Innate Health Threat Among a Visibly Hidden Immigrant Group: A Formative Field Data Analysis for HIV/AIDS Prevention Among Zimbabwean Workers in Botswana

As a result of the collapse of the national economy and political instability, Zimbabwe has experienced a diaspora in recent years. Although Zimbabweans are now the largest immigrant group in most sub-Saharan countries, Zimbabwean immigrants are a mostly illegal and socioeconomically marginalized population. This study explores the lives of Zimbabwean workers in Botswana from a health communication perspective and provides suggestions for accelerating the diffusion of HIV/AIDS prevention information and practices among the target population. In particular, this ethnographic report portrays how the Zimbabwean workers in Botswana make sense of their surroundings and perceive information on HIV/AIDS prevention and other public health risks. Field data analysis highlights several communication features among the immigrants, including reliance on interpersonal communication, high rate of mobile phone adoption, inaccurate public awareness on HIV/AIDS and prevention messages, and stagnated communication with health care services. By connecting Dervin's sensemaking theory to Roger's diffusion of innovations theory, the suggestions from this study can be applied to design HIV/AIDS prevention interventions for the immigrants and socioeconomically marginalized groups.     

Development of a quality assurance handbook to improve educational courses in Africa

Background  

The attainment of the Millennium Development Goals has been hampered by the lack of skilled and well-informed health care workers in many developing countries. The departure of health care workers from developing countries is one of the most important causes. One of the motivations for leaving is that developed countries have well-established health care systems that incorporate continuing medical education, which enables health care workers to develop their skills and knowledge base. This provision is lacking in many developing countries. The provision of higher-education programmes of good quality within developing countries therefore, contributes to building capacity of the health care workforce in these countries.     

Why I Became a Home Support Worker: Recruitment in the Home Health Sector

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57 home support workers in three Canadian provinces, to examine the factors that attract individuals to employment in this sector. These factors include: previous experience, financial considerations, and enjoying working with people. Understanding these overlapping factors can aide in the recruitment of future workers.     

Why I became a home support worker: recruitment in the home health sector

Home care is considered an essential pillar of the health care systems in many industrialized countries. With an increased demand for home health workers, there has been growing interest in examining recruitment and retention of these workers. With a focus on recruitment of home support workers, in this study we draw on data from interviews with 57 home support workers in three Canadian provinces, to examine the factors that attract individuals to employment in this sector. These factors include: previous experience, financial considerations, and enjoying working with people. Understanding these overlapping factors can aide in the recruitment of future workers.     

Measuring and managing the work environment of the mid-level provider – the neglected human resource

Background  

Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years). Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries.     

Factors and considerations for establishing and improving seasonal influenza vaccination of health workers: Report from a WHO meeting,January 16–17, Berlin,Germany

Health workers represent an important target group for seasonal influenza vaccination because of their increased risk of infection as well as the risk of transmitting infection to vulnerable patients in the health care setting. Moreover, seasonal vaccination of health workers contributes to pandemic preparedness. However, many countries, especially in Africa and Asia, do not have policies for health worker influenza vaccination. In countries where such policies exist, vaccination coverage is often low. The World Health Organization (WHO) is developing a manual to guide the introduction of seasonal influenza vaccination of health workers. An Independent External Advisory Group (IEAG) that is advising WHO on the content of the manual met to discuss issues that are relevant and often unique to health worker vaccination. This meeting report summarizes the main issues that were discussed and the outcomes of the discussion. The issues include policy considerations, including the evidence in support of health worker vaccination; categorization and prioritization of health workers; the choice of vaccination strategy; its integration into broader health worker vaccination and occupational health policies; planning and management of vaccination, particularly the approaches for communication and demand generation; and the challenges with monitoring and evaluation of health worker vaccination, especially in low and middle-income countries.     

Practical and affordable measures for the protection of health care workers from tuberculosis in low-income countries.

With the global upsurge in tuberculosis (TB), fueled by the human immunodeficiency virus (HIV) pandemic, and the increase in multidrug-resistant TB, the condition has become a serious occupational hazard for health care workers worldwide. Much of the current understanding about nosocomial TB transmission stems from the USA; however, little is known about the risk of such transmission in low-income countries. The focus of this review is on sub-Saharan Africa, since this is the region with the highest TB incidence, the highest HIV incidence, the worst epidemic of HIV-related TB, and where the risk to health care workers is probably greatest. Measures used in industralized countries to control nosocomial TB transmission (ventilation systems, isolation rooms, personal protective equipment) are beyond the resources of low-income countries. Protecting health care workers in these settings involves practical measures relating to diagnosis and treatment of infectious cases; appropriate environmental control; and relevant personal protection and surveillance of health care workers. Research needs to be carried out to examine the feasibility and cost-effectiveness of measures such as voluntary HIV-testing of health care workers (to enable known HIV-positive health care workers to avoid high-risk settings) and isoniazid preventive therapy for workers in high-risk settings. More resources are also needed to ensure full implementation of currently recommended measures to decrease the risk of nosocomial and laboratory-acquired TB.     

Standing still: why North American workers are not insisting on seats despite known health benefits.

Prolonged standing is associated with health problems. Despite regulations providing for access to seats, most Québec (Canada) workers usually stand. Only one in six can sit at will. Standing service workers such as cashiers and sales personnel are often confined to a small area where sitting is theoretically feasible. In many other countries, such workers have access to seats. This study asks why North American workers do not press for seats. In a qualitative, exploratory approach, 30 young workers who usually work standing were interviewed about their perceptions and experiences of prolonged standing at work. All but one experienced discomfort associated with this posture, and two-thirds reported that they had changed their lifestyle in some way as a result of their symptoms. However, their accounts of relationships with employers, health care personnel, and the health and safety system suggest that many environmental factors as well as attitudes toward work, employers, health, and the body contribute to maintaining the status quo. Workers describe problems with the image of a seated worker and thought that asking for a seat would threaten their relationship with the employer. Personal comfort was considered an insufficient reason to challenge worksite design, attitudes, and organization.     

Push, Pull, and Reverse: Self-Interest, Responsibility, and the Global Health Care Worker Shortage

The world is suffering from a dearth of health care workers, and sub-Saharan Africa, an area of great need, is experiencing the worst shortage. Developed countries are making the problem worse by luring health care workers away from the countries that need them most, while developing countries do not have the resources to stem the flow or even replace those lost. Postmodern philosopher Emmanuel Levinas offers a unique ethical framework that is helpful in assessing both the irresponsibility inherent in the current global health care situation and the responsibility and obligation held by the stakeholders involved in this global crisis. Drawing on Levinas’ exploration of individual freedom and self-pursuit, infinite responsibility for the Other, and the potential emergence of a just community, we demonstrate its effectiveness in explaining the health care worker crisis, and we argue in favor of a variety of policy and development assistance measures that are grounded in an orientation of non-indifference toward Others.     

Ethical issues in health workforce development

Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed.     

Development of the National Health Information Systems in Botswana: Pitfalls,prospects and lessons

Background: Studies evaluating development of health information systems in developing countries are limited. Most of the available studies are based on pilot projects or cross-sectional studies. We took a longitudinal approach to analysing the development of Botswana’s health information systems.Objectives: We aimed to: (i) trace the development of the national health information systems in Botswana (ii) identify pitfalls during development and prospects that could be maximized to strengthen the system; and (iii) draw lessons for Botswana and other countries working on establishing or improving their health information systems.Methods: This article is based on data collected through document analysis and key informant interviews with policy makers, senior managers and staff of the Ministry of Health and senior officers from various stakeholder organizations.Results: Lack of central coordination, weak leadership, weak policy and regulatory frameworks, and inadequate resources limited development of the national health information systems in Botswana. Lack of attention to issues of organizational structure is one of the major pitfalls.Conclusion: The ongoing reorganization of the Ministry of Health provides opportunity to reposition the health information system function. The current efforts including development of the health information management policy and plan could enhance the health information management system.     

Migration of health-care workers from developing countries: strategic approaches to its management

Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.     

Health care experiences and preferences of uninsured workers

An exploratory study of the experiences, beliefs, and preferences of uninsured workers found that uninsured workers are active in seeking solutions to their health care needs and have decided opinions about health care. They use a cost-benefit analysis in deciding which health problems warrant professional attention. However, uninsured workers also exhibit a contradictory pattern of behaviors and beliefs. They say their health is good, yet many have illnesses that they neglect. They are satisfied with the health care services they use, yet they want health insurance because they believe it provides more choice and ensures better care and treatment. They express few negative feelings about Medicaid, yet even among the poorest of these workers, few have recently used Medicaid. These findings can inform policy options being considered.     

The role of training in STD prevention and control

The World Health Organization (WHO) estimates that 340 million new cases of curable sexually transmitted diseases (STDs) (excluding HIV and herpes simplex virus) occurred in 1995. The level of infection with STDs is especially troubling in developing countries, where they cause considerable morbidity. The consequences of infection with STDs can be personal, social, and economic. STD control programs are based upon the principles of primary and secondary prevention. Primary prevention strategies involve preventing the occurrence of new infections, while secondary prevention strategies aim to improve the management of STDs, and thereby to reduce their transmission and subsequent associated morbidity and mortality. Both primary and secondary prevention strategies require the dissemination of information from health workers to the at-risk population at a grassroots level, usually in primary health care centers. Health workers must therefore have a comprehensive and up-to-date knowledge of the many aspects of STDs, and be confident in their ability to communicate that information to others. A study in Tanzania determined that improvement in primary health care, including the provision of worker training, resulted in a 40% reduction in the incidence of HIV. The Wellcome Trust's new Topics in International Health series provides information on STDs on an interactive CD-ROM covering the epidemiology, diagnosis, clinical features, and treatment of the major STDs, except HIV, which is the subject of a separate CD-ROM. The CD-ROM was designed to be used in training programs for medical students and health care workers.     

Human resources and the quality of emergency obstetric care in developing countries: a systematic review of the literature

Background

The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities.

Methods

We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. Inequalities were measured by calculating Gini and concentration indices.

Results

There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline.

Conclusion

The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce.     

Population density index and its use for distribution of Covid-19: A case study using Turkish data

Since March 2020, many countries around the world have been experiencing a large outbreak of a novel coronavirus (2019-nCoV). Because there is a higher rate of contact between humans in cities with higher population weighted densities, Covid-19 spreads faster in these areas. In this study, we examined the relationship between population weighted density and the spread of Covid-19. Using data from Turkey, we calculated the elasticity of Covid-19 spread with respect to population weighted density to be 0.67 after controlling for other factors. In addition to the density, the proportion of people over 65, the per capita GDP, and the number of total health care workers in each city positively contributed to the case numbers, while education level and temperature had a negative effect. We suggested a policy measure on how to transfer health care workers from different areas to the areas with a possibility of wide spread.     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.     

Community health workers and integrated primary health care teams in the 21st century

Community health workers are an integral part of many healthcare systems. Their roles vary and include both the socially oriented tasks of natural helpers and specific constrained tasks of health extenders. As natural helpers, community health workers play an important role in connecting public and primary care to the communities that they serve. As primary health care becomes more patient-centered and community-oriented, the natural helper roles that include trust, rapport, understanding, and the ability to communicate with the community take on an increased significance. Community health workers are effective and make the health care system more efficient. In some states, the community health worker has become a more formal member of the integrated primary health care team, and it is in this role that she or he provides structured linkages between the community, the patient, and the health care system. The effective community health workers are strongly embedded in the communities that they serve; they have clear supervision within the health care system; they have clearly defined roles in the health care system; and they are well trained and have a defined system of advancing their education and roles within the health care system.     

Closing the gap in HIV prevention and care for children: early insights from a model that links communities and health care facilities in Uganda

Inequities in access to HIV prevention and treatment for children remain a global challenge and a black spot to effective HIV prevention and response especially in many HIV endemic countries like Uganda. In Uganda while about 51% of the adults living with HIV are on antiretrovirals, only 39% of the children aged 0–14 years accessed the needed HIV care in 2014. In this article, it is argued that much focus on health system interventions with little regard to bridging the gap between health facilities, where much of the care is provided, and the communities, where children are conceived, born and cared for, contributes to and sustains this inequality. Investments need to be made in building and implementing models that create and enhance linkages between communities and health care facilities. Success factors from the Towards an AIDS Free Generation in Uganda project model in creating these linkages are bringing all actors together in one approach, building on existing community structures and enabling community health workers to be the linking pin between communities and facilities. Only with models like this, full elimination of mother-to-child transmission and paediatric HIV care coverage (0–14 years) can be reached in Uganda and other HIV endemic countries.