When caring for critically ill patients, health workers often need to ‘call-for-help’ to get assistance from colleagues in the hospital. This study aims to describe health workers’ experiences about calling-for-help when taking care of critically ill patients in hospitals in Tanzania and Kenya. Ten hospitals across Kenya and Tanzania were visited and in-depth interviews conducted with 30 health workers who had experience of caring for critically ill patients. The study identified three thematic areas concerning the systems for calling-for-help when taking care of critically ill patients: i. Calling-for-help structures: with a lack of functioning structures for calling-for-help; ii. Calling-for-help processes: with calling-for-help processes noted to be innovative and improvised; and iii. Calling-for-help outcomes: with the help provided not that which was requested. Calling-for-help when taking care of a critically ill patient is a necessary life-saving part of care, but health workers in Tanzanian and Kenyan hospitals experience a range of significant challenges. Hospitals lack functioning structures, processes for calling-for-help are improvised and help that is provided is not as requested. These challenges are observed to be likely to cause delays and to decrease the quality of care, potentially resulting in unnecessary mortality and morbidity.
Human Resources
This paper examined the health workforce governance strategies applied by 15 countries in the WHO Africa Region in responding to the COVID-19 pandemic. The authors extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited an additional 35 812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. The paper raises strengthening multi-sector engagement in the development of public health emergency plans as critical to promote the development of the holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination and to ensure optimized utilization based on competencies, especially for the existing health workers.
This paper aimed to assess the knowledge and practice of health workers (HWs) towards maternal and child health (MCH) in Kasai and Maniema, two Democratic Republic of the Congo provinces with very high maternal mortality ratios and under-5 mortality rates. This cross-sectional study was conducted with all HWs in charge of MCH in 96 health facilities of Kasai and Maniema provinces in 2019. Among participating HWs, 43% were A2 nurses, 82% had no up-to-date training in MCH, and 48% had only 1-5 years of experience in MCH. In the two provinces combined, about half of HWs had poor knowledge and poor practice of MCH. Good knowledge and practice scores were significantly associated with high qualification, continuing up-to-date training in MCH, and 6 years of experience or more in MCH. The authors argue that conversion of A1 nurses into midwives as well as the provision of up-to-date training in MCH, supervision, and mentorship could improve the skill level of HWs and could thus reduce the burden of MCH in the DRC.
The authors present how the implementation of some functional reviews in the health sector exacerbated occupational stress (OS) and burnout among clinical officers at public hospitals in Malawi through a qualitative case study at four district hospitals and one central hospital, all state-owned. The functional reviews are found to have aggravated occupational stress and burnout among clinical officers at public hospitals, and perpetuated interprofessional conflicts between clinical officers and medical doctors. The authors recommend that a psychosocial risk assessment should be conducted to avoid or minimise the risks of occupational stress and burnout among clinical officers posed by the implementation of functional reviews in the health sector.
This study sought to identify strategies for implementing Income-Generating Activities (IGAs) for Community Health Volunteers (CHVs) in Kilifi County in Kenya to improve their livelihoods, increase motivation, and reduce attrition. Focus group discussions were carried out with CHVs and in-depth interviews among local stakeholder representatives and Ministry of Health officials. A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work does not provide remuneration. Individual savings through table-banking, seeking funding support through loans from government funding agencies, and grants from corporate organizations, politicians, and other donors were proposed as viable options for raising capital for IGAs. Empowering CHVs with entrepreneurial and leadership skills, and connecting them to support agencies were proposed to support implementation and the sustainability of IGAs. Group-owned and managed IGAs were preferred over individual IGAs. The authors propose that agencies seeking to support CHVs’ livelihoods should engage with and be guided by the input from CHVs and local stakeholders.
Healthcare workers (HCWs) are at the frontline of response to the COVID-19 pandemic. This study investigated the burden of COVID-19 among HCWs and infection prevention and control (IPC) gaps during the first to the third wave of the pandemic in a retrospective cohort study in the Democratic Republic of Congo using its National Department of Health database and a WHO questionnaire. The investigation revealed that about 32% of HCWs were infected from household contacts, 11% were infected by health care facilities, 35% were infected in the community and 22% were infected from unknown exposures. IPC performance was moderate, with lower or minimal performance on triage and screening, hand hygiene, PPE availability, waste segregation, waste disposal, sterilization, and training of HCWs. HCWs who tested positive for the COVID-19 virus was higher among frontline healthcare workers from 6 provinces of DRC. The authors recommend strategies to strengthen IPC capacity building and provide HCWs with sufficient PPE stocks and budgets to improve IPC performance and enable adherence to WHO recommendations to minimize COVID-19 transmission in HCFs, communities, and public gatherings.
This report estimates the economic burden of health care worker infection and death during COVID-19 to understand the direct and indirect cost of health care worker (HCW) infections, their contributions to wider community transmissions and the economic toll of disrupted health services. The economic burden of HCW infection was heaviest in the countries that had low HCW density and were most severely affected by staff shortages. The heaviest costs were associated with secondary infections and excess maternal and child deaths. The costs of onward viral transmission outweighed those associated with direct HCW infections, ranging from 13% of total economic costs linked to HCW infections in Kenya to 70% in KwaZulu-Natal, South Africa. The burden in Kenya was estimated at almost $34,000 or 18 x GDP per capita and in Eswatini at almost $36,000 or 9 x GDP per capita. As a percentage of annual health expenditure, the total burden associated with HCW infection and death was highest in Western Cape, South Africa, at 8.4. The report demonstrates the importance of prioritizing the protection of health care workers.
This paper explored teacher and community-based health worker experiences in addressing adolescent sexual, reproductive, health and rights (SRHR) in rural health systems in Zambia through 21 qualitative in-depth interviews. Teachers and community-based health workers mobilise the community for meetings, provide SRHR counselling services to both adolescents and guardians, and strengthen referrals to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution. The study emphasizes the need to fully engage adolescents in addressing adolescent SRHR problems.
This study explored health workers’ perceptions of clinic- and community-level stigma against adolescent girls and young women seeking HIV and sexual and reproductive health services in Lusaka, Zambia. The authors conducted 18 in-depth interviews in August 2020 with clinical and non-clinical health workers across six health facilities in urban and peri-urban Lusaka. Health workers reported observing stigma driven by attitudes, awareness, and institutional environment. Clinic-level stigma often mirrored community-level stigma. Health workers described the negative impacts of stigma for adolescent girls and young women and expressed a desire to avoid stigmatization. Despite this lack of intent to stigmatize, results suggest that community influence perpetuates stigma, although often unrecognized and unintended, in health workers and clinics. These findings demonstrate the overlap in health workers’ clinic and community roles and suggest the need for multi-level stigma-reduction approaches that address the influence of community norms on health facility stigma. The authors propose that stigma-reduction interventions should aim to move beyond fostering basic knowledge to encouraging critical thinking about internal beliefs and community influence and how these may manifest in service delivery to adolescent girls and young women.
The report offers the first global dataset of labour protests of key workers during the pandemic. It focusses on two sectors, healthcare and retail. The results show that, overall, despite large volumes of protest over acute COVID-related problems such as the provision of Personal Protective Equipment (PPE), the main concern of protesting workers during the pandemic was their pay. Collective action accompanying demands for pay rises involved not only the withdrawal of labour, but also demonstrations and leverage tactics. Health and safety was the second most important concern, and protests linked to these demands did not cease when the pandemic became less deadly. Protest spiked during the initial March 2020 lockdowns, before continuing at a lower level throughout the pandemic. The report identifies important variation between countries and sectors, and highlights specific local contingencies, and strategic decisions taken by workers and their unions.