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This study explored the challenges experienced by HIV infected pregnant women and the coping strategies used by those who disclose or do not disclose, to inform community and health workers roles in supporting pregnant women around disclosure. It aimed to explore dimensions of (and impediments to delivery of) Primary Health Care responses to HIV and AIDS in Namibia. The work was implemented at Katutura state hospital, an intermediate hospital in Windhoek, at the Centre for Disease Control, antenatal care and PMTCT services within the hospital complex. The work was done with a small sample (20) due to the criteria of voluntary participation and follow through of a more intensive longitudinal participatory process with the women. The use of participatory methods, while demanding, proved effective even over short time periods to build the empowerment and communication needed to for the changes found. Nursing students proposed that future PRA projects run throughout the year for effective learning and include more students. PHC responses to AIDS start and end in the community, involving households, networks of affected groups, educational, religious and social institutions and supported by primary care services. The study indicates features of this for testing and counselling. Namibia needs to provide high levels of knowledge of services for prevention, testing, health promotion in positive people, partner notification and treatment options to people in the community from an early age onwards. It can also create an enabling social environment encouraging support of PLWHA, openness and reinforcing information on the positive implications of testing and disclosure, including to partners and family members. Another factor is ensuring that testing, counselling and information supporting disclosure, including on positive prevention, is provided at every ANC and PMTCT contact. In addition, it's important to support health worker communication on testing and disclosure with inputs from support groups and expert patients at facilities, and build a health sector response that addresses community as well as health service dimensions of intervention.

This workshop will take place after the EQUINET Regional Conferebce September 23-25 2009. It will draw on the experiences of the African Population and Health Research Center (APHRC) to strengthen skills in effective and innovative strategies of communicating health research evidence to effect policy change. It will be an interactive workshop, and will address some major challenges in communicating health research in an accessible and compelling manner. The workshop will use evidence from APHRC's research in the area of sexual and reproductive health in the sub-Saharan Africa region. The workshop will be useful to people charged with communicating research in their organizations, researchers, advocates/activists, and anyone else who finds the issues above interesting. Visit the conference website to register for the workshop and for the conference.

This study, commissioned by EQUINET, ECSA-HC and WHO, aimed to review and critically analyse the literature and secondary evidence on the impact of HIV and AIDS programmes on health care worker (HCW) retention in east and southern Africa. Early studies reported negative effects of HIV and AIDS and the delivery of HIV and AIDS services on HCW morale with stigma, burn-out, resignation and deaths due to HIV and AIDS, while more recent ones speak of hope, high prestige, high motivation and better retention of HCWs in HIV and AIDS programmes, largely due to effective antiretroviral therapy (ART) which has improved the prognosis of AIDS. Global Health Initiatives have contributed to the expansion of HCW numbers through training, higher salaries or salary supplements, such as better furnished facilities or appointment at higher levels, often to the exclusion of other HCWs. Selectively applied incentives tend to demoralise and discourage those who are excluded; as illustrated by examples from programmes in South Africa, Tanzania and Guyana. But well funded HIV and AIDS programmes are attractive to HCWs and may contribute to internal brain drain. In contrast, more inclusive approaches, such as in Malawi where MSF supplemented salaries of all health workers in the operational districts, and Namibia where the Ministry of Health and Social Services applied uniform terms and conditions of service for all HCWs, reportedly experienced no problems. Some countries have an ‘emergency response’ approach to HIV and AIDS; hence they accept any help, usually on the funders’ terms, leading to fragmented vertical programmes. The lack of integration of HIV and AIDS services into other health programmes is a problem in many countries. Where successfully integrated programmes do exist - such as HIV and TB, HIV and sexual and reproductive health, and even those where HIV and AIDS services are fully integrated into the public health system - integrated programmes benefited the whole system. There have been fears that existing inequalities in health care may be intensified in scaling up HIV and AIDS services. There are, however, reports showing that a public health and equitable approach to the roll-out of ART is possible across all socio-economic groups with similar outcomes. HIV and AIDS programmes have the potential to benefit the health system by attracting and retaining HCWs in the health system; and indeed, innovations such as task shifting and the integrated management of adult and adolescent illness have been applied to more efficiently use available HCWs. Many vertical programmes recruit their own HCWs, especially counsellors and home-based caregivers. This can increase the pool of HCWs. By relying on the health system for the more skilled health professionals, however, HIV and AIDS programmes may also undermine other health programmes. We recommend that country-level case studies be undertaken to document the various approaches, such as engagement between countries and funding agencies, country perspective on NGO roles, the implementation of the ‘Three Ones’, SWAP and public health approach; and the impact of national and project specific initiatives on HCWs.

Have non-financial incentives been successful in retaining health workers in Swaziland? This study reviewed health policy and programme documents in Swaziland relevant to health workers and found that only one that mentioned non-financial incentives, suggesting that the value of these incentives is under-rated in policy. In contrast, a field study interviewing health workers at different levels of the health system revealed that most workers in Swaziland consider non-financial incentives to be more important than salary in determining whether or not they will remain in their jobs or join the 'medical brain drain' overseas.