diseases will receive their proper treatment, however, ordinary procedures will not be done.
After the new law comes into effect, physicians who have their own private clinic will not be able to work at
private or public hospitals. Demirdizen said the minimum hours per workweek would decrease from 45 to 40
hours for physicians. He said doctors who want to work more will be able to, but they will have to log those
hours in their main place of work, be it public or private hospital or their own clinic, they won’t be able to work
at more than one place. The law, however, does not solve the problem of overtime, said Demirdizen, adding
that around 15 percent of physicians have their own private clinics.
More than half of physicians who participated in a survey by Türk Sağlık-Sen, a healthcare worker’s union, said
they do not support the new law. Also, more than 60 percent of respondents said they will chose to work in the
public sector after the law comes into effect. The survey sampled 588 physicians in 27 provinces across
Turkey.
Although the majority of physicians are skeptical about the draft bill and most are expected to protest it today,
Health Minister Recep Akdağ said last week that this law is for the benefit of citizens, adding that it’s a shame
for physicians to call for a strike, Anatolia news agency reported.
32
Akdağ blamed Turkey’s Medical Association’s call for a national strike, saying that the draft bill is for the benefit
of both the patients and doctors, speaking at a meeting in the eastern province of Erzurum on Jan. 16.
Recalling that the if physicians want extra income they can work at hospitals instead of their private clinics,
Akdağ said, “The increase in doctors’ incomes will not be paid by citizens but by the state under the new law.”
One year following the approval of the bill, part-time lecturers at medical faculties must ask for full-time
employment at universities or their relations with the university will be canceled, reported daily Milliyet on
Monday. They will also have to be in the classroom for a minimum of 10 hours a week.
10
L’hôpital, le grand raté des 35 heures
Le Parisien, France
18/01/2010
Odile Plichon
Octobre 2001. En un temps record, l’accord sur les 35 heures à l’hôpital est paraphé par la totalité des
syndicats de médecins. On les comprend… ils escomptaient décrocher entre 5 et 10 jours de RTT, la ministre
du Travail, Elisabeth Guigou, leur en propose… 20 ! « C’était trop beau pour être vrai », se souvient le
président de la Coordination médicale hospitalière, François Aubart.
Et, en intégrant leur pause déjeuner dans leur temps de travail, les 66 000 agents des Hôpitaux de Paris vont
de facto passer de 39 heures à 32 h 30 par semaine. Pourquoi une telle générosité ? « Nous étions tétanisés à
l’idée de voir les Hôpitaux de Paris faire grève, et contaminer les 800 000 salariés du secteur », se souvient un
conseiller ministériel en poste à l’époque.
Et les patients dans tout ça ? C’est bien là le problème : faute d’avoir eu l’occasion de réorganiser les services,
partout le temps consacré aux malades a diminué, soit parce que certaines consultations ont dû fermer,
notamment le samedi, soit parce que la pression au travail s’est accrue.
Pénuries persistantes de soignants
Autre aberration : « La négociation des médecins a été totalement déconnectée de celle des autres personnels,
alors même qu’ils travaillent ensemble ! » pointe François Aubart. « Il arrive encore qu’un bloc opératoire
ferme le mardi parce que le chirurgien est en RTT, et le mercredi parce que l’infirmière anesthésiste a fait de
même », ironise une surveillante. Dernier reproche, majeur : « Le gouvernement a lancé les 35 heures au pire
moment, nous étions déjà en pénurie de personnel », rappelle Jean-Marie Sala, de SUD-Santé. Faute
d’étudiants en nombre suffisant, il faudra d’ailleurs attendre plusieurs années avant que les 45 000 créations
de postes promises en contrepartie des 35 heures ne deviennent réalité. « Si les 35 heures adoucissent notre
vie privée, côté professionnel c’est toujours Ubu roi, résume Cathy Roudaut, infirmière à l’hôpital Beaujon de
Clichy (Hauts-de-Seine) : les temps de transmission entre équipes, qui permettaient de parler de nos patients,
de rencontrer les médecins, ont disparu. » Et si, en réanimation, où elle exerce, les normes strictes (une
infirmière pour 2,5 malades) servent de garde-fous, à quelques couloirs de là, le nombre d’infirmières par lit a
baissé. « Elles courent sans cesse d’un patient à l’autre. »
Soignants, médecins… tous s’accordent sur un point : aujourd’hui, les 35 heures restent toujours en partie
virtuelles : du fait des pénuries persistantes de soignants, tous cumulent, qui des heures supplémentaires, qui
des jours de RTT. En 2008, grâce à un protocole d’accord, Cathy s’est fait payer 100 heures supplémentaires et
il lui en reste autant. Ses collègues de la nuit, elles, ont parfois une ardoise de 400 heures. Idem chez les
blouses blanches malgré l’apurement d’une partie de cette dette-jours en 2008. « Fin 2010, les médecins
auront à nouveau accumulé 900 000 jours, l’équivalent de 540 millions d’euros », calcule François Aubart.
Plutôt que de se les faire payer, les praticiens qui le souhaitent devraient avoir la possibilité de partir sept ans
plus tôt à la retraite.
Back to top
Latin America & Caribbean
2
Reconocen labor de enfermeras
El Informador, Mexico
13/01/2010
GUADALAJARA, JALISCO.- En Jalisco, 17 mil 500 enfermeras trabajan en las diferentes instituciones de salud,
pero hay otras dos mil 500 que no están registradas porque laboran en clínicas o consultorios que no forman
parte del sector.
Ayer, el Hospital General de Occidente (HGO) celebró el Día de la Enfermera, en un evento donde estuvo
presente el secretario de Salud en Jalisco, Alfonso Petersen Farah, quien felicitó y otorgó un reconocimiento a
las enfermeras del nosocomio.
33
Angélica Rodríguez Chávez fue una de ellas. Se trata de una enfermera médico-quirúrgica, con más de 15 años
de servicio, cuya experiencia está basada en la satisfacción de servir a los pacientes y ofrecerles “lo mejor en
sus momentos más difíciles”.
Sin embargo, asegura que la labor no está reconocida 100%: “La mayoría de las veces los aplausos son para
los médicos. Hace falta más reconocimiento porque hay muchas que se han destacado y no se les reconoce
como contribuyentes en la salud”.
Angélica acepta con nostalgia que cuando un paciente fallece, es un dolor que no se puede describir.
“Se siente como si fuera tu familiar, se hace un vínculo de amistad; además, es el primer vínculo que tiene el
paciente cuando llega al hospital, antes del doctor”.
Alfonso Petersen Farah reconoce que el trabajo de las enfermeras no es considerado un oficio sino una
profesión, pues su labor es fundamental en la atención médica y emocional de los enfermos.
Aunque la cobertura de profesionistas es amplia, señala que es un hecho que existe un déficit de enfermeras
en la Entidad, principalmente en el primer nivel de atención.
“Calculo que se debería tener el doble de enfermeras en el sector salud en Jalisco. Lamentablemente hay una
disminución en la cantidad de plazas vacantes; por otro lado, tenemos una disminución de la cantidad del
personal que actualmente se está preparando para cumplir la función”.
Para saber
En los Hospitales Civiles de Guadalajara, así como en el Instituto Mexicano del Seguro Social (IMSS) en Jalisco,
también fueron reconocidas las enfermeras en su día.
3
Honduras: Ampliar cobertura el reto en salud
La Prensa, Honduras
11/01/2010
SAN PEDRO SULA - Veintinueve hospitales entre nacionales, regionales y de área no son suficientes para 7.8
millones de hondureños que requieren de los servicios de Salud.
En algunas zonas del país los enfermos tienen que salir en hamacas, burros, pailas de carro y hasta en
avionetas de sus hogares para ser trasladados al hospital más cercano.
Por ello, el gran reto del nuevo ministro de Salud será ampliar la cobertura de atención en todo el país;
además de implementar la prevención como medida de combate para enfermedades como el dengue y la
influenza A/H1N1, pues ambas mantuvieron en alerta a las autoridades y a toda la población el año anterior.
Según las estadísticas de Salud, sólo en 2009 se reportaron 16 muertes por la gripe H1N1 y doce por dengue
hemorrágico; además de cientos de contagiados.
Durante 2009 también hospitales como el Escuela y el Mario Rivas sufrieron un desabastecimiento de
medicamentos en el último trimestre del año.
Sumado a ello las innumerables huelgas de los diferentes gremios.
Urgen más especialistas
Aunque aún no es oficial el nombre del funcionario que ocupará el cargo como secretario de Salud, algunos
médicos han hecho un análisis de las medidas que se requieren para mejorar la asistencia.
Nicolás Montes, director del hospital Mario Rivas, dijo que es vital aumentar el número de especialistas en
áreas donde la cantidad de enfermos crece cada día. Otra de las soluciones que recomienda es la construcción
de más hospitales para la zona norte y que sean similares al Mario Rivas, pues este centro ya no se da abasto
para atender a los miles de ciudadanos que llegan día a día.
“Si no se construyen otros hospitales las medidas que se tomen serán paliativas. Aquí a diario se gasta
1,300,000 lempiras y recibimos una emergencia cada cuatro minutos y medio.
Estas cifras nos preocupan porque van en aumento y no podemos dejar de recibir a un enfermo; pero a veces
no ajustan las camillas”, señaló el funcionario.
Reveló que en el centro asistencial se atienden 1,500 personas en consulta externa, además de 720 internos y
160 en áreas críticas. Todos los enfermos acuden de diferentes municipios.
Julio Rodríguez, de la Región Metropolitana de Salud, asegura que una de las soluciones para ampliar la
cobertura está en extender los horarios de atenciones en los centros de salud. La secretaría tiene a su cargo
1,900 centro de salud, pero la mayoría de éstos cierran a las tres de la tarde, lo que obliga a los ciudadanos a
acudir a los hospitales por una diarrea, vómitos o alergias, enfermedades que podrían ser tratadas en los
cesamos si estuvieran abiertos.
“Se congestionan los hospitales por cosas mínimas. Es necesario que los centros de salud estén abiertos por lo
menos hasta las siete de la noche”, expresó el profesional, quien tiene a su cargo 16 cesamos en San Pedro
Sula.
Dijo también que en algunas zonas hay hasta dos cesamos cercanos y se debe hacer un análisis para ubicarlos
en las zonas que más lo requieren.
La prevención
34
A su criterio es importante que las autoridades tomen como prioridad la prevención para virus como el dengue
y la gripe H1N1, pues es más costoso y riesgoso el tratamiento que las medidas para evitar ser víctima de
estas mortales enfermedades.
“Se tienen que hacer campañas masivas y reducir los índices de víctimas, continuar orientando a la gente para
que entienda lo grave de estas enfermedades y que colabore”, indicó el médico.
Su versión fue reforzada por Marcos Pinel, director de Vigilancia Epidemiológica a nivel nacional. “Las próximas
autoridades tienen que hacer un plan de reconstrucción. Es necesario que se fortalezca la vigilancia
epidemiológica y que ésta se rija bajo los lineamientos que establece la Organización Mundial de la Salud,
OMS”, aseveró el especialista.
Edgardo Umaña, subdirector del hospital Leonardo Martínez, recomienda a las autoridades de Salud el
fortalecimiento de equipo en los hospitales, ya que a medida que avanza la tecnología se pueden hacer
mejores diagnósticos.“Es difícil cambiar el equipo en un hospital porque es muy costoso, pero muchos ya están
obsoletos”, indicó el médico. A su criterio también se debe lograr que el recurso humano, como médicos
especialistas, se mantenga en los hospitales rurales y no sólo en las ciudades.
Promesas de campaña
Las esperanzas de los hondureños en el sector salud están puestas en las promesas de campaña del presidente
electo, Porfirio Lobo Sosa, quien ofreció seguro médico para un millón de ciudadanos como parte de la primera
etapa de un programa que beneficiará, principalmente, a los niños, adultos mayores y discapacitados.
Lobo Sosa se comprometió a apoyar la construcción de cuatro nuevos hospitales en reemplazo de los que hay
en Roatán, La Ceiba, Choluteca y Santa Bárbara.
Ampliarían atención hasta los 18 años
El Seguro Social forma parte de la red hospitalaria del país a la cual tienen acceso un grupo grande de
hondureños.
Bessy Alvarado, gerente general del Ihss, dijo que el plan es convertirlo en un hospital de especialidades y no
sólo regional.
Este año se enfocarán en la cobertura de la población infantil.
“Queremos ampliar atención desde los niños de 11 años que se extienda hasta los 18 años, pues es una
debilidad del sistema que los menores no tengan protección de seguridad social”, señaló la especialista.
Aseveró que trabajarán en la recuperación de la mora y se mejorará la atención y calidad.
“Éste es un proceso que lleva todo un trabajo de parte de Recursos Humanos, esta área tiene que implementar
los programas de capacitación al personal médico, administrativo y enfermeras”, indicó Alvarado.
Añadió que en la parte clínica se mejorará la atención en oncología, diabetes, cardiología y la emergencia de
adultos.
En pediatría se tiene contemplado un programa de cobertura para apoyar a la madre en cuanto a lactancia
infantil. “Ya se definió que en San Pedro Sula será el lugar donde se harán los trasplantes de riñón”, anunció
Alvarado.
Tómelo en cuenta
La alta demanda de pacientes ha disminuido la capacidad de respuesta. Debido a ello han aumentado las
moras quirúrgicas en todas las áreas y las citas para consulta externa.
La falta de medicinas en los principales hospitales ha sido uno de los grandes problemas en la red de salud.
Muchas veces los pacientes tienen que comprar los fármacos.
El personal es insuficiente y, según las autoridades de los principales hospitales, no hay aperturas de plaza
para aumentarlo. Faltan técnicos, enfermeras y médicos.
Por las enormes necesidades de los hospitales de área, los enfermos son trasladados a hospitales como el
Escuela y el Mario Rivas, lo que causa congestionamiento.
4
Enfermeras mantendrán sus medidas por conflicto con ASSE
El Espectador, Uruguay
11/01/2010
El Colegio de Enfermeras decidió en asamblea mantener en todos sus términos el conflicto que mantienen con
ASSE, ante la falta de respuesta de las autoridades en cuanto a sus reclamos. Harán una campaña de
sensibilización de la sociedad e intentarán llegar al presidente electo, José Mujica.
Luego de más de tres horas de discusión, las profesionales decidieron denunciar públicamente la
“insensibilidad” de las autoridades ante la opinión pública.
Es por eso que, según explicó a El Espectador Silvia Santana, presidenta del Colegio de Enfermeras, la
institución repartirá volantes en la vía pública e instalará parlantes ante la sede del Ministerio de Salud Pública.
Además, dijo que, ante la negativa de ASSE a recibirlas, intentarán llegar al futuro presidente de la República.
“Vamos a ir hacia las nuevas autoridades, o sea que vamos a ir hacia el presidente electo de la República, a
llevarle un documento y denunciando la insensibilidad de estas autoridades, y vamos a salir a la puerta de los
hospitales, del Ministerio, a denunciar a la opinión pública lo que está pasando con nosotras. Vamos a seguir
reclamando nuestros salarios, que están adeudados y vamos a seguir pidiendo la mesa bipartita”, sentenció.
35
El Colegio de Enfermeras denunció que ASSE aún no ha cumplido con el pago de los adeudos salariales, que
según las autoridades se efectuaría el pasado fin de semana.
Las profesionales reclaman que se haga efectivo el pago de un salario de 161 pesos la hora, tal cual lo estipula
un acuerdo firmado en febrero de 2009.
5
Hospitales dominicanos, repletos de haitianos
El Universal, Mexico
16/01/2010
Los haitianos heridos por el terremoto que asoló el martes a Haití, en especial su capital, Puerto Príncipe,
continúan hoy llegando en masa a los desbordados hospitales dominicanos en la frontera.
Los heridos presentan todo tipo de traumas, así como lesiones abiertas severas e infecciones, dijeron a EFE
médicos dominicanos desplazados hasta la zona y que calificaron de "indescriptible" la situación que se vive en
los centros de salud fronterizos tras el sismo de 7 grados Richter, que devastó al vecino país.
El 90 por ciento de los pacientes que se encuentra en estado delicado en el hospital municipal de Jimaní
(fronterizo con Haití) requieren de amputaciones, declaró en conversación telefónica con EFE la doctora Idalia
Zapata, quien se desplazó al lugar al otro día de la tragedia desde Santo Domingo, donde trabaja.
"No hay palabras para describir esto", dijo la ortopedista, quien reconoció que el personal médico no da
abasto.
El hospital municipal de Jimaní tiene capacidad para unas 100 personas, pero hay ingresados unas 300, precisó
la galena.
"Y todos están en las mismas condiciones, niños y adultos", subrayó.
Los heridos que han tenido más suerte permanecen en camas, pero los demás están en los pasillos de los
hospitales o el algún rincón a la espera de recibir la atención de los médicos, según las declaraciones de
Zapata.
Para hacer algún hueco en el hospital, los heridos que ya han sido atenidos fueron enviados a una especie de
refugio improvisado alrededor del centro de salud.
El coordinador de emergencia del centro, Sentalo Martínez, dijo que desde el miércoles han recibido unos dos
mil 300 heridos, pero que sólo han podido asistir a unos 450.
Los demás han sido referidos a otros hospitales de la zona, agregó e indicó que "es muy importante que el
mundo sepa lo que está pasado" a raíz del siniestro en la vecina nación caribeña.
República Dominicana está acogiendo heridos de esta tragedia, además, en hospitales situados en Barahona,
en San Juan de la Maguana, Duvergé y en Neyba, en la zona más próxima a la línea fronteriza, así como a
varios hospitales de Santo Domingo, entre ellos el de las Fuerzas Armadas y en el de la Fuerza Aérea.
Algunos sectores locales alertaron de que muchos de los haitianos heridos corren el riesgo de morir por la
carencia en los hospitales en la frontera.
El Consejo Nacional de Seguridad Social (CNSS) dominicano anunció ayer que destinará 108 millones de pesos
(5 millones de dólares) para reforzar los centros de salud del país tras el terremoto.
6
Fies poderá ser pago com trabalho
Tribuna do Norte, Brazil
16/01/2010
São Paulo (AE) - Médicos ou professores formados poderão pagar o financiamento estudantil que receberam
durante a faculdade com trabalho em escolas públicas ou no programa Saúde da Família. A lei que muda os
critérios do Fundo de Financiamento ao Estudante do Ensino Superior (Fies), do governo federal, foi publicada
na edição de sexta-feira no “Diário Oficial da União”. As regras já valem para este ano. O abatimento será de
1% da dívida a cada mês trabalhado. A Lei 12.202 também inclui alunos da educação profissional técnica de
nível médio no programa. Porém, a prioridade de atendimento continua sendo dos estudantes da graduação.
Quem faz mestrado ou doutorado também pode requerer o benefício.
A nova legislação estende aos contratos formalizados até agosto do ano passado a redução de 6,5% para 3,5%
dos juros incidentes sobre o saldo devedor. A taxa foi aprovada pelo Conselho Monetário Nacional (CMN) e está
em vigor para os contratos assinados a partir de agora. O prazo para quitar a dívida com governo foi ampliado
de duas para três vezes o período financiado pelo Fies. Um estudante que financiou um curso universitário
durante 4 anos, terá até 12 anos para pagar.
36
O médico integrante do Saúde da Família que se graduou com a ajuda do Fies terá abatimento na dívida
somente se atuar “em especialidades e regiões com carência e dificuldade de retenção desse profissional,
definidas como prioritárias pelo Ministério da Saúde”, diz a lei. Segundo a assessoria de comunicação do MEC,
será publicada uma portaria para regulamentar a questão. Os formandos em medicina que optarem por
ingressar em programa de residência médica também serão beneficiados.
7
Falta de médicos retrasa atención a damnificados: ONG
El Financiero, Mexico
15/01/2010
Puerto Príncipe, 15 de enero.- Las diversas organizaciones humanitarias que prestan ayuda en Haití para paliar
las consecuencias del terremoto que destrozó la isla, coincidieron en que la falta de médicos retrasa la atención
de damnificados.
Según el Comité Internacional de la Cruz Roja (CICR), los hospitales privados y la infraestructura médica están
en un nivel "límite", pues no hay suficientes médicos ni enfermeras para afrontar la llegada continúa de
heridos.
A su vez, la organización Manos Unidas indicó que se puso en contacto con su contraparte en la isla, la ONG
Concert Action, la cual perdió a dos de sus miembros en el terremoto.
De acuerdo con un comunicado de esta organización, "se ha retrocedido 60 años y la recuperación será dura.
Se trata de un verdadero desastre.
"Los hospitales no pueden hacer frente a la afluencia de las víctimas, los medios son mínimos y la
improvisación domina".
Otra de las Organizaciones no Gubernamentales (ONG) que proporcionará apoyo a los caribeños es la Cruz
Roja española, la cual informó que este viernes arribó el primer convoy humanitario que envió.
Indicó además que 10 de sus delegados especializados en emergencias llegarán en las próximas horas para
unirse a los que ya están en la isla.
En tanto, la organización Farmacéuticos Mundi (Farmamundi) envió otras 3.5 toneladas de medicamentos
esenciales y material sanitario, suministros con los que se estima podría atenderse a más de 20 mil personas
durante tres meses.
Oxfam Internacional, que es otras de las organizaciones que colabora en las acciones de rescate ha entregado
entre otras cosas, palas y picos a los residentes para rescatar a quienes aún permanecen atrapados bajo los
escombros en la capital.
Mientras, Movimiento por la Paz indicó que desde República Dominicana realiza los trabajos de identificación de
necesidades junto con otras organizaciones, para elaborar un plan conjunto de emergencia que permita la
rápida distribución de suministros a las poblaciones afectadas. (Con información de Notimex/TPC)
8
"Machadadas" no SNS levam profissionais a fugir para privados
Rádio Renascença, Brazil
18/01/2010
A criação de um "Corpo Médico de Estado" para o Serviço Nacional de Saúde (SNS) será uma medida
necessária para combater a saída de médicos e enfermeiros para o sector privado.
A ideia é defendida por Paulo Mendo – um ex-ministro da Saúde – que avalia como sendo meros paliativos, as
recentes medidas da actual ministra para atrair clínicos ao interior do país.
Paulo Mendo diz ser decisivo valorizar a profissão médica. “O que me parece errado é, eventualmente, não
haver uma política que faça com que a carreira do Serviço Nacional de Saúde seja suficientemente digna,
hierarquizada e considerada como um Corpo de Estado, que faça com que o médicos e enfermeiros tenham
orgulho em pertencer ao SNS”.
Na opinião do ex-governante, nos últimos anos, o SNS “tem apanhado tantas machadadas, no seu prestígio,
que os profissionais estão a fugir para o privado”.
No último concurso de internato médico, a maioria das vagas que ficaram por preencher destinavam-se a
clínicos no interior do país, onde é maior a carência destes profisionais
9
Novos empreendimentos na Amazônia ameaçam sobrevivência dos índios
Terra Brasil
14/01/2010
37
A instalação de novos empreendimento na Amazônia gerou consequências trágicas e irreversíveis para os
povos indígenas da região. É o que revela publicação inédita da Organização das Nações Unidas (ONU) sobre a
situação dos mais de 370 milhões de índios no mundo, divulgada hoje (14) no Rio de Janeiro e em várias
capitais.
Embora o relatório não cite a construção das usinas hidrelétricas de Jirau e de Santo Antônio, em Porto Velho,
alerta que há relatos de índios isolados vivendo na região, que estão sendo dizimados por doenças tratáveis
como malária, pneumonia e varíola.
O documento ataca o avanço desordenado de "infraestruturas da globalização" e lembra que a instalação de
grandes usinas, como a Hidrelétrica de Tucuruí, na década de 1980, gerou "um aumento dramático" dos casos
de malária. No período, também foi registrado crescimento da incidência de doenças como oncocercose
(cegueira dos rios) e esquistossomose.
Na Amazônia peruana, o relatório cita os impactos com a exploração de petróleo e gás (Projeto Camisea)
desenvolvido pela Shell Oil, também na década de 1980. O contato de trabalhadores da empresa com a
população local trouxe tosse, varíola e gripe, matando 50% da comunidade tradicional.
Além das enfermidades trazidas com as alterações no meio ambiente, como os grandes alagamentos para a
instalação da usinas, novos empreendimentos na Amazônia também obrigam o reassentamento de famílias,
que deixam para trás, além do território, tradições e relações seculares com o lugar e formas de subsistência.
"Grupos indígenas dispersados anteriormente foram forçados a viver em assentamentos, onde eram expostos a
novas doenças, como infecções intestinais e gripes", afirma o relatório, que aponta também a carência de
assistência médica adequada e a falta de vacinação regular.
Durante a divulgação do relatório, o líder Marcos Terena, articulador do Comitê Intertribal - Memória e Ciência
Indígena (ITC), disse que, para minimizar os problemas provocados por esses empreendimentos, os índios
querem ser consultados sobre os impactos das instalações em suas terras, como determina a Declaração das
Nações Unidas sobre os Direitos dos Povos Indígenas.
"A ONU trabalha para que os bancos de financiamento e organismos multilaterais como o Banco Mundial Bird e
o Banco Interamericano de Desenvolvimento BID sejam obrigados a estabelecer mecanismos de consulta e
diálogo com os povos indígenas para levar em conta a opinião deles. Isso vai ajudar na garantia dos direitos
humanos", concluiu Terena.
Back to top
News from WHO and partners
1
PAHO/WHO Coordinating Regional Efforts to Assist Haiti after Earthquake
PAHO/WHO
14/01/2010
Washington, D.C., Jan. 14, 2010 (PAHO) - The Pan American Health Organization/World Health Organization
(PAHO/WHO) is coordinating the mobilization of efforts to help health authorities in Haiti meet the basic health
needs of their people in the aftermath of Tuesday's earthquake, through its country offices.
Dr. Mirta Roses, PAHO Director, convened a regional virtual meeting this morning linking all PAHO/WHO
Representatives in Latin America and the Caribbean to exchange information on actions taken by PAHO/WHO
Member States in the region in response to the earthquake. Dr. Roses in turn provided updated information on
the situation in Haiti and emphasized the importance of a coordinated response to ensure more efficient and
effective delivery of disaster assistance.
PAHO is coordinating and facilitating the mobilization of health experts and rescue teams from a number of its
Member States and other regions to provide relief and recovery. PAHO/WHO is working with other United
Nations agencies, international partners, and local authorities in these efforts and is assessing the impact of
the earthquake on the health situation. Donors countries including USA,Canada and Spain have pledged
additional funds through PAHO.
All the countries in the Region have responded with great solidarity by sending rescue missions, medical
teams, medical supplies, water, food and other general provisions to Haiti. Some of these relief efforts include:
◦Dominican Republic has strengthened the health services and hospitals along the border to assist with
evacuations of injured and care for the sick.
◦Cuba provided 403 health workers, 334 of whom were already working in the country prior to the earthquake.
The ministries of health of Cuba and Haiti are coordinating the evacuation of survivors with urgent medical
needs for treatment in Cuba.
◦Jamaica has also agreed to receive earthquake victims in their hospitals, which have been placed on alert.
◦Brazil had contributed US$10 million and an air bridge with critical supplies.
◦Venezuela has offered to help reestablish the provision of free fuel to medical facilities.
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◦Cargo planes carrying provisions including medical, rescue and military personnel, medical supplies, water,
food, and shelter (tents) have been sent by countries including Argentina, Chile, Ecuador and Peru.
◦Mexico has sent rescue teams, cargo planes and hospital vessels.
◦Colombia, Costa Rica, Ecuador, El Salvador, Honduras, Nicaragua, and the CARICOM countries, among others,
are also providing important contributions and are awaiting information on additional specific needs.
In a press briefing today, PAHO's Deputy Director, Jon Andrus, noted that "coordination is the key role that
PAHO/WHO can play." "Our PAHO Emergency Operations Center [in Washington, D.C.] is operating as a
clearinghouse for information," said Andrus. "We are conducting daily global conference calls with WHO
headquarters in Geneva and with partners in the U.N. Global Health Cluster to best coordinate the response to
the emergency."
In her virtual conference, PAHO Director Dr. Roses emphasized the following priorities:
◦In this first week, the most important health priorities are search-and-rescue efforts to find survivors trapped
beneath rubble and treatment for people with major injuries.
◦Countries offering support should coordinate an effective delivery of that support with their embassy in Haiti or
with the UN Stabilization Mission in Haiti (MINUSTAH).
◦Any medical personnel, field hospitals, rescue teams set up by donor countries and organizations sent to Haiti
must be self-sufficient and should not require support from the local community.
◦Disaster assistance from donor countries and organizations is best provided on the basis of on-the-ground
needs assessments, and in coordination with national authorities.
◦After the first two weeks, donor countries and organizations should be prepared to provide assistance in the
medium and long term, including the provision of safe water, food, medical supplies and personnel, as well as
coordinated actions and projects to reconstruct health facilities and the health system in general, and address
other longer-term needs.
◦Hospitals can and should be built to withstand the impact of disasters and should be planned and equipped to
remain functioning after disasters.
PAHO's Director will continue to hold virtual conferences with PAHO/WHO Representatives and Ministers of
Health in the Region, as part of the PAHO coordination efforts and response to the situation on Haiti.
2
Overcrowded Hospital Wards: Performing Caesarean Sections on a Park Bench
UNFPA
18/01/2010
PORT-AU-PRINCE—Six days after the devastating earthquake that hit Haiti, hospitals in the capital, Port-auPrince, are flooded with victims, many of them with crushed limbs or fractured bones. But another kind of
emergency, perhaps less visible but equally deadly, can occur when pregnant women are forced to give birth in
unsanitary conditions and without access to medical care.
Giving birth under such conditions can quickly turn deadly if complications such as bleeding, obstructed
delivery or high blood pressure occur. Everyday hygiene supplies, including sanitary napkins and soap, are also
necessary, but often forgotten in emergencies.
As hospitals struggle to meet the needs of the thousands of wounded, maternity wards have in some cases
given way to surgeries and orthopaedic treatment because of the overwhelming number of serious injuries.
The Hopitale Generale, near the city’s centre and the maternity clinic, Maternite Isaie Gentil, are expected to
reopen their maternity wards on Monday, 18 January.
Dr. Alex Lasegue, the Director of Hopitale Generale, said that doctors at his hospital had performed two
Caesarean sections and assisted two regular deliveries on a park bench outside the hospital on Saturday.
“The water broke, and we had nowhere else to do the deliveries,” he said.
There are more than 60 sites around Port-au-Prince where large groups of people who have lost their homes
are camping out in makeshift tents made from sheets and sticks. UNFPA, the United Nations Population Fund,
estimates that about 37,000 women among the affected population are pregnant and in need of maternal
health services.
UNFPA has been on the ground in Haiti for 30 years and now forms a critical part of the United Nations team
assisting the affected population.
Safe delivery equipment and dignity-kits containing sanitary napkins, soap and other personal hygiene articles
have been delivered and more are under way—a small but important step on the long way back to a semblance
of normalcy in this devastated city.
4
Survey Shows Attention Required to Keep Ugandan Nurses in the Profession
International Council of Nurses
11/01/2010
39
Kampala, Uganda, 11 January, 2010 – Commenting on the recently published nurses’ attitudinal survey,
General Secretary of the Uganda Nurses and Midwives Union (UNMU), Sulaiman Bateganya said today, “the
results clearly show that the severe workload challenges faced by nursing in Uganda are impacting patient care
and health outcomes which, if remain unaddressed, will lead to the additional exodus of nurses from the
profession within our country and the continued erosion of Uganda’s health system.”
The survey provided a snapshot of the primarily urban nursing population who on average spend
approximately 75% of their working day in contact with patients. The two hundred nurses surveyed in Uganda
formed part of a global survey of more than 2 000 nurses across eleven countries.
Only 12% of nurses in Uganda say they are very satisfied with nursing as a career making Uganda among the
lowest ranking of the countries surveyed. Further, only 32% of Ugandan nurses said they were very likely to
remain in the profession in the next five years against a global average of 53%, making Uganda the lowest
ranking of the eleven countries surveyed.
“With a nurse patient ratio of 6 per 100,000 against the WHO recommended 2.5 per 1,000, it is not surprising
that the respondents cited workload as the main cause of dissatisfaction,” said Bateganya. “What is of great
concern is that nurses view the high workloads as having a negative impact on the quality of patient care, and
seventy four percent said having the opportunity to spend more time with their patients would have very
significant impact on patient health.” he continued.
According to Bateganya, the results clearly show that under the right conditions, nurses in Uganda are
committed to working towards improved patient health. If current conditions are not improved, an exodus
from the profession could be experienced with dire consequences for an already burdened public health
system.
Commenting on the findings, the International Council of Nurses (ICN), the global federation of national nurses
associations, underlined the urgency of responding to the needs of nurses in Uganda.
_________________________________
Editor’s note
ICN and Pfizer Inc. External Medical Affairs collaborated on a global representative survey of 2,203 nurses in
eleven countries, including Brazil, Canada, Colombia, Japan, Kenya, Portugal, South Africa, Taiwan, Uganda,
the UK, and the U.S. The survey was conducted by APCO Insight. Collated global results and methodology
can be viewed at www.icn.ch.
Key findings in Uganda include:
More than four in ten respondents said that nursing was better today than 5 years ago (45%) and that the
recognition you receive for your contribution as a nurse is better than it was 5 years ago (43%).
27% of respondents stated workload as the most unfavourable part of nursing today followed by pay, benefits
and incentives (18%) and then supply shortages, budget cuts and inadequate systems (10%), as well as risk
of contracting infectious disease 10%.
Nurses in Uganda scored lowest in terms of the likelihood of remaining in their profession – 32% against a
global average of 53%.
29% of nurses in Uganda have the authority to prescribe medicines versus the global average of 17%. 84%
feel that to have this authority would be of benefit.
The International Council of Nurses (ICN) is a federation of 133 national nurses' associations representing the
millions of nurses worldwide. Operated by nurses for nurses since 1899, ICN is the international voice of
nursing and works to ensure quality care for all and sound health policies globally.
5
Merlin joins call to address critical health worker shortages
Merlin, UK
15/01/2010
Merlin along with over 20 other organisations has signed a letter from the Health Worker Advocacy Alliance
(HWAI) calling for the strengthening of the Global Code of Practice on the International Recruitment of Health
Personnel.
The Code is vital for addressing the critical human worker shortages and realising the right of everyone to the
enjoyment of the highest attainable standard of health – “the right to health” – in all contexts.
The Health Workforce Advocacy Initiative (HWAI), supported by the Global Health Workforce Alliance, is an
international civil society-led coalition that works to support and strengthen human resources for health and
seeks to ensure that all people everywhere have access to skilled, motivated and supported health workers.
Merlin is a member of HWAI.
The letter will be circulated at next week’s WHO Executive Board meeting and makes a number of
recommendations to strengthen the Code and calls on the Executive to submit the Code to the 63rd World
Health Assembly in May 2010.
Join our campaign for change: Put your hand up for a health worker
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6
Haiti: The health issues right now
Merlin, UK
15/01/2010
Read an interview with Linda Doull, Merlin’s Director of Health and Policy, describing the main health concerns
currently facing those affected by the earthquake in Haiti.
What are the main disease concerns in Haiti right now?
With an earthquake of this magnitude common illnesses quickly become one of the most serious concerns. In
the absence of clean running water or proper sanitation and a lack of shelter, diarrhoeal diseases and acute
respiratory infections pose the most serious threats to earthquake survivors. What’s more, as the homeless
population is moved into camps for displaced people, diseases such as measles can quickly spread.
How long does the aid community have to prevent them?
We need to act as fast as possible to implement disease prevention and control measures. Merlin's Emergency
Response Team will set up a network of mobile and static clinics which will be used to prevent, diagnose and
swiftly treat common illnesses. We expect to be faced with people suffering from diarrhoea, acute respiratory
infections and malaria. We will also set up a disease surveillance and monitoring system to quickly identify sick
people and prevent further spread of communicable disease. This is standard Merlin practice in any emergency
scenario so we’ll be able to get it up and running very quickly.
What about water and sanitation?
A key part of all Merlin's emergency responses is to ensure people have access to safe water and sanitation to
minimise the risks of diarrhoea and illnesses such as hepatitis. Merlin's Emergency Response Team has chlorine
tablet supplies for mass distribution and will distribute personal hygiene kits.
What are the likely health effects of the destruction of the hospitals?
In the immediate aftermath we expect to see and treat a large number of wounds and injuries. The lack of
surviving qualified health care staff is proving a huge challenge: health workers have either been injured or
killed, or are suffering their own loss. Given the devastation to clinics and hospitals, Merlin’s team is likely to
set up a network of tented clinics and support surgical activities to manage the immediate acute needs.
Merlin's primary objective will be to focus on the emergency response but we always work to help rebuild the
health care system from the onset. Haiti's health system was in a fragile state before the disaster and Merlin
will be working closely with the Ministry of Health to train and retrain local health workers and will look to stay
on as long as we are needed.
7
Field Hospital Supported by the Government of Canada now Deployed in Haiti
CIDA
18/01/2010
Ottawa―The Honourable Beverley J. Oda, Minister of International Cooperation, announced today that the Red
Cross emergency field hospital, as well as 10 Canadian medical and technical professionals, are now deployed
in Haiti and providing medical care. The hospital, set up in Port-au-Prince, will help the Canadian Red Cross
provide health and medical care to Haitians affected by the earthquake. The hospital and medical personnel
arrived over the weekend and are fully operational today.
"This field hospital will help provide emergency medical attention, one of the most pressing needs on the
ground in Haiti in the wake of Tuesday's earthquake," said Minister Oda. "Our government is working closely
with the Norwegian Red Cross and the Canadian Red Cross to provide the essential surgical and medical care
that the hospital will bring to those who have suffered serious injuries."
"We are incredibly grateful for this generous contribution from the Government of Canada," says Conrad
Sauvé, Secretary General and Chief Executive Officer of the Canadian Red Cross. "This contribution, along with
all the donations we have received, will allow us to continue to provide urgently needed care to the many
people devastated by this earthquake."
The Government of Canada is providing $800,000 in support of this emergency field hospital and the medical
professionals.This field hospital is a Norwegian and Canadian Red Cross co-funded facility, which will provide
essential surgical and medical care for up to 300 individuals per day. It includes customized modules such as
surgery, first aid and triage, a ward of 70 beds, a community health unit, and a psychosocial support unit.
Reports indicate that many hospitals in the capital city have collapsed, and those that are open at full capacity.
Support for this field hospital is part of the initial $5 million for immediate humanitarian assistance announced
on January 13 by Minister Oda. Further assistance will be based on needs assessments.
41