In this post in the IntraHealth “Global Health Blog,” Kate Tulenko, senior director of health systems innovation at IntraHealth, provides an excerpt of her recently published book, “Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad,” in which she argues that the practice of “relying on foreign-born health workers to fill health care gaps, particularly in providing primary care … has dire economic and social consequences, threatening the quality of medical care in both source countries and the U.S.” (8/30). The blog also links to a recent interview by IntraHealth in which Tulenko discusses the issues raised in her book (8/29).
Health Workforce & Capacity
“Abortions are just as safe when performed by trained nurse practitioners, midwives and physician assistants as when doctors do them, a new review of the evidence suggests,” Reuters reports. “Researchers analyzed five studies that compared first-trimester abortion complications and side effects based on who performed the procedures in close to 9,000 women — and typically found no differences,” the news service writes. The review is published in BJOG: An International Journal of Obstetrics and Gynaecology, according to the news service.
This Lancet editorial reflects on a medical crisis in Syria, highlighting a new report (.pdf) by Amnesty International that “documents the human rights abuses already occurring in the city.” The editorial states, “A disturbing feature of modern conflicts and, indeed, the Arab uprisings, has been the flagrant disregard for the Geneva Conventions, including targeting of civilians, persecution of health workers, and attacks on hospitals, alongside the failure of the U.N. system to prevent these violations,” and it highlights several examples cited in the report.
A study led by World Bank economist Jishnu Das and published in Health Affairs on Monday examines the quality of primary care delivered by private and public health care providers in rural and urban India, a World Bank press release notes. The study found many providers do not have medical degrees; the quality of medical training is low; and less than half of providers provide correct diagnoses, according to the press release, which says the results show an “urgent need” to carefully measure the quality of care. “The study could help policymakers make evidence-based decisions,” the press release notes, adding, “In November, the government announced a five-year plan to triple health spending and improve the quality of health services” (12/3).
“Three workers in a polio eradication campaign were shot in Pakistan on Wednesday, and two of them were killed, the latest in an unprecedented string of attacks over the past three days that has partially halted the U.N.-backed campaign,” Reuters reports (Ahmad, 12/19). “Earlier on Tuesday, five health workers involved in the vaccination drive were killed in the cities of Karachi and Peshawar,” News Pakistan notes (12/19). Another health care worker was killed on Monday, according to a statement issued Tuesday by the WHO, UNICEF and the Pakistani and provincial governments, which condemned the multiple attacks. “We call on the leaders of the affected communities and everyone concerned to do their utmost to protect health workers and create a secure environment so that we can meet the health needs of the children of Pakistan,” the statement said (12/18). The Associated Press reports the WHO suspended the vaccination campaign in two of the country’s provinces (Khan, 12/19). However, CNN reports the “attacks prompted authorities to suspend the campaign throughout the country” (Khan, 12/19). “Under the canceled program, Pakistani health officials planned to administer millions of ‘polio drops’ to immunize people,” according to International Business Times, which adds, “The program involved 25,000 workers targeting more than 30 million children” (Ghosh, 12/18).
The AIDS.gov blog recaps some of the major themes of the mHealth Summit: Connecting the Mobile Health Ecosystem, which was held at the beginning of December in Washington, D.C. According to the blog, these include the effectiveness of wireless technology in health programs; the importance of policy, infrastructure, and ownership; and the need for health literacy in any intervention. Noting “the Summit has grown from 800 attendees to thousands” in four years, the blog adds that more information about the meeting is available online at mhealthsummit.org (12/18).
Seattle Times Examines Partnership Between Hutchinson Cancer Research Center, Uganda Cancer Institute
The Seattle Times examines a partnership between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute (UCI). In 2008, “the two institutes formally agreed to collaborate on clinical care and research projects, and more recently a major building project at Uganda’s only cancer-research center,” the newspaper writes. Corey Casper, director of the UCI/Fred Hutchinson Research Center Cancer Alliance, “says [the partnership] has the potential to demonstrate ‘that you can do first-rate research that can alter the impact of cancer care in the developing world, and that the craft of oncology can be practiced as well in Africa as it is in the developed world, just like it is with HIV,'” according to the Seattle Times (Silberner, 12/16).
Chris Endean of the GAVI Alliance writes ahead of the GAVI Partners Forum in a CNN opinion piece about efforts to vaccinate members of the Maasai tribes in Tanzania’s Arusha National Park. Noting Maasai tribes are “constantly on the move searching for water and fresh pasture for their cattle,” he describes “severe logistical challenges” health workers face when trying to reach their patients and notes, “The need to get to hard-to-reach people like the Maasai and the rest of the estimated eight percent of Tanzania’s population that do not receive basic life-saving vaccines has taken on a new urgency with the country’s recent launch of a five-year development plan” called the “One Plan.” Endean notes the forum is taking place in the country’s capital, Dar es Salaam, and that during the event, “the health ministry will launch two new vaccines into the national immunization program — pneumococcal and rotavirus — tackling the primary causes of pneumonia and diarrhea — two of the leading killers of under-fives in Tanzania” (12/5).
IRIN reports on the HIV/AIDS response in Guinea-Bissau, writing, “One year after the Global Fund to Fight AIDS, Tuberculosis and Malaria reduced funding to the Guinea-Bissau government body in charge of coordinating HIV prevention and treatment activities, health centers outside the capital are facing medicine shortages, patients are not receiving the treatment they need, and the transport of patients to treatment centers has been cut.” According to the news service, “The Global Fund stopped most of its funding to the Secretriado National de Luta Contra le Sida (SNLS), the government structure in charge of coordinating the HIV response, at the end of 2011, because of poor performance management and a lack of transparent fiduciary controls.”
PRI’s “The World” this week features a series examining the challenges of addressing cancer in the developing world. The series, produced in collaboration with the Pulitzer Center on Crisis Reporting, includes radio stories, multimedia features, an interactive map, and infographics, according to the main page. The radio stories examine cancer prevention, control, and research efforts in Uganda, Haiti, India, and the U.S. (12/3). In an interview with the series’ principal reporter, Joanne Silberner, Lancet editor Richard Horton said, “Cancer is certainly being under-recognized and neglected in low- and middle-income countries. … I think cancer is slowly becoming more recognized but there is a long way to go before it gets the attention it so urgently needs (12/3). On December 5, PRI will host a Facebook chat from 10am-4pm EST that will feature Silberner and cancer researchers and advocates (12/4).