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Patel-Larson A, Ledikwe JH, West T, Cheever L, Hauck H, Andrews G, Lipita F, Gugsa S, Life T, Perlman J, Wilson A, Phillips HJ, Haddad C. Looking back to see forward: multidirectional learning between the US Ryan White HIV/AIDS Program and the US President's Emergency Plan for AIDS Relief. BMJ Glob Health 2024; 8:e013953. [PMID: 38395451 PMCID: PMC10897372 DOI: 10.1136/bmjgh-2023-013953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/28/2023] [Indexed: 02/25/2024] Open
Abstract
To end the HIV epidemic as a public health threat, there is urgent need to increase the frequency, depth and intentionality of bidirectional and mutually beneficial collaboration and coordination between the USA and global HIV/AIDS response. The US Health Resources and Services Administration (HRSA) is uniquely positioned to showcase bidirectional learning between high-income and low-income and middle-income countries (LMICs) in the fight against HIV. For 30 years, HRSA has successfully administered the Ryan White HIV/AIDS Program (RWHAP), the largest federal programme designed specifically for people with HIV in the USA. Further, HRSA has developed and delivered innovative, cost-effective, impactful HIV programmes in over 30 countries as an implementing agency for the US President's Emergency Plan for AIDS Relief (PEPFAR). When PEPFAR was authorised in 2003, HRSA rapidly developed systems and infrastructures to deliver life-saving treatment, initiated workforce development programmes to mitigate health worker shortages, and laid the path for transitioning PEPFAR activities from US-based organisations to sustainable, country-led entities. As global programmes matured, lessons learnt within LMICs gradually began strengthening health services in the USA. To fully optimise synergies between RWHAP and PEPFAR, there is a critical need to build on successful initiatives, harness innovation and technology, and inculcate the spirt of multidirectional learning into global health. HRSA is promoting bidirectional learning between domestic and international HIV programming through documenting, sharing and implementing strategies, lessons learnt, best practices and effective models of care to accelerate achievement of HIV epidemic control and support country-led, sustained responses to public health threats.
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Affiliation(s)
| | | | | | | | | | - Gail Andrews
- Republic of South Africa Department of Health, Pretoria, Gauteng, South Africa
| | - Faless Lipita
- Meharry Medical College School of Medicine, Nashville, Tennessee, USA
| | | | | | | | - Amber Wilson
- National Institutes of Health, Bethesda, Maryland, USA
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Nachega JB, Serwadda D, Abimiku A, Sikazwe I, Abdool Karim Q. PEPFAR at 20 - A Game-Changing Impact on HIV in Africa. N Engl J Med 2023. [PMID: 37395552 DOI: 10.1056/nejmp2304600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Jean B Nachega
- From the Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh (J.B.N.); the Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health (J.B.N.), and the Institute of Human Virology, University of Maryland School of Medicine (A.A.) - both in Baltimore; the Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa (J.B.N.), Makerere University School of Public Health, Kampala (D.S.), and Rakai Health Sciences Program, Kalisizo (D.S.) - both in Uganda; the International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria (A.A.); the Centre for Infectious Disease Research in Zambia, Lusaka (I.S.); the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.); and the Mailman School of Public Health, Columbia University, New York (Q.A.K.)
| | - David Serwadda
- From the Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh (J.B.N.); the Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health (J.B.N.), and the Institute of Human Virology, University of Maryland School of Medicine (A.A.) - both in Baltimore; the Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa (J.B.N.), Makerere University School of Public Health, Kampala (D.S.), and Rakai Health Sciences Program, Kalisizo (D.S.) - both in Uganda; the International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria (A.A.); the Centre for Infectious Disease Research in Zambia, Lusaka (I.S.); the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.); and the Mailman School of Public Health, Columbia University, New York (Q.A.K.)
| | - Alash'le Abimiku
- From the Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh (J.B.N.); the Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health (J.B.N.), and the Institute of Human Virology, University of Maryland School of Medicine (A.A.) - both in Baltimore; the Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa (J.B.N.), Makerere University School of Public Health, Kampala (D.S.), and Rakai Health Sciences Program, Kalisizo (D.S.) - both in Uganda; the International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria (A.A.); the Centre for Infectious Disease Research in Zambia, Lusaka (I.S.); the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.); and the Mailman School of Public Health, Columbia University, New York (Q.A.K.)
| | - Izukanji Sikazwe
- From the Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh (J.B.N.); the Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health (J.B.N.), and the Institute of Human Virology, University of Maryland School of Medicine (A.A.) - both in Baltimore; the Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa (J.B.N.), Makerere University School of Public Health, Kampala (D.S.), and Rakai Health Sciences Program, Kalisizo (D.S.) - both in Uganda; the International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria (A.A.); the Centre for Infectious Disease Research in Zambia, Lusaka (I.S.); the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.); and the Mailman School of Public Health, Columbia University, New York (Q.A.K.)
| | - Quarraisha Abdool Karim
- From the Departments of Epidemiology and Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh (J.B.N.); the Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health (J.B.N.), and the Institute of Human Virology, University of Maryland School of Medicine (A.A.) - both in Baltimore; the Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa (J.B.N.), Makerere University School of Public Health, Kampala (D.S.), and Rakai Health Sciences Program, Kalisizo (D.S.) - both in Uganda; the International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria (A.A.); the Centre for Infectious Disease Research in Zambia, Lusaka (I.S.); the Centre for the AIDS Programme of Research in South Africa, Durban (Q.A.K.); and the Mailman School of Public Health, Columbia University, New York (Q.A.K.)
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Tankwanchi AS, Asabor EN, Vermund SH. Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6210. [PMID: 37444057 PMCID: PMC10341112 DOI: 10.3390/ijerph20136210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.
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Affiliation(s)
- Akhenaten Siankam Tankwanchi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Emmanuella N. Asabor
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
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Evidence-based practice profiles of nurses: a transcultural study †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To compare (i) the evidence-based practice (EBP) profiles and (ii) socio-demographic characteristics of nurses in 4 selected low-middle income countries (LMICs).
Methods
A cross-sectional survey was conducted among 677 nurses from 4 hospitals in 4 countries (Afghanistan, Ghana, Iran, and Uganda).
Results
The findings revealed that there are significant differences between the 3 EBP subscales (that is, practice/use, attitude, and knowledge/skill) across the 4 countries (P < 0.05). No significant EBP differences were identified across age groups and gender in the subscales of practice, knowledge, and attitude. Practice and knowledge subscales were significantly associated with working schedules (that is, part-time and full-time) (P < 0.05). Analyses also revealed significant differences between attitude and knowledge subscales and working experience (P < 0.05).
Conclusions
Nurses in the 4 countries have moderate practice, attitude, and knowledge/skills of EBP. Nurses in LMICs require continuous professional development programs and support to enhance their practice and knowledge regarding EBP in clinical settings.
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Liberia's First Health Workforce Program Strategy: Reflections and Lessons Learned. Ann Glob Health 2021; 87:95. [PMID: 34707975 PMCID: PMC8499710 DOI: 10.5334/aogh.3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Following civil war and the Ebola epidemic, Liberia's health workforce was devastated, essential health services and primary care were disrupted, and health outcomes for maternal and child mortality were amongst the worst in the world. To reverse these trends, the government of Liberia developed the Health Workforce Program (HWP) Strategy 2015-2021. With the goal of building a resilient and responsive health system to ensure access to essential services and the ability to respond to future crises, this strategy aimed to add 6,000 new professionals to the workforce. In the context of the COVID-19 pandemic, we share lessons learned from the program's development and first years of implementation.
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Ezeonwu M. The Role of African Nurse Diaspora in Addressing Public Health Priorities in Africa. Glob Qual Nurs Res 2021; 8:23333936211031501. [PMID: 34291124 PMCID: PMC8278446 DOI: 10.1177/23333936211031501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 01/31/2023] Open
Abstract
African countries experience many complex public health challenges that, to tackle, require coordinated, multi-stakeholder, collaborative partnerships at local and global levels. The African nurse diaspora is a strategic stakeholder, contributor, and liaison to public health interventions, given their roots in the continent, their professional connections in the west, and their ability to build an extensive network of global partners. Using a descriptive qualitative approach that amplifies the voices of the Africa nurse diaspora, this study provides an insider view of the continent’s public health priorities and what roles the diaspora can play to improve health and population outcomes. Findings show that Africa’s high disease burden is generally preventable but compounded by enduring socioeconomic challenges. Against this situation, African-born nurses in the diaspora are uniquely positioned to mobilize both local and global stakeholders in coordinated global health policy interventions and actively engage communities in preventive care while earning their trust.
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Kiguli-Malwadde E, Budak JZ, Chilemba E, Semitala F, Von Zinkernagel D, Mosepele M, Conradie H, Khanyola J, Haruruvizhe C, Martin S, Kazembe A, De Villiers M, Reid MJA. Developing an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa. BMC MEDICAL EDUCATION 2020; 20:499. [PMID: 33298029 PMCID: PMC7725217 DOI: 10.1186/s12909-020-02420-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/03/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND With funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice. METHODS Ten faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula. RESULTS Between April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020. CONCLUSIONS To our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, cross-institutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.
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Affiliation(s)
- E Kiguli-Malwadde
- African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | - J Z Budak
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - E Chilemba
- University of Malawi, College of Nursing, Zomba, Malawi
| | | | | | - M Mosepele
- University of Botswana, Gaborone, Botswana
| | - H Conradie
- Stellenbosch University, Stellenbosch, South Africa
| | - J Khanyola
- University of Global Health Equity , Kigali, Rwanda
| | | | - S Martin
- University of California, San Francisco, USA
| | - A Kazembe
- University of Malawi, College of Nursing, Zomba, Malawi
| | | | - M J A Reid
- University of California, San Francisco, USA.
- Global Health Delivery, Diplomacy & Economics, Institute for Global Health Sciences | UCSF, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
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Kilmarx PH, Katz F, Razak MH, Palen J, Cheever LW, Glass RI. The Medical Education Partnership Initiative: Strengthening Human Resources to End AIDS and Improve Health in Africa. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1704-1713. [PMID: 30334836 PMCID: PMC6467693 DOI: 10.1097/acm.0000000000002489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Faced with a critical shortage of physicians in Africa, which hampered the efforts of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Medical Education Partnership Initiative (MEPI) was established in 2010 to increase the number of medical graduates, the quality of their education, and their retention in Africa. To summarize the accomplishments of the initiative, lessons learned, and remaining challenges, the authors conducted a narrative review of MEPI-from the perspectives of the U.S. government funding agencies and implementing agencies-by reviewing reports from grantee institutions and conducting a search of scientific publications about MEPI. African institutions received 11 programmatic grants, totaling $100 million in PEPFAR funds, to implement MEPI from 2010 to 2015. The National Institutes of Health (NIH) provided an additional 8 linked and pilot grants, totaling $30 million, to strengthen medical research capacity. The 13 grant recipients (in 12 countries) partnered with dozens of additional government and academic institutions, including many in the United States, forming a robust community of practice in medical education and research. Interventions included increasing the number of medical school enrollees, revising curricula, recruiting new faculty, enhancing faculty development, expanding the use of clinical skills laboratories and community and rural training sites, strengthening computer and telecommunications capacity, and increasing e-learning. Research capacity and productivity increased through training and support. Additional support from NIH for faculty development, and from PEPFAR for health professions education and research, is sustaining and extending MEPI's transformative effect on medical education in select African sites.
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Affiliation(s)
- Peter H. Kilmarx
- P.H. Kilmarx is deputy director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, and infectious diseases medical epidemiologist; ORCID: http://orcid.org/0000-0001-6464-3345
| | - Flora Katz
- F. Katz is director, Division of International Training and Research, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Myat Htoo Razak
- M.H. Razak was program officer, Medical Education Partnership Initiative, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, and is currently director, Division of Global HIV/AIDS Programs, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - John Palen
- J. Palen is deputy coordinator for program quality, Office of the U.S. Global AIDS Coordinator, Department of State, Washington, DC
| | - Laura W. Cheever
- L.W. Cheever is associate administrator, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Roger I. Glass
- R.I. Glass is director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-7968-9530
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Ridge LJ, Dickson VV, Stimpfel AW. The Occupational Health of Nurses in the Economic Community of West African States: A Review of the Literature. Workplace Health Saf 2019; 67:554-564. [PMID: 31364508 DOI: 10.1177/2165079919859383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nurses provide the majority of health care in sub-Saharan Africa, which has high rates of Hepatitis B Virus (HBV) and human immunodeficiency virus (HIV). This systematic review used PRISMA methodology to synthesize the literature published between January 2008 and December 2018 examining the occupational health of nurses practicing in the Economic Community of West African States (ECOWAS). The United States' National Institute for Occupational Safety and Health's Hierarchy of Controls is used to frame the findings. This research was mostly conducted in Nigeria and Ghana and focused on administrative controls. Nurses practicing in ECOWAS are at high risk of acquiring a bloodborne illness due to inadequate engineering and administrative controls, as well as limited access to personal protective equipment (PPE). These findings indicate interventions to improve these controls would likely lower the occupational risks faced by nurses practicing in ECOWAS. Research in more countries in ECOWAS would likely find differences in occupational health practices in Nigeria and Ghana, which are relatively wealthy, and other countries in the region. This literature showed nurses practicing in ECOWAS did not have adequate protection from biological hazards. Regional health groups, such as the West African Health Organization, should commit to improving occupational health practice. Needle recapping and double gloving must be discontinued, and PPE must be made more widely available in ECOWAS. Occupational health professionals in the region should advocate for better distribution of PPE and consider offering trainings on these behaviors.
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Ajuebor O, McCarthy C, Li Y, Al-Blooshi SM, Makhanya N, Cometto G. Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 being implemented in countries? Findings from a cross-sectional analysis. HUMAN RESOURCES FOR HEALTH 2019; 17:54. [PMID: 31300058 PMCID: PMC6626395 DOI: 10.1186/s12960-019-0392-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs). METHODS This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively. RESULTS Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of "completed"; 55% were reportedly "in progress" and 26% indicated a status of "not started". Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented. CONCLUSION Monitoring and accountability of countries' commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers' deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.
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Affiliation(s)
- Onyema Ajuebor
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Carey McCarthy
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | | | | | - Giorgio Cometto
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
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Ridge LJ, Klar RT, Stimpfel AW, Squires A. The meaning of "capacity building" for the nurse workforce in sub-Saharan Africa: An integrative review. Int J Nurs Stud 2018; 86:151-161. [PMID: 30029056 DOI: 10.1016/j.ijnurstu.2018.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND "Capacity building" is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what "capacity building", or even "capacity" itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. OBJECTIVES This study explored how "capacity" was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model was for fit with "capacity's" definition in the field. DESIGN An integrative review of the literature using systematic search criteria. DATA SOURCES SEARCHED INCLUDED PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. REVIEW METHODS This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term "capacity" in the nursing context. Content analysis was conducted separately for how capacity building practitioners described "capacity" versus how their programs operationalized it. Identified themes were then assessed for fit with Grindle and Hilderbrand's (1995) "Dimensions of Capacity" model. RESULTS Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Grindle and Hilderbrand (1995) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. CONCLUSIONS This review indicates there is significant informal consensus on the definition of "capacity" and that the Grindle and Hilderbrand (1995) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.
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Affiliation(s)
- Laura Jean Ridge
- New York University, 433 First Avenue, New York, NY 10010, United States.
| | - Robin Toft Klar
- New York University, 433 First Avenue, New York, NY 10010, United States
| | | | - Allison Squires
- New York University, 433 First Avenue, New York, NY 10010, United States
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Strengthening the health workforce to support integration of HIV and noncommunicable disease services in sub-Saharan Africa. AIDS 2018; 32 Suppl 1:S47-S54. [PMID: 29952790 DOI: 10.1097/qad.0000000000001895] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The successful expansion of HIV services in sub-Saharan Africa has been a signature achievement of global public health. This article explores health workforce-related lessons from HIV scale-up, their implications for integrating noncommunicable disease (NCD) services into HIV programs, ways to ensure that healthcare workers have the knowledge, skills, resources, and enabling environment they need to provide comprehensive integrated HIV/NCD services, and discussion of a priority research agenda. DESIGN AND METHODS We conducted a scoping review of the published and 'gray' literature and drew upon our cumulative experience designing, implementing and evaluating HIV and NCD programs in low-resource settings. RESULTS AND CONCLUSION Lessons learned from HIV programs include the role of task shifting and the optimal use of multidisciplinary teams. A responsible and adaptable policy environment is also imperative; norms and regulations must keep pace with the growing evidence base for task sharing, and early engagement of regulatory authorities will be needed for successful HIV/NCD integration. Ex-ante consideration of work culture will also be vital, given its impact on the quality of service delivery. Finally, capacity building of a robust interdisciplinary workforce is essential to foster integrated patient-centered care. To succeed, close collaboration between the health and higher education sectors is needed and comprehensive competency-based capacity building plans for various health worker cadres along the education and training continuum are required. We also outline research priorities for HIV/NCD integration in three key domains: governance and policy; education, training, and management; and service delivery.
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Bvumbwe T, Mtshali N. Nursing education challenges and solutions in Sub Saharan Africa: an integrative review. BMC Nurs 2018; 17:3. [PMID: 29434521 PMCID: PMC5793415 DOI: 10.1186/s12912-018-0272-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Lancet Commission and the Global Health Workforce Alliance reported that professional education has generally not kept up the pace of health care challenges. Sub Saharan Africa needs an effective and efficient nursing education system to build an adequate, competent and relevant nursing workforce necessary for the achievement of Sustainable Development Goals. The Plan of Action for Scaling up Quality Nursing and Midwifery Education and Practice for the African Region 2012 - 2022 provided a framework for scale up of nurses and midwives. This integrative review examined literature on nursing education challenges and solutions in Sub Saharan Africa to inform development of a model for improving the quality, quantity and relevance of nursing education at local level. METHODS A search of PubMed, Medline on EBCSOhost and Google Scholar was conducted using key words: nursing education, challenges, solutions and/ or Africa. Published works from 2012 to 2016 were reviewed to explore reports about challenges and solution in nursing education in Sub Saharan Africa. Full texts of relevant studies were retrieved after reading the tittles and abstracts. Critical appraisal was undertaken and the findings of the relevant studies were analysed using thematic analysis. RESULTS Twenty articles and five grey sources were included. Findings of the review generally supports World Health Organisation framework for transformative and scale up of health professions education. Six themes emerged; curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building and infrastructure and resources. Challenges and solutions in nursing education are common within countries. The review shows that massive investment by development partners is resulting in positive development of nursing education in Sub Saharan Africa. However, strategic leadership, networking and partnership to share expertise and best practices are critical. CONCLUSION Sub Saharan Africa needs more reforms to increase capacity of educators and mentors, responsiveness of curricula, strongly regulatory frameworks, and availability of infrastructure and resources. The review adds to the body of knowledge to enhance efforts of stakeholders in the improvement of the quality, quantity and relevance of nursing education in Sub Saharan Africa.
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Affiliation(s)
- Thokozani Bvumbwe
- Faculty of Health Sciences, Mzuzu University, P/ Bag 201, Luwinga, Mzuzu, Malawi
| | - Ntombifikile Mtshali
- School of Nursing, University of KwaZulu Natal, Durban, 4041 Republic of South Africa
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Bvumbwe T. Enhancing nursing education via academic–clinical partnership: An integrative review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Ousman K, Polomano RC, Seloilwe E, Odero T, Tarimo E, Mashalla YJ, Voss JG, O’Malley G, Chapman SA, Gachuno O, Manabe Y, Nakanjako D, Sewankambo N, Urassa D, Wasserheit JN, Wiebe DJ, Green W, Farquhar C. Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium. J Assoc Nurses AIDS Care 2016; 27:331-43. [PMID: 27086192 PMCID: PMC4834555 DOI: 10.1016/j.jana.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/29/2016] [Indexed: 02/03/2023]
Abstract
HIV continues to challenge health systems, especially in low- and middle-income countries in Sub-Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1-year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service-oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale-up, evaluate, and lead health programs that are population-based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.
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Affiliation(s)
- Kevin Ousman
- Principal Partner, African Health Resource Group, Baltimore, Maryland, USA
| | - Rosemary C. Polomano
- Professor of Pain Practice, University of Pennsylvania School of Nursing, and Professor of Anesthesiology and Critical Care (Secondary), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Esther Seloilwe
- Associate Professor, School of Nursing University of Botswana, Gaborone, Botswana
| | - Theresa Odero
- Senior Lecturer, School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Edith Tarimo
- Senior Lecturer, Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yohana J. Mashalla
- Dean, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Joachim G. Voss
- Professor and Director, Sarah Cole Hirsh Center for Evidence Based Practice, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Gabrielle O’Malley
- Assistant Professor, Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Susan A. Chapman
- Associate Professor, Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, California, USA
| | - Onesmus Gachuno
- Senior Lecturer, Department of Obstetrics and Gynecology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Yukari Manabe
- Associate Professor, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Damalie Nakanjako
- Associate Professor, Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Principal, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David Urassa
- Associate Dean, Department of Community Health, College of Health Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Judith N. Wasserheit
- Chair, Department of Global Health, and Professor of Global Health & Medicine, University of Washington, Seattle, Washington, USA
| | - Douglas J. Wiebe
- Associate Professor, Departments of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Green
- Assistant Professor, Counseling, Administration, Supervision & Adult Learning, Cleveland State University, Cleveland, Ohio, USA
| | - Carey Farquhar
- Director and Professor, Departments of Medicine, Epidemiology, and Global Health, School of Medicine, University of Washington, Seattle, Washington, USA
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Knight SE, Van Wyk JM, Mahomed S. Teaching research: a programme to develop research capacity in undergraduate medical students at the University of KwaZulu-Natal, South Africa. BMC MEDICAL EDUCATION 2016; 16:61. [PMID: 26879830 PMCID: PMC4754994 DOI: 10.1186/s12909-016-0567-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/26/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Improved research ability is a core competency to achieve in health professionals. The Selectives is a three-year, longitudinal, community-based programme within the undergraduate curriculum which aims to develop research capacity in all medical students during the prescribed curriculum. In relation to the programme, the authors describe the types of studies conducted by students, conditions that facilitated their learning, how the experience improved students' knowledge of research and public health and their development of reflective learning practices. METHODS A cohort of 212 students completed the Selectives Programme in 2014, and 69 (32 %) completed an anonymous online evaluation thereafter. Data collected include students' perceptions of the research component of Selectives; its impact on their knowledge of research and a documentary analysis of their research protocols and posters. Ethical approval for the ongoing evaluation of the Selectives was sought and obtained from the institutional Biomedical Research Ethics Committee. RESULTS During Selectives, 75 groups of 2-4 students conducted research studies of primary health care problems in community settings. Each group is assessed on their presentation of research findings as a scientific poster. The Selectives facilitated learning for the majority of the cohort. Students reported positive learning experiences about the research process, including ethics; protocol writing; data processing; dissemination of findings and results; and their use in informing a health promotion intervention. Students reported having gained a better understanding of their strengths and weaknesses through reflective learning from this academic activity. The Selectives is scheduled adjacent to the students' mid-year vacation. This scheduling together with the placement in the students' home community minimizes travel and accommodation costs associated with working outside the academic teaching platform and therefore makes it a cost-effective model in a low resource context. CONCLUSIONS The Selectives has proven beneficial to develop a range of generic and practical research competencies for a full cohort of students enrolled in the undergraduate medical curriculum. The Selectives research process is integrated with learning about population health and the social determinants of health in a primary health care setting.
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Affiliation(s)
- Stephen E Knight
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Room 217 George Campbell Building, Durban, 4041, South Africa.
| | | | - Saajida Mahomed
- School of Laboratory and Laboratory Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Abstract
Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.
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Affiliation(s)
- Roger Strasser
- Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada;
| | - Sophia M Kam
- School of Rural and Northern Health, Laurentian University, Sudbury, ON P3E 2C6 Canada
| | - Sophie M Regalado
- Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada;
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Li J, Assanangkornchai S, Lu L, Jia M, McNeil EB, You J, Chongsuvivatwong V. Development of internalized and personal stigma among patients with and without HIV infection and occupational stigma among health care providers in Southern China. Patient Prefer Adherence 2016; 10:2309-2320. [PMID: 27877022 PMCID: PMC5108600 DOI: 10.2147/ppa.s112771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND HIV/AIDS-related stigma is a major barrier of access to care for those infected with HIV. The aim of this study was to examine, validate, and adapt measuring scales of internalized, personal, and occupational stigma developed in Africa into a Chinese context. METHODS A cross-sectional study was conducted from January to September 2015 in Kunming, People's Republic of China. Various scales were constructed on the basis of the previous studies with modifications by experts using exploratory and confirmatory factor analyses (EFA + CFA). Validation of the new scales was done using multiple linear regression models and hypothesis testing of the factorial structure invariance. RESULTS The numbers of subjects recruited for the development/validation samples were 696/667 HIV-positive patients, 699/667 non-HIV patients, and 157/155 health care providers. EFA revealed a two-factor solution for internalized and personal stigma scales (guilt/blaming and being refused/refusing service), which were confirmed by CFA with reliability coefficients (r) of 0.869 and 0.853, respectively. The occupational stigma scale was found to have a three-factor structure (blaming, professionalism, and egalitarianism) with a reliability coefficient (r) of 0.839. Higher correlations of factors in the HIV patients (r=0.537) and non-HIV patients (r=0.703) were observed in contrast to low-level correlations (r=0.231, 0.286, and 0.266) among factors from health care providers. CONCLUSION The new stigma scales are valid and should be used to monitor HIV/AIDS stigma in different groups of Chinese people in health care settings.
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Affiliation(s)
- Jing Li
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- School of Public Health, Kunming Medical University
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Lin Lu
- Yunnan Center for Disease Prevention and Control
- Correspondence: Lin Lu, Yunnan Center for Disease Prevention and Control, 158 Dongsi Street, Xishan District, Kunming 650022, Yunnan Province, People’s Republic of China, Email
| | - Manhong Jia
- Yunnan Center for Disease Prevention and Control
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jing You
- Infectious Diseases Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China
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Labonté R, Sanders D, Mathole T, Crush J, Chikanda A, Dambisya Y, Runnels V, Packer C, MacKenzie A, Murphy GT, Bourgeault IL. Health worker migration from South Africa: causes, consequences and policy responses. HUMAN RESOURCES FOR HEALTH 2015; 13:92. [PMID: 26635007 PMCID: PMC4669613 DOI: 10.1186/s12960-015-0093-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/23/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND This paper arises from a four-country study that sought to better understand the drivers of skilled health worker migration, its consequences, and the strategies countries have employed to mitigate negative impacts. The four countries-Jamaica, India, the Philippines, and South Africa-have historically been "sources" of skilled health workers (SHWs) migrating to other countries. This paper presents the findings from South Africa. METHODS The study began with a scoping review of the literature on health worker migration from South Africa, followed by empirical data collected from skilled health workers and stakeholders. Surveys were conducted with physicians, nurses, pharmacists, and dentists. Interviews were conducted with key informants representing educators, regulators, national and local governments, private and public sector health facilities, recruitment agencies, and professional associations and councils. Survey data were analyzed using descriptive statistics and regression models. Interview data were analyzed thematically. RESULTS There has been an overall decrease in out-migration of skilled health workers from South Africa since the early 2000s largely attributed to a reduced need for foreign-trained skilled health workers in destination countries, limitations on recruitment, and tighter migration rules. Low levels of worker satisfaction persist, although the Occupation Specific Dispensation (OSD) policy (2007), which increased wages for health workers, has been described as critical in retaining South African nurses. Return migration was reportedly a common occurrence. The consequences attributed to SHW migration are mixed, but shortages appear to have declined. Most promising initiatives are those designed to reinforce the South African health system and undertaken within South Africa itself. CONCLUSIONS In the near past, South Africa's health worker shortages as a result of emigration were viewed as significant and harmful. Currently, domestic policies to improve health care and the health workforce including innovations such as new skilled health worker cadres and OSD policies appear to have served to decrease SHW shortages to some extent. Decreased global demand for health workers and indications that South African SHWs primarily use migratory routes for professional development suggest that health worker shortages as a result of permanent migration no longer pertains to South Africa.
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Affiliation(s)
- Ronald Labonté
- Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada.
| | - David Sanders
- School of Public Health, University of Western Cape, P. B. X17, Bellville, South Africa.
| | - Thubelihle Mathole
- School of Public Health, University of Western Cape, P. B. X17, Bellville, South Africa.
| | - Jonathan Crush
- Balsillie School of International Affairs, N2L 6C2, Waterloo, Ontario, Canada.
- University of Cape Town, P/B Rondebosch, South Africa.
| | - Abel Chikanda
- Department of Geography, University of Kansas, Lawrence, KS, USA.
| | - Yoswa Dambisya
- East, Central and Southern African Health Community, P.O. Box 1009, Arusha, Tanzania.
| | - Vivien Runnels
- Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada.
| | - Corinne Packer
- Faculty of Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, Ontario, Canada.
| | - Adrian MacKenzie
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, Nova Scotia, Canada.
| | - Gail Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, B3H 4R2, Halifax, Nova Scotia, Canada.
| | - Ivy Lynn Bourgeault
- Telfer School of Management, University of Ottawa, 1 Stewart St., K1N 6N5, Ottawa, Ontario, Canada.
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Schooley RT. Editorial Commentary: All's (Almost) Quiet on the Western Front: Will We Be Ready for the Next War? Clin Infect Dis 2015; 61:503-5. [DOI: 10.1093/cid/civ337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/13/2022] Open
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Cancedda C, Farmer PE, Kerry V, Nuthulaganti T, Scott KW, Goosby E, Binagwaho A. Maximizing the Impact of Training Initiatives for Health Professionals in Low-Income Countries: Frameworks, Challenges, and Best Practices. PLoS Med 2015; 12:e1001840. [PMID: 26079377 PMCID: PMC4469419 DOI: 10.1371/journal.pmed.1001840] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Corrado Cancedda and colleagues outline a framework for health professional training initiatives in low-income countries.
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Affiliation(s)
- Corrado Cancedda
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Paul E. Farmer
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Vanessa Kerry
- Harvard Medical School, Boston, Massachusetts, United States of America
- Seed Global Health, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Tej Nuthulaganti
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Kirstin W. Scott
- Harvard University, Cambridge, Massachusetts, United States of America
| | - Eric Goosby
- University of California San Francisco, San Francisco, California, United States of America
| | - Agnes Binagwaho
- Harvard Medical School, Boston, Massachusetts, United States of America
- Ministry of Health of Rwanda, Kigali, Rwanda
- Geisel School of Medicine—Dartmouth, Hanover, New Hampshire, United States of America
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Collins PY, Musisi S, Frehywot S, Patel V. The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa. Glob Health Action 2015; 8:26682. [PMID: 25783229 PMCID: PMC4363204 DOI: 10.3402/gha.v8.26682] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 01/13/2023] Open
Abstract
The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders.
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Affiliation(s)
- Pamela Y Collins
- Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, MD, USA;
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Seble Frehywot
- Department of Health Policy, The George Washington University, Washington, DC, USA
- Department of Global Health, The George Washington University, Washington, DC, USA
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
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