This Week's News 6-10 June 2011

Health Service workers ask FWSC to be fair in job re-evaluation

Ghana News Agency

06/06/2011

Accra, June 6, GNA – The leadership of the Health Service Workers’ Union of Ghana TUC has urged the Fair Wages and Salaries Commission (FWSC) to remain focused to ensure consistency, transparency and fairness in the job re-evaluation exercise of members.

It said the exercise was aimed at addressing the Union’s concerns of distortions and disparities in the internal pay relativity within the health sector.
This was contained in a press release issued in Accra on Monday after the leadership said it had critically examined the results of the job re-evaluation of some benchmark jobs of their members received from the FWSC.

This was in response to the Union’s letter by the General Secretary, Mr Abu D. Kuntulo.

The press release said the Union’s leadership noted that there was a fundamental error in the job re-evaluation of about 70 per cent of the jobs of their members.
The Union said it believed that the right method was not applied in the exercise and that if the re-evaluation had been conducted in a fair and transparent manner, the results would have been different.
The Union therefore called on the FWSC for a more detailed explanation on how the job re-evaluation was conducted and why 70 per cent of the jobs re-evaluated have had their values reduced drastically compared to the original job evaluation.

7

Children’s plight ignored in war against Aids pandemic

Business Daily, Kenya

08/06/2011
By Immaculate Karambu
When Finance minister Uhuru Kenyatta reads the Budget today, Health sector players will be keen to see what allocation he gives towards child health and if any money will be allocated to HIV/Aids among children.
Health experts say the field has largely been ignored in the past, thanks to high costs of diagnosing and treating HIV in children. “Diagnosing HIV/Aids in children is a topic that has not been well addressed due to the high costs it attracts. Children’s medicines are more expensive than those for adults,” said National Aids Control Council deputy director Sobbie Mulindi.
In Kenya, 22,000 new cases of HIV/Aids among children are reported annually. The figure does not represent the total number of paediatric HIV/Aids cases as not all children are diagnosed and the results documented at health facilities.
Cases of children being orphaned at early ages have been cited as the main reason that accounts for the undocumented incidents as most are never presented for diagnosis at health facilities. According to Dr Mulindi, lack of information on the prevalence of HIV/Aids among children has led to poor planning for paediatric programmes.
Statistics show that about 117,000 Kenyan children are infected with the virus. However, only 46,000 children access ARVs even while it is mandatory for all HIV positive children to receive the treatment.
“Children do not have fully developed immune systems. All those infected with HIV should be put under anti-retroviral therapy (ART), but we have never achieved this,” said Mr James Kamau, the coordinator of Kenya Treatment Access Movement (KETAM).
Infected

Issues to do with HIV/Aids have made headlines locally for negative reasons like inadequate government commitment to funding programmes.

Budgetary allocation towards HIV/Aids has been wanting, often below 25 per cent of requirements.
Donors carter for the bulk of funding through organisations such as PEPFAR, the Global Fund, and the World Bank.
Due to limited government funding of the fight against the pandemic and lack of an HIV/Aids programme specifically for children, sick children have often ended up forgotten when it comes to funding as other needy cases take top priority.
For example, Sh900 million was set aside to buy anti-retroviral drugs in this year’s health budget but only a paltry share of the amount went to paediatric cases.
“When we talk about increasing budgetary allocation to health programmes, we should also say that such funds need to be specified as to what they are intended to achieve. Maternal and child health programmes have not been given fair sharing,” said Mr Kamau. In addition to inadequate funding, the fact that very few health workers specialise in child health is also a challenge to the war on paediatric HIV/Aids.
While a wide range of health workers can diagnose HIV/Aids in children, follow up on treatment is a speciality of paediatricians.
Kenya is among countries with the lowest number of paediatricians in the world, 250 professionals serve a population of 20 million people under 15 years of age.

Out of these, 170 live in Nairobi, further posing a big challenge to monitoring and managing HIV/Aids treatment among children in rural areas. “It is true that children, especially in rural areas, are not getting enough services from paediatricians as regards HIV treatment and this is also true for other conditions,” said Dr John Wachira, a consultant paediatrician at Getrude’s Children’s Hospital in Nairobi.

Dr Wachira said several factors such as few admission slots for paediatricians in local medical institutions and brain drain account for the problem.
Inadequate

Inadequate personnel has also led to only a handful of health institutions offering infant diagnosis of HIV/Aids. Only 1,000 of the country’s health facilities offer this service.

Mother to child transmission of HIV is the leading mode of passing on the virus to children. While campaigns to scale this down are said to be bearing positive outcomes, their full potential has not been achieved as currently more than half of pregnant women in Kenya do not practice safe motherhood.
Save for 42 per cent of women who deliver in health facilities under the assistance of skilled medical personnel, the rest seek unqualified delivery assistance posing risk of transmitting the virus to new born babies as no medical tests are carried out during such deliveries.
The fact that only half of Kenya’s health facilities offer prevention of mother to child transmission of HIV/Aids services, coupled with the low number of health facilities available for delivery, is an indication that fresh plans need to be drawn to win the war on HIV/Aids in children.

8

Botswana to allow sacked strikers to re-apply for jobs

Times Live, SA

07/06/2011

By Sapa-AFP

Botswana will allow more than 1,400 health workers to re-apply for their jobs after they were sacked for ignoring a court order to end a strike, an official said Tuesday.
But the government will give no guarantee that they will be re-hired, said Eric Molale, secretary to President Ian Khama, further enraging unions for public workers who went on strike seven weeks ago.
"All employees in essential services who have been dismissed for taking part in the strike, declared by the Industrial Court as illegal and unprotected, are eligible to re-apply with immediate effect," he said.
Any decision on rehiring the workers -- including doctors, nurses and cleaning staff -- will depend on vacancies available and the interest of the public service, he said.
More than 90,000 public workers went on strike on April 18 to demand a 16 percent wage hike, causing schools to close schools and leaving health facilities on skeletal staffing.
They have accepted the government's offer of a three percent raise but insist that it should be applied in a pyramid form that would give the lowest-paid workers the biggest increase.
Government has rejected the demand and said the increase would be applied across the board from September 1.
"The strike continues because there are some outstanding issues which we haven't agreed on with the employer," said unions spokesman Goretetse Kekgonegile.
Unions say public service workers have not received a salary increase in three years, but government argues that it has no money for big raises. The International Monetary Fund has urged Botswana to rein in its wage bill.
Botswana, the world's top diamond producer, was hard hit by the global economic crisis which resulted in a sharp decline of sales. The economy shrank by 4.9 percent in 2009 but bounced back with 7.2 percent growth in 2010.
Government employees complain their buying power is shrinking in the face of inflation that hit 8.2 percent in April.

9

UN: Raise budget on Health

The Citizen, Tanzania

06/06/2011

By Bernard Lugongo,

Dar es Salaam. Tanzania should increase the health budget to 15 per cent, invest in universal access to reproductive health services and improve human resources for health, it has been suggested. The UN Resident Coordinator, Alberic Kacou, yesterday also asked the Government to stop further political commitments on reducing maternal and child mortality, but have a special focus on skilled health workers.
He was speaking in Dar es Salaam during the launch of a campaign on accelerated reduction of maternal mortality in the country.The campaign was in implementation of an agreement among Health ministers in African countries during a meeting they held in Addis Ababa, Ethiopia, in May 2009.
“Tanzania… has made pledges towards the global strategy for women’s and children’s health; today let us not make any more commitments, let us take action,” suggested Mr Kacou. He said, despite commendable government commitments, the trend in martenal health and child care was not all that positive.
According to the recently launched 2010 Tanzania Demographic and Health Survey, only half of all births occur in health facilities. The rest take place at home and just over half of all births were assisted by skilled provider, it noted.
“While we have seen improvements in infant death rates, little has been achieved in decreasing maternal and newborn deaths,” he said.He cited transportation and poor infrastructure as still major reasons for the delay in seeking medical assistance.
“Anyone who has had to rush a wife, child or relative to hospital has to cover a long distance to reach the place,” he said. Speaking on behalf of President Jakaya Kikwete, the minister for Health and Social Welfare, Mr Hajji Mponda, said the campaign would focus on sensitizing the public over the reproductive health.
He further said that under the campaign the ministry would direct local authorities to allocate adequate budgets for reducing maternal and child deaths.“In the central government we shall work to put the issue as the main agenda,” he added.

10

Death by (lack of) pathologists

The Jerusalem Post

08/06/2011
By STEPHEN FRIST
So there is a shortage of pathologists in Israel (“Errors in treatment possible from lack of pathologists,” May 9, 2011) and the situation is getting worse. For most, this is not the most distressing news of the day. After all, when does the average person spend a second thinking about this group of somewhat macabre practitioners? And with good reason. Pathologists are the doctors no one sees. While many folks don’t know that pathologists are physicians – medical school graduates who chose this specialty in the same way others choose pediatrics or surgery – the impact we make on the lives of patients is not something that should be discounted.
I remember one Shabbat meal at which I was introduced as a pathologist. A sweet-faced octogenarian suggested: “Why don’t you learn some other line of work?” My take is that pathologists have not done a great job of explaining our vital role. True, pathologists occasionally perform autopsies.
It may be argued that, historically, the post-mortem exam ushered in modern medicine. Finally, doctors could compare normal and abnormal organs, describe the changes, and define disease entities. This led to diagnostic advances, treatments based on scientific evidence and, importantly, a way of assessing the value of medical intervention. With current technology, lab tests and imaging, for example, a lot of this information is now determined during life. The number of autopsies has declined significantly.
THE SURPRISE for many is that pathologists choose the field primarily to help living patients. The first step in medical care is making the right diagnosis. It might be a skin biopsy, a Pap smear or a segment of colon removed in the operating room. A pathologist must analyze the tissue or organ. Frequently the urgent question at hand is “is the growth benign or malignant?” It doesn’t end there: If the tumor is completely removed, are the adjacent lymph nodes involved, and if so, how many... and the malignant tumor – is it aggressive or indolent, is it sensitive to radiation therapy, is it isolated, or does the pattern indicate that it is multifocal; might there be another growth hiding somewhere? Questions such as these cross the clinician’s mind and pathologists provide the answers.
Here’s the bottom line: providing these life-and-death answers takes expertise, and Israel doesn’t have enough experts. It also takes time – swamp pathologists with an unreasonable case load and risk delays or errors. Over 90 percent of patients should receive a pathologist’s opinion within 48 hours, not a week or more. It can be done with adequate staffing.
Lastly, pathologists practice the art and science of medicine – cancer cells are not wearing T-shirts with a capital “C” across the front.
It is subtle, and there are differences of opinion. Some time ago, I saw a gentleman who was to undergo a major operation for pancreatic cancer, a Whipple’s procedure.
Before surgery the slides were reviewed and we corrected the diagnosis to pancreatic inflammation. The inflammation made the pancreatic cells appear “angry” (normal cells react to inflammation) and they were mistaken for cancer. The patient responded well to relatively routine antibiotic treatment.
For this reason, pathologists need a large dose of humility – enough to ask for a second opinion when there is any doubt.
Having an acceptable number of pathologists is a vital need for the Israeli medical system. These are the doctors charged with identifying and diagnosing some of the most serious diseases known. If pathologists are overworked and underpaid, we will all pay the price in the quality of medical care we receive. This is definitely a challenge that should be examined – and resolved.
The writer is a veteran pathologist who moved to Israel from America several years ago. He firmly advocates independent ‘second opinions’ by qualified pathologists in most life-threatening cases.

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Asia & Pacific

1

Young docs urged to specialise

The Star, Malaysia

03/06/2011

MALACCA: Doctors who have completed their housemanship have been urged to pursue specialist studies to overcome the shortage of specialists in government hospitals nationwide.

Health director-general Datuk Dr Hasan Abdul Rahman said this was because there were only 43 public hospitals with specialists out of 136 hospitals in the country.
“Although the number of doctors pursuing specialist studies doubled from about 400 to 800 last year, Malaysia is still lacking in specialist doctors,” he said after launching the Third Malaysian International Medical Students Conference at the Malacca Manipal Medical College here yesterday.
Although the Government had hired more foreign doctors and was asking Malaysian doctors who migrated overseas to return, the number of available specialists was still discouraging, he said.
Dr Hasan said housemen who were posted to the six different medical fields during their two-year stint should explore the specialist field that they preferred.
“Doctors can enjoy many benefits, including fully-paid study leave, if they want to pursue specialist studies,” he said.
He also said 3,277 housemen had reported for duty last year while 3,058 reported in 2009 and 2,319 in 2008.
Dr Hassan said the ministry was targeting to have 4,500 medical graduates this year.
Meanwhile, Dr Hasan said there were no reports on the detection of E.coli bacterial infection.
He advised the people to practise precaution and observe personal hygiene when preparing food, especially vegetables.

2

Putting money in wrong place (Editorial)

Bangkok Post

03/06/2011
This is scandalous. When the country is facing a serious shortage of physicians and is in dire need of budgetary support to improve the public health system, our military budget, when compared to the size of the economy, is one of the world's highest.
Last week, the Public Health Ministry revealed that the country needs about 40,000 physicians and is still about 10,000 short. According to acting Public Health Minister Jurin Laksanavisit, one-third of the 30,000 physicians are now breaking their backs to serve the majority of the population in the public health system. Another one-third are in universities or other state agencies, and the final third work in the private sector.
According to the World Health Organisation, the acceptable patients per doctor ratio is at 1:5,000. In Thailand it is 1:7,000. The breakdown is even more shocking in the northeastern province of Loei, where the ratio is 1:14,000. In Bangkok it is 1:850.
This shortage of doctors and the resulting heavy workload is one of the reasons for the high incidence of medical error and strained patient-doctor relations.
Of course, producing more physicians alone cannot solve this problem nor lead to the citizens' general well-being. Respect for patients' rights aside, preventive care and such basics as proper hygiene, nutrition, exercise and a toxic-free environment are all crucial. Still, easy and equal access to public health services is indispensable for people's quality of life. And that requires a high investment in both human resources and infrastructure. It is unfortunate that providing people with health security has a lower priority than military might in this country.
After the 2006 coup, which plunged the country into deep political division, the military budget rose by 50%, apparently because the Abhisit government dared not raise its voice. According to economics professor Pasuk Phongpaichit, the military budget accounts for 1.8% of our gross domestic product. This is higher than Germany's, the largest economy in Europe, with a military budget at 1.3% of GDP, and higher than Japan's 1%. When it comes to the soldier per population ratio, it is 7.9:1,000 in the United States and 2.2:1,000 in Japan. In Thailand, it is 10:1,000. Should we feel safe, angry or sad?
A strong political will to contain the military's ferocious appetite for war-toys is sorely needed in order to channel the money to strengthen the public health and welfare system. Sadly, even when election campaigning is in high gear, discussing a military budget cut is not on any political party's agenda.
At the meet-the-media forum co-organised by the Thai Journalists Association and the Thai Broadcast Journalists Association over last weekend, representatives from the Democrat, Pheu Thai, and other political parties were even defensive about the military. All were in agreement that the question of military budget is not about how much, but how it is used.
This is greatly disappointing.

All political parties are now competing to win votes through handout policies. No matter who wins, the need to finance the populist schemes will be huge. With the currently small tax base, the difficulty to push for progressive land and property taxes, and the politicians' reluctance to agitate the military, it is most likely that the financing of populist and mega projects will eat into the budgets for social and welfare benefits. Ordinary citizens will then have to continue suffering from the shortage of doctors, and public health must take a back seat to military might.

3

More than 32,900 doctors serving in Malaysia

Borneo Post

03/06/2011
MELAKA: There are 32,979 doctors serving in the country as of last year, with 22,429 of them working in the public sector, Health director-general, Datuk Dr Hasan Abdul Rahman said.
The number provided a doctor to population ratio of 1:827, he said, adding that the Health Ministry was targetting a ratio of 1:400 by 2020.
Speaking to reporters after opening the International Malaysian Medical Students Conference at the Melaka-ManipalMedical College here yesterday, Dr Hasan said out of the total number of doctors working in the public sector, 19,429 of them were with the Health Ministry.
The remaining are with other government agencies like the public universities, the Defence Ministry and the Housing and Local Government Ministry, he added.
On shortage of doctors, he said efforts were being made by the Health Ministry to bring back Malaysian specialist doctors who were working abroad, as well as to employ on contract basis foreign specialist doctors, like from Egypt and India.
“We have shortage of doctors in Sabah and Sarawak because many doctors want to be in the peninsula, especially the Klang Valley area,” he added.
He said there were 1,339 government doctors in Sabah and 1,254 government doctors in Sarawak.
“Besides the shortage of doctors in Sabah and Sarawak, we are also facing shortage of specialist doctors nationwide,” he added.
However, he believed that with the presence of 33 medical institutions in the country currently, including 11 owned by the government, Malaysia would be able to produce more doctors.
The ministry is targetting to produce 4,500 housemen this year, he said, adding that in an effort to produce more specialist doctors, the ministry, with the collaboration of several local universities, had increased the number of places for Master’s degree to 727 this year.
On the hemolytic-uremic syndrome (HUS), Dr Hasan said there had been no report on the spread of the disease in the country this week. — Bernama

4

Economic Survey 2010-11: Infant and maternal mortality rate rising

Express Tribune, Pakistan

03/06/2011
ISLAMABAD: Pakistan is among those underdeveloped countries of the world where infant and maternal mortality rate has been on the rise in past several years.
The country is bearing the two-fold burden of diseases and inadequate health care facilities despite starting major initiatives to overcome them and huge international funding, reveals the Economic Survey 2010-11.
The high population growth rate, one of the highest in the world, and poverty are further complicating and worsening the situation, said the survey that gives economic indicators for the year. An allocation of Rs16.9 billion was made for 82 projects in the Public Sector Development Programme during 2010-11, which is not sufficient when compared with the increasing population and requirements of health services, the survey said.
The country is facing an immense shortage of doctors and nurses. According to the survey, by 2010, there were 144,901 physicians, 10,508 dentists, 73,244 nurses and 27,153 midwives serving a population of well over 170 million people. There were 972 registered hospitals across the country with 104,137 beds, 4,842 dispensaries and 5,344 basic health units.
To overcome health issues and provide better health service facilities in both private and public sectors, the government initiated the Benazir Income Support Programme, Pakistan Baitul Mal Food Security Programme, and provision of Vitamin A supplements to children less than five years of age and micronutrient deficiency control programme. However, it is far behind in achieving the Millennium Development Goals.

5

Sindh govt raises doctors’ pay & perks

The News International, Pakistan

05/06/2011
Imtiaz Ali
Karachi -The Sindh government has raised the pay and allowances of doctors to end growing unrest among them over low salaries — an issue that has triggered off protests in Punjab and Balochistan.
Addressing a press conference at the CM House on Saturday, Chief Minister Syed Qaim Ali Shah announced that the pay of doctors doing house job had been increased from Rs12,000 to Rs18,000, and the pay of post-graduate doctors would be increased from Rs12,000 to Rs22,000.
According to the announcement, the non-practising allowance for doctors of 17 and 18 grades has been raised from Rs400 to Rs4,000 while this allowance has been raised from Rs700 to Rs6,000 for doctors of 19 and 20 grades.
Doctors performing their duty at casualty or emergency would get Rs6,000 as hardworking allowance. Doctors (17 and 18 grades) willing to work in rural and remote areas would get Rs6,000 as rural allowance while 19-grade doctors would get an allowance of Rs8,000.
The increases in pay and allowances for doctors would cost the provincial government up to Rs2.9 billion, said the chief minister.
He also announced that if Punjab or any other province increased the pay and allowances of doctors, Sindh would follow suit. The government would also give all incentives and whatever the doctors wanted, he said.
Shah said now the government expected the doctors to deliver, especially in remote areas. The medical profession was important and doctors deserved a better deal, he added.
He urged that instead of going abroad, doctors should stay in the country, where they were especially needed in rural areas. He stated that people in rural areas were suffering from many diseases, especially hepatitis, and poor people tended to sell their lands and animals to come to urban centres for the treatment of their ailments.
He urged doctors to visit rural areas and come up to the expectations of the people.
Answering a question, the chief minister said health and education would be a top priority of the government in the next budget. He said that owing to the devastation caused by floods last year, the government was compelled to cut the Annual Development Programme by up to 33 percent. He added that this loss would be compensated in the next fiscal year’s budget.
Regarding the repair of the Indus River embankments damaged by the floods, the provincial chief executive said the repair work was being carried out effectively, and hoped that up to 80 percent of work would be completed by the end of June.
Speaking about Dr Zulfiqar Mirza, the chief minister said that the home minister was still on leave.
Answering a question about the funding of devolved departments/divisions, he said the Centre had given funds for the devolved departments for one year, but now it had refused to provide funding for the same except universities. He noted hat talks with the federal government were going on to get assets of the devolved departments.
Finance Minister Murad Ali Shah, who also was present on the occasion, said it had been agreed that if Punjab increased the salaries of doctors in its forthcoming budget, Sindh would also incorporate such an increase after getting approval from the cabinet. He said the government was taking concerted efforts to improve conditions at district hospitals.
The finance minister appreciated cooperation from the PMA and doctors who demonstrated their confidence in a committee formed by the government.
Health Minister Dr Sagheer Ahmed recalled that the young doctors’ pay had been increased from Rs6,000 to Rs12,000 in the year 2009, which had now been increased further.
He disclosed that it had been agreed that the government would approach the CPSP (College of Physicians and Surgeons Pakistan) to include the practice of doctors at district hospitals in their post-graduation. He also suggested that now it was time to determine the post-graduation policy for doctors.
Ahmed expressed his regret over the increasing trend of hooliganism at emergency wards, which, he said, created problems for doctors.
Replying to a question about the less- than-expected release of the development budget for the Health Department, the health minister said that over Rs6 billion was the ADP of the Health Department in the outgoing financial year, out of which the department had so far got only Rs3 billion.
As a result, he said, uplift schemes were adversely affected. However, the he said that the chief minister had promised to compensate it in the next budget as three departments — roads, health and education — would be given a priority in the development budget.