Between November and December 2024, the authors evaluated healthcare providers’ knowledge, attitudes, and practices related to nutrition management for patients with type 2 diabetes in Kinshasa and the links between knowledge, attitudes, and practice. The study was implemented across all 35 health zones, and 877 healthcare providers were interviewed. The median age was 39 years, and a minority had received diabetes-related training within the past 12 months. Mean scores for knowledge were 11.9/19, for attitude 11.9/14, and for practice 10.0/17. While most healthcare providers agreed that nutrition is fundamental for diabetes care, many viewed this to be the nutritionist’s responsibility and did not use any record form for nutritional assessment or for recording nutrition-related issues or diagnoses. The study revealed major gaps in healthcare providers’ knowledge and practices on nutrition management in Kinshasa, shaped by both knowledge and attitudes. Differences by profession and sex highlighted training inequities. The study highlighted the need for targeted, context-specific interventions to strengthen frontline healthcare providers’ skills and attitudes on nutrition support.
Human Resources
A systematic search of study databases in 2023 and 2025 explored community health worker roles in cervical cancer screening (CCS) in sub-Saharan Africa. Despite methodological limitations, all studies involved CHWs in health education and counseling. CHWs conducted home visits to recruit participants for CCS, rescheduled follow-up appointments, facilitated access to care, and provided childcare during screening attendance. Interventions involving CHWs significantly increased CCS uptake in three of the five studies assessing it as the primary outcome and improved follow-up attendance in the single study examining this indicator. The authors argue that while the effectiveness of CHW-based interventions varies by type and context, CHWs show potential to enhance CCS uptake in SSA.
This cross-sectional study investigated the prevalence of hypertension and its associated factors among healthcare workers in Kinshasa's hospitals in December 2023 to January 2024, focusing on occupational factors. Of 566 healthcare workers enrolled in the study, 55% were female and 45% were male, with a mean age of 39.0 ± 10.4 years. The prevalence of hypertension was 23.3%, with 57.6% of hypertensive participants unaware of their diagnosis at the time of data collection. The socio-demographic and lifestyle factors associated with hypertension were age ≥ 40 years, physical inactivity, being overweight and being obese. Seniority ≥ 10 years, night shift work, and burnout syndrome were also associated with hypertension. The authors note that addressing hypertension requires tackling both lifestyles and modifiable work-related factors, integrating healthy practices, routine blood pressure monitoring with structured shift schedules, stress management programs, and supportive workplace environments.
This qualitative study explores the counseling strategies employed by fistula care providers in Uganda, the challenges they face, and implications for practice, using key informant interview of thirty providers. Providers used individualized strategies including emotional support, expectation-setting, and specialist referral, with tailored approaches based on patients' hysterectomy status. Cultural attitudes toward infertility and patients' financial constraints further shaped the counseling process. Key challenges included the emotional toll of discussing sensitive issues, insufficient training, and limited access to specialist care. Findings indicate that effective infertility counseling after fistula repair requires a comprehensive approach spanning medical, emotional, and social dimensions. Enhancing provider training in counseling skills and integrating psychosocial support are observed to be critical steps toward improving care quality.
The authors examined how, for whom, and under what conditions technical support works in Tshopo Province, DRC, using a realist case study design and document reviews, interviews, questionnaires, and routine health information system data. Challenging conditions — including limited resources, hierarchical culture, poor leadership, and narrow decision spaces — hindered the capacity building and motivation of Provincial Health Administration (PHA) staff, resulting in mixed competencies. This compromised the quality of technical support provided to District Health Management Teams (DHMTs), which fell short of being personalised, problem-solving-centred, and regular. Sub-optimal support undermined PHA staff credibility among DHMT members, limiting their active participation and learning, and resulting in inconsistent management capacities and low motivation, self-efficacy, and perceived autonomy.
Low and middle income countries are are seeking concrete measures to address inequities in the international recruitment of health workers. A Resolution on the Global Code of Practice on the International Recruitment of Health Personnel is scheduled to be adopted at the 79th Session of the World Health Assembly (WHA79) to take place from 17 to 23 May at the WHO headquarters in Geneva. This resolution attempts to address structural inequities faced by source countries caused by the uneven progress in the application of the different provisions of the Code. In ongoing negotiations, low- and middle-income countries have called for concrete measures such as ring-fenced taxation to address inequities, emerging from the migration of workers. High-income countries continue to oppose.
This paper focuses on the emotional dimensions of nurses’ daily work in newborn units in Kenya. These dimensions of newborn nurses’ work are rarely documented and are under-supported in policy and practice. The authors conducted an empirical qualitative study design in two public hospital newborn units, with in-depth interviews with 21 health workers, and self-administered questionnaires. Neonatal nurses reported emotions ranging from pride and satisfaction to devastation, heartache, and indifference, with handling infant deaths and communicating bad news to families particularly distressing. Influenced by individual, interpersonal, and structural factors, emotions play a central role in nurses’ interactions with their peers, supervisors, ward-in charges, and parents. Interactions with supervisors and in-charges have an especially powerful impact on staff emotional well-being and team cohesion, and informal support from peers is a key coping strategy.
This paper explored the role of the community health assistants (CHA) in delivering as maternal and child health (MCH) services in Zambia. Key informant interviews and focus group discussions were held in all 10 provinces of the country with the CHAs, and their supervisors, health workers, neighbourhood health committees and community members. The community health systems strengthening interventions (provision of training manuals, streamlined recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration) contributed to improved delivery and acceptability of MCH services. The CHAs leveraged community networks, linkages and partnerships when delivering these services, including with traditional and religious leaders, contributing to improved coverage and acceptability of MCH services. Health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide by the CHA recruitment and selection criteria affected delivery and acceptability of the services. The authors emphasize the need to integrate provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA program to enhance the provision and acceptability of health services.
This paper examined the effect of a workplace-based HIV self-testing intervention (HIVST) on the use of HIV self-testing among unskilled workers in Wakiso Uganda. A quasi-experimental one-group pretest-posttest design was conducted among 46 participants systematically and randomly selected. A comparison of the mean differences between the pre-post-test scores for the intervention group showed a statistically significant difference for HIVST knowledge, perceived susceptibility, perceived benefits, perceived barriers, and HIVST use. However, perceived barriers increased exponentially than earlier hypothesized amidst the knowledge acquired. Multiple regression showed that HIVST knowledge and individual beliefs predict 37.2% of the variance in HIVST use and that the overall biggest predictor of HIVST use was perceived susceptibility. The authors propose advocacy for frequent knowledge sharing about self-testing among unskilled working populations in Uganda. Organizations, alongside HIV testing implementing partners, should awaken people operating in risky environments and those engaging in risky sexual acts on the threat of succumbing to HIV as this greatly increases HIVST and repeat testing.
This paper assessed in 2022 the feasibility and acceptability of using pharmacy outlets and community health volunteers to increase women’s and girls’ access to information, medication abortion and other sexual and reproductive health services and rights. The study utilized a single arm pre-test and post-test design that involved implementing a set of interventions and comparing the baseline and endline indicators using simple frequencies considering the number of respondents involved in the study. Data collected from 10 pharmacy staff and 20 community health volunteers, along with pharmacy sales records, showed steady increase in service uptake. Medication abortion clients increased from 15 to 112 monthly, with 527 total clients, of whom 523 also obtained family planning methods. All pharmacy staff and health volunteers reported satisfaction and positive attitudes toward service provision. The intervention demonstrated the feasibility and acceptability of providing medication abortion and reproductive health services through private pharmacies, with community health volunteers effectively increasing awareness and strengthening referral systems. Results suggest potential for addressing unsafe abortion, a leading cause of maternal mortality in Kenya.