The Human Resource crisis in the Zambian Health Sector – a discussion paper

Objectives: The human resource crisis facing the Zambian health sector has potential to derail existing health programs including millennium development goals. This paper will highlight the underpinning factors, analyze current interventions and propose alternative solutions to this crisis. Design: The study was done through a review of articles and reports covering the topic. Main outcomes/results: The human resource crisis has been recognized by the Zambian government, Zambian organizations and the international community as the greatest challenge that threatens the entire healthcare system. The situation is getting worse and solutions implemented thus far have neither been totally effective nor comprehensive in arresting, let alone reversing the trend. Conclusion: The human resource crisis in Zambia has reached a disastrous stage with the health system at breaking point. Corrective measures have been started but these need to be strengthened and as comprehensive as can be. There is also need for innovation to consider other solutions that have not been tried before. This is important in order to safeguard Zambia’s development and all the other investments that the country has made into its future through programs such as the fight against HIV/ AIDS. Although there is need for stronger international cooperation, the primary solutions can and must come from within Zambia

Patterns of Musculoskeletal Diseases seen in Zambian Children

Background: Musculoskeletal disorders are a common cause of long-term pain and physical disability affecting many people worldwide and have an enormous economic and social impact on the individual, society and national health systems. Although the burden of disease due to musculoskeletal disorders is said to be on the rise in the developing world, the full extent of this burden remains unknown.Objectives: To describe the patterns of musculoskeletal disorders seen in Zambian children aged below 15 years as baseline for future orthopaedic research, training and health management policy.Methods: Through a hospital-based cross-sectional study design, relevant data was collected onto an evaluation form from medical records of 1246 patients at the University Teaching Hospital (UTH), Zambian-Italian Orthopaedic Hospital (ZIOH) and the Flying-Specialist (FLYSPEC) nationwide orthopaedic outreach. The data was then entered into a spreadsheet and imported into SPSS for analysis.Results: Congenital abnormalities, other noncongenital deformities, and traumatic fracture dislocations were the commonest conditions affecting the 1246 sampled children with prevalence rates of 0.49, 0.22 and 0.14 respectively. Most patients presented late (more than 3months from the onset of their condition) with 509 (42.2%) having travelled for more than 10 kilometres to get to their treatment sites. 561 (45.4%) had been treated conservatively prior to their presentation to orthopaedics with another 471 (38.1%) having received no treatment at all.Conclusion: congenital abnormalities, noncongenital limb deformities and traumatic conditions were the commonest musculoskeletal disorders in that order. More males than females were afflicted though this distribution was different within the age ranges. Most of these patients presented late and distance to health facility was strongly correlated to late presentation. Furthermore, at first presentation these children receive little or no appropriate treatment from the first-line health workers at local health centres.Keywords: Musculoskeletal diseases, Children, Zambia

Joint replacement in Zambia: A review of Hip & Knee Replacement surgery done at the Zambian-Italian Orthopaedic Hospital

Background: Incidence of major joint replacement surgery is on the rise in Africa but this trend has not been matched by proper audits in the form of National Joint Registries.Objective: This paper presents the short-term findings from a joint replacement register started at the Zambian-Italian Orthopaedic Hospital (ZIOH) in Lusaka and compares the variables entered in this register with those captured in the Malawian National Joint Register for purposes of synchronizing these in the near future in the East, Central and Southern African region .Methods: Data captured by the different variables entered into the Joint Register covering the pre-op, intra-op and post-op period of all total hip and knee replacement surgery done at the ZIOH from 1998 to 2010 was entered into a spreadsheet after verification with individual patient medical records. This was then imported into spss for analysis yielding the following results.Results: 44 total hips and seven total knee replacement operations were done on 46 patients, 59% of which were female and 41% male. The average age was 58 years. The HIV sero-status of 86.3% was unknown. 36 (70.6%) of the patients had primary osteoarthritis as the diagnosis with pain and joint stiffness being the indication for surgery. Three consultants and one senior registrar did the operations mainly using the Hardinge approach to the hip. 43 (84.3%) were primary Total Hip replacement with only one revision. The 28mm hip head size was the commonest fitted with most patients, 48 (94.1%) being functionally mobile at six weeks post operation.Conclusion: This audit clearly shows a rising trend of major joint replacement over the years and highlights the gaps in variables entered into the ZIOH joint register such as HIV status. It also helps us recognize the need for setting up a National Joint Register that is comparable to others that have been set up in the region such as is the case in Malawi which is key in improving orthopaedic training and patient care.Keywords: Joint replacement, National Joint Register, HI

A quick needs assessment of key stakeholder groups on the role of family medicine in Zambia

Background. Zambia is a nation of nine million people, and has too few physicians to meet the country’s health needs. Following the strategy of other sub- Saharan countries, Zambia has developed a training programme in family medicine to help improve the medical competencies of its physician workforce. A needs assessment was undertaken to better understand the landscape into which Zambian family medicine is being placed.Methods. In 2014, a nine-question survey in Likert-scale format was developed, validated, and then delivered to four stakeholder groups: (i) practicing clinical physicians, (ii) the general public, (iii) the University of Zambia’s School of Medicine’s academic faculty and (iv) medical students. The needs assessment was delivered through several different mechanisms: via web-based service, to respondents’ email addresses; in paper form, to population samples of convenience; and verbally, through face-to-face encounters.Results. The number of stakeholders from each group who responded to the needs assessment were: clinical physicians, 27; general public, 15; academic faculty, 14; and medical students, 31. Five of the nine survey statements achieved super-majority consensus, with >66% of stakeholders in each group agreeing. Two additional statements achieved a simple-majority consensus with >50% agreement within each stakeholder group.Conclusion. This survey suggests that there is a broad-based a priori understanding of family medicine in Zambia, and general agreement that its presence would be valuable to Zambia’s healthcare system

Surgery as a component of universal healthcare : where is South Africa?

CITATION: Reddy, C. L., et al. 2019. Surgery as a component of universal healthcare : where is South Africa?. South African Medical Journal, 109(9):624-625, doi:10.7196/SAMJ.2019.v109i9.1423.The original publication is available at http://www.samj.org.zaENGLISH ABSTRACT: No abstract availablehttp://www.samj.org.za/index.php/samj/article/view/12697Publisher's versio

Decline in HIV Prevalence among Young Women in Zambia: National-Level Estimates of Trends Mask Geographical and Socio-Demographic Differences

Background: A decline in HIV incidence has been reported in Zambia and a number of other sub-Saharan countries. The trend of HIV prevalence among young people is a good marker of HIV incidence. In this study, different data sources are used to examine geographical and sub-population group differentials in HIV prevalence trends among men and women aged 15–24 years in Zambia. Design and Methods: We analysed ANC data for women aged 15–24 years from 22 sentinel sites consistently covered in the period 1994–2008, and HIV data for young men and women aged 15–24 years from the ZDHS 2001/2 and 2007. In addition, we systematically reviewed peer-reviewed articles that have reported findings on HIV prevalence and incidence among young people. Findings: Overall trends of the ANC surveillance data indicated a substantial HIV prevalence decline among young women in both urban and rural areas. However, provincial declines differed substantially, i.e. between 10 % and 68 % among urban women, and from stability to 86 % among rural women. Prevalence declines were steeper among those with the highest educational attainments than among the least educated. The ZDHS data indicated a significant reduction in prevalence between the two survey rounds among young women only. Provincial-level ZDHS changes were difficult to assess because the sample sizes were small. ANC-based trend patterns were consistent with those observed in PMTCT-based data (2002

Intent to migrate among nursing students in Uganda: Measures of the brain drain in the next generation of health professionals

Background: There is significant concern about the worldwide migration of nursing professionals from low-income countries to rich ones, as nurses are lured to fill the large number of vacancies in upper-income countries. This study explores the views of nursing students in Uganda to assess their views on practice options and their intentions to migrate. Methods: Anonymous questionnaires were distributed to nursing students at the Makerere Nursing School and Aga Khan University Nursing School in Kampala, Uganda, during July 2006, using convenience sampling methods, with 139 participants. Two focus groups were also conducted at one university. Results: Most (70%) of the participants would like to work outside Uganda, and said it was likely that within five years they would be working in the U.S. (59%) or the U.K. (49%). About a fourth (27%) said they could be working in another African country. Only eight percent of all students reported an unlikelihood to migrate within five years of training completion. Survey respondents were more dissatisfied with financial remuneration than with any other factor pushing them towards emigration. Those wanting to work in the settings of urban, private, or U.K./U.S. practices were less likely to express a sense of professional obligation and/or loyalty to country. Those who have lived in rural areas were less likely to report wanting to emigrate. Students with a desire to work in urban areas or private practice were more likely to report an intent to emigrate for financial reasons or in pursuit of country stability, while students wanting to work in rural areas or public practice were less likely to want to emigrate overall. Conclusion: Improving remuneration for nurses is the top priority policy change sought by nursing students in our study. Nursing schools may want to recruit students desiring work in rural areas or public practice to lead to a more stable workforce in Uganda.University of Washington Department of Global Healt

Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia

Background: The PLACE-method presumes that targeting HIV preventive activities at high risk places is effective in settings with major epidemics. Livingstone, Zambia, has a major HIV epidemic despite many preventive efforts in the city. A baseline survey conducted in 2005 in places where people meet new sexual partners found high partner turnover and unprotected sex to be common among guests. In addition, there were major gaps in on-site condom availability. This study aimed to assess the impact of a condom distribution and peer education intervention targeting places where people meet new sexual partners on condom use and sexual risk taking among people socializing there. Methods: The 2005 baseline survey assessed the presence of HIV preventive activities and sexual risk taking in places where people meet new sexual partners in Livingstone. One township was selected for a non-randomised intervention study on condom distribution and peer education in high risk venues in 2009. The presence of HIV preventive activities in the venues during the intervention was monitored by an external person. The intervention was evaluated after one year with a follow-up survey in the intervention township and a comparison township. In addition, qualitative interviews and focus group discussions were conducted. Results: Young people between 17-32 years of age were recruited as peer educators, and 40% were females. Out of 72 persons trained before the intervention, 38 quit, and another 11 had to be recruited. The percentage of venues where condoms were reported to always be available at least doubled in both townships, but was significantly higher in the intervention vs. the control venues in both surveys (84% vs. 33% in the follow-up). There was a reduction in reported sexual risk taking among guests socializing in the venues in both areas, but reporting of recent condom use increased more among people interviewed in the intervention (57% to 84%) than in the control community (55% to 68%). Conclusions: It is likely that the substantial increase in reported condom use in the intervention venues was partially due to the condom distribution and peer education intervention targeting these places. However, substantial changes were observed also in the comparison community over the five year period, and this indicates that major changes had occurred in overall risk taking among people socializing in venues where people meet new sexual partners in Livingstone

The metrics and correlates of physician migration from Africa

<p>Abstract</p> <p>Background</p> <p>Physician migration from poor to rich countries is considered an important contributor to the growing health workforce crisis in the developing world. This is particularly true for Africa. The perceived magnitude of such migration for each source country might, however, depend on the choice of metrics used in the analysis. This study examined the influence of choice of migration metrics on the rankings of African countries that suffered the most physician migration, and investigated the correlates of physician migration.</p> <p>Methods</p> <p>Ranking and correlational analyses were conducted on African physician migration data adjusted for bilateral net flows, and supplemented with developmental, economic and health system data. The setting was the 53 African birth countries of African-born physicians working in nine wealthier destination countries. Three metrics of physician migration were used: total number of physician émigrés; emigration fraction defined as the proportion of the potential physician pool working in destination countries; and physician migration density defined as the number of physician émigrés per 1000 population of the African source country.</p> <p>Results</p> <p>Rankings based on any of the migration metrics differed substantially from those based on the other two metrics. Although the emigration fraction and physician migration density metrics gave proportionality to the migration crisis, only the latter was consistently associated with source countries' workforce capacity, health, health spending, economic and development characteristics. As such, higher physician migration density was seen among African countries with relatively higher health workforce capacity (0.401 ≤ <it>r </it>≤ 0.694, <it>p </it>≤ 0.011), health status, health spending, and development.</p> <p>Conclusion</p> <p>The perceived magnitude of physician migration is sensitive to the choice of metrics. Complementing the emigration fraction, the physician migration density is a metric which gives a different but proportionate picture of which African countries stand to lose relatively more of its physicians with unchecked migration. The nature of health policies geared at health-worker migration can be expected to depend on the choice of migration metrics.</p