This Week's News
18-22 January 2010 Weekly news clippings service featuring articles on the Global Health Workforce Alliance and selection of articles from around the world on the issue of the health workforce crisis
The Global Health Workforce Alliance ? Africa & Middle East ? Asia & Pacific ? North America ? Europe ? Latin America & Caribbean ?
News from WHO and partners
This compilation is for your information only and should not be redistributed
Date Headline Publication
Crisis in Haiti: The Alliance calls for health workforce support ;; 15.01.10 The Alliance
20.01.10 Medicus Mundi, World Health Professional Alliance and Health The Alliance Workforce Advocacy Initiative urge for discussion of the Code of Practice at the next World Health Assembly ;;
Date Headline Publication
Second cardio centre for Ghana ;; 16.01.10 Ghanaian Times
Nigeria's Problematic Health Insurance Scheme (Op-Ed);; 17.01.10 The Guardian, Nigeria 14.01.10 Malaria Consortium to improve community health workers Afrique en ligne performance in Africa;;
Kaduna Health Workers Give Govt Ultimatum ;; 14.01.10 Daily Trust, Nigeria
Babies Dying From Poor Care After Delivery;; 18.01.10 New Vision, Uganda
Brain Drain, Funding, Bane of Health Sector;; 20.01.10 Daily Champion, Nigeria 16.01.10 Un départ massif des sages-femmes en retraite pénaliserait le métier Algérie Focus ;;
Date Headline Publication
Govt. planning medical degree course to produce rural doctors ;; 15.01.10 NetIndian News Network
High-strung city has only 400 psychiatrists ;; 14.01.10 Hindustan Times, India
Innovative and affordable ;; 14.01.10 Hindustan Times, India
India to turn out 1,750 mental health workers a year ;; 20.01.10 Sify News, India
An Area Health Centre with lack of water and space ;; 14.01.10 Solomon Star
Rural doctor warning;; 19.01.10 Weekly Times Now, Australia
SA-based national health agency under fire ;; 15.01.10 Adelaide Independent Weekly, Australia
Minister happy with healthy new year ;; 16.01.10 PS News, Australia
Date Headline Publication
In Haiti, aid workers face a dual challenge;; 15.01.10 Los Angeles Times
Will IT change how doctors treat you in 2010?;; 04.01.10 Computer World
Health Reform Revisionism ;; 12.01.10 Newsweek
For Severely Ill Children, a Dearth of Doctors ;; 12.01.10 Wall Street Journal 08.12.09 The Need for Management Capacity to Achieve VISION 2020 in Sub-PLoS Medicine Saharan Africa ;;
Broad Demand for Healthcare Workers Seen in Most US Markets;; 15.01.10 Health Leaders Media
Closing the Health Care Workforce Gap ;; 15.01.10 Center for American Progress
Nurse shortage replaced by job shortage ;; 14.01.10 Carin‘s New York Business
Personnel infirmier dans l'Est-du-Québec: pénurie majeure en vue;; 16.01.10 Le Soleil, Canada
'Serious threats to jobs' fuel health negotiations ;; 17.01.10 Victoria Times, Colonist, Canada
Date Headline Publication
Busy maternity units turn away hundreds of women in labour;; 16.01.10 The Times, UK
Baby boom causes midwife shortfall;; 15.01.10 Morning Star, UK
12.01.10 The Accelerated Child Survival and Development programme in west The Lancet, UK Africa: a retrospective evaluation;;
40 per cent more nurses join dole queue ;; 17.01.10 The Mirror, UK
Fears for health service as cuts loom ;; 16.01.10 Belfast NewsLetter, UK 18.01.10 Rising birth rate is leading to a shortage of midwives, report Daily Mail, UK warns;;
Governo admite contratar mais médicos estrangeiros em 2010;; 19.01.10 RCM Pharma, Portugal 15.01.10 Trabajadores del Hospital de A Coruña denuncian la falta de La Opinión personal;; Coruña, Spain
Health workers on national strike today;; 18.01.10 Hürriyet Daily News, Turkey
L’hôpital, le grand raté des 35 heures ;; 18.01.10 Le Parisien, France
Date Headline Publication
Reconocen labor de enfermeras ;; 13.01.10 El Informador, Mexico
Honduras: Ampliar cobertura el reto en salud ;; 11.01.10 La Prensa, Honduras
Enfermeras mantendrán sus medidas por conflicto con ASSE;; 11.01.10 El Espectador, Uruguay
Hospitales dominicanos, repletos de haitianos ;; 16.01.10 El Universal, Mexico
Fies poderá ser pago com trabalho ;; 17.01.10 Tribuna do Norte, Brazil
Falta de médicos retrasa atención a damnificados: ONG;; 15.01.10 El Financiero, Mexico
"Machadadas" no SNS levam profissionais a fugir para privados;; 18.01.10 Rádio Renascença, Brazil 14.01.10 Novos empreendimentos na Amazônia ameaçam sobrevivência dos Terra Brazil índios ;;
Date Headline Publication
14.01.10 PAHO/WHO Coordinating Regional Efforts to Assist Haiti after PAHO/WHO Earthquake ;;
18.01.10 Overcrowded Hospital Wards: Performing Caesarean Sections on a UNFPA Park Bench ;;
11.01.10 Survey Shows Attention Required to Keep Ugandan Nurses in the ICN Profession ;;
Merlin joins call to address critical health worker shortages;; 15.01.10 Merlin, UK
Haiti: The health issues right now;; 15.01.10 Merlin, UK
18.01.10 Field Hospital Supported by the Government of Canada now CIDA Deployed in Haiti;;
19.01.10 *Scaling up proven public health interventions through a locally HRH Journal owned and sustained leadership development programme in rural Upper Egypt ;;
* All links to HRH Journal will be to an external web page - copy is not reproduced in this document.
Crisis in Haiti: The Alliance calls for health workforce support The Alliance 15/01/2010 15 January 2010 - Following the catastrophic earthquake in Haiti on 12 January, the Global Health Workforce Alliance appeals to all members and partners to provide urgent support to the country's health workforce, to enable help and aid the population. "Haiti is one of the 57 countries with crisis-level shortages of health workforce and a weak health system. Due to this terrible disaster, people are in urgent need of help from health care workers to treat their injuries. We hope our partners and members will act to aid Haiti in building and strengthening its health workforce in the coming period," said Dr Mubashar Sheikh, Executive Director of the Alliance. Merlin, an international charity for emergency medical help and a member agency of the Alliance is already on the ground in Haiti. "Haiti's health system was in a fragile state before the disaster and Merlin will be working closely with the Ministry of Health to train and retrain local health workers and will look to stay on as long as we are needed," Merlin said on its website. WHO and other partners are spearheading action to coordinate immediate health response. "At least eight health facilities have been damaged or destroyed. Many people are unaccounted for underneath rubble, a large number of survivors suffer from severe trauma injuries," said WHO.
Countries with chronic shortages of health personnel face devastation of unimaginable proportions when hit by disasters and emergencies. The Alliance and its members and partners are committed to intensifying action to improve health workforce planning and management in countries to enable decent health services for all. Related links: Follow WHO updates on relief efforts for Haiti Donate to Merlin's Haiti Emergency Earthquake appeal
Medicus Mundi, World Health Professional Alliance and Health Workforce Advocacy Initiative urge for discussion of the Code of Practice at the next World Health Assembly The Alliance 20/01/2010 20 January 2010 - Coalitions of the Alliance member civil society organizations have released statements and a public letter, responding the WHO Executive Board (EB) discussions on the draft global code of practice on international recruitment of health personnel. The public letter signed by 25 international NGOs and released by the Health Workforce Advocacy Initiative (HWAI) stressed the importance of the Global Code of Practice and urged the EB to submit the Code for discussion at the 63rd WHA in May 2010. The letter reads: "The Code is necessary to (1) respond to the critical HRH shortages and (2) ensure the full realization of the right of everyone to the enjoyment of the highest attainable standard of health – ―the right to health‖ – in all contexts. While recognizing the importance of respecting the right of health professionals to migrate, we also support strong language to set clear boundaries and expectations on State and non- State actors on recruiting HRH, particularly from developing countries, and to prioritize health systems strengthening." The HWAI signatories also stressed the need for improvements of the current Draft of the Code, including the need for "provision on abstaining ―from active recruitment of health personnel from developing countries unless‖ equitable agreements (or other arrangements) supporting that recruitment are in place." Anke Tijtsma of Wemos read a statement by Medicus Mundi International Network, highlighting the need to further strengthen the ability of State and non-State actors to adhere to the Code and enhance its overall impact. She said, "while the Code refers to the right and responsibility of all States to progressively achieve full realization of the Right to Health, it needs to explicitly incorporate that the right to health entails both the obligation of countries to strengthening their own health systems and the obligation of international cooperation and assistance." She also mentioned the importance of participation of non-State actors in the implementation and monitoring processes of the Code. The World Health Professional Alliance (WHPA) is an umbrella body of organizations such as the International Council of Nurses, International Pharmaceutical Federation, World Dental Federation and World Medical Association. The WHPA also supported the revised global draft code of practice and its submission to the World Health Assembly. Its statement said, that "the balance between the individual rights of health personnel and the right to the highest attainable standard of health of the populations of source countries is clearly a priority issue which has been addressed in the Code. It is important that the Code applies globally, to private as well as public sectors, temporary as well as permanent workers." The WHO Executive Board comprises of 34 members and acts as a decision-making body to advise on the policies of the World Health Assembly.
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Second cardio centre for Ghana Ghanaian Times 16/01/2010 A second cardiothoracic centre in the country is to be established within the next six months at the 37 Military Hospital Post-graduate centre to train doctors for the diagnosis and treatment of heart-related diseases. Lieutenant-Colonel Dr. Sunny Mante, Head of Surgery, and Cordinator of the 37 Military Hospital Post-graduate College, disclosed this at a press conference in Accra on Friday ahead of the African Heart Summit on Saturday. The four-day Heart Summit is a collaboration between the 37 Military Hospital and the German Heart Institute, Berlin. It is aimed at creating awareness of cardiovascular diseases in African society besides forging capacity building in cardiovascular medicine in Africa.
About 50 resource persons across the world will forge partnership with Ghanaian doctors at the workshop to promote cardiovascular health service delivery. Throwing more light on the Summit, Professor Charles Yankah, Course Director at the German Heart Institute, said to improve upon the country‘s health workforce, it must take cardiovascular diseases more seriously. The World Health Organisation and World Bank Statistics have indicated that by 2025, cardiovascular diseases would surpass HIV/AIDS infections to be the leading cause of death in Africa. He said between two and three per cent of Ghana‘s estimated 23 million population has cardiovascular related diseases. Professor Yankah said the ideal situation was to have at least two physicians in the regional hospitals specialised in the diagnosis and treatment of heart related diseases to ease off the load at the Korle-Bu Teaching Hospital. Prof. Yankah said the German Heart Institute was working with the Ghanaian authorities to have more cardiovascular surgeons, cardiologists, nurses, and physicians trained in the country to improve the wellbeing of the workforce. He said the cardiovascular physicians would be trained to diagnose and treat people who suffer from heart-related diseases but do not necessarily require operation. The Course Director said the society should be more scientific to recognise and seek early treatment for heart-related diseases rather than to be superstitious about such conditions. Prof. Yankah advised people to check their diet and undertake regular medical checkups. Dr. Edward Asumanu, Deputy Coordinator, Postgraduate College of the 37 Military Hospital, said the heart summit sought to deepen the awareness of cardiovascular diseases among the medical community to carry the message to the wider society. He said cardiovascular diseases which were categorised under non communicable disease were gradually emerging as major killers but the awareness was very low. Dr. Asumanu said medical examination should be made mandatory in the country.
Nigeria's Problematic Health Insurance Scheme (Op-Ed) The Guardian, Nigeria 17/01/2010 By Reuben Abati One of the major fall-outs of President Umaru Yar'çdua's prolonged absence from the country and his seeming "incarceration" in a Saudi Hospital has been the protest that if the Nigerian health care system were developed and well managed, the President not to talk of ordinary citizens would not have cause to travel abroad for medical treatment. Meaning: if President Yar'çdua had been in a Nigerian hospital receiving treatment, the noise about his health would have been less strident. But unfortunately, Nigeria runs a healthcare system that is worse than what they have in Haiti where tragedy has currently assumed its original human form. The seriousness of this matter was conveyed afresh only a few days ago, I guess inadvertently, through an advertorial in The Guardian newspaper placed by the management of the NHIS (Thursday, January 14 at page 62). In it, the NHIS says it is suspending a number of HMOs and HCPs. The import of that advert is that the National Health Insurance Scheme is not working. It has failed. This is the simple fact. When the NHIS was introduced by the Obasanjo government, the expectation was that it would help to improve access to healthcare for the majority of Nigerians, particularly persons in the public service and the private sector. In typical Nigerian style, the scheme began to die slowly a-borning. Many Nigerians depend on out of pocket spending for healthcare. With widespread poverty in the land, this creates special difficulties; unable to spare an extra Naira on healthcare, many Nigerians patronise quacks, or they make compromises with their health with tragic consequences. Even the educated, acting out of ignorance or expediency make uninformed choices. The NHIS as conceived was meant to bridge an existing gap and widen opportunities for access to qualitative healthcare with strong private sector participation, and with government defining policy and framework. Nobody had any illusions that a national health insurance scheme would solve all of Nigeria 's problems, surely a strong primary healthcare system would still be required to care for the usually marginalised segments of the population. But through insurance a sizeable and strategic segment of the population would have been captured. In the United States , health care reform remains a major issue, but despite the controversies, the national health insurance scheme works. The British NHIS is also so attractive that many Nigerians travel regularly to take advantage of it, even when they are not resident in the United Kingdom . I hope I am not revealing any secret among the immigrant community but I understand there is a way around these things to enable even ordinary visitors masquerading as residents to have good medical attention in the UK . Britain has been running a health insurance system since 1911; Germany since 1883.
As ever, the Nigerian system needed to be strengthened. In 2005, when the NHIS was officially launched, the then President Olusegun Obasanjo had uttered the following words: "with the start of the National Health Insurance Scheme, (NHIS), we see a future of opportunity to improve our health indicator which is related to our poverty index. The scheme will never go the way of other government programmes. The scheme will prove to Nigerians, our administration is serious and sincere about the reform agendas." Four years later, nothing has been proved. The poverty index has risen, and so have the country's poor health indicators. Initially, Nigeria 's NHIS had faced problems arising from what was defined as "global capitation"; in layman's terms that came across as rivalry among several professionals and service providers within the health sector but it was all the more about how to share revenue. Nevertheless, this was the least of the problems. Managing a health care system for results and actual difference requires leadership, careful management, and capacity building. As at 2005, average expenditure on healthcare as measured through GDP was 4.6; Federal Government average expenditure on health was about 1.5 %. Very poor you would say, but state and local governments fared worse. And yet ensuring the well-being of all Nigerians is part of government's constitutional mandate. Not doing so is a violation of the rule of law. Nigerian governments have voted for the latter, indeed the failure of the NHIS is a comment on the failure of governance. In the advertorial under review, the management of the NHIS claims inter alia,, that HMOs have not lived up to expectations, they have not made "sufficient progress" and that further re-accreditation of HMOs will be necessary. It is not impossible that certain HMOs have not been so efficient. The irony though is that HMOs have long been in the business of health insurance in the private sector before the same policy was formally adopted. What happened to the pool of knowledge that had been acquired? The NHIS advertorial does not tell the full story, but it also does in a way through the caveat that it provides rather conclusively. According to the NHIS, "the suspension shall not affect the following categories of providers: i. Providers in states folding into the Community Health Insurance Programmes for the Maternal and Child Health Project. ii. Providers in states folding into the NHIS Formal Sector Programme where additional facilities would be required." Our straight interpretation is that the big problem with Nigeria 's NHIS is the ambition of the Federal Body to seize control of it. This does not serve the purpose of efficiency rather it satisfies the urge of a cabal for power and profit. The NHIS in its concluding paragraphs uses the phrase "fold into", that is, the states folding into the NHIS formal sector programme. We are confronted here, therefore, with the original problem with Nigerian federalism. We run an over-centralised state. The centre would rather dictate what happens in other parts of Nigeria in scandalous breach of the law! The management of the NHIS needs to be told a few truths. One, health is on the concurrent list. The states don't have to fold into the Federal NHIS programme. They can set up their own management and administrative systems and accredit their own HMOs. Two, at the root of the Federal NHIS office's territorial aggression is money. NHIS wants subscription from the states. At least two states have hurriedly co-operated (Bauchi and Cross River states, but even that is not working). The states can have their own separate NHIS programmes which will not run contrary to the national NHIS. This allows for variety and diversity rather than over-centralisation. HMOs can then operate independently at various levels, they do not have to be under the control of a Federal Government that is widely regarded to be absent-minded. Three, our fear is that when civil servants seek to over-centralise everything as the NHIS authorities are struggling to do, they are not interested in the public good, they are more interested in creating a large pot from which they hope to draw honey until the pot is bankrupted. There have been integrity questions in the past about the management of the NHIS. Even now, there are questions about premiums paid. The NHIS insists that premiums are non-refundable. But when they are non-refundable, where do they go? To what purpose are they put? Four, our biggest concern is that the NHIS authorities in Abuja , talking about regulation and accreditation, are only interested in the collection of premiums. They seem to have abandoned regulation the object of which should be to make sure that the stakeholders do their job, a point that is only faintly, albeit cleverly referred to in the advertorial under review. On December 4, 2009, ThisDay newspaper at page 50 published an interview with the Director-General of the NHIS, Dr Dogo Muhammad titled "Why NHIS may not achieve universal coverage." The DG provides a self-indicting explanation that he should be ashamed of. He says in simple terms that the only reason the NHIS is not growing is because some states have refused to place their health schemes under the umbrella of the Federal Government. Why should they do so in a federal system, and in a matter that is concurrent? Dogo Muhammad wants the enabling law changed. What he really wants is more powers for the Federal NHIS. He is wrong. Universal coverage will be better achieved through decentralisation and greater investment in primary health care targeted at the poor. I admit that there are countries in the world where healthcare insurance is completely public sector driven as part of an overall reform framework, but it is a model that is ill-suited to Nigeria , given government's record of performance. What Nigerians need is a healthcare system that guarantees access to qualitative medicare at affordable price. There is no denying the fact that Nigeria 's healthcare index is very poor, and that the people are suffering. Today, this country has one of the highest maternal morbidity and infant mortality rates in the world. Public hospitals are grossly under-equipped. Private hospitals provide cash and carry services, and take-away medical services too, a sign of the intrusion into the medical sector of the fast food phenomenon. Self-medication is on the increase just as the market for quackery has blossomed. Governments at all levels provide little support for the medical sector. There is a yawning gap between promises and actual performance. When Nigeria 's big men fall ill, they jump onto the next available aircraft to seek help abroad. Without any doubt, the NHIS over which so much air has been split is a programme for the elites. Providing a non-discriminatory, broad-based healthcare opportunity for all Nigerians should be the overriding objective. There is a lot to be done. Health workers need to be motivated to take their jobs more seriously and to be
interested in serving Nigeria, not a foreign land whose attraction are the better conditions that it promises. Governments at all levels must assign more funds to the growth of the health sector with international standards in mind. Special attention must be paid to colleges of medicine, teaching hospitals and health related institutions to ensure quality training of medical personnel. A lot more energy should also be devoted to public enlightenment and the creation of social safety nets. People need to know what health insurance is all about: are they entitled to discounts? Is there a linkage between lifestyle choices and health insurance packages? Can they make choices and if so, what kind of choices? In March 2007, the following memorable statement was made by President Umaru Yar'çdua: "My personal experience demonstrated clearly the inadequacies of the Nigerian healthcare system. When I become the President of the Federation, I will fight to ensure that no Nigerian travels beyond the shores of the country to seek or obtain medical care" (ThisDay, March 20, 2007, p. 19). When the same man became President two months later, he forgot to include health in his famous seven-point agenda. He has since then travelled in and out of the country for foreign medical care! For the past 50 days, he has been in Saudi Arabia in a hospital. I doubt if the President is on the NHIS. So, who is picking up the bills for his long stay in a Saudi Arabian hospital? The same funds should be more than enough to set up a world-class hospital to take care of his health problem. Nigeria is losing all that. In real terms, the entire nation is sick. When the opportunity arises, someone should calculate and announce how much it is costing Nigeria to keep the President in a five-star hospital in Jeddah , Saudi Arabia for such a prolonged period. The short of it on all fronts is good governance which Nigeria lacks. I recommend a review of the NHIS and a decentralisation of the health insurance system in law and operation. The role of government should be restricted to regulation and monitoring and no more. Finally, a point of information: much better progress is being made with the NHIS in Ghana next door.
Malaria Consortium to improve community health workers performance in Africa Afrique en ligne 14/01/2010 Limited community involvement, shortages of medicines and shortfalls in training materials are among factors severely hampering the effectiveness of community based agents (CBAs) in the treatment of malaria and other communicable diseases in resource-poor countries, according to the UK-based Malaria Consortium. While there are many advantages in using CBAs, evidence to date has revealed that their effectiveness was also prevented by lack of refresher training and supervision, while the data collected by CBAs remained under-utilised, the Consortium said in a statement Thursday after receiving a US$10 million grant from the Bill & Melinda Gates Foundation. The grant is intended to demonstrate how government-led integrated community case management (iCCM) programmes can be scaled-up, leading to a sustained increase in the proportion of children with diarrhoea and other common diseases receiving appropriate treatment. 'Malaria Consortium is excited to have secured this important grant from the Bill & Melinda Gates Foundation,' said Dr James Tibenderana, Director, Case Management for Malaria Consortium. 'We estimate that each year diarrhoea causes about 30,000 and 36,000 deaths in children aged under five years in Mozambique and Uganda respectively, where this project will be implemented. This grant will give us the opportunity to prevent some of these deaths which is a responsibility we take very seriously.' A crucial element in attaining this goal is to gain a better understanding of the CBAs motivation and attrition, and find workable solutions to their retention and performance. According to the Malaria Consortium, this is essential if iCCM implementation is to be successful on a national scale. Health systems in resource-poor countries are often unable to scale up essential child health interventions. Many are strengthening their human resource capacity by investing in CBAs to deliver lifesaving treatment to children suffering from common but deadly diseases. As the lead agency, Malaria Consortium said it would build on established operations and excellent relations with the health ministries in Mozambique and Uganda, as well as other key national and international partners. It will manage a partnership combining expertise in research, communications and information technology, including the London School of Hygiene & Tropical Medic i ne, University College London Centre for International Health and Development, Strai ght Talk Foundation, N'Weti and Software Factory. 'This five-year project will complement the work recently started by Malaria Consortium through a Canadian International Development Agency (CIDA) funded project in four countries, including Uganda and Mozambique. 'While the CIDA project will carefully measure the impact of interventions, the Bill & Melinda Gates Foundation funded programme will add implementation research and activities to promote uptake of iCCM to 50 percent coverage in both countries,' the statement added.
Malaria Consortium works in partnership with communities, health systems, government and non-government agencies, academic institutions and local and international organisations to ensure good evidence supports delivery of effective services. Dar es Salaam - Pana
Kaduna Health Workers Give Govt Ultimatum Daily Trust, Nigeria 14/01/2010 Ismail Mudashir Health workers in Kaduna State yesterday gave an ultimatum to the state government to abide by the agreement reached last November or face an indefinite industrial action. The state government had promised to meet the requirements of the union after a three-day warning strike over improved welfare package by the workers in November. Addressing newsmen in Kaduna yesterday, the state chairman of the Association of Resident Doctors Dr. William Ayet said the workers would resume the suspended strike if the government failed to take appropriate action to address the issues affecting the workers. He said the state government had failed to implement the agreement of the Memorandum of Understanding (MOU) on the acceptance and implementation of their demands in November last year. "We suspended the three-day strike following a memorandum of understanding signed by the consultative health workers and the Head of Service to reach an agreement before the passage of the 2010 budget. They promised to address our demands before the presentation of the budget to the House of Assembly but now they have violated the agreement reached by presenting it before addressing our demands," he said. The chairman noted that the 350 per cent increase approved for the health workers was to enable them catch up with other states which goes to show how poor the state's health workers' salaries had been in recent years
Babies Dying From Poor Care After Delivery New Vision, Uganda 18/01/2010 Frederick Womakuyu Kampala — AT Kwirot Village, on the fringes of Mt. Elgon, Kapchorwa district, a Traditional Birth Attendant (TBA) battles in vain to save a life, but the three-year-old infant dies before he can reach the health centre 40km away. This is not an isolated issue. According to the 2007 new born health report by the child and reproductive health division of the Ministry of Health, Uganda's infant and child mortality rates are still high, with six out of 10 children dying annually before the age of one. Of these deaths, four out of 10 are newborn deaths. This is equivalent to 45,000 a year, an equal number of babies being born dead. The mothers are not spared either. At the annual conference of gynaecologists and obstetricians last year, Dr. Romano Byaruhanga of Nsambya Hospital, noted that 16 mothers also die per day due to pregnancy and birth-related complications. Health experts say the major cause of mothers dying is excessive bleeding after delivery. This is defined as blood loss greater than 500 millilitres during vaginal delivery or greater than 1,000 millilitres during caesarean delivery. In a paper entitled "Hurdles and Opportunities for newborn care in rural Uganda," Dr. Byaruhanga noted that Uganda may not be able to achieve the Millennium Development Goal 4. In the year 2000, UN member states agreed that by the year 2015, child mortality should be reduced by two-thirds or 4.1 per 1,000 live births. Dr. Jessica Nsungwa, co-presenting the report, blamed the high deaths on poor health seeking behaviour by mothers and staffing shortages in Uganda's health facilities. "In Uganda, about 59% of the babies are born outside a formal health facility. In addition, only 45% of the women attend four antenatal visits (during their pregnancy) and of these, 38% of deliveries are performed by skilled attendants," Dr. Nsungwa revealed. Dr. Byaruhanga says delivering at home is very risky. "The society does not adhere to guidelines on newborn care. Some have negative perceptions of practices on newborns." He adds that 80% of babies born in Uganda
suffer from hypothermia (extreme cold), because they are bathed immediately after birth. He cautions that this is very risky because the baby may die, develop pneumonia, feeds less and the amount of glucose or sugar in the blood decreases. This affects the baby's brain and increases risk of infection. He says the baby may develop infections like diarrhoea, tetanus and failure to breathe. The Ministry of Health report reveals that only three out of 10 mothers and babies born in a health facility, receive check-ups and support during the first 24 hours after childbirth. "The health facilities discharge the mother and the new born, usually after six hours when the mother and the baby are still at risk of ill health and death," the report reveals. Dr. Juliet Kiguli, a gynaecologist who attended the conference, noted that health facilities lack equipment and staff to support the mother and baby beyond 24 hours. According to the Ministry of Health, only 51% of health worker positions are filled in the country and of these, 20 % of the health facilities meet midwife staffing levels. Interventions The National Situation Analysis of newborn health recommends that health centres and communities recognise and refer newborn illnesses through community health workers during the infant period, to save their lives. Dr. Kiguli called for the training of health workers and health facility support in dissemination of guidelines, service standards for post-natal care, especially the policy on timing and service package for post-natal care within the first seven days after birth. The report called for health workers to sensitise the community about seeking formal health care with an aim of increasing the number of mothers who deliver in the health facility. The report also called for the Government to review the essential drug list for inclusion of pre-referral drugs for lower level health units. The essential drug policy should be reviewed to include availability of priority drugs for newborns at lower levels (healthcentre IIs and IIIs), including gentamicin and injectable ampicilin. But what is the Government doing? According to the Department of Human Resource in the Ministry of Health, in the next five years, they will recruit health workers countrywide to a staffing level of 71%. "However, health worker shortages increase outwardly from the urban, to the rural areas because of lack of staff housing, with some having as low as 36% staff positions filled," says a source in the department who preferred anonymity. Proper Care fr Newborns Dr. Byaruhanga says when a child is born, the amniotic fluid should be wiped off with a cloth, not water (even warm water) and the baby should be wrapped in a dry sheet and covered before the umbilical cord is cut off. The report also called for initiating early breastfeeding to keep the baby warm. "Warmth through skin-to-skin contact for low birth weight and premature babies should be encouraged," the report says, adding that proper cord care should be undertaken by a trained health worker to avoid unnecessary bleeding of the baby."
Brain Drain, Funding, Bane of Health Sector Daily Champion, Nigeria 20/01/2010 Florence Udoh Nigeria's plan to attain the health goals of the Millennium Development Goals (MDGs) by 2015 may be a mere dream as the country has only one doctor to over 5,000 patients. World Health Organisation (WHO), however, stipulated ratio of one doctor to 30 patients. Former National Secretary of the Nigerian Medical Association(NMA), Dr Kayode Akinlade said though thousands of medical doctors are trained in the country annually, only 25,000 are available to serve 150 Million Nigerians. "Funding is not the only constraint in the health sector. There is also capacity by which I mean the health workforce. Nigeria has produced well over 25,000 doctors because in the register we have about 50,000 doctors but many have gone outside the country," he said. Akinlade, who said doctors should not be blamed for their migration to other countries because of their high demand abroad. "For instance, there is this attraction in salaries. Here an average nurse is paid about N40,000 per month, whereas abroad, a nurse can earn as high as US$3,000. So there is a lot to gain. Why won't they run away if they have the opportunity?, he said.
He blamed the problem in the health sector on political environment, saying nobody seemed ready to address the problems in the health sector or the demands of health workers. "Abroad when something like this happens, the Minister will resign, Commissioners will resign. Political consideration is another factor. Maybe also the godfather syndrome. Somebody puts you there and therefore you cannot be removed and the masses are suffering. So, how will our health indices improve? "I am aware of parts of the country where there are no doctors, other categories of health personnel carry out surgical procedures and consultation with all kinds of complications. Nigeria needs to train more doctors to be able to take care of the health of the populace," he said.
Un départ massif des sages-femmes en retraite pénaliserait le métier Algérie Focus 16/01/2010 Poste par Sat [Aps 16/1/10] ALGER – La secrétaire générale de l‘Union nationale des sages-femmes, Akila Guerrouche, a affirmé samedi à Alger qu‘un départ massif des sages-femmes en retraite pénaliserait ce métier. S‘exprimant lors d‘une rencontre de concertation avec le ministère de la Santé, de la Population et de la Réforme hospitalière autour du statut particulier de ce corps paramédical, Mme Guerrouche a relevé qu‘un nombre considérable de sages-femmes, sur l‘ensemble du territoire national, ont atteint l‘âge légal de la retraite. Elle a, à cet égard, averti contre le ? manque flagrant ? de sages-femmes dans les services de santé dû à un départ massif en retraite en dépit du programme de formation tracé par le ministère de tutelle. Mme Guerrouche a saisi cette rencontre pour souligner l‘urgence de revaloriser le métier de sage femme, plaidant pour une protection contre d‘éventuelles poursuites judiciaires suite à des erreurs médicales ? dans la plus part du temps non commises ?. Elle a appelé aussi au renforcement de la formation continue des sages-femmes et à une mise à niveau de leur cursus professionnel afin qu‘elles puissent être en amont avec l‘évolution que connaît le secteur de la santé et assurer ainsi de bonnes prestations. Pour Mme Guerrouche, une formation de qualité des sages femmes ? ne peut être garantie que par la réouverture de l‘Ecole nationale des sages femmes qui a fonctionné en Algérie depuis 1825″, la prolongation de la durée de formation à cinq années et l‘introduction d‘un module sur l‘examen par échographie. Concernant la prévention contre la grippe A/H1N1, Mme Guerrouche a déploré la non participation des sages femmes à la campagne de sensibilisation sur cette pandémie, alors que la sage femme, a-t-elle dit, ? est présente dans toutes les maternités et fait partie du corps médical et paramédical à la tête des campagnes de vaccination ?. De son coté, la chargée du dossier formation et suivi des statuts particuliers des corps médicaux et paramédicaux au ministère de la Santé, a affirmé que le statut particulier des sages femmes et à l‘ordre du jour au ministère. Sur la formation de ce corps paramédical, elle a expliqué que le ministère a tracé un plan consacré à ce volet, dont certains points relèvent des prérogatives du ministère de l‘Enseignement supérieur et de la Recherche scientifique.
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Govt. planning medical degree course to produce rural doctors NetIndian News Network 15/01/2010 Union Minister for Health & Family Welfare Ghulam Nabi Azad today said the Government was planning to introduce a three-and-a-half year medical degree course to meet the shortage of doctors in rural areas. This would be a course leading to a Bachelor's degree in Medicine and Surgery to produce doctors who would work in rural areas and district hospitals with specified bed capacities could be utilised as medical schools, he said at a meeting of State Health Secretaries. Mr Azad said the expansion of health services under the National Rural Health Mission (NRHM) and emergence of non-communicable diseases had resulted in a high demand for specialists and doctors. He said the Government had, therefore, initiated various reforms in medical education to increase the intake at the level of post-graduation and also rationalise the process of setting up new medical colleges in deficient States and regions. He pointed out that the Post-Graduate Medical Education Regulations, 2000 had been amended recently, wherein the teacher-student ratio had been revised from 1:1 to 1:2.