50 research outputs found
Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel â Ethical and Systems Perspectives
The relevance and effectiveness of the World Health Organizationâs (WHOâs) Global Code of Practice on the International
Recruitment of Health Personnel is being reviewed in 2015. The Code, which is a set of ethical norms and principles
adopted by the World Health Assembly (WHA) in 2010, urges members states to train and retain the health personnel
they need, thereby limiting demand for international migration, especially from the under-staffed health systems in low-
and middle-income countries. Most countries failed to submit a first report in 2012 on implementation of the Code,
including those source countries whose health systems are most under threat from the recruitment of their doctors
and nurses, often to work in 4 major destination countries: the
United States
, United Kingdom, Canada and Australia.
Political commitment by source country Ministers of Health needs to have been achieved at the May 2015 WHA to
ensure better reporting by these countries on Code implementation for it to be effective. This paper uses ethics and
health systems perspectives to analyse some of the drivers of international recruitment. The balance of competing ethics
principles, which are contained in the Codeâs articles, reflects a tension that was evident during the drafting of the Code
between 2007 and 2010. In 2007-2008, the right of health personnel to migrate was seen as a preeminent principle by
US representatives on the Global Council which co-drafted the Code. Consensus on how to balance competing ethical
principles â giving due recognition on the one hand to the obligations of health workers to the countries that trained
them and the need for distributive justice given the global inequities of health workforce distribution in relation to need,
and the right to migrate on the other hand â was only possible after President Obama took office in January 2009. It is
in the interests of all countries to implement the Global Code and not just those that are losing their health personnel
through international recruitment, given that it calls on all member states âto educate, retain and sustain a health
workforce that is appropriate for their (need)
...â (Article 5.4), to ensure health systemsâ sustainability. However, in some
wealthy destination countries, this means tackling national inequities and poorly designed health workforce strategies
that result in foreign-trained doctors being recruited to work among disadvantaged populations and in primary care
settings, allowing domestically trained doctors work in more attractive hospital setting
Politics Matters: A Response to Recent Commentaries
McCoy and Singh rightly comment on how extraordinary it is to need to spell out the political nature, actions and motivations underlying global health policy (1), which articulates where they (and we) are coming from. Yet without such commentators, it would be easy for the global health community today to forget how political and macro-economic decisions in the 1980s and 90s gave oxygen to the social determinants that undermined the health of populations, especially in low-income countries. These fuelled the diseases that are the focus of todayâs global health partnerships; and some of the same organisations played leading roles in setting the global health agenda then, as today
Global Surgery â Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa
Abstract
Surgery has the potential to address one of the largest, neglected burdens of disease in low- and middle-income
countries (LMICs), especially in sub-Saharan Africa (SSA). The Lancet Commission on Global Surgery (LCoGS)
has provided a blueprint for a systems approach to making safe emergency and elective surgery accessible and
affordable and has started to enable African governments to develop national surgical plans. This editorial
outlines an important gap, which is the need for surgical systems research, especially at district hospitals which
are the first point of surgical care for rural communities, to inform the implementation of country plans. Using
the Lancet Commission as a starting point and illustrated by two European Union (EU) funded research projects,
we point to the need for implementation research to develop and evaluate contextualised strategies. As illustrated
by the case study of Zambia, coordination by global and external stakeholders can enable governments to lead
national scale-up of essential surgery, supported by national partners including surgical specialist associations
A concept in flux: questioning accountability in the context of global health cooperation
Abstract Background: Accountability in global health is a commonly invoked though less commonly questioned concept. Critically reflecting on the concept and how it is put into practice, this paper focuses on the who, what, how, and where of accountability, mapping its defining features and considering them with respect to real-world circumstances. Changing dynamics in global health cooperation -such as the emergence of new health public-private partnerships and the formal inclusion of non-state actors in policy making processes -provides the backdrop to this discussion
Whatâs distressing about having type 1 diabetes? A qualitative study of young adultsâ perspectives
Background: Diabetes distress is a general term that refers to the emotional burdens, anxieties, frustrations, stressors and worries that stem from managing a severe, complex condition like Type 1 diabetes. To date there has been limited research on diabetes-related distress in younger people with Type 1 diabetes. This qualitative study aimed to identify causes of diabetes distress in a sample of young adults with Type 1 diabetes. Methods: Semi-structured interviews with 35 individuals with Type 1 diabetes (23â30 years of age). Results: This study found diabetes related-distress to be common in a sample of young adults with Type 1 diabetes in the second phase of young adulthood (23â30 years of age). Diabetes distress was triggered by multiple factors, the most common of which were: self-consciousness/stigma, day-to-day diabetes management difficulties, having to fight the healthcare system, concerns about the future and apprehension about pregnancy. A number of factors appeared to moderate distress in this group, including having opportunities to talk to healthcare professionals, attending diabetes education programmes and joining peer support groups. Young adults felt that having opportunities to talk to healthcare professionals about diabetes distress should be a component of standard diabetes care. Conclusions: Some aspects of living with diabetes frequently distress young adults with Type 1 diabetes who are in their twenties. Clinicians should facilitate young adultsâ attendance at diabetes education programmes, provide them with opportunities to talk about their diabetes-related frustrations and difficulties and, where possible, assist in the development of peer-support networks for young adults with diabetes
Community patterns of stigma towards persons living with HIV: A population-based latent class analysis from rural Vietnam
<p>Abstract</p> <p>Background</p> <p>The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma.</p> <p>Methods</p> <p>To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership.</p> <p>Results</p> <p>We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46).</p> <p>Conclusions</p> <p>Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analyzing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.</p