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16th World Congress on Public Health Rome, 2020

16th World Congress on Public Health Rome, 2020

Midwifery crisis in Africa: the introduction of the human resources information systems

 Authors: Silvia Ussai Researcher, Francesca Palestra

 Keywords

Midwife, work capacity, information system

 Background

 Each year, 2.7 million newborns die during their first day of life: a number that equals the entire population of Namibia. In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants such as a midwife, who is trained to manage normal pregnancy and childbirth.

 Researchers estimatea 56% of maternal, fetal and neonatal deaths reduction in case of midwife assisted delivery.

 The 73 African, Asian and Latin American countries, represented in the State of the World's Midwifery (SoWMy) 2014, suffer from 96% of the global burden of maternal deaths, 91% of stillbirths and 93% of newborn deaths. However, these Statesface a critical shortage of health professionals, particularly nurses and midwives. This article describes the Human Resources for Health (HRH).

The abstract urges countries to invest in education and training in midwifery is to strengthen health service delivery and to achieve health equity for the poor.

Investments in education and training in midwifery with agreed international standards can generate, as evidenced by a pilot study from Bangladesh, up to 16 times the return on investment.

According to the 2006 World Health Report, 57 countries were in severe health workforce crises, with 37 of these in sub-sahara region—a region with only 3% of global health workforce, despite contributing about a quarter to the global disease burden.

 Methods

Authors propose an integrative review involving a mapping exercise of the literature. The search included peer reviewed research and discursive literature published between 2000 and 2020 on healthcare workers capacitation.

Results

 Research shows that steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening.

 Central Africa Republic, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Liberia, Madagascar, Rwanda, Sierra Leone, Uganda and Tanzania all experience a midwife density per 1000 population lower than 1.

A shortage of skilled and qualified healthcare workers remains one of the major bottlenecks toward the availability of accessible high-quality healthcare also in Botswana.

Specific midwifery strategies and economic analyses will enable countries to fill the gap in their national health work force.

 Improved service provision may be associated with development of supervision systems like the introduction of a human resources information system to help mobilise domestic resources.

 This review also looks at the level and the relative importance of each revenue.

 Conclusion

 Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.

Our findings set the ground for future research investigating healthcare workforce issues and support evidence-based planning for health human resources. Information systems may contribute to the development of national and local policies in the country, which address the human resources needs of the health care system to meet regional and national demands.

 References

 World Health Organization. The World Health Report 2006—working together for health. Geneva: World Health Organization; 2006.

 Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, et al. Human resources for health: overcoming the crisis. Lancet. 2004;364(9449):1984–1990.

 Dovlo D. Migration of nurses from sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;32(3):1373–1388.

 Dawson A, Brodie P, Copland F et al, Collaborative approaches towards building midwifery capacity in low income countries: a review of experiences. Midwifery2014 Apr;30(4):391-402.

Kinfu Y, Dal Poz MR, Mercer H, et al. The health worker shortage in Africa: are enough physicians and nurses being trained? Bull World Health Organ. 2009 Mar;87(3):225-30.

 Bergen N, Hudani A, Asfaw S et al. Promoting and delivering antenatal care in rural Jimma Zone, Ethiopia: a qualitative analysis of midwives' perceptions. BMC Health Serv Res. 2019 Oct 21;19(1):719.

 Nakano K, Nakamura Y, Shimizu A et al. Exploring roles and capacity development of village midwives in Sudanese communities. Rural Remote Health. 2018 Oct;18(4):4668.

 Asamani JA, Chebere MM, Barton PM et al. Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016-2026. Int J Health Policy Manag. 2018 Nov 1;7(11):1040-1052.

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The Italian health system and the COVID-19 challenge

The Italian health system and the COVID-19 challenge

Italy is facing a massive burden from the coronavirus disease 2019 (COVID-19) pandemic. Since Feb 21, 2020, when the first case of COVID-19 was recorded in Italy, the National Healthcare Service, which offers universal access to health care, has faced increasing pressure, with 41 035 total cases of COVID-19 and 3405 deaths as of March 19, 2020.

 In the most affected regions, the National Healthcare Service is close to collapse the results of years of  fragmentation and decades of finance cuts, privatisation, and deprivation of human and technical resources.

 The National Healthcare Service is regionally based, with local authorities responsible for the  organisation and delivery of health services, leaving the Italian Government with a weak strategic leadership. Over the period 2010–19, the National Healthcare Service suffered financial cuts of more than €37 billion, a progressive privatisation of health-care services. Public health expenditure as a proportion of gross domestic product was 6·6% for the years 2018–20 and is forecast to fall to 6·4% in 2022.

 The Lombardy region has the heaviest burden of the COVID-19 pandemic, with (as of March 19, 2020) 19 884 total cases of the disease, 2168 deaths, and 1006 patients requiring advanced respiratory support. At its standard operational level, Lombardy has a capacity of 724 intensive care beds.3 To tackle the medical equipment shortage, Italian Civil Protection undertook a fast-track public procurement to secure 3800 respiratory ventilators, an additional 30 million protective masks, and 67 000 severe acute respiratory

syndrome corona virus 2 (SARS-CoV-2) tests.4 To avert the shortage of health workers produced by decades of inadequate recruitment practices, the Italian Government authorized regions to recruit 20 000 health workers, allocating €660 million for the purpose.

 There are lessons to be learned from the current COVID-19 pandemic. First, the Italian decentralisation and fragmentation of health services seems to have restricted timely interventions and effectiveness, and stronger national coordination should be in place. Second, health-care systems capacity and financing need to be more flexible to take into account exceptional emergencies. Third, in response to emergencies, solid partnerships

between the private and public sector should be institutionalised. Finally, recruitment of human resources must be planned and financed with a long-term vision. Consistent management choices and a strong political commitment are needed to create a more sustainable system for the long run.

 Saverio Bellizzi

Medical epidemiologist

Benedetta Armocida, Luca Cegolon, Francesca Palestra, Antonio Manca, Giuseppe Pichierri, Silvia Ussai

Geneva

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Clinicians are leading service reconfiguration to cope with covid-19

Reconfiguration of health services to cope with COVID-19 is ongoing also in Italy. On 25 March 2020, the Italian Ministry of Health published an update on COVID-19 guidelines for hospital preparedness. Among others, it includes i) the option to convert several facilities and hospitals into COVID-19 medical hubs and ii) plans to cancel elective and non-urgent procedures to expand hospitals’ capacity to provide critical care. The decision can also affect abortion care, increasing the risk to make the voluntary interruption of pregnancy inaccessible.

To date, pharmacologically induced abortion (Mifepristone, RU486) accounts for 17% of the total pregnancy interruption interventions performed in Italian public hospitals. The procedure requires up to three-days hospitalization for women, in order to reduce excessive uterine bleeding and infection risks associated with the abortion pill. Medical abortion is only considered an outpatient procedure in five out of 20 Italian regions, while surgical abortion is usually a one-day procedure. Therefore, RU486 does not represent the preferred choice to perform pregnancy termination, given this unjustifiable refinement of the Diagnosis-Related Group (DRG) system.

In UK the government recently approved the temporary use of abortion pills at home to avoid the risk of COVID-19 infection for women attending clinics. This leads to an unprecedent change in abortion policy of the Country . Furthermore, the World Health Organization, under specific circumstances, welcomes the self-management of the abortion pill without direct supervision of a health care provider during the first trimester. On this basis, COVID-19 pandemic imposes on the Italian healthcare system the need to: i) improve women’s access to abortion care, including the introduction of e-consultation; ii) ensure continued access to key services with early medical abortion pills delivered at home; iii) protect public safety either for women and abortion care staff avoiding unnecessary facility visits.