Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. METHODS: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. RESULTS: Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. CONCLUSIONS: This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas

Reclaiming the child left behind: the case for corporate cultural responsibility

Although a reasonable understanding of corporate social responsibility (CSR) exists, one dimension remains largely ignored. That is, the cultural impacts of corporations, or the bearing, at various levels of their business models, activities, and outcomes on the value systems and enduring beliefs of affected people. We introduce the notion of corporate cultural responsibility (CCR). The way corporations address CCR concerns can be reflected according to three stances: cultural destructiveness, cultural carelessness, and cultural prowess. Taken sequentially, they reflect a growing comprehension and increasingly active consideration of CCR concerns by corporations. In turn, we explicitly address issues related to the complex question of determining the cultural responsibilities of corporate actors; specify key CCR-related conceptualizations; and lay a foundation for discussions, debates, and research efforts centered on CCR concerns and rationales

Data on palliative care in Germany

Palliativversorgung steht zunehmend im Blickfeld von Politik und Öffentlichkeit. Dabei wird deutlich, dass der Bedarf an palliativen Angeboten hoch und noch keine flächendeckende Versorgung erreicht ist, auch wenn Angebot und Inanspruchnahme der Palliativversorgung in den letzten Jahren stark angestiegen sind. Um die Entwicklung in Deutschland darzustellen, vorhandene Versorgungslücken aufzuzeigen und die Auswirkungen politischer Maßnahmen zu beurteilen, sind belastbare und kontinuierlich zur Verfügung stehende Daten unabdingbar. Im vorliegenden Beitrag werden die öffentlich zugänglichen Datenquellen zur Palliativversorgung in Deutschland systematisch dargestellt, ihre Potenziale und Limitationen aufgezeigt. Dabei zeigt sich, dass vor allem Daten zum Angebot an Palliativversorgung verfügbar sind. Daten zur Inanspruchnahme beschränken sich im Wesentlichen auf die stationäre Versorgung und die spezialisierte ambulante Palliativversorgung (SAPV). Um die Datenlücken zu schließen, wäre u. a. eine regelmäßige Auswertung von Routinedaten der Krankenkassen und Kassenärztlichen Vereinigungen wünschenswert. Ebenfalls interessant wäre ein Monitoring im Hinblick auf die soziodemografischen Merkmale derjenigen, die eine Palliativversorgung in Anspruch nehmen. Einen wichtigen Indikator stellen auch die Sterbeorte dar. An deren Abgleich mit den Wünschen der Bevölkerung lässt sich ablesen, dass weiterhin die Notwendigkeit besteht, ambulante Strukturen der palliativen Versorgung zu stärken