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BACKGROUND: Public health emergencies of international concern (PHEICs) as the COVID-19 pandemic and others that have occurred since the early 2000s put enormous pressure on health and care systems. This is being a context for protests by health and care workers (HCWs) because of additional workload, working conditions and effects on mental and physical health. In this paper, we intended to analyze the demands of HCWs associated with industrial actions, protests, strikes and lockouts (IAPSLs) which occurred during COVID-19 pandemic and other PHEICs; to identify the impact of these grievances; and describe the relevant interventions to address these IAPSLs. METHODS: We included studies published between January 2000 and March 2022 in PubMed, Embase, Scopus, BVS/LILACS, WHO's COVID-19 Research Database, ILO, OECD, HSRM, and Google Scholar for grey literature. Eligibility criteria were HCWs as participants, IAPSLs as phenomenon of interest occurring in the context of COVID-19 and other PHEICs. GRADE CERQual was used to assess risk of bias and confidence of evidence. RESULTS: 1656 records were retrieved, and 91 were selected for full-text screening. We included 18 publications. A system-wide approach, rather than a limited approach to institutions on strike, makes it possible to understand the full impact of the strike on health and care services. PHEICs tend to aggravate already adverse working conditions of HCWs, acting as drivers for HCWs strikes, leading to staff shortages, and financial issues, both in the North and in the Global South, particularly evident in Asia and Africa. In addition, issues related to deficiencies in leadership and governance in heath sector and lack of medical products and technologies (e.g., lack of personal protective equipment) were the main drivers of strikes, each contributing 25% of the total drivers identified. CONCLUSIONS: It is necessary to focus on the preparedness of health and care systems to respond adequately to PHEICs, and this includes being prepared for HCWs' IAPSLs, talked much in the context of COVID-19 pandemic. Evidence to assist policymakers in defining strategies to respond adequately to the health and care needs of the population during IAPSLs is crucial. The main impact of strikes is on the disruption of health care services' provision. Gender inequality being a major issue among HCWs, a proper understanding of the full impact of the strike on health and care services will only be possible if gender lens is combined with a systemic approach, rather than gender-undifferentiated approaches limited to the institutions on strike.
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COVID-19 , Personal de Salud , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Personal de Salud/psicología , Pandemias , Salud Pública , Huelga de Empleados , Carga de TrabajoRESUMEN
Objective: To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. Method: The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. Results: The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. Conclusion: The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.
Objetivo: Calcular el indicador del consumo de alcohol per cápita en Brasil a partir de datos nacionales, con miras a establecerlo como patrón de referencia para el país en sustitución del indicador calculado anteriormente por la Organización Mundial de la Salud a partir de datos internacionales. Métodos: Se seleccionaron las fuentes públicas de datos de Brasil necesarias para estructurar el cálculo del consumo de alcohol per cápita registrado y se definió la concentración de alcohol por clase de bebida. Para las variables de consumo de alcohol per cápita por parte de turistas y consumo per cápita no registrado, que no están disponibles en Brasil, se utilizaron estimaciones de las Naciones Unidas y de la Organización Mundial de la Salud. Se calculó el indicador del consumo de alcohol per cápita en Brasil y se comparó con el indicador elaborado por la OMS mediante un análisis de las medianas correspondientes al período 2005-2020. Resultados: El indicador nacional del consumo de alcohol fue de 9,2 litros per cápita en el 2005, con un aumento a 9,8 en el 2020. El indicador de la Organización Mundial de la Salud mostró un consumo de 8,4 litros per cápita en el 2005, con una reducción hasta el 2016 y un leve aumento a 7,8 en el 2020. Conclusión: Se calculó el consumo de alcohol per cápita en Brasil a partir de fuentes nacionales, lo que mostró una tendencia distinta de la tendencia descendente del indicador de la Organización Mundial de la Salud. La disponibilidad transparente y regular de este indicador por medio de los canales gubernamentales permitirá su seguimiento, con lo cual se podrán formular políticas para enfrentar el consumo de alcohol en el país.
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Introduction: Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services. Methods: Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible. Results: A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals. Discussion: This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.
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Personal de Salud , Huelga de Empleados , Humanos , África del Sur del Sahara , Personal de Salud/estadística & datos numéricos , Médicos/estadística & datos numéricosRESUMEN
BACKGROUND: The Bacillus Calmette-Guérin vaccine (BCG) against tuberculosis (TB) shows beneficial nonspecific effects, which are likely related to innate immune training. Until 2016, a single BCG dose was administered to all newborns in Portugal. In July 2016, a clinical guideline established that only children under 6 years belonging to high-risk groups should receive BCG. This might have prevented nonvaccinated children from developing trained immunological responses as effectively as BCG-vaccinated children. OBJECTIVE: This study aims to investigate if there is variation in TB-related and all-cause mortality, and severe, moderate, or mild morbidity in children under 5 years of age, and whether such variation might be explained by the BCG vaccination policy change in 2016. METHODS: This population-based historical birth cohort study includes children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021. Newborns with low birth weight, premature status, or known or suspected HIV infection are excluded. The follow-up period is until the completion of 5 years of age or the end of follow-up (June 30, 2021). The study will use secondary data from the National Health Service user registry, death certificate database, vaccination registry, communicable diseases surveillance system, TB surveillance system, diagnosis-related group information system for hospital admissions and emergency department visits, and primary health care information system. The data will be linked. Primary outcomes include person-time incidence rates of death (all causes and TB), TB diagnosis, and all causes and some specific causes of severe, moderate, or mild morbidity, and the incidence rate ratio of nonvaccinated to BCG-vaccinated children. We will compare the probability of surviving the first and fifth years of life or of not having severe, moderate, or mild morbidity during the follow-up period according to exposure (BCG vaccinated or nonvaccinated, number of doses, and time from birth until the first dose), using the log-rank test for assessing differences in survival rates between exposed and nonexposed children and hazard ratios for quantifying the differences. Moreover, we will perform a proportional hazards regression analysis. RESULTS: Ethics approval has been obtained. In March 2022, database owners were contacted to present the project and discuss the request for data. A unique identifier will be used. In July 2023, a process of redefinition of the variables per database was initiated. Data were received in October and November 2023. In November 2023, further work was conducted. By April 2024, we expect to start analyzing the full data set. CONCLUSIONS: The results will contribute to the accumulating body of knowledge and might have relevance to guide global BCG vaccination policy. Data linkage can contribute to a swifter mechanism to use available health data to conduct population-based studies and inform policy decision-making. TRIAL REGISTRATION: ClinicalTrials.gov NCT05471167; https://clinicaltrials.gov/study/NCT05471167. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55332.
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BACKGROUND: Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). METHODS: We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. RESULTS: The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. DISCUSSION: PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.
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COVID-19 , Humanos , COVID-19/epidemiología , Pandemias , SARS-CoV-2 , Salud Pública , Calidad de Vida , Estudios Transversales , Urgencias Médicas , PolíticasRESUMEN
In this article we argue that the Member States of the European Union (EU) have consistently, since its inception, developed a shared framework to measure, monitor and intervene to improve the health status of its population, while invoking the subsidiarity principle for the health sector. As a result, a European Health Union (EHU) has been emerging insidiously and consistently, following the concept of a system for health. Using the World Health Organisation Building Blocks Framework, we analyse the normative and institutional developments related to EU citizens' health that have created a de facto EHU. Developments towards an EHU remain unequally distributed among the different building blocks analysed. The existing EHU is the result of a fragmented and incremental process, mostly grounded in governance, health intelligence and services' development. Health crisis, the Commission's agenda-setting activities and market pressures have been the most important push factors for these step-by-step processes.
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Instituciones de Salud , Unión Europea , Organización Mundial de la SaludRESUMEN
Notwithstanding the understandable rationale of the logical, expected and natural evolution of human behaviour towards an anthropocentric view of its relationship with other animals and the environment, a shift from this predatory "Ego-centric" behaviour towards an "Eco" conduct, with regard to their view of the world and of the global health, has become mandatory, contributing to the development of the "One Health" and of "One Health Systems" concepts. We contend for the usefulness of a building-blocks approach to facilitate an understanding of the development of One Health Systems. We assert that a building-blocks approach to One Health Systems with strong similarity to WHO's building-blocks for human health systems would help to strengthen the case for robust,resilient and anti-fragile One Health systems.
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BACKGROUND: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers' safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. OBJECTIVE: The objective of this protocol review is to identify countries' range of experiences with policies and management interventions that can improve health and care workers' capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. METHODS: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization's COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. CONCLUSIONS: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. TRIAL REGISTRATION: PROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327041. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/50306.
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BACKGROUND: The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries' range of policies and management interventions implemented to improve HCWs' capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. METHODS: The literature was searched in PubMed, Embase, Scopus, LILACS-BVS, WHO's COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. RESULTS: The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI's CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). CONCLUSIONS: Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.
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COVID-19 , Humanos , COVID-19/epidemiología , Pandemias , Personal de Salud , Políticas , Recursos HumanosRESUMEN
Prior to the COVID-19 pandemic, adolescents in most countries experienced a syndemic of malnutrition, obesity, deprivation, mental health problems, inequalities, and the effects of climate change. Today, other factors have added to this burden during the pandemic, and it is important to have an updated reflection. We aimed to assess the risk and protective factors for COVID-19-related adolescent mortality and morbidity in the European region. Three double models were fitted to analyze the relationship between different factors with the number of diagnosed cases and deaths. The 1a and 1b use a multiple Poisson regression. The 2a and 2b are optimized models that use the same variables as prior models but with backward selection with a p value < 0.05 as the limit. Finally, the 3a and 3b models (backward stepwise multivariable Poisson regression) include the variable "fully vaccinated." All models used the at-risk population (15-19 years or total population) as a regression covariate (offset). Increased access to quality healthcare (IRR 0.68; CI 0.55-0.84), increased private sector involvement (IRR 0.86; CI 0.82-0.90), Gini coefficient (IRR 0.93; CI 0.88-0.99), and full vaccination (IRR 0.94; CI 0.90-0.99) represent protective factors of COVID-19 mortality in this population. Additionally, a positive association between pollution and mortality was found. Conclusion: Being fully vaccinated and having access to quality medical care are protective factors against COVID-19 mortality in this age group. Interestingly, the more the pollution, the greater the risk of dying from COVID-19. We stress the great importance of coordination between the public and private sectors to address crises such as the current one. What is Known: ⢠Compared to other age groups, adolescents have been little studied, and most studies focused on mental health during the COVID-19 pandemic. What is New: ⢠In this study, we show how in 19 European countries, different factors interact, such as socio-demographic, environmental, health system, and control measures with morbidity and mortality by COVID-19, in a very little studied age group as teenagers.
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COVID-19 , Desnutrición , Humanos , Adolescente , COVID-19/epidemiología , Pandemias , Morbilidad , Europa (Continente)/epidemiologíaRESUMEN
The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.
Foram analisadas tendências da mortalidade prematura por doenças crônicas não transmissíveis (DCNT) entre 1990 e 2019, as projeções até 2030 e os fatores de risco atribuíveis a estas doenças na Comunidade dos Países de Língua Portuguesa (CPLP). Utilizou-se estimativas do estudo Carga Global de Doenças e análise da carga de mortalidade prematura por DCNT para nove países da CPLP, utilizando taxas padronizadas por idade, usando-se RStudio. Portugal, Brasil, Guiné Equatorial, Angola e Guiné Bissau apresentam taxas de mortalidade prematura por DCNT em declínio e; Timor Leste, Cabo Verde, São Tomé e Príncipe e Moçambique apresentaram aumento das taxas. As projeções indicam que nenhum dos países deverá atingir as metas de redução em um terço da mortalidade prematura por DCNT até 2030. A carga de doença atribuível mostrou que os fatores de riscos mais importantes em 2019 foram: pressão arterial sistólica elevada, tabaco, riscos dietéticos, índice de massa corporal elevado e poluição do ar. Conclui-se pelas profundas diferenças na carga de DCNT entre os países, com melhores resultados em Portugal e Brasil e que nenhum país do CPLP deverá atingir a meta de redução das DCNT até 2030.
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Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/epidemiología , Portugal/epidemiología , Factores de Riesgo , Mortalidad Prematura , LenguajeRESUMEN
Research for health and development (R4HD) acknowledges that many of the determinants of health lie outside the boundaries of the health system. The size and quality of the health and care workforce (HCWF) are key drivers towards the future trajectory of many of these factors. We consider researchers for health and development an abiding, pervasive but neglected constituent part of this HCWF. This workforce straddles many professional groups and sectors. The diversity of occupations, lack of standardization in occupational cadres, the complexity and gendered aspects of the labour market, and the variable demographic, epidemiological, socio-economic and health systems' contexts in the global south and the global north, led to a kaleidoscopic perception of the health research workforce that have kept it hidden from public opinion. This led to neglect by science as well as health policymakers and created an orphan sub-set of the HCWF. Understanding the health researchers' labour market will help to identify means to develop, retain and utilize the health research workforce, addressing size, composition, role, skills transferability, careers and social impact through building, enabling or sustaining its research functions, capacity, employment opportunities and career tracks, among other issues. This thematic series of the Human Resources for Health Journal, calls for papers that go beyond narrow conceptual approaches and professional understandings of health care workers and the health research workforce, and requests that contributors examine important workforce issues through the broad lens of R4HD within a sustainable development goals framework.
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Personal de Salud , Fuerza Laboral en Salud , Humanos , Recursos Humanos , OcupacionesRESUMEN
Resumo Foram analisadas tendências da mortalidade prematura por doenças crônicas não transmissíveis (DCNT) entre 1990 e 2019, as projeções até 2030 e os fatores de risco atribuíveis a estas doenças na Comunidade dos Países de Língua Portuguesa (CPLP). Utilizou-se estimativas do estudo Carga Global de Doenças e análise da carga de mortalidade prematura por DCNT para nove países da CPLP, utilizando taxas padronizadas por idade, usando-se RStudio. Portugal, Brasil, Guiné Equatorial, Angola e Guiné Bissau apresentam taxas de mortalidade prematura por DCNT em declínio e; Timor Leste, Cabo Verde, São Tomé e Príncipe e Moçambique apresentaram aumento das taxas. As projeções indicam que nenhum dos países deverá atingir as metas de redução em um terço da mortalidade prematura por DCNT até 2030. A carga de doença atribuível mostrou que os fatores de riscos mais importantes em 2019 foram: pressão arterial sistólica elevada, tabaco, riscos dietéticos, índice de massa corporal elevado e poluição do ar. Conclui-se pelas profundas diferenças na carga de DCNT entre os países, com melhores resultados em Portugal e Brasil e que nenhum país do CPLP deverá atingir a meta de redução das DCNT até 2030.
Abstract The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.
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The health of people, wild and domesticated animals, and natural living systems is syndemically connected, and this interplay is a pillar of the concept of One Health [...].
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Fuerza Laboral en Salud , Salud Única , Animales , Animales Domésticos , Recursos Humanos , Programas de GobiernoRESUMEN
â¢Multidimensionality of AMR determination argues in favour of considering it a glocal syndemic.â¢Lack of attention to syndemic nature of AMR limits the effectiveness of measures taken so far.â¢The syndemic approach provides policy makers with conceptual tools to design effective responses.
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This report revisits data used to describe the typology and the perceived impact of violence against health care workers (VHCW) at the health services of the City of Lichinga in Mozambique, based on an observational, descriptive, cross-sectional study, carried out from March to May 2019. In this report we attempt to understand if our reanalysis of VHCW in Niassa can explain it as an example of gender-based violence. Our findings-particularly that women more than men reported not knowing if the health services had any policies or procedures to deal with VHCW, felt that they were not encouraged to report acts of VHCW and were more frequently threatened/violented by different sex aggressors-although not conclusive, support the need to consider gender as a dimension when conducting research on VHCW. If we do not do so, gender will continue to be an invisible and ignored dimension of intervention strategies to prevent and address VHCW.
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Violencia Laboral , Masculino , Humanos , Femenino , Mozambique , Estudios Transversales , Personal de Salud , Lugar de TrabajoRESUMEN
INTRODUCTION: Recognition of the relevance of violence against health workers in their work place has been growing around the world. In Mozambique, workplace violence in the health sector needs better documentation. Therefore, this article is part of a study that describes the typology and the perceived impact of violence against health care workers in their workplace at the Lichinga Provincial Hospital and at the Health Centre of the City of Lichinga in 2019. METHOD: This was an observational, descriptive, cross-sectional study. The study was carried out in a simple random sample of health workers victims of violence at the Provincial Hospital and the Health Centre of the City of Lichinga, in the Province of Niassa in northern Mozambique. The questionnaire applied was adapted from the original developed by the International Labour Organization, the International Council of Nurse, the World Health Organization and Public Services International and applied in Maputo, Mozambique during 2002. Statistical analysis was carried out with Statistical Package for the Social Sciences 20.0 and WinPepi 11.65. RESULTS: Two hundred and 60 healthcare workers (HCW) were selected to participate, 180 agreed, 145 had inclusion criteria and five gave up participating in the study during the consent procedure. Thus, a total of 140 HCW answered the questionnaire. Predominant types of violence were: verbal threat/aggression 34% (n = 62/180); moral pressure/bullying/mobbing 30% (n = 54/180); ethnic discrimination 9% (n = 16/180); against personal property 6% (n = 10/180); physical 4% (n = 8/180); sexual harassment 4% (n = 8/180). One hundred and 37 victims reported 154 episodes of violence, where 7% (n = 13/180) reported more than one type of violence. Most victims reported no reaction (55%, n = 76/137) and few said that they confronted the offender (16%, n = 22/137, particularly victims of sexual harassment, 38%, n = 3/8). Most HCW reported non-existence (39%, n = 54/137) or unawareness (32%, n = 44/137) of procedures to report violence within the Institution. Most (80%, n = 33/41) of those knowing about the procedures, knew how to use them. More than half (55%; n = 76/137) of HCW said that they were discouraged to report acts of violence. CONCLUSIONS: Like for previous studies in Mozambique and elsewhere in Africa, the study confirms: a relatively high prevalence, a reluctance to talk about the issue and unawareness about procedures on how to report incidents. The findings reconfirm the necessity for the development and implementation of procedures to address violence incidents towards HCW, to develop support services for victims of health workplace violence. Like elsewhere in Africa, successive health workforce plans in Mozambique have failed to address this issue.