The negative impact of global health worker migration, and how it can be addressed.

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.

Evaluation of outcomes for psychosis and epilepsy treatment delivered by primary health care workers in Nepal: a cohort study.

BACKGROUND: Most evaluations of task-shifting have focused on common mental disorders. Much less work has been done on severe mental neurological and substance use (MNS) disorders, such as chronic psychosis and epilepsy. Given the high burden associated with severe MNS and the lack of mental health professionals in low and middle income countries, evaluations on the impact of task-shifting for these disorders are important. METHODS: In a rural district of Nepal, a community mental health program, based on World Health Organization's Mental Health Gap Action Programme guidelines, was evaluated using a cohort study design. People with epilepsy and psychotic disorders were interviewed at treatment initiation and at 12-month follow-up. We also compared a group that was offered a comprehensive package of care (medication combined with psychosocial interventions, such as counselling and peer support groups) to a group that received medication only. RESULTS: One-hundred nineteen persons were enrolled in the epilepsy cohort (EC) and 85 in the psychosis cohort (PC). The patients were enrolled in either the comprehensive package (n = 157) or medication only (n = 47). There was significant improvement (P < 0.0001) in psychosis symptoms (PC: Z = 6.78, r = 0.80) and depressive symptoms (EC: Z = 7.43, r = 0.73; PC: Z = 6.02, r = 0.70), seizures (EC: Z = 6.78), functional disability (EC: Z = 6.38, r = 0.67; PC: Z = 4.60, r = 0.57), family and caregiver burden (EC: Z = 8.09, r = 0.85; PC: Z = 6.81, r = 0.84), and social behaviour (PC: Z = 5.94, r = 0.84). There was greater risk reduction for recent seizures among people with epilepsy in the comprehensive treatment package vs. medication only (risk ratio = 0.52, 95% CI 0.29-0.95; P = 0.03); no other significant differences were observed between treatment arms. CONCLUSIONS: A community mental health program in Nepal, implemented by non-specialists, resulted in moderate to large effects among people with epilepsy or psychosis. A comprehensive package of care, including counselling and patient support groups, appears to offer added clinical benefits for patients with epilepsy. For people with psychosis, the basic package of care (i.e., psychotropic medications) performed similar to the comprehensive package, suggesting a less resource-intensive package may offer comparable results.

Sexual, reproductive health needs and rights of young people with perinatally acquired HIV in Uganda.

BACKGROUND: Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs, children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding, new challenges have emerged in their care and support needs. The most dynamic being, their sexual and reproductive health needs and rights (SRHR). OBJECTIVES: This paper aimed at establishing the gaps at policy, program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned. METHODS: This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives. RESULTS: The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet, existing policies, programs and services are inadequate in responding to their sexual and reproductive health needs and rights. CONCLUSION: Against these findings, it is important, that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized.

Sexual; Reproductive Health Needs and Rights of Young People with Perinatally Acquired HIV in Uganda

Background: Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs; children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding; new challenges have emerged in their care and support needs. The most dynamic being; their sexual and reproductive health needs and rights (SRHR). Objectives: This paper aimed at establishing the gaps at policy; program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned. Methods: This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives. Results: The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet; existing policies; programs and services are inadequate in responding to their sexual and reproductive health needs and rights. Conclusion: Against these findings; it is important; that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized

Epilepsy

A seizure (fit) is the clinical manifestation of abnormal and excessive discharge from nerve cells in the brain. Prevalence: Population based prevalence rates for epilepsy vary between 3and 42. Incidence rates are highest in the youngest age groups especially in the first months of life. There is a wide disparity between rates in the developed world and in developing countries. In the developed countries; prevalence can be as low as 0.01 in 100;000 whereas a study done in Nigeria found rates as high as 150 in 100;000. In Uganda; epilepsy is a very prevalent disorder. It is the commonest disorder presenting at mental health clinics. A good number of the districts that have regular mental health clinics have already noted just how big the burden of epilepsy can be. Epilespy reflects the types of health services that a country has