Public sector nurses in Swaziland: can the downturn be reversed?

BACKGROUND: The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland. METHODS: We visited Swaziland twice within 18 months in order to capture the HRH situation as well as the responses to it in 2004 and in 2005. Using semi-structured interviews with key informants and group interviews, we obtained qualitative and quantitative data on the HRH situation in the public and mission health sectors. We complemented this with an analysis of primary documents and a review of the available relevant reports and studies. RESULTS: The public health sector in Swaziland faces a serious shortage of health workers: 44% of posts for physicians, 19% of posts for nurses and 17% of nursing assistant posts were unfilled in 2004. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce. The annual training output of only 80 new nurses is not sufficient to compensate for these losses, and based on the situation in 2004 we estimated that the nursing workforce in the public sector would have been reduced by more than 40% by 2010. In 2005 we found that new initiatives by the Swazi government, such as the scale-up of ART, the introduction of retention measures to decrease emigration and the influx of foreign nurses could have the potential to improve the situation. A combination of such measures, together with the planned increase in the training capacity of the country's nursing schools, could even reverse the trend of a diminishing health workforce. CONCLUSION: Emigration and attrition due to HIV/AIDS are undermining the health workforce in the public sector of Swaziland. Short-term and long-term measures for overcoming this HRH crisis have been initiated by the Swazi government and must be further supported and increased. Scaling up antiretroviral treatment (ART) and making it accessible and acceptable for the health workforce is of paramount importance for halting the attrition due to HIV/AIDS. To this end, we also recommend exploring ways to make ART delivery less labour-intensive. The production of nurses and nursing assistants must be urgently increased. Although the migration of HRH is a global issue requiring solutions at various levels, innovative in-country strategies for retaining staff must be further explored in order to stem as much as possible the emigration from Swaziland

Registered nurses' perceptions regarding nurse-led antiretroviral therapy initiation in Hhohho region, Swaziland

Background Swaziland has the highest HIV prevalence globally. It faces a critical shortage of health workers for addressing the HIV pandemic. To curb this human resource challenge, Swaziland adopted a nurse‐driven model for antiretroviral therapy delivery in line with the recommendations of the World Health Organization on task shifting. Objective The study explored the perceptions of registered nurses on the nurse‐led antiretroviral therapy initiation programme in the Hhohho region of Swaziland (NARTIS). Design The study utilized a phenomenological design, specifically a phenomenographic design. Setting The study was conducted in ten health facilities in the Hhohho region of Swaziland. These facilities comprised eight clinics, a hospital and a health centre. Participants These were registered nurses, trained and certified in the nurse‐led antiretroviral therapy initiation programme. The nurses also had experience of working in a nurse‐led antiretroviral therapy initiation programme. Eighteen (18) nurses were purposively selected and recruited to participate in the study. Methods Data were collected through open and deep individual interviews guided by a semi‐structured interview schedule. The audio‐recorded interviews were transcribed and analysed thematically using Sjöström and Dahlgren's approach to data analysis. Results Three major themes emerged from the study data: nurses' emotional reactions to the implementation of the NARTIS programme, and influences and overcoming barriers to the programme. Conclusions The study findings have generated insights into this program which is useful for the provision of care to people living with HIV/AIDS in Swaziland. But nurses need support to ensure effective implementation. Implication for nursing and health policy The study findings have implications for both the practice of the NARTIS programme and health policy development. The development of a health policy that alleviates the barriers to the NARTIS programme can enhance nurses' role and make care provision to people living with HIV/AIDS more effective

Mild and Highly Flexible Enzyme-Catalyzed Modification of Poly (ethersulfone) Membranes

Poly(ethersulfone) (PES) membranes are widely used in industry for separation and purification purposes. However, the drawback of this type of membranes is fouling by proteins. For that reason, modification of PES membranes has been studied to enhance their protein repellence. This paper presents the first example of enzyme-catalyzed modification of PES membranes. Various phenolic acids (enzyme substrates) were bound to a membrane under very mild conditions (room temperature, water, nearly neutral pH) using only laccase from Trametes versicolor as catalyst. The extent of modification, monitored, for example, by the coloration of the modified membranes, can be tuned by adjusting the reaction conditions. The most significant results were obtained with 4-hydroxybenzoic acid and gallic acid as substrates. The presence of a covalently bound layer of 4-hydroxybenzoic acid on the grafted membranes was confirmed by X-ray photoelectron spectroscopy (XPS), infrared reflection absorption spectroscopy (IRRAS), and NMR. In the case of gallic acid, PES membrane modification is mainly caused by adsorption of enzymatically formed homopolymer. The ionization potential of the substrates, and the electronic energies and spin densities of the radicals that are intermediates in the attachment reaction were calculated (B3LYP/6-311G(d,p)) to determine the reactive sites and the order of reactivity of radical substrates to couple with the PES membrane. The calculated order of reactivity of the substrates is in line with the experimental observations. The calculated spin densities in the phenolic radicals are highest at the oxygen atom, which is in line with the formation of ether linkages as observed by IRRAS. The liquid fluxes of the modified membranes are hardly influenced by the grafted layers, in spite of the presence of a substantial and stable new layer, which opens a range of application possibilities for these modified membrane