#WoncaAfrica 26 December 2016

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Soweto health club making a difference

What started out as a small health group for five Soweto senior citizens just four years ago has grown to into a massive health club with 349 active members and a proud track record of improved overall health.  Earlier this month the Soweto Senior Citizens Health Club met at the Chiawelo Community Park where they participated in a diabetes awareness event. It was an event on a packed calendar that has members participating regularly in exercise and other health-related activities. Francis Muthakhi, the club’s coordinator, said: “The Soweto Senior Citizen Health Club has been growing well since we started it four years ago. Now we have meetings of over 300 people at a time who get together to participate in exercise sessions.”….more

Decree for 20% maths pass mark sets a dangerous precedent for schooling

The Department of Basic Education has reacted to pupils’ low marks for maths in a controversial way. It issued an urgent circular to its heads of departments, principals, managers, directors and exam and curriculum heads outlining a “special condonation dispensation”. This applies to pupils completing grades 7, 8 and 9 in the 2016 academic year just ended. Pupils who did not get 40% in mathematics may now progress to the next grade, provided they got more than 20% in mathemantics and met all other pass requirements. Only those who passed Grade 9 maths with 30% or more will be allowed to continue with the subject. Those who scored in the 20% band will in their final school years have to take mathematical literacy — a somewhat different and far less demanding subject. The move has been widely condemned. For instance, the Western Cape education department warned that if no “drastic action” was taken “we will be sitting in the same position next year”. The national department claims its directive is “an interim measure”. But how does it hope to address the crisis in maths education? What can be done to develop necessary skills through good maths teaching? ….more

SA’s medical scheme fees are shooting up as the package of care is sliding

With more above-inflation medical scheme tariff increases on the horizon for 2017, many consumers have been left bewildered by the escalating costs of medical care. Most feel powerless in the face of double-digit increases such as Discovery Health’s 10.2% contributions hike, Momentum Health’s average hike of 11% and Government Employees Medical Scheme’s (GEMS’s) increases ranging from 13% to 16.8%. These increases are coming at the same time that the South African Society of Anaesthesiologists (Sasa) is seeing a consistent below-inflation increase for healthcare practitioners and an erosion of their payments. It is becoming harder for practitioners to provide services and harder for the consumer to afford the cover….more

Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes

O`Neil PM, Miller-Kovach K, Tuerk PW, et al. Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes. Obesity (Silver Spring). 2016 Nov;24(11):2269-2277. doi: 10.1002/oby.21616. (Original) PMID: 27804264

OBJECTIVE: Modest weight loss from clinical interventions improves glycemic control in type 2 diabetes (T2DM). Data are sparse on the effects of weight loss via commercial weight loss programs. This study examined the effects on glycemic control and weight loss of the standard Weight Watchers program, combined with telephone and email consultations with a certified diabetes educator (WW), compared with standard diabetes nutrition counseling and education (standard care, SC).

METHODS: In a 12-month randomized controlled trial at 16 U.S. research centers, 563 adults with T2DM (HbA1c 7-11%; BMI 27-50 kg/m(2) ) were assigned to either the commercially available WW program (regular community meetings, online tools), plus telephone and email counseling from a certified diabetes educator, or to SC (initial in-person diabetes nutrition counseling/education, with follow-up informational materials).

RESULTS: Follow-up rate was 86%. Twelve-month HbA1c changes for WW and SC were -0.32 and +0.16, respectively; 24% of WW versus 14% of SC achieved HbA1c <7.0% (P = 0.004). Weight losses were -4.0% for WW and -1.9% for SC (Ps?

CONCLUSIONS: Widely available commercial weight loss programs with community and online components, combined with scalable complementary diabetes education, may represent accessible and effective components of management plans for adults with overweight/obesity and T2DM.

WHO technical package on the management of cardiovascular disease (“HEARTS”) in low resource settings

The Lancet Commission on Hypertension will create a library of success stories (studies) on strategies to improve blood pressure control in low-resource settings/countries – and you might be able to help

A recent paper by Mills et al. (Circulation 2016;134:441-450) demonstrated that the age-adjusted prevalence of hypertension increased from 2000 to 2010 in low- and middle-income countries (LMIC), surpassing that of high-income countries. Three-quarters of patients with hypertension are now living in LMIC. Furthermore, awareness and treatment improved only slightly from 2000 to 2010, whereas control rates of hypertension in men decreased in LMIC. The situation is even worse in low-income countries compared to middle-income countries. Therefore, the Lancet Commission on Hypertension (Olsen MH et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. Lancet. 2016 Sep 22. doi:10.1016/S0140-6736(16)31134-5) will focus efforts to try to improve blood pressure control in low-income settings/countries.

To initiate this action, the Lancet Commission on Hypertension will collaborate with the International Society of Hypertension (ISH), World Hypertension League (WHL), World Heart Federation (WHF), Pan-African Society of Cardiology (PASCAR), African Heart Network (AHN), Latin American Society of Hypertension (LASH), and Centers for Disease Control and Prevention (CDC), in order to create a library of success stories (studies) on strategies to improve blood pressure control in low-income settings/countries as a foundation for more impactful initiatives.

Therefore, we invite you, as a member of the ISH, to contribute to this initiative. Are you aware of a published success story (study) on methods to improve blood pressure control in low-income settings/countries? If you recall such a success story, please go to our web-page using the link

http://bpstudyform.hypertensioncommission.org to answer a few questions regarding the studymho@dadlnet.dk. If some of the questions cannot be answered, please write N/A.

The Commission will present the results at the European Meeting on Hypertension and Cardiovascular Protection in Milan in June 2017. Furthermore, the Lancet Commission on Hypertension and the organizers of the ISH Meeting on Hypertension 2018 in Beijing will invite abstract submissions for a new topic “Methods to Improve Blood Pressure Control in Low-Income Settings/Countries” and host a session dedicated entirely to this very important area of clinical research.

Listen To Community Health Workers To Strengthen Health Systems

I would like to share a couple of articles produced by our research group regarding CHW roles.

1. Trapé CA, Soares CB. Educative practice of community health agents analyzed through the category of praxis. Rev Latino-am Enfermagem 2007 janeiro-fevereiro; 15(1):142-9. http://www.scielo.br/pdf/rlae/v15n1/v15n1a21.pdf

This study aimed to: analyze the conceptions of health education that guide educational practices of community health agents in the Family Health Program of the Butantã Health Coordination, São Paulo, Brazil, and analyze the character of these educational activities. Data were collected through focus groups and indepth semi-structured interviews with 39 agents. The analysis procedures followed the recommendations of thematic content analysis, and praxis was the analytical category. Regarding theoretical activity as a component of praxis, we found that most health education conceptions were based on the transmission of normative information learned from health technicians. This theoretical activity ended up guiding a practical activity typical of repetitive praxis, in which the agents do not participate in the health work planning process and do not dominate the “ideal object”, reproducing tasks planned by others.

2. Work Process in Primary Health Care: action research with Community Health Workers. http://www.scielosp.org/pdf/csc/v20n11/en_1413-8123-csc-20-11-3581.pdf

The aim of this article was to describe and analyze the work of community health workers (CHW). The main objective of study was to analyze the development process of primary health care practices related to drug consumption. The study is based on the Marxist theoretical orientation and the action research methodology, which resulted in the performance of 15 emancipatory workshops. The category work process spawned the content analysis. It exposed the social abandonment of the environment in which the CHWs work is performed. The latter had an essential impact on the identification of the causes of drug-related problems. These findings made it possible to criticize the reiterative, stressful actions that are being undertaken there. Such an act resulted in raising of the awareness and creating the means for political action. The CHWs motivated themselves to recognize the object of the work process in primary health care, which they found to be the disease or addiction in the case of drug users. They have criticized this categorization as well as discussed the social division of work and the work itself whilst recognizing themselves as mere instruments in the work process. The latter has inspired the CHW to become subjects, or co-producers of transformations of social needs.

Thank you for your attention,

Cassia Baldini Soares

Associate Professor, Department of Collective Health Nursing

School of Nursing, University of São Paulo

HIFA profile: Cassia B Soares is Director at the Joanna Briggs Institute Collaborating Centre in Brazil. cassiaso AT usp.br

New collection of articles highlights effectiveness of health communication in HIV care continuum

On December 9, the Journal of Acquired Immune Deficiency Syndromes (JAIDS) published a supplement highlighting the effectiveness of health communication in keeping people engaged and on treatment throughout the HIV continuum of care – leading to more positive health outcomes.

The supplement, Impact of Health Communication on the HIV Continuum of Care, presents a series of 10 articles that make the case for using health communication in highly diverse HIV contexts in low- and middle-income settings.

http://healthcommcapacity.org/health-communication-leads-to-better-outcomes-for-those-receiving-hiv-treatment/?utm_source=twitter.com&utm_medium=social&utm_campaign=hc3&utm_term=hiv

Please take a look and feel free to spread the word among your colleagues by sharing within your networks.

The articles in this supplement are open access.

Click here for easy tweet:

https://twitter.com/intent/tweet?text=New%20collection%20of%20articles%20%40journalaids%20highlights%20effectiveness%20of%20health%20communication%20in%20HIV%20care%20continuum%3A%20http%3A%2F%2Fbit.ly%2F2hflp6A%20&source=clicktotweet&related=clicktotweet

New collection of articles @journalaids highlights effectiveness of health communication in HIV care continuum: http://bit.ly/2hflp6A  

This collection was coordinated by the Health Communication Capacity Collaborative (HC3) and is a follow-up to the 2014 JAIDS supplement [http://healthcommcapacity.org/technical-areas/hiv-and-aids/jaids-health-communication-plays-hiv-prevention-care/] devoted to health communication and its role in and impact on HIV prevention and care. More information can be found here on the HC3 website [http://healthcommcapacity.org/health-communication-leads-to-better-outcomes-for-those-receiving-hiv-treatment/], along with a list of articles, authors and related tweets.

Marla K. Shaivitz

Digital Communications Manager | Health Communication Capacity Collaborative

111 Market Place, Suite 310 | Baltimore, Maryland  21202 | 410-223-1618

www.healthcommcapacity.org

HIFA profile: Marla Shaivitz is Digital Communications Manager, Health Communication Capacity Collaborative, USA. marla.shaivitz AT jhu.edu

WHO: World Malaria Report 2016 – Malaria control improves for vulnerable in Africa, but global progress off-track

Download at

http://www.who.int/malaria/publications/world-malaria-report-2016/report/en/

Press Release at

http://www.who.int/mediacentre/news/releases/2016/malaria-control-africa/en/

[extracts of Press release below]

Malaria control improves for vulnerable in Africa, but global progress off-track

News release

13 December 2016 | GENEVA – WHO’s World Malaria Report 2016 reveals that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control. Across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last 5 years. Among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly…

Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving treatment. New findings presented in the report show that, in 2015, approximately half (51%) of children with a fever seeking care at a public health facility in 22 African countries received a diagnostic test for malaria, compared to 29% in 2010…

In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large proportion (36%) of children with a fever were not taken to a health facility for care in 23 African countries…

If global targets are to be met, funding from both domestic and international sources must increase substantially.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Health For All: What’s Next for a Movement Hitting its Stride?

Below are extracts from a blog by the Managing Director of the Rockefeller Foundation, Michael Myers.

https://www.rockefellerfoundation.org/blog/health-whats-next-movement-hitting-stride/

‘If the events of 2016 have taught us anything, it’s that we cannot know for sure what tomorrow will bring. But change has a way of illuminating those things about which we are certain. As a new year dawns, my conviction that every country can and must accelerate progress toward universal health coverage has never been stronger…

‘What can be done?

‘Build Country Capacity: We’ve entered a new era of health and development where countries that were traditionally recipients of aid are creating their own paths toward universal health coverage. If we’re serious about achieving UHC and reducing out-of-pocket payments in the long run, we need to support countries at every income level to find ways to increase domestic public health budgets. An example of work at this level is the Joint Learning Network for UHC, which The Rockefeller Foundation helped establish, in which today 27 countries are working together in the hard work of building and strengthening their health systems to assist all of their citizens.  And more countries are joining each year.

‘Focus on the Intersections: Universal health coverage is inherently cross-cutting—it impacts (and is impacted by) economic opportunity, the environment, gender equity and so much more. That’s why we need to place a greater emphasis on the intersections of UHC: how it builds resilience against climate threats, how the private sector can contribute, how overlapping efforts—like work to expand access to primary health care—can be harnessed to help us achieve our shared goal.

‘Get Serious about Accountability: We’ve set the stage for meaningful UHC measurement by advocating for a strong SDG indicator 3.8.2 and the establishment of the International Health Partnership for UHC 2030. Now we need to execute. This starts by asking the tough questions: Are we truly reaching everyone, everywhere, with the quality, affordable health services they need and deserve? Are we keeping people healthy in the first place? If not, what can we do to change course? Strong measurement tools and communication across efforts will allow us to expand basic, essential health services to the 400 million people who currently lack them. We can and must do better.’

Best wishes, neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

WHO Universal Health Coverage Data Portal

WHO has launched a new data portal to track global access to universal health coverage:

http://apps.who.int/gho/cabinet/uhc.jsp

Below is a press release from the United Nations website:

http://www.un.org/apps/news/story.asp?NewsID=55784#.WFAhqbKLS9I

12 December 2016 – Marking Universal Health Coverage Day, the United Nations World Health Organization (WHO) has launched a new data portal to track global access to universal health coverage, including information about equity of access and where services need to be improved.

The portal aggregates the latest data on universal health coverage for all of WHO’s 194 Member States. Next year, the portal will feature the impact of paying for health services on household finances.

“Any country seeking to achieve UHC must be able to measure it,” said the Director-General of the WHO, Dr. Margaret Chan, in a news release. “Data on its own won’t prevent disease or save lives, but it shows where governments need to act to strengthen their health systems and protect people from the potentially devastating effects of health care costs.”

The purpose of universal health coverage is to ensure that all people have the means to secure their right to health without financial hardship. This means that countries must build a health infrastructure system that supports readily available, quality services and products through an experienced workforce.

According to the portal, fewer than 50 per cent of children diagnosed with pneumonia are taken to a health care provider. 44 per cent of WHO’s Member States have less than 1 physician per 1000 people. While Africans suffer from 25 per cent of global diseases, the continent has only 3 per cent of the world’s health workers.

Universal health coverage is foundational to the success of the 2030 Agenda and its Sustainable Development Goals (SDGs), particularly Goal 3, which aims to secure the health and wellbeing of every individual.

“Expanding access to services will involve increasing spending for most countries,” announced Dr. Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation. “But as important as what is spent is how it’s spent. All countries can make progress towards universal health coverage, even at low spending levels.”

Worldwide, at least 400 million people are without access to essential health services. Every year, 100 million fall into poverty and 150 million suffer “financial catastrophe” due to out-of-pocket costs for health care.

As part of the SDGs, all WHO Member States have agreed to achieve universal health coverage by 2030. In order to make this objective a reality, more than 18 million new health workers will be needed by 2030 in order to meet the growing demand, particularly in low and lower-middle income countries.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Strengthening Health Systems for the SDGs and UHC: Healthy Systems, Healthy People

Dear dr. Martin Ekeke, Dear Friends at the First Regional Forum on Strengthening Health Systems for the SDGs and UHC: Healthy Systems, Healthy People in Windhoek Namibia,

We want to bring you a contribution from The Primary Health Care Family Medicine Network in Africa. The African continent suffers a very high burden of disease and only a marginal workforce of health workers available, resulting in difficult access to care, fragmented care, lack of infrastructure and technology and poor health systems. The World Health Report 2008: “Primary health care: now more than ever!” emphasizes the importance of strengthening primary care in addressing these health challenges. Evidence from WHO shows that strengthening primary health care is an important strategy to address inequities in health. In the recent report by the high-level commission on Health Employment and Economic growth: “Working for health and growth: investing in the health workforce”, the importance of investing in primary care workforce is stressed once again.

Primafamed (Primary Health Care & Family Medicine Network)(www.primafamed.ugent.be) is an international network active in the field of research, service delivery and capacity building in primary health care in Africa, committed to universal health coverage and addressing the challenges described above, since its conception in 1997. The Network subscribes to the SDG. In 1997 the Department of Family Medicine and Primary Health Care of Ghent University became a partner in the “South-African Family Medicine Educational Consortium”, an interuniversity cooperation in the field of postgraduate training of family physicians. Later on a “twinning-strategy” was developed, twinning each of the 8 South-African departments of family medicine with another African country, to train family physicians.  In addition to capacity building, Primafamed incorporated a focus on service delivery and research, with the creation of the “African Journal for Primary Health Care and Family Medicine” (www.phcfm.org).

In the meantime, research projects on the concept and implementation of family medicine in Africa were developed, resulting in a “Consensus Statement of on Family Medicine” (see attachment [*]). In 2012, at the 5th Primafamed workshop in Victoria Falls (Zimbabwe), a strategy was adopted to scale up family medicine and primary health care in Africa integrating education, research and services delivery, and with special emphasis on development of primary care oriented health systems (see attachment [*]). Thanks to a wide variety of funding sources over the years (Belgian VLIR-UOS- Own Initiatives 2003-2006-2009; VLIR-INC; ACP-EU-Cooperation Programme in Higher Education-Edulink; EU-FP7-HURAPRIM;…) Primafamed grew and consolidated into an international network, including institutions in Europe (Denmark, U.K,…)and Africa (South-Africa, Tanzania, Kenya, DRC, Ruanda, Uganda,…).  It is this consortium of committed partners that has often worked together in the past and have proven their scientific capacity, and their contribution to universal health coverage through concrete actions in the pedagogical field (e.g. curriculum development, improvement of training programs, appropriate skills training) and in the area of development of research capacity, as well as working at the “health system” level.

At this moment, based on the experience of the PRIMAFAMED-Network, we would like to suggest the following strategies to the First Regional Forum on Strengthening Health Systems for the SDGs and UHC: Healthy Systems, Healthy People in Namibia:

1. According to the Abuja Declaration African countries should invest 15% of the public spending in health care in order to address the actual challenges of infectious diseases and chronic conditions, especially multi-morbidity.

2. African countries should double the percentage of their public health spending, that is invested in primary health care, in order to strengthen primary health care systems, as there is clear evidence that strong primary health care systems have an essential role to play in achieving the Sustainable Development Goals and contribute to universal health coverage.

3. Actually there is an important input of resources by international donor organizations like USAID, Bill & Melinda Gates Foundation, Global Fund, Danida,… through vertical disease-oriented programs. As was already asked by the campaign “15by2015”, launched in March 2008 (see article in BMJ 8 March 2008), that donors that invest in vertical disease oriented programs (HIV/AIDS, malaria, tuberculosis,…) should invest by 2020 20% of the resources of their investment in these vertical programs, in strengthening local primary health care systems. By doing so, they put into practice the recommendation by the World Health Assembly 2009 (WHA62.12), that “… vertical disease oriented programs should be integrated and implemented in the framework of integrated primary health care systems”. By doing so, the campaign “15by2015”, could be followed-up by a campaign “20by2020”.

4. National Ministers of Health should formally recognize the discipline of family medicine operating in the primary health care system (already of lot of countries did so), and should define the role of family medicine in the framework of the primary health care team and provide financing in order to create posts for family physicians in the framework of primary health care teams. In annex, the “Consensus Statement of Family Medicine in Africa” gives a clear picture of how this could happen.

5. There is an urgent need to scale up the capacity in family medicine and primary health care in Africa. According to the “Vic Falls Declaration” (see attachment), at least 40% of the students finishing undergraduate medical training, should start a post-graduate training in family medicine in order to strengthen primary health care teams. One of the strategies to make this happen is to increase the early exposure in undergraduate curriculum of all medical students to primary health care settings and family medicine practice.

6. All stakeholders involved at national provincial and local level should invest in strengthening the primary health care team, including strengthening the cooperation between nurses, family physicians, midwifes, social workers, community health workers in the context of primary health care centers and ­ where needed ­ in the framework of district health hospitals.

7. In order to address the problem of brain-drain there should be an appeal to the receiving (Western) countries’ governments that receive health care providers who are trained in Africa and integrate them in their (Western) health system, that the receiving governments, reimburse the full cost of the training of such a health care provider in their own country, to the country where the provider has been trained. This would contribute to more equity in availability of health care providers worldwide.

The Primafamed-Network, in cooperation with other stakeholders, that may support these strategies, is willing to cooperate to these Developments. Can this document and annexes immediately be made available to the participants at the First Regional Forum in Windhoek.

Looking forward to your reaction, Prof Jan De Maeseneer Primafamed Network

Director International Centre for Primary Health Care and Family Medicine ­ Ghent University, WHO Collaborating Centre on PHC.

HIFA profile: Jan De Maeseneer is Secretary General of the Network Towards Unity for Health. The Network: TUFH is a global association of individuals, groups, institutions and organisations committed to improving and maintaining health in the communities they have a mandate to serve. The Network: TUFH is a Non-Governmental Organisation in official relationships with the World Health Organization (WHO). Jan is a working family physician (part time) in the Community Health Centre Ledeberg-Ghent (Belgium). He is Head of Department of Family Medicine and Primary Health Care of Ghent University (Belgium). He is the Chairman of the European Forum for Primary Care:        www.euprimarycare.org  

www.the-networktufh.org         jan.demaeseneer AT UGent.be

[*Note from HIFA moderator (Neil PW): Thank you Jan, I look forward to comments fro other HIFA members. The original message carried attachments but HIFA does not carry attachments. Please contact Jan for further details]

Webinar: Working Together towards Integrated Primary Care, 10 January 2017 (12.30 P.M CET)

The European Forum For Primary Care invites you to the webinar: Working together towards Integrated Primary Care. This webinar represents a great opportunity to witness an interview between two influential primary care leaders Jan De Maeseneer and Sally Kendall (actual and future elected chairman of the European Forum For Primary Care) that will drive the audience towards a journey in their careers and will raise the importance of primary care and the challenges of integrated care for shaping the future at a global level.

Primary care is the first level of professional care in Europe, where people present their health problems and where the majority of the population’s curative and preventive health needs are satisfied. It is widely believed that a well-developed system of primary care has beneficial effects on the health care system as a whole. As a consequence, systems with a strong primary care level appear to be better able to control costs and have better health outcomes.

However, a growing and changing society, financial constraints, changing health threats, workforce developments and technological advantages, have bring new and different challenges for healthcare systems in Europe,  including primary care. Jan and Sally will exchange reflections and values on primary care from a personalized view to the system.

Date : 10 January,2017 (12.30 P.M C.E.T)

Registration : info@euprimarycare.org (max 100 participants)

More information : www.euprimarycare.org

HIFA profile: Diana Castro Sandoval is Junior Project Coordinator at the European Forum For Primary Care in the Netherlands. Professional interests: Be updated within different healthcare initiatives around the world and look for interesting projects, possible partnerships and collaborations to raise awareness of different healthcare issues.  d.castrosandoval AT euprimarycare.org

Perceptions of men in South Africa around illness and HIV

This open-access paper looks at perceptions of men in South Africa around illness and HIV, and consequent fears about HIV counselling and testing.  

CITATION: Development of a National Campaign Addressing South African Men’s Fears About HIV Counseling and Testing and Antiretroviral Treatment

Orr N1, Hajiyiannis H, Myers L, et a. Journal of Acquired Immune Deficiency Syndromes (January 2017), 74 Suppl 6:S69-S73.

View Abstract: http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2017&issue=01011&article=00010&type=abstract

INTRODUCTION: South African men are less likely to get tested for HIV than women and are more likely to commence antiretroviral treatment (ART) at later stages of disease, default on treatment, and to die from AIDS compared with women. The purpose of this study was to conduct formative research into the ideational and behavioral factors that enable or create obstacles to mens’ uptake of HIV counseling and testing (HCT) and ART. The study consulted men with a goal of developing a communication campaign aimed at improving the uptake of HIV testing and ART initiation among men.

METHODS: Eleven focus groups and 9 in-depth interviews were conducted with 97 male participants in 6 priority districts in 4 South African provinces in rural, peri-urban, and urban localities.

RESULTS: Fears of compromised masculine pride and reputation, potential community rejection, and fear of loss of emotional control (“the stress of knowing”) dominated men’s rationales for avoiding HIV testing and treatment initiation.

CONCLUSIONS: A communication campaign was developed based on the findings. Creative treatments aimed at redefining a ‘strong’ man as someone who faces his fears and knows his HIV status. The resultant campaign concept was: “positive or negative-you are still the same person.”

SELECTED EXTRACTS:

Men’s work-related mobility, lower perceptions of HIV risk compared with women, fear of stigma, and rejection by communities because of being seen standing in queues at health centers, lack of trust in health workers (especially lack of confidentiality), and perceptions of demasculization by being attended to by female health workers4–6; and (3) The anticipated psychological burden of living with HIV, including inability to cope with an HIV positive result, an associated lack of will to live, perceptions that an HIV-positive status hastens death, and that HCT results in being perceived by others as having been sexually promiscuous.

For example, where masculinity is framed as being strong and not needing help, and where cultural beliefs associate weakness with illness, men are less likely to seek help at health facilities.

Stigma around HIV threatens masculine notions of respectability, independence and emotional control and can prevent men from admitting illness and making use of health services. The experience of being sick and taking treatment forces men to redefine their sense of identity and masculinity.

Men said they felt self-conscious and uncomfortable at public clinics because it was unusual to find young men there for reasons other than HIV, and other people would assume any man at the clinic would be HIV positive. Negative participant experiences at public sector clinics included being shouted at and judged by health professionals and confidentiality violations.

“We were raised with the mentality that a man … is this strong person so when people see a weakness I will be afraid because I won’t be seen as a man and I will be called a woman… Other men will say you are a woman and must wear panties” (rural male, 25–35 years, Gert Sibande, Mpumalanga).

“Nobody fears being sick (more) than a male person, we are more terrified of being sick than our female counterparts. So if I have to take medication, it’s the same as giving in” (admitting illness) (urban male, 18–24 years, Gert Sibande, Mpumalanga).

Some men stated that traditional healing practices influence late initiation of ART and nonadherence because traditional medicine is taken when one is ill, and stopped when one is cured.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa.org  

Union pinpoints the jobs for which demand will be rising in the future

As technology creates a new set of rules for the economy‚ school leavers and prospective students should take heed of the professions likely to be in demand to ensure their future “employability”‚ says the one of the oldest trade unions, United Association of SA (Uasa).

Union spokesman Andre Venter expects decline in major economies in areas such as office and administrative jobs; manufacturing and production; construction and extraction; arts‚ design‚ entertainment‚ sports and media; and legal and installation and maintenance‚

But he expects growth in job categories such as business and financial operations; management; computer and mathematics; architecture and engineering; sales and related jobs; and education and training.

Venter has broken down this further‚ based on international research and the World Economic Forum’s The Future of Jobs report to highlight jobs that will be in greater demand or remain stable in the next five years:….more

Turmoil threatens Africa’s state-owned airline model

Ethiopia, indelibly linked with images of grinding poverty and famine, has quietly built one of Africa’s rare corporate success stories, with the continent’s only consistently profitable airline shuttling passengers from around the world through its hub in Addis Ababa.

Yet just as state-owned Ethiopian Airlines starts to vie with the likes of Dubai-based Emirates, outbreaks of violence around ethnic and human-rights protests have claimed an estimated 500 lives since June, threatening to deter travellers and undermining the political stability that helped it flourish. It is also grappling with the challenges of doing business in the region, with more than $200m in ticket payments tied up in countries including Nigeria and Angola, which the airline says is putting pressure on its liquidity. …more

Looming crisis for SA healthcare as specialists face 30% pay cut

A new overtime policy introduced by the national Department of Health could see some doctors in the public sector facing a pay cut as high as 30% in January.

Several KwaZulu-Natal doctors speaking to News24 on condition of anonymity have warned of a mass exodus of specialists from the public sector to the private sector if the policy is implemented.

The doctors, most of whom are specialists, raised concerns after the South African Medical Association (Sama) released a statement on Wednesday saying it intended lodging a formal dispute with the National Bargaining Council after the department’s decision….more

WHO: Family practice: towards universal health coverage

This advocacy video highlights the role of family practice in moving towards universal health coverage and demonstrates the 13 key elements of the family practice approach. It is directed at regional decision-makers and directors in the field of service delivery, care providers and communities and aims to build awareness on the family practice approach as a model for integrated health care service delivery.  The video includes messages from senior WHO experts about the implementation of family practice in the Eastern Mediterranean Region…..more