This document summarizes key findings from visits to Malawi, Mozambique, Swaziland, and South Africa regarding scaling up access to antiretroviral treatment. It finds that lack of human resources is seen as the biggest obstacle, as health worker shortages are severe and increasing due to illness, death, and brain drain. While funds are becoming available for drugs, none of the countries have comprehensive strategies to address the shortage of qualified staff needed to implement ambitious national treatment plans, which aim to increase those receiving treatment by 50-fold or more within just a few years. Addressing the human resources crisis for health is critical to achieve treatment targets and ensure long-term sustainability of health systems overwhelmed by AIDS.
Sahana Software Foundation presentation to the World Conference on Disaster Management, Toronto, Canada, June 25, 2012, delivered by SSF CEO Mark Prutsalis
The document outlines the International Federation of Red Cross and Red Crescent Societies' framework for disaster risk reduction in South-East Asia. It begins by providing background on the Red Cross' work in disaster risk reduction and commitments to building more resilient communities. It then discusses hazard and vulnerability trends specific to South-East Asia, noting that the region experiences many disasters and has populations at high risk. The framework aims to enhance National Societies' disaster risk reduction capacities and provide guidance for building safety and resilience through integration into policies and programming, mitigation activities, and risk-informed humanitarian work.
Hazard reduction strategies for flood vulnerable communities of anambra state...Alexander Decker
This document summarizes a study on hazard reduction strategies for flood vulnerable communities in Anambra State, Nigeria. The study found that the 2012 floods had a major impact in Anambra State, displacing over 2.3 million people and killing 363. It analyzed the structure and operations of flood management agencies in Nigeria from the national to local levels. The study recommended sustainable strategies like improving coordination among agencies, developing flood maps and public participation techniques, building flood-resistant infrastructure, and empowering vulnerable communities through groups and capacity building. Adopting a multi-sector approach and reviewing agency policies and structures were also suggested to better mitigate flooding in Anambra State.
Polio has existed for thousands of years, but concern grew in the early 20th century due to epidemics. The first vaccines were developed in the 1950s but it took global campaigns led by organizations like Rotary International, the WHO, and UNICEF in the late 20th century to nearly eradicate the disease. Through mass immunization efforts and fundraising, the number of polio-endemic countries has declined from over 125 in 1988 to just 3 in 2014 - Afghanistan, Nigeria, and Pakistan. India was declared polio-free in 2014, a major milestone in global eradication efforts.
Malaria is a major cause of low productivity in tropical areas like Africa. It is a debilitating disease that affects almost everyone in tropical Africa. Eliminating the mosquito vector that transmits malaria is the preferred solution, as is done in developed countries. This requires commitment, funding, and technical capacity for mosquito control programs. Failure to address malaria has huge economic costs due to lost productivity and lives. A sustained effort is needed to eliminate malaria through mosquito control.
Indigenous knowledge for disaster risk reduction: Good practices and lessons ...Noralene Uy
This publication presents a collection of indigenous practices for disaster risk reduction developed over time in communities in the Asia-Pacific region.
Local and indigenous knowledge for community resilience: Hydro-meteorological...Noralene Uy
A project officially launched in 2011 focusing on local and indigenous knowledge related to hydro- meteorological hazards and climate change in Indonesia, the Philippines and Timor-Leste has documented local and indigenous knowledge and practices that help communities to predict, mitigate and adapt to hazards; developed tools for integrating local and indigenous knowledge with science; and published information, education and communication materials that integrate local and indigenous knowledge and science on hydro-meteorological hazard risk reduction and climate change impacts.
Indigenous Knowledge, Disaster Risk Reduction Policy NoteNoralene Uy
This Policy Note aims to provide a directional path in mainstreaming Indigenous Knowledge in Disaster Risk Reduction for national authorities and ministries of disaster management, ministries of education, institutions of higher education in disaster management, and international and national NGOs in Asian countries.
Sahana Software Foundation presentation to the World Conference on Disaster Management, Toronto, Canada, June 25, 2012, delivered by SSF CEO Mark Prutsalis
The document outlines the International Federation of Red Cross and Red Crescent Societies' framework for disaster risk reduction in South-East Asia. It begins by providing background on the Red Cross' work in disaster risk reduction and commitments to building more resilient communities. It then discusses hazard and vulnerability trends specific to South-East Asia, noting that the region experiences many disasters and has populations at high risk. The framework aims to enhance National Societies' disaster risk reduction capacities and provide guidance for building safety and resilience through integration into policies and programming, mitigation activities, and risk-informed humanitarian work.
Hazard reduction strategies for flood vulnerable communities of anambra state...Alexander Decker
This document summarizes a study on hazard reduction strategies for flood vulnerable communities in Anambra State, Nigeria. The study found that the 2012 floods had a major impact in Anambra State, displacing over 2.3 million people and killing 363. It analyzed the structure and operations of flood management agencies in Nigeria from the national to local levels. The study recommended sustainable strategies like improving coordination among agencies, developing flood maps and public participation techniques, building flood-resistant infrastructure, and empowering vulnerable communities through groups and capacity building. Adopting a multi-sector approach and reviewing agency policies and structures were also suggested to better mitigate flooding in Anambra State.
Polio has existed for thousands of years, but concern grew in the early 20th century due to epidemics. The first vaccines were developed in the 1950s but it took global campaigns led by organizations like Rotary International, the WHO, and UNICEF in the late 20th century to nearly eradicate the disease. Through mass immunization efforts and fundraising, the number of polio-endemic countries has declined from over 125 in 1988 to just 3 in 2014 - Afghanistan, Nigeria, and Pakistan. India was declared polio-free in 2014, a major milestone in global eradication efforts.
Malaria is a major cause of low productivity in tropical areas like Africa. It is a debilitating disease that affects almost everyone in tropical Africa. Eliminating the mosquito vector that transmits malaria is the preferred solution, as is done in developed countries. This requires commitment, funding, and technical capacity for mosquito control programs. Failure to address malaria has huge economic costs due to lost productivity and lives. A sustained effort is needed to eliminate malaria through mosquito control.
Indigenous knowledge for disaster risk reduction: Good practices and lessons ...Noralene Uy
This publication presents a collection of indigenous practices for disaster risk reduction developed over time in communities in the Asia-Pacific region.
Local and indigenous knowledge for community resilience: Hydro-meteorological...Noralene Uy
A project officially launched in 2011 focusing on local and indigenous knowledge related to hydro- meteorological hazards and climate change in Indonesia, the Philippines and Timor-Leste has documented local and indigenous knowledge and practices that help communities to predict, mitigate and adapt to hazards; developed tools for integrating local and indigenous knowledge with science; and published information, education and communication materials that integrate local and indigenous knowledge and science on hydro-meteorological hazard risk reduction and climate change impacts.
Indigenous Knowledge, Disaster Risk Reduction Policy NoteNoralene Uy
This Policy Note aims to provide a directional path in mainstreaming Indigenous Knowledge in Disaster Risk Reduction for national authorities and ministries of disaster management, ministries of education, institutions of higher education in disaster management, and international and national NGOs in Asian countries.
Livestock Insurance Schemes: Demand for and Application by Small holders and ...copppldsecretariat
Presentation from the Livestock Inter-Agency Donor Group (IADG) Meeting 2010. 4-5 May 2010 Italy, Rome IFAD Headquarters.
The event involved approximately 45 representatives from the international partner agencies to discuss critical needs for livestock development and research issues for the coming decade.
[ Originally posted on http://www.cop-ppld.net/cop_knowledge_base ]
Indegenious knowledge in disaster risk reductionIndependent
Members provided examples of indigenous knowledge used for disaster risk management in India and Indonesia. In India, some communities use traditional methods for weather forecasting and disaster warnings. In Indonesia and India, unusual animal behaviors or environmental changes are sometimes used as warning signs for disasters like tsunamis and earthquakes. Respondents also described traditional agricultural practices, housing construction techniques, and other social and economic coping strategies used by indigenous communities. They emphasized the importance of understanding, respecting, and building upon existing indigenous knowledge and social systems for effective community-based disaster management.
YARD is a tool for engaging with communities to design and validate public space interventions. It provides a new way to engage the public to co-create better places through augmented reality (AR): YARD lets users choose and place objects into real space, building virtual scenes to plan and test design interventions that improve the quality of the public domain.
This article discusses domestic violence against women in Kenya. It profiles several women who have experienced abuse and oppression from their husbands, including being physically assaulted, having their business assets sold without permission, and being abandoned with children to support. The founder of an organization for victims of domestic violence organized a Valentine's Day ceremony and dinner for over 50 abused women. The event aimed to share experiences and views, as well as bring awareness to the issue and support for victims.
International Union for Conservation of Nature World Parks Congress 2014 - Is...Graciela Mariani
Volume 89 Number 15 - 19 November 2014
IUCN WORLD PARKS CONGRESS 2014 HIGHLIGHTS
Tuesday, 18 November 2014
In the morning, participants attended stream sessions while a high-level roundtable convened. Government representatives provided inputs to the vision of the Promise of Sydney and pledged national commitments for the next decade. An evening World Leaders’ Dialogue focused on finding the balance between the global appetite for mineral resources and how this defines PAs.
Dipecho5 news letter 5th edition- march10DIPECHO Nepal
The document discusses capacity building efforts for disaster risk reduction in Nepal. It describes several organizations' projects:
1) Action Aid's project enhances knowledge and skills through trainings, develops systems/institutions, and advocates for stronger disaster policy.
2) CARE's project builds communities' capacity for risk reduction through participatory vulnerability analysis and supporting disaster management committees.
3) Several other organizations like Danish Red Cross, Handicap International, Mercy Corps, etc. also emphasize community-based disaster preparedness and capacity building.
The document discusses the dire state of global biodiversity and species extinction. It notes that according to the IUCN Red List, over 20% of mammals and 30% of amphibians are threatened with extinction. However, it also provides some reasons for cautious optimism. International meetings in 2010 will focus on developing concrete biodiversity targets, and the concept of ecosystem services is gaining recognition and support for conservation efforts. Examples from Brazil show how preserving forests can both help endangered species and provide economic benefits to local communities. Addressing threats like habitat loss and climate change will require greater international cooperation and funding to support biodiversity conservation.
The Partners for Resilience (PfR) alliance was formed by five Dutch humanitarian, development, and environmental organizations to reduce disaster risk through an integrated approach combining disaster risk reduction, climate change adaptation, and ecosystem management and restoration. The PfR will work with vulnerable communities in nine countries across three areas: 1) strengthening community resilience through local projects, 2) empowering civil society organizations, and 3) promoting policy dialogue. By taking an integrated approach and combining the extensive networks and experience of its members, the PfR aims to significantly increase resilience to environmental hazards exacerbated by climate change.
This document discusses lessons learned from the 2014-2016 Ebola outbreak in West Africa. It provides background information on Ebola virus disease, including its symptoms, transmission, and history of outbreaks. It notes that while many countries committed to preparing for pandemics under the WHO International Health Regulations, few were fully prepared when Ebola emerged. The document discusses the roles of various organizations in responding to the outbreak, including militaries, NGOs, the UN, and clusters. It outlines strengths and weaknesses of military involvement in humanitarian aid. Finally, it quotes Bill Gates recommending that countries and alliances like NATO identify military resources available for future epidemics.
This document provides a summary of the history and evolution of UNICEF (United Nations Children's Fund) over several decades. It describes how UNICEF was originally established in 1946 to provide emergency relief to children in war-torn Europe. It then expanded its mission to helping children worldwide, focusing on combating diseases and improving child health, nutrition, and education. The document highlights how in the 1980s under Executive Director James Grant, UNICEF adopted an ambitious goal of cutting worldwide child mortality in half by prioritizing simple and cost-effective interventions like breastfeeding promotion, oral rehydration, immunizations, and growth monitoring (the "GOBI" program). This strategic shift helped UNICEF generate significant
"The Aid Enclave: Mapping an Emerging Geography of Global Health"guest39dc2f5
The document discusses how global health initiatives have led to the emergence of "aid enclaves" - self-contained areas focused on health research and aid that become isolated from their surroundings. It describes how these enclaves develop through economic, political, and ethical processes. Economically, they are tax-free areas that offer high salaries and privileges to foreign workers but not local staff, creating inequality. Politically, they represent a form of neo-imperialism and new systems of global governance. Ethically, they position themselves as correcting issues in the communities they serve but can end up marginalizing local practices and knowledge. The document critiques how enclaves can act as "parasites" taking from host communities without providing
Over the past decade, UNDP has supported disaster risk governance (DRG) in 125 countries through projects focused on strengthening institutional and legal frameworks for disaster risk reduction. A review of UNDP's work in 17 countries found that the organization has helped establish national platforms for DRG, supported mainstreaming of DRR into sectoral policies and budgets, and promoted community-based disaster risk management. Key achievements include the adoption of new laws and plans to decentralize DRR responsibilities. However, challenges remain in fully integrating DRR at local levels due to capacity and resource gaps. Going forward, UNDP is well positioned to further disaster risk governance by clarifying its conceptual approach, transforming programming to focus on local implementation, and supporting post-
Dipecho5 news letter 4th edition- january10DIPECHO Nepal
The document is a newsletter from Nepal that discusses disaster risk reduction efforts. It provides the following key details:
- The newsletter focuses on "Mass Sensitization" efforts to raise awareness about disasters in 19 districts supported under DIPECHO Action Plan V.
- DIPECHO partners in Nepal describe mass sensitization activities they have implemented, including radio and TV programs, street dramas, and community meetings to disseminate information.
- The activities aim to fulfill the third priority of Nepal's National Strategy for Disaster Risk Management, which is raising awareness and disseminating disaster risk reduction information.
The document provides information about malaria, including its transmission, symptoms, impact, and efforts to prevent and treat it. It discusses how malaria kills hundreds of thousands each year in Africa, particularly children, and the economic costs. It outlines the goals and activities of the ELCA Malaria Campaign to raise $15 million by 2015 to support prevention, treatment, and education efforts through Lutheran churches and organizations in 11 African countries. Key interventions discussed are insecticide-treated bed nets, indoor spraying, and preventive treatment for pregnant women. Progress in reducing malaria is highlighted, but more work remains to be done to control and eliminate this preventable and treatable disease.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
The document contrasts the paradigms and characteristics of primary health care (PHC) and emergency medical assistance (EMA). PHC aims to promote long-term health as part of development, using a reasonable share of resources. EMA focuses on short-term physical survival in emergencies, mobilizing all available resources. Care in PHC balances multiple objectives, while EMA prioritizes effectiveness. PHC services are permanent and decentralized, with financial participation. EMA emphasizes accessibility and temporary specialized services.
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
Livestock Insurance Schemes: Demand for and Application by Small holders and ...copppldsecretariat
Presentation from the Livestock Inter-Agency Donor Group (IADG) Meeting 2010. 4-5 May 2010 Italy, Rome IFAD Headquarters.
The event involved approximately 45 representatives from the international partner agencies to discuss critical needs for livestock development and research issues for the coming decade.
[ Originally posted on http://www.cop-ppld.net/cop_knowledge_base ]
Indegenious knowledge in disaster risk reductionIndependent
Members provided examples of indigenous knowledge used for disaster risk management in India and Indonesia. In India, some communities use traditional methods for weather forecasting and disaster warnings. In Indonesia and India, unusual animal behaviors or environmental changes are sometimes used as warning signs for disasters like tsunamis and earthquakes. Respondents also described traditional agricultural practices, housing construction techniques, and other social and economic coping strategies used by indigenous communities. They emphasized the importance of understanding, respecting, and building upon existing indigenous knowledge and social systems for effective community-based disaster management.
YARD is a tool for engaging with communities to design and validate public space interventions. It provides a new way to engage the public to co-create better places through augmented reality (AR): YARD lets users choose and place objects into real space, building virtual scenes to plan and test design interventions that improve the quality of the public domain.
This article discusses domestic violence against women in Kenya. It profiles several women who have experienced abuse and oppression from their husbands, including being physically assaulted, having their business assets sold without permission, and being abandoned with children to support. The founder of an organization for victims of domestic violence organized a Valentine's Day ceremony and dinner for over 50 abused women. The event aimed to share experiences and views, as well as bring awareness to the issue and support for victims.
International Union for Conservation of Nature World Parks Congress 2014 - Is...Graciela Mariani
Volume 89 Number 15 - 19 November 2014
IUCN WORLD PARKS CONGRESS 2014 HIGHLIGHTS
Tuesday, 18 November 2014
In the morning, participants attended stream sessions while a high-level roundtable convened. Government representatives provided inputs to the vision of the Promise of Sydney and pledged national commitments for the next decade. An evening World Leaders’ Dialogue focused on finding the balance between the global appetite for mineral resources and how this defines PAs.
Dipecho5 news letter 5th edition- march10DIPECHO Nepal
The document discusses capacity building efforts for disaster risk reduction in Nepal. It describes several organizations' projects:
1) Action Aid's project enhances knowledge and skills through trainings, develops systems/institutions, and advocates for stronger disaster policy.
2) CARE's project builds communities' capacity for risk reduction through participatory vulnerability analysis and supporting disaster management committees.
3) Several other organizations like Danish Red Cross, Handicap International, Mercy Corps, etc. also emphasize community-based disaster preparedness and capacity building.
The document discusses the dire state of global biodiversity and species extinction. It notes that according to the IUCN Red List, over 20% of mammals and 30% of amphibians are threatened with extinction. However, it also provides some reasons for cautious optimism. International meetings in 2010 will focus on developing concrete biodiversity targets, and the concept of ecosystem services is gaining recognition and support for conservation efforts. Examples from Brazil show how preserving forests can both help endangered species and provide economic benefits to local communities. Addressing threats like habitat loss and climate change will require greater international cooperation and funding to support biodiversity conservation.
The Partners for Resilience (PfR) alliance was formed by five Dutch humanitarian, development, and environmental organizations to reduce disaster risk through an integrated approach combining disaster risk reduction, climate change adaptation, and ecosystem management and restoration. The PfR will work with vulnerable communities in nine countries across three areas: 1) strengthening community resilience through local projects, 2) empowering civil society organizations, and 3) promoting policy dialogue. By taking an integrated approach and combining the extensive networks and experience of its members, the PfR aims to significantly increase resilience to environmental hazards exacerbated by climate change.
This document discusses lessons learned from the 2014-2016 Ebola outbreak in West Africa. It provides background information on Ebola virus disease, including its symptoms, transmission, and history of outbreaks. It notes that while many countries committed to preparing for pandemics under the WHO International Health Regulations, few were fully prepared when Ebola emerged. The document discusses the roles of various organizations in responding to the outbreak, including militaries, NGOs, the UN, and clusters. It outlines strengths and weaknesses of military involvement in humanitarian aid. Finally, it quotes Bill Gates recommending that countries and alliances like NATO identify military resources available for future epidemics.
This document provides a summary of the history and evolution of UNICEF (United Nations Children's Fund) over several decades. It describes how UNICEF was originally established in 1946 to provide emergency relief to children in war-torn Europe. It then expanded its mission to helping children worldwide, focusing on combating diseases and improving child health, nutrition, and education. The document highlights how in the 1980s under Executive Director James Grant, UNICEF adopted an ambitious goal of cutting worldwide child mortality in half by prioritizing simple and cost-effective interventions like breastfeeding promotion, oral rehydration, immunizations, and growth monitoring (the "GOBI" program). This strategic shift helped UNICEF generate significant
"The Aid Enclave: Mapping an Emerging Geography of Global Health"guest39dc2f5
The document discusses how global health initiatives have led to the emergence of "aid enclaves" - self-contained areas focused on health research and aid that become isolated from their surroundings. It describes how these enclaves develop through economic, political, and ethical processes. Economically, they are tax-free areas that offer high salaries and privileges to foreign workers but not local staff, creating inequality. Politically, they represent a form of neo-imperialism and new systems of global governance. Ethically, they position themselves as correcting issues in the communities they serve but can end up marginalizing local practices and knowledge. The document critiques how enclaves can act as "parasites" taking from host communities without providing
Over the past decade, UNDP has supported disaster risk governance (DRG) in 125 countries through projects focused on strengthening institutional and legal frameworks for disaster risk reduction. A review of UNDP's work in 17 countries found that the organization has helped establish national platforms for DRG, supported mainstreaming of DRR into sectoral policies and budgets, and promoted community-based disaster risk management. Key achievements include the adoption of new laws and plans to decentralize DRR responsibilities. However, challenges remain in fully integrating DRR at local levels due to capacity and resource gaps. Going forward, UNDP is well positioned to further disaster risk governance by clarifying its conceptual approach, transforming programming to focus on local implementation, and supporting post-
Dipecho5 news letter 4th edition- january10DIPECHO Nepal
The document is a newsletter from Nepal that discusses disaster risk reduction efforts. It provides the following key details:
- The newsletter focuses on "Mass Sensitization" efforts to raise awareness about disasters in 19 districts supported under DIPECHO Action Plan V.
- DIPECHO partners in Nepal describe mass sensitization activities they have implemented, including radio and TV programs, street dramas, and community meetings to disseminate information.
- The activities aim to fulfill the third priority of Nepal's National Strategy for Disaster Risk Management, which is raising awareness and disseminating disaster risk reduction information.
The document provides information about malaria, including its transmission, symptoms, impact, and efforts to prevent and treat it. It discusses how malaria kills hundreds of thousands each year in Africa, particularly children, and the economic costs. It outlines the goals and activities of the ELCA Malaria Campaign to raise $15 million by 2015 to support prevention, treatment, and education efforts through Lutheran churches and organizations in 11 African countries. Key interventions discussed are insecticide-treated bed nets, indoor spraying, and preventive treatment for pregnant women. Progress in reducing malaria is highlighted, but more work remains to be done to control and eliminate this preventable and treatable disease.
2006 Expert Patients For Art Lit Review Kk&Wvdwvdamme
The document reviews expert patient programs for chronic disease management in high-income countries and explores their relevance for HIV/AIDS care in low-income countries with severe shortages of health care workers. It finds that current models of antiretroviral treatment delivery are too intensive in their use of skilled staff to scale up in most sub-Saharan African countries. However, chronic disease self-management programs that train lay people living with the conditions to support others have improved health outcomes and reduced healthcare use. Similarly, people living with HIV/AIDS currently play roles in HIV prevention, home-based care, treatment adherence and literacy that could be expanded under an expert patient model to help address the human resource constraints facing HIV treatment scale-up
2006 Lancet Viewpoint Poverty And User Fees Uganda&Cambodiawvdamme
The document compares Uganda's abolition of user fees for public health care to Cambodia's establishment of health equity funds, noting that both increased access to care for the poor but through different approaches. Uganda took a universal approach by removing all user fees, while Cambodia targeted the poor through a system that reimburses costs and administers means testing. Key considerations for policymakers regarding targeting, benefits packages, quality of care incentives, and necessary funding levels are discussed.
This document describes chronic disease clinics in Cambodia that integrated care for HIV/AIDS, diabetes, and hypertension. Over three years, the clinics demonstrated the feasibility of this integrated care approach. Good outcomes were achieved through complementary adherence support strategies. Services were well-accepted by patients, which helped reduce stigma around HIV/AIDS. The experience showed how HIV/AIDS care can help address other common chronic diseases.
The document contrasts the paradigms and characteristics of primary health care (PHC) and emergency medical assistance (EMA). PHC aims to promote long-term health as part of development, using a reasonable share of resources. EMA focuses on short-term physical survival in emergencies, mobilizing all available resources. Care in PHC balances multiple objectives, while EMA prioritizes effectiveness. PHC services are permanent and decentralized, with financial participation. EMA emphasizes accessibility and temporary specialized services.
2008 Shsop Fin Obstetric Care Vouchers In Cambodia Por &Cwvdamme
1) Voucher and Health Equity Fund (HEF) schemes in Cambodia aimed to improve access to safe delivery for poor pregnant women by increasing facility deliveries at public health centers and hospitals.
2) The programs increased the number of deliveries at public facilities, with voucher and HEF beneficiaries accounting for about one-third of total facility deliveries.
3) However, the impact on improving access remained limited due to various financial and non-financial barriers. To be fully effective, vouchers and HEFs need to be complemented by supply-side interventions that also address issues like staff incentives and transportation barriers.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
This document summarizes the challenges of scaling up antiretroviral (ARV) therapy in low-income countries with a high burden of HIV/AIDS. It notes that while funding has increased, the rate of scaling up treatment has been slower than hoped. Key challenges are the need to transition health systems from acute to chronic care and insufficient human resources. Countries with the highest ratios of people living with HIV/AIDS to doctors and nurses will likely need to develop new delivery models that rely less on clinical staff. Existing models are also likely insufficient and new approaches adapted to local contexts will be needed to achieve the massive scale up required.
2008 Mal J Access To Act In Cambodia Yeung 1475 2875 7 96wvdamme
This document summarizes a study on access to artemisinin combination therapy (ACT) for malaria treatment in remote areas of Cambodia. It finds that without specific interventions, only a small percentage of people received biological diagnosis or ACT treatment. However, both village malaria worker (VMW) schemes and malaria outreach teams (MOTs) significantly increased access to trained providers and ACT treatment. The study highlights the challenge of ensuring effective malaria treatment in remote communities with limited formal healthcare access, but finds that community-based approaches like VMWs can help address this challenge.
2008 Pov Ill Book Comparative Anal Social Assistance Cambodia Belgium Itmwvdamme
This document summarizes and compares public social assistance systems in Belgium and Health Equity Funds in Cambodia. It describes Belgium's long-standing, multi-purpose social assistance system operated through public centers. It then discusses Cambodia's Health Equity Funds, which aim to pay healthcare costs for the poorest. Finally, it considers potential lessons from Belgium's experience for designing social assistance programs in low- and middle-income countries, such as the importance of addressing political as well as technical dimensions and considering expanding services beyond only the destitute.
This document discusses the debate around "vertical" versus "horizontal" financing of health services in developing countries. It argues that a "diagonal" approach, which aims to achieve disease-specific results through strengthening health systems, offers a better solution. The Global Fund and new International Health Partnership initiatives may help broaden the scope of Global Fund financing in this diagonal direction. However, this evolution faces challenges due to limited Global Fund resources and potential constraints from the IMF on countries' ability to expand health spending even with increased foreign aid. The authors argue for a gradual transformation of the Global Fund into a more diagonal and horizontal fund, while maintaining features like civil society participation that help ensure aid additionality.
The document summarizes a New Deal project launched in Sotnikum district, Cambodia by the Ministry of Health, MSF, and UNICEF. The New Deal aims to address two major bottlenecks in Cambodia's public health system: low staff motivation due to inadequate salaries, and a mismatch between services offered and population needs. The New Deal introduces the principle of "better income for health staff in exchange for better service." After one year, the New Deal has shown success in Sotnikum by increasing staff salaries, improving commitment and utilization of services. The New Deal has also stimulated policy discussions on sustainable ways to strengthen Cambodia's public health sector.
2007 P Lo S Medicine 04 04 13 Ooms Medicines Without Doctorswvdamme
The document discusses the Global Fund's intention to focus more on fighting AIDS, tuberculosis, and malaria, and leave strengthening of health systems and support for health workers to other organizations. This could create a "Medicines without Doctors" situation. The authors argue that supporting health worker salaries is crucial for expanding treatment, as shown in Mozambique and Malawi which face major health workforce gaps. The Global Fund's novel approach of sustained international funding for treatment programs is what these countries need to strengthen their workforces long-term. However, some actors want to limit the Global Fund's role in health systems strengthening.
2007 Hrh Internat Health Volunteers Laleman Wvd & Co 1478 4491 5 19wvdamme
This document summarizes a study on the contribution of international health volunteers to the health workforce in sub-Saharan Africa. The study estimated that in 2005, volunteer organizations employed around 2,072 full-time international health volunteers in sub-Saharan Africa, with around 1,500 being doctors. The study also explored perceptions of these volunteers from the organizations that send them and from health managers in sub-Saharan Africa, finding more negative than positive views among the latter group.
This editorial discusses the concept of "iatrogenic poverty", where illness itself can lead to poverty in developing countries through two pathways. First, the death or disability of an income earner reduces future income generation. Second, the costs of seeking treatment, including opportunity costs and direct costs, can force households to deplete their savings, sell assets, or fall into debt, potentially tipping them into poverty. The convergence of demand for modern treatments, supply of new medical technologies, and lack of regulation in transitional economies exacerbates this problem. Solutions proposed include social health insurance, reforms to improve healthcare provision and costs, and targeted social assistance to directly transfer resources to the poor.
1) A refugee assistance program in Guinea that provided medical care to refugees from Sierra Leone and Liberia may have also benefited the local host population.
2) The study examined rates of major obstetric interventions in a rural Guinean prefecture between 1988-1996, before, during, and after the arrival of over 200,000 refugees.
3) The rates of major obstetric interventions for the host population increased most significantly over time in areas with high numbers of refugees compared to areas with medium or low refugee numbers. This suggests the refugee assistance program improved access to health services for local residents through investments in the local health system and infrastructure.
The document summarizes a pilot project called the "New Deal" implemented in Sotnikum district, Cambodia to improve the public health system. The New Deal negotiated higher salaries for health workers in exchange for increased access, quality of care, and adherence to regulations. It led to higher patient utilization and quality of services. However, challenges remained with financial management, transparency, and sustainability without external support. Lessons indicated that changing entrenched systems is difficult and benefits different stakeholders unevenly.
The document discusses concerns about an overreaction to the potential threat of an influenza pandemic. While a catastrophic global pandemic is possible, the actual risk is relatively low compared to more common health threats. There is a tendency for the media and some experts to exaggerate rare health risks, distorting public perception and fueling unnecessary panic. Stockpiling of antiviral drugs is not necessarily the best response, as the effectiveness of such drugs is limited and their high cost could be better spent on more widespread health needs. An objective assessment of risk is needed to avoid an "iatrogenic pandemic of panic."
Ichd 2004 H Pol 6 Catastrophic Health Expenditurewvdamme
This document discusses catastrophic health expenditures, which occur when out-of-pocket health costs financially burden households. Evidence from household surveys shows some countries have very high rates of catastrophic spending over 40% of income on health. Determinants include high out-of-pocket costs, for-profit healthcare systems with few safety nets, and weak insurance. To reduce catastrophic expenditures, countries can subsidize costs, expand risk pooling through insurance, and improve access to affordable quality care for the poor. Context-specific strategies may include free or cheap essential services, social or community-based health insurance, and combining supply and demand interventions.
The document discusses the history and current state of the AIDS epidemic in Africa. It begins by tracing HIV back to chimpanzees in Cameroon in the 1930s and its spread to humans. By the 1980s, AIDS cases rose sharply across Eastern Africa due to factors like labor migration. Treatment was not widely available until the 1990s. Currently, South Africa has the most HIV cases but prevalence has declined by a third over the past decade due to treatment programs. However, the number of people needing treatment is expected to exceed resources by 2020 without increased prevention and sustainable treatment options. More work is still needed to curb the epidemic.
The document discusses the challenge of drug-resistant malaria in Southeast Asia and the need to accelerate efforts to eliminate malaria in the region. It notes that malaria deaths have decreased 47% globally since 2000 due to increased funding and interventions. However, artemisinin resistance poses a threat as the only effective treatment for malaria. Elimination of malaria in Southeast Asia, where resistance originated, is seen as the only way to stop the spread of resistance. Political will and sustained funding are needed to achieve elimination goals. A roundtable of experts discussed these challenges and maintaining momentum in the fight against malaria.
Malaria is a major public health concern in Malawi, especially among pregnant women and children under 5. It is the leading cause of morbidity and mortality in the country, accounting for one-third of outpatient visits. The government and organizations like USAID and PMI are working to reduce the burden of malaria through initiatives like indoor residual spraying, distribution of long-lasting insecticide treated bed nets, and improved access to artemisinin-based combination therapy. These efforts have led to a 44% reduction in anemia rates among children in some areas. However, more funding is still needed to fully address the issue of malaria in one of the poorest countries in the world.
SCIP_Factors Associated with Mosquito Bed Net Use_Malaria JMelanie Lopez
- The document summarizes two cross-sectional household surveys conducted in Zambézia Province, Mozambique in 2010 and 2014 to assess mosquito bed net possession and factors associated with their use.
- The surveys found that 64.3% of households possessed at least one mosquito bed net in 2010 and 2014, with higher possession in Namacurra district (90% in 2014) compared to Alto Molócuè (77%) and Morrumbala (34%).
- Use of mosquito nets increased from 2010 to 2014 among pregnant women (58.6% to 68.4%) and children under 5 (50% to 60%), but intensified focus is still needed to improve equity
This research grant proposal seeks funding to evaluate the effects of a randomized microcredit lending and health education program on malaria preventative behavior in Mali. The program, run by Medicine for Mali, will offer microfinance loans and health education to villages in Mali. Some villages will receive both interventions, some only microfinance, and some only health education. The researchers hypothesize that offering both microfinance and health education will lead to higher uptake of insecticide-treated bednets compared to the other conditions. The goal is to study how microfinance and health education individually and jointly impact malaria preventative knowledge and behaviors.
Today we stand at a vital threshold. Within our grasp is the opportunity to end 30 years of suffering and death due to HIV/AIDS. Individuals and communities around the world have been mobilized toward prevention, and existing treatment can prolong life for many years. While we celebrate these successes, we reject any modicum of complacency. Now is the time to double down and finish the job. The world is fighting AIDS today just as it had previously fought to eliminate smallpox. For centuries, smallpox was a feared scourge that killed nearly half of those infected and maimed those that survived. A worldwide campaign to end the disease began in earnest in the late 1960s and by 1980 smallpox was officially eradicated.
Planet Aid anticipates the day when AIDS, too, will be stopped. To this end, we have been helping mobilize communities around the globe to increase HIV/AIDS prevention and care. With this special issue of the Planet Aid Post, we focus on the battle ahead. We also extend a warm welcome to those joining us on the forefront of this work,
A Review on International Donor Agencies and the Control of Malaria in Nigeri...AJHSSR Journal
The study has examined the role of International Donor Agencies in the control of malaria in
Nigeria. The study becomes necessary because of the increase in cases of malaria and high rate of infant
mortality in the country. The role of donor agencies, national and state ministries of health is very important in
reducing these challenges in Nigeria. The study reviewed available secondary information sources. The study
revealed that the role of International donor agencies includes supporting the State Governments with funds,
provision of free mosquito treated nets, provision of subsidized drugs, provision of vaccines for childhood killer
diseases etc. Some of the challenge affecting donor agencies includes diversion of funds of by relevant bodies
for personal use, lack of political will to implement programme, cultural and religious beliefs about sickness and
illness etc. Based on these, some recommendations were made on the fights against malaria which includes
improved funding by government, zero tolerance to corruption, recruitment of more health personnel,
establishments of more primary health centres especially in the rural areas.
Malaria status & challenges of the epidemicGreenFacts
Malaria is one of the most common infectious diseases and a great public health problem worldwide. About one million people die each year from malaria, and half of the world's population lives in areas where there is a risk of getting the disease through the bites of infected mosquitoes.
What is being done to control the spread of malaria? Can the disease be eradicated?
How Africa turned AIDS around By Michel Sidibé Celebrating 50 Years of Africa...Dr Lendy Spires
Michel Sidibé Executive Director UNAIDS At the May 2013 African Union Summit celebrating the 50 years of African unity, a new commission will be launched to explore HIV and global health in the post-2015 debate. “The UNAIDS and Lancet commission: from AIDS to sustainable health” will be co-chaired by Malawi President Joyce Banda, African Union Commission Chairperson Nkosazana Dlamini Zuma and London School of Hygiene and Tropical Medicine Director Peter Piot.
The pace of progress is quickening in Africa. Nowhere have we seen this more clearly than in the AIDS response. Fewer people are dying from AIDS. The number of HIV infections is coming down, with young Africans leading the prevention revolution. There is true hope that in a matter of years, Africa will reach an AIDS-free generation. It has taken a massive shift in how we work together. It has required leaders to show immense courage, passion and action from all sectors. It has taken a united Africa. I am not saying it has been easy— but it has happened. We have a shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
And today there is an African Union endorsement of a new Roadmap to accelerate progress in HIV, Tuberculosis and Malaria—through shared responsibility and global solidarity. Given the extraordinary history of the AIDS response in Africa—in terms of both galvanizing political support and mobilizing resources and communities—the Roadmap sees AIDS as a pathfinder for tuberculosis, malaria and other diseases affecting the continent that require African-sourced solutions. Leadership, it turns out, was that elusive magic bullet. It is the “disruptive innovation” that has irrevocably changed the course of AIDS and now can do even more. As we look to our future goals, I am confident that African leadership can be UNAIDS | Special report with vision and action we can change the world
This document is a special report from UNAIDS highlighting progress and challenges in the AIDS epidemic in Africa. It features statistics and facts about the status of the AIDS epidemic in different African countries, profiles of individuals living with HIV, and articles on various topics related to the AIDS response in Africa, including innovations, the role of the private sector, using sports to raise awareness, and challenges and successes in preventing mother-to-child transmission of HIV.
2006 Aids Real Challenges Art In S Sa Wvd+Kk+Mlwvdamme
This document summarizes the challenges of scaling up antiretroviral therapy (ART) in sub-Saharan Africa. It notes that while the WHO "3 by 5" initiative has made progress expanding ART access, the long-term outlook requires treating millions of people indefinitely. This growing caseload will overwhelm health systems unless new ART delivery models are developed. It also stresses that prevention efforts must be strengthened in parallel to reduce new HIV infections and make treatment sustainable over the long run. New strategies are needed to address both the escalating treatment needs and enhance prevention across communities and healthcare.
Address by president Cyril Ramaphosa on South Africa’s response to the corona...SABC News
- South Africa is moving to alert level 3 lockdown from level 4, allowing more economic activity but keeping restrictions to slow the spread of COVID-19.
- Hotspots with high infection rates like certain cities and districts will have enhanced measures and restrictions.
- Most business sectors can resume operations by following strict health and safety protocols, but some high-risk activities like restaurants and travel remain restricted. Schools will gradually reopen starting with grades 7 and 12 on June 1st.
This document provides an overview of how microfinance services can help address the economic impacts of HIV/AIDS. It discusses how HIV/AIDS affects households economically, forcing them to utilize coping strategies like taking children out of school, selling assets, or taking on debt. Microfinance can help strengthen households' ability to manage risks and losses by helping them generate income, build savings, and avoid selling productive assets. While microfinance should not explicitly target HIV-positive individuals, targeting areas with high HIV prevalence can help the families and communities impacted. The document argues microfinance has a comparative advantage over other interventions in mitigating HIV/AIDS' economic effects through increasing income, providing secure savings, and reducing vulnerability.
The document discusses the grim reality of the AIDS epidemic globally and in Sub-Saharan Africa in particular. It then describes DREAM, a program started by the Community of Sant'Egidio to prevent mother-to-child HIV transmission in Mozambique using highly active antiretroviral therapy. DREAM has expanded to other African countries with the help of the Daughters of Charity and focuses on adherence, nutrition support, and capacity building within local communities. Financing comes from various sources and the annual cost per patient is $300. The goal of DREAM is long-term systemic change through a sustainable, holistic approach that empowers local people.
Three Novartis associates - Roger Waltzman, Perla Maldonado, and Manishha Patel - visited clinics, schools, and communities in Kenya that are impacted by malaria as part of the Power of One campaign. They saw first-hand the challenges families and health workers face living in impoverished neighborhoods of Nairobi like Kibera, where garbage and standing water allow malaria to spread. In western Kenya, annual rains and sugar cane production create ideal conditions for mosquitos near Lake Victoria. The associates visited health facilities there and saw many employees of Mumias Sugar Company affected by malaria. Seeing the realities of battling this disease in Kenya gave the associates new perspectives to inform their work developing antimalarial
Bristol-Myers Squibb Foundations SECURE THE FUTURE? Programme Announces New F...Koos Dorssers
The document summarizes research that found the Grandmothers Against Poverty and AIDS (GAPA) program in Tanzania has had a positive impact in mitigating the effects of HIV/AIDS. The research found that GAPA members benefited from higher self-esteem and saw lower levels of poverty and stigma in their communities due to peer support and income generation activities. Over 72% of GAPA members reported someone in their household died from HIV/AIDS in the past 10 years. The program has empowered grandmothers to support children orphaned by AIDS and influence policies affecting their families and communities.
Bristol-Myers Squibb Foundations SECURE THE FUTURE? Programme Announces New F...Koos Dorssers
New research found that the Grandmothers Against Poverty & AIDS (GAPA) program in Tanzania has had a positive impact on grandmothers caring for families affected by HIV/AIDS. The GAPA program provides community support, psychosocial support, and income generation activities to empower grandmothers. A study of 301 grandmothers found that being part of a GAPA peer support group improved self-esteem and community cooperation, and helped grandmothers earn income. The GAPA program aims to reduce poverty and stigma faced by grandmothers caring for orphans due to HIV/AIDS.
This document provides guidance and materials for marking World Cancer Day on February 4, 2013, which focuses on dispelling myths and misconceptions about cancer. It includes background on World Cancer Day, levels of engagement, social media guidance, key messages, quotations, and next steps. The goal is to raise awareness of actual cancer facts and increase events and participation from the previous year's World Cancer Day activities.
Malaria: breaking the cycle | Have your say on our new strategyDFID
Help us shape the UK Government’s policy and plans for tackling malaria in the developing world.
Please use this presentation to find out more about the issues and to discuss your ideas with colleagues.
Find out more and have your say in our online consultation at:
http://consultation.dfid.gov.uk/malaria2010/
50 breakthroughs: inspiration for FoED SymposiumAlice Marks
The 50 Breakthroughs from LIGTT represent breakthroughs that with have significant impact on the lives of those in developing countries. I turned the list into illustrated slides designed to provide inspiration for attendees of the RAEng Frontiers of Engineering for Development Symposium, November 2016.
Similar to 2004 Lancet Art In S Afr Do The Job Kk & Wvd Small (20)
2008 Pov Ill Book Challenges In Identifying Poor Oddar Meanchey Cambodiawvdamme
This document summarizes a study that assessed household eligibility for a Health Equity Fund (HEF) in Oddar Meanchey, Cambodia four years after an initial pre-identification process. The study evaluated three tools to assess HEF eligibility: 1) a scoring tool used in the original pre-identification, 2) interviewer assessments, and 3) a socioeconomic status index. The results showed high targeting errors across all three tools, suggesting that the original HEF eligibility granted through pre-identification four years prior did not accurately reflect households' current poverty status. Regular updates of pre-identification combined with post-identification are recommended to minimize targeting errors in the future.
This document discusses the costs associated with increasing access to artemisinin combination therapy (ACT) for malaria treatment in Cambodia. It finds that in addition to the costs of ACT drugs, substantial investments are needed for appropriate delivery systems, including:
- The cost of blister packaging ACT drugs locally, which was higher than estimated due to low production rates.
- The annual costs per capita of $0.44-0.69 for malaria outreach teams and village malaria workers who improved access to diagnosis and treatment in remote communities.
- The total annual costs of $19.31 and $11.28 per patient treated for the outreach teams and village workers respectively, which included costs of rapid diagnostic tests and drugs
2008 Aids Community Support & Art Outcomes S Afr Edwin Wouterswvdamme
This study analyzed data from 268 patients enrolled in South Africa's public sector antiretroviral treatment (ART) program to assess the impact of baseline health, patient characteristics, and community support on ART outcomes after 6 and 12 months. The results showed that delayed ART initiation reduced treatment response, while support from treatment buddies, community health workers, and support groups significantly improved outcomes. Community support had a greater positive influence on outcomes over time, suggesting it can help address human resource shortages in scaling up ART programs.
2008 Ssm Art&Fhs Scale Up In S Afr Wvd Kk Gk Ssm6213wvdamme
This document discusses the challenges of scaling up antiretroviral treatment (ART) in Southern African countries with human resource shortages. It notes that the continuously growing caseload of people needing lifelong ART, shortages and uneven distribution of health workers, and the labor-intensive nature of current ART delivery models pose significant challenges. The document analyzes different scenarios for how health systems may adapt, including maintaining the status quo, strengthening the overall health system through task shifting and community-based care, or more technocratic reengineering of services. Achieving universal access to ART will require innovative approaches to address human resource constraints.
2007 Bmc H Serv Chi&Che Deva 1472 6963 7 43wvdamme
This document summarizes a study on two Indian community health insurance (CHI) schemes and whether they protect households from catastrophic health expenditures. The two schemes studied were ACCORD, which provides insurance to indigenous people in Tamil Nadu, and SEWA, which insures self-employed women in Gujarat. Both schemes cover hospitalization costs up to a maximum limit. The study reviewed insurance claims from 2003-2004 to analyze out-of-pocket payments and catastrophic expenditures. The results showed that both schemes halved the number of households experiencing catastrophic expenditures compared to having no insurance. However, 4% of ACCORD households and 23% of SEWA households still experienced catastrophic expenditures, related to low incomes, low maximum limits
2007 Hpp Panorama 4 He Fs In Cambodia Mathieu Czm015wvdamme
The document provides a comparative analysis of four health equity funds in Cambodia that aim to improve access to hospital care for poor patients. The key findings are:
1) The health equity fund model appears superior to traditional waiver systems in improving health service utilization among targeted poor groups.
2) Design aspects essential to the model's performance include the existence of donor funding, the presence of a driving agent, a clear separation of roles, appropriate identification techniques, and consideration of multiple barriers to health service utilization.
3) The comparative framework may be a useful tool for designing, operating, or evaluating similar strategies in other contexts, though early adoption of common documentation would facilitate generating evidence about comparative performance.
2007 Hrh Doctors & Art In Cambodia 1478 4491 5 12wvdamme
1) The study examines the use of doctor time for antiretroviral treatment (ART) delivery in Siem Reap, Cambodia between 2004 and 2005.
2) It finds that the doctor time needed per patient was reduced by 14-33% from 2004 to 2005 due to fewer patient visits and shorter consultations.
3) Extrapolating to 2013, the clinic will need between 2 to 5 full-time doctors to provide ART based on assumptions about patient survival and further reductions in doctor time per patient.
2006 Hrh Nurses In Swaziland 1478 4491 4 13wvdamme
population ratio is estimated at around 30 per
100 000.
Nurses
The total number of registered nurses in Swaziland was
estimated at 2317 in 2004. Of the 1484 established posts
for nurses in the public and mission sectors, only 1108
were filled (Table 1). This means that 19% of nursing posts
were vacant. The majority of nurses are employed in the
public sector, with only around 300 nurses working in the
mission sector. Based on the information available, we
estimate that
land in 2004. Of these, only around 80 were actually
employed in the public sector, giving a doctor:population
ratio of around 7 per 100 000. The remaining 102 doctors
2004 Tmih Out Of Pocket Expenditure In Cambodia 1194wvdamme
This document summarizes a study on out-of-pocket health expenditures and debt in poor households in Cambodia during a dengue epidemic. The study found that:
1) Households that exclusively used private providers paid an average of $103 out-of-pocket, while those that combined private and public providers paid $32, and those that only used public hospitals paid $8.
2) Households financed these costs through savings, selling consumables, selling assets, and borrowing money. After treatment, 63% of households were in debt, with those using private providers more likely to borrow or sell assets.
3) A follow-up found that most households with initial debts were unable to pay
Fake antimalarial drugs pose a major threat to malaria control in Southeast Asia. A survey of antimalarial drugs purchased in pharmacies and shops across the region found that 53% of artesunate tablets labeled as such did not contain any artesunate. All counterfeit artesunate tablets were labeled as manufactured by Guilin Pharma and had packaging that was increasingly difficult to distinguish from genuine products. The prevalence of counterfeit artesunate increased 15% compared to a previous survey, with the exception of Myanmar which saw an 18% decrease. A small percentage (9%) of mefloquine samples also contained inadequate active ingredients, undermining treatment and confidence in antimalarials. The proliferation of
2004 Tmih Disease Control & Health Services In Guinea 1189wvdamme
The document analyzes the cost-effectiveness of epidemic control measures implemented in Guinea during cholera, measles, and meningococcal meningitis outbreaks from 1993-1995. Routine health services alone reduced potential deaths by an estimated 51% on average. Additional interventions further decreased potential deaths by an estimated 28% on average. The marginal cost per death averted was $29 for routine health services and $93 for additional interventions. The analysis found that strengthening health services to control epidemics, as was done in Guinea, was highly cost-effective.
This document summarizes the experience of a Health Equity Fund (HEF) managed by a local NGO in Sotnikum, Cambodia. The HEF aimed to improve access to healthcare for the poor by identifying poor patients and paying their user fees. Over its first 25 months, the HEF supported 16% of hospitalized patients. The authors conducted interviews and found that while the HEF effectively improved financial access, poor patients still faced other barriers like geographical, informational, and intra-household constraints. The study concluded that the HEF model showed promising results with minimal benefits leaking to non-poor individuals, but that further research is needed in different contexts.
2002 Tmih V07 P1001 Editorial On Aids Crisis & Ceawvdamme
This editorial discusses the controversy sparked by cost-effectiveness analyses that concluded HIV prevention is more cost-effective than providing antiretroviral therapy (HAART) in sub-Saharan Africa. While the analyses made valid points, the authors argue they overlooked key ethical and human rights considerations in directly linking their conclusions to policy recommendations. Specifically, (1) treating the sick is a basic human right regardless of cost, (2) cost-effectiveness is just one factor in complex policy decisions that must also consider equity and community values. Overall, the response showed that resource allocation for HIV/AIDS should ensure treatment including HAART is made globally accessible based on principles of health as a human right.
The New Deal is an approach used in Cambodia to improve the public health system. It involves providing performance-based bonuses to health staff from resources freed up by donors and user fees. The New Deal has been implemented in Sotnikum district, Thmar Pouk district, and several provincial hospitals with positive results after 2 years in Sotnikum and 1 year in Thmar Pouk. Activities have increased as staff are more motivated. New institutional arrangements like management committees and Health Equity Funds to help the poor access care have also yielded good results. The document analyzes the implementation and lessons learned from the New Deal experiments to help guide further health sector reforms in Cambodia.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
2004 Lancet Art In S Afr Do The Job Kk & Wvd Small
1. Reportage
Scaling up access to antiretroviral treatment in southern
Africa: who will do the job?
Katharina Kober, Wim Van Damme Lancet 2004; 364: 103–07
See Comment page 6
Malawi, Mozambique, Swaziland, and South Africa have some of the highest HIV/AIDS burdens in the world. All Institute of Tropical Medicine,
four countries have ambitious plans for scaling-up antiretroviral treatment for the millions of HIV-positive people in Department of Public Health,
Antwerp, Belgium
the region. In January 2004, we visited these countries with the intention of directly observing the effect of AIDS,
(K Kober MSc,
especially on health systems, to talk with policy makers and field workers about their concerns and perspectives W Van Damme MD)
regarding the epidemic, and to investigate the main issues related to scaling up antiretroviral treatment. We found Correspondence to:
that financial resources are not regarded as the main immediate constraint anymore, but that the lack of human Dr Wim Van Damme,
resources for health is deplored as the single most serious obstacle for implementing the national treatment plans. Department of Public Health,
Institute of Tropical Medicine,
Yet, none of the countries has developed an urgently required comprehensive human resource strategy. This may
2000 Antwerp, Belgium
also need increased donor attention and resources. wvdamme@itg.be
Approaching Malawi’s capital Lilongwe on the road communities, describes AIDS as a disaster affecting the
from Blantyre, its second main city, the traffic is getting entire society: “Funerals are for days interrupting all
denser. Small shops line the road, little wooden shacks productive activities in the villages. The social fabric of
with signposts advertising their business. Small groups communities and families is being overstretched by the
of people stroll from one shop to the next—a scene number of AIDS orphans, it is very serious.” In
familiar to anyone who has ever travelled through the Swaziland, child-headed households are common and in
African countryside. What makes this scene gruesomely 2003, the country was thought to have 60 000 orphans in
special is that almost all of the shops deal exclusively in a population of just over 1 million. Derek Von Wissel,
the production and sale of coffins (figure 1). We visit director of the National Emergency Response Council
some of the small workshops and talk with their owners for HIV/AIDS, expects this figure to double by 2010,
who say that “there is a lot of dying these days— when an almost unimaginable 10–15% of the
business is going well”. Grieving families are walking population will be orphaned children. Society faces a
from shop to shop, warily comparing prices. Still, the daunting challenge in dealing with the effects of so
price of a coffin is often only a small part of the total cost many parentless children.
of a funeral, of which there are many these days. Malawi, Increasing illness and death from AIDS, it is feared,
like the rest of southern Africa, is ravaged by AIDS. will have a devastating impact on agricultural production
in southern Africa, where most of the population relies
Background on subsistence farming. Already, food consumption is
being reduced in many places and nutritious crops are
Travelling through Malawi, Mozambique, Swaziland,
being replaced by less labour intensive, starchy root
and South Africa, AIDS is an obvious and visible
crops. It is feared that falling supplies and shifts to lower
concern in all four countries. Mass prevention
quality foods may lead to chronic food insecurity and
campaigns have left their mark, from roadside
billboards, to condom promotion posters, to mural higher levels of malnutrition.9
paintings in the inner cities (figure 2). These campaigns,
however, are difficult to evaluate and reduction of
infection rates remains a major challenge.1
The rates of adult HIV-infection in the four countries
are among the highest in the world, ranging from an
aggregate 14% in Mozambique, 15% in Malawi, 20% in
South Africa to a staggering 38% in Swaziland.2 In 2003,
an estimated 8 million people were living with
HIV/AIDS in the four countries (table 1).3–8 The
numbers are overwhelming, yet they can only describe
the quantitative dimension of the epidemic, the reality
behind the figures is one of individual human suffering
and whole societies affected by AIDS.
While part of the epidemic’s effect is already visible,
the long-term damage will be slower to show. Christine
Kamwendo, director of the Malawian Social Action
Fund, which funds non-governmental organisations
Figure 1: One of the many coffin workshops near Lilongwe, Malawi
(NGOs) and grassroots organisations to empower local
www.thelancet.com Vol 364 July 3, 2004 103
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2. Reportage
HIV/AIDS is required in which access to antiretroviral
treatment is dealt with as a global health emergency. In
December, 2003, WHO launched its 3 by 5 initiative, a
project that aims to have 3 million people on
antiretroviral treatment by the end of 2005.15
Although South Africa plans to rely mainly on its own
resources for the nationwide scaling up of antiretroviral
treatment, for Swaziland and especially for Malawi and
Mozambique, increased donor commitments have now
put antiretroviral drugs within the financial reach of large
numbers of HIV-positive people. Spurred on by the
prospect of sufficient financial resources, the
governments of all four countries have prepared large-
scale AIDS treatment plans in line with the 3 by 5
initiative. Yet, a huge gap exists between the number of
people currently receiving antiretroviral treatment and the
target number in national plans.
Figure 2: Mural painting about AIDS in Mozambique Within less than 2 years, a more than fifty-fold increase
Portuguese text reads “AIDS. I’m responsible—are you?”. in the number of people on treatment is planned in South
Africa, with seven-fold and twenty-fold increases in
Financing the response to HIV/AIDS Swaziland and Malawi, respectively (table 2).5–8,16 These
In recent years, the global response to AIDS has entered national treatment plans would seem ambitious for most
a new phase. The Global Fund to Fight AIDS, of the world’s health systems, yet they are to be realised in
Tuberculosis, and Malaria started to operate in January, countries where health systems are already struggling
2002, and had by April, 2004, disbursed almost with severe constraints. However, all policy makers we
US$150 million for HIV/AIDS.10 The World Bank is interviewed in the four countries no longer regard
committing large amounts of funds through its financial resources as the main obstacle for scaling up
Multicountry HIV/AIDS Programme for Africa (MAP) antiretroviral treatment in the short term. Instead, they
and private foundations, such as the Bill and Melinda see the lack of health workers as the single biggest
Gates Foundation, and the Clinton Foundation are constraint. Tackling the issue of human resources for
contributing to increased funding for HIV/AIDS. From health is of paramount importance not only for achieving
January, 2003, the US President’s Emergency Plan for the 3 by 5 goal but also for the survival of these countries’
AIDS Relief (PEPFAR) intends to spend US$15 billion in health systems in times of AIDS.
the fight against AIDS over 5 years. Several other major
The human resource reality
donor countries have committed substantial amounts of
funds globally and, above all, in the countries with the About 30 minutes drive south of Blantyre, we arrive at
highest HIV/AIDS burden in southern Africa. the rural district hospital of Thyolo. We are welcomed by
With the increased financial resources for HIV/AIDS Roger Teck, head of a Médecins Sans Frontières (MSF)
and the prices of antiretroviral drugs recently reduced to mission running an HIV/AIDS project in the district. On
US$140 per patient per year, the debate about the cost- our visit, the hospital is overcrowded with patients lying
effectiveness of antiretroviral treatment versus that of in beds and on the floor (figure 3).
prevention has subsided.11–14 Today, it is widely MSF reckons that in Thyolo district around 50 000
acknowledged that a comprehensive response to people are HIV positive and that about 8000 people are
in need of antiretroviral treatment; however, fewer than
South Africa Malawi Mozambique Swaziland
400 are receiving it. The Malawian staff is eager to show
Total population3 43 600 000 11 200 000 18 000 000 1 029 000
us their hospital, we must see the reality: “The situation
Mean adult HIV 25% 15% 14% 38%
is very difficult, we have so many patients, but we are so
seroprevalence2
few to do all the work, it is very exhausting.” AIDS has
Total number of 5 300 000* 900 000† 1 400 000† 200 000†
HIV-positive enormously increased the need and demand for care,
people
and over 80% of admissions to the medical ward are for
Estimated number 400 000† 170 000† 270 000† 20 000†
conditions related to HIV/AIDS.
of people in need
Hospital care for AIDS patients is not the only factor
of ART
leading to facilities being overburdened, the anti-
ART=antiretroviral treatment. *Data from reference 4. †National HIV/AIDS treatment
plans of Malawi,5 Mozambique,6 Swaziland,7 and South Africa.8 None of the plans retroviral treatment projects we visit are also very labour-
provides detailed explanations about the calculation of these figures.
intensive. Pretest and post-test counselling, appoint-
Table 1: HIV prevalence and the need for antiretroviral treatment in ments with a medical doctor for every patient requiring
South Africa, Malawi, Mozambique, and Swaziland antiretroviral treatment, and regular individual follow-up
104 www.thelancet.com Vol 364 July 3, 2004
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3. Reportage
As a result of the international brain drain, South Africa
South Africa Malawi Mozambique Swaziland
itself has to recruit health workers from elsewhere. A
People on ART <3500* <4000† < 2000‡ About
2003 USAID report19 has shown that only a quarter of
in the public and 1500§
NGO sector in
rural doctors were South African nationals, with most of
2003 (estimates)
the remainder coming from other African countries, such
People on ART 190 000¶ 80 000 4000 (end 10 000 (end
as Zambia, Zimbabwe, and Congo.
(plans for (April, 2005) (end 2005)¶ 2004)¶ 2005)¶
Yet, the brain drain is not only on an international
2004/05)
People on ART 1400 000¶ NA 130 000¶ NA
level; country-level human resource indicators conceal
(plans for (April, 2009) (end 2008)
the internal mobility of health workers. Medical
2008/09)
personnel are moving from public to private sectors,
ART=antiretroviral treatment. NA=not applicable.* Data from Treatment Action
rural to urban areas, and primary to tertiary facilities
Campaign;16 †Malawi Ministry of Health and Population;5 ‡Calculated from figures
within countries. In South Africa, the number of doctors
provided by Médecins Sans Frontières, and Sant’ Egidio; §Swaziland Ministry of Health
and Social Welfare;7 ¶National HIV/AIDS treatment plans of Malawi,5 Mozambique,6
per head of population in the Western Cape is four times
Swaziland,7 and South Africa.8
higher than that in some of the rural provinces. In 1999,
Table 2: Population on antiretroviral treatment by the end of 2003 and 73% of general practitioners were estimated to be
national plans for scaling up antiretroviral treatment
working in the private sector, despite the fact that this
sector catered for less than 20% of the population.21
appointments with nurses involve a high number of
Tackling the human resource crisis
qualified staff working to the limits of their capacity.
Staff shortages are striking in most public sector In Thyolo, where only 40% of posts in the public health
facilities of all four countries. In Thyolo, MSF estimates sector are filled, MSF has recruited extra staff, thus adding
that 60% of posts in the district’s public health facilities another 20% to the health workforce. Nevertheless, this
are vacant. In South Africa, 29 000 positions in the public number is not sufficient to cope with the normal
health sector are currently unfilled, yet the national AIDS workload, let alone with the extra HIV/AIDS-related
treatment plan aims to create 12 000 new posts.8 The burden. MSF acknowledges that “we can only do this
ratio of doctors to head of population in Mozambique is because we are a pilot project, for scaling up antiretroviral
1/30 000, and in Malawi the figure is 1/100 000.17 In 1998, treatment, solutions for the human resource crisis must
WHO estimated the number of doctors in Swaziland was be found at the national level”. The recruitment logic of
15 per 100 000 population.18 pilot projects reaches its limits when applied to scaling up
The human reality behind these numbers is that health treatment, which requires different measures to overcome
workers are caught in a vicious cycle, a cycle in which they the human resource bottleneck. Pilot projects have
themselves are victims of the epidemic in several ways. provided very valuable lessons, such as having shown that
Five-to-six-fold increases in health-worker illness and treating HIV-positive people with antiretroviral drugs in
death rates have been reported for Malawi, and the resource-limited settings is feasible, and that adherence to
number of deaths in nurses represents 40% of the average treatment is as good or better than that in richer countries.
annual output of nurses from training.19 Yet, health Furthermore, in Thyolo which has not even one Malawian
workers often fail to seek care, and MSF staff from project doctor for a population of 490 000, we saw the quality of
sites in several countries shared stories of health workers
who would rather die than disclose their HIV status to a
colleague. As a consequence of this high attrition, a staff
dwindling in size has to cope with ever higher work loads,
and the remaining health workers’ fear of infection with
HIV in unsafe care situations contributes to growing
emotional and physical stress and job dissatisfaction.
In such a situation, it is not surprising that many health
workers decide to leave their countries of origin. Anton,
our young black taxi driver from a township near Cape
Town, confides “next week my wife, who is a nurse, will
leave South Africa and go to work in England. This is
better than staying here, for here nursing is not only an
exhausting but also a dangerous job, there is much
violence in the hospitals and you are always working in
fear of catching AIDS”. South African statistics show that
more than 82 000 health workers left the country between
1989 and 1997. 31% of the UK National Health Service
(NHS) workforce in the UK are from overseas, and
Figure 3: An overcrowded medical ward in Thyolo hospital, Malawi
around 6% are from South Africa.20
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4. Reportage
organisations, too, are losing staff to other countries and
an antiretroviral treatment programme managed mostly
some have designed programmes and incentives for their
by very professional nurses and clinical officers. Yet, the
nursing workforce such as performance-based pay and
overall shortage of health workers in all categories of the
long-service rewards.22 Yet, international brain drain is a
public-health systems means that even if national
programmes rely mainly on paramedical staff, they will problem that cannot be tackled with retention measures
still lack the people needed to scale-up antiretroviral alone, and in June 2001, the health ministers of the
treatment. Southern African Development Community (SADC)
In our interviews with national policy makers, human issued a statement urging industrialised countries to
resources always surfaced as a major concern, and we refrain from active recruitment of staff in developing
learned of many ideas and initiatives to tackle this most countries.23 However, Eric Goemaere, the MSF head of
important bottleneck. Thus, in Mozambique the Ministry mission in South Africa voices his frustration that
of Health is planning to substantially increase the output “despite the UK’s Code of Conduct on International
of medical schools and training institutions for Recruitment private agencies continue to recruit viciously
paramedical staff. However, as Avertino Barreto, Deputy throughout South Africa”.
Director of Health in Maputo points out, “this is a long-
Present measures are falling short
term measure and in the short term we will have to resort
to intermediate solutions such as importing medical Will what is being done and what is being proposed to
doctors from Cuba”. In Malawi, where most nursing tackle the human resource crisis be sufficient to turn the
schools are running well below capacity and many tide? Our observations in the health facilities and our
missionary nursing schools have completely closed, interviews with people from all levels of the health
measures have been taken to raise the standards of systems in the four countries make us doubt this. We did
secondary schools in order to produce more entrants for not come across a truly comprehensive national human
medical and nursing programmes. A previous decision to resource strategy, even though the lack of health workers
upgrade nursing training was revoked because it had is acknowledged everywhere as the most seriously lacking
resulted in a lower intake of students.19 Reactivation and resource for realising the national AIDS plans.
short-course training to return former community-health Increasing the number of health workers is very
workers to the workforce is also being considered. important. More innovative thinking is required to
In South Africa, many call for a change in the type and increase the number of staff in a short time, and to ensure
orientation of training to increase its relevance to health their long-term commitment. The creation of new
needs in the country instead of focusing mainly on professional cadres will require further deliberation.
European style tertiary hospital skills. Lilian Dudley, from While the mobilisation of former community health
the Health Systems Trust in South Africa, tells us that “in workers warrants caution based on previous poor
South Africa the medical students are still predominantly experiences,24 the use of less highly trained nurses or
urban whites and enrolment fees may be one of the clinical officers could be worth further exploration,
barriers for black people from poorer rural backgrounds”. particularly since many clinical officers are already used to
Recently, the minister of health has announced a new taking the responsibility of doctors in rural environments
training programme for medical assistants, which is where there have never been any doctors. But, as has been
expected to enrol more than a hundred students from seen in Uganda and Zimbabwe, creating lower trained
rural districts when it is piloted next year. To make better professional cadres may meet with resistance from
use of the skills mix of existing staff, South Africa’s plan associations who regard this as a threat to their
for scaling up antiretroviral treatment relies mainly on professionalism and international competitiveness.25
nurses instead of doctors. Von Wissel in Swaziland, says Pilot projects, such as in Thyolo, show the extent to
that “with this epidemic we have to keep our minds open which antiretroviral programmes can be entrusted to
for new ideas and keep looking for innovative ways of clinical officers and nurses. Additional ways of
dealing with it”. One such way is the Swazi strategy of optimising the use of staff in the currently very labour
including both public and private health sector medical intensive antiretroviral treatment programmes would
doctors in the national AIDS plan. be worth investigating. How could less qualified staff be
In all four countries people tell us not only about usefully employed to free doctors’ time? One path to be
measures to increase the production of health workers but explored could be to tap the pool of literate and
also about retention measures to keep them in rural areas, educated HIV-positive people, such as teachers, who
in the public sector or in the country. In Mozambique and are already receiving antiretroviral treatment. With
South Africa, for example, medical graduates are obliged their personal experiences of the disease, they could be
to do a period of community service before being allowed employed on many more levels of an HIV/AIDS
to register in an urban centre. The South African programme than is currently the case. Their official
government is experimenting with a variety of incentive recognition and employment could additionally have a
schemes, distance learning possibilities, and support for beneficial effect on the widespread stigma of HIV-
spouses and families in rural areas. Private healthcare positive people.
106 www.thelancet.com Vol 364 July 3, 2004
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5. Reportage
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www.thelancet.com Vol 364 July 3, 2004 107
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