Is the Role of Physicians Really Evolving Due to Nonphysician Clinicians Predominance in Staff Makeup in SubSaharan African Health Systems? Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

Health workforce shortages in Sub-Saharan Africa are widely recognized, particularly of physicians, leading the training and deployment of Non-physician clinicians (NPCs). The paper by Eyal et al provides interesting and legitimate viewpoints on evolving role of physicians in context of decisive increase of NPCss in Sub-Saharan Africa. Certainly, in short or mid-term, NPCs will continue to be a proxy solution and a valuable alternative to overcome physicians’ shortages in sub-Saharan Africa. Indeed, NPCs have an important role at primary healthcare (PHC) level. Physicians at PHC level can certainly have all different roles that were suggested by Eyal et al, including those not directly related to healthcare provision. However, at secondary and higher levels of healthcare, physicians would assume other roles that are mainly related to patient clinical care. Thus, attempting to generalize the role of physicians without taking into account the context where they will work would be not entirely appropriate. It is true that often physicians start the professional carriers at PHC level and progress to other levels of healthcare particularly after clinical post-graduation training. Nevertheless, the training programs offered by medical institutions in sub-Saharan Africa need to be periodically reviewed and take into account professional and occupational roles physicians would take in context of evolving health systems in sub-Saharan Africa

Violence against health care workers in the workplace in Mozambique – An unrecognised managerial priority

Funding Information: We acknowledge support of the Niassa Provincial Health Directorate (provided administrative authorization and support for the research to be carried out). We are also thankful to all study participants for their time and effort by taking part in the study. Professor Inês Fronteira advised on the statistical analysis. The Research Center on Global Health and Tropical Medicine (GHTM) receives support from the Portuguese Science and Technology Foundation (grant GHTM UID/04413/2020). Publisher Copyright: © 2022 John Wiley & Sons Ltd.Introduction: Recognition of the relevance of violence against health workers in their work place has been growing around the world. In Mozambique, workplace violence in the health sector needs better documentation. Therefore, this article is part of a study that describes the typology and the perceived impact of violence against health care workers in their workplace at the Lichinga Provincial Hospital and at the Health Centre of the City of Lichinga in 2019. Method: This was an observational, descriptive, cross-sectional study. The study was carried out in a simple random sample of health workers victims of violence at the Provincial Hospital and the Health Centre of the City of Lichinga, in the Province of Niassa in northern Mozambique. The questionnaire applied was adapted from the original developed by the International Labour Organization, the International Council of Nurse, the World Health Organization and Public Services International and applied in Maputo, Mozambique during 2002. Statistical analysis was carried out with Statistical Package for the Social Sciences 20.0 and WinPepi 11.65. Results: Two hundred and 60 healthcare workers (HCW) were selected to participate, 180 agreed, 145 had inclusion criteria and five gave up participating in the study during the consent procedure. Thus, a total of 140 HCW answered the questionnaire. Predominant types of violence were: verbal threat/aggression 34% (n = 62/180); moral pressure/bullying/mobbing 30% (n = 54/180); ethnic discrimination 9% (n = 16/180); against personal property 6% (n = 10/180); physical 4% (n = 8/180); sexual harassment 4% (n = 8/180). One hundred and 37 victims reported 154 episodes of violence, where 7% (n = 13/180) reported more than one type of violence. Most victims reported no reaction (55%, n = 76/137) and few said that they confronted the offender (16%, n = 22/137, particularly victims of sexual harassment, 38%, n = 3/8). Most HCW reported non-existence (39%, n = 54/137) or unawareness (32%, n = 44/137) of procedures to report violence within the Institution. Most (80%, n = 33/41) of those knowing about the procedures, knew how to use them. More than half (55%; n = 76/137) of HCW said that they were discouraged to report acts of violence. Conclusions: Like for previous studies in Mozambique and elsewhere in Africa, the study confirms: a relatively high prevalence, a reluctance to talk about the issue and unawareness about procedures on how to report incidents. The findings reconfirm the necessity for the development and implementation of procedures to address violence incidents towards HCW, to develop support services for victims of health workplace violence. Like elsewhere in Africa, successive health workforce plans in Mozambique have failed to address this issue.publishersversionpublishe

Male partners' involvement in prevention of mother-to-child HIV transmission in sub-Saharan Africa : a systematic review

In sub-Saharan Africa (SSA), male partners are rarely present during prevention of mother-to-child transmission (PMTCT) services. This systematic review aims to synthesize, from a male perspective, male partners' perceived roles, barriers and enablers of their involvement in PMTCT, and highlights persisting gaps. We carried out a systematic search of papers published between 2002 and 2013 in English on Google Scholar and PubMed using the following terms: men, male partners, husbands, couples, involvement, participation, Antenatal Care (ANC), PMTCT, SSA countries, HIV Voluntary Counseling and Testing and disclosure. A total of 28 qualitative and quantitative original studies from 10 SSA countries were included. Men's perceived role was addressed in 28% (8/28) of the studies. Their role to provide money for ANC/PMTCT fees was stated in 62.5% (5/8) of the studies. For other men, the financial responsibilities seemed to be used as an excuse for not participating. Barriers were cited in 85.7% (24/28) of the studies and included socioeconomic factors, gender role, cultural beliefs, male unfriendly ANC/PMTCT services and providers' abusive attitudes toward men. About 64% (18/28) of the studies reported enablers such as: older age, higher education, being employed, trustful monogamous marriages and providers' politeness. In conclusion, comprehensive PMTCT policies that are socially and culturally sensitive to both women and men need to be developed

Is workplace violence against health care workers in Mozambique gender related?

Funding Information: We acknowledge support of the Niassa Provincial Health Directorate (provided administrative authorisation and support for the research to be carried out). We are also thankful to all study participants for their time and effort by taking part in the study. Fundação para a Ciência e Tecnologia for funds to research centre GHTM UID/04413/2020. Funding Information: We acknowledge support of the Niassa Provincial Health Directorate (provided administrative authorisation and support for the research to be carried out). We are also thankful to all study participants for their time and effort by taking part in the study. Fundação para a Ciência e Tecnologia for funds to research centre GHTM UID/04413/2020. Publisher Copyright: © 2022 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.This report revisits data used to describe the typology and the perceived impact of violence against health care workers (VHCW) at the health services of the City of Lichinga in Mozambique, based on an observational, descriptive, cross-sectional study, carried out from March to May 2019. In this report we attempt to understand if our reanalysis of VHCW in Niassa can explain it as an example of gender-based violence. Our findings—particularly that women more than men reported not knowing if the health services had any policies or procedures to deal with VHCW, felt that they were not encouraged to report acts of VHCW and were more frequently threatened/violented by different sex aggressors—although not conclusive, support the need to consider gender as a dimension when conducting research on VHCW. If we do not do so, gender will continue to be an invisible and ignored dimension of intervention strategies to prevent and address VHCW.publishersversionpublishe

Mudanças climáticas e saúde pública: Uma reflexão com enfoque para Moçambique

As mudanças climáticas são uma realidade inegável e resultam, sobretudo, das acções humanas (antropogénicas). Estas mudanças colocam em sério perigo a saúde humana e de outros seres vivos existentes no planeta Terra. As manifestações dessas mudanças ocorrerem em múltiplos sectores e aos diferentes níveis. No sector da saúde, as manifestações incluem a ocorrência de distúrbios psicossociais, em consequência dos eventos climáticos extremos (seca, cheias, ciclones, etc.); alterações nos padrões de ocorrência de doenças transmitidas por vectores (como malária e dengue) e por água contaminada (como cólera e outras doenças diarreicas); e doenças respiratórias (sobretudo as resultantes da poluição ambiental como asma e outras crónicas não-transmissíveis). Alguns dos efeitos das mudanças climáticas já se fazem sentir em Moçambique, incluindo a ocorrência com relativa frequência de eventos climáticos, como vagas de calor e de frio, secas e cheias. Apesar de Moçambique não ser grande tributário das mudanças climáticas globais, tem corroborado em incitativas e esforços internacionais de forma activa. Assim, este artigo pretende informar, duma forma sumária, particularmente sobre o impacto das mudanças climáticas sobre a saúde humana. Por outro lado, pretende estimular uma reflexão sobre o papel dos diferentes sectores na resposta coordenada e atempada para fazer face aos efeitos das mudanças climáticas no contexto global de Saúde Pública no país. O artigo poderá ser útil também para despertar a atenção e o interesse dos académicos sobre esta temática e incentivá-los a darem o melhor de si próprios na busca de soluções mais adequadas através da realização de pesquisas e partilhando experiências das diversas áreas científicas com finalidade de contribuir para um controlo mais eficaz dos factores que favorecem a ocorrência das mudanças climáticas no nosso país e ao nivel global.Palavras-chave: mudanças climáticas, impacto, saúde públic

exploring knowledge, risk perception, and sexual behaviors

High circular mobility creates vulnerability and elevates risk for sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). We aim to explore knowledge, perceptions of risk, and sexual behaviors in relation to STIs/HIV, in Mozambican women involved in an informal cross border trade (ICBT) and residing in South Mozambique. A cross-sectional quantitative study, in 200 women cross border traders (WICBT), affiliated to the Mukhero Association, using a structured, face-to-face questionnaire, was conducted. Descriptive statistics and Pearson’s Chi-square test were used. The median age of participants was 37.0 years (interquartile range (IQR): 31.0–43.0), 100% were literate, travelled on average six times a month. WICBT with a high education level were more likely to have awareness of Gonorrhea, Syphilis, and Candidiasis; to self-perceive being at risk of getting HIV, Syphilis, and Human Papilloma Virus (HPV); and to test for HIV and Syphilis. Those with a low education level were more likely to have misconceptions about HIV and ever have sex in exchange for money/goods/services. Married participants were more likely to know how to prevent HIV. Participants with a high income were more likely to know about HPV; to self-perceive being at risk of getting Syphilis; to point sex workers as being at higher risk of getting HPV; and to ever test for HIV. WICBT with a low income were more likely to have sex in exchange for money/goods/services. Low and inconsistent knowledge and misconceptions of STIs/HIV, high sexual risky behavior, low perception of risk of getting STIs/HIV among this neglected and key population suggests their increased vulnerability to the STIs/HIV.publishersversionpublishe

Why do some physicians in Portuguese-speaking African countries work exclusively for the private sector? Findings from a mixed-methods study

Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The present work adopts a mixed-methods approach to explore characteristics, working patterns, choices, and motivations of the physicians working exclusively for the private sector in the capital cities of Cape Verde, Guinea Bissau, and Mozambique. The paper's objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries

Task-shifting: experiences and opinions of health workers in Mozambique and Zambia

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Supervision of community health workers in Mozambique: a qualitative study of factors influencing motivation and programme implementation

Background Community health workers (CHWs) in Mozambique (known as Agentes Polivalentes Elementares (APEs)) are key actors in providing health services in rural communities. Supervision of CHWs has been shown to improve their work, although details of how it is implemented are scarce. In Mozambique, APE supervision structures and scope of work are clearly outlined in policy and rely on supervisors at the health facility of reference. The aim of this study was to understand how and which aspects of supervision impact on APE motivation and programme implementation. Methods Qualitative research methodologies were used. Twenty-nine in-depth interviews were conducted to capture experiences and perceptions of purposefully selected participants. These included APEs, health facility supervisors, district APE supervisors and community leaders. Interviews were recorded, translated and transcribed, prior to the development of a thematic framework. Results Supervision was structured as dictated by policy but in practice was irregular and infrequent, which participants identified as affecting APE’s motivation. When it did occur, supervision was felt to focus more on fault-finding than being supportive in nature and did not address all areas of APE’s work – factors that APEs identified as demotivating. Supervisors, in turn, felt unsupported and felt this negatively impacted performance. They had a high workload in health facilities, where they had multiple roles, including provision of health services, taking care of administrative issues and supervising APEs in communities. A lack of resources for supervision activities was identified, and supervisors felt caught up in administrative issues around APE allowances that they were unable to solve. Many supervisors were not trained in providing supportive supervision. Community governance and accountability mechanisms were only partially able to fill the gaps left by the supervision provided by the health system. Conclusion The findings indicate the need for an improved supervision system to enhance support and motivation and ultimately performance of APEs. Our study found disconnections between the APE programme policy and its implementation, with gaps in skills, training and support of supervisors leading to sub-optimal supervision. Improved methods of supervision could be implemented including those that maximize the opportunities during face-to-face meetings and through community-monitoring mechanisms