Analysis of adequacy levels for human resources improvement within primary health care framework in Africa

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects: - adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations, - adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations, - adequacy between human resource management within health care system and medical standards, - adequacy between human resource management within education/teaching/training and needs from health care system and education sectors, - adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body, - adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...). This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate

L’aidant principal face à l’AVC d’un proche.

La survenue d'un accident vasculaire cérébral (AVC) est un événement majeur. Ses effets dépendent des rapports sociaux antérieurs dont les éléments sont fortement liés au genre. Objectifs : Analyser les conséquences et comparer les retentissements sociaux, psychoaffectifs chez les aidants principaux (AP) qui assistent le malade dans la vie courante. Méthode : Enquête par questionnaire au domicile de 215 foyers de personnes victimes d'un AVC1. Résultats. Les AP sont composés de 155 femmes (72,1 %, âge moyen 57,8 ans) et de 60 hommes (âge moyen 57,9 ans), en moyenne 7 ans plus jeunes que les malades \; 43 % étaient âgés de 65 ans et plus. 81,7 % des AP hommes accompagnaient des femmes victimes d'un AVC, 70,3 % des AP femmes des hommes victimes d'un AVC. Les niveaux de dépendance des patients étaient équivalents (indice moyen de katz 9,1 vs 9,3). 60,8 % des AP hommes vs 42,2 %2 des AP femmes ont déclaré que « l'AVC a eu des répercussions financières importantes pour l'ensemble de la famille [malgré] les allocations ou aides financières privées ou publiques » \; 96,7 % vs 89,3 %* jugeaient que c'est « sur le plan psychologique que ça a été le plus difficile » \; 45,4 % vs 31,4 %* que « les amis sont gênés car ils ont peur du handicap »\; 51,5 % vs 22,1 %*** qu'ils faisaient maintenant « plus qu'avant les tâches ménagères/la cuisine/les courses/les invitations d'amis et/ou de la famille/la pratique d'activités, avec la personne qui a eu l'AVC, tel que du sport et des voyages ». Les AP hommes soulignaient les sentiments tels que l'irritabilité et la régression, les AP femmes plutôt l'angoisse. Discussion. L'AVC constitue toujours un handicap financier grave. Il déstabilise les relations familiales et sociales. Les AP hommes sont plus nombreux à souligner le retentissement sur leur vie que les AP femmes. Il est possible que cela exprime une moins bonne préparation, ce qui reste à confirmer par de nouvelles études

What cancer tells us about general practice. Birth of an hypothesis

We are presenting in this paper a study about general practitioners' behaviours and attitudes towards the cancer patients they take care of. To begin with, the approaching methods are presented in a critical way. The choice of these methods finds an explanation in the fact that we were looking for an information as near as possible to the real physicians' behaviours and supplying, at the same time, an important material, giving us the opportunity to undertake an interpretative analysis of the different medical cases about cancer patients (64) written by some (12) of the general practitioners (31) who had been interviewed before about cancer in their medical practice. We have tried, particularly, to point out and to illustrate with some examples the specific contribution of a chosen method compared with another one; for instance, the interviews compared to the written questionnaire, and the medical cancer cases written by the physicians compared to the interviews realized with the same general practitioners. In this paper we are also trying to report the preoccupations, the difficulties and the theoretical and methodological problems which appeared during the process of this research. Concerning the findings of this study, it is possible to assert that the main hypothesis seems coherent with the collected information: it really seems that cancer, with its social image in which fear for suffering and for dying prevail, is for the general practitioner a borderline situation in which his personal psychology and his feelings seem to play a more important part than his medical knowledge. In this 'drama', his previous relationship to his patient, the type of cancer involved, the patient's social and family background, the way in which he represents his profession, his medical experience, as well as his specialists network, also play an important part. If cancer is a challenge for the general practitioner, it seems that it is especially a challenge for the image he has of himself as a physician, but also as a human being, precisely because the part he can play concerning the therapeutics is very small. So, unlike the thesis of some authors, we think that the general practitioners (as a result also of a widely spread adhesion to values of a non-technical idea of his practice) can assume a determinant function, by advising the patient, by doing in the same time a good following up of the disease he suffers from, and by keeping with him a good relationship, which he often qualifies as 'interesting'.