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

Male partners\u27 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\u27 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\u27s 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\u27 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\u27 politeness. In conclusion, comprehensive PMTCT policies that are socially and culturally sensitive to both women and men need to be developed

The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: a cluster-controlled trial

BACKGROUND: Regular supportive supervision is critical to retaining and motivating staff in resource-constrained settings. Previous studies have shown the particular contribution that supportive supervision can make to improving job satisfaction amongst over-stretched health workers in such settings. METHODS: The Support, Train and Empower Managers (STEM) study designed and implemented a supportive supervision intervention and measured its' impact on health workers using a controlled trial design with a three-arm pre- and post-study in Niassa Province in Mozambique. Post-intervention interviews with a small sample of health workers were also conducted. RESULTS: The quantitative measurements of job satisfaction, emotional exhaustion and work engagement showed no statistically significant differences between end-line and baseline. The qualitative data collected from health workers post the intervention showed many positive impacts on health workers not captured by this quantitative survey. CONCLUSIONS: Health workers perceived an improvement in their performance and attributed this to the supportive supervision they had received from their supervisors following the intervention. Reports of increased motivation were also common. An unexpected, yet important consequence of the intervention, which participants directly attributed to the supervision intervention, was the increase in participation and voice amongst health workers in intervention facilities

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

HIV knowledge and health-seeking behavior in Zambe´ zia Province, Mozambique

HIV prevalence rates in Zambe´zia Province were estimated to be 12.6% in 2009. A number of educational campaigns have been aimed at improving HIV transmission and prevention knowledge among community members in an effort to reduce infection rates. These campaigns have also encouraged people to seek health care at clinical sites, instead of employing traditional healers to cure serious illness. The impact of these programs on the rural population has not been well documented. To assess the level of knowledge about HIV transmission and prevention and health-seeking behavior, we interviewed 349 people in 2009 using free response and multiple choice questionnaires. Over half reported first seeking treatment at a government health clinic; however, the majority of participants had visited a traditional healer in the past. Knowledge regarding prevention and transmission of HIV was primarily limited to the sexual origins of infection and the protective advantages of condom use.Increased educational level and having learned about HIV from a community health worker were associated with higher HIV prevention and transmission knowledge. Traditional healers and community health-care workers were both conduits of health information to our study participants. HIV education and use of clinical services may be facilitated by partnering more closely with these groups

Consensus on context-specific strategies for reducing the stigma of human immunodeficiency virus/acquired immunodeficiency syndrome in Zambe´ zia Province, Mozambique

Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambe´zia Province, Mozambique. Qualitative data gathering methods, including indepth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and  community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.Keywords: stigma reduction, consensus, HIV/AIDS, Mozambiqu

The COVID-19 pandemic presents an opportunity to develop more sustainable health workforces

Abstract This commentary addresses the critically important role of health workers in their countries’ more immediate responses to COVID-19 outbreaks and provides policy recommendations for more sustainable health workforces. Paradoxically, pandemic response plans in country after country, often fail to explicitly address health workforce requirements and considerations. We recommend that policy and decision-makers at the facility, regional and country-levels need to: integrate explicit health workforce requirements in pandemic response plans, appropriate to its differentiated levels of care, for the short, medium and longer term; ensure safe working conditions with personal protective equipment (PPE) for all deployed health workers including sufficient training to ensure high hygienic and safety standards; recognise the importance of protecting and promoting the psychological health and safety of all health professionals, with a special focus on workers at the point of care; take an explicit gender and social equity lens, when addressing physical and psychological health and safety, recognising that the health workforce is largely made up of women, and that limited resources lead to priority setting and unequitable access to protection; take a whole of the health workforce approach—using the full skill sets of all health workers—across public health and clinical care roles—including those along the training and retirement pipeline—and ensure adequate supervisory structures and operating procedures are in place to ensure inclusive care of high quality; react with solidarity to support regions and countries requiring more surge capacity, especially those with weak health systems and more severe HRH shortages; and acknowledge the need for transparent, flexible and situational leadership styles building on a different set of management skills.</jats:p

Violence against health workers in the workplace in Lichinga, Niassa Province, from March till May 2019

Introdução: O reconhecimento da violência contra os trabalhadores da saúde (TDS) no local de trabalho como um fenómeno que compromete os cuidados de saúde e as relações entre os utentes dos serviços de saúde e os TDS tem estado a crescer no mundo. Em Moçambique são poucos os estudos sobre a violência no local de trabalho no sector da saúde. Com este estudo caracterizamos a violência contra os TDS em Lichinga, no norte de Moçambique.Material e métodos: Trata-se de um estudo observacional, descritivo, transversal que decorreu de março a maio de 2019, envolvendo 140 TDS dos quais, 120 exercendo no Hospital Provincial de Lichinga e no 20 no Centro de Saúde da cidade de Lichinga, na província de Niassa. O questionário aplicado foi adaptado do original desenvolvido pela Organização Internacional do Trabalho, o Conselho Internacional de Enfermeiros, a Organização Mundial da Saúde e os Serviços Públicos Internacionais sobre a violência no local de trabalho. Os dados colhidos foram introduzidos numa base de dados em SPSS 20. 0 e feita uma análise descritiva: frequências absolutas e relativas, médias e desvios padrão. Resultados:Este estudo confirma: a elevada prevalência de violência; uma tipologia de violência fisica, ameaça/agressão verbal, pressão moral, violência ou assédio sexual e discriminação, semelhante à observada noutros países e em 2003 em Maputo; um perfil de agressores constituido mais frequentemente por acompanhantes dos doentes/utentes ou colegas da instituição embora com menos realce para a agressão pelos doentes/utentes; uma perceção de que a violência é aceite de uma forma passiva; que os TDS não conhecem os procedimentos para tramitar as queixas; que os TDS se mostram geralmente preocupados com o risco de violência no seu local de trabalho e insatisfeitos com a forma como a instituição responde a essas queixas; e que a violência é percebida pelos TDS como sendo prevenível.Conclusão: Este estudo documenta uma elevada prevalência de diferentes tipos de violência contra os TDS. Há necessidade óbvia de intervenções para a prevenção destes incidentes. Introduction: Recognition of the relevance of violence against health workers in their in the workplace has been growing in the world. In Mozambique workplace violence in the health sector needs better documentation. Therefore, this study had as its main objective to assess violence against health workers in the workplace in Lichinga Northern Province of Mozambique. Material and methods: This is an observational, descriptive, cross-sectional study. Data collection took place from March to May 2019, involving 140 health professionals, 120 from Lichinga Provincial Hospital and 20 from the Health Center of the City of Lichinga, in the Province of Niassa. The questionnaire applied was adapted from the original developed by the International Labor Organization, the International Nurses Council, the World Health Organization and Public Services International. Data were entered into a database in SPSS 20.0. The statistical analysis was mostly descriptive: absolute and relative frequencies, means and standard deviations. Results: This study confirms: the high prevalence of violence; a typology of physical violence, verbal threat/aggression, moral pressure, sexual violence or harassment and discrimination, similar to that observed in other countries and in 2003 in Maputo; a profile of aggressors consisting more often of companions of patients / users or colleagues of the institution, although with less emphasis on aggression by patients / users; a perception that violence is accepted passively; that health workers do not know the procedures for handling complaints; that health workers are generally concerned about the risk of violence in their workplace and dissatisfied with the way the institution responds to these complaints; and that violence is perceived by health workers as being preventable .Conclusion: This study documents a high prevalence of different types of violence against health workers. There is a need for interventions to prevent incidents of violence against workers in the workplace.publishersversionpublishe