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This Week's News 1 July 2011 Weekly news clippings service featuring articles on the Global Health Workforce Alliance and selection of articles from around the world on the issue of the health workforce crisis News from WHO and partners ¦ Africa & Middle East ¦ Asia & Pacific ¦ North America ¦ Europe ¦ Latin America & Caribbean This compilation is for your information only and should not be redistributed News from the Global Health Workforce Alliance Date Headline Publication 30.06.11 To maximize participation to the community of practice on the HRH Policy Impact Assessment Tool and HRH Toolkit, the online discussion has been extended to 15 July 2011 Read more online and join us on the HRH Exchange >> The Alliance News from WHO and partners Date Headline Publication 27.06.11 “Co-development” is key to promoting universal access to healthcare British Medical Journal 06.11 Working in Health World Bank 24.06.11 *Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes HRH Journal 06.11 HIFA-Zambia HIFA2015 06.11 Handbook on Measurement and Monitoring: Indicators of the Regional Goals for Human Resources for Health Observatory of Human Resources 29.06.11 The Women, Girls, and Gender Equality of the Global Health Initiative (GHI): Assessment of the GHI Plus Country Strategies Global Health Council 27.06.11 Rapid response and cultural sensitivity among plus points in Pakistan Merlin, UK 23.06.11 AMREF Seeks Support from Kenyan Manufacturers AMREF 24.06.11 UNICEF and AMREF Formalise Partnership to Improve Health of Women and Children AMREF * All links to HRH Journal will be to an external web page - copy is not reproduced in this document. Africa & Middle East Date Headline Publication 1 27.06.11 SOUTH AFRICA: Midwife shortage impacts maternal health UN IRIN 24.06.11 New nurses start one-year community service The New Age, SA 23.06.11 Zimbabwe has huge midwife shortage - official Afrique en ligne 28.06.11 Discovery Foundation boosts rural healthcare News24, SA 23.06.11 Hôpital Jeetoo : Manque d’infirmières et aides-soignantes dans les salles pour femmes L’Express, Mauritius 21.06.11 Tamale Nurses Community School graduates lack knowledge in some key health areas - Study Ghana News Agency 26.06.11 Série d’agressions sur des médecins El Watan, Algeria Asia & Pacific Date Headline Publication 27.06.11 Mental Hospital: 374 posts, 72 vacant! Times of India 26.06.11 MCI approves 150 seats for LG Medical College Times of India 23.06.11 The contract Manila Bulletin 25.06.11 Help for public hospitals China Daily 28.06.11 Experts call for bridging nurse shortage Times of India 25.06.11 Doctors for closed hospitals 28.06.11 Survey warns of country doctor shortage 27.06.11 Institute 'good' for Fiji Daily News, Sri Lanka ABC News, Australia Fiji Times 28.06.11 High taxes, cost of living deterring overseas recruits The Australian North America Date Headline Publication 21.06.11 Experts Explore Solutions to Nursing Shortage, Skills Gap Business Wire 22.06.11 Money woes, infighting plague UW nursing school Seattle Times 24.06.11 Central Nebraska hospitals prepare for national nursing shortage 23.06.11 University Partners with Healthcare Organization to Increase Academic Opportunities for Nurses. News 5 KHASTV US News University 26.06.11 U.S. Plans Stealth Survey on Access to Doctors New York Times 21.06.11 Doctor of Nursing Practice programs prepare students for advanced roles in health care Graduate Guide 28.06.11 Administration Halts Survey of Making Doctor Visits New York Times 29.06.11 Nursing School Leads HIV/AIDS Research, Outreach in Rural South African Communities UVA Today 23.06.11 Alberta nursing grads can expect casual, not permanent jobs Edmonton Journal, CA Europe Date Headline Publication 2 18.06.11 Facebook use leads to health-care reform in Taiwan The Lancet, UK 19.06.11 Right on song: the rebuilding of Haiti The Observer, UK 20.06.11 How to meet the challenge of ageing populations BMJ. UK 20.06.11 Midwife burnout poses threat to reducing maternal mortality The Guardian, UK 22.06.11 Nurses will be forced to do more work 27.06.11 Doctors may face two years' work in public hospitals The Independent, Ireland Irish Times 20.06.11 Health agency looks to Pakistan and India to solve doctor shortage Irish Times 28.06.11 NHS cost-cutting measures 'driving midwives to emigrate for jobs' Wales Online 26.06.11 South Sudan faces grim health and humanitarian situation The Lancet, UK 29.06.11 Le nouvel hôpital rend malade son personnel Midi Libre.fr Latin America & Caribbean Date Headline Publication 29.06.11 COMENENAL frena huelga y da plazo de 2 semanas al MINSA La Estrella, Panama 29.06.11 Advierten sobre déficit de enfermeras en México 29.01.11 Enfermeras a nuevas asambleas informativas 28.06.11 Servidores do Samu realizam panfletagem no Centro Diario de Yacatán, Mexico La Tribuna, Honduras InfoNet, Brazil 28.06.11 Cadê o médico que estava aqui? O Povo, Brazil 27.06.11 En Santa Fe hay un enfermero y un médico cada mil habitantes 30.06.11 2 mil médicos del Táchira se suman al paro nacional Agencia Fe, Argentina Diario de los Andes, Venezuela Back to top News from WHO and partners 2 “Co-development” is key to promoting universal access to healthcare British Medical Journal 27/06/2011 Matthew Limb + Author Affiliations 1London Progress in tackling huge global health inequalities remains slow, despite poorer countries becoming more assertive and innovative in tackling problems, a symposium has heard. There were calls at the Nuffield Council on Bioethics symposium in London for richer nations to do more to foster “co-development” and promote universal access to healthcare. The event, entitled “Global health: responsibility, ethics and policy,” was held on 22 June. Some 150 delegates, including researchers, clinicians, ethicists, international aid specialists, and advisers, heard about the “unacceptable” burden of disease affecting the poorest countries. In the keynote address Nigel Crisp, a former head of the NHS in England (2000-6) who chairs the international charity Sightsavers, outlined how infectious and chronic diseases, poverty, lack of resources, and migration of health workers were affecting regions such as sub-Saharan Africa. But he said that there were some positive trends. Around the world there was now a better understanding of global “interdependence” in terms of healthcare and some shifts in power towards the interests of poorer countries and regions. 3 He said that many low and middle income countries were developing new approaches in public health that involved local communities and that tied in with wider development, employment, and education issues. Lord Crisp said that an ethical framework for global health had to include support for people’s rights to access healthcare and live independently. Richer nations needed to think in terms of co-development rather than tell people what to do or adopt the “old patronising attitudes that knowledge transfer is one way,” he said. “Looking at the future, each of us has something to teach, and each of us has something to learn,” he said. Anthony Kessel, director of public health strategy at the UK Health Protection Agency, said he was concerned that global health issues would slip down the agenda because of financial austerity in rich and in poor countries. Describing the agency’s role in several initiatives worldwide, he said, “What we are doing is just a drop in the ocean of need.” Amar Jesani, coordinator of the Centre for Studies in Ethics and Rights, an institute of the Anusandhan Trust in Mumbai, India, which sets up and runs institutions to undertake research on health and allied themes, warned that selective or technology driven global health policies could undermine countries’ health systems. He described how India had faced international pressure to introduce the human papillomavirus vaccine against cervical cancer in two states at high cost, something he called a “violation of ethics.” Dr Jesani said that traditional policies on global health, shaped by unfair trade relations and favouring private business interests, should instead promote universal access to healthcare. Frances Baum, a fellow of the Australian Research Council who was a commissioner on the World Health Organization’s Commission on the Social Determinants of Health from 2005 to 2008, said that empowering local communities to take control was vital. “When it is done properly it makes a big difference, and it’s a very different model to charity,” she said. Thelma Narayan, coordinator of the Centre for Public Health and Equity in Bangalore and joint convenor of the People’s Health Movement in India, said that corporate led globalisation and neoliberal economic reforms had adversely affected the “social majority nationally and globally.” She added, “We all agree we need greater social justice in global health. How much space is there for community and civil society engagement?” Albert Weale, chairman of the Nuffield Council and professor of political theory and public policy at University College London, said he hoped that the symposium’s output would feed into practical policy recommendations. Notes Cite this as: BMJ 2011;342:d4043 3 Working in Health World Bank June 2011 Working in Health addresses two key questions related to health workforce policy in developing countries: What is the impact of government wage bill policies on the size of the health wage bill and on health workforce staffing levels in the public sector? Do current human resources management policies and practices lead to effective use of wage bill resources in the public sector? Health workers play a key role in increasing access to health services for poor people in developing countries. Global and country level estimates show that staffing levels in many developing countries—particularly in subSaharan Africa—are far below what is needed to deliver essential health services to the population. One factor that potentially limits scaling up the health workforce in developing countries is the government overall wage bill policy which sometimes creates restrictions. Through a review of literature, analysis of data, and country case studies in Kenya, Zambia, Rwanda, and the Dominican Republic, this book examines the process that determines the health wage bill budget in the public sector, how this is linked to overall wage bill policies, how this affects staffing levels in the health sector, and the relevant policy options. But staff numbers are not everything and more money for the health wage bill alone will not solve the health workforce problems of developing countries. Working in Health looks at how effectively governments use the available wage bill resources in the health sector and policy options. Policies and practices in recruitment, deployment, promotion, transfer, sanctioning, and remuneration for health workers are reviewed to identify their influence on budget execution rates, geographic distribution, and productivity of health workers. 4 The book can be ordered online, and an electronic versions can be downloaded using the links below. Also available are Powerpoint presentation summarizing each of the chapters, and a briefing note with ‘Key Messages’’ for policy makers. 5 HIFA-Zambia HIFA2015 June 2011 HIFA-Zambia is the only global e-mail forum on health issues in Zambia. It aims to raise awareness and share best practice on health issues and initiatives in Zambia. The intended audience of HIFA-Zambia are all individuals, from anywhere around the world, who work and/or contribute to and/or are interested in health issues and initiatives in Zambia. Why HIFA-Zambia? We need HIFA-Zambia for at least 3 reasons: 1. There is no alternative global e-mail forum on health in Zambia. An e-mail forum is a cost-effective way of increasing awareness of health policy in Zambia, enabling dialogue and the sharing of best practice. It is also expected to add value to face-to-face meetings or conferences on Zambian health issues in Zambia and around the world. 2. The member organisations of the Zambia-UK Health Workforce Alliance and other organisations working on health in Zambia, have repeatedly expressed the need for a communications platform to discuss and raise awareness of health issues and initiatives in Zambia in order to increase effectiveness and efficiency. 3. HIFA2015 is a global-level network and based on some of the forum’s discussions and topics, have identified that there is increasing demand to explore more in-depth networking of this type at a country level. Also, in line with the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action, the diversity and large number of health initiatives in Zambia supported by bilateral, multilateral, national Civil Society Organisations or International NGOs, creates need for coordination and harmonising in order to facilitate the accountability of all those involved on health in Zambia. HIFA-Zambia aims to bring together all organisations and individuals worldwide with an interest in health in Zambia. How will it work? HIFA-Zambia is a 1-year pilot initiative and collaboration between the Zambia-UK Health Workforce Alliance and the Global Healthcare Information Network/HIFA2015. HIFA-Zambia and HIFA2015 will work in the following ways: 1. HIFA-Zambia will contribute to efforts to raise awareness on health issues and initiatives in Zambia, in line with the Zambia UK Health Workforce Alliance’s vision, as well as contributing towards the HIFA2015 goal of health information for all by 2015. 2. Share a common methodology (Reader-Focused Moderation) and email platform (Dgroups) 3. The lead moderator of HIFA-Zambia, Susana Edjang, liaises with the moderators of other HIFA Global Networks: HIFA2015, CHILD2015, HIFA-Portuguese and HIFA-EVIPNet. 4. Establish a HIFA-Zambia Working Group in parallel (and linking) with the existing HIFA2015 Steering Group. 5. HIFA-Zambia has its own email discussion platform. HIFA networks in other countries HIFA-Zambia is the first country-level e-mail network associated with HIFA2015. If successful, HIFA2015 aims to adapt and replicate the approach in other countries. Zambia UK Health Workforce Alliance The Zambia UK Health Workforce Alliance is a growing network of Zambian-based and UK-based organisations. They work together to promote and improve the coordination and impact of Zambia-UK joint work in health. The Alliance’s aim is to support the Government of the Republic of Zambia to implement its plans to increase and develop its health workforce and its health systems. The Alliance was launched in 11th June 2009 in London, UK. There over 40 member organisations. For further information please feel free to contact us. Susana Edjang, Coordinator, HIFA-Zambia Neil Pakenham-Walsh, Coordinator, HIFA2015 Join HIFA-Zambia 5 6 Handbook on Measurement and Monitoring: Indicators of the Regional Goals for Human Resources for Health Observatory of Human Resources June 2011 The purpose of the handbook is to provide a standardized reference document for countries of the Region that clarifi es the terms and parameters of each of the twenty goals of PAHO’s Resolution CSP27/10, “Regional Goals for Human Resources for Health (HRH) 2007-2015,” in order that they may be consistently understood, applied, measured and monitored. As a self-contained technical instruction manual, the handbook is intended to provide a practical tool to guide the identifi cation and defi nition of initial baseline data to be collected in order to provide a descriptive profi le of countries’ human resources for health to facilitate monitoring their progress towards achieving their HRH goals over time. Available also in Spanish. Visit PAHO website for Manual under Human Resources for Health http://new.paho.org/hq/index.php?option=com_content&task=view&id=1245&Itemid=1497 7 The Women, Girls, and Gender Equality of the Global Health Initiative (GHI): Assessment of the GHI Plus Country Strategies Global Health Council 29/06/2011 This report assesses how countries are responding to a U.S. Global Health Initiative (GHI) principle to address women, girls and gender equality. The report examines country strategies for seven of the eight "GHI Plus" nations: Bangladesh, Ethiopia, Guatemala, Kenya, Mali, Malawi, and Nepal. (The eighth, Rwanda, has not yet completed its strategy.) Each country strategy was developed by interagency U.S. government teams in consultation with host country representatives. All seven strategies addressed the health of women and girls as a top priority, and several went further, including efforts to include women and girls as decision-makers and planners in health care programs. © 2011 The Henry J. Kaiser Foundation For complete article, visit: http://www.kff.org/globalhealth/8206.cfm Read Report: http://www.kff.org/globalhealth/upload/8206.pdf 8 Rapid response and cultural sensitivity among plus points in Pakistan Merlin, UK 27/06/2011 Last year’s floods were a human tragedy on a vast scale. Disease outbreaks, malnutrition and lack of shelter led to serious health problems, requiring urgent action. More than a million homes were destroyed, 2000 people lost their lives and vital fields and livestock were swept away. The British public responded amazingly by donating £71m - £41m via the DEC and £30m via its member agencies, which include Merlin. Today’s report, commissioned by the DEC and produced by the UK-based ThinkAhead consultancy, is an impartial evaluation of the emergency operation mounted by the DEC’s member agencies. Commenting on the report, Merlin’s International Director, Charles Nelson, said: “The rapid response of agencies is mentioned. In our case, we were able to respond so quickly because we had been in Pakistan since the 2005 earthquake. Merlin’s emergency health services were well established, as was our relationship with the government and ministries of health. Our good track record and in-country experience meant we could immediately scale up our operation, sending medical teams into remote communities, setting up health centres and training health workers.” He added: “When disaster strikes, a partnership approach makes a real difference. The report highlights our work with Age UK/HelpAge following the earthquake. We continue to collaborate with other agencies and with the ministries of health because this is the best way to bring lasting benefit, particularly in minimising the impact of future emergencies. Making sure that health centres are well-stocked and that there is a network of trained staff is part our ‘disaster risk reduction’ work, helping to make Pakistan more resilient and less reliant on help from abroad.” 6 He continued: “We were pleased to read the comments about the cultural sensitivity shown by most international agencies. An example of this is our ability to recruit, train and deploy Lady Health Workers who are trusted by local people to provide reliable advice and be the first port of call for basic treatment. “Using a high proportion of national staff and taking care to create health services and facilities that cater for the different needs of men and women is central to the way Merlin works. Community involvement was also praised, although there is always room to work at a deeper level with local people who want to help.” 9 AMREF Seeks Support from Kenyan Manufacturers AMREF 23/06/2011 The Kenya Association of Manufacturers (KAM) recently hosted a breakfast meeting to explore ways in which the association and AMREF can work together. The event was held on June 14 at the Serena Hotel in Nairobi. Welcoming guests to the function, the Chief Executive officer of KAM, Betty Maina, said the breakfast was the result of a discussion that she had had with AMREF’s Director General, Dr Teguest Guerma, on the need for increased local support for organisations such as AMREF, so that they do not have to rely on external support. She stressed the need for corporates and companies to invest in long-term support of local initiatives, rather than one-off projects that do not make a real and sustained impact on people’s lives. “For over 50 years, AMREF has been working with African communities in the most remote and impoverished areas of the continent and making a real difference in the lives of communities. With KAM’s support we are looking at ways for the African corporates to be involved in this success story, and to ensure that AMREF continues to develop and share innovative ways to improve health in Africa,” she said. Dr Guerma gave an overview of AMREF and the work that it does within communities, with a current focus on the health of women and children. She emphasised the fact that AMREF values partnerships – with governments, institutional and corporate donors, communities and community organisations, academic institutions and research organisations – because this is the only way to be efficient and effective, and to reach as many people as possible. Private-public partnerships, she said, provide a win-win situation because organisations like AMREF are better able to meet their objectives with support from the private partners, while the corporates build goodwill among their clients and a healthy customer base, leading to increased sales. The Director General pointed out that AMREF is not an emergency organisation seeking to find quick solutions to problems. “We do not treat the symptoms. We find the root cause, and work with communities to find long-lasting solutions to their health problems,” she said, and urged KAM members to get involved in long-term support of AMREF’s work. The meeting was also addressed by Madame Ida Odinga, Chief Executive Officer of East Africa Spectra and patron of the White Ribbon Alliance in Kenya, KAM chairman Mr Jas Bedi and Mr Rene Kiamba, Johnson&Johsnon’s manager for Corporate Contributions and Giving in Sub-Saharan Africa. Madame Odinga, who is also the wife of Kenya’s Prime Minister, stressed the importance of nutrition in ensuring that the country raises healthy children, who will in turn become healthy parents. Noting that nutrition is one of the areas where AMREF has placed great emphasis, Madame Odinga urged food manufacturers to boost this effort by fortifying their products with vitamins and minerals. Mr Bedi said he was excited about the proposed partnership between KAM and AMREF because it aimed to set up systems for long-term support to communities, rather than one-of projects that did not make a real change in the lives of the people. “This partnership is important because it offers value addition for AMREF and KAM members. Increasingly, companies are moving away from merely meeting their Corporate Social Responsibility through projects to becoming Responsible Social Corporates, with greater and more meaningful engagement with society.” To showcase an example of how AMREF works with Corporates, Mr Kiamba gave an overview of AMREF’s partnership with Johnson&Johnson, which supports the Management Development Institute (MDI). The MDI is a training programme run by AMREF and the Anderson School at the University of California at Los Angeles (UCLA) to enhance the leadership and management skills of administrators of governmental and nongovernmental institutions in delivery of health services to underserved populations. Thirty-five students attended the first MDI class, held in Nairobi, Kenya in 2006. The course has now been established in West Africa and Southern Africa as well, and has so far graduated 537 students. Said Mr Kiamba: “It is important that donors think beyond giving cheques, and instead find ways to interact with AMREF in sustainable programmes that make a real impact in Africa.” A couple of days after the breakfast meeting, Dr Guerma addressed a wider group of KAM members at their Annual General Meeting with a similar appeal for support. Several members pledged to explore ways in which they could partner with AMREF. 7 10 UNICEF and AMREF Formalise Partnership to Improve Health of Women and Children AMREF 24/06/2011 AMREF and UNICEF have signed a Memorandum of Understanding to establish areas of mutual interest and collaboration. To achieve greater efficiency, the two organisations have agreed to develop and implement programmes jointly, particularly to improve the health of women and children. The MOU was signed at AMREF Headquarters by Elhadj As Sy, UNICEF Regional Director for Eastern and Southern Africa, and AMREF’s Director General Dr Teguest Guerma. It spells out several areas of collaboration between the two organisations, including promotion of vaccination of children and women; training of health workers involved in management of maternal, newborn and childhood illnesses, elimination of mother-to-child transmission of HIV, and research to improve public health approaches. Other areas of collaboration are gender mainstreaming, equity and advocacy for women’s and children’s rights, programming for water, sanitation and hygiene, evaluation of projects and resource mobilisation. Dr Guerma described the MOU as timely, as AMREF is reorganising itself and working to position itself as a leading organisation working in health. AMREF, she said, considers it important to work with other organisations in areas of mutual interest in order to develop a common position on Africa’s position on global health issues. For the next three years, AMREF is focusing on the health of women and children, Dr Guerma said, and expressed confidence that the collaboration with UNICEF would go a long way towards making a difference in the health of African communities. Commenting on the new partnership, Elhadj Sy said that UNICEF was committed to making a difference in the lives of communities but needed partners like AMREF in order to do this effectively. “We work in the area of policy and practice, but we need to work with others on the ground to determine what those policies and practices should be, and whether they work. If we are to meet the Millennium Development Goals, it is important that we reach the poorest and most isolated. This MOU with AMREF will enable us to do that because AMREF has a presence in these communities.” Elhadj Sy said that the fact that AMREF works at all levels, from the ground right up to the policy and practice arena, makes it a valuable partner that can help others understand the technicalities of what works in communities. He added that AMREF’s long history of working in Africa has earned it legitimacy and a good reputation, which gives UNICEF confidence in formalising a working relationship through the MOU. Expounding on the implications of the MOU, AMREF’s Head of Programme Management, Mette Kjaer, explains that the MOU gives AMREF greater potential to scale up activities and a wider scope for operation than it would have been able to reach on its own. It points to AMREF’s credibility and therefore opens doors for collaboration with more UN bodies and other organisations. The partnership also gives AMREF an important platform for influencing policy and practice at a global level on issues relating to community health, and especially the health of women and children. Mette adds that the MOU provides avenues for AMREF and UNICEF to fundraise together and leverage each others’ strengths in order to become more effective and expand their activities. “UNICEF does not have direct access to communities, but AMREF does. UNICEF will continue to influence policy and practice at global level, while AMREF as the implementing agency will test policies and practices proposed by UNICEF to see if they work and if they can be scaled up.” Back to top Africa & Middle East 1 SOUTH AFRICA: Midwife shortage impacts maternal health UN IRIN 27/06/2011 DURBAN, 27 June 2011 (IRIN) - At Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, the largest township outside the South African port city of Durban, using midwives to provide maternity services has positively impacted maternal care in the area, but a national shortage of these specialist health personnel has made it difficult to replicate the model elsewhere. “Midwives are integral to ensuring that we take quality care of our mothers and babies,” Rachel Gumbi, the hospital’s CEO, told IRIN. “The success story of this hospital is because of the teamwork between doctors and midwives.” The maternity ward at PMMH is one of the busiest in the country, with more than 1,200 deliveries a month, but the staff of 123 midwives and 15 doctors have managed to reduce both infant and maternal mortality rates. Although 40 percent of the women visiting the hospital’s antenatal clinic are HIV positive, the midwives play a key role in ensuring that 95 percent of those in need of antiretroviral (ARV) medication receive it, and that the rate of mother-to-child transmission of HIV is below 3 percent. 8 The midwives are involved in every aspect of a pregnant woman's health, from pregnancy screening to postdelivery care and the provision of family planning and pap-smears to detect cervical cancer. They receive ongoing training through monthly meetings where they discuss difficult cases, and informationsharing sessions that ensure they are up-to-date on the latest policies and protocols. An outreach mentorship programme is also in place for midwives in outlying clinics who may need to refresh their skills. Such success stories are relatively rare in South Africa. Rather than making progress towards the Millennium Development Goal of reducing maternal mortality by 75 percent by 2015, the number of deaths resulting from pregnancy or childbirth has doubled in the past 20 years. For every 100,000 babies born, up to 625 mothers die due to childbirth complications. Mortality in children under five has also risen steadily and remains stubbornly high at 104 deaths per 1,000 live births, according to government figures. Loveday Penn-Kekana, a maternal health researcher at the Centre for Health Policy, University of the Witwatersrand in Johannesburg, believes South Africa’s poor maternal health outcomes are linked to the lack of midwifery services. “In order for us to address South Africa's maternal health we need to invest in more and better trained midwives,” she said. “Doctors only come into maternity wards from time to time, but it is the midwives who are running the entire service and they are overworked.” Midwives are classified as nurses in South Africa so there are no figures on their numbers, but it is clear that there are too few. Low enrolment at nursing colleges is part of the problem but many midwives have also left the public sector to work for higher salaries overseas or in managerial positions because of the limited opportunities for career development and advancement in the clinical area. No more home deliveries Although pregnant women in South Africa are entitled to free healthcare, Penn-Kekana noted that some face difficulties accessing services because they lack money for transport. The Department of Health has initiated the use of maternal ambulances to transport pregnant mothers to health facilities but challenges remain in rural areas where there are no roads. “I have no job and it is expensive for me to get to the hospital,” said a woman at PMMH who was expecting her seventh child. “I am happy with the service, but it is sometimes very difficult for me to get to my appointments here… because I have no money.” In the past, midwives helped women give birth at home, but there are no longer enough of them for this to be possible. “It makes more sense for the few trained midwives to be stationed at facilities so that they can see more women than for them to be scattered across areas,” said Meisie Lerutla, National Programme Officer for Sexual and Reproductive Rights at the United Nations Population Fund in South Africa. Deliwe Nyathikazi, President of the Society of Midwives of South Africa, noted: "The biggest challenges for us as midwives in South Africa is that there are not enough of us to provide the best care possible. Because people are first trained as a nurse and then given midwifery skills, midwifery is not prioritized.” A plan by South Africa’s Health Minister, Dr Aaron Motsoaledi, to reopen unused nursing colleges across the country and increase the number of nurses should also result in more midwives being trained. Lerutla pointed out that “Once we have increased the number of midwives in South Africa dramatically, the practice of midwife-assisted births at home for women in remote areas can be revisited.” 2 New nurses start one-year community service The News Age, Australia 24/06/2011 Elfas Torerai The crippling shortage of health personnel at various centres across the province is set to ease as 71 new community-service nurses will be deployed to healthcare facilities next month. The nurses will be doing their mandatory one-year community service. The number adds to the 227 nurses who began their community service between January and April. Department of health spokesperson Tebogo Lekgethwane said the nurses had completed their four-year nursing training studies or upgraded their qualifications at Mmabatho College of Nursing and Excelsius Nursing College in Klerksdorp. “A total of 57 nurses will be doing their community service, while the rest have been practising as nurses and upgraded at the colleges,” he said. 9 The department said the new nurses would help address an acute shortage in hospitals, community health centres and clinics, especially in remote rural areas. “Benefits such as rural allowances and occupation specific dispensation are available to all the nurses working in the province. “The department of health will in the next five years increase access to healthcare by placing 1592 nurses to curb the current shortage of nurses in government facilities,” said Lekgethwane. Meanwhile, 220 bursaries would be awarded to new recruits at government nursing colleges and North West University to study a four-year diploma in nursing science and midwifery. Plans are also afoot to reopen the nursing school at Taung Hospital. 3 Zimbabwe has huge midwife shortage - official Afrique en ligne 23/06/2011 Most hit by the departures was the under-paying public service, with teachers and health professionals top of the list. Mombeshora said specialised health services like midwifery lost much of the staff because they were readily in demand, especially in neighbouring countries. As a result, he said the government had started training Primary Care Nurses (PCN) in midwifery as a way of addressing the huge manpower shortage the country was experiencing. But he said the scale of the training did not match the huge numbers required, and therefore Zimbabwe will continue to suffer the shortage of midwives for years to come. 'Our midwifery schools do not have the capacity to train midwives at the rate at which they left the country, and we are trying our best by opening more schools as we did at Howard Mission Hospital,' Mombeshora said, referring to a new midwife training centre which was opened recently. 'There is a huge shortage of midwives in the country and to cover the gap, we are now capacitating PCNs with fundamental midwifery proficiency to assist pregnant women. This is not an ideal situation but only a stop gap measure,' he said. He said another hope for Zimbabwe lay in trying to attract back the midwives who left, but this depended on the current economic recovery and political stability holding. So far, most of the professionals who left the country have stayed put in their jobs abroad, reluctant to return home where the remuneration is low, particularly in the public service. On average, Zimbabwean civil servants are paid US$250 a month, far lower than their counterparts in most countries in the region. 'We hope that salary adjustments for civil servants will help lure back professionals for the betterment of the country,' Mombeshora said. As a result of the midwife shortage, the majority of Zimbabwean women rely on traditional midwives, especially in the rural areas where the bulk of the country's population lives. But in the era of HIV/AIDS and other communicable diseases, this is not only fraught with dangers, but is also strongly discouraged. (Pana) 4 Discovery Foundation boosts rural healthcare News24, SA 28/06/2011 Five years on, The Discovery Foundation has committed some R69 million of its R100 million pledge to bring a total of 300 new medical specialists into South Africa's healthcare system by 2016. The principle aim of the Discovery Foundation is to strengthen healthcare delivery in South Africa by investing in the education and training of medical specialists and the development of academic and research centres. The Foundation focuses on those areas with the greatest need, such as boosting academic and clinical research and sub-specialist training and enabling resource and skills development in rural areas. Celebrating health-care champions The Discovery Foundation recently celebrated 146 healthcare champions at its fifth anniversary annual awards function. These awards provide much-needed support for teaching and research institutions. 10 Dr Jonathan Broomberg, Chief Executive of Discovery Health, said: "Over the years Discovery has maintained its strengthening of the national healthcare system. We are particularly focused on underserved rural areas, where we aim to assist in the development of quality healthcare infrastructure and services for the many communities who previously did not have access". "Access to quality healthcare by rural people, is a dream still to be fulfilled in our life-time," says Prof. Hlengiwe Mkhize, Deputy Minister of Higher Education and Training. Service in remote areas Some of the previous recipients of Discovery rural awards are beginning to show the value of services in remote areas and their communities. The Zithulele Hospital in the Eastern Cape, a recipient in Mqanduli, previously under-resourced district facility with little in the way of resources, proper protocols, or capacity is now a beacon of quality rural healthcare. Dr Patrick Rogers, Chief Medical officer at the Tonga Hospital in Mpumalanga has used part of the grant from the Discovery Foundation to procure much-needed equipment, such as piping for medical air, a wind-up oxygen saturation monitor, and reclining chairs for mothers who have to spend hours a day keeping their underweight babies warm and safe. More rural workers needed "South Africa urgently needs more rural health workers, at all levels," states Dr Broomberg. "However, the dedication of the rural specialists already in the field, coupled with increased training, funding, and support, will help ease the rural healthcare burden, and perhaps inspire more and more young graduates to answer the call of care in the country." Dr Ian Couper, Director of the Centre for Rural Health at Wits University and also a Discovery Foundation recipient, says rural areas, home to 43,6% of the population, are served by only 12% of South Africa's doctors and 19% of its nurses. "Of the 1,200 medical students graduating in South Africa yearly, only about 35 end up working in rural areas in the longer term. And alarmingly, three out of the four districts with the highest HIV prevalence are rural and the burden of non-communicable disease is rising," Couper said. Challenges to healthcare delivery Healthcare delivery faces many challenges in rural areas with high transport and communication costs that cripple clinics and patients alike. Couper says: "One size does not fit all in service delivery to rural areas. A National Human Resources Plan must take rural and remote healthcare into account." As one intervention, the World Health Organisation (WHO) and South Africa's Department of Health issued a report that offers global recommendations on rural access and staff retention. From an educational perspective the report advises the use of targeted admission policies to enrol students with a rural background in education programmes for various health disciplines, in order to increase the likelihood of graduates choosing to practise in rural areas. Few docs in rural practices South African research (De Vries & Reid) reveals that of all the medical students who graduated in South Africa in 1991-2 from 5 medical schools (UCT, UFS, Medunsa, UP, US), 14.4% of graduates were of rural origin, 38.4% of the rural origin graduates currently in rural practice and 12.4% of urban origin graduates in rural practice. The report says the location of health professional schools, campuses and family medicine residency programmes outside of capitals and other major cities as graduates of these schools and programmes are more likely to work in rural areas. Local examples include Stellenbosch University, Wits District Educational Campus model and Wits-North West Family Medicine registrar programme. Exposing undergraduate students of various health disciplines to rural community experiences and clinical rotations can have a positive influence on attracting and recruiting health workers to rural areas, the report says. From a regulatory perspective, one of the suggestions is to introduce and regulate enhanced scopes of practice in rural and remote areas to increase the potential for job satisfaction, thereby assisting recruitment and retention. "It's important to ensure compulsory service requirements in rural and remote areas are accompanied with appropriate support and incentives so as to increase recruitment and subsequent retention of health professionals in these areas," the report says. Financial incentives are also important. "Use a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention." - (Health24, June 2011) 5 Hôpital Jeetoo : Manque d’infirmières et aides-soignantes dans les salles pour femmes L’Express, Mauritius 23/06/2011 Estelle Bastien 11 L’insuffisance de personnel dans les hôpitaux publics est un mal récurrent qui fait régulièrement l’objet des revendications syndicales. lexpress.mu s’est rendu à l’hôpital Dr A.G Jeetoo, à Port-Louis pour voir comment travaillent les infirmières et les aides-soignantes, quand il y a un manque d’effectifs Il est 21h05. Nous sommes dans une salle qui accueilllant les patientes atteintes de diabète et d’hypertension. Il y à là 21 malades. La plupart d’entre elles sont âgées de plus de 65 ans. En temps normal, deux infirmières en charge, deux aides-soignantes et une stagiaire sont affectées à cette salle. Toutefois, ce soir du mardi du mois de juin, tout le personnel de ce département est absent. Seulement deux infirmières venant de d’autres sections y sont affectées en remplacement. « A 18 heures on m’a informé que la salle des patientes diabétiques n’avaient aucune infirmière pour la nuit et que je devais changer de poste. Cela implique que ma collègue doit assurer ma part de service, à mon poste habituel. Sans compter qu’il me faut me familiariser avec le dossier de chaque patiente diabétique, car il n’y a eu aucune passation», nous confie une des infirmières venue en renfort. Elle ajoute que cette situation se répète souvent. Outre le fait de connaître le dossier de chaque patiente, l’infirmière doit s’occuper des admissions, donner les traitements à ses malades, et comme il s’agit souvent de personnes âgées, il faut également les aider à se déplacer. «Nous faisons tout cela. Et il se peut que toutes ces tâches arrivent en même temps, et là, il nous faut, à notre tour demander du renfort », poursuit notre interlocutrice, qui souhaite garder l’anonymat. Les infirmières soulèvent également un autre point. Par moment, il leur est demandé d’assurer le service du soir au moment où elles devraient être en congé, toujours en raison du manque d’effectifs. « Nous sommes payés mais ce n’est pas évident de travailler dans ces conditions, surtout que l’hôpital Jeetoo est un centre de santé régional », explique l’infirmière. En effet, l’établissement hospitalier doit accueillir les malades venant des faubourgs de Port-Louis, mais également ceux des basses Plaines-Wilhems, de Moka, de Saint-Pierre, et de Quartier-Militaire. Selon le personnel soignant de la section des femmes, leur charge de travail est beaucoup plus importante que celle de leurs collègues hommes, à l’hôpital Dr A.G Jeetoo, puisqu’il y a 15 sections pour le traitement des femmes contre sept pour celui des hommes. Avec les grands projets du gouvernement tels que la construction du nouvel hôpital Jeetoo, la crainte du personnel soignant ne fait que s’amplifier puisque le dernier budget ne prévoit pas le recrutement de personnel additionnel. «Il faut compter beaucoup d’années de service pour être infirmière en charge. Mais on est forcé de reconnaître qu’il n’y a pas un grand intérêt pour la médecine. Le nouvel établissement est encore plus grand. Je me demande bien comment nous allons fonctionner ? » s’interroge une autre soignante, qui tient également à rester anonyme. Le président de la Nursing Association, Bagooaduth Kallooa, tient, pour sa part, à mettre en garde le ministère de la Santé. Il affirme qu’à maintes reprises des demandes ont été formulées pour dénoncer les conditions difficiles dans lesquelles opèrent le personnel soignant de l’hôpital Dr A.G Jeetoo mais aussi à ceux de Flacq et de Candos. «S’il y a une erreur médicale, que le ministère prenne ses responsabilités. Puisque les infirmiers sont fatigués de travailler dans ces conditions et aucune provision n’est faite pour recruter du personnel. De l’autre côté, le nombre de patients ne diminue pas pour autant », avertit le syndicaliste. Bagooaduth Kallooa ajoute que pour pallier le manque d’effectifs le gouvernement devrait recruter quelque 500 à 600 infirmiers. 6 Tamale Nurses Community School graduates lack knowledge in some key health areas - Study Ghana News Agency 21/06/2011 Tamale, June 21, GNA- Trainees of the Tamale Community Health Nurses Training School (TCHNTS) lacked knowledge in some key health areas thus making them partially prepared to work at the various heath posts, a 2010 study conducted by the school, has revealed. The study also identified deficiencies in the work of Community Health Officers (CHO) in their areas of competence including safe delivery, management of common ailments, disease surveillance, collection and analysis of routine data as well as report writing. This was made known at a gathering in Tamale on Monday to disseminate and discuss the findings. The study titled: “Evaluating the Relevance and Effectiveness of the CHNT in preparing CHN graduates for the Community-based Health and Planning Service”, was financed by the Netherlands Development Organization with technical support from the UNFPA. 12 Madam Juliet Atinga, Principal of CHNT, giving an overview of the study said the study sought to establish factors that militate against the performance of CHO at the community level. She said that the study employed a qualitative survey methodology with a combination of semi-structure interviews and questionnaire for graduate students working at CHPS, Officials of Ghana Health Service, Supervisors of CHPS and staff of CHNT in four districts in the region. On steps to help the graduates to be productive, she said, the study recommended that the current curricula should be expanded to cover some of the community expectations, especially in the areas of safe delivery and curative nursing. Madam Atinga said the study recommended that the CHPS compounds should be expanded to contain students during their practical training and proposed that the school authorities should collaborate with the GHS to frequently provide in-service training for tutors of the school to upgrade their knowledge and to abreast of current issues on health. It also called on the school authorities to urgently act on the reports that supervisors at the CHPS facilities write about students who undertake practical training in their area. Dr. Akwasi Twumasi, the Northern Regional Director of the Ghana Health Service (GHS), said there was the need to develop nursing models that would be at par with modern trends. He said there should be a strong collaboration between theoretical and practical work to ensure that CHO were well prepared to contribute meaningfully to solving the health challenges of the Northern Region. Dr Twumasi expressed worry that despite improvements in the healthcare facilities, there were inadequate personnel to man these facilities. He noted that in the face of improvements in the various healthcare delivery institutions in the region, maternal mortality was still a major problem, with 81 maternal deaths in 2010 as against 96 in 2009. Improving maternal health is a Millennium Development Goal five, with a global target to reduce the maternal mortality ration by three quarters by 2015. Statistics from the 2008 Ghana Millennium Development Goal Report 2010 indicates that the country attained 56 per cent in 2008 and hopes to achieve a 100 per cent by 2015. Dr. Robert Mensah Reproductive Health Specialist at UNFPA said among the critical roles of CHO’s were the provision of family planning; school health; focused ante-natal care and HIV/AIDS/STI prevention and management services among others which fell within the mandate of UNFPA. “UNFPA has over the years contributed towards raising the health status of Ghanaians by supporting various programme interventions of the Ghana Health Service, among them is the campaign to end obstetric fistula,” he said. Mr. Alhassan Issahaku Amadu, Zangbalung Bomahe-Naa, said the fading role of ethical nursing education had been observed in several circumstances which needed to be checked. He said the desires of patients continued to change and called for modifications in the training methodology to enable graduates appreciate current trends in the profession. 10 Série d’agressions sur des médecins El Watan, Algeria 26/06/2011 Mahmoud Boumelih En plus du manque d’hygiène patent, de l’inconfort et des mauvaises conditions de travail, le corps médical active dans un climat d’insécurité. Le pavillon des urgences médicochirurgicales du tout nouveau établissement public hospitalier (EPH) de Chelghoum Laïd, est sous l’emprise d’une engeance d’énergumènes qui menacent, voire terrorisent impunément la corporation féminine des médecins. C’est ce que nous a déclaré une quinzaine de praticiennes rencontrées sur place. «Nous vivons ces derniers temps un véritable climat d’insécurité induit par la multiplication de menaces et d’agressions tant physiques que verbales, alors que l’hôpital est censé être doté d’agents devant réguler le mouvement des visiteurs et nous protéger contre les dépassements en tout genre», se sont-elles indignées. Que faisaient les préposés à la sécurité de l’établissement, et où étaient-ils au moment de la survenance de ces actes répréhensibles ? Telles sont les questions posées par les intéressées qui n’arrivent pas à s’expliquer qu’elles soient harcelées et violentées par des quidams sur les lieux mêmes du travail. Le pire, selon leurs dires, c’est que lorsqu’elles se mettent à s’insurger et dénoncer les harcèlements qu’elles subissent au 13 quotidien, elles sont menacées de rupture de la relation de travail, vu que la plupart d’entre-elles ne sont pas confirmées dans leurs postes respectifs. Harcèlements répétitifs Craignant donc d’éventuelles mesures répressives, nos interlocutrices ont, sous le sceau de l’anonymat, révélé qu’«en date du 29 mars passé, vers 12h30, deux femmes-médecins ont été menacées et traitées de tous les noms d’oiseau par deux personnes accompagnant un malade». Selon leurs dires, le même scénario se répéta le même jour vers 15h30, lorsqu’un patient (pantalon baissé jusqu’aux pieds) a agressé verbalement une équipe de quatre médecins sans la moindre intervention des services concernés. En date du 17 avril, une femme médecin a été brutalisée par une patiente déchaînée et s’en est sortie avec un certificat d’incapacité de 5 jours délivré par le médecin légiste. Pas plus tard que mardi dernier, un énergumène, profitant de l’absence d’agents de sécurité, des infirmiers et du directeur de garde, s’est introduit à 3h30 du matin dans la chambre de garde, dont il a forcé la porte barricadée par une médecin avec un réfrigérateur pour parer l’attaque de son agresseur. Résultat : entorse grave du poignet ayant nécessité la pose d’un gant plâtré. En réaction à ces deux derniers incidents ayant fait l’objet de rapports circonstanciés, la direction de l’EPH a provoqué un conseil médical extrême et décidé du renforcement de la fonction sécurité avec l’apport de quatre agents. A ce juste propos, les concernées considèrent qu’il «est vain et inutile de renforcer le dispositif sécuritaire si nous devrions continuer à subir le diktat de voyous et d’intrus». Back to top Asia & Pacific 1 Mental Hospital: 374 posts, 72 vacant! Times of India 27/06/2011 Snehlata Shrivastav, TNN | NAGPUR: Shortage of staff, especially qualified psychiatrists, in the regional mental hospital (RMH) in city is emerging as a big hurdle in not just the day-to-day functioning of the hospital but also smooth implementation of various programmes at district and division level. State government has not made the required appointments since 2007 despite enough sanctioned posts. At RMH Nagpur the list of vacant posts is long. It includes one deputy medical superintendent, eight psychiatrists, one anesthetist and chief administrative officer in class I category. In class II category vacant posts include a clinical psychologist, accounts officer, administrative officer and assistant nurse. Seven technical posts are lying vacant in Class III section. In all out of the 374 sanctioned posts, 72 posts are vacant. Majority of them are clinical posts. The hospital does have trained counsellors, therapists and nurses in the field. The shortage of staff at different cadre were brought to the notice of the state government by the 'estimation committee' which visited all the government hospitals in city a few months back. Two years ago a ministerlevel committee too had conducted a study of all the four RMHs in Thane, Ratnagiri, Pune and Nagpur and suggested upgradation of the hospitals and increasing its staff strength. But apparently mental health does not figure in the priority list of the government. Repeated requests during these years by the hospital administration have also fallen on deaf ears. "We have been continuously writing to the state government but didn't get any response," said Nagpur RMH medical superintendent Dr Abhay Gajbhiye. The only good thing that has happened in the recent past is the release of Rs 2 crore funds for construction and infrastructure. This helped in an overall renovation and construction of daycare centre. Some major equipment like the EEG and ECT machines too were procured recently from the Rs 10 lakh fund received from district collectorate. "There is some news about converting all the four RMHs into centres of excellence on NIMHANS pattern. Nagpur RMH too has submitted a proposal for the same. But we are yet to receive any response from the authorities," he said. RMH experts are expected to conduct a tri-monthly inspection of various private psychiatric nursing homes. They are also responsible for ground level implementation of all the government schemes at district level. RMH Nagpur also takes care of such activities in the Akola division which means all the 11 districts in Vidarbha comes under its purview. The deficiency of qualified psychiatrists (eight posts) is affecting all these supervision and implementation activities in rural areas. "We are not able to take up any developmental project. Our staff is so overloaded with just the hospital, which at any given time has at least 500 indoor patients and an OPD of 150-200 daily. Somehow we are managing the show with three temporary psychiatrists appointed on contract basis. Most doctors work for over 12 hours a day," said Dr Gajbhiye. 14 2 MCI approves 150 seats for LG Medical College Times of India 26/06/2011 TNN - AHMEDABAD: After much heated argument amongst its members, the Medical Council of India (MCI) in Delhi finally approved 150 medical seats for LG Medical College on Saturday. The MCI had put the college's name on the no admission list recently after they found deficiencies in infrastructure, staff and other facilities. The college had started its sessions last year. The MCI had visited LG College twice this year-the latest visit being on May 14 before it finally gave approval for the medical seats. The MCI team had earlier reported shortage of nurses and operation theatre (OT) technicians, inadequate facilities and equipment in the labour room. It had also reported of some rusty old equipment in some rooms. The team pointed out the absence of emergency exits and also lack of provision of an OT ventilation as per standards, including a central suction facility. Along with LG Medical College, the MCI also approved 50 medical seats for Bhavnagar Medical College. "These seats were rejected last year owing to some problems," says a source in MCI. The MCI has also increased medical seats in Surat Medical College from 120 to 150. 3 The contract Manila Bulletin 23/06/2011 By RACHEL C. BARAWID MANILA, Philippines — We all know this bitter reality – that thousands of doctors, nurses, and other health professionals march out of the country to seek better opportunities elsewhere. This exodus thus aggravates the shortage in doctors and nurses in the provinces and other remote places in the country. University of the Philippines (UP) Manila Chancellor Dr. Ramon Arcadio says that 75 percent of Filipinos who go abroad are health professionals. In UP Manila alone, Dr. Arcadio reveals that 70 percent of a graduating class go abroad, while only 30 percent remain in the country. “In the mid ‘90s, 70 percent would stay, 30 percent would leave. Ngayon mas marami na ang umaalis. But the good news is that of that 70 percent who leave, a certain number will come back after a few years of training or experience working abroad,” says Dr. Arcadio. Some people blame the schools for this brain drain for not teaching nationalism to their students. Dr. Arcadio believes this should not be the case. “We already included public service in the curriculum. Our students serve marginalized groups in San Juan, Batangas during their internship. But the curriculum cannot remedy this situation. The graduates don’t leave because the curriculum is defective. The decision to go abroad is based on personal and family reasons, the economic situation and even peace and order,” Dr. Arcadio notes. Return service agreement To help address brain drain and further enhance the University’s role in public service, UP Manila has intensified its Return Service Agreement (RSA) policy, requiring all freshmen in its seven health colleges to sign a contract that mandates them to work in the Philippines for a period of not less than two years after graduation. The colleges covered by the RSA policy are the Colleges of Medicine, Allied Medical Professions, Dentistry, Nursing, Pharmacy, Public Health, and the School of Health Sciences (SHS) in Baler, Aurora, Palo, Leyte and Koronadal, South Cotabato. Freshmen students in these colleges should sign the contract which is an absolute requirement for admission in the University. Shiftees and transferees to these colleges are also covered by the RSA policy. Dr. Arcadio says regional Medicine students (those coming from the provinces) are required to render a return service of five years, preferably in their respective provinces. Regular Medicine students, on the other hand, must serve the three-year minimum return service obligation within a time frame of five years from graduation. Students from the rest of the colleges, meanwhile, must complete a two-year return service obligation, also in any part of the country, preferably in underserved areas. In the SHS campuses in Baler, Palo and Koronadal, students are required to render two years of return service per one year of education. All must perform the functions of their respective professions and may also engage in education/training and research. 15 The return service shall be preferably with government agencies, NGOs, and cause-oriented organizations in underserved communities. Residency training in government hospitals can be considered as return service. Serve -- or pay Dr. Arcadio says those who fail to honor the contract will have to pay the penalty -- which is their cost of education times two, plus interest, minus the tuition paid. In Medicine where tuition is one million pesos for a five-year education, the penalty would be two million plus interest, minus the tuition paid. He adds that those who get accepted to fellowships abroad will be allowed to leave, as long as they deposit the amount equivalent to the penalty. This will be refunded to them when they come back and continue their return service. Furthermore, UP Manila is establishing a placement office to assist its graduates in finding jobs in the country, specifically to help them complete their return service obligations. “After four years, that’s the only time we will see how the RSA will really take effect. That’s why as early as now, we are already challenging the Department of Health to provide jobs for the certain number of health care professionals who will graduate in 2015. The university is involved in health care by producing the professionals. The hospitals and the Department of Health should provide the employment.” Need to earn vs. need to serve Dr. Arcadio says health care professionals who do return service will still earn even while serving in depressed communities, although it is not as big as what they can get if they go abroad. “When you get employed in a government hospital, you still get a salary. When you to go to private practice, you earn because you get paid for your services. That’s still counted as return service,” he says. While UP Manila alumni give back in many ways, this still doesn’t count as return service duty. The UP Medical Alumni Society in America, for instance, is very active in giving back to the University through donations, scholarships, professorial chairs and medical missions. But much more is asked of the ‘’Iskolar ng Bayan.’’ “In the future when you’re making good you should be able to contribute to your alma mater and to your community. For many that is acceptable. But the ultra nationalists will not accept (that as part of a return service). Pinagaral ka dito dapat magsilbi ka muna. Pag umalis ka, kahit anong donasyon hindi makakapantay sa iyong hindi naibigay na serbisyo sa mamamayan. The value here is really to serve the people,” stresses Dr. Arcadio. Temporary solution For Gab, a Medicine student (Class 2015), the RSA seems like a temporary solution to address the shortage in health care professionals. He also thinks the policy limits the options of the graduate who cannot work in private hospitals in urban places because that’s part of the conditions of the contract. “After three years, puwede na sila umalis. So hindi dumarami yung doctor mo, pero dumarami yung may sakit,” Gab says. Nicole Bernardo, a third year Medicine student (Class 2014), says the RSA will not limit her options because it has always been a part of her plan to give back in any way she can. “Ingrained na sa akin ‘yung goal to give back and serve the underprivileged. Whenever we do community work, we can already see how big an impact we can make on them. Even our teachers who chose to stay here and made a valiant choice to teach us are very few now but are admirable for making such sacrifice,” she adds. Freshman Medicine student Eman understands their their responsibility as scholars of the state but disapproves of their lack of freedom to choose what they want to do. “The downside is we are forced to do return service. Ang pangit ng itsura na kapag orientation sinasabi na dapat mag serve kayo. Hindi kayo nabibigyan ng choice,” he adds. Martin of Class 2015 says the RSA policy is really necessary for the country today. “Kung aalis lahat ng mga doctors, health care professionals, sino pang maiiwan? Sa abroad I’m sure malaki talaga ang kita doon. Dito maaari kang mahirapan pero kasama mo naman family mo, friends, and relatives. Mas marami kang mabibuild na connections at dito ka pa makakatulong,” he points out. Early tradition The RSA policy is not new to UP as it was first implemented in the College of Medicine (UPCM) in 1915. Then, the University granted tuition fee waiver to those who signed the contract and agreed to serve for two years in government. The provision however, was discontinued in 1920. The RSA policy was later revived in UP Manila’s extension school, SHS in Tacloban, Leyte in 1976 under a verbal contract. In 2008, it became the first college to require students to sign a tripartite contract with the University and the LGUs. 16 The Regionalization program of the College of Medicine, on the other hand, was first implemented under the Acceptance to Serve and Assumption of Liability (ASAL) Agreement” in 2005 where students from the regions undertake annual summer immersion in the provinces. In 2009, the UPCM freshmen were the first to sign the RSA policy for implementation by the time they graduate in 2014. The RSA policy was approved by the UP Board of Regents 4 Help for public hospitals China Daily 25/06/2011 (HK Edition) There's serious public concerning, arising from a shortage of medical staff resulting from a sharp increase in the number of pregnant women coming to Hong Kong from the mainland to have their babies. Measures recently announced by the Hospital Authority appear to have eased the situation somewhat. Restrictions were placed on the number of mothers-to-be coming from the mainland. Overworked medical staff were given what amounted to cash handouts. Nevertheless, the shortage of manpower remains at public hospitals remains. The government has promised to train more doctors and nurses but it will take years for there to be any tangible result. It is obvious the government must permit the hiring of medical professionals from outside Hong Kong to alleviate the crisis at home in the public interest. It is learned that the authorities will slash the quota for pregnant women from the mainland permitted to give birth at public hospitals. That will reduce the numbers from some 10,000 this year to about 3,000 next year, but the limit for private hospitals will be kept at last year's level, which is 10 times higher than their public counterparts. Whether the measure will work depends on how well private hospitals observe the new restriction. Public hospitals will very likely lose more medical staff if private clinics manage to find "grey areas" in the new rules to allow them to exceed their quotas for mainland women. That would enable them to lure more doctors and nurses from public hospitals to meet their growing demand for maternity ward staff. The government plans to hire a small number of high-caliber professionals from overseas to practice medicine without requiring them to take qualifying examinations. This has been met with fierce opposition from local groups, on grounds the outsiders may compromise Hong Kong's medical service quality and harm the public interest. The argument appears specious, since it assumes that medical personnel coming to Hong Kong may have lower qualifications than local staff. There are, in fact, strict criteria for foreign doctors to work here. This is an English translation of excerpts from a Ming Pao editorial published on June 24. 5 Experts call for bridging nurse shortage Times of India 28/06/2011 CHENNAI: There is an immediate need to encourage more students to pursue nursing and paramedical courses to meet the large demand in the field, academicians said here on Monday. At the UK-India Medical Education Seminar, experts said the projected growth in the country's healthcare industry would provide huge opportunities for skilled medical staff here and abroad. "By 2020, the Indian healthcare industry is estimated to be worth $275.6 billion. As of now, 8% of our GDP is spent on healthcare. India needs to spend at least $80 billion more in the next five years to meet targets," said Pradipta Mahapatra, past chairman of the Confederation of Indian Industry (CII) and chairman of the Executive and Business Coaching Foundation India Limited. "Along with around 800,000 doctors, India needs many paramedics and nurses. There is also a large requirement for administrative and management staff," he added. India is one of the major countries sending medical sciences students to the UK and doctors and industry experts said collaboration between UK and Indian universities may provide a solution to the current shortage. In 2009-10, there were more than 4 lakh Indian students in the UK, almost 800 of them nursing students. According to experts, for most of those choosing to study in the UK, cost is a major concern. 6 Doctors for closed hospitals Daily News, Sri Lanka 25/06/2011 Ridma DISSANAYAKE The Health Ministry will resume treating patients at 77 government hospitals which had been kept closed due to the non-availability of doctors after providing sufficient medical officers. 17 The Health Ministry was able to provide doctors to 20 of the 97 hospitals which had been closed for years due to the lack of doctors. Action has now been taken to provide doctors to the remaining 77 hospitals, Health Minister Maithripala Sirisena said. The minister was addressing the Provincial Health Ministers' conference at the National Blood Centre on June 23 participated by provincial health ministers, secretaries and directors, officers from all departments of the Health Ministry and Finance Ministry. According to Health Ministry sources, five hospitals in the North Central Province, three in the Central Province, five in Wayamba, 14 in the Eastern Province, 46 in the North, two in Uva and two in the Southern Province have been closed due to the lack of doctors, of which vacancies are to be filled. 8 Survey warns of country doctor shortage ABC News, Australia 28/06/2011 The South Australian Rural Doctors Association's annual survey shows the average age of country doctors is 51. The survey measures the concerns of country doctors about their work and also shows some country patients wait up to three weeks to see their usual doctor. The association's president, Dr Tim Wood, says fewer rural doctors want to do on-call work, placing pressure on other doctors' ability to work at country hospitals in specialist and emergency treatment. Dr Wood says health administrators should be preparing now for a shortage of country doctors. "We're a little bit disappointed that most of our doctors have not been contacted by their local hospitals with respect to succession planning," he said. "We think really Country Health probably should take a little bit more interest in who's going to be staffing their hospitals in the next five years." 9 Institute 'good' for Fiji Fiji Times 27/06/2011 Mary Rauto THE establishment of an eye training institute is good for Fiji. PAC Eyes, a group of ophthalmologists, president Doctor Ana Cama said prior to Pacific Eye Institute opening its doors in Suva some four years ago, locals had to go abroad for training. She also said the lack of resources was a hindrance in Fiji. "Resources are lacking," she said. Pacific Eye Institute does the training for doctors, nurses and other medical personnel," she said. "So right now the shortage is filled by expatriate personnel but hopefully in the next few years we will have enough trained locals to take up the posts. "Pacific Eye Institute is good because before they came in 2007 we had to go offshore and it was really hard to get offshore hands-on training." Explaining a disadvantage of going abroad for training, Dr Cama said: "You could go and do other course work but to get hands-on training on patients was difficult. "With Pacific Eye Institute, you have hands-on training that's relevant for the Pacific ù eye conditions we see in the Pacific, resources, equipment, all these things are very relevant." 10 High taxes, cost of living deterring overseas recruits The Australian 28/06/2011 Teresa Ooi, Recruitment RECRUITMENT companies have warned that the chronic skills shortage in Australia could become worse because overseas candidates are deterred by our higher taxes and the rising cost of living - thanks to the strong Australian dollar. 18 "We are finding it very difficult to attract the right overseas candidates because of our higher taxes," said Robin Jerome, chief executive of Hamilton, James and Bruce. "The United Arab Emirates and Qatar have zero income tax. In the US, the tax regime is between 18 per cent to 22 per cent. "Why would talented, professional people move to Australia when they have to pay taxes two to three times higher?" However, he said it was less of a problem attracting candidates from Britain and Ireland, which also have a high tax system. "We need significant changes in our taxation system. Australia is also an expensive place to live which has not been helped by the strong dollar, Mr Jerome said." Mr Jerome has called for more flexible visa regulations to help in the recruitment of overseas candidates. His views were shared by Drake Australia chairman Ron Urwin, who said Australia had "a severe skills-shortage problem" that would only get worse. "We have to try to simplify the process of recruiting overseas candidates because the visa restrictions are far too complex and lengthy. "Previously, we were able to recruit nurses on visa 457, but this is not available any more - and yet we can recruit doctors on visa 457. I just don't understand why." Mr Urwin said the government should focus on making it easier and simpler to recruit overseas candidates. "Our economy will not be able to reach its full capacity to grow if we continue to be restricted in getting overseas candidates to come here," Mr Urwin said. There has been a softening in the full-time jobs market in the past three months - down 37,000 compared to the previous quarter. But listed recruiter Talent2 chief executive John Rawlinson is not phased by the blip, saying it reflects a "slight nervousness in the marketplace". Mr Rawlinson said there was a chronic shortage of mid-tier professionals in infrastructure, engineering, IT, nursing and medicine. "The problem is only going to get more acute unless the government becomes more flexible in allowing the recruitment of overseas professionals in the high-demand industries such as mining and medical. "Australia is an attractive place to live and we are among the top two or three countries in the world with a good standard of living. But we have become a relatively costly place and highly taxed when compared to Hong Kong, Singapore and the Middle East. This has certainly been a deterrent and puts us at a competitive disadvantage." Mr Rawlinson said the mining boom had also put additional pressure on wages. "The wage difference is mind-boggling. A welder working on an offshore oil project could earn as much as $300,000 a year compared to $70,000 to $80,000 for a welder working in a factory or on construction site." He also singled out cooks and truck drivers in West Australian mines being paid $150,000 a year compared to $50,000 to $60,000 working in mainstream jobs. Mr Jerome said there was an acute shortage of skilled labour across the board - from sales and marketing managers to doctors, nurses and accountants. Ranstad Recruitment chief executive Fred van der Tang has also called for a relaxation of the red-tape for overseas recruitment. "The tests of overseas candidates are very stringent," he said. "These could be eased, and the number of foreign workers should also be increased. "At the same time, companies should fund more training of staff and not depend on overseas candidates to solve the skills-shortage problem. "More could also be done to employ more retirees on a part-time basis. But Australia is still a little oldfashioned in this area. "We need a balanced approach to solving this issue." Mr van der Tang said. While Australia has a high tax system, overseas candidates looking to work here are not going to be swayed by salaries only. "Unfortunately, many companies are wanting to recruit 25-year-olds with 40 years' experience." Adecco Group's chief executive for Australia, Jeff Doyle, suggested one way of solving the chronic shortage of skilled workers was to adopt a flexible approach by employing more temporary workers including retirees. "There are about 400,000 temporary workers in Australia and we expect this number to grow by about 6 per cent a year until 2015 due to the shortage of skilled and semi-skilled workers," Mr Doyle said. 19 He said employing temporary workers enabled companies to adjust their labour supply to meet the peaks and troughs of their business needs, which would help them to save on labour costs. Back to top North America 1 Experts Explore Solutions to Nursing Shortage, Skills Gap Business Wire 21/06/2011 WASHINGTON--(BUSINESS WIRE)--The Bureau of Labor Statistics predicts the U.S. will need to add 580,000 nurses to the workforce by 2018. Moreover, these nurses will need higher skill levels than current nurses possess. The Institute of Medicine recommends that 80% of registered nurses hold a bachelor’s degree or higher by 2020. Yet only half of nurses now have this credential. Experts say the nursing shortage and skills gap jeopardize our nation’s ability to provide care, especially for the aging population. To explore these issues and possible solutions, on Tuesday, June 21, the University of Phoenix Research Institute sponsored the expert panel event, “Critical Conditions: Preparing the 21st-Century Nursing Workforce,” at the National Press Club in Washington, DC. Hosted by The Chronicle of Higher Education, the event attracted academic and industry leaders with a wide range of expertise in nursing education, practice, and policy. Panelists included nursing school deans, healthcare executives, and technology experts. They addressed educational and policy strategies to advance a new generation of competent and compassionate nurses. “Academia needs to partner with organizations employing nurses to ensure that students are learning the skills employers need today,” said panelist Dawn Bazarko, senior vice president for the Center for Nursing Advancement at UnitedHealth Group. She noted that the nation’s hotly debated nursing shortage is a “paradox” because “many graduates can’t find employment.” Some educators believe the future of nursing depends on recruiting more men and minorities into the profession. Panelist May Wykle, nursing dean at Case Western Reserve University, described her institution’s community outreach program in which nursing students work with underserved schoolchildren and teenagers to get them interested in a nursing career. Panelists discussed the role of technology in preparing nurses to be more efficient while not losing the “human touch.” One of the most important benefits that technology can provide nursing students, said Parvati Dev, president of Innovation in Learning, Inc., is a “library of virtual experiences that it would take years for them to acquire in real life.” Moderator Tracey Wilen-Daugenti, vice president and managing director of the University of Phoenix Research Institute, presented preliminary findings from current research on nurses’ technology skills related to electronic health records. “The research shows that higher education must do more to help nurses develop technical skills to improve the quality and efficiency of care,” she said. Educating the next-generation nursing workforce requires adaptable educational models, said Pamela Fuller, dean of the University of Phoenix College of Nursing. “Many nurses have heavy family and work obligations, and need education that fits their full schedules,” she said. “Educators need to provide flexible options for taking classes, whether on-campus or online.” Other panelists included Carlton G. Brown, president of the Oncology Nursing Society; Maureen Swick, senior vice president and chief nurse executive, Inova Health System; Athena Palearas, corporate vice president of education, Fresenius Medical Care North America; and Kristy Chambers, cofounder and principal partner of Medical Simulation Design. Drawing on current research related to nursing education, technology and workforce skills, panelists explained what actions today can ensure a healthier tomorrow for the nursing profession. The University of Phoenix Research Institute will publish a special report on the event in fall 2011. About University of Phoenix Research Institute Affiliated with one of the largest providers of higher education for working adults, the University of Phoenix Research Institute conducts scholarly research on working learners, higher education, and industry to improve academic outcomes and promote a more prepared workforce. Visit www.phoenix.edu/institute. About University of Phoenix University of Phoenix is constantly innovating to help students balance education and life in a rapidly changing world. Through flexible schedules, challenging courses and interactive learning, students achieve personal and career aspirations without putting their lives on hold. University of Phoenix serves a diverse student population, 20 offering associate, bachelor’s, master’s, and doctoral degree programs from campuses and learning centers across the U.S. as well as online throughout the world. For more information, visit www.phoenix.edu. 2 Money woes, infighting plague UW nursing school Seattle Times 22/06/2011 By Carol M. Ostrom, Seattle Times health reporter The University of Washington's top-ranked School of Nursing is losing its dean and — according to a sharply critical consultant's report — is beset by low morale, internal strife and a lack of shared purpose among its faculty and staff members. Hit with budget cuts, the school is suffering from a lack of trust between faculty and Dean Marla Salmon, according to the report, commissioned by Salmon in collaboration with top UW administrators. The consultants, who presented their report to the school earlier this month, said that instead of a shared vision for the future, they found what they termed "tribal behavior," with separate departments and specialty areas pitted against one another and the school as a whole. Last month, Salmon tendered her resignation, effective a year from now. The situation couldn't come at a worse time for the school, which is not only braced for another round of cuts in state funding but is under pressure by lawmakers and hospitals to help relieve an acute shortage of both nurses and the teachers to train them. With an aging population and a national health overhaul ahead, many see the UW school as uniquely qualified to train leaders for expanded roles in health care and research. But for now, the school has work to do. The report paints a picture of a formerly flush academic institution unprepared for the tough choices made necessary by devastating budget cuts. In the consultant's survey, 64 percent of staff and faculty said they were highly concerned about the school's leadership and vision. Over the next year, Salmon, a nationally known nursing leader, will help the school comply with the recommendations outlined in the report. "I was looking for help for all of us — me included," Salmon said in an interview last week. "I didn't have the answers, either." Walking into a crisis In early 2008, Salmon, then at Emory University where she'd been dean of nursing since 1999, accepted the UW's job offer. A former nursing director in the U.S. Department of Health and Human Services, she was a national voice on work-force issues, warning of a growing shortage of nurses and nursing instructors. Her new job paid $337,000 and, she believed, would focus on building up UW programs — in particular global health, an area close to her heart. But the reality she found when she arrived here in October 2008 was much different. Instead of leading the school forward, she realized, her new role would be to slash long-standing programs in the face of the school's "worst financial crisis ever." The school's resources, she said, were all poured into teaching and research, with no budgeting system or reserve fund that might cushion a sudden loss of revenue. "The systems we needed to address the challenges — even down to basic information like how much revenue we had — were not in place." Like much of the university before mid-2008, the nursing school had never had to confront such a grim budget and tough choices. Whatever the school was doing, some had figured, it must be right because year after year it got top billing among its academic peers in the U.S. But within months after arriving, Salmon was plunged into what she described as no-win choices: Cut the popular family-nurse-practitioner program — or require students to shoulder the entire cost. Angering faculty, she pulled the plug on a beloved study-abroad program in Costa Rica and Thailand, increased teaching loads and reduced teaching assistance. "This kind of change leaves you reeling," Salmon said in an interview last week. "Failure of leadership" 21 Salmon, 62, spoke admiringly of the "ingenuity and entrepreneurial spirit" at the school, saying it has "succeeded in ways that no other school in this country has succeeded." But, as the consultant's report noted, such individuality can have a double edge. Like surgeons, academic faculty members have specific expertise and see themselves as semi-independent, a posture that can — and did — bump up against the reality of budget constraints. As the economic crisis hit, for example, lawmakers were irked by the school's decision, later rescinded, to require advanced registered nurse practitioner (ARNP) students to seek doctorates instead of master's degrees. In letters to Salmon, heads of both House and Senate health committees complained that the change would cost students time and money and shrink the supply of nurses "at a time when they are needed the most." As cutbacks began, David Lovell, then chairman of the UW's Faculty Senate, began hearing more and more from nursing faculty. While all schools were feeling the pinch, the level of "disagreement and disaffection" among nursing faculty stood out, Lovell said. Many faculty members blamed Salmon — not for the budget crisis, he said, but for what they saw as "a failure of leadership, consultation and civility, and a perceived disregard for the faculty's right to substantial authority over curricular decisions." Sorting out the turmoil at the nursing school was "one of the gnarliest challenges" consultant Steve Boyd of MacDonald Boyd & Associates had faced in his long career, he later told faculty and staff. His company's three-month investigation found that those in the school's various departments and specialty areas operated as a "disaggregated set of interests" rather than an integrated whole. One of the school's employees, he said, summed it up best: "The school hasn't really had a vision for years — (being) #1 is it. It really is all about us as individuals." In a show and tell, Boyd laid it out: Your hierarchy is too heavy-handed. Learn to make decisions and resolve conflicts. Get a sustainable business model. Don't support work that doesn't further future priorities. And find a better balance of research and teaching — a sore point for some. Josephine Ensign, who has taught at the school for 16 years, said morale is at an all-time low, with a "chaotic and inefficient system — a lack of clear communication channels and a lack of strong leadership at all levels," making it increasingly difficult to be a good teacher. Faculty and staff reacted to the critical report with relief, heartfelt responses and even tears. "This has been hard work for everybody," said Salmon, who told staff in a memo it was the right time for her to return to the work that had brought her to the UW in the first place — global health, social responsibility and public health. A longtime board member of the Robert Wood Johnson Foundation, she was recently appointed to a special committee of the Council on Foundations, and has consulted with members of the World Health Organization. Business principles Nancy Woods, who was dean from 1998 to 2008, said committed faculty members always reach beyond the budget. "The mark of a great university is that your ambitions as a faculty always exceed your resources," she said. "We didn't get that top ranking by just demurring." That's true, said UW Interim President Phyllis Wise, "but unrealistic today." Faculty all around the university are now warily confronting that "b" word — "business" — as UW leaders emphasize the need to infuse business principles into their academic plans now that cuts have slashed more than 50 percent of state funding over three years, Wise said. As provost, Wise worked closely with Salmon during the crisis and turmoil. "I think it's very important to do what Marla has attempted to do — and that is to prioritize," she said. "If you try to do everything today, it's not going to be possible to do it at that level of excellence we've come to expect here at the University of Washington." Wise and Interim Provost Mary Lidstrom have formed committees to help the nursing school move ahead, and Wise said she's optimistic it will continue to thrive. But, like other UW colleges and schools, "it is going to be a different place two or three years from now than it was five years ago. I think we all have to acknowledge that." 3 Central Nebraska hospitals prepare for national nursing shortage News 5 KHAS-TV /01/2011 22 Jordan Shefte Across the country, we're facing a major nursing shortage, and it's only expected to get worse. By 2020, it's estimated hospitals nationwide will be short 340,000 nurses. Good Samaritan Hospital says at any given time, they have about 20 nursing jobs available. It's not a large number compared to other states across the country. But, officials fear that more positions may be opening in the near future. "We're gonna have a lot of nurses who are in the field right now will be retiring," said Carol Wahl, RN. "That is probably the main reason. At the same time the national need for nursing continues to rise, so we need a greater supply." According to the Nebraska Center for Nursing, it is projected that in 2020, Nebraska will face a nursing shortage of nearly 4,000 professionals. The current nursing shortage has been the longest in the last 50 years. But the lack of nursing doesn't start in the medical field, it originates in education. When the nursing shortage was first announced, there was immediately an increase in students looking to major in the area. But, that causes another problem. "We now are at the point where the schools are at maximum capacity given size of their building, the size of their classroom, the number of classrooms that they have, and the number of faculty," said UNK School of Nusring Assistant Dean Steven Pitkin. The lack of space and lack of educators means that schools have had to turn away qualified applicants from their programs. Last year, 147,000 students were rejected from nursing schools across the nation. But for those who already have a diploma in their hand, the shortage might not be a bad thing. "Through 2020 and beyond there will be more than enough positions for nurses," Wahl said. The University of Nebraska is currently working to offset the nursing education problem. The Norfolk, Lincoln, and Omaha divisions all have plans for new facilities that will allow them to increase their student enrollment. 4 University Partners with Healthcare Organization to Increase Academic Opportunities for Nurses US News University 23/06/2011 By Scott Manning As healthcare rules and regulations continue to change, many organizations are suggesting that the industry would benefit from more nurses earning higher degrees. This would allow for facilities such as hospitals and nursing homes to give these professionals more responsibilities, which would be a big help in light of a potential shortage of primary care providers. In an effort to to meet the growing demand for nurses who hold advanced credentials, many postsecondary schools are partnering with healthcare facilities to increase opportunities for career development among employees. For example, the University of Indianapolis (UIndy) recently collaborated with Franciscan St. Francis Health to offer on-site courses at St. Francis facilities and faculty exchanges, according to a press release. Through the partnership, students in UIndy's bachelor's of science in nursing (BSN) or master's of science in nursing (MSN) programs have the opportunity to receive real-world experience. "In the current healthcare marketplace, there's a real need for nurses with the advanced preparation to take on management and administrative roles, as well as for educators who can prepare new generations of nurses and meet the workforce demand," said Anne Thomas, dean of the UIndy School of Nursing. 5 U.S. Plans Stealth Survey on Access to Doctors New York Times 26/06/2011 By ROBERT PEAR 23 WASHINGTON — Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it. The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates. Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem” of a shortage of such physicians in the United States, the Department of Health and Human Services said in a description of the project prepared for the White House. Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government. “I don’t like the idea of the government snooping,” said Dr. Raymond Scalettar, an internist in Washington. “It’s a pernicious practice — Big Brother tactics, which should be opposed.” According to government documents obtained from Obama administration officials, the mystery shoppers will call medical practices and ask if doctors are accepting new patients and, if so, how long the wait would be. The government is eager to know whether doctors give different answers to callers depending on whether they have public insurance, like Medicaid, or private insurance, like Blue Cross and Blue Shield. Dr. George J. Petruncio, a family doctor in Turnersville, N.J., said: “This is not a way to build trust in government. Why should I trust someone who does not correctly identify himself?” Dr. Stephen C. Albrecht, a family doctor in Olympia, Wash., said: “If federal officials are worried about access to care, they could help us. They don’t have to spy on us.” Dr. Robert L. Hogue, a family physician in Brownwood, Tex., asked: “Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.” In response to the drumbeat of criticism, a federal health official said doctors need not worry because the data would be kept confidential. “Reports will present aggregate data, and individuals will not be identified,” said the official, who requested anonymity to discuss the plan before its final approval by the White House. Christian J. Stenrud, a Health and Human Services spokesman, said: “Access to primary care is a priority for the administration. This study is an effort to better understand the problem and make sure we are doing everything we can to support primary care physicians, especially in communities where the need is greatest.” The new health care law includes several provisions intended to increase the supply of primary care doctors, and officials want to be able to evaluate the effectiveness of those policies. Federal officials said the initial survey would cost $347,370. Dr. Hogue said the money could be better spent on the training or reimbursement of primary care doctors. The White House defended the survey, saying a similar technique had been used on a smaller scale in President George W. Bush’s administration. Most doctors accept Medicare patients, who are 65 and older or disabled. But many say they do not regard the government as a reliable business partner because it has repeatedly threatened to cut their Medicare fees. In many states, Medicaid, the program for low-income people, pays so little that many doctors refuse to accept Medicaid patients. This could become a more serious problem in 2014, when the new health law will greatly expand eligibility for Medicaid. Access to care has been a concern in Massachusetts, which provides coverage under a state program cited by many in Congress as a model for President Obama’s health care overhaul. In a recent study, the Massachusetts Medical Society found that 53 percent of family physicians and 51 percent of internal medicine physicians were not accepting new patients. When new patients could get appointments, they faced long waits, averaging 36 days to see family doctors and 48 days for internists. In the mystery shopper survey, administration officials said, a federal contractor will call the offices of 4,185 doctors — 465 in each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia. The doctors will include pediatricians and obstetrician-gynecologists. The calls are to begin in a few months, with preliminary results from the survey expected next spring. Each office will be called at least twice — by a person who supposedly has private insurance and by someone who supposedly has public insurance. Federal officials provided this example of a script for a caller in a managed care plan known as a preferred provider organization, or P.P.O.: Mystery shopper: “Hi, my name is Alexis Jackson, and I’m calling to schedule the next available appointment with Dr. Michael Krane. I am a new patient with a P.P.O. from Aetna. I just moved to the area and don’t yet have a primary doctor, but I need to be seen as soon as possible.” 24 Doctor’s office: “What type of problem are you experiencing?” Mystery shopper: “I’ve had a cough for the last two weeks, and now I’m running a fever. I’ve been coughing up thick greenish mucus that has some blood in it, and I’m a little short of breath.” In separate interviews, several doctors said that patients with those symptoms should immediately see a doctor because the symptoms could indicate pneumonia, lung cancer or a blood clot in the lungs. Other mystery shoppers will try to schedule appointments for routine care, like an annual checkup for an adult or a sports physical for a high school athlete. To make sure they are not detected, secret shoppers will hide their telephone numbers by blocking caller ID information. Eleven percent of the doctors will be called a third time. The callers will identify themselves as calling “on behalf of the U.S. Department of Health and Human Services.” They will ask whether the doctors accept private insurance, Medicaid or Medicare, and whether they take “self-pay patients.” The study will note any discrepancies between those answers and the ones given to mystery shoppers. The administration has signed a contract with the National Opinion Research Center at the University of Chicago to help conduct the survey. Jennifer Benz, a research scientist at the center, said one purpose of the study was to determine whether the use of mystery shoppers would be a feasible way to track access to primary care in the future. The government could survey consumers directly, but patients may not accurately recall how long it took to get an appointment, and their estimates could be colored by their satisfaction with the doctor, researchers said. A version of this article appeared in print on June 27, 2011, on page A1 of the New York edition with the headline: Stealth Survey To Test Access To Physicians. 6 Doctor of Nursing Practice programs prepare students for advanced roles in health care Graduate Guide 21/06/2011 The American Association of Colleges of Nursing (AACN) expects the U.S. to experience a nursing shortage over the next several years. A factor that is contributing to the shortage is an aging baby boomer population in need of health care. As a result, there is a need for new professionals in the field of nursing, in addition to advanced programs that can train them. AACN states that 160 Doctor of Nursing Practice (DNP) programs are currently in the planning stages at various schools. Loyola University at New Orleans is among the schools that plan to address this situation. The school recently announced that it has received initial approval from the Louisiana State Board of Nursing to develop a DNP advanced track. "Nurse practitioner education is evolving and offering this new course of training is the next step in that process," says Gwen George, assistant professor of nursing at the university. This three-year program allows individuals who hold a bachelor's degree to earn a DNP. George adds that graduates of this track will be eligible to receive certification and can become a family nurse practitioner. The university hopes to launch the DNP in April 2012, pending state board approval. By Monique Smith 7 Administration Halts Survey of Making Doctor Visits New York Times 28/06/2011 By ROBERT PEAR WASHINGTON — The Obama administration said Tuesday that it had shelved plans for a survey in which “mystery shoppers” posing as patients would call doctors’ offices to see how difficult it was to get appointments. “We have determined that now is not the time to move forward with this research project,” the Department of Health and Human Services said late Tuesday. 25 The decision, after criticism from doctors and politicians, represents an abrupt turnabout. On Sunday night, officials at the health department and the White House staunchly defended the survey as a way to measure access to primary care, and insisted that it posed no threat to privacy. Health policy experts have long expressed concern about a shortage of primary care doctors, including family physicians and internists. The shortage, they say, could become more serious if, as President Obama hopes, more than 30 million people gain insurance coverage under the health care law passed last year. Having coverage is not the same as having ready access to care — a fact demonstrated in Massachusetts, which has come closer than any other state to the goal of universal coverage. A recent survey by the Massachusetts Medical Society found that about half of family doctors and internists were not accepting new patients. Plans for the federal survey were devised by the office of the assistant health secretary for planning and evaluation, Sherry A. Glied, and the government retained a big survey research company to help conduct it. Ms. Glied declined Tuesday to respond to questions about cancellation of the survey. Administration officials evidently concluded that the survey could be a political liability. But Christian J. Stenrud, a Health and Human Services spokesman, said, “Politics did not play a role in the decision” Tuesday. Doctors and many Republican lawmakers criticized the project, after a New York Times article about it on Monday. “The cost and proposed clandestine method of collecting information from physician offices are questionable,” said a letter to the administration drafted Monday by Senator Mark Steven Kirk, Republican of Illinois. Mr. Kirk demanded answers to 12 questions about the survey. Mr. Kirk asked why the survey was needed, since, he said, “there have been a number of reputable studies that confirmed many patients on Medicaid and Medicare cannot find a doctor to see them.” A spokesman for the health department said the survey was “on indefinite hold.”’ Dr. George J. Petruncio, a family doctor in southern New Jersey who had criticized the idea of using secret shoppers, welcomed the decision to lay it aside. “Let’s hope that we can make progress the right way, build trust in the government and work together to find solutions,” Dr. Petruncio said Tuesday. Senator Orrin G. Hatch of Utah, the senior Republican on the Finance Committee, said the administration was “wasting taxpayer dollars to snoop into the care physicians are providing their patients.” Mystery shoppers had been planning to call the offices of 4,185 doctors — 465 in each of nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia. 8 Nursing School Leads HIV/AIDS Research, Outreach in Rural South African Communities UVA Today, University of Virginia 29/06/2011 June 29, 2011 — Palliative care, focused on relieving and preventing suffering and other complications associated with dire illness, is an "urgent humanitarian responsibility," according to the World Health Organization. In South Africa, the need for such care is great. It has the highest number of HIV/AIDS infections in the world and the disease and associated complications account for an estimated 42.5 percent of maternal deaths and for 35 percent of deaths in children under 5. To help meet the need for palliative care in South Africa, University of Virginia nursing professors Marianne Baernholdt and Cathy Campbell and two students will spend three weeks there building partnerships, researching palliative care needs, developing care assessment tools and training health care providers and community workers in Mpumalanga and Limpopo provinces, rural areas where there is limited access to basic services like health care, clean water and transportation. The project, "Palliative Care Partnerships in South Africa: Research and Education," is funded by a $20,000 Deepening Global Education grant from U.Va.'s Center for International Studies. One goal is to involve South African partners at every level of the project to learn what ideas and programs they have in place, and not merely to implement a set of preconceived plans and procedures, Baernholdt said. The team developed an expert panel to advise them and help develop a palliative care needs assessment tool that incorporates culturally appropriate instructional material. It includes the use of narratives about challenging situations for health care providers and community health workers. The panel also helped develop a tool for evaluation of palliative care processes and outcomes. 26 Campbell's research and clinical work are focused on hospice and palliative care decision-making and outcomes, with an emphasis on making end-of-life decisions -and educating nurses in rural communities about pain management. Baernholdt's research centers on how to measure quality of care in global rural areas and the factors that impact quality of care. The U.Va. team and its South Africa partners have been communicating via Skype every two weeks since January. "Our South African partners are part of the planning and organization of the project," Baernholdt said. "They have identified participants and helped with logistics down to the very last detail." That collaboration has included where they will find the nearest place to buy drinks and snacks in such a rural area, whether they need to bring markers, pens and other materials for the education sessions, and helping identify meeting locations that are easily accessed by health care providers and community workers. The hope is that by building partnerships and involving organizations in the community, the project will help local organizations, caregivers and community workers to continue palliative care assessments, learning sessions and evaluations of palliative care processes and outcomes after the research team departs. The team will meet with 70 to 80 health care providers and community workers. "They are able to tell us what is important to them and what their needs are," Campbell said. "Often research available in journals is not current and working with community partners we can get current information. It makes for a better project. "If we do what we do the right way, the community will champion the project." They will also spend four days interacting with faculty and developing interdisciplinary partnerships related to palliative care at the University of Venda in Thohoyandou, Limpopo province, with which U.Va. has established an ongoing relationship. A second goal is to identify Mpumalanga as a future site for U.Va. student outreach projects and clinical practicums for nursing students, Baernholdt said. The two students who will travel to South Africa with Baernholdt and Campbell will assist with all aspects of the project and help analyze research data. They also each will work on an independent research project. Caitlin Carr is a May graduate of U.Va.'s Frank Batten School of Leadership and Public Policy who is returning in the fall for the fifth-year master's program. She is the first recipient of the school's Stephanie Jean-Charles Fellowship, named for the Batten student who died in the 2009 Haiti earthquake. The fellowship will fund her independent research while she is in South Africa, including talking with administrators and creating an analysis for HIV/AIDS palliative care policy. "We thought the interdisciplinary aspect of the project was very important," Baernholdt said. Fourth-year nursing student Sarah Borchelt received two grants from the School of Nursing to fund her independent research: a Rodriguez Nursing Student Research and Leadership Fund award and Susan McDonald Nursing Student Research Award. She will assess palliative care needs and resources for children whose lives are affected by HIV/AIDS, either because they are sick or have lost friends and family. She will work with The Hospice and Palliative Care Association of South Africa and partner organizations. "The AIDS rate is so high there and the parents are dying so young," Borchelt said. Borchelt's goal is to assess existing palliative care services in the Nkomazi region of Mpumalanga to find out how many children are seeking and receiving palliative care; identify specialists who work specifically with children; assess training needs of health care workers who work with children; seek out facilities that are childfriendly; and identify hospice care. She will also talk with workers to ascertain their views on palliative care for children and ascertain whether there are national or provincial policies that address children. Palliative care is taken in a broader context in South Africa than in the U.S., where it is focused on hospice and pain relief and has a medical framework, Campbell said. "In South Africa, health care workers may have to make sure that patients have food, which they need to take with the HIV/AIDS medications, or that the children have shelter or are going to school." — By Jane Ford 10 Alberta nursing grads can expect casual, not permanent jobs Edmonton Journal, CA 23/06/2011 By Jodie Sinnema, edmontonjournal.com EDMONTON - Alberta is hiring more than 70 per cent of new nursing graduates, but isn’t quite fulfilling its contractual promise to do so because many of those positions are casual rather than full-time. 27 Heather Smith, president of the United Nurses of Alberta, says it’s disappointing 59 per cent of new graduates have been hired into casual positions. But the union isn’t overreacting, since Alberta is heading in the right direction after years of upheaval and mixed messages that flipped nursing shortages into nursing gluts and back again. “We know they haven’t met the mark on the new grad initiative, but what are we going to do to turn it around,” Smith said. “This is part of that big ship we had going in reverse for a while and turning it around takes time. … It’s slow and it’s been demoralizing and I think it’s been a real challenge to try to keep people’s spirits and optimism up that things can change and will change and that Alberta Health Services and the government is committed to making those changes.” Smith said Alberta has been short 1,500 and 2,000 nurses for the last four to five years. Provincial health authorities struggled with that shortage in 2008. While recruiting from India, the Philippines and United Kingdom, it had to close operating rooms due to lack of staff which forced people with broken bones to wait longer for care. One year later, the situation appeared to reverse. External recruitment stalled and the new provincial health authority suggested to the nursing union that Alberta had too many nurses. Alberta Health Services, squeezed by a $1.3-million deficit, froze hiring efforts and set up a voluntary retirement program that paid more than $20 million in buyout packages. Vacant positions were left empty. Now, the province acknowledges a perennial nursing shortage and signed a three-year contract with the union representing 24,000 registered nursing, in which it promised to hire 70 per cent of all nursing graduates into regular positions. Those are full-time, part-time or temporary positions as opposed to casual ones, which give no benefits or regular hours. From the time that contract was signed in June 2010 until the end of March, Alberta Health Services hired 1,383 new nursing graduates, or 87 per cent of the total. Of those, 650, or 41 per cent, were regular positions. The rest were casual. “We are pretty confident that we will hit our 70 per cent commitment this coming year,” said Deb Gordon, senior vice-president and chief nursing and health professions officer for Alberta Health Services. She said the health authority would hire 100 per cent of the new graduates if that were possible. “We all know that over the course of time, we are likely, like every other industry, going to experience a shortage of professionals so we’re working really hard in Alberta Health Services to come up with our model, strategy and plan that will allow us to make sure we have the people in place to look after patients and families.” Gordon said the government’s five-year funding plan, which guarantees health budget increases of six per cent for three years and 4.5 per cent the following two, has brought financial stability to the system and an ability to better predict nursing demand. Alberta Health Services currently has 400 nursing jobs posted. That’s a good start, but more of those positions need to offer regular hours, Smith said. Of the 400 positions, 100 are full-time, about 230 are part-time and 70 are casual, she said. “Staffing is a huge, huge issue and the 400 positions that are posted bear no relationship to the actual needs,” Smith said. In a recent survey of the union’s members, while 25 per cent said staffing was adequate on the front lines, 29 per cent they needed one more full-time registered nurse to provide adequate care. Another 39 per cent said more than one full-time nurse was needed. She said the care gaps have been Band-Aid-ed over by part-time, even full-time, nurses picking up extra hours. Yet there is growing recognition that regular staffing positions are a better way to go. Last year, Alberta’s health superboard employed 24,560 registered nurses. This year, 24,686 are working, or a net increase of 126 nurses. “‘We desperately need you,’” Smith tells nursing grads. They are part of the shortage solution, as is expanding training programs and offering incentives to help fill rural and remote nursing positions. “It’s hiring 100 per cent of the grads and hoping we can turn around some of the toxicity in some of the workplaces.” Ashley Estrin, one of 106 students graduating Friday from Grant MacEwan University’s first bachelor of science in nursing class, would prefer a full-time position, but is happy gaining experience in two casual positions. She’s working in the Grey Nuns obstetrics department and in surgery at St. Albert’s Sturgeon Hospital. When she first started the four-year degree at MacEwan, the job market was so wide she was virtually guaranteed a job. “‘For sure, you’ll have a job when you’re done. You’ll never have to worry,’” she remembers hearing. That changed partway through her degree, when Estrin heard graduates from other nursing programs couldn’t get jobs. “It was scary to hear that there wasn’t enough money and there was a hiring freeze.” Now, all her graduating friends have jobs, although many are casual. “Everybody is pretty receptive to having me there,” said Estrin, 24. “As new graduates we bring a lot of new knowledge and new practice.” 28 jsinnema@edmontonjournal.com © Copyright (c) The Edmonton Journal Back to top Europe 1 Facebook use leads to health-care reform in Taiwan The Lancet, UK 18/06/2011 Volume 377, Issue 9783, Pages 2083 - 2084 Correspondence Shabbir Syed Abdul a, Che-Wei Lin b, Jeremiah Scholl c, Luis Fernandez-Luque d, Wen-Shan Jian e, Min-Huei Hsu f, Der-Ming Liou a, Yu-Chuan Li g Social networking services are transforming the delivery of health care. Facebook, for example, is now commonly used by medical students, patients, and other stakeholders in the health-care system.1, 2 We describe how Facebook enabled collaboration between stakeholders in emergency-medicine policy in Taiwan, which led to reforms. The Taiwan Society of Emergency Medicine3 has been in slow-moving negotiation with the Department of Health for the past several years over an appropriate solution to emergency-room overcrowding. A turning point was reached on Feb 8, 2011, when an emergency physician who was an active social network user and popular blogger among the emergency-room staff created a Facebook group called “Rescue the emergency room”. Within a week about 1500 people—most of the emergency department staff around Taiwan—became members of this group and started discussing actively and sharing their experiences. One of the members then posted the group's concerns and problems on the Facebook profile of the Taiwanese Minister of Health. This caused the minister to join the group and get engaged in the discussion. A multiparty dialogue involving many different stakeholders and perspectives was suddenly possible. Early on one of the members posted “Is there any use of these posts? Does our minister have time to read Facebook?” The Minister replied by posting “every message is read by me and my staff”. This modest gesture satisfied the emergency-room staff that their concerns were being taken seriously by the Department of Health, and further motivated them to engage in discussing the issue. By March 11, there were about 1800 members, 455 posts, and 3745 comments and “likes” on these posts. The number of members and posts is increasing every hour. After monitoring these discussions, the Minister and his team decided to make a surprise visit to emergency departments in ten different cities. The next day, in a press release, he also promised to initiate dialogue with the Bureau of National Health Insurance on organisational issues affecting emergency departments and vowed to spend more resources for hospitals to improve emergency-room overcrowding and quality of care. This case has implications for the future of health care, since it shows how social networking can break down the rigid social and professional hierarchical structures that can hinder reform. 2 Right on song: the rebuilding of Haiti The Observer, UK 19/06/2011 Will Butler One pound, dollar, or euro from each ticket we've sold since 2007 has gone to organisations that work in Haiti, chiefly Partners in Health. This past year ticket buyers have given more than $300,000 to PIH. Our upcoming show in Hyde Park will raise in the realm of £60,000. One point of our trip to Haiti was to see how this money is being used. Partners in Health works all over the world. In Haiti, PIH and its sister organisation Zanmi Lasante ("Partners in Health" in Creole) employs more than 5,000 Haitians. There are some non-Haitian employees and foreign volunteers – visiting orthopaedic surgeons, engineers – but the vast majority of the doctors and nurses are Haitian, as are the construction workers, janitors, community health workers, secretaries and so on. One thing I learned was that PIH employs lots of construction wohelrkers. They are building a large teaching hospital in the town of Mirebalais (the biggest construction project begun in Haiti since the earthquake). The main result will be access to high-level medical care for the 140,000 people living in the region, but employment is an intended side effect. Haitians do the construction as far as possible. Where locals are unskilled – in plumbing, electrical wiring, welding – foreign volunteers are brought in to work and help train. John Chew, the project co-ordinator, was excited about how his bricklayers could now read blueprints – a good, marketable skill. When people have jobs, other people can sell them cell phones or, hey, bootlegged 29 DVDs. The economy slowly grows. This is happening not just in Mirebalais but also with smaller clinics and schools PIH is building throughout rural Haiti. Health, as you might think, is the main concern of PIH. They are known and celebrated for their successful treatment of Aids and TB patients in extremely poor regions. But they take a broad view of health. One employee talked about digitising medical records and seeing several prescriptions for "needs new roof". And these prescriptions had been filled. We met Genevieve Joubert, a nurse who lives and works in the tent camp of Dadadou in Port-au-Prince. She has helped deliver more than 150 babies since the earthquake. But she is also focused on latrines – on the struggle to find someone to build more. And on the more infuriating struggle to get someone to regularly empty them. The people who work for Partners in Health work there for the same reason any of us would. Some work just because they need a job. Most seem to strongly believe in PIH's vision. The doctors and nurses could get higher pay working for other foreign organisations, or the UN. Many, with foreign graduate degrees, could get jobs any where in the world. Dr Patrick Almazor is from Port-au-Prince and a former Fulbright scholar with a master's degree in public health. He runs the hospital in St Marc, a coastal town where cholera hit particularly hard last year. He'd started with PIH because of a mandatory year of service post-medical school. He'd stayed because he realised he wanted to serve the poor, and he found working with PIH was the best way to do that. PIH are breathtakingly competent. I would describe them as efficient, but that might imply a focus on costeffectiveness and the system, instead of on the patient. I'd rather say that PIH are thorough in all aspects of operation and wise in their use of money and supplies. They are part of a strong, organic movement towards a functioning society in Haiti. For more information on Partners in Health, go to pih.org/ 3 How to meet the challenge of ageing populations British Medical Journal 20/06/2011 1. 2. 3. 4. Nick Fahy, consultant and researcher on European health issues1, Martin McKee, professor of European public health 2, Reinhard Busse, professor of healthcare management3, Emily Grundy, professor of demographic gerontology2 + Author Affiliations 1. 1Nick Fahy Consulting, Tunbridge Wells TN1 2HX, UK 2. 2London School of Hygiene and Tropical Medicine, London, UK 3. 3Technical University of Berlin, Berlin, Germany 1. nick@nickfahyconsulting.eu EU countries need to work together with health professionals and other stakeholders One of the main arguments used to justify major reform of the NHS is the potential cost of an ageing population. The United Kingdom is not alone; the number of people aged over 65 in the European Union will almost double over the next 50 years,1 and there will be only two people of “working age” for each person over 65 compared with four today. It is estimated that this could cost EU countries as much as 15-40% on top of current expenditure to maintain existing health services. So how is Europe collectively responding? EU leaders (including those from the UK) are pinning much hope on “innovation”—speeding up the process of bringing new ideas from research to practical application.2 As part of this “innovation union” initiative, the European Commission has proposed a “pilot partnership on active and healthy ageing.”3 By bringing together government officials, industry, health professionals, and other stakeholders from across Europe, the commission hopes to find ways of removing bottlenecks and speeding up the application of science in practice. The first meeting of the partnership’s steering group was held in May; its concrete priorities for specific research, development, and deployment, and the necessary support, are due later this year. These could include better tools for early diagnosis of heart disease, for example, or using remote monitoring to help people with chronic conditions take care of themselves more independently. The proposed benchmark for this partnership is to add two years of life in good health to the European average by 2020. Long term trends of improving life expectancy suggested that this was likely to be achieved with no additional intervention.4 However, the commission’s recent figures are not encouraging, with the most recent data published in March 2011 showing a fall in average European healthy life expectancy by 0.3 years for women and 0.6 years for men between 2007 and 2008.4 The most important element of this benchmark, however, is not the precise figures or even whether they are achieved. It is the commitment by all EU countries to work together with health professionals and other stakeholders to meet the challenge of ageing. This does not change the primary responsibility of countries for their own health systems. Nevertheless, the partnership’s public consultation (which ran from November 2010 to January 2011) identified common problems, such as fragmentation of funding (for example, between health and social care), lack of clear and accessible evidence about which new innovations work, complex regulatory requirements (such as uncertainty over which legislation applies to new technologies such as telemedicine), and failure to involve patients and professionals in the development of the new solutions they will be using.5 30 Each country can then use the collective European effort as a basis to tackle the local and specific challenges of their ageing population. What already exists can offer a great deal. Apart from any new solutions that this EU partnership may help to generate, there is already much scope for cross European learning to help health systems respond to healthy ageing.6 The European Observatory on Health Systems and Policies (a collaboration of international organisations, governments, and universities that supports evidence based policy making7) has summarised evidence showing where European systems should focus for maximum improvement.8 This includes better coordination of care across health and social services, as well as within health systems; the targeting of priority conditions that create the greatest burden of ill health, such as hypertension, stroke, and dementia; better management of hospital admissions; and encouragement of better self care. It also highlights the scope for prevention—again, tackling the burdens from heart disease and stroke, flu immunisation, smoking and alcohol misuse, injuries from falls, healthy diet and nutrition, and inappropriate combinations of drugs for older people with multiple conditions. It also emphasises the importance of linking policies in the health sector to those in other sectors to create appropriate housing and living environments, and keeping people in work and involved in their communities.9 At a practical level, the observatory is sharing evidence through a summer school this July on the response of the health systems to the ageing crisis (www.observatorysummerschool.org). Although efforts are being made to deal with the problems across Europe and beyond, no single country has the answers, as the recent reports of the Care Quality Commission on failures in care for older people have highlighted clearly.10 While debates continue in England about the future organisation of the NHS, Europe is facing the same underlying challenge of ageing. Rather than focusing on the structure of the health service, England could benefit from applying good practices from other countries to close the gap in funding for its ageing population. References 1. ↵ European Commission. 2009 Ageing report. 2009 http://ec.europa.eu/economy_finance/publications/publication14992_en.pdf. 2. ↵ European Council. Conclusions. 2011. www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/ec/119175.pdf. 3. ↵ European Union. Europe 2020 flagship initiative Innovation Union. 2010. http://bookshop.europa.eu/uri?target=EUB:NOTICE:KI3110890:EN:HTML. 4. ↵ European Commission. Heidi data tool. Health expectancy: healthy life years (HLY) from 2004 onwards. http://ec.europa.eu/health/indicators/echi/list/echi_40.html#main?KeepThis=true&TB_iframe=true&height=45 0&width=920. 5. ↵ European Commission. Synthesis report on the public consultation on the European innovation partnership on active and healthy ageing. 2011 http://ec.europa.eu/research/innovation-union/index_en.cfm?section=activehealthy-ageing&pg=consultation. 6. ↵ Doyle YG, McKee M, Sherriff M. A model of successful ageing in British populations. Eur J Public Health2010: published 29 September; doi:10.1093/eurpub/ckq132. 7. ↵ European Observatory on Health Systems and Policies. www.euro.who.int/en/home/projects/observatory. 8. ↵ Rechel B, Doyle Y, Grundy E, McKee M. How can health systems respond to population ageing? WHO, 2009. www.euro.who.int/en/what-we-do/data-and-evidence/health-evidence-network-hen/publications/2009/howcan-health-systems-respond-to-population-ageing. 9. ↵ Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K. Health in all policies: prospects and potentials. Ministry of Social Affairs and Health, 2006. 10. ↵ Care Quality Commission. Dignity and nutrition for older people. 2011. www.cqc.org.uk/reviewsandstudies/inspectionprogramme-dignityandnutritionforolderpeople.cfm. 4 Midwife burnout poses threat to reducing maternal mortality The Guardian, UK 20/06/2011 PovertyMattersBlog Posted by Ros Davies An innovative UN Population Fund (UNFPA) report launched on Monday, The State of the World's Midwifery, focuses much needed attention on service providers, and will help to achieve millennium development goals (MDGs) 4 and 5. 31 A recent paper on maternal health staff in a district referral hospital in Malawi concluded that burnout appears to be common among those providing antenatal, delivery and postnatal health services. Of the 101 participants, nearly three-quarters (72%) reported emotional exhaustion, more than one-third (43%) reported de-personalisation and three-quarters (74%) experienced reduced personal accomplishment. Malawi has one of the worst maternal mortality rates in the world; from 2005 to 2009, for every 100,000 live births, 1,140 mothers died. By comparison, in the UK on average 8.2 mothers die per 100,000 live births. Malawi's health service is chronically under-staffed – the World Health Organisation recommends that each country has a minimum of one physician for every 5,000 people; Malawi has one for every 62,000. Through its own work in Malawi, Women and Children First (UK) (WCF) has observed that maternal and newborn health staff are overworked and underpaid. There are insufficient midwives, so staff work long hours and have few breaks. In addition, they deal with death after death of mothers and babies – a highly emotional experience. Hospital staff report they suffer stress and fatigue from such a relentless workload, which has increased over the last two to three years since government policy began to push for all women to give birth in health facilities, although the supply of hospital beds, drugs and staff has not kept pace. As a result, quality of care is compromised and, at times, delay in providing skilled care ends in needless fatalities. Is it any wonder, then, that medical staff in resource-poor settings frequently suffer burnout? A psychological term for the negative response to chronic job-related emotional stress, burnout is on the rise and poses a serious threat to achieving the MDGs aimed at reducing maternal and newborn mortality. Burnout occurs when people give too much of their time, energy, and effort to a job over a long period of time, without adequate time to recover physically or emotionally. Though maternal health has improved in Malawi over the last few years, the positive trend will reverse if staff continue to be placed under unremitting physical and emotional stress. Quality midwifery is a well-documented component of success in saving the lives of women and newborns; it also promotes health in general and spurs development. If midwives are looked after, it follows that their patients' health will improve. Sadly, Malawi is not a unique case. Dissatisfaction with pay and working conditions, migration, and deaths from Aids-related illnesses has meant that, globally, the number of skilled healthcare providers has not significantly increased over the last 30 years. It is even declining in some countries. The WHO reports a 350,000 shortage of midwives. For MDGs 4 and 5 to be achieved, there needs to be a significant increase in midwifery staff across the developing world. This involves governments, NGOs and health workers understanding and addressing the working conditions of current staff. The UNFPA report addresses these issues. It provides an insight into the state of midwifery in 58 countries across the world. The report examines the number and distribution of health professionals involved in the delivery of midwifery services; explores emerging issues related to education, regulation, professional associations, policies and external aid; analyses global issues regarding health personnel with midwifery skills, and the constraints and challenges that they face in their lives and work; and calls for more investment in scaling up midwifery services. The UNFPA and Unicef have long produced annual reports on the state of the world's children and the state of the world's population, but service providers have not previously been a focus. This is the first time that such intensive attention has been paid to midwives, and it will be a vital tool for governments and NGOs when it comes to improving maternal and neonatal health. Though the report is no silver bullet, it will take us a step closer towards achieving MDGs 4 and 5. Governments should take note of the contents and use it to formulate policy. Stakeholders should use it to make demands on their governments, and international development workers should use it to highlight the unacceptable disparity in health provision across the world. • Ros Davies, CEO, Women and Children First (UK) 5 Nurses will be forced to do more work The Independent, Ireland 22/06/2011 By independent.ie reporters Nurses will have to provide extra services from July 11 when doctors are rotated between posts, a leading consultant has warned. Dr John Barton, a consultant physician and cardiologist at Portiuncla Hospital in Ballinasloe, Co Galway, said the pressure will come on nurses at smaller hospitals when the July changes will lead to a shortage of nonconsultant hospital doctors. 32 "We are beginning to move within the system, for instance, to what we call the advance nurse practitioners and different grades of nurses that will be able to provide certain services that may have been provided by doctors previously, and they can do so in an excellent form," said Dr Barton. "This is what’s going to have to happen in our health system." Health Minister Dr James Reilly has already admitted that problems will arise in July but he added that efforts are being made to address the problem. Minister Reilly has also conceded emergency departments will "struggle" to fill junior doctor posts. Hospitals across Dublin and the rest of the country may also have to curtail services due to the shortage of doctors. There are also concerns that closing smaller hospitals will lead to larger A&E units, which are already at breaking point, being swamped by patients. - independent.ie reporters 6 Doctors may face two years' work in public hospitals Irish Times 27/06/2011 CARL O'BRIEN DOCTORS WHO train in Ireland may be required to work for at least two years in the public health system as part of a fresh attempt to keep junior doctors in the country. Hospitals in all parts of the State face a shortage of junior doctors from the middle of next month when posts are rotated as part of doctors’ training programme. Health authorities have been seeking to recruit doctors from India and Pakistan to help alleviate staff shortages. However, Minister for Health James Reilly is considering a requirement that graduates from Irish medical colleges undertake a longer period of internship in the public hospital system. At present, graduates undertake a one-year internship. Following this, they can apply for so-called senior house posts or leave the system. The Minister has been advised by the Health Service Executive that there is no shortage of interns in the public hospital system. However, health authorities are recruiting doctors from overseas because there is an immediate shortage at senior house officer and registrar level. A total of 450 posts are due to be filled from July 11th when the next rotation of junior doctors takes place. Dr Reilly said in a recent parliamentary question that most of these posts were service rather than training posts and were “not attractive to newly qualified doctors”. Medical organisations say that the long working day in Irish hospitals, cuts in pay, lack of training opportunities and opportunities for career progression means many graduates are heading abroad for work. In the meantime, in many areas health authorities have been seeking to recruit doctors from India and Pakistan to help alleviate staff shortages. However, The Irish Times reported last week that only one in six of the more than 400 doctors recruited by the health service to deal with the problem has so far sought entry on to the Irish medical register. The Medical Council said that most of those who applied for registration had failed to submit all the documentation necessary to process their applications for registration. The Irish Association for Emergency Medicine, which represents consultants working in hospital emergency departments, estimated last week that only five of the 32 hospital emergency departments would have sufficient junior doctors to operate a normal level of service unless additional recruits could be found. 7 Health agency looks to Pakistan and India to solve doctor shortage Irish Times 20/06/2011 EITHNE DONNELLAN 33 BACKGROUND : Irish-trained doctors are emigrating because of long hours, pay cuts and poor career prospects THE CURRENT shortage of junior doctors in the Irish healthcare system didn’t just happen overnight. The shortages have been well known about since at least 2009 but the fact that they have worsened to a point where even large hospitals like the Mid Western Regional Hospital in Limerick may have difficulty keeping its emergency department open from next month has helped focus fresh attention on the problem. Reasons for the shortages are multifaceted but undoubtedly one factor is young Irish-trained doctors are leaving for Australia and other countries in greater numbers because of long working hours, pay cuts, lack of protected training time and little prospect of career advancement. They have a one in four chance of going on to be consultants. Added to that is the fact that in the last couple of years it has became more awkward for non-EU doctors – which a 2007 audit by the Royal College of Physicians found accounted for in excess of 50 per cent of all junior doctors working as registrars or senior house officers in hospitals in Ireland – to get into the country and register to work here. In 2009 their visas were restricted so they would have to be renewed every six months, though this has now been changed to every two years. Then changes to the Medical Council registration process under the 2007 Medical Practitioners Act, which came into effect in 2009, meant they had to get a higher mark in their English language exam – a change also since reversed – and had to pass what’s called the Pres exam, which includes a 2½-hour multiple choice question exam to test their medical knowledge as well as a 3½-hour examination of their clinical skills. This exam is only held in Ireland. About 4,600 junior doctors are needed to staff our hospitals and most of them rotate jobs every six months as part of their training schemes, so they get six months’ experience in paediatrics, another six months in surgery, psychiatry and obstetrics and so on. Of the more than 4,000 junior doctor posts in the system, about 3,650 or 80 per cent are in training posts accredited by colleges such as the Royal College of Surgeons in Ireland. The 1,000 non-training posts have traditionally been the ones which proved more difficult to fill – though more than half of these are now staffed by doctors on contracts of indefinite duration – but this year even training posts are proving less attractive to applicants. Eunan Friel, managing director of surgical affairs at the royal college, said that to date 219 out of a total of 255 places across the three years of its basic surgical training scheme have been filled, leaving 36 vacant. In April it was predicted some 400 junior doctor posts could remain unfilled on July 11th but more recent estimates presented to Minister for Health James Reilly suggest that figure could be 180. There are now fears that while locums will have to be retained to staff essential services in larger hospitals, the Health Service Executive may no longer continue to fund costly agency staff to keep smaller emergency departments open. So where lies the solution? The HSE on the one hand says there is a worldwide shortage of junior doctors and on the other says it has found more than 420 experienced doctors during a recent trip to India and Pakistan who would be willing to come and work here if only they didn’t have to jump through so many hoops to get on the medical register. Yet the Medical Council says only 30 of these 420 have even applied to register here yet. It appears the HSE is hoping Dr Reilly will amend the law to make it easier for non-EU doctors to come and work here. He is considering this option but must exercise caution so as to ensure patient safety is not put at risk. The Irish Medical Organisation is meanwhile urging the HSE to take steps to retain Irish doctors in the system rather than focusing on overseas recruitment. 8 NHS cost-cutting measures 'driving midwives to emigrate for jobs' Wales Online 28/06/2011 by Aled Blake, Western Mail Cost-cutting measures to control medical vacancies are turning newly-qualified midwives away from jobs and forcing hospitals to close midwifery units, doctors have warned. While enough new midwives are being trained to fill posts in Wales, they are not being given jobs once trained. Many are emigrating to Australia where they can find work in hospitals instead of being given jobs here where they are needed most. 34 Dr Phillip Banfield, of the British Medical Association’s Clwyd North division, said “vacancy controls” mean midwives are being trained – but “none are being given proper jobs”. He told the BMA’s conference at St David’s Hall in Cardiff: “The system has ground to a halt and it seems that our joined and merged organisations have lost touch with the frontline.” Frontline staff are becoming exhausted with low morale. “The service becomes unfit because it is being run down,” he added. Figures obtained by the Welsh Conservatives last month revealed the number of midwives fell by 10% between 2008 and 2010. The number of whole-time equivalent midwives employed by the NHS now stands at 1,322. Dr Banfield said that as most money within the NHS is spent on staffing, the medical frontline is affected by the budget cuts. And while management seems to have been protected despite reform to Welsh NHS structures, midwifery units and other specialist services are bearing the brunt of spending cuts and “vacancy control measures”, such as non-replacement of departing staff. He said: “When people leave the health service is not replacing them and it causes stress and strain. There seems to be a discrepancy between what the health boards are saying and what the reality is. “The public is being told there is a shortage of midwives, yet we have got fully trained midwives not being employed. “Specialist care baby units are being closed because of staff shortages, yet posts are being frozen.” Cover is being provided by locums, increasing costs again and making it less possible for midwives to be taken on. “From what our members are saying, this is happening across Wales – and England,” he added. “It is difficult because we have had these mergers of health boards but there is a lot of senior management that have been protected.” Dr Andrew Dearden, chairman of the BMA’s Welsh Council, said while there are shortages in medical staff, there is no similar shortage in management positions. “I think that is shown in the increased proportion of management staff to clinical staff. It used to be that you would have a clear majority of clinical staff in the NHS, that is a much smaller difference now. “We don’t seem to see the same accountability, while clinical staff have accountability – for every action there are three or more ways to be accountable. “You don’t always see that same accountability with management decisions.” Dr Richard Lewis, secretary of BMA Cymru, agreed there has not been an “equivalent process” in frontline staff and management positions. Stressing the BMA’s support for the no-redundancies policy, he argued that doctor vacancies were not being treated in the same way as management. Non-replacement of staff was a “false economy”. Earlier, BMA chairman Dr Hamish Meldrum said health boards faced difficult times with pressure on NHS finances across the UK, and pensions. A Welsh Government spokesman said: “The number of midwives trained is based on what the NHS determines it will require to meet future demand. “Health Boards in Wales are reviewing maternity, gynaecology, neonatal and child health services as they work to continually improve services. Midwives will continue to have a crucial role in caring for mothers and their babies.” 9 South Sudan faces grim health and humanitarian situation The Lancet, UK 26/06/2011 Volume 377, Issue 9784, Pages 2167 - 2168 Wairagala Wakabi When South Sudan gains independence in early July, it will have to deal with some intractable difficulties to reverse the region's poor health indicators. Wairagala Wakabi reports. When South Sudan becomes Africa's youngest nation on July 9, 2011, it will inherit some formidable health and humanitarian challenges. Emerging from several decades of civil war, South Sudan has a severe shortage of health workers and facilities, with only 16% of people in the region accessing health care. 35 Furthermore, violence has escalated in South Sudan in 2011, claiming 800 lives in less than 4 months. And the region faces a heavy disease burden, with meningitis, measles, yellow fever, and whooping cough endemic in many areas. River blindness, sleeping sickness, cholera, and poliomyelitis outbreaks are common too. The civil war in South Sudan started in 1955, but lulled in 1972. It resumed in 1983, and lasted until 2005, when a peace deal was signed allowing the south to determine through a referendum if it wanted to secede. The UN estimates that 2 million people died as a result of famine, fighting, and disease, whereas 4·5 million were displaced during this war. The region still has nearly 2 million internally displaced people. Additionally, in view of hostilities that were expected to come with the secession, some 290 100 people have fled the north to return to the south since October, 2010, placing further pressure on health facilities. The war in Sudan, Africa's largest country, resulted from the oppression and marginalisation of the south by the north where the national capital Khartoum is located. According to the Sudan Peoples' Liberation Movement (SPLM), which led the fight for independence, the regimes in Khartoum concentrated all development in the north and denied southerners meaningful participation in government. In a referendum in January, 2011, more than 98% of voters in Southern Sudan chose to secede from the larger Sudan. The country's President, Omar al-Bashir, has accepted the outcome of the referendum, and pledged to work harmoniously with the new state. “Southern Sudan has been at war for far too long but it has also been severely marginalised. There is hardly any health infrastructure, as the little that had been built was destroyed during the war, or it was abandoned”, Lul Riek, the director for community and public health in the South Sudan health ministry, told The Lancet. “Since 2005, we have tried to put things together from the start—health centres, health workers, everything, but we face acute shortages of health workers.” With a population of 8 million people, South Sudan has a little more than 120 medical doctors and boasts just over 100 registered nurses. The Government of Southern Sudan (GOSS) has made a target of one primary health care worker per 25 000 people and a hospital for every 50 000 people. “It will not be easy, even if we start training tomorrow. It will take us up to 20 years to meet these targets”, said a government official. “We need to find ways of training as many health workers as possible—midwives, laboratory technicians, doctors.” South Sudan does not have any institutions that train doctors. In the past, the universities of Juba, Upper Nile, and Wau trained doctors but because of the war, their medical faculties were shifted to the north. Observers say that most of their instructors, who are predominantly northerners, are likely be reluctant to relocate to the south, even if the medical faculties were returned to the newly independent state. With South Sudan now only training a handful of medical assistants every year, the GOSS is sending many of its people to medical schools in Kenya, South Africa, Uganda, UK, and the USA. Some agencies, such as the International Medical Corps (IMC), are helping to train nurses to help meet the acute manpower shortage. “The health needs are enormous in South Sudan…there is also a massive shortage of trained health workers”, remarks Laurence Holmes, a communications officer for the agency. The IMC does a 2·5 year training for certified nurses, and an 18-month training course for community midwives. Currently, humanitarian agencies provide more than 85% of all health care in South Sudan. But UN and humanitarian officials say that the new country faces enormous health challenges, particularly if the international community does not maintain or step up its support. According to the South Sudan Demographic and Health Survey of 2006, one in six children born die within their first year of life, and the maternal mortality ratio is more than 2054 per 100 000 livebirths. UNICEF says that around 10% of children in South Sudan are fully vaccinated against major childhood diseases and one in seven children dies before the age of 5 years. The high levels of illiteracy, and limited supplies of drugs and equipment, contribute to the high mortality rates. Sara Fajardo, an official of the international humanitarian agency Catholic Relief Service, remarks that without adequate access to proper prenatal care and vaccinations, some newborns in South Sudan contract tetanus during the birthing process, resulting in exceedingly high infant and maternal mortality rates. “We have the highest maternal mortality rate in the world, at 2054 per 100 000, not just because of the lack of medical services but also because of lack of roads”, said Riek. “During the rainy season, very many women simply can't make it to health centres because the roads are impassable.” Because of low literacy and poor roads, even where there are facilities, their use often tends to be low. For instance, the International Rescue Committee reports that at facilities it supports, only 105 deliveries of an estimated target population of 7680 were assisted from January to August, 2010. From October, 2009, through September, 2010, just 29% of pregnant women in these areas attended two or more antenatal care visits, whereas less than 1% of women accepted family planning methods. Another problem with roads is the presence of landmines, a legacy of the civil war. According to the UN, the mine action sector cleared 2·9 million square metres of land and destroyed 1544 anti-personnel mines, 321 anti-tank mines, 60 137 small arms and ammunition, and 8590 items of unexploded ordnance in the past year. However, several kilometres of roads, and thousands of hectares of farmland, remain heavily mined and littered with unexploded ordnances of war. Health ministry officials who spoke to The Lancet said that 25% of all hospital visits and admissions are attributable to malaria. And now, HIV/AIDS is also emerging as a major threat. South Sudan is very 36 susceptible to HIV/AIDS, because it neighbours countries such as Kenya, Uganda, Ethiopia, and the Central African Republic, where infection rates are high. Several thousands of Sudanese refugees who have lived in these countries are returning home where there is limited knowledge about HIV/AIDS, and where health facilities are in short supply. The 2006 household survey in the country found that among women aged 15—24 years, less than 4% had comprehensive knowledge of HIV, meaning they could identify at least two ways of avoiding HIV infection and reject three common misconceptions about transmission of the disease. “We are very concerned about HIV because it is the single disease which, if not tackled expeditiously, can take away this joy of being a new independent state”, stated Riek, who has spear-headed his country's fight against the disease. Barnaba Marial Benjamin, the GOSS information minister, says it is crucial to boost public awareness about the disease—which has a prevalence of 1·1%. According to him, the fight against the disease has not been effective because of limited funding. He added that the low literacy rate had also undermined awarenesscreation efforts. Whereas the South Sudan AIDS Commission currently treats 2600 individuals, a plan just endorsed by the cabinet will put more than 46 000 people on treatment. An estimated 300 000 South Sudanese are living with HIV/AIDS. But as the health challenges persist, humanitarian workers are worried that violence might make a difficult situation worse. According to Lise Grande, the UN humanitarian coordinator for Sudan, by early April, 2011, more than 800 people had died in violence in South Sudan since the start of the year, while another 94 000 had fled their homes. Most of the fighting has been between the South Sudanese army and militia allied to the north, and there have been some inter-ethnic conflicts over land, water, and livestock. “In the last month, if you have seen a doubling of the number of the people who are displaced, you have to be worried, and we are”, Grande told reporters. If the insecurity persisted, she said, there would be more people in need of emergency aid. Human Rights Watch (HRW) said that both government forces and rebel militia committed human rights violations during clashes in Upper Nile state in March this year. “If the Southern Sudan government wants a sustainable peace when it becomes fully independent in July, it should demonstrate its commitment now with a prompt and thorough investigation into human rights violations in Upper Nile”, Daniel Bekele, Africa director for HRW, said in a statement. “Southern Sudan's government should show no tolerance for crimes against civilians by either side.” 10 Le nouvel hôpital rend malade son personnel Midi Libre.fr 29/06/2011 LAURE DUCOS Nous sommes en danger et les patients aussi." La phrase paraît violente, mais pour Isabelle, aide-soignante à la maternité, elle reflète totalement la réalité. "La direction n’a pas consulté le personnel et aujourd’hui cela ne va plus", renchérissent Ingrid et Laurie, infirmières aux urgences. Hier, une trentaine d’agents hospitaliers qui avaient terminé leur service, ont manifesté devant le hall du nouvel hôpital pour faire valoir leurs revendications. "Il faut que cela change, nous avons tous intérêts à ce que cet hôpital reste de qualité", explique Bruno Rivier de la CGT. Publicité Le manque d’effectif est au cœur du problème. "On est en permanence en dessous de l’effectif minimum aux urgences, et en plus de ce manque flagrant, le poste d’hôtesse d’accueil a été supprimé, c’est une infirmière qui reçoit les patients." Idem côté maternité où deux postes ont été supprimés. Avec la fermeture de la maternité de Bonnefon, le personnel avait pris son mal en patience, mais après un mois d’ouverture de la nouvelle structure, neuf personnes sont déjà en arrêt maladie. "Soit près de la moitié, précise-t-on dans le service. On n’en peut plus. Et il y a un réel manque de considération de la part de la direction." Les agents précisent qu’en plus, ils ont sérieusement mis la main à la patte durant le déménagement. "Ce qui devrait être prévu par des enveloppes budgétaires s’élevant respectivement à 800 000 et 600 000 €." Le personnel soignant s’indigne également de l’organisation des locaux et du matériel. "Les chambres sont trop petites. On est obligé de tout sortir pour emmener un patient en brancard, il n’y a pas de prise de courant dans les couloirs..." Aux urgences, on s’inquiète du manque de confidentialité et de pudeur pour les patients à cause de l’organisation des locaux. Mais tous ceux présents hier le certifient : "On aime notre métier, on fait de notre mieux pour faire un service de qualité, mais aujourd’hui, ça devient difficile..." Back to top Latin America & Caribbean 1 37 COMENENAL frena huelga y da plazo de 2 semanas al MINSA La Estrella, Panama 29/06/2011 Deivis Eliecer Cerrud Los representantes de la Comisión Médica Negociadora Nacional (COMENENAL) aplazó los vientos de huelga y dio un nuevo ultimátum de 2 semanas a las autoridades de Salud para evaluar las conversaciones. En la sede del Ministerio de Salud (MINSA), se reunieron los dirigentes con el ministro de Salud, Franklin Vergara, luego que la COMENENAL se declara en estado de alerta y anunciara una posible huelga de médicos debido a supuestas deficiencias en la infraestructura y en la administración de la entidad. El coordinador del grupo médico, Julio Osorio, deploró la ausencia de la Caja de Seguro de Social (CSS) a la mesa de acuerdos. "Demuestra una posición poco inmadura, en el sentido que lo primordial es dialogar, es llegar a acuerdos que mejoren la salud del país", cuestionó. La COMENENAL conversó con el titular de Salud sobre falta de insumos, equipos, desabastecimiento, la contratación de médicos extranjeros y el borrador de la ley de turnos médicos. Igualmente, los reclamos por problemas en el Hospital San Miguel Arcángel, el Nicolás Solano, los temas médicos para el sistema penitenciario y otros acuerdos, que según lo expresado, no se estaban cumpliendo. 2 Advierten sobre déficit de enfermeras en México Diario de Yucatán, Mexico 29/06/2011 MÉXICO (Notimex).— México registra un déficit de enfermeras y enfermeros de por lo menos 35 por ciento de las plazas en hospitales y clínicas del sector salud público y privado, aseguraron representantes de escuelas donde se imparte esa profesión. En rueda de prensa atribuyeron esa situación a la falta de interés de los estudiantes por esa carrera, los bajos salarios y la migración de esos profesionales a Estados Unidos, donde se les ofrece empleo seguro con visa de trabajo, incluso para sus parejas o hijos. Al dar a conocer resultados y continuación de la campaña 'México necesita 4 veces más enfermeras' promovida por la aseguradora Axa, la enfermera Pilar Servitje, titular del Consejo Directivo en el Distrito Federal de la Cruz Roja Mexicana, estimó que ese déficit se podría duplicar dentro de ocho años. Informó que de las 18 escuelas de enfermería de la Cruz Roja Mexicana las del Distrito Federal y la zona conurbada cada vez registran menos alumnos para estudiar la licenciatura en el ramo, pues muchos optan por otras profesiones mejor remuneradas y más reconocidas. Dijo que, por ejemplo, en el Hospital de la Cruz Roja de Polanco las enfermeras y enfermeros realizan hasta tres turnos debido a que 34 por ciento de las plazas están desocupadas, en detrimento de la atención al paciente. En su oportunidad la coordinadora general del Instituto de Estudios Avanzados de Enfermería, Gloria Hernández García, señaló que debido a que en Estados Unidos 42 por ciento de las enfermeras que laboran en ese país se va a jubilar en 2020 se requerirán 800 mil profesionistas para ocupar esas plazas. Comentó que los estadounidenses buscan a las enfermeras mexicanas que van a egresar de las escuelas y les ofrecen capacitación en el idioma inglés, visas de trabajo para ellas y sus esposos, así como empleos bien remunerados, lo que representa una amenaza pues en México cada vez más migran esos profesionales a ese país. Precisó que el universo de enfermeras en México en el sector público como privado es de 234 mil y la mayoría recibe sueldos de cuatro mil pesos, ya que sólo se reconoce a quienes tienen licenciatura en la Secretaría de Salud y se les paga un sueldo como profesional. En tanto en el IMSS sólo se tiene a 15 por ciento de su planta con ese nivel universitario con un salario de poco más de 10 mil pesos, más prestaciones, mientras que en el ISSSTE sólo perciben un sueldo similar sin otras remuneraciones o prestaciones. Pilar Servitje refirió que en el sector privado esas profesionales que realizan un trabajo excepcional se les pagan sueldos de cinco mil pesos y en los hospitales estatales la remuneración es máximo de cuatro mil pesos. En tanto la escritora Gabriela Vargas, presidenta de la fundación Marillac, que es apoyada por AXA para becar al ciento por ciento a 50 jóvenes para que estudien la licenciatura en enfermería, expuso el diagnóstico de esos profesionales en el país. 38 Informó que en México se cuenta con 19 enfermeras por cada 10 mil habitantes, mientras que la Organización Mundial de la Salud (OMS) recomienda un mínimo de 84. De acuerdo con el Plan Nacional de Salud en el país se cuenta con 2.2 enfermeras y enfermeros para atender a mil habitantes. En el Distrito Federal se considera a cinco de esos profesionales por cada mil habitantes, situación que se agrava en el Estado de México, donde se tiene a menos de uno por cada mil habitantes, cuando lo mínimo conforme a estándares internacionales sería de ocho profesionales por cada mil habitantes. La directora de la Escuela de Enfermería de la Universidad Panamericana, María Antonieta Cavazos, destacó que los servicios profesionales de enfermería constan de una carrera universitaria con especialización a nivel de maestría y doctorado. Puntualizó que esos profesionales no son ni asistentes ni ayudantes de médicos o de quirófano, pues desempeñan una misión fundamental para el seguimiento y restablecimiento de la salud de los pacientes. Finalmente el director de la Aseguradora Axa, Xavier de Bellefón, explicó que por segundo año consecutivo se apoya con un porcentaje de la venta de seguros a la fundación Marillac para la formación de enfermeras y enfermeros en el país. Detalló que en 2009 se recaudaron cuatro millones de pesos durante los cuatro meses que duró la campaña, que sirvieron para becar a 30 estudiantes al ciento por ciento con hogar, comida, uniformes, colegiatura y libros y ahora en la segunda etapa se espera obtener lo mismo y apoyar a 20 estudiantes más. Esos recursos también se destinaron a remodelar y fortalecer las instalaciones del instituto Marillac, con lo que se beneficia a más de 800 enfermeras que se capacitan en esa institución. 3 Enfermeras a nuevas asambleas informativas La Tribuna, Honduras 29/06/2011 TEGUCIGALPA.- La Asociación Nacional de Enfermeras y Auxiliares de Honduras (ANEAH) amenazó con irse a asambleas informativas a nivel nacional, a partir del próximo viernes ante la falta de los pagos de reclasificación por parte de la Secretaría de Salud. La determinación fue adoptada ante el incumplimiento en el pago de un aumento de 1,100 lempiras a cada enfermera, como se los prometió el gobierno en abril pasado, cuando el Presidente Porfirio Lobo Sosa y el ministro de Salud, Arturo “Tuky” Bendaña alcanzaron con ellas un acuerdo de reclasificación a técnicos en enfermería. La presidenta de la ANEAH, Janet Almendárez, informó que los 1,100 lempiras debían haber sido cancelado en los primeros días de junio conjuntamente con los aguinaldos. “En el país hay 6,200 enfermeras que nos tienen que pagar los 1,100 lempiras, porque eso fue los que nos prometieron”, recalcó. El paro de labores se extendería a todas las áreas hospitalarias y centros de salud del país. Las asambleas informativas comenzarían a partir de las 6:00 de la mañana del viernes próximo a nivel nacional, y no descartan que el paro sea indefinido si no les atiende en sus peticiones laborales. Almendárez aclaró que en este paro de labores cumplirán con atender las salas de emergencia y las áreas de labor y parto en neonatos dentro de los hospitales. La ANEAH emplazó al gobierno hasta el 30 de junio próximo para obtener una respuesta positiva a su reclamo. (GZ). 4 Servidores do Samu realizam panfletagem no Centro InfoNet, Brazil 08/06/2011 Servidores do Serviço de Atendimento Móvel de Urgência (Samu) realizaram uma panfletagem ao redor da praça Fausto Cardoso na manhã desta terça-feira, 28. O motivo é que a categoria luta para obter melhoras na estrutura de trabalho do serviço que segundo os profissionais está defasada. O Samu Estadual realiza cerca de oito mil atendimentos por mês e além da estrutura, faltam mais profissionais e melhores salários. A lista de reclamações é extensa como ambulâncias velhas do ano de 2004, equipamentos quebrados e não cumprimento da lei trabalhista. Os servidores do Samu procuraram os deputados para intercedam a seu favor e discursos em prol dos profissionais da saúde eram esperados na Assembleia Legislativa. De acordo com a presidente do Sindicato do Samu 192, Samanta Bicudo, manifestação em frente à Assembleia Legislativa é uma tentativa de sensibilizar as pessoas para os problemas que o serviço vem enfrentando. 39 “As propagandas que passam na televisão são muito bonitas, mas infelizmente não mostram a realidade e aí as vezes a população acredita que a falta de atendimento é por falta de vontade dos profissionais. Então estamos mostrando qual é a nossa realidade, ambulâncias velhas em processo de sucateamento, falta de alojamento. Queremos pedir o apoio da população para os nossos problemas, estamos com os salários a cinco anos congelados”, destaca Samanta. A sindicalista contou ainda que eram esperados depoimentos dos deputados em favor dos servidores. “Hoje vamos ouvir o pronunciamento dos deputados com relação aos nossos problemas porque nós precisamos sensibilizar a todos”, diz. Juntamente com o Sindicato dos Trabalhadores da Saúde (Sintasa), o Sindicato 192 realiza no próximo dia 4 de julho uma caminhada com a participação de diversos profissionais até o Palácio do Governo do Estado para pedir melhorias. “A caminhada em direção ao Palácio que estava marcada para o dia 1º de julho foi remarcada para o dia 4 de julho com a participação de farmacêuticos, psicólogos, fisioterapeutas e terá início em frente ao Huse”, finaliza. Por Bruno Antunes 5 Cadê o médico que estava aqui? O Povo, Brazil 28/06/2011 “É impossível trabalhar sozinho. A população chega a ficar agressiva diante da desassistência nos hospitais. Os médicos também sofrem porque estão cansados e mal remunerados. Faltam insumos e equipamentos”, desabafa um clínico geral, que preferiu não se identificar. As condições de trabalho insatisfatórias e as baixas remunerações contribuem para que os médicos sumam das emergências dos hospitais de média complexidade da Capital. A situação não justifica que os profissionais faltem ao trabalho, mas explica o pouco interesse dos médicos em trabalhar na rede pública. A falta mais sentida é por pediatras e clínicos gerais - justo as especialidades de maior procura. Ontem, O POVO denunciou a dificuldade de se conseguir atendimento nos hospitais da rede secundária. Ao todo, são 878 médicos, entre concursados e prestadores de serviço. O número é considerado pequeno para a demanda. Pacientes chegam a voltar para casa sem atendimento. Aqueles que buscam atendimento com clínicos gerais e pediatras são os mais prejudicados. A dona de casa Germana Mara Mota, 23, procurou duas vezes uma consulta para o filho, Mikael Mota,3. Na primeira ida ao Gonzaguinha de Messejana, não encontrou nenhum pediatra no plantão da emergência. “O jeito foi voltar para casa com meu filho doente”, relembra. Na segunda tentativa, no dia seguinte, acabou enfrentando uma longa espera por atendimento. “Tenho é que me contentar porque tem pediatra, mesmo que seja apenas um”, reclama. O presidente do Sindicato dos Médicos do Ceará (Simec), José Maria Pontes, aponta três causas para o agravamento da situação. “Atenção básica precária, poucos profissionais concursados e péssimas condições de trabalho”. Ele afirma ainda que a falta de estrutura nos hospitais deixam o ambiente propício ao descontentamento de médicos e pacientes. Tesoura que não corta “Trabalhamos com material enferrujado, pinça que não pega, tesoura que não corta e sala sem ventilação. no centro cirúrgico, já ficamos sem água”, relata. Para o presidente do Simec, os prejuízos vão se acumulando e deixando a saúde ainda mais crítica. “Também somos vítimas do sistema. Por isso o atendimento é precário”, opina. A saída seria a contratação de mais médicos concursados e a melhoria nos salários. “Só assim os profissionais voltariam a escolher a rede pública para trabalhar”, acredita O coordenador da rede hospitalar do município, Helly Ellery, rebate críticas ao afirmar que não existe decisão de não contratar médicos. “Não há decisão de redução de custos para a contratação. O problema é que não encontramos médicos pediatras e clínicos gerais disponíveis. Essa situação se repete em todo o País”, diz. No Hospital Nossa Senhora da Assunção, por exemplo, o valor pago por plantão de 12 horas é maior:R$750. A média nas demais unidades é de R$700. Mesmo assim, a situação se repete com a dificuldade de fechar o quadro de clínicos gerais e pediatras. “Reconheço que temos escalas com lacunas”. ENTENDA A NOTÍCIA Baixas remunerações e condições de trabalho insatisfatórias tem afastado os médicos dos hospitais da rede secundária do município. Pediatras e clínicos gerais são as especialidades mais procuradas pela população que depende da rede pública de saúde. 6 40 En Santa Fe hay un enfermero y un médico cada mil habitantes Agencia Fe, Argentina 27/06/2011 Según el primer informe de la Sala de Situación del Ministerio de Salud de la provincia, en Santa Fe, hay 1,63 médicos y 1,55 enfermeros cada mil habitantes, y la relación médicos/enfermeros es de 0,95 (es decir, que hay un médico cada un enfermero). No obstante, “con una relación enfermeros/médicos de 0,95 como promedio para el sistema público de salud provincial, se observa (ver cuadro) que casi la mitad de los departamentos se ubican por debajo del promedio (San Lorenzo, Belgrano, San Martín, Rosario, Caseros, General López, San Justo y Castellanos), mientras que el resto presenta un indicador mayor al promedio (Constitución, La Capital, San Jerónimo, Las Colonias, General Obligado, 9 de Julio, San Cristóbal, Vera, Iriondo, Garay y San Javier)”, explica el informe de la Sala de Situación al que accedió Diario UNO. Y analiza: “Si bien el dato no refleja absolutamente la realidad, y por ello sería aventurado realizar conjeturas, cabe reflexionar sobre la valoración de la práctica profesional de la enfermería. Puede ocurrir al igual que en otras jurisdicciones, que otras profesiones y oficios de la salud sean más valoradas socialmente y por ello demandadas por los futuros profesionales”. Esta “tendencia” no sólo se observa en la provincia. En todo el país trabaja la mitad de los enfermeros que hacen falta. El sistema de salud público y privado cuenta con 80 mil, pero harían falta unos 160 mil para que la calidad de atención mejorará. Para colmo, el 66 por ciento de todos los enfermeros de la Argentina son auxiliares de enfermería, lo que quiere decir que aprendieron a hacer las tareas profesionales de modo empírico, pero no tienen una formación sólida como para cumplir con todas las tareas. Según la ley (la 24.004, de 1991), los auxiliares de enfermería sólo podrían controlar los signos vitales y la alimentación de los pacientes, moverlos, lavarlos y darles los medicamentos. Pero no estarían habilitados para colocar inyecciones, vacunas ni sueros. La realidad es otra. En el país hay un enfermero por cada dos médicos. Salud de la Nación trazó en 2009 el objetivo de que la relación sea de un enfermero por médico (lo que sucede en la provincia, en promedio). Seiscientos por año En igual sentido, el ministro de Salud de la provincia de Santa Fe, doctor Miguel Ángel Cappiello, reconoció que existe un déficit de enfermeros a nivel nacional. “Hay una gran falta de enfermeros en todo el país. Faltan alrededor de 45 mil en toda la Argentina”, dijo a Diario UNO. “En Santa Fe hemos incrementado el cupo para formar enfermeros para llegar a los 600 que anualmente se necesitan”, remarcó el titular de la cartera sanitaria. “Hay una concentración de enfermeros en muchos lugares y hay otros sitios a los que aún no pudimos llegar con los enfermeros y los médicos”, remarcó el ministro Cappiello. Médicos El primer informe de la Sala de Situación expresa que considerando como fuente de información el análisis de la totalidad de médicos de la provincia de Santa Fe elaborado por la Dirección General de Estadísticas del Ministerio de Salud se presentan los datos acerca de médicos matriculados en la provincia. Dicho análisis fue elaborado a partir de padrón del Colegio de Médicos de Santa Fe (Primera y Segunda Circunscripción) de 2009. La cantidad de profesionales colegiados es 14.291. Las poblaciones utilizadas en el análisis corresponden a las proyecciones realizadas al 2009, siendo de 3.264.095 personas y dado que en todo el territorio residen 14.291 médicos, la proporción de personas por cada médico es de 228. “Un aspecto de gran interés a analizar es la cantidad de médicos que residen en la provincia de Santa Fe por departamento. Rosario es el más populoso de la provincia de Santa Fe y el que más cantidad de médicos presenta. En segundo lugar se encuentra La Capital, aunque el mismo presenta una población menor que la mitad del departamento Rosario y la cantidad de médicos es tres veces inferior. Los departamentos que menor cantidad de médicos presentan son Garay, San Javier y 9 de Julio”, describe el informe. En el país, faltan entre 45 y 90 mil enfermeros El Instituto Superior de Ciencias de la Salud (ISCS) dijo en un informe que en la Argentina faltan al menos 45 mil de estos enfermeros, aunque si se tomaran parámetros más exigentes, esa cifra podría llegar a 90 mil. Las estadísticas del Ministerio de Salud de la Nación señalan que por cada 10.000 habitantes hay 3,8 enfermeros, incluidos enfermeros profesionales y licenciados en enfermería. Y que cada 10.000 habitantes hay 32,1 médicos, por lo que se concluye que existe un solo enfermero cada ocho médicos, muy lejos de los estándares internacionales. “Las recomendaciones de los organismos internacionales señalan que debe haber de dos a cuatro enfermeros por cada médico y esa cifra arroja como resultado que faltan entre 40.000 y 90.000 enfermeros en la Argentina”, señaló el trabajo del ISCS que dirige el médico Claudio Santa María. Distribución “A la problemática de la escasez de enfermeros, hay que sumarle una distribución despareja en el territorio nacional”, dijo el ISCS en un comunicado. Las provincias de Buenos Aires, Córdoba y Santa Fe tienen el mayor número de enfermeros, pero tienen también el mayor porcentaje de población. En tanto, Mendoza y Salta se destacan por tener el mayor número de enfermeros profesionales. La Patagonia llega a 85 por ciento el número de auxiliares de enfermería y en la zona norte del país aumenta el porcentaje de voluntarios con experiencia. Migración Según el Instituto, lo que complica más aún el panorama es “la migración de enfermeros a Europa, principalmente a Italia y España y también a los EE.UU. y a Australia, entre otros países”. El informe recordó cómo ponderan la actividad la Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) y el Consejo Internacional de Enfermería (CIE), para quien la profesión es parte integral del Sistema de Atención de Salud, que abarca la promoción de la salud, la prevención de las enfermedades, el cuidado de enfermos físicos, mentales e impedidos de todas las edades en todos los sitios en los que brinda atención de salud y en otros servicios comunitarios. 7 2 mil médicos del Táchira se suman al paro nacional Diario de los Andes, Venezuela 30/06/2011 41 escrito por Jhoana Suarez/DLA Táchira Con la intención de conseguir finalmente una respuesta por parte de los entes gubernamentales nacionales, los médicos del país se unirán al paro indefinido de actividades electivas convocado por la Federación Médica Desde hoy a las 7 de la mañana, los médicos del país y específicamente del Táchira se unirán al paro indefinido convocado por la Federación Médica Venezolana. La doctora Nelly Núñez, presidenta del Colegio de Médicos del Táchira, explicó en rueda de prensa que efectivamente a partir de las 7 de la mañana de este jueves se estará cumpliendo con el paro, con el cual se espera obtener una respuesta por parte de los entes gubernamentales relacionados con la lucha que los galenos vienen liderando desde abril y que aún no ha logrado conseguir la atención necesaria. Núñez, quien estuvo acompañada por el vicepresidente del Colegio de Médicos, Gustavo Uribe, y algunos miembros del Comité de Conflicto, señaló que este paro obedece a la falta de dotación hospitalaria, a la deficitaria infraestructura, a la no culminación de los trabajos empezados en los centros dispensadores de todo el país, a la falta de medicamentos, insumos en las áreas de emergencias de los hospitales de todo el país. "Las quejas de los galenos y de los usuarios fue lo que provocó que todos los médicos fuéramos representados por la Federación Médica que en un comité ampliado el pasado 27 de abril se declaró en conflicto y empezaron a cumplir una serie de paros escalonados en busca de una respuesta por parte de la Ministra de Salud, la Ministra del Trabajo, la Inspectoría General del Trabajo y la Asamblea Nacional". La representante gremial explicó que del único ente que se recibió atención fue de la Comisión de Desarrollo Integral de la AN, donde fueron recibidos por el diputado Oswaldo Vera, pero no pasó de allí. Esta actitud provocó que la Federación se volviera a reunir y decidiera durante este martes un paro indefinido de médicos a nivel nacional. Esperando Núñez destacó que están esperando que las autoridades nacionales respondan como debe ser, llamando al diálogo, para poder iniciar de una vez la discusión de la contratación colectiva, incluyendo dentro de estas cláusulas lo que tiene que ver con el salario de los médicos venezolanos. "Estamos esperando que esta reacción se produzca y que finalmente podamos motivar a los entes gubernamentales nacionales para que nos den una respuesta y podamos ofrecerles al gremio médico algo más que desde el punto de vista gremial nos corresponde". La doctora Nelly Núñez aclaró que este paro indefinido es solamente de actividades electivas, es decir, los pacientes van a ser atendidos en las emergencias, que serán todos aquellos pacientes que ingresen a esta área del Hospital, todos los pacientes pediátricos, todos aquellos que están sometidos a diálisis, los pacientes con padecimientos oncológicos, pues de ninguna manera la quimioterapia se va a parar, quienes están hospitalizados serán atendidos por los médicos de guardia sea cual fuera el centro asistencial donde se encuentren recluidos. Para esta ocasión, la doctora espera una mayor colaboración por parte del gremio médico del Táchira, recordando que últimamente estas acciones no han tenido una buena participación. "Somos muy puntuales al recordar que este paro de carácter indefinido empezará este jueves desde las 7 de la mañana, e incluye todas las áreas que no tengan que ver con una urgencia". 2 mil médicos La galena recordó que son al menos 2 mil médicos quienes se estarían paralizando durante este jueves, esperando que sean los hospitales tipo II como La Grita, Rubio, Colón y San Antonio, los que colaboren en este sentido, es decir, los médicos deben permanecer en sus sitios de trabajo protestando pacíficamente, atendiendo a los pacientes que tengan una emergencia. "Aunque tenemos bastantes reclamos qué hacer, quedará a decisión de cada galeno el participar o no en este paro indefinido, que busca conseguir una contratación colectiva después de 8 años de espera, que los pacientes que vayan de emergencia reciban una atención digna, que se recuerde que a los jubilados se les debe pagar sus prestaciones como debe ser, todo esto es lo que nos mueve y lo que debería mover al resto de médicos en la región". Sin especificar La representante del Colegio de Médicos en el Táchira comentó que la Federación Médica no especificó el tiempo que esperarán para recibir una respuesta, sin embargo cree que en 8 días estarían revisando la situación y estaría en manos de una asamblea el radicalizar las medidas que hasta ahora han venido aplicando. "Esperamos que finalmente le presten atención a las solicitudes del gremio médico". 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