Despite the clear prohibition against sexual relations with one’s patients, complaints of a sexual nature against practitioners registered with the Health Professions Council of South Africa (HPCSA) have been increasing. The authors of this paper set out to ascertain how a group of medical practitioners felt about the presence of chaperones during the consultation and intimate examination of patients. They distributed a self-administered, questionnaire-based survey to gynaecologists and medical practitioners. There was a 43% response rate with 72% of practitioners in favour of using a chaperone during an intimate examination, although only 27% always do so. Most practitioners felt that consensual sexual relationships with patients are unacceptable; 83% felt that ethical guidelines on this topic were needed. The authors recommend that the HPCSA should develop guidelines on the use of chaperones to assist practitioners. With medical litigation increasing, using chaperones will benefit patients and practitioners.
Human Resources
Undergraduate teaching on global health has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalisation, cross-border movement of pathogens and international migration of health care workers. In this study, researchers carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance. The authors suggest that there are three types of doctor who may wish to work in global health - the 'globalised doctor', 'humanitarian doctor' and 'policy doctor' - and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special developing countries track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study. The authors argue that teaching of global health in undergraduate medical curricula must reflect the social, political and economic causes of ill health.
The purpose of this study was to investigate the performance of health workers since decentralisation of health services in Uganda in the 1990s in order to identify and suggest possible areas for improvement. Researchers conducted a cross-sectional descriptive survey, using quantitative research methods to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. The study revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. Health workers take initiative to ensure that they are available for work, although low staffing levels undermine these efforts. While the data shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. In general, the results show that health workers are proficient, adaptive, proactive and client-oriented. Although Uganda is faced with a number of challenges as regards human resources for health, these findings show that the health workers that are currently working in the health facilities are enthusiastic to perform. This may serve as a motivator for the health workers to improve their performance and that of the health sector.
Antiretroviral therapy (ART) adherence clubs, already operating in several high burden areas in Cape Town, have the potential to revolutionise the treatment of millions of HIV-positive South Africans and lighten the load on overburdened health workers, according to Medecins Sans Frontieres (MSF). In a nutshell, the ART adherence clubs are a long-term retention model of care for stable patients on ARVs. Between 20 and 30 patients meet and are facilitated by a non-clinical staff member who provides a quick clinical assessment, a referral where necessary and peer support in the form of a short group meeting. Pre-packed ARVs are distributed, enough to last for two months until the next meeting. Once a year, the patient is referred for blood tests and is seen by a doctor. This means that for one year the patient does not need to be seen by a professional health worker, essentially freeing the workers up to treat more complex cases and creating space in waiting rooms. By August 2012, 149 new clubs had been established in Khayelitsha, Cape Town, totalling 5,195 patients, which represents 20% of those enrolled for ART in the township. A spokesperson from the provincial health department said the province was also looking at integrating the clubs into a chronic care model, which means that patients with for example diabetes or high blood pressure could benefit.
In recognition of the critical shortage of human resources within health services, community health workers in Ethiopia have been trained and deployed to provide primary health care in developing countries. In this study, researchers investigated the knowledge and performance of these health extension workers (HEWs) on antenatal and delivery care, as well as the barriers to and facilitators for the provision of maternal health care. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Almost half of the respondents had at least five years of work experience as a HEW. More than half (54%) of the HEWs had poor knowledge on contents of antenatal care counseling, and most (88%) had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructure like water supply, electricity, and waiting rooms for women in labour. On average, within six months, a HEW assisted in only 5.8 births. Only a few births (10%) were assisted at the health posts, most (82%) were assisted at home and only 20% of HEWs received professional assistance from midwives. Based on these findings, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their knowledge and competencies, while creating appropriate working conditions.
Competency-based education (CBE) is argued to provide a useful alternative to time-based models for preparing health professionals and constructing educational programmes. In this paper, the authors describe the concept of 'competence' and 'competencies' as well as the critical curricular implications that derive from a focus on 'competence' rather than 'time'. These implications include: defining educational outcomes, developing individualised learning pathways, setting standards, and the centrality of valid assessment so as to reflect stakeholder priorities. They also highlight four challenges to implementing CBE: identifying the health needs of the community, defining competencies, developing self-regulated and flexible learning options, and assessing learners for competence. While CBE has been a prominent focus of educational reform in resource-rich countries, the authors argue that it has even more potential to align educational programmes with health system priorities in more resource-limited settings. Because CBE begins with a careful consideration of the competencies desired in the health professional workforce to address health care priorities, it provides a vehicle for integrating the health needs of the country with the values of the profession.
In this cross-sectional descriptive survey the authors investigated the performance of health workers after decentralisation of the health services in Uganda to identify and suggest areas for improvement. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. Results revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiative to ensure that they are available for work, but low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicated that health workers are competent, adaptive, proactive and client oriented.
While there is optimism surrounding Africa’s growth potential, the continent appears to be lagging behind in training the necessary people to match its economic growth, according to this article. Although the number of students enrolling for tertiary education has been growing, the numbers are still low. Only 6% of students in sub-Saharan Africa are enrolled in tertiary institutions. Educationists and economists have observed that if Africa is going to compete in the global economy, this needs to increase to 15%. Africa can overcome barriers to student enrollment by using e-Learning and correspondence to extend education to students who face time and space constraints. There are significant challenges to this, such as limited and high cost internet connectivity on the continent, intermittent power disruption, a lack of national and institutional policies, a scarcity of experienced human resources and a perception that distance education may not offer the same quality as face-to-face education.
In this study, the authors quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria. They performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. They estimated that, for universal access to HIV treatment for all patients with a CD4 cell count of less than or equal to 350 cells/muL, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of R929 million, equivalent to US$ 141 million. For universal treatment ('treatment as prevention'), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of R2.6 billion (US$ 400 million). Universal access to HIV treatment for patients with a CD4 cell count of less than or equal to 350 cells/mul in South Africa may be affordable, but the number of HHWs available for HIV will need to be substantially increased. Unfortunately, treatment as prevention strategies will require considerable additional financial and human resource commitments.
South Africa has begun producing a new type of health professional - a clinical associate. Clinical associates are people ideally suited to working in hospitals, helping doctors carry out some of their tasks – like dealing with emergencies and doing procedures. They don’t replace doctors or nurses – they work with them, sharing some of their workload, and allowing them to concentrate on the tasks for which only they are qualified. There is no doubt that more doctors and nurses need to be trained and recruited into the South African health system. But will this alone solve the country’s staff shortages? It takes less time to train a clinical associate. They can become very skilled at what they do because they focus on a special set of skills and are supervised by doctors. They are recruited from rural and disadvantaged communities. So, the author argues, clinical associates could do a lot to address staff shortages in the public sector, especially in district hospitals. Clinical associates are noted as a priority in the latest government human resource strategy but the future of clinical associates and the strategy of National Health Insurance need to become much more closely intertwined.