What NDZ stands for

The crowd packed into the Osizweni Community Hall is oblivious to the bitter Tuesday night cold as ANC presidential hopeful Dr Nkosazana Dlamini-Zuma wraps up her address to a party cadres’ forum in the township in Newcastle, KwaZulu-Natal.

The crowd – predominantly women and young people from the ANC’s Emalahleni region – breaks into Dlamini-Zuma’s unofficial campaign anthem, On Your Marks, Get Set, We Are Ready for Nkosazana…..more


Traditional Birth Attendants 2015

This is the TBAs Video that was shot in 2015, the 10th Anniversary of the Association of TBAs in Cross River State, Nigeria. It was shot by the Dr Bassey Kubiangha Education  Foundation (BK Foundation) whose main objective is Health Promotion in the state. The President of the Association was informed about the visit but there were no prepared questions and she did not know that the interviewer would request to talk to the mothers. Their answers were carried verbatim.

The CRS TBA Association, 12 years on, still meets on the last Friday of every month in the main hall of BK Foundation in Calabar, Nigeria. The agenda routinely includes lectures from invited skilled health workers from medical doctors to Nurses and Midwives.

Obviously the experience varies from country to country and within country too. Many countries still cite WHO as the organization whose recommendation makes them ignore TBAs. We look forward to that a clearer recommendation from the WHO on the role of this cohort of human resource because that will better guide countries on what to do given that the shortage of skilled manpower is not about to end in the near-term. In our experience TBAs are trainable and can play a positive role in care of pregnant women in LMICs if trained, equipped and monitored effectively.

Joseph Ana.

Africa Center for Clin Gov Research & Patient Safety

@ HRI West Africa Group – HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria


WONCA E-Update Friday 29th September 2017

WONCA E-Update
Friday 29th September 2017

WONCA News – September 2017
The latest WONCA News (September 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

Rural Roundup
This month’s “Rural Roundup” is written by Jesse Rockmore, a 4th year osteopathic medical student in the United States. As a member (and current Chair) of the National Rural Health Association Student Constituency Board, he is excited to share his personal experiences in rural health and the goals of the NRHA Student Group with rural physicians worldwide. Originally from a small town in the lower Appalachian Mountains in Georgia, poor access to primary and surgical care in his small town compelled him to pursue a career in rural health care. Read more about his choice of rural health, and why he chose osteopathic medicine.

WONCA SIG on Migrant Care, International Health and Travel Medicine
Continuing our series of reports on WONCA’s Special Interest Groups (SIGs); this week we feature the WONCA SIG on Migrant Care, International Health and Travel Medicine. As the Convenor, Dr Maria van den Muijsenbergh, reports, this WONCA SIG was established in 2008 with the aim of improving the knowledge and skills of general practitioners as well as the organizational and financial conditions to deliver culturally competent, good quality primary care to migrants of all kinds: travellers, economic migrants as well as refugees including the undocumented. As of July 2017, the SIG has grown to a group of 60 members, from 18 different nations. Its members are involved in international research, medical (postgraduate) education and health care delivery related to refugees and other migrants and travellers. This has been of especial significance in recent years, given the migrant crisis in Europe and other regions – and more recently in Bangladesh

2018 WONCA Europe Conference in Krakow

WONCA Europe and the College of Family Physicians in Poland are pleased to invite you to the 23rd WONCA Europe Conference which will be held from 24th to 27th May 2018 in Krakow, Poland. Krakow is a charming, mediaeval city, and an old capital of Poland, and offers its tradition, history, culture and unforgettable magical atmosphere, which attracts millions of visitors each year. The theme is “Family Medicine: Quality, Efficiency, Equity”, and keynote speakers include Prof. Michael Kidd, and Drs Sera Tort, Andrzej Rys, and Mukesh Chawla.

PEARLS – Practical Evidence About Real Life Situations
PEARLS are brief (minimalistic summaries) of Cochrane Primary care systematic reviews with the answer in the title (so you only read the ones you like). The following have just been added to the WONCA website:

520 Mixed evidence on interventions for improving outcomes in patients with multi-morbidity
519 Limited benefit from non-steroidal anti-inflammatory drugs for chronic low back pain
518 Limited evidence for benefits of interventions to reduce sitting at work
517 Skin grafting and tissue replacement effective for diabetic foot ulcers
516 Legislative smoking bans improve health outcomes
515 Over-the-counter artificial tears effective for dry eye syndrome
514 Therapist-supported internet CBT effective for adult anxiety disorders
513 Limited evidence for effectiveness of home-based end-of-life care
512 Topical steroids effective for scalp psoriasis
511 Herpes zoster vaccine effective in older adults

Position Vacancy – Ulster University Foundation Dean of School of Medicine and Professor 

Ulster University is establishing a Graduate Entry Medical School with a particular emphasis on primary care and rural health. The University wishes to appoint an outstanding individual to lead development of the school. The appointment to Professor will be a permanent appointment, whist the Foundation Dean appointment will be for a period of four years in the first instance. Closing date for applications is 30th October 2017 and further details can be found at www.ulster.ac.uk/jobs or via the WONCA Global Jobs portal – www.woncarecruitment.com

MEC Gwen Ramokgopa spells out problems with health system

Poor management is at the heart of the issues plaguing the Gauteng health department, according to its political head, health MEC Gwen Ramokgopa.

Ramokgopa told Business Day on Wednesday that the poor management system, coupled with inadequate control and insufficient performance management, needed to be dealt with in order to advance public health in the province.

The MEC’s view is in line with the findings and recommendations contained in a ministerial task team report presented to Parliament’s portfolio committee on health by the health minister last week……more

Smokers with HIV 10x more likely to die from lung cancer

People living with HIV who adhere to antiretroviral therapy but smoke cigarettes are around 10 times more likely to die from lung cancer than from HIV itself, according to a study led by researchers at Massachusetts General Hospital (MGH). The report suggests that lung cancer prevention through smoking cessation should be a priority in the care of people living with HIV…..more

Disguised Uganda minister catches corrupt hospital workers

Uganda’s State Minister of Health for General Duties disguised herself as a patient and caught two medical workers demanding a bribe for free government services.

Health State Minister for General Duties Sarah Opendi said in a report in The Independentthat she wore a face veil and travelled to a hospital in the capital Kampala on a boda-boda (motorbike taxi) to disguise her identity.

“I received many complaints that the staff at the hospital was extorting money from patients,” Opendi said…..more

Cosatu backs NHI but expert says state workers’ benefits will be majorly cut

Trade union federation Cosatu is pushing for the state’s National Health Insurance (NHI) plan to be implemented‚ but not every union is happy about workers losing medical scheme subsidies of between R1‚000 and R3,000 a month.

There are about 8.8-million people on medical schemes in SA.

TimesLIVE calculated that there were at least 2.2-million beneficiaries on government medical schemes‚ including 1.7-million on the Government Employee Medical Scheme (Gems), about 500‚000 on Polmed and just more than 5‚000 on smaller schemes such as the SABC and parliamentary schemes.

GEMS members who earn as much as R3‚000 a month in medical scheme subsidies could lose this if the government gets its way. This is unlikely to be allowed by workers‚ says healthcare analyst Johann Serfontein…..more

WONCA E-Update Friday 15th September 2017

WONCA E-Update
Friday 15th September 2017

WONCA News – September 2017
The latest WONCA News (September 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

Policy Bite: PHC funding as a percentage of total healthcare spending
This month’s guest policy bite comes from the American Board of Family Medicine and the Robert Graham Center, in the USA. The ABFM is the national certifying board for nearly 90,000 family physicians. The Graham Center is a research center which aims to improve individual and population healthcare delivery through the generation or synthesis of evidence that brings a family medicine and primary care perspective to health policy deliberations from the local to international levels. Both organizations frequently collaborate on research that informs primary health care, population health, and health policy.

Their paper – Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries –looks at whether primary health care is adequately funded to ensure access, provide protection against catastrophic expenditures, and ensure equitable use of resources.

SIG on Conflict and Catastrophe Medicine
This week we highlight the work of the WONCA Special Interest Group on Conflict and Catastrophe Medicine. This SIG provides a coordinated forum through which WONCA lends its support to improving the quality of care of peoples of the world when they face some of life’s greatest challenges. Prof Rich Withnall (UK), Convener of the SIG, provides the group’s annual report for 2016-2017.

WHO – Patient Safety and Risk Management
The Patient Safety and Risk Management unit at WHO HQ in Geneva has announced the roll-out of their updated patient safety website. The website has been updated to include the most recent WHO initiatives and resources in patient safety. A navigation panel on the left of the page allows for quick access to important content areas, ranging from policies and strategies to education and training to patient engagement. The ‘Publications’ page includes a library of all WHO patient safety publications all accessible from one page, separated into topic areas and chronological order.

Super Early bird registration for WONCA Rural 2018: New Delhi – DEADLINE EXTENDED
A final reminder that the deadline for super-early-bird registration for the 15th WONCA World Rural Health Conference – planned for New Delhi from 26th to 29th April 2018 – has been extended until 15th September.

‘I would buy the HIV home test because it’s easier than being disrespected by nurses’

South Africa is one of about three dozen countries that supports HIV self-testing, but will it catch on? Here’s what people who live here had to say.

It’s been almost two years since the South African Pharmacy Council approved the over-the-counter sale of HIV self-testing kits. The kits are now available at pharmacies for between R60 and R160.

South Africa is one of 40 countries that have incorporated self-testing as part of its national HIV testing guidelines, says the World Health Organisation. The body recommended in 2016 that do-it-yourself diagnostics should be offered alongside traditional testing at clinics to help more people know their HIV status. The national health department is expected to have new draft guidance on how self-testing should work in the country by September.

For years, the idea of testing for HIV in the comfort of your own home – and without a counsellor – sparked fears that it might put people who test positive at risk of, for example, suicide. But these fears have not been borne out in studies from Malawi and increasing data from South Africa as organisations like Doctors Without Borders (MSF) and others find new ways to use the DIY test. So far, the lure of added privacy and convenience seems to be doing the trick to get people to self-test…..more

Moribund ANC’s salvation lies in losing next election

A decade of President Jacob Zuma’s leadership has brought the ANC to the point of no return: it is finished, and a better version can emerge only if it loses the 2019 election.

The ANC has undergone many transformations during its history, but few periods have seen changes as radical since Jacob Zuma became ANC president in December 2007. The only comparable period, in disruption, but not in content, was the Mandela-Sisulu revolution in the mid-1940s….more

A decade is a long time, even for a body 105 years old — enough time to inflict permanent changes in its composition, nature, structure and function.

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

Introduction:  Deployment and retention of a sufficient number of skilled and motivated human resources for health (HRH) at the right place and at the right time are critical to ensure people’s right to access a universal quality of health care. Vision Tokyo 2010 Network, an international network of HRH managers at the ministry of health (MoH) level in nine Francophone African countries, identified maldistribution of a limited number of healthcare personnel and their retention in rural areas as overarching problems in the member countries. The network conducted this study in Senegal to identify the determining factors for the retention of qualified HRH in rural areas, and to explore an effective and feasible policy that the MoH could implement in the member countries.
Methods:  Doctors, nurses, midwives and superior technicians in anesthesiology who were currently working (1) in a rural area and had been for more than 2 years, (2) in Dakar with experience of working in a rural area or (3) in Dakar without any prior experience working in a rural area were interviewed about their willingness and reasons for accepting work or continuing to work in a rural area and their suggested policies for deployment and retention of healthcare workers in rural areas. In-depth interviews were conducted with policy makers in MoH, asking for their perceptions on human resource management in health and about their suggested policies for deployment and retention.
Results:  A total of 176 healthcare workers and eight policy makers were interviewed. The willingness to face challenges in a new place was one of the main reasons for accepting work in rural areas. The identified factors to motivate or demotivate healthcare workers in rural areas were related to pre-service and in-service education, regulatory systems, financial and non-financial incentive schemes and environmental support. Factors not included in WHO’s global recommendation but highly valued in this study were (1) the fairness, transparency and predictability of human resource management by the MoH and (2) employment status, ie permanent government staff versus contract staff. Financial incentive schemes were less commonly suggested. Family bonding and religious-related non-financial incentive schemes were found to be specific factors in Senegal, but would also be applicable in countries where family and religion play important roles in the values of healthcare workers.
Conclusions:  Improved HRH management, eg the transparency of human resource management by the MoH, was identified as a pre-condition of any policy implementation related to HRH. This factor can be considered in other countries struggling to retain healthcare workers in rural areas. The Vision Tokyo 2010 Network or HRH managers’ network in Francophone Africa, Senegal MoH and the research team plan to conduct a quantitative survey to confirm the generalizability of the results of this qualitative survey, and to identify the most effective combination of policies to improve the retention of qualified healthcare workers and seek their implementation in other countries in the region as network activities.

Citation: Nagai M, Fujita N, Diouf IS, Salla M.  Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study. Rural and Remote Health (Internet) 2017; 17: 4149. Available: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=4149 (Accessed 15 September 2017)

VACANCY for Emergency Medicine Doctor

MSF.pngVACANCY for Emergency Medicine Doctor

  1. Position Details:
  • Country of Mission: Iraq
  • Location: Baghdad
  • Duration: 6-8 weeks
  1. Key responsibilities:

Primary functions of the job is to resuscitate and stabilize patients then refer them to the appropriate medical departments for further medical management. Other specific responsibilities entails implementing SATS, protocols and training of ER team to achieving a well-functioning ER unit.  The ER MD works as part of a medical team in hospital.

  1. Requirements:
  • Medical Doctor with ER specialisation.
  • Valid Registration with HPCSA
  • Valid Passport
  • Good communication skills
  • Team-player
  • Flexible to work in insecure context.
  1. Benefits :
  • Volunteer stipend.
  • All expenses covered.
  • Professional liability coverage, medical insurance and repatriation cover.
  • Humaniterian and international experience.

Contact MSF


Mandela hospital faces funding crisis

It took R1bn in donations to build the Nelson Mandela Children’s Hospital in Johannesburg, but nine months after its launch party, the world-class facility is not fully open yet and lacks funding to cover operational costs.

Built by the Nelson Mandela Children’s Fund and owned by a trust established by it, it was envisaged that the hospital would be a state-of-the-art facility for children needing cancer treatment, dialysis or heart operations.

It has top-of-the-range equipment, theatres that can broadcast operations to remote locations for training or for communicating with specialists abroad. It looks like a children’s hotel, is decorated with wallpaper inspired by doodles, has free living facilities for 27 families and an in-house radio station…..more

Gauteng health department faces R10.9bn funding gap

WONCA E-Update Friday 8th September 2017

WONCA E-Update
Friday 8th September 2017

WONCA News – September 2017
The latest WONCA News (September 2017) is accessible via the WONCA website, with lots of WONCA news, views and events.

From the President 
Networks, opportunities and prioritisation – does enthusiasm need to be balanced with realism? The President has been in Tanzania at both the Aga Khan University and meeting with the International Federation of Medical Student Associations and has many more international trips throughout the rest of the year. In this month’s column Professor Amanda Howe reflects on what added value a visit from the WONCA President adds to events globally.

SIG on Cancer and Palliative Care
WONCA is blessed with 13 Special Interest Groups, and in the coming weeks we’ll be highlighting the activities of several of them. This week we begin by promoting the activities of the SIG on Cancer and Palliative Care. Dr Annette Berendsen, Convenor of the SIG, provides some details in her report on activities in 2016-17, which you can read here: http://www.globalfamilydoctor.com/News/SIGonCancerandPalliativeCareAnnualReport.aspx

Dr Artenca Collaku – WONCA Featured Doctor
One of this month’s featured doctors is Dr Artenca Collaku of Albania. She works as a family doctor in Health Centre No4 in Tirana, serving a population of around 60,000. During her time as Director of the Centre she got it formally accredited – the first centre accredited in Albania. Together with some other family doctors they founded the Albanian Academy of Family Doctor three years ago and are working to enhance the role and importance of family doctors, through education and scientific activities. You can read more about life as an Albanian family doctor here:

Super Early bird registration for WONCA Rural 2018: New Delhi – DEADLINE EXTENDED
The 15th WONCA World Rural Health Conference will take place in New Delhi from 26th to 29th April 2018. The organizers have advised us that the deadline for super-early bird registration has now been extended until 15th September, so there is still time to take advantage of the very special delegate rates.

Want to know how good your doctor is?

If patients had better information about private health providers, this would stimulate competition, says the Health Market Inquiry. Patients should be able to compare the performance of private hospitals and doctors before making their choice, according to the Competition Commission’s Health Market Inquiry (HMI)
The HMI proposed this week that an independent organisation, the Outcomes Measurement and Reporting Organisation (OMRO), be set up to report on the health outcomes of private healthcare providers. It defines outcomes as “the results achieved for a patient after a given set of interventions”.
For much of last year, the HMI held public hearings into the private healthcare sector. One of its finding is that the public lacks information about how private health providers perform. It believes that public access to this information would stimulate competition. The kind of information they want us to have include clinical outcomes (eg cure rates), how long it takes for patients to get treated at facilities, the infection rate in facilities and the rate of “avoidable adverse events”…..more

We don’t want no ‘ethics what-what’

An issue that has lingered in the presidency for the past seven years came to a head in Parliament this week – and, in an ironic move, a former ally of President Jacob Zuma was the one agitating to put the matter to rest.

ANC MPs tried to stonewall an attempt by Parliament’s justice portfolio committee to comply with the remedial actions put forward by former public protector Thuli Madonsela in her State of Capture report.

But in an ironic twist, committee chairperson Mathole Motshekga argued against further delaying the matter. Even the DA was moved to say that, for once, it agreed with the former ANC chief whip. The DA is usually at loggerheads with Motshekga.

It all started back in April 2010, when Madonsela recommended that Parliament amend the Executive Members’ Ethics Act, a law that governs the conduct of Cabinet members, deputy ministers and members of provincial executive councils….more

A shift in thinking is needed to counter South Africa’s startling rise in poverty

South Africa urgently needs new policy ideas to reverse the alarming increase in poverty among its population. New figures reveal an increase of three million South Africans living in poverty over the last five years. More than half (55%) of the population lives on less than R1,138 (USD$107) a month, up from 53% in 2011.

In a country with 55 million people, 34 million are going without some of the basic necessities, like housing, transport, food, heating and proper clothing. The escalation in hardship and vulnerability reverses the steady progress made since the 1990s.

The poorest have been hit the hardest. One in four citizens survives on less than R531 a month and can’t afford to buy enough food to keep healthy. This proportion has risen from one in five in 2011.

The consequences are plain to see. They include more street begging, homelessness, loan sharks, social discontent, substance misuse and violent crime in many communities. Income is not the only measure of poverty. Progress on education, health and basic living conditions also seems to have stalled….more