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.
Human Resources
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.
This study estimated the prevalence of burnout among primary health-care professionals in low- and middle-income countries and factors associated with burnout. The authors systematically searched nine databases up to February 2022 to identify studies investigating burnout in primary health-care professionals in low- and middle-income countries. Three studies collected data during the coronavirus disease 2019 pandemic but provided limited evidence on the impact of the disease on burnout. The overall single-point prevalence of burnout ranged from 2.5% to 87.9%, the pooled prevalence of a high level of emotional exhaustion was 28.1%, and a high level of reduced personal accomplishment was 31.9%. The authors note that a high prevalence of burnout among primary health-care professionals in low- and middle-income countries, particularly in Africa, has implications for patient safety, care quality and workforce planning and call for further evidence-based assessment to inform solutions..
In this qualitative study, the authors aimed to understand how tuberculosis (TB) health workers and other stakeholders viewed mental health conditions linked to TB and how they screened and treated these in their patients. It was conducted in eight urban communities in Zambia through focus group discussions with local health committee members and TB stakeholders and in-depth interviews with key TB health workers. TB stakeholders and health workers were reported to have an inadequate understanding of mental health and commonly described mental health conditions among TB patients by using stigmatizing terminology and overtones, using for example “madness” to imply a character flaw rather than illness, or describing psychological distress as “overthinking", and not a condition that would benefit from mental health intervention. There were no standard screening and treatment options for mental health conditions in TB patients and most TB health workers had no mental health training, but TB Stakeholders and health workers understood the negative implications of mental health conditions on TB treatment adherence and overall wellbeing for TB patients. The authors propose integrating mental health training in TB services and screening TB patients for mental health conditions followed by care and treatment for those identified with mental health disorders.
This systematic review aimed to synthesise research findings on the Community Health Worker (CHW) effectiveness at reaching the most disadvantaged groups in low- and middle-income countries (LMIC) contexts, and in reducing health inequities in the populations they serve. One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. In order to optimise the equity impacts of CHW programmes, the authors propose moving beyond seeing CHWs as a temporary sticking plaster, and instead building meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity.