Sub-Saharan Africa

This article builds on a recent publication on the capacity of the existing health workforce in Africa to expand through increasing production of its non-physician clinicians and by suggesting that there are four further issues to be urgently addressed if NPCs are to realize their full potential. [adapted from author]

Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. [from abstract]

Throughout Africa, the private retail sector has been recognised as an important source of antimalarial treatment, complementing formal health services. However, the quality of advice and treatment at private outlets is a widespread concern, especially with the introduction of artemisinin-based combination therapies (ACTs). This research aimed at assessing the performance of the retail sector in rural Tanzania. Such information is urgently required to improve and broaden delivery channels for life-saving drugs. [from abstract]

The so-called brain drain is a complex phenomenon with a web of push-pull factors determining final outcomes. There are no quick fixes. Yet, those on the front lines addressing the critical personnel shortages in South Africa’s public health system - especially in rural areas - have pointed to approaches that could slow the exodus and eventually turn the situation around. [from author]

This document explores some FBO health networks and facility-based services in Uganda and Tanzania. A pilot project in the Kasese District of Uganda illustrates how protestant, catholic and muslim health care providers and communities can work together from household-to-hospital levels to improve health outcomes. [from author]

This report calls for a rapid and significant scaling up of the education and training of health workers as part of a broader effort to strengthen health systems. It highlights the importance of training to meet a country’s own health needs and the great opportunity represented by the increased use of community- and mid-level workers. [from foreword]

There are also case studies from Ghana, Malawi, Pakistan, Ethiopia and Bangladesh on strategic implementation of health worker training plans.

This brief discusses the Capacity Project’s work to train health workers to help prevent mother to child transmission of HIV.

This brief describes the successful process of working within the government to achieve results in HIV planning. [adapted from author]

This note discusses challenges and options in scaling up the production of skilled health workers and strengthening the health professions educational capacity of the countries in crisis, particularly in Africa. [from introduction]

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

The mapping exercise illustrated in this report was conducted to inform and support the efforts of the Ugandan Ministry of Health to increase the contraceptive prevalence through enhanced community-based distribution (CBD) of family planning. The specific objectives of the exercise were to determine the historical and current coverage of CBD of family planning services in Uganda, by both governmental and nongovernmental programs, and to identify potential districts for scaling up these services. [adapted from summary]

The emphasis of the COPHIA program is the provision of home-based care and support services by multi-purpose community-based health workers to vulnerable households in the geographic focus areas that are coping with the burden of caring for seriously ill family members or caring for orphans and vulnerable children. The COPHIA community-based health workers, with the support of clinical and non-clinical supervisors, provide the direct physical and emotional care and support services to PLWHA and orphans and vulnerable children in the project catchment area with the support of trained primary caregivers.

This paper presents field narratives selected as illustrations of mythologising and masking in popular responses to HIV/AIDS in South Africa. The stories appear in the context of traditional health practitioners and the testimony of the healers is used to demonstrate the ways in which they interpret these narratives, and seek to challenge them.2 The examination then re-assesses these accounts, and the healers’ responses to them, in relation to the antipathy that exists between western medicine and traditional healing in the context of HIV/AIDS. [introduction]

This paper documents the results of the second year of operation of the HOPE Cape Town (HIV Outreach Program and Education) Pilot Traditional Healer Project, an innovative HIV/AIDS collaboration between traditional health practitioners and western medicine in the Western Cape Province. The paper identifies the project’s achievements, and explores key problems in operation and management, including recommendations for the design and implementation of future initiatives. [from introduction]

This brief is a best practice model for improving the quality and accessibility of family planning and HIV services in rural communities in Zimbabwe. [from author]

During the 1990s in Kenya, nurse midwives, a new group of private-sector service providers, were licensed to operate private clinics close to communities. The private nurse midwives operate private clinics, nursing and maternity homes primarily in densely populated peri-urban areas, rural trading centers and towns. The networks described in this report emerged out of the need for a sustainable supervision system and a continuing education program for the private nurse midwives. [from introduction]

This survey is the first attempt to examine the preparedness of the health
system to implement guidelines for HIV testing in clinical settings, and to provide comprehensive AIDS management. This includes availing HIV testing in clinical settings to both adult and pediatric patients, and providing treatment for HIV disease. The survey also examines the working environment in health care facilities, with an emphasis on HIV infection control and access to post-exposure prophylaxis for health workers themselves. [from foreword]

This paper examines the employment preferences of public sector registered nurses working in Malawi and identifies the range and relative importance of the factors that affect their motivation. The research was designed in the light of the Malawi government’s programme to address the shortage of health workers, which is based on salary top-ups as a means of increasing employee motivation and reducing high rates of attrition. This policy has been adopted despite relatively little quantitative exploration into the employment preferences of health workers in developing countries.

Knowing that quality is never an accident, always the result of high intention, sincere effort, intelligent direction and skillful execution, and that it represents the wise choice of many alternatives, this abbreviated version of the Policy attempts to provide the strategic direction health facilities and officials need to follow to assure quality in health care and continuous improvement in the care that is being provided. Health care personnel are encouraged to use this copy of the Policy to focus their intentions and guide their efforts. [from foreword].

The Canadian health care system is one of the places where push comes to pull in terms of attracting health care professionals from sub-Saharan Africa. The authors call this the perverse subsidy: the costs of training these professionals are paid for by poorer people in poorer countries. The pull to Canada is equally a push from Africa. Reflections on a pilot study on a labour mobility issue that is equally a question of conscience. [from author]

This study evaluated biases in guideline untilization of evidence-based practice concerning contraception perscription. It was found that in India, Peru, and Rwanda, health care providers underutilize evidence-based practice guidelines as they prescribe contraceptives. This article ends with recommendations for providers to most effectively utilize evidence-based practice. [adapted from abstract]

Telemedicine is viewed as a new way of offering medical services. It is seen as a means of overcoming the growing shortage of health practitioners in developing countries. The aim of this paper is to highlight the need for the formulation of guidelines for the ethical practice of telemedicine in South Africa. [from abstract]

Within the Southern African prevention of mother to child transmission (PMTCT) programmes, counsellors talk with pregnant mothers about a number of interrelated decisions and behaviour changes. Current counselling has been characterised as ineffective in eliciting behaviour change and as adopting a predominantly informational and directive approach. Motivational interviewing (MI) was chosen as a more appropriate approach to guide mothers in these difficult decisions, as it is designed for conversations about behaviour change. MI has not previously been attempted in this context. This paper reflects on how MI can be incorporated successfully into PMTCT counselling and what lessons can be learnt regarding how to conduct training with counsellors.

Clinical skills and the ability to perform procedures is a vital part of general medicine. Teaching these skills to aspiring doctors is a complex task and it starts with a good theoretical preparation and some practical experience at university. On graduating from university, each doctor is faced with the task of transforming theoretical knowledge into the practical, procedural skills of a competent professional. This study aims to assess the perceptions of intern doctors working in regional hospitals in the Western Cape of their skills training both at undergraduate level and during the intern year.

Following health sector reform, Ethiopia started training new categories of health workers. This study addresses students’ perspectives regarding their training and career plans. This study suggests that the current training programs have serious inadequacies that need to be addressed. [from abstract]

The objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive-health workers, or adolescent peer mobilizers could administer intermittent preventive treatment (IPTp) for malaria with sulfadoxine-pyrimethamine to pregnant women. The study concludes that the use of the guideline with adequate training significantly improved correctness of malaria treatment with chloroquine at home. Adoption of this mode of intervention is recommended to improve compliance with drug use at home. The applicability for deploying artemisinin-based combination therapy at the community level needs to be investigated.

Many Nigerian children with malaria are treated at home. Treatments are mostly incorrect, due to caregivers’ poor knowledge of appropriate and correct dose of drugs. A comparative study was carried out in two rural health districts in southwest Nigeria to determine the effectiveness of a guideline targeted at caregivers, in the treatment of febrile children using chloroquine. [from abstract]

The purpose of this study was to assess physicians’ knowledge, attitude and global comfort in caring for patients with AIDS (PWA), to determine the sociodemographic variables that could influence physicians and to identify any relationship between their knowledge, attitude and comfort. The study reinforced the need for an ongoing education focused on experiential learning and professional socialization in order to influence physicians’ attitude and enhance their feeling of comfort when caring for PWA. [adapted from abstract]

In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality. [from author]

This article describes the efforts within the Cuban medical system to collaborate with health authorities around the globe to develop medical education programs to train such urgently-needed professionals with curricula formulated to meet international standards and local health needs. Special emphasis is placed on the assistance that Cuba provided to Gambia in establishing a medical school in that country. [from author]