Health workers' strikes in low-income countries: the available evidence

State of Physician Unionization

OBJECTIVES

To provide an overview of the current state of physician unionization, potential factors surrounding increased unionization, and the ethical and financial issues that may arise.

DESIGN

Review article.

SETTING

Not applicable.

PARTICIPANTS

Not applicable.

RESULTS

Over the last few years, there has been a recent surge in physician unionization. Union membership among residents and fellows is also at an all-time high and continues to increase, as seven residency programs voted to unionize in 2023. The resulting threat of strikes has grown considerably over the last year as residents across 6 hospitals have threatened to strike, resulting in New York's first physician strike in over three decades. As physician practice continues to shift from private to corporate health system-based employment, more opportunities for unionization will arise. Globally, these trends have been comparable, with thousands of physicians striking across the United Kingdom, Germany, Italy, Nigeria, and New Zealand in the last year.

CONCLUSION

The current state of physician unionization is of increasing significance as more physicians are presented with opportunities for unionization. Physicians perceive a lack of autonomy, and the demand to deliver high level outcomes with diminishing resources is becoming an insurmountable challenge. Additionally, physician satisfaction with their workplace has decreased with increased burnout rates. Thus, it is important to understand the current state of unionization, potential reasons for unionization among physicians and residents, and its future impact on the field of medicine.

Strikes of physicians and other health care workers in sub-Saharan African countries: a systematic review

Introduction

Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services.

Methods

Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible.

Results

A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals.

Discussion

This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.

Public-Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study

In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG's non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG's ability to provide quality, affordable care. This study underscores private providers' pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.

Fear of violence and working department influences physical aggression level among nurses in northwest Ethiopia government health facilities

Purpose

Violence is recognized as an extreme expression of aggressive behavior and physical violence is most recognized type among victims. Patients always come to the hospitals looking for a cure, remedy, or assurance; however, incompatibility of demand and service often results in violent incidents that become statuesque in health facilities. This study aims to investigate physical violence and associated factors among nurses in health facilities in Gondar town, Ethiopia.

Method

The study was an institutional-based cross-sectional study among nurses in Gondar town from April to May 2017. Data were collected using a pretested modified version of the standard [ILO/ICN/WHO/PSI] questionnaire by trained data collectors among 339 nurses across health facilities. Multivariable logistic regression analysis with 95% confidence interval (CI) was used to identify the factors significantly associated with physical violence at p-value ≤0.05.

Result

Over one fourth (28.9%) [95% CI: (24.8, 33.9)] of nurses were victims of violence in the past 12 months. Level of verbal abuse (AOR = 2.35; 95%CI, 1.26-4.40), working in emergency (AOR = 4.58; 95%CI, 1.47-14.30) and inpatient (AOR = 3.33; 95%CI, 1.15-9.66)departments; having moderate (AOR = 0.41; 95%CI, 0.18-0.90),high (AOR = 0.41; 95%CI, 0.18-0.90), optimal (AOR = 0.41; 95%CI, 0.18-0.90) level of concern of violence were significantly associated with physical violence.

Conclusion

This study underlines findings nurses are at high-risk of physical violence and it is ranked second highest only to psychiatric and trauma facilities in Gondar town. Exposure to verbal abuse, working in emergency and inpatient departments and perceived level of concern are the precursors of experiencing physical violence. Therefore, investing time and capital in training like restraining and de-escalation, structural measures that deter the assailants are important.

Factors associated with vaccine coverage improvements in Senegal between 2005 and 2019: a quantitative retrospective analysis

OBJECTIVE

Senegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared with other low-income and lower-middle income countries. Understanding factors associated with historical changes in childhood vaccine coverage in Senegal, as well as heterogeneities across its 14 regions, can highlight effective practices that might be adapted to improve vaccine coverage elsewhere.

DESIGN

Childhood vaccination coverage rates, demographic information and health system characteristics were identified from Senegal's Demographic and Health Surveys (DHS) and Senegal national reports for years 2005-2019. Multivariate logistic and linear regression analyses were performed to determine statistical associations of demographic and health system characteristics with respect to childhood vaccination coverage rates.

SETTING

The 14 administrative regions of Senegal were chosen for analysis.

PARTICIPANTS

DHS women's survey respondents with living children aged 12-23 months for survey years 2005-2019.

OUTCOME MEASURES

Immunisation with the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3), widely used as a proxy for estimating immunisation coverage levels and the retention of children in the vaccine programme.

RESULTS

Factors associated with childhood vaccination coverage include urban residence (β=0.61, p=0.0157), female literacy (β=1.11, p=0.0007), skilled prenatal care (β=1.80, p<0.0001) and self-reported ease of access to care when sick, considering travel distance to a healthcare facility (β=-0.70, p=0.0009) and concerns over travelling alone (β=-1.08, p<0.0001). Higher coverage with less variability over time was reported in urban areas near the capital and the coast (p=0.076), with increased coverage in recent years in more rural and landlocked areas.

CONCLUSIONS

Childhood vaccination was more likely among children whose mothers had higher literacy, received skilled prenatal care and had perceived ease of access to care when sick. Overall, vaccination coverage is high in Senegal and disparities in coverage between regions have decreased significantly in recent years.

Contract doctors' strike in Malaysia: A content analysis of the perception of medical fraternity and stakeholders on Facebook

Contract appointment policy for newly graduated medical officers was implemented by the Ministry of Health Malaysia in 2016 to overcome the lack of permanent posts. Contract officers faced disadvantages in terms of salary, leave provision, and career prospects. A nationwide strike, Hartal Doktor Kontrak (HDK) was organised on 26th July 2021. Besides generating widespread public attention, HDK was also closely scrutinised by the medical fraternity and stakeholders. This content analysis aimed to explore how the medical fraternity and stakeholders viewed the strike as their perception would offer vital insights into the fundamental causes and viable solutions to the contract appointment policy. A qualitative content analysis of Facebook (FB) posts on the HDK strike was conducted from 1st June 2021 until 28th February 2022. A total of 182 FB posts were retrieved from stakeholders, medical fraternity groups, and medical key opinion personnel. Inductive coding was used in the thematic analysis to identify pertinent themes. Three main themes emerged: triggering factors, reactions to the strike, and outcomes of the strike. Factors that led to the strike included unequal treatment faced by contract officers, frustration with the government's lack of long-term solutions, and aggravation by the COVID-19 pandemic. In terms of reactions, there was a mixture of supportive and opposing voices. No substantial negative impact on the healthcare service resulted from the strike. Instead, it generated widespread attention that propelled the government into implementing solutions to prevent adverse short and long-term consequences. Various suggestions were proposed, including the reform of human resource planning and undergraduate medical education. The results highlight the importance of proactive systemic measures by the government to prevent further strikes that may jeopardise healthcare provision. In summary, social media was found to influence the progress and outcome of HDK, thus demonstrating the impact of media influence on similar issues.

A small area model to assess temporal trends and sub-national disparities in healthcare quality

Monitoring subnational healthcare quality is important for identifying and addressing geographic inequities. Yet, health facility surveys are rarely powered to support the generation of estimates at more local levels. With this study, we propose an analytical approach for estimating both temporal and subnational patterns of healthcare quality indicators from health facility survey data. This method uses random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We applied this method for three countries in which at least four health facility surveys had been conducted since 1999 - Kenya, Senegal, and Tanzania - and estimated measures of sick-child care quality per WHO Service Availability and Readiness Assessment (SARA) guidelines at programmatic subnational level, between 1999 and 2020. Model performance metrics indicated good out-of-sample predictive validity, illustrating the potential utility of geospatial statistical models for health facility data. This method offers a way to jointly estimate indicators of healthcare quality over space and time, which could then provide insights to decision-makers and health service program managers.

Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope

Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.

Critical success factors for high routine immunization performance: A case study of Senegal

Background

The essential components of a vaccine delivery system are well-documented, but robust evidence is lacking on how policies and implementation strategies are operationalized to drive catalytic improvements in coverage. To address this gap, we identified success factors that supported improvements in routine immunization coverage in Senegal, especially from 2000 to 2019.

Methods

We identified Senegal as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national, regional, district, health facility, and community-level, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data.

Results

The following success factors emerged: 1) Strong political will and prioritization of resources for immunization programming supported urgent allocation of funding and supplies; 2) Collaboration between the Ministry of Health and Social Action and external partners fostered innovation, capacity building, and efficiency; 3) Improved surveillance, monitoring, and evaluation allowed for timely and evidence-based decision making; 4) Community ownership of vaccine service delivery supported tailored programming and response to local needs; and 5) Community health workers spearheaded vaccine promotion and demand generation for vaccines.

Conclusion

The vaccination program in Senegal was supported by evidence-based decision making at the national-level, alignment of priorities between governmental entities and external partners, and strong community engagement initiatives that fostered local ownership of vaccine delivery and uptake. High routine immunization coverage was likely driven by prioritization of immunization programming, improved surveillance systems, a mature and reliable community health worker program, and tailored strategies for addressing geographical, social, and cultural barriers.

The effect of supervision on community health workers' effectiveness with households in rural South Africa: A cluster randomized controlled trial

BACKGROUND

Community health workers (CHWs) can supplement professional medical providers, especially in rural settings where resources are particularly scarce. Yet, outcomes of studies evaluating CHWs effectiveness have been highly variable and lack impact when scaled nationally. This study examines if child and maternal outcomes are better when existing government CHWs, who are perinatal home visitors, receive ongoing enhanced supervision and monitoring, compared to standard care.

METHODS AND FINDINGS

A cluster randomized controlled effectiveness trial was conducted comparing outcomes over 2 years when different supervision and support are provided. Primary health clinics were randomized by clinic to receive monitoring and supervision from either (1) existing supervisors (Standard Care (SC); n = 4 clinics, 23 CHWs, 392 mothers); or (2) supervisors from a nongovernmental organization that provided enhanced monitoring and supervision (Accountable Care [AC]; n = 4 clinic areas, 20 CHWs, 423 mothers). Assessments were conducted during pregnancy and at 3, 6, 15, and 24 months post-birth with high retention rates (76% to 86%). The primary outcome was the number of statistically significant intervention effects among 13 outcomes of interest; this approach allowed us to evaluate the intervention holistically while accounting for correlation among the 13 outcomes and considering multiple comparisons. The observed benefits were not statistically significant and did not show the AC's efficacy over the SC. Only the antiretroviral (ARV) adherence effect met the significance threshold established a priori (SC mean 2.3, AC mean 2.9, p < 0.025; 95% CI = [0.157, 1.576]). However, for 11 of the 13 outcomes, we observed an improvement in the AC compared to the SC. While the observed outcomes were not statistically significant, benefits were observed for 4 outcomes: increasing breastfeeding for 6 months, reducing malnutrition, increasing ARV adherence, and improving developmental milestones. The major study limitation was utilizing existing CHWs and being limited to a sample of 8 clinics. There were no major study-related adverse events.

CONCLUSIONS

Supervision and monitoring were insufficient to improve CHWs' impact on maternal and child outcomes. Alternative strategies for staff recruitment and narrowing the intervention outcomes to the specific local community problems are needed for consistently high impact.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT02957799.

Exploring the impact of health worker strikes on maternal and child health in a Kenyan county

Background

Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect of national strikes on maternal and child health. It looked at the impact on health system activity in both public and non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses strike from June 2017 and then the clinical officers for 21 days that September.

Methods

Time series descriptive analysis of attendance data from the Kenyan Health Management Information System (public, non-public sector facilities). The setting was Kilifi, a coastal county in Kenya with a population of about 1.5 million.

Results

Along the care pathway from antenatal, postnatal and out-patient child health clinics, activity levels dropped markedly in the public sector with only partial compensatory increases in non-public sector activity. The number of fully immunised children fell during the nurses strike as did women seen with PPH during all strikes. These health care strikes caused significant adverse health impacts at the time and potentially inter-generationally as exemplified by the fall in antenatal haematinics supplementation and syphilis testing. Some post-strike ‘’catch-up” activity occurred, however this may have been too late in some instances.

Conclusions

Policy-makers at national and county level need to ensure population health is protected at times of strikes and ideally resolve disputes without such action. Not to do so risks major negative effects on maternal and child health. Increased use of the non-public health sector could be done by the authorities in mitigation should strikes occur again.

Vulnerability, Moral responsibility, and Moral Obligations: the case of Industrial Action in the Medical and Allied Professions

The article addresses issues at the nexus of physician industrial action, moral agency, and responsibility. There are situations in which we find ourselves best placed to offer aid to those who may be in vulnerable positions, a behavior that is consistent with our everyday moral intuitions. In both our interpersonal relationships and social life, we make frequent judgments about whether to praise or blame someone for their actions when we determine that they should have acted to help a vulnerable person. While the average person is unlikely to confront these kinds of situations often, those in the medical professions, physicians especially, may confront these and similar situations regularly. Therefore, when physicians withhold their services for whatever reason in support of industrial action, it raises issues of moral responsibility to patients who may be in a vulnerable position. Using theories of moral responsibility, vulnerability, and ethics, this paper explores the moral implications of physician industrial action. We explore issues of vulnerability of patients, as well as the moral responsibility and moral agency of doctors to patients. Determining when a person is vulnerable, and when an individual becomes a moral agent, worthy of praise or blame for an act or non-action, is at the core of the framework. Notwithstanding the right of physicians to act in their self-interest, we argue that vulnerability leads to moral obligations, that physicians are moral agents, and the imperatives of their obligations to patients clear, even if limited by certain conditions. We suggest that both doctors and governments have a collective responsibility to prevent harm to patients and present the theoretical and practical implications of the paper.

Knowledge, Attitudes, and Practice towards Occupational Health and Safety among Nursing Students in Gaza Strip, Palestine

Background

Health and safety in the workplace are critical components in healthcare institutions. Unsafe working conditions are among the causes of poor quality of care and burnout. This study aims to assess the knowledge, attitudes, and practice of occupational health and safety among nursing students at Al-Israa University.

Methods

In this cross-sectional study, a structured online questionnaire was distributed from March to May 2021. Of the 350 eligible students, 219 students answered the questionnaire (Response rate=62.6). Data were analyzed using the statistical software IBM-SPSS version 22. Descriptive statistic, Independentsamples T-Test, and ANOVA tests were used.

Results

The majority of participants were female (81.7%) and studying in a diploma program. 21% of nursing students have experienced a needle stick injury. The mean scores for knowledge, attitudes, and practice were (M±SD:78.2% ±12.9, M±SD:80.6% ±7.1, and M±SD:81.2% ±7.6) respectively. In terms of knowledge, attitudes, and practice the mean scores were statistically significant between nursing students who attended a safety precautions course and those who didn not (P-value <.05). In terms of attitudes, the mean scores were statistically significant between diploma and bachelor students (P-value =.026). In terms of practice, the means scores were statistically significant between males and females (Pvalue =.017), nursing students who had experience with needle sticks and those who didn't (P-value =.015).

Conclusions

The authors recommend that clinical training departments and universities continue to offer occupational health and safety courses and training for health science students. Since the training had a positive impact on the students' practices.

The process of developing health workforce strategic plans in Africa: a document analysis

BACKGROUND

Many countries are faced with a multitude of health workforce-related challenges partly attributed to defective health workforce planning. Earlier efforts to guide the process and harmonise approaches to national health workforce policies and planning in the Africa Region included, among others, the development of the WHO Africa Regional Office (WHO/AFRO) Policies and Plans for Human Resources for Health Guidelines for Countries in the WHO African Region in 2006. Although this guideline has led to uniformity and rigour in developing human resources for health (HRH) policies and strategies in Africa, it has become imperative to synthesise the emerging evidence and best practices in the development of health workforce strategies.

METHODS

A document analysis was conducted using the READ ( R eadying materials; E xtracting data; A nalysing data and D istilling) approach.

RESULTS

Fourteen HRH policy/strategic plans were included in the study. The scope of the HRH strategic plans was described in three dimensions: the term of the strategy, sectors covered by the strategy and the health workforce considered in the projections. We found that HRH strategic plan development can be conceptualised as a cyclical, sequential multimethod project, with one phase feeding the subsequent phase with data or instructions. The process is very complex, with different interest groups and sectors that need to be satisfied. The HRH strategic plan development process comprises five main phases linked with external forces and national politics.

CONCLUSION

There is a need for accurate and comprehensive HRH data collection, astute HRH leadership, and broad base and multisectoral stakeholder consultation with technical support and guidance from experts and major external partners for effective HRH strategic plan development.

When Doctors strike: Making Sense of Professional Organizing in Kenya

Little is known about how the health professions organize in low- and middle-income countries (LMICs). This is particularly troubling as health worker strikes in LMICs appear to be growing more frequent and severe. While some research has been conducted on the impact of strikes, little has explored their social etiology. This article draws on theory from organization and management studies to situate strike behavior in a historical process of sensemaking in Kenya. In this way, doctors seek to expand pragmatic, moral, and cognitive forms of legitimacy in response to sociopolitical change. During the first period (1963-2000), the legacy of colonial biomedicine shaped medical professionalism and tensions with a changing state following independence. The next period (2000-2010) was marked by the rise of corporate medicine as an organized form of resistance to state control. The most recent period (2010-2015) saw a new constitution and devolution of health services cause a fractured medical community to strike as a form of symbolic resistance in its quest for legitimacy. In this way, strike behavior is positioned as a form of legitimation among doctors competing over the identity of medicine in Kenya and is complicating the path to universal health coverage.

A Draconian Law: Examining the Navigation of Coalition Politics and Policy Reform by Health Provider Associations in Karnataka, India

A comprehensive picture of provider coalitions in health policy making remains incomplete because of the lack of empirically driven insights from low- and middle-income countries. The authors examined the politics of provider coalitions in the health sector in Karnataka, India, by investigating policy processes between 2016 and 2018 for developing amendments to the Karnataka Private Medical Establishments Act. Through this case, they explore how provider associations function, coalesce, and compete and the implications of their actions on policy outcomes. They conducted in-depth interviews, document analysis, and nonparticipant observations of two conferences organized by associations. They found that provider associations played a major role in drafting the amendments and negotiating competing interests within and between doctors and hospital associations. Despite the fragmentation, the associations came together to reinterpret the intentions of the amendments as being against the interests of the profession, culminating in a statewide protest and strike. Despite this show of strength, provider associations only secured modest modifications. This case demonstrates the complex and unpredictable influence of provider associations in health policy processes in India. The authors' analysis highlights the importance of further empirical study on the influence of professional and trade associations across a range of health policy cases in low- and middle-income countries.

Key informant perspectives on the challenges and opportunities for using routine health data for decision-making in Senegal

Background

Increasing the performance of routine health information systems (RHIS) is an important policy priority both globally and in Senegal. As RHIS data become increasingly important in driving decision-making in Senegal, it is imperative to understand the factors that determine their use.

Methods

Semi-structured interviews were conducted with 18 high- and mid-level key informants active in the malaria, tuberculosis and HIV programmatic areas in Senegal. Key informants were employed in the relevant divisions of the Senegal Ministry of Health or nongovernmental / civil society organizations. We asked respondents questions related to the flow, quality and use of RHIS data in their organizations. A framework approach was used to analyze the qualitative data.

Results

Although the respondents worked at the strategic levels of their respective organizations, they consistently indicated that data quality and data use issues began at the operational level of the health system before the data made its way to the central level. We classify the main identified barriers and facilitators to the use of routine data into six categories and attempt to describe their interrelated nature. We find that data quality is a central and direct determinant of RHIS data use. We report that a number of upstream factors in the Senegal context interact to influence the quality of routine data produced. We identify the sociopolitical, financial and system design determinants of RHIS data collection, dissemination and use. We also discuss the organizational and infrastructural factors that influence the use of RHIS data.

Conclusions

We recommend specific prescriptive actions with potential to improve RHIS performance in Senegal, the quality of the data produced and their use. These actions include addressing sociopolitical factors that often interrupt RHIS functioning in Senegal, supporting and motivating staff that maintain RHIS data systems as well as ensuring RHIS data completeness and representativeness. We argue for improved coordination between the various stakeholders in order to streamline RHIS data processes and improve transparency. Finally, we recommend the promotion of a sustained culture of data quality assessment and use.

Case analysis and justification of physicians, collective actions

Since the last 100 years, physicians from many countries have been taking collective action. However, the media, civic groups, and the government have denounced them as inhuman and unethical. This study comprehensively analyzed the background and results of physicians’ collective actions that occurred in countries around the world, and reviewed the issues surrounding them. Among 314 cases in 70 countries discussed in the literature, 180 cases in 65 countries were analyzed. Of these 180 cases, 111 (61.7%) were successful, indicating that collective action has brought favorable results to physicians. Furthermore, 177 out of 301 requirements brought favorable results (58.8%). The main reason for collective actions was ‘improvement of working conditions’, which includes improving the medical and the reimbursement systems, adjusting working hours and wages, increasing manpower, supporting medical research, and improving other working environment and conditions. This study is significant because it provides statistical data on the causes and results of collective actions taken by physicians in countries around the world.

Implementation and evaluation of a specialized diabetes clinic in Guinea-Bissau: lessons learnt from the field

Introduction

diabetes care in Guinea-Bissau (GB) is characterized by a lack of properly trained healthcare professionals (HCPs) and guidelines for diagnosis, treatment and follow up of patients. To address these issues, this project was launched with the objective to train HCPs in the management of diabetic patients and establish a specialized diabetes clinic in the Hospital Nacional Simão Mendes, a public tertiary care hospital in Bissau, capital of GB. This project is led by the Geneva University Hospitals (HUG) in collaboration with the Swiss Association for the Aid to Diabetic People in Guinea-Bissau, with the support of the International Solidairty Office (SSI) of the State of Geneva, and AIDA (Ayuda, Intercambio y Desarrollo).

Methods

specialists from the HUG in collaboration with local experts in GB developed and delivered a culturally and contextually adapted training course pertaining to diabetes care to HCPs in this hospital. Pre and post training tests were conducted to assess differences in knowledge and practices. Following the training program, a diabetes clinic was set up and an audit was conducted to assess its performance.

Results

a total of 24 HCP attended the training program and exhibited statistically significant improvements in their knowledge pertaining to diabetes care (mean difference between pre and post-test = 14.53, SD 11.60, t=-4.8, p < 0.001). The diabetes clinic was established and provided consultations 2 days per week. A total of 63 patients consulted at this clinic, of which 49 had type two diabetes treated with oral antidiabetic drugs and 14 were type 1 diabetics treated with insulin. Patients had blood glucose measurements and received therapeutic, dietary and physical activity counselling. Several barriers leading to occasional interruptions of service were encountered, including a political instability in the country and strikes of healthcare staff demanding better wages and working conditions.

Conclusion:

this study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers. To ensure successful running of such consultation clinics, continued buy-in and support from stakeholders should be ensured. Diabetes training should be incorporated in pre-and post-graduate training curriculums of all HCP to help shape a better workforce.

Occupational Exposure to Blood and Body Fluids among Health Care Workers in Gondar Town, Northwest Ethiopia: A Result from Cross-Sectional Study

Background

Health care workers are at the greatest risk of developing blood-borne diseases through occupational exposure to blood and other contaminated body fluids. Occupational exposure to blood and body fluids (BBFs) continues to be the major public health problems and serious concern for the health care force in Ethiopia. Therefore, this study was aimed to determine the prevalence of exposure to blood and other body fluids and its associated risk factors among health care workers.

Methods

The institution-based cross-sectional study design was employed from January 20 to February 30, 2018. A stratified random sampling followed by a simple random sampling technique was used to select 286 study participants. Data were collected using a pretested and structured questionnaire. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with occupational exposure to BBFs. The significance level was obtained at a 95% confidence interval (CI) and p value ≤ 0.05.

Results

The prevalence of occupational exposure to blood and body fluids among health care workers in the last 12 months was 65.3% (95% CI: 59.4, 70.9). Lack of readily available personal protective equipment (adjusted odds ratio (AOR)) = 3.01, 95% CI: 1.56, 5.84), lack of training (AOR = 3.36, 95% CI: 1.1, 11.2), Khat chewing (AOR = 2.74, 95% CI: 1.3, 5.8), and being a medical doctor (AOR = 5.1, 95% CI: 1.68, 15.21) were significantly associated risk factors with occupational exposure to blood and other body fluids.

Conclusions

In this study, occupational exposure to blood and other body fluids among health care workers remains a major health problem. Hence, ensuring the availability of personal protective equipment, developing strategies on banning, and strict monitoring of Khat chewing and training on infection prevention should be emphasized to minimize the problem.

Doctor and healthcare workers strike: are they ethical or morally justifiable: another view

PURPOSE OF REVIEW

This review analyzed legal and ethical issues surrounding recent doctor and healthcare worker (HCW) strikes and considered whether HCW strikes are legally and morally justifiable, underlying causes, and impact of such strikes on healthcare service delivery.

RECENT FINDINGS

Recent reports show that doctor and HCW strikes are an ongoing phenomenon globally, occurring in both developed and developing countries. The main reasons for HCW strikes are failed employer-employee negotiations regarding fair wages and working conditions, policy issues, infrastructural deficiencies in poorer countries, and concerns by HCWs regarding personal security in the workplace. The main impact of HCW strikes is disruption of healthcare service delivery, such as canceled outpatients' appointments, hospital admissions, and elective surgeries. There was no clear evidence of increased patients' mortality during strikes, except in isolated cases, where emergency services were also withdrawn during strikes.

SUMMARY

Doctors and HCWs strikes are lawful deadlock-breaking mechanisms when collective bargaining negotiations have reached an impasse. Doctors' strikes appear to create an ethical conflict with the Hippocratic tradition and obligation to place patients' best interests as the primary moral consideration in medical practice. However, the rise of consumerism in healthcare, and loss of power by doctors, many of whom now work as employees, subject to regulations imposed by different stakeholders, including governments, health-maintenance organizations, and healthcare insurers, has impacted on modern medical practice. Therefore, doctors, like other employees may occasionally resort to strikes to extract concessions from employers. Mortality is rarely increased during HCW strikes, especially where emergency healthcare services are provided.