This Week's News
19-23 October 2009
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
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
Africa & Middle East
Date Headline Publication
17.10.09 Govt to hire 5700 medical personnel o KBC, Kenya
20.10.09 Michigan Varsity Trains 40 in Aviation, NursingMi This Day, Nigeria
14.10.09 UGANDA: Camp closures worry HIV-positive IDPsU G PlusNews-Africa
15.10.09 Conference of Medical Superintendents Group opensC o Ghana News
15.10.09 Another Woman Dies in Labour 'Out of Negligence' n Daily Monitor,
21.10.09 UCH Doctors Embark On StrikeU C Daily Champion,
15.10.09 IMF accused of impeding health sector progress M Business Daily
21.08.09 Be kind, health workers urgedB e New Vision,
Asia & Pacific
Date Headline Publication
18.10.09 ‘Intensify barangay’s dengue drive’ I Inquirer Global
16.10.09 'Made in India' dominates US AIDS scheme M Business
17.10.09 Mission accomplished for Okinawa 'substitute doctor'Mi Japan Times
17.10.09 Hospital workers speak out Taranaki Daily
77 News, N. Zealand
17.10.09 Rural GPs glad to bend Kevin Rudd's earR u The Australian
16.10.09 New Clinical Training Agency Board appointedN e N. Zealand Doctor
21.10.09 Health Board denies hospital review claims e Ashburton
Date Headline Publication
19.10.09 Governor Rendell Announces Application for $5 Million Federal PR Newswire
Recovery Act Grant to Train, Place Health Care Workers e
20.10.09 Nurses' Union Plans to StrikeN u Wall Street
15.10.09 Return of India's Traditional Birth Attendants Urged to Meet MDG IPS Terra Viva
16.10.09 Flu shots not mandatory for local health workers l Star News
18.10.09 Curbing costs falls to wayside in health-reform push u Denver Post
19.10.09 What Might Health Care Reform Have to Do With H1N1? h Huffington Post
16.10.09 HEALTH CARE AND PHYSICIAN SHORTAGESH E Cypress Times,
20.10.09 Health workers say passing I-1033 will hurtH e Yakima Herald-
19.10.09 H1N1 could mean forced overtime for Quebec health workers 1 CBC News,
16.10.09 De plus en plus d'infirmières enceintes au travail e Le Droit, Canada
Date Headline Publication
21.10.09 Iraqi doctors seize first training opportunity in 20 years in unique UK BMJ, UK
21.10.09 Health workers first for flu jabH e BBC News, UK
20.08.09 IntraHealth to Lead $300 Million USAID Project in Global Health Reuters, UK
Workforce, Systems Strengthening o
11.09 Operational research in low-income countries: what, why, and how? Lancet Infectious
Op Diseases, UK
20.10.09 World Medical Association calls on Iran to respect medical ethics BMJ, UK
16.10.09 Lyon sud : des opérations reportées faute d'infirmièresL y Le Progrès,
16.10.09 Admin.ch : Conférence nationale sur les places d'apprentissage 2009 Romandie News,
- Invitation à la conférence de presse- CH
19.10.09 Overcrowded hospital wards: Government blames industrial The Malta
actiona c Independent
19.10.09 Occupational health and safety : Maltese nurses lack information and The Malta
safe modes of practice – MUMN a Independent
19.10.09 Telemedicina contra las listas de espera e El País, Spain
Latin America & Caribbean
Date Headline Publication
16.10.09 Médicos venezolanos a la calleMé El Universal,
18.10.09 Desafía la epidemia al sistema de Salud e Tabasco Hoy,
17.10.09 Hospital de Guanare no satisface demanda quirúrgica de Entorno
pacientesp a Inteligente,
17.10.09 Mozarildo apresenta sugestões para suprir a carência de médicos nas Direito2.com,
regiões pobres do paísr e Brazil
17.1009 Moradores de Deodoro torcem para que Jogos tragam progresso o JB Online, Brazil
17.10.09 Médicos pedem demissãoMé O Dia, Brazil
News from WHO and partners
Date Headline Publication
21.10.09 Childhood vaccines at all-time high, but access not yet equitableC h WHO
15.10.09 European Development Days: GAVI and Global Fund organise debate GAVI Alliance
on health Millennium Development Goals n
20.10.09 Asia Pacific Meeting Reaffirms Commitment to Reproductive and UNFPA
Sexual Health e
22.10.09 *Contracting private sector providers for public sector health HRH Journal
services in Jalisco, Mexico: perspectives of system actors e
19.10.09 Philippines typhoons: Deadly disease threat as emergency Merlin, UK
* All links to HRH Journal will be to an external web page - copy is not reproduced in this document.
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Africa & Middle East
Govt to hire 5700 medical personnel
Kenya Broadcasting Corporation
The government will this year employ 5,700 health workers to ease the shortage in public hospitals medical
services Ps Ole Kipyapi has said.
He also said the Ministry of Medical Services is also working on improving the packages of health workers in
the next financial year
In a bid now to take healthcare services next to Kenyans and alleviate the shortage the government thought
the stimulus package intended to employ 20 nurses per constituency.
Kipyapi says to curb the mushrooming of bogus medical training institutions the ministry will table in
parliament a report on the national health training policy.
He was speaking in the 7th graduation ceremony for Cline Irvine College of Nursing in Chogoria.
The country's health sector has been facing acute shortage of personnel for years now.
This was even made worse by the ban on the employment of civil servants in the late 1990s and the problem
compounded by the setting up of new health facilities through the Constituency Development Fund
Michigan Varsity Trains 40 in Aviation, Nursing
This Day, Nigeria
Umuahia — No fewer than 40 youths from Abia State have been pencilled down for a scholarship programme
which would enable him to be trained in aviation and nursing at the Western Michigan University in the United
States of America.
The scholarship scheme, which is a product of a tripartite partnership involving the Abia State government,
Cita Triax Education Foundation, and the Western Michigan University , is expected to commence this month
after conclusion of the selection process for he pioneer beneficiaries
To implement the scholarship programme, a committee has been set up headed by the Chief of Staff to the
governor, Mr. Mascot Uzor Kalu as the chairman with the commissioners for health, local government and
chieftaincy affairs; information, education, youths as members.
Secretary of the committee, Mr Ben Kalu told newsmen at Umuahia that was saddled with the task of fine
tuning the relationship structure between the state, the education foundation and the Western Michigan
University in order to realise "this dream of raising a formidable army of young people from different localities
of the state that will take up the role of leadership, tomorrow in this country and in this state."
He said that the training programme was initially restricted to aviation but nursing was later added to address
the immediate needs of the state, adding that in future it would further be expanded to include economics and
agriculture as the state is desirous of introducing mechanised agriculture to enhance food production.
Kalu acknowledged that the awareness of the existence of the scholarship programme was still poor, adding
that the committee would involve traditional rulers, community leaders and the media to create the necessary
According to him, those eligible for the scholarship programme must be in the age bracket of 16 and 24 with
the requisite O'Level qualifications, adding that the selection process would be conducted annually and would
involve the US Embassy in order to smoothen the visa process.
The committee secretary explained that the number of beneficiaries would not exceed 40 no matter the
number of applicants that scale through the qualifying examination and screening process because the
"economic crunch" would make it difficult for the state government to foot the bill in excess of 40 students. "It
is better for the state to do forty and do it very well than make too broad and not be able to give them quality
education," he said.
UGANDA: Camp closures worry HIV-positive IDPs
GULU, 14 October 2009 (PlusNews) - The imminent closure of internally displaced persons (IDP) camps in
northern Uganda is causing concern among HIV-positive residents, who fear they may not have access to vital
health services when they return to their villages.
The decommissioning of the IDP camps started in the region on 1 October, with six closed in Gulu district. The
camps have accommodated more than one million people for the duration of the 20-year war between the
government and the rebels of the Lord's Resistance Army; peace talks between the warring parties and more
than two years of sustained security in the region prompted the decision to close the camps.
"I don't know what is going to happen to some of us on ARVs; we are not being told where to access these
drugs from our villages," said Joseph Ochieng*, who lived in Bobi camp, in Gulu district, until its recent closure.
No services at home
"There are no health or distribution centres for these drugs in the return villages," said Jane Atimango*,
another former IDP. "We have no option but to travel long distances to look for these drugs."
Organizations working in HIV have also expressed concern that monitoring their clients may become more
difficult as they disperse to places lacking easy access to health centres.
"In camps the facilities were in abundance, but now we need transport for proper monitoring as people are
scattered in the villages," said Louis Okello, a representative of people living with HIV in Patiko sub-county,
Prevention services are needed as well. Recent research by the AIDS, Security and Conflict Research Hub
shows that the transition from war to peace can increase risks of HIV transmission as refugees go home,
soldiers leave the army, relief agencies wind down, and rapid economic growth occurs around key urban
According to the Ministry of Health, HIV prevalence in Uganda's northern-central region is just over 8 percent,
higher than the national average of 6.4 percent.
Government officials say there are plans to roll out health services to the community by building new health
centres and improving the capacity of existing ones.
"There are already health centres in the return areas, although they are not sufficient," Kabakumba Masiko,
the Minister of Information and National Guidance, told IRIN/PlusNews. "The government is committed to the
rehabilitation and development of the region."
"At the moment the services are only available at health centres … in county headquarters," said Stephen
Oloya, chairman of Gulu District's camp phase-out committee.
"For VCT services [voluntary counselling and testing], we are expanding them to sub-county level as we have
tried to operationalize all the health centres at sub-county level," he added. "We are also planning to open
health centres at parish level."
One local NGO, however, has already put in place measures to ensure people in its care continue their
treatment uninterrupted; the AIDS Support Organization has opened community drug distribution points in
various villages where patients can collect their drugs as well as seek psycho-social support and medical care.
"We have the capacity to map and follow the clients to the places they will go; to make our work easy, we
encourage them to give us maps to their places," said Sam Emukok, a TASO public relations officer. "TASO will
continue delivering services to the registered clients regardless of where they will go after camp decongestion."
Emukok said most HIV-positive IDPs would be happy to return to their homes, where they could cultivate their
own food and eat a more balanced and varied diet than in the camps.
"People who are living with HIV and are under our care know the importance of camp closure given the
challenges they have faced in the camps; they can now engage in agriculture to get food to supplement their
diets," he added. "We give this information during health education in the clinics, outreaches and during radio
More than two-thirds of the IDPs in the region have already left the camps - some returning to their original
villages and others to satellite camps between the IDP camps and their villages.
Conference of Medical Superintendents Group opens
Ghana News Agency
Busua (W/R) Oct. 15, GNA - The Western Regional Health Directorate, has initiated steps to set up a Regional
Research Unit to facilitate clinical excellence and provide evidence for critical medical decision- making.
Mr Paul Evans Aidoo, Regional Minister, made this known in a speech read on his behalf, on Wednesday, at the
opening of the 8th Annual General Conference of the Medical Superintendents' Group (MSG) at Busua.
He said the Effia-Nkwanta Regional Hospital, the major referral centre in the region, was poorly equipped for
adequate medical research.
The three-day conference was on the theme: "Research and Medical Practice, Capacity Building in our
Mr Aidoo said inadequate infrastructure and lack of key personnel including pathologists hinder clinical medical
"New discoveries and expansion of medical frontiers could only be achieved with a well strategise medical
research," he said.
Mr Aidoo said critical areas that needed special attention were the re-emergence of certain tropical diseases
such as yaws, filariasis, which abound in the Ahanta West District and guinea worm.
He also listed the high disease burden of malaria, HIV/AIDS, hypertension, diabetes, soaring maternal and
infant mortality and morbidity as well as health care financing improvement options and high technology
development as other areas of focus.
Mr Aidoo urged the conference to examine the issue of ethics, which relates to patients privacy and consent in
Dr George Acquaye, President of MSG, said there was the need for the expansion of the country's health
facilities, to avoid over crowding of patients.
He said there was the need to regularly replace equipment at the facilities to increase efficiency and to
motivate health workers to attend to patients.
Dr Acquaye spoke of the delay in reimbursing health facilities under the National Health Service Insurance
He asked members of the group to publish their research works in the Ghana Medical Journal and other
medium and also read other study findings.
Dr Linda Vanotoo, a medical superintendent said health delivery in the region had to change because of the
discovery of oil and asked the conference to consider the issue.
She noted that organisational barriers and lack of requisite number of personnel and technical know-how at the
medical centres could be overcome when the officials use guidelines that are developed by experts or availing
themselves of competency based training and putting in structures that would help them to use results
obtained from research.
Another Woman Dies in Labour 'Out of Negligence'
Daily Monitor, Uganda
Kisakye was admitted to Mbale Regional Hospital but after examination, the midwives on duty neglected her
and only returned to attend to her in the evening at about 9p.m. when the situation had gone out of hand.
When Olivia Kisakye arrived at Mbale Regional Hospital on September 23, in labour, she knew she would give
birth normally under the supervision of qualified medical personnel and return home.
But unfortunately, when they reached the hospital's maternity ward from Bugusege, it took them the entire
day to get the services of a medical worker and by the time the midwives responded, Kisakye had passed on.
Amina Nabukwasi, the deceased's mother is a bitter woman and does not want to talk to anyone from the
hospital. Why? She believes her daughter (Kisakye) could have been saved if the medical workers had
attended to her in time.
"What did I do to these nurses? Why do they treat me like this? The Ministry should intervene, investigate this
matter to save other mothers who go to deliver at this hospital," Nabukwasi laments.
Kisakye was admitted to the maternity ward at about 3.a.m. but after examination, the midwives on duty
neglected her and only returned to attend to her in the evening at about 9p.m. when the situation had gone
out of hand.
"They told me to buy medicine and gloves before my patient could be attended to. I pleaded with them several
times but they chased me away and said that they were too busy to attend to my daughter. They even threw a
pillow at me to go away," Nabukwasi says.
She says at about 11pm when they later responded, the nurses sent her out to go and look for hydralazine,
magnesium sulphate and gloves. "I moved through the streets and never found anything. I decided to go back
and found my daughter breathing her last, the foetus had already died," Nabukwasi narrates.
Although the body was supposed to have undergone a post-mortem to ascertain the cause of death and
remove the foetus, Ms Nabukwasi says they were chased out of the hospital and told to take the body with
The girl was admitted after she experienced labour pains. She was examined by the doctor but shortly
developed fits and high blood pressure, so he prescribed hydralazine and magnesium sulphate but
unfortunately this medicine was not available at the hospital so we told her relatives to go the drugs buy but
they did not," the senior principal nursing officer, Monica Odella says.
She says at the time of Kisakye's death, there were only two midwives in the ward; one was attending to four
women who were undergoing casearian deliveries and another attending to 24 women who were delivering
She says that maternal mortality rates especially for women in labour are common at the hospital because of
shortage of drugs and understaffing at particularly the maternity ward. However, Ms Odella denies reports that
the hospital refused to have a post mortem taken on the deceased and says her relatives came and demanded
to be given the body to avoid mortuary and postmortem expenses.
Sources at the hospital say that there is an outcry of lack of services at the maternity and casuality wards,
theatre and the blood bank to the extent that if a patient does not have money they cannot access treatment.
"We buy everything even if it means a medical worker just touching your patient. IV fluids are sold at
Shs2000, a canular at Shs3000, a syringe at Shs500 and gloves at Shs2000.
These prices are double the cost in some private clinics, so we are being cheated," a patient who spoke on
condition of anonymity said.
The patients cite poor services, scarcity of drugs; unsuccessful attempts to see a doctor, corruption, tribalism,
poor attitude towards patients and an unhygienic environment as some of the setbacks of the hospital.
"Our hospital is not operating as referral. In fact, it is not fit to be called referral as it is worse off than a health
centre II in rural areas. It is an abuse to refer to Mbale Hospital as a referral when it refers patients to private
clinics for diagnosis," a doctor who spoke on condition anonymity reveals.
He said the situation at the hospital has forced many people to lose trust in the government and health system
and opt for herbal remedies or private clinics which unfortunately offer sub-standard medical treatment.
UCH Doctors Embark On Strike
Daily Champion, Nigeria
Ibadan — Resident doctors of the University College Hospital (UCH), Ibadan on Tuesday embarked on an
indefinite strike to express their grievances over the current developments at the premier teaching hospital.
Specifically, the doctors are said to be annoyed over the recent hike in the tariff for services being rendered to
patients by the hospital and recent hike in their official accomodation tariff together with the amount they pay
for other utility services such as electricity.
Sources close to the hospital revealed that the UCH management recently increased the accomodation tariff
being paid by resident doctors by 700 per cent while amount being charged the doctors for electricity by the
hospital also went up by almost the same percentage. The hospital management equally directed that the
deduction of the new accomodation fees and fees for electricity should commence this month.
It would be recalled that the hospital management had earlier in the year, increased the fee being charged
patients attending the hospital to raise internally generated revenue for the hospital.
It was reliably gathered that efforts by the resident doctors to make the hospital management rescind its
decisions had met with stiff opposition.
According to sources, the executives of the resident doctors had on about eight occasions met with
management where their appeals for the downward review of the newly introduced fees were rebuffed.
"We have no alternative than to commence this strike. In as much as we appreciate the hardships this may
inflict on our patients, we have found ourselves in a situation where management has turned deaf ears to our
grievances", one of the aggrieved resident doctors who pleaded for anonymity said.
Commenting on the development, another resident doctor said management of the hospital had also given all
the resident doctors 'quit notice' from their respective apartments under the guise that the apartments are to
be renovated between now and next January.
He said: "The idea is to cow us into paying the new rate. Even if you want us to pay new rate, where do you
want us to be staying between now and January when the supposed renovation is expected to end. Some of us
are not from this state. Some are from the East while some are from the North and you are saying we should
quit; quit for where?"
Vice Chairman of the UCH Branch of the resident doctors association, Dr. Adewole Badiru who confirmed the
strike however, declined comments on the issue.
Majority of the resident doctors who were sighted at the hospital were seen at the 'Resident Doctors' lounge
where they congregated and were discussing the issue.
In a sharp reaction however, the UCH Chief Information Officer, Mr. Toye Akinrinlola told newsmen that the
management has met with the executive of the striking resident doctors expressing the hope that any moment
from now, they might call off the strike.
IMF accused of impeding health sector progress
Business Daily Africa
By STEVE MBOGO (email the author
Civil society groups are blaming conditions set by the International Monetary Fund for saddling patients with
high medical bills and increasing the prevalence of infectious diseases such as Aids and tuberculosis.
The organisations say expenditure ceilings on public health spending imposed in the ‘90s as part of the
conditions for disbursing financial support to Kenya have held back progress in the health sector by restricting
the recruitment of medical professionals.
Kenya’s public health officials have previously said that the country urgently needs 10,000 nurses but an eight
per cent ceiling on wage spend has made it difficult to hire them.
“As a result of inadequate funding, coupled with the wage bill ceiling and employment freeze, Kenya is
experiencing a health workforce crisis,” said Allan Ragi, the executive director of the Kenya Aids NGOs
He spoke during the launch of a report that profiles how IMF policies in Kenya have impacted treatment
HIV/Aids and tuberculosis.
The study, conducted by the Center for Economic Governance and Aids in Africa in collaboration with Kanco
and Results Educational Fund reveals that the fund’s policies restrict government spending, denying sick
Kenyans access to drugs and quality healthcare.
The ceiling has also left Kenya’s fight against HIV/Aids virtually dependent on donor funding.
Institutions such as Kenyatta National Hospital have been acutely affected by the ceiling as the inability to
engage additional personnel has also meant they cannot invest in new equipment because there will be no one
to operate it.
Of the Sh500 million allocated to the hospital this financial year, Sh100 million will go into the repair of lifts,
with the remainder being applied to salaries and the construction of a national burn centre.
Altough the hospital currently needs renal units to provide affordable care to the growing number of kidney
patients in Kenya, each renal unit would cost about Sh250 million, and would require the hospital to hire
The report by the non-profit groups calls on the IMF to phase out activities outside its areas of core
competence which carry with them these conditions.
“The IMF does not have a mandate for, or competence in, the long-term development of low-income
countries,” said the groups.
The report recommends that IMF’s Policy Support Instrument be phased out in order to end the IMF’s
monopoly on ‘signalling’ to donors whether or not developing countries warrant support.
Some of the conditions set by the IMF are that inflation should be at about 5 per cent, fiscal deficits should be
at about 3 per cent and foreign currency reserves should be least two and a half months of export earnings.
The groups said that the low-inflation targets set by the IMF lead to limits on overall national spending within
the economies of poor countries which in turn reduces the pace of growth in these economies. It also
For instance, Kenya has more than 10,000 trained but unemployed nurses who cannot get public sector jobs
because of the IMF policies.
In an earlier response to non-profit groups, IMF said the wage bill condition was being phased out and would
henceforth be used only in countries with unstable macroeconomic conditions such as those emerging out of
According to the the non-profit groups, however, the IMF still maintains these conditions only not as directly as
they used to.
The fund has also insisted that high wage bills have been a significant source of macroeconomic imbalances
and that wage and employment conditions in other sectors would need to be reformed to allow for sustainable
expansion in health and education.
Kenya’s health budget has grown from Sh15.2 billion in 2002 to Sh37 billion 2010.
Be kind, health workers urged
New Vision, Uganda
By Frank Mugabi
HEALTH workers have been urged to be kind to patients despite the difficulties involved. The registrar of the
Allied Health Professionals Council, Benjamin Odongo, said being a health practitioner is a calling just like
priesthood, where service to the people is a priority.
“As health professionals, we handle life. Always smile although things are difficult. Very many are called but
very few are chosen. You are lucky to be among the chosen few,” Odongo said.
He was addressing the first graduands of Arua School of comprehensive nursing in Arua town last week.
Odongo described nursing as a “noble” profession and urged the graduates to register with the professional
council to help weed out quacks.
He also urged them to adhere to the ethical code of conduct that was jointly developed by the health ministry
and the professional council. The Bishop of Madi and West Nile diocese, Joel Obetia, advised the graduates to
grow in their spiritual lives if they are to be compassionate.
“It is surprising to see some nurses looking after vulnerable patients with a face of thunder. This shouldn’t be
part of you,” Obetia advised. A total of 444 students, 246 of them females, got diplomas and certificates in
enrolled nursing, midwifery and comprehensive nursing. The principal, Margaret Nyakuni, said the school which
was built for 120 students, currently accommodates 533 students following the introduction of new
The chairman of the governing council, Christopher Yiiki, applauded the education ministry for providing a bus
to the school. Yiiki said a new resource centre and classrooms had been constructed with support from the
European Union. He added that the old buildings had also been rehabilitated.
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Asia & Pacific
‘Intensify barangay’s dengue drive’
Inquirer Global Nation, Philippines
By Fe Marie D. Dumaboc
Cebu Daily News
The barangay health workers (BHWs) in the city and province of Cebu were urged yesterday to intensify their
information campaign against dengue virus.
The call was made yesterday to at least 8,000 BHWs of at least 100 barangays from the province and city, who
attended the start of the weeklong celebration marking the 15th anniversary of the establishment of the BHWs.
Disseminate information and call the attention of the people in your barangays to maintain cleanliness to
prevent being afflicted with dengue virus, said Ermelinda Abadiano, seven-year president of the National
Confederation of Barangay Health Workers of the Philippines, Incorporated (NCBHWPI).
Abadiano cited that dengue scourge and the lack of medicine in the barangay health centers were a common
problems of the BHWs.
“We do referrals if naay magkasaskit na didto sa health clinic, doctors, or hospital, we also do health teaching
regarding environmental sanitation and preventive measures,” Abadiano said of what other measures the
BHWs do to prevent the dengue virus.
“We also do orientations regarding dengue, we recruit blood donors for a blood letting to help regional blood
center,” she added.
Abadiano, who spoke before the BHWs at the Cebu City Sports Center, asked the barangay health workers to
be united in accepting the challenges in their barangays.
She encouraged them to go on with the spirit of voluntarism for the betterment of our country.
One of the health workers, Josefina Villasan, 51 years old, of barangay Caladcaran, San Fernando town in
Southern Cebu, said she had been a barangay health worker for 11 years and was happy to serve the people
specially those in her barangay.
“I don't care if the honorarium is small. I volunteered to serve the barangay. I'm just happy to serve and help
even the children of the barangay,” she said
Abadiano said honorariums for the BHW differs from place to place.
Cebu City Councilor Hilario Davide III, who attended the activity, said the city's BHWs receive a P3,000
Abadiano said the lowest honorarium was P50 for a BHW. She didn't however specify what place this was.
in Cebu City, the City Health Department, reported 1460 dengue case with 32 deaths since January to October
Yesteday's gathering started with a parade from Fuente Osmena Rotunda to Mango Avenue to Lorega Street
and to Cebu City Sports Center.
Most of the BHWs who attended were in at least in their 50s but Abadiano said they preferred to join the
parade to prove that they were physically fit and capable to do their jobs.
'Made in India' dominates US AIDS scheme
Business Standard, India
P B Jayakumar / Mumbai
Indian drug companies have cornered an overwhelming majority of drug approvals under the US President's
Emergency Plan for AIDS Relief (Pepfar).
Out of the 100 approvals by the US drug regulator Food and Drug Administration (FDA) so far, close to 95 per
cent are for Indian companies.
Aurobindo leads the list with 34 approvals, followed by Cipla and US-based Mylan Laboratories' Indian arm
Matrix Laboratories with about 15 approvals each. Companies such as Strides, Emcure and Hetero also would
supply about 5-15 drugs each under the programme.
The Pepfar programme, started in 2003, aimed at the prevention, treatment, and care of people infected with
On October 6, the FDA approved the 100th anti-retroviral drug under the Pepfar programme.
"It is a service to the society and we are happy to be the leader in supplying anti-retrovirals, at one-third of
the prices of original drugs under the programme," said K Nityananda Reddy, managing director of Hyderabad-
The service to society makes business sense, too, for the drug companies. Pepfar is the largest commitment
ever by any nation for an international health initiative dedicated to a single disease and is focused on 15 of
the hardest-hit countries in Africa, Asia, and the Caribbean.
These countries are Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria,
Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia. In May 2007, then US President George W
Bush reauthorised the programme by increasing procurement of generic drugs and offered another $30 billion,
in addition to the initial $15 billion commitment made in 2003.
“On average, we have earned $20 million to $25 million (Rs 92 crore to Rs 115 crore) annually in the last few
years from Pepfar supplies. I anticipate a slight plus or minus revenue to this figure in the coming years from
this programme,” said Amar Lulla, joint managing director of Mumbai-based Cipla, another major supplier.
As on September 30, 2008, the most recent figure available, Pepfar supported life-saving antiretroviral
treatment for more than 2.1 million living with HIV/AIDS. In 2008, it provided nearly $1.6 billion in support of
treatment programmes, including antiretroviral drugs and services.
“There is no separate data on the spend for drug procurement under the programme. Companies involved in
the programme do not reveal their revenues separately. Supplies are staggered and procurement takes
months or quarters later from the date the orders are placed,” said Ranjit Kapadia, vice president, institutional
research with HDFC Securities.
"It is estimated that FDA’s actions are allowing Pepfar to spend $150 million (Rs 690 crore) more each year on
patient access to care,” US FDA Commissioner Margaret A. Hamburg said in a statement.
The approval process for drugs is rapid. Even patent-protected drugs are procured for supply with a tentative
approval in the countries covered under the programme.
The goal of the programme is to support treatment of at least 3 million people, prevention of 12 million new
infections, and providing care for more than 12 million HIV-infected and affected people by 2013. In addition,
Pepfar will support training for at least 140,000 health care workers in HIV/AIDS prevention, treatment, and
Mission accomplished for Okinawa 'substitute doctor'
Zensho Miyazato's Okinawa hometown had been reduced to ashes by the time he returned in 1946 at age 25
from the Solomon Islands, where he had served as a medic during World War II
The banana trees with their cool shade and fields of sugar cane that he once loved were gone. What remained
unchanged was the scorching sun and emerald green sea.
Okinawa was the site of one of the biggest battles between Japan and the United States, resulting in the
deaths of thousands of civilians.
After Japan's defeat, Okinawa was flooded with starving and sick people. But only about 60 doctors survived
To make up for the shortage, the U.S., which had control of Okinawa and Amami Island, had former Japanese
soldiers who served as medics take medical courses and start practicing in remote areas in 1951.
They were called "substitute doctors" and were allowed to practice medicine for a generation in a remote area.
At his home village, Miyazato was the only soldier who returned from the Solomons.
"The fact that I survived might mean that I was given a mission," said Miyazato, 88.
That is how he became one of the 126 former medics who passed the medical exam to serve as substitute
In 1952, Miyazato opened a clinic in the Heshikiya district of Uruma, Okinawa, becoming the only doctor
serving in the area.
He started working early in the morning and called on patients until late at night, treating up to 200 people a
He walked through the mountains with a flashlight at night and took boats to call on patients on remote
Miyazato did not take money from the poor and even offered to pay the bus fare for patients in critical
condition who had to go to a bigger hospital in the town.
"He knew everything from family issues to financial situations," said Hatsuko Oshiro, 71. "When I went to the
clinic, he would ask for my parents and brothers and didn't take money when we were going through a rough
In prewar Okinawa, midwives and those who cured people with medicinal herbs and other traditional methods
effectively served as doctors, according to Sumiko Ogawa, 43, associate professor on public health at Meio
University in Okinawa.
"Substitute doctors were the same in the sense that the ones people were familiar with and had confidence in
treated the patients," she said.
When Okinawa was returned to Japan in 1972, the medical system rapidly developed as the political system
and economy were integrated with the mainland.
A medical department opened in the state-run University of the Ryukus in 1979 and a doctor shortage in
remote areas was expected to be resolved.
But most doctors wanted to practice in cities instead of remote villages and towns.
According to research Ogawa conducted, only eight out of some 1,400 doctors who graduated from the
University of the Ryukus served at clinics in remote areas.
This proves that, in those areas, it was substitute doctors who offered the necessary medical services.
But that did not mean the medical treatment given to residents there was below standard.
Masazumi Harada, 75, a professor at Kumamoto Gakuen University, was surprised when he visited the remote
Henza Island for a month in 1965 to conduct research into the mental health of the local residents.
Harada was hoping to prove that Okinawa's medical standard was below average and that further support from
the mainland was necessary.
But what he saw instead were patients, who he thought needed to be hospitalized, living normal lives with the
help of substitute doctors and neighbors.
"I wonder which medical system is underdeveloped?" Harada asked.
Is it better to increase the number of hospitals and admit more patients or to support them in a way that they
can lead a normal life at home?
It was this question that motivated Harada to become a doctor.
When he was a researcher at Kumamoto University in 1960, he dealt with patients with Minamata disease, an
illness caused by mercury poisoning, in the region.
"Even if I sent all of them to the hospital, the problem won't be resolved," he said. "A health care system
involving the local community is necessary."
Harada got the answer from Okinawa — training people with medical knowledge like substitute doctors so the
community can support each other.
From two years to 1977, Harada ran a private school to teach basic medicine for Minamata patients and their
Those who participated later became doctors and practitioners of acupuncture and moxibustion, practicing in
Substitute doctors attracted attention from abroad as well.
In 2004, several Senegalese nurses visited Miyazato to learn about substitute doctors to address the shortage
of doctors in their home country.
Even though many of his fellow substitute doctors retired due to old age and illness, Miyazato continued his
But last autumn, he finally closed down his clinic because he was beginning to have difficulty hearing.
"I have completed my mission," said Miyazato. "I have no regrets."
Hospital workers speak out
Taranaki Daily News, New Zealand
By GRETA CLEARY
Hundreds of "undervalued" hospital workers vented their frustration in protests around the country yesterday.
The Service and Food Workers Union said health boards were offering no wage increases this year and had
been told they could not give raises without them being signed off by the Government.
The union said more than 2700 cleaners, kitchen staff and orderlies at 35 hospitals across New Zealand took
part in the protest.
There were toots aplenty for Hawera and New Plymouth hospital orderlies and cleaners who took to the streets
with placards to protest a possible five-year wage freeze.
Union members gathered near both hospitals for a two-hour stopwork meeting calling for the wage freeze to
Finance Minister Bill English said at the end of last month the health workers could face five years without a
On the picket in Hawera, union delegate and hospital cleaner Jennifer Dudley said the group was sick of being
left behind despite being valuable and essential workers.
"We do a lot for patients and we do important jobs," she said.
"If they want a healthy hospital they need us there and if they want healthy patients, they need to be fed."
They are already the lowest paid and have not had a pay rise in two years, she said.
The Taranaki District Health Board has just been given a 3.1 per cent increase in funding and the protesting
workers are not seeing any of it, said union representative Sam Jones.
"They just want a fair deal. We're only asking for 3 per cent."
Nurses had been given a 4 per cent pay rise and doctors also recently received an increase, he said.
Health board negotiating team spokesman Craig Climo said the protest was all part of the usual bargaining
"People have a right to make their views heard and this is part of the negotiating process," he said.
"We value our staff who are doing valuable work in the DHBs."
While maintaining good relationships with staff was a priority the health boards were facing unusual
circumstances with tough financial restraints, he said.
"Employers and staff want the same things: The best possible health care for patients, satisfying and valued
work, and well-run and effective health services.
"We want to work together with our staff to provide that."
Rural GPs glad to bend Kevin Rudd's ear
Adam Cresswell, Health editor
RURAL doctors have taken heart that they will not be overlooked in the looming reforms to the nation's health
system, after Kevin Rudd extended a scheduled meeting at a country practice to hear concerns about the
The Prime Minister was due to spend 15 minutes in a private meeting with doctors from the Bridge Clinic in
Murray Bridge, southeast of Adelaide, on Wednesday but the talks ended up lasting nearly an hour, and
finished with doctors hopeful of obtaining some key concessions.
Peter Rischbieth, one of the 13 general practitioner partners who run the clinic and a former president of peak
medical rural lobby the Rural Doctors Association of Australia, says these include the issue of taxation of
government grant money, better support for overseas-trained doctors and the opportunity to enlist rural GPs
to deliver the government's commitment to improving preventive health.
``This is the first general practice he has been to as part of the 50 visits done under the reform consultations,''
``We were keen for him to come. Our main message was about infrastructure and the chance for general
practice to be part of the new reform practices in preventive health care.''
Rischbieth says Rudd has indicated he will follow up concerns over inequitable tax treatment of commonwealth
grant payments, which means that a private practice that receives infrastructure grants has to pay 45 per cent
of the money back to the government as tax while similar grants paid to regional organisations called divisions
of general practice are allowed to keep all themoney.
He says overseas-trained doctors, on which rural Australia is particularly dependent, also need better support
because at present they generally are not eligible for Medicare payments if they or their families become sick.
In some cases their children are not even entitled to free public education. These are all issues that serve to
make it difficult for overseas-trained doctors to perform at their best or stay longer than they need to.
``Pleasingly, after hearing RDAA's concerns, Prime Minister Rudd invited us to also work directly with his office
in combating the key issues fuelling the continuing health workforce crisis in rural and remote Australia,''
``We came away from the meeting with a great feeling that the Prime Minister now clearly appreciates the
wide scope of work that rural doctors undertake in their communities, and the additional workload they carry
from providing general practice-based primary care right through to being the emergency doctor at the local
``In rural and remote areas, the same doctors who see you in their general practice invariably are the ones
who will be working closely with a range of other health professionals at the local hospital to deliver your baby,
stabilise an acutely psychotic patient, save your life in the hospital (emergency department) after a car
accident or a heart attack, treat your child in a pediatric emergency and provide the anaesthesia for local
surgery such as orthopedic surgery, gynaecological surgery and general surgery like ear, nose and throat
operations,'' Rischbieth says.
Since the release of the final report by the National Health and Hospitals Reform Commission Rural in July,
rural doctors have been increasingly anxious about the federal government's commitment to fixing health
problems in the bush.
At the time, the RDAA was particularly critical of what it saw as the report's failure to include ``any substantial
recommendations to increase the number of health professionals working in the bush''.
It also feared Rudd's decision to tour leading hospitals nationwide to gain feedback from health workers about
the reform proposals would entrench a city-centric view of what reform changes were most required.
The RDAA wrote to the Prime Minister in August, asking him to stage a national fact-finding tour of rural
hospitals, rural practices, health centres and Aboriginal Medical Services to expand on the reform
After Wednesday's meeting, Rudd said the discussions at the Bridge Clinic had included ``other support
mechanisms ... including helping with the expansion of primary health care capital facilities as well''.
``The government is rolling out GP SuperClinics across the country and one of the discussions we've had today
is how do we tailor a program like that to the expansion of existing GP SuperClinic-type facilities which already
exist in rural and regional areas in particular,'' Rudd said.
Rischbieth says his and many other rural practices already operate as defacto SuperClinics, and in his case has
spent about $1million on upgrades that allow it to offer a range of services including minor surgery as well as
training GP registrars.
The RDAA says it hopes Rudd will visit more rural practices before the government decides on the shape of its
health reform proposals to be put to the Council of Australian Governments by year's end.
New Clinical Training Agency Board appointed
New Zealand Doctor
Health Minister Tony Ryall has today announced the make up of the Clinical Training Agency Board, a new
national body to unify workforce planning in New Zealand.
Mr Ryall says, "The Government wants better and urgent integration of health education and training. There
have been multitudes of reports mixed with indecision over the past 10 years, and it is past the time when we
need to take a stronger approach to health workforce planning."
"New Zealand has a health workforce crisis with too many clinicians disengaged and leaving the country."
"This new Clinical Training Agency Board will unify workforce planning in New Zealand and ensure coordination
of workforce training, planning and funding for our nurses and doctors and other health professionals."
Mr Ryall has previously announced that the Board is being chaired by Professor Des Gorman, the Head of the
School of Medicine at the University of Auckland.
Professor Gorman is being joined on the Board by:
Professor Max Abbott, Clinical Psychologist, Pro Vice-Chancellor (North Shore Campus) and Dean of the Faculty
of Environmental Sciences at the Auckland University of Technology; and Deputy Chair of Waitemata District
Professor Gregor Coster, General Practitioner, Dean of Graduate Studies at the University of Auckland, and
Chair of Counties Manukau DHB.
Ms Helen Pocknall, nurse, Director of Nursing at Wairarapa DHB; and Chair of the Central Region Directors of
Nursing and Chief Medical Officers group.
Ms Karen Roach, enrolled nurse and midwife; Chief Executive Officer (CEO) of Northland DHB; Chair of
Northern Region CEO Group; and Chair of the 21 DHB Employment Relations Strategy group.
Professor Don Roberton, Paediatrician; Pro Vice-Chancellor, Division of Health Sciences; and Dean of the
Faculty of Medicine at the University of Otago. He was a member of the Medical Training Board, the Health
Dr Andrew Wong Public Health Medicine specialist; CEO of Ascot Mercy (private) Hospital. He is Managing
Director of HealthCare Holdings Limited
Mr Ryall says, "These people are not appointed as sector or professional representatives. They are there
because of their abilities to support Professor Gorman and the government in driving change."
"We know that with the workforce crisis we inherited, problems won't be fixed overnight, but we are taking
action rather than taking stock."
Health minister Tony Ryall made this announcement at AUT yesterday, click here for his speech notes
Health Board denies hospital review claims
Ashburton Guardian, New Zealand
By Susan Sandys October 21 2009
Ashburton Hospital anaesthetist Ross Warring asked rural health representatives last night to seek retention of
24-hour surgical services.
Dr Warring said continuation of the hospital’s around-the-clock service was being assessed, but the Canterbury
District Health Board has denied this, saying there is no “active review” under way.
Dr Warring, who is also an Ashburton GP, put his concerns to Rural Canterbury Primary Health Organisation
(PHO) board members at a public meeting following their annual general meeting in the town last night.
He said the other issue facing Ashburton was a fall-off in maternity services.
Due to a desperate shortage of both hospital and independent midwives, not many babies were born at
Ashburton Hospital’s maternity unit.
Women were having to travel to Christchurch, resulting in more births on the side of the road.
“I think these are very important issues facing the whole of our community at the moment,” Dr Warring said.
He said the hospital was like a “stack of cards”, in that once services were withdrawn it became less attractive
for medical personnel to work there.
The hospital no longer offers orthopaedic surgery and caesarians as it did some years ago.
If the 24-hour service was cut, those requiring surgery out of business hours would have to travel to
Dr Warring called on the PHO to make representation to the Canterbury District Health Board on the issues.
He suggested it seek increased salaries for the midwives in this area, who worked without GP back-up.
“Rural midwives carry extra stress and they don’t get any recompense for that,” he said.
Board member Marina Hughes said locals often knew best and it would be good to get information on the type
of services the hospital should have.
Dr Warring said a considerable amount of time had been spent on the “Doing it Differently” document about
services in the area, but it was an older document many new board members may not be aware of.
“Some of the issues in that document have been acted on, but very many of them have not,” he said.
“I think what everybody in our area would like to see is more implementation of the ideas in the document. I
think they are extremely relevant to care in this area.”
Fellow GP and Canterbury District Health Board board member Chris Ryan wanted to see the PHO assist
recrutiment of skilled medical personnel.
Inactivity on “Doing it Differently” had meant the district had missed an opportunity to recruit surgeons, and
there was a unique opportunity for the hospital to be accredited as a training venue which would ultimately
Canterbury District Health Board rural health service general manager Garth Bateup said after the meeting
there was no active review of surgical services under way at Ashburton, and any such review would have to be
approved by the DHB board.
Back to top
Governor Rendell Announces Application for $5 Million Federal Recovery Act Grant to Train, Place
Health Care Workers
HARRISBURG, Pa., Oct. 19 /PRNewswire-USNewswire/ -- Governor Edward G. Rendell today said the
commonwealth's application for a $5 million American Recovery and Reinvestment Act grant will help provide
training and placement services for approximately 1,430 Pennsylvanians seeking careers in health care.
"To help ensure that Pennsylvanians have access to the high-quality care they deserve, our workforce must
have a greater number of highly skilled health care workers," Governor Rendell said. "Health care is among our
most important industries and it is adding jobs - even during this recession."
If awarded, the Pennsylvania Workforce Investment Board, or PA WIB, will use the grant to enhance statewide
training and placement efforts for allied health workers. The Pennsylvania Center for Health Careers, an arm of
the PA WIB, will develop a pipeline of allied health workers that is diverse and representative of Pennsylvania.
The project will focus on traditionally underserved populations including dislocated, unemployed, low-wage
workers such as those on public assistance, high school dropouts, individuals with disabilities, veterans and
individuals with limited English proficiency.
For more information about how Recovery Act funds are benefitting Pennsylvania, visit www.recovery.pa.gov.
Christopher S. Manlove, L&I; 717-787-7530
Barry Ciccocioppo, Governor's Office; 717-783-1116
SOURCE Pennsylvania Office of the Governor
Nurses' Union Plans to Strike
Wall Street Journal
By KRIS MAHER
A union is threatening a one-day strike involving 16,000 registered nurses at 39 hospitals in California and
Nevada, saying hospitals aren't providing enough protections against swine flu for its members.
The 86,000 member California Nurses Association, which covers all 50 states and is the nation's largest union
representing nurses, is negotiating contracts that expired in June, covering 13,000 nurses.
The planned Oct. 30 protest underscores the continuing debate over what kind of masks are needed to protect
health-care workers against the H1N1 virus, as well as broader issues of staffing levels that have become a
contract-negotiating issue. Nurses have long complained that hospitals keep nurse-staffing levels artificially low
The union said one of its members died in August after contracting swine flu and that dozens of others have
been sickened by the disease. It wants to use the contract negotiations to establish safety procedures around
More than 3,000 people have been hospitalized in California for swine flu, and 200 have died, according to the
California Department of Health Services.
The union decided to strike after "an onslaught" of patients admitted to hospitals made negotiations more
urgent, said Jill Furillo, who heads union bargaining with Catholic medical facilities. She said the union was
mainly striking over safety issues: "This is not really about money."
The union is asking the health-care systems to create a monitor position to ensure that staffing ratios comply
with California state mandates. The union also said it wants hospitals to stop a practice called "floating," in
which nurses are assigned to areas outside of their expertise, such as an emergency-room nurse being
assigned to labor and delivery.
A union official also said a few hospitals are seeking salary freezes, which the union is fighting, and some
hospitals have proposed increasing employee payments for health insurance.
Elizabeth Nikels, vice president of communications for Daughters of Charity Health System, disputed the
union's claim that it was striking only over safety issues. She said the health system was "dismayed" and
"deeply disappointed" by the union's announcement that it will strike over safety issues and that the H1N1
virus "has never been discussed at any bargaining session."
Chuck Idelson, a spokesman for the California Nurses Association, said that "swine flu has consistently been a
major focus of our organization for months, and we've talked to hospitals about it."
The nurses' association wants hospitals to require the use of disposable respirators known as N95 masks for
nurses who have patients with swine flu.
There has been debate in the medical community about whether the masks are practical because they have to
be fitted to each individual's face.
The Centers for Disease Control and Prevention has issued a statement saying the N95 respirators should be a
priority, a recommendation that was disputed by the Society for Healthcare Epidemiology of America, which
said the masks were neither necessary nor practical.
Kevin Andrus, a spokesman for St. Joseph Health System in Orange, Calif., said its hospitals had made
adequate preparations, including providing N95 respirators.
"In all situations we are taking every precaution we can," Mr. Andrus said. The hospitals will provide H1N1 flu
vaccinations for all employees, depending on its availability, he said: "We want them to be protected. They are
our front line defense against the illness."
Jan Emerson, a spokeswoman for the California Hospital Association, said the union was "grandstanding" by
raising the respirator issue. She said hospitals would offer them but that there is a manufacturing shortage and
"hospitals can not get enough of them."
Write to Kris Maher at email@example.com
Return of India's Traditional Birth Attendants Urged to Meet MDG 5
IPS Terra Viva
NEW DELHI, Oct 14 (IPS) - As India struggles to lower one of the world's highest maternal mortality rates,
activists and experts are calling for a revision of polices aimed at "institutionalising" deliveries in resource-poor
rural settings and phasing out the 'dai' or traditional birth attendant (TBA).
According to a report released last week by Human Rights Watch (HRW), India's maternal mortality rate is 16
times higher than Russia's and 10 times higher than China's. Also, in several parts of the vast country, the
rates have been worsening in spite of various government schemes and programmes - and possibly because of
In 2005, the maternal mortality ratio (MMR) in India was 450 per 100,000 live births, slightly lower than the
average ratio of South Asia (which comprises the country), estimated at 490, considered the second highest by
region, next to African. According to the United Nations Children's Fund (UNICEF) an estimated 80,000 Indian
women, either pregnant or new mothers, die each year from preventable causes, including haemorrhage,
eclampsia, sepsis and anaemia.
The HRW report, 'No Tally of the Anguish: Accountability in Maternal Health Care in India,' focuses on India's
most populous state of Uttar Pradesh to show persistent failures in providing care for pregnant women. It also
identifies caste discrimination, lack of accountability and limited access to emergency care as chief causes of
Annie Raja, general secretary of the Communist Part of India-affiliated National Federation of Indian Women
(NFIW), told IPS that the failures were at least partly driven by policies blindly designed to meet the fifth
Millennium Development Goal (MDG5) of reducing MMR by three quarters by 2015.
MDGs are eight development goals to be achieved by 2015.
''There is a belief that MMR can be brought down by increasing skilled attendance at deliveries without
considering realities on the ground such as non-functional or absent primary health centres as well as lack of
personnel and funds," said Raja. A key MDG5 prescription is to maximise the number of births attended by
skilled health personnel.
In India this has meant a gradual phasing out of the 'dai' or TBA, who is considered illiterate, unskilled and
difficult to train in the handling of pharmaceutical drugs that may be required during a birth emergency.
Until 2005 when India launched its flagship National Rural Health Mission, some of the country's estimated one
million 'dais' were also given training and had some recognition, but they have since then been steadily
replaced by Accredited Social Health Activists (ASHAs) whose main job is to register pregnant women and
encourage them to seek institutionalised care at government facilities.
An ASHA (which translates as 'hope' in Hindi) must be literate and have received primary education until class
eight. She acts as a primary health worker and receives incentives for providing referral and escort services for
pregnant women to health care centres.
But there are real practical problems, said Raja. "An ASHA gets just 600 rupees (12.8 US dollars) per live
delivery in a government facility and is expected to bear the costs of transporting the pregnant woman and
other costs along the way. If the delivery takes place outside the hospital premises, she gets nothing and then
she has no training in midwifery."
"Also, while the programme promised 'concrete service guarantees' such as free care before and during
childbirth, emergency obstetric services and referral in case of complications, beneficiaries were limited to
women classified as living below the poverty line or else belonged to tribal or 'dalit' (low caste) groups," Raja
While a few 'dais' turned into ASHAs, the literacy criterion ensured that the vast majority of them got excluded,
along with skills gained through sheer experience.
"There is nothing wrong with the concept of 'skilled attendance at birth' as defined by the World Health
Organization [WHO] and UNICEF except for the simple fact that basic health services are simply not available
to the vast majority of people in India," said Raja.
Dr Usha Shrivastava, a former researcher at the prestigious All-India Institute of Medical Sciences, said the
problem is one of resources. "'Dais' provided a real service by operating in areas far away from any centre
where a skilled birth attendant (SBA) may be available and deal with pregnant women who are often anaemic,
malnourished and have no access to safe drinking water and, therefore, already compromised," she said.
Shrivastava, editor of 'Health Positive,' a journal that specialises in 'best practices in clinical and public health,'
said that even if qualified doctors or SBAs can be taken to remote rural areas, there is little that they can do in
a birth emergency in a setting where there is no electricity, blood bank or sterile settings.
Usha and Raja are not alone in their view that 'dais' should be empowered rather than phased out, as
envisaged under MDG5.
A team of researchers led by Anthony Costello at the department of child health at University College, London,
reported in 2006 that while TBAs were not a substitute for trained midwives, they were the main provider of
care during delivery of millions of women, especially in settings where mortality rates were high.
"Since 1990 international agencies and academics without robust evidence have persuaded governments to
stop training programmes for traditional birth attendants," Costello commented in the British 'Lancet' journal.
Many national policies promoting institutionalisation of birth deliveries follow the ideals of the 'Safe Motherhood
Initiative' launched in Nairobi in 1987 by the WHO, UNICEF, the United Nations Population Fund and the World
Bank and by the International Conference on Population and Development in 1994. In September 2000, 189
world leaders committed their nations to the MDGs, which included improving maternal health.
Raja said that in India a medical elite and a bureaucracy anxious to tote up figures showing increasing
institutionalisation of deliveries have forgotten the harsh realities of rural India. "It is not difficult to see why, in
spite of various government policies, only 17 percent of all deliveries in this country take place in a hospital or
are attended to by an SBA," she said.
Raja said the best way out is to develop alternate strategies that recognise the services and skills of TBAs, and
incorporate them into the health system in such a way that women in the rural areas and those that belong to
marginalised groups are adequately covered.
Gargi Chakravarthy, a Delhi University historian and an activist with the NFIW, said the marginalisation of TBAs
or 'dais' stretches back to British colonial times and has continued into contemporary India through policies
drawn up by a bureaucracy with colonial moorings. "We need firstly to reorient the bureaucracy to current
realities," she said.
Chakravarthy pointed to copious documentation that shows the systematic devaluation of traditional health
practitioners under colonial rule and the gradual replacement of the 'dai' by "lady health visitors" who
promoted modern obstetric practices. The colonial period also saw the setting up of many hospitals where
lying-in care was first made available for pregnant women.
"It was possible for Britain and other industrialised countries in the West to drastically reduce maternal
mortality in the last century by providing professional midwifery care and by improving access to hospitals.
This model was later followed by developing countries, but success depended crucially on the existence of a
functioning health delivery system," Chakravarthy said.
Raja believes that the success of MDG5 lies in first implementing MDG3, which calls for the promotion of
gender equality and the empowerment of women. "Too many of the decisions in public health are made by
men while women's voices and concerns are routinely ignored."
"Last week's HRW report," said Raja, "comes as no great surprise when the cruel reality is that the public
health system, which was once a mainstay of healthcare for more than 75 percent of the population, has fallen
into neglect through the privatisation of health care and reduced budgetary allocations that now stands at
slightly more than one percent of GDP."
"There is also the question of political will. Surely a country that calls itself an emerging power produces world-
class doctors, has some of the finest medical facilities anywhere and promotes medical tourism can find a way
to reach meet the MDGs," Raja said.
Flu shots not mandatory for local health workers
Star News Online, NC
By Vicky Eckenrode
Area hospitals are offering flu shots to their employees but not making it a requirement as other facilities
across the state and country have done
Mandatory vaccination of health workers for the seasonal flu and H1N1 virus has kicked up controversy in
some locations where employee groups bristle at the threats of people being punished or losing their jobs for
not taking the shots.
In New York, a suit has been filed against the statewide regulation that health care workers in the state receive
both vaccinations this year.
Despite all the messages for the public to get immunized against the seasonal flu, only 45 percent of health
care workers got vaccinated last year – slightly higher than the 36 percent of the general population who did
so, according to the U.S. Centers for Disease Control and Prevention.
With the H1N1 virus creating an unusually active flu season this year, hospital administrators in Southeastern
North Carolina have stepped up their encouragement for doctors, nurses and other staffers to receive the
vaccines but have not made it compulsory.
More than 60 percent of New Hanover Regional Medical Center’s staff has received seasonal flu shots, said
spokeswoman Carolyn Fisher.
She added that the hospital is making plans now for when more H1N1 vaccine becomes available – only a
limited supply has been distributed lcoally so far.
“We’ll have educational classes that will be starting within the next few days for employees who have questions
or concern about the (H1N1) shot,” she said.
Officials with UNC Health Care and Duke Medicine said this week their hospitals and medical facilities were not
making vaccinations mandatory. But Wake Forest University Baptist Medical Center has made both seasonal flu
and H1N1 vaccines a requirement for its more than 11,000 workers.
Employees there can ask for religious or medical condition exemptions, such as being allergic to eggs, which
can cause a reaction with the flu vaccine.
Bonnie Davis, a spokeswoman at Wake Forest Baptist, said employees were given notice about the new policy.
“If the 30 days comes and goes, and the employee has not gotten the vaccine, then it is assumed that
employee is giving up their employment, and then the process begins there,” she said. “From the medical
perspective, our folks, our medical experts here felt that requiring this vaccine is the best way to protect not
only ourselves but also our patient population.”
Like New Hanover Regional, Brunswick Community Hospital also will not require employees to take the
seasonal flu or H1N1 vaccines.
“We are asking physicians, employees and even volunteers to sign a declination form,” hospital spokeswoman
Amy Myers said about workers who do not want the shot, whether for religious, medical or other reasons.
But health workers at Brunswick Community who decline the H1N1 vaccine when it becomes available will be
required to wear masks if they are within 4 to 6 feet of a patient. “It’s more to protect the patient no matter
why they’re here,” Myers said.
Local Private practices also strongly encourage their workers to get vaccinated.
At Wilmington Health Associates, where staffers wear buttons to let patients know they have received their flu
shot, 93 percent of the practice’s staff, or more than 480 employees, has been vaccinated against the seasonal
“According to the CDC, vaccinating health care workers against influenza is the single most important
intervention to prevent the spread of flu in health care facilities,” said Paul Kamitsuka, an infectious disease
doctor at the practice.
Curbing costs falls to wayside in health-reform push
By Michael Riley
It's a simple idea with years of studies and data that show it works: Teams of nurses, nutritionists and
community health workers that coordinate care of elderly patients with chronic disease can dramatically reduce
hospital admissions and cut costs.
But a $30 billion program to set up what are known as community health teams in all 50 states is nowhere to
be found in the thousands of pages of draft health reform legislation — even though data show it would save
three to four times that in lower Medicare costs.
The absence of that program in the bills is a lesson in the failure of reform to achieve one of its basic goals —
instituting widely agreed upon ideas that would curb runaway inflation in the cost of delivering care.
Veering off cost course
To their dismay, many health experts say they have watched the reform debate move from a starting point
several months ago that emphasized curbing the cost of America's bloated system of delivering health care to
one dominated by contentious debate about insurance coverage and cost.
"The dilemma was that the committees were at a point where they were basically throwing everything
overboard as fast as they could to get the bills down under $1 trillion," said Ken Thorpe, an Emory University
professor who had discussed the teams program with lawmakers and their staffs over several months.
Lobbyists weighed in, nixing some well-conceived reforms. Others were scuttled by growing concerns over
deficits or the vagaries of Congressional Budget Office scoring.
"Once we get the insurance reform piece in place — which is essentially what this bill is — and we get everyone
enrolled in insurance, we can start filling in the gaps of implementing best practices," said Rep. Diana DeGette,
a Denver Democrat and key negotiator on health care.
"There are a lot of us in Congress who feel like health care reform will not be complete until we implement
some of these practice reforms," she said.
That two-pronged approach was not the original plan.
In making the public case for sweeping reform, President Barack Obama and other Democrats pitched reining
in costs as a primary justification.
"The bill I sign must reflect my commitment and the commitment of Congress to slow the growth of health
care costs over the long run," Obama said in July.
That's because the problem plaguing the American health care system is not just the uninsured, but the fact
that the cost of care is much higher than in other countries and growing rapidly. The $2.1 trillion the U.S.
spent on health care in 2006 was almost $650 billion above what would be expected based on the country's
relative wealth, according to researchers.
Angry town-hall meetings over the summer were filled with frustrated stories of $200,000 hospital stays and
redundant tests prescribed by multiple physicians.
Stack those stories one upon another, economists say, and you get a system of hyper-expensive care and
misaligned incentives that drive the rising insurance costs now grabbing lawmakers' attention.
For years — in some cases decades — reformers have been studying a set of ideas that could alter that
"About 60 percent of the recent rise in Medicare spending is driven by nine chronic diseases, including
diabetes, cardiovascular disease and hypertension," said Thorpe. Those diseases are poorly addressed in
America's fee-for-service delivery system.
Community health teams combine nutritionists, mental- health experts and nurse practitioners who stress
continuity of care and the critical transition period after hospital stays. Studies suggest they could help avoid
$12 billion annually in preventable hospital readmissions. A study of one program in Pennsylvania found it
reduced total medical costs by 7 percent while delivering higher-quality care.
Reform bills in both the House of Representatives and the Senate contain pilot programs designed to gather
more information about how those and other innovative approaches would work in different settings.
Providers must join in
Thorpe and other experts counter that there are already years of high-quality studies.
"It's fair to say their characterization of the literature is accurate," said Len Nichols, a health-reform expert
from the New America Foundation who also is working closely with lawmakers.
"But the reality is Congress can't just dictate what must happen. Providers have to be led into it.
"It is true we could do it if we had the 101st Airborne take over. But you and I really don't want that to
happen," Nichols said.
Democrats say that while the bills they have written may not be as aggressive as reform experts like, they do
provide significant opportunities to change the way doctors and hospitals deliver care.
The Senate Finance Committee proposal includes a Medicare Commission, which could ask Congress to pass
innovative cost-saving measures if Medicare costs rise faster than expected. Those might include a national
version of health teams and other ideas.
The Finance bill establishes a $1 billion a year Innovation Center to test new payment structures and methods
that could help contain costs. But an analysis by the Brookings Institution found no clear path for how those
ideas could be expanded or implemented nationally.
"If the way we implement these changes doesn't work for doctors and patients, it's not really health care
reform," said Erin Shields, a spokeswoman for the Senate Finance Committee.
"What we've really tried to do is create a common-sense balanced approach that meets the president's goals of
slowing health care cost growth but also can be implemented in a realistic fashion," she said.
But the reform process has exposed the limits of Congress' ability to undertake a sweeping re-engineering of
one-sixth of the economy.
Critics' claims that Democrats wanted to ration care made lawmakers skittish of some reforms, experts say.
And as the debate heated up and opponents focused on cost, lawmakers were increasingly driven by how the
Congressional Budget Office would score the bills, DeGette and others said. The CBO consistently failed to find
costs savings from innovative programs that Democratic staffers assumed would occur based on other studies.
Many experts are still hopeful some of the innovations and cost-cutting ideas will be inserted in the bills during
floor debates, especially as conservative Democrats look for ways to further justify the bill to voters back
What's more likely, reform experts and some lawmakers say, is that Congress will have to return to the
question of runaway costs again — and probably sooner than later.
What Might Health Care Reform Have to Do With H1N1?
Health Care Policy Specialist
In June of 2008, researchers from the Tohoku University School of Medicine in Tokyo warned, in a report re-
published by the CDC, well before the masked and panic-laden Spring Break of 2009 images from Mexico City
emerged, that mortality rates from a future pandemic would likely be higher in countries where:
Its citizens lack access to adequate medical care
Its public health infrastructure is weak
Conditions, including housing and population density, contribute to spread of disease
Host factors exist, including nutritional status and co-existing medical conditions; and
Its citizens experienced a high HIV/AIDS prevalence.
The researchers from Japan were profiling the potential impact of the next influenza pandemic in developing
countries, well before H1N1 burst on the scene. And, in the end, they may be right -- deaths associated with
H1N1 will likely be considerably higher in developing countries than in high-income countries.
But how will the United States fare against other industrialized countries that offer adequate health care to all
of its citizens? Already we are observing death rates in children and teenagers early in the year. Indeed, as of
October 9, we had already seen over 75 deaths in children, a figure that is higher than the rate typically seen
for seasonal flu over an entire season, and winter hasn't even begun.
And could these heartbreaking deaths, many of them affecting otherwise healthy children, have been avoided
in the United States, still the richest country in the world?
We must ask our policymakers whether some children died in the U.S. because a) care was delayed or refused
because of cost, b) there weren't enough providers to diagnose and treat , c) whether too many of our children
have underlying diseases, including diabetes and asthma, because of health and reimbursement policies
skewed away from prevention and/or chronic disease management and/or d) our public health infrastructure
has been significantly impacted because of thousands of layoffs in the last two years. We must also ask about
vaccine production, but more on that later.
Consider the following information, because for good or ill, California is often a harbinger of what's to come for
the rest of the country.
Since the recession began, 661,000 Californians have lost their employer-based coverage, resulting in an
uninsured statewide rate of over 26%.
Even for those who have coverage, access to care is no guarantee -- scores of hospitals and emergency
departments have closed throughout California leaving long lines, and delay of care to critically ill patients.
Many of these facilities closed because of bankruptcy driven by increasing numbers of uninsured patients and
patients on public plans with low reimbursement rates.
In the poorest parts of Los Angeles, citizens with the highest rates of diabetes, asthma, cancer and HIV in the
country, have a difficult time obtaining access because of high rates of un-insurance and limited numbers of
healthcare providers, thus placing an even greater burden on the remaining provider community.
Even if we expand coverage, the American Academy of Family Physicians reports that we do not have enough
primary care practitioners to treat everyone who needs care, and estimates that we will face a shortage of
40,000 family practice physicians by 2020 just when the baby boomers' health care needs spike. Estimates are
that California's shortfall alone will exceed 4,200 by that time. This means that even for families with
healthcare coverage, the emergency room has become the 'primary care' default office, once again leading to
long lines and delayed care. The numbers of medical students going into primary care has declined by more
than 50% since 1990, in great part, because the reimbursement rates from both commercial and public payers
is much lower than those paid to specialists.
And finally, a strong public health infrastructure is integral to a nation's ability to respond to a public health
disaster. The U.S. has been preparing for such an occurrence, particularly since 2002, and has taken many
steps to protect its citizens. The recession, however, has taken its toll, at exactly the wrong time. In 2008
alone, over 12,000 public health workers were laid off.
And what about the H1N1 Vaccine?
Policymakers initially indicated that distribution of H1N1 vaccine to high-risk groups and healthcare workers
would begin by mid-October with an anticipated delivery of 40 million vaccines. Instead, we are learning about
delays of approximately 25% of promised vaccines, amounting to delays of 10 to 12 million doses.
Perhaps the delay is warranted because of the time it takes to develop and distribute a safe vaccine. Clearly,
many concerned parents are worried about safety, and some are indicating that they will not have their
children vaccinated even when the vaccine becomes available.
But the question must be asked as to whether companies charged with the production of the H1N1 vaccine are
setting aside production of, say, more profitable drugs, in order to get needed vaccines to our high-risk groups
and/or are refusing to commit more resources to expediting delivery. Indeed, GlaxoSmithKlein, the only
manufacturer licensed to develop H1N1 vaccine for Canada, has already been challenged and, as of August
19th, has apparently refused to commit more resources to packaging the vaccine in order to facilitate its
Hospitals are typically required to comply with surge capacity protocols, including the diversion of ambulances
and cancellation of elective procedures when disasters strike, even though this means the potential loss of
millions in revenue. Are pharmaceutical manufacturers privileged to do business in the United States similarly
required to expedite the safe manufacture and distribution of antivirals and vaccines, even if doing so means
more profitable business lines are placed on hold, and/or the cost of meeting pre-established delivery dates is
higher than originally contracted?
If the answer isn't yes, then policymakers should act fast to create the appropriate remedy to protect our most
medically vulnerable populations.
Thus far, it should be painfully obvious, even to families who haven't been affected by H1N1 yet, that policies
skewed toward the maximization of profits for health insurance and, quite possibly, pharmaceutical companies,
may not be good for American families.
As the healthcare reform debate continues, we must ask whether our country's collective 'Katrina' movement
has arrived. And have we served our children well?
HEALTH CARE AND PHYSICIAN SHORTAGES
Cypress Times, TX
Doctors are forecasted to be in short supply. Although plenty of physicians are currently in practice across the
country, surveys indicate that the availability is on the decline. According to AAMC.org, over the past several
years, a growing number of national and state or specialty specific studies indicate that the U.S. physician
workforce is facing current or future shortages.
Since 2002, there have been at least 24 studies of current or future state physician workforce needs. In nearly
all of these studies, the underserved and elderly populations are most likely to be affected. Additionally, many
of the state reports point out shortages in specialties that are featured in the specialty report section, including
allergy and immunology, cardiology, child psychiatry, dermatology, endocrinology, neurosurgery, primary care,
and psychiatry. If physician supply and use patterns stay the same, the United States will experience a
shortage of 124,000 full-time physicians by 2025. The report details shortages by state and specialty and can
be found at http://www.aamc.org/workforce/stateandspecialty/recentworkforcestudies.pdf .
According to AmedNews.com (American Medical News--AMN), the number of physicians, especially primary
care physicians, in the pipeline is not sufficient to keep pace with the needs of a growing and aging population.
The problem is not that the supply of physicians, including those in primary care, isn't growing -- because it is.
It's just not growing fast enough. Physicians, like the rest of the population, are reaching retirement age in
large numbers. In 2017, more than 24,000 will turn 63, and the number of new physicians entering practice
each year is about 26,000--just about enough to maintain the status quo. If suddenly, 20,000 to 60,000 more
doctors retire because the stock market is back up, America will be in trouble. The problem, according to AMN,
has been highlighted by efforts at health system reform that, if successful, likely will require additional primary
Among the steps suggested to bolster the supply is to increase graduate medical education slots and to expand
the use of support staff, including physician assistants and nurse practitioners, where numbers of new
graduates are soaring. Some physicians describe another method -- reach out to students in medical school
early, expose them to the health professions and "nurture the heck out of them". This approach has been
underway for several years in rural areas and areas with high concentrations of minorities -- parts of the nation
that have long faced a dearth of health care professionals.
There are reasons that physicians leave the medical practice, according to AMN. A chaotic work environment --
with insufficient time for proper patient care and lack of control over work -- takes a toll on primary care
physicians. Studies show that more than half of these physicians feel time pressure during office visits, while
48% said their work pace is chaotic and 78% said they have little control over their work. These conditions
were strongly associated with low physician satisfaction, high stress, burnout and intent to leave.
Health system reform efforts to provide coverage to the uninsured make it especially important to attract and
retain primary care physicians. A major issue in health reform is who is going to care for those millions of
uninsured people, so recruitment and retention in primary care is a major issue for the country.
According to HealthLeadersMedia.com, an alternative suggestion is worth strong consideration. If experts are
predicting a shortfall of doctors under the current workforce model, maybe it's the model, and not the number
of doctors, that needs to be fixed. The analysis goes like this: While there is a healthcare services shortage,
that doesn't necessarily translate into a doctor shortage. There are a number of ways to meet that demand for
services, and the mistake reformers of any industry often make is to look for answers from existing models
and stakeholders. The alternative is to ask what doctors are doing today that could be shifted to other workers
who may be more affordable, but could have very specific technical expertise in treating certain select
conditions, and do it very well, like a form of outsourcing. Some care can be shifted from some of physicians'
workloads onto non-physician practitioners, such as nurses, physician assistants, and technicians, and shifting
certain types of care to retail clinics and other settings outside of physician offices.
Healthcare services are already being provided outside of doctors' offices more frequently, according to
HealthLeadersMedia.com. It's not just happening in retail clinics—over-the-counter at-home tests and medical
devices now let patients diagnose, monitor, and treat conditions that were formerly the physician's domain. If
the shortage projections are accurate, increasing medical school enrollment and funneling more money into
physician development aren't alone enough to meet the growing demand for medical services. So if there will
not be enough physicians, consideration must be given on how to care for an aging population in that