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Dozens of Cases Approve Myanmarese Forces Rape Rohingya Women: UN Medics

The doctors of United Nations have confirmed several reports regarding sexual abuse committed by Myanmarese military against Rohingya women. According to Reuters, doctors treating hundreds of thousands of Rohingya Muslims who fled to Bangladesh from Myanmar in recent weeks have seen dozens of women with injuries consistent with violent sexual attacks, UN clinicians and other health workers said; "Since August 25, over 429,000 Rohingya Muslims fled to Bangladesh when Myanmar regime forces and extremist Buddhist started a new wave of crack down which the United Nations has termed as ethnic cleansing.  
 Recent exodus of Rohingya has brought the number of refugees from Rakhine living in Bangladesh to over 800,000.The UN medics’ accounts, backed in some cases by medical notes reviewed by Reuters, lend weight to repeated rape allegations leveled by women from the stateless minority group against Myanmar’s armed forces. According to Reuters report, eight health and protection workers  had treated more than 25 individual rape cases since late August in Bangladesh’s Cox’s Bazar district.
The medics say they do not attempt to establish definitively what happened to their patients, but have seen an unmistakable pattern in the stories and physical symptoms of dozens of women, who invariably say Myanmar soldiers were the perpetrators. It is rare for UN doctors and aid agencies to speak about rape allegedly committed by a state’s armed forces, given the sensitivity of the matter.

INHUMAN ATTACK:

The doctors at the clinic operated by The UN's International Organization for Migration (IOM) at the Leda makeshift refugee say they treated hundreds of women with injuries they said were from violent sexual assaults during the army operation in October and November.
Dr. Niranta Kumar, the clinic’s health coordinator, told Reuters they have seen have injuries among recent influx of refugees suggesting “more aggressive” attacks on women. Several health workers suggested that, whereas in October many women had initially remained in their villages believing the army sweeps were only targeting Rohingya men, this time most had fled at the first sign of military activity.

RAPE AS A WEAPON:

In April, the UN Secretary General reported that sexual assaults were "systematically employed to humiliate and terrorize their community". Before her rise to power, Suu Yi gave a speech concerning rape last year. It is used as a tool of division in the country's myriad ethnic conflicts. 
“It is used as a weapon by armed forces to intimidate the ethnic nationalities and to divide our country, this is how I see it,” she said in 2011 in a video message to a conference on sexual violence in conflict. However, the Buddhist Nobel laureate has chosen to keep silence when it comes to brutal sexual attacks committed by regime’s forces against Muslim women.
Her spokesman Zaw Htay said there was “nothing to say” when asked if her view had changed since then. “Everything should be according to the rule of law,” he said. “The military leaders also have said they will take action.”

REFERENCES:

United Nations. Dozens of Cases Approve Myanmarese Forces Rape Rohingya Women. UN Medics. 27th September, 2017
http://www.awdnews.com/index/dozens-cases-approve-myanmarese-forces-rape-rohingya-women-un-medics/

Health Workforce and Governance: The Crisis in Nigeria

All persons involved in activities primarily devoted to enhancing heath in the health workforce is an important block of any functioning health system in any country. In the absence of which clinical and public health services cannot be delivered to the population (World Health Organization, 2006). The health governance-led steering and rule-making functions targeted at achieving national health policy objectives for effective delivery of health services and attainment of universal health coverage (World Health Statistics 2014).

Experts have shown direct links between efficient health system governance and promising health workers outputs, which ultimately have positive effects on overall health outcomes (World Health Organization, 2007). However, poor administration and continued underinvestment in health even with the spread of HIV/AIDS, re-emerging diseases and persistent violent conflicts, have contributed greatly to the fragile health systems in many African states (Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, et al, 2004). While there have been calls for concerted efforts- social, economic, environmental and multisectoral towards health system strengthening in sub-Saharan Africa (Senkubuge F, Modisenyane M, Bishaw T, 2014), human resources' crises in the health sector have continued to be a major challenge (Dovlo D, 2003).

Many African countries' governmnets have reported challenges in training, funding, employment, capacity building and efficient deployment of the health workforce (Dovlo D, 2003). Consequently, the continent has continued to experience a rapidly progressive health workforce migration to high-income settings in search of better opportunities (Dovlo D, 2007).
Crises within the health workforce have been repoted as perhaps the biggest constraint towards global health system develoment and sustenance, particularly in Africa (Dovlo D, 2007).

According to the World health report in 2006, 57 countries were in severe health workforce crises, with 37 of these in Sub-Sahara Africa. A region with only 3% of global health workforce, despite contributing about a quarter to the global disease burden (World Health Organization, 2006).
Nigeria, the most populous country in Africa, possibly contributes even more to these crises in the region. Increasing annual rates of population growth, as observed in Nigeria, has been adjudged a major factor in countries with severe health workforce crises (Pacqué-Margolis S, Muntifering C, Ng C, Noronha S, 2011). Nigeria requires significant increase in the number of additional health workers to achieve desired population coverage. However, beyond the shortfall in health workforce, the Nigeria health sector has particularly experienced a number of other lingering crises inrecent times.
There are growing concerns locally and internationally over these issues with this linked to the overall poor states of health governance in the country (World Health Organizatio, 2016).  Persistently low and inequitable distribution of health workers remain a major challenge in the Nigerian health sector (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016). Bangdiwala stated that there is a global crisis in health workforce by acute shortages and uneven distribution of health workers in several settings (Bangdiwala SI, Fonn S, Okoye O, Tollman S, 2010). In Nigeria, experts have reported that historically, "brain drain", in the form of migration of health workers to high-income settings, has been a major setback in the country (Ike So, 2007).

Current statistics show that 1 in 4 doctors, and 1 in 20 nurses trained in Africa are currently working in developed countries, with this accounting for a shortfall of over 1.5million health workers in the region (World Health Organization, 2014). In Nigeria, the health workforce density is estimated at 1.95 per 1000 population (World Health Organization, 2016). According to the report of Abimola, this shortfall in Nigeria has been complicated by gross inequity in the distribution of health workforce, as there is no national policy guiding the postings and transfers of health workers-redeployment is often based on discretion of administrative officers with multiple influences and several competing interests (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016).

REFERENCES

World Health Organization. The World Health Report 2006—working together for health. Geneva: World Health Organization; 2006. https://books.google.ca/books?hl=en&lr=&id=taYsDwAAQBAJ&oi=fnd&pg=PR13&ots=9eg7-pFfy-&sig=rQqts3bHKOp6dhcfViLM2-AwYds&redir_esc=y#v=onepage&q&f=false

World Health Organization. Health systems. In: World Health Statistics 2014. Geneva: World Health Organization; 2014. p. 128–40.

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7:23568. https://www.ncbi.nlm.nih.gov/pubmed/24560261?dopt=Abstract

Dovlo D. Wastage in the health workforce: some perspectives from African countries. Hum Resour Health. 2005;3:6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198245/

Dovlo D. Migration of nurses from sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;32(3):1373–88. http://onlinelibrary.wiley.com/doi/

Pacqué-Margolis S, Muntifering C, Ng C, Noronha S, IntraHealth International. Population growth and the global health workforce crisis. Washington: United States Agency for International Development; 2011. https://www.capacityplus.org/files/resources/population-growth-global-health-workforce-crisis.pdf

World Health Organization. Nigeria. In: Global Health Workforce Alliance. Geneva: World Health Organization; 2016.

Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL: Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria. Int J Health Plann Manage. Int J Health Plann Manage 2016, Epub ahead of print. http://onlinelibrary.wiley.com/doi/10.1002/hpm.2356/full

Bangdiwala SI, Fonn S, Okoye O, Tollman S. Workforce resources for health in developing countries. Public Health Rev. 2010;32(1):296–318. https://publichealthreviews.biomedcentral.com/articles/10.1007/BF03391604

Ike SO. The health workforce crisis: the brain drain scourge. Niger J Med. 2007;16:204–11. http://europepmc.org/abstract/med/17937154

In Country Retention Of Healthcare Professionals in Romania

Romania began its transition from communism in 1989, with an extinct  industrial base, and a profitable guide unfiting to the needs of the country. The recession of industrial output, service contracts, and the collapse in investment increased as the trade gap extended for a number of years. The recent shortcoming of account remained at 5.4% of the GDP in 1998. By 1989-2002, unemployment increased, many large scale businesses were under government control, yet to tackle the primary issues which empowers the growth of business in a competitive environment (Vlădescu & Scîntee, 2008).
Over the years, according to the world bank, there has been a rise in figures on the Romanian healthcare system, revealing that access to healthcare is biased towards the more privilege classes. In addition, according to Raiffeisen Bank Romania, the ratio of doctors to patients, is two doctors to 1000 of population, below average in Europe. On the account of Romania joining the EU, the availability of medical personnel declined, decreasing access to healthcare services among citizens (Oreste Ross, 2014).  
In 2006, the mass media raised awareness by predicting huge emigration of medical doctors and nurses that would threaten the health system. The emigration rate increased by 2007, 1421 medical doctors left the country which affected the most economical deprived area of Romania more than other regions (Suciu, Popescu, & Buzoianu, 2017).  
By the end of 2009, the economic crisis begun to impact the Romanian society deeply, including the health system. Furthermore, there were additional obstacles introduced in 2010 for  the healthcare professionals, as well as a 25% salary discount. As a result, there was shortage of staff, hence, developments regarding the domestic workforce combined with the emigration of healthcare practitioners became a critical problem in Romania  (Galan, Olsavszky, & Vladescu, 2006).  
The purpose of these measures is to straight-up a line with the priorities of the strategic partnership. Also, to support the network for the provision of healthcare services (hospitals), increase the services of medical practices increase the availability of primary healthcare at the community level and strengthen governance within the health system. The stakeholder for this responsibility is the World Bank.


LONG TERM MEASURES:-
Strategic Management:
Strategic management an organizational management activities that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholder are working towards common goals and establish agreement around intended outcomes/results access and adjust the organization´s direction in response to a changing environment.
The efforts put in health planning are initiated by either the state or local government agencies (The Ministry of Health), through implemented legislation or private or non-governmental organizations. As a result, a variety of state health policy makers have designed to: enhance the quality of care, provide and control the access of care (through hospital survey), and contain cost (health insurance) (Swayne, Duncan, & Ginter, 2006).


MEDIUM TERM MEASURES:-
Improving Occupational Health in a Work Place:
The working condition of nurses are likely associated to the quality of care provided to patients and patients’ safety. This is also linked with the health and safety outcomes for nurses and other healthcare providers (Geiger-Brown J; Lipscomb J, 2010).
According to the 2005 survey by the National Institute of Statistics, more than half of the people working in Romania reported poor working conditions in the healthcare sector (European Observatory of Working Life, 2006). It has been statistically proven that nurses endanger themselves with the risk of exposure to infectious diseases, physical violence, ergonomic injuries related to the movement and repositioning of patients, exposure to hazardous chemicals and radiologicals, and sharp object related injuries. These risk threats could be avoided by the appropriate use of technology, environmental controls, and protective equipment. nurses are revoked in accessing these health cautions. It is upon the ministry of health, and private healthcare facilities to provide adequate workplace safeguards, enforce protective procedures, educate staff regarding the risks, provide protective equipment, utilize safety engineered sharps, and cooperate with research into actual and potential risk (American Nurses Association , 2007).
The code of practice for recruitment of international health personnel by WHO encourages countries to receive emigrant healthcare workers to assist in improving working conditions in developing countries. This has proven efficient mechanism for healthcare institutes. This is an economical advantage for the country as it increases the revenue per capita (Annalee Yassi, 2009).
The government should advocate some support provided for these initiatives, however, there should be collaboration between WHO, the International Labour Organization, the International Commission on Occupational Health, and the International Social Security Association and Public Services International (this is a representative for public sector trade unions) Romania would have a genuine responsibility to reciprocate with their resources as beneficiaries of healthcare worker migration. At university level, researchers and practitioners can contribute to the exchange of knowledge by aligning with their colleagues from other low-income countries (WHO, 2009).
To assure the development of information system, it is significant to promote evidence-based decision making, and share information with those who can benefit from it (integration of worker safety and patient safety).  This will aid in sharing jurisdiction. That way, millions of dollars won’t be spent annually to design, implement and maintain different systems that could be distributed and reproduced easily. To achieve this, there has to be an international agreement to reach consensus on data dictionary; establish programming of non-proprietary information system which can be tailored to different mechanical environment made available for easy licensing; train health and safety committees ( focusing on occupational health and infection control) to conduct workplace audits, use the information system and implement appropriate prevention mechanisms; conduct campaign studies to evaluate and refine approaches to improve working conditions among healthcare workers (Weerdta & Baratta, 2005).
Introduction to International Strategy:
The involvement of the state is essential to provide adequate workforce in any situation involving two sides of an equation; demand and supply regarding the workforce of health professionals. There are limitations and opportunities that apply to both aspect (Barriball L, 2015).
The government should be involved in the planning and managing of a healthcare sector because they have the power to sign a treaty among other EU countries (National Rural Health Alliance, 2008). For example; the WHO Assembly adopted the WHO Global Code of Practice on international recruitment of healthcare personnel in May 2010. This sketches a voluntary principle for ethical international recruitment, with the intend for improving the authorized and institutional framework for the enrollment practices (WHO, Managing health workforce migration - The Global Code of Practice, 2010).
As a result, the unilateral contract provides an extra tool for implementing the principles of the Code. Such agreement recognizes the need of the country to monitor the extent of migration and its impact on the country’s economy to ensure sufficient training and strategies for financial support to the health system (Global Health Workforce Alliance, 2008).


SHORT TERM MEASURES
Training of Healthcare Workers:
Hospitals should reintroduce demanding programs to train nurses in their specialties. This contributes in retaining nurses who are seeking for a transfer opportunity as well as recruiting new staff. It also establishes career development path for staff. These training are not inexpensive and nursing governance must be ready to justify the proposed budget. Given the cost of temporary staff, this aids as a logical solution for the organization’s leadership to approve (Watkins, 2005).
Shared Governance and Leadership:
This facilitates a steady condition in a healthcare environment. Reports done on magnet hospitals has proven that organizational characteristics that attract and retain nurses include professional practice models for care delivery with autonomy and responsibility for decision-making (Sebai, 2015).
Hence, effective administrative structure is significant for patient care quality, and investment in professional development of nurses. There must be an involvement of staff in defining and developing the practice of care in the institution due to their closeness with patients; In inclusive with participation in the financial management of their unit (Nevidjon & Erickson, 2001).
Introduction of Emergency Medical Services(EMS)
This is a comprehensive system that provides the arrangements of personnel facilities and equipment for the effective, coordinated and efficient delivery of health and safety services to victims of sudden illness or injury (Moore, 1999). This is essential for providing timely care to patients with life threatening emergencies to avoid unnecessary mortality or long-term morbidity (J & AL., 2002).
EMS is a job opportunity for nurses, as it is a mechanism to decrease the rate of emigration in Romania. Recent studies show that nurses are dissatisfied with the role of coordinating care. It is important that nurses are assigned to positions they are trained to. This prevents them from being overwhelmed with work load (DK, McNeese-Smith, 1999).
Reduction in patients´ length of stay.
The supply of nurses is not adequate to meet the current demand and the shortage is projected to grow more severe as future demand increases and nursing schools are not able to keep up with the increasing educational demand. Example of demand of nurses is the length of patients’ stay. As a result, hospital nurses today take care of patients who are sicker than in the past; therefore, their work is more intensive (Héctor Bueno, Joseph S. Ross, & Yun Wang, 2010). Research studies show that heavy workloads among nurses adversely affect patient safety. Furthermore, it negatively affects nursing job satisfaction, and as a result, contributes to higher turnover, and shortage in nurses (Clarke, 1996).
In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses´ workload. Nurses are expected to perform non-professional tasks such as; delivering and retrieving food trays, housekeeping duties, transporting patients, and ordering, coordinating or performing ancillary services (Patricia W. Stone*, 2004). Certain establishment should be earned to reduce the workload of nurses like; unit level, job level, patient level, and situation level (Stone, Clarke, Cimiotti, & Correa-de-Araujo, 2004).
These measures lead to better communication between nurses and their patients, and also set an organized program for the nurses. Example; in a clinical unit, numerous nursing tasks need to be performed by a group of nurses during a specific shift (unit level workload). The type and amount of workload of nurses is partly determined by the type of unit and specialty. Example; intensive care unit (ICU), nurse versus general floor nurse (job level workload). When nurses perform their job, they encounter situations and patients (National Academy of Sciences, 2004).
Improving Data Collection:
According to Diallo, having reliale and valid data about health workforce is a key to better managment and planning. This acknowledges the difficulties in finding accurate data, and he recommends a process of triangulation of different sources to give the most comprehensive overall picture (Diallo K, 2004) .
For example; data can prove the significance of non-finanacial incentives in other developing countries. Such countries in Afrca. This can be adopted by the state in Romania, to improve their law enforcement in the healthcare system. Due to the underinvestment of the countries’resources, there has been a decrease in the wages, as well as working conditions (korte et al).
Studies have proven the effectiveness of non-financial incentives which include, training study leave, opportunites to work in teams, support and feedback from supervisors. As result, the performance of our healthcare practitioners will increase due to the enhancement of their job satisfaction (Stilwell B, 2001).
It is important that the country has an auditor who maintains and keeps records of the performance of the healthcare system. This will help in determing the flaws of the actions authorised by the state to improve the healthcare organizations.
EXPECTED RESULTS:
Raising funds for the health system.
Reducing financial barrier to access through prepayment and subsequent pooling of funds in preference to direct out of-pocket.
 Allocating or using funds in a way that promotes efficiency and equity.
Health system stewards must, therefore, seek ways to influence the motivations and behaviors of multiple actors and their diverse agendas, finances and organizational structures forming coherent arrangements for health system accountability. 
There should be adequate supply of Emergency Medical Services (EMS).


REFERENCES:


  1. American Nurses Association . (2007). Health Care Worker Safety. Department of Government Affairs. Retrieved from http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Work-Environment/Work-Environment/WorkerSafety.pdf
  2. Annalee Yassi, M. M. (2009, September 15). Assuming our global responsibility: improving working conditions for health care workers globally. OPEN MEDICINE. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090118/
  3. Barriball L, B. J. (2015). Recruitment and Retention of the Health Workforce in Europe. EUROPEAN COMMISSION. Retrieved from https://ec.europa.eu/health//sites/health/files/workforce/docs/2015_healthworkforce_recruitment_retention_frep_en.pdf
  4. BUSINESS DICTIONARY. (n.d.). Retrieved from http://www.businessdictionary.com/definition/audit.html
  5. Clarke, A. (1996, September 05). Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1055402/?page=1
  6. Diallo K. (2004). Data on migration of healthcare workers. Bulletin of the World Health Organization, 82-601.
  7. DK, McNeese-Smith. (1999, JUNE 29). A content analysis of staff nurse descriptions of job satisfaction and dissatisfaction. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10354227
  8. European Observatory of Working Life. (2006, JUNE 01). Working conditions in Romania. EUR WORK. Retrieved from https://www.eurofound.europa.eu/observatories/eurwork/articles/working-conditions-in-romania
  9. Galan, A., Olsavszky, V., & Vladescu, C. (2006). Emergent challenge of health professional emigration: Romania’s accession to the EU.
  10. Geiger-Brown J; Lipscomb J. (2010). The health care work environment and adverse health and safety consequences for nurses. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21639028
  11. Global Health Workforce Alliance. (2008). Guidelines: incentives for health professionals. Retrieved from http://www.who.int/workforcealliance/knowledge/resources/guidelines_healthprofessional/en/
  12. Héctor Bueno, M. P., Joseph S. Ross, M. M., & Yun Wang, P. (2010, June 2). Trends in Length of Stay and Short-term Outcomes Among Medicare Patients Hospitalized for Heart Failure, 1993-2006. THE JAMA NETWORK. Retrieved from http://jamanetwork.com/journals/jama/fullarticle/185996
  13. J, R., & AL., K. (2002, DECEMBER 03). Emergency medical care in developing countries: is it worthwhile? PUBMED. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12481213
  14. Moore. (1999, OCTOBER-DECEMBER 3). Measuring quality and effectiveness of prehospital EMS. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10534034
  15. National Academy of Sciences. (2004). Keeping Patients Safe: Transforming the Work Environment of Nurses. Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25009849
  16. National Rural Health Alliance. (2008, FEBRUARY). Improving the rural and remote health workforce. Retrieved from http://ruralhealth.org.au/sites/default/files/submissions/sub-08-02-08.pdf
  17. Nevidjon, B., & Erickson, J. I. (2001, JANUARY 31). The Nursing Shortage: Solutions for the Short and Long Term. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/NursingShortage/Resources/NursingShortageSolutions.html
  18. Oreste Ross. (2014, MAY 12). EU must 'support and improve' Romanian health system. THE PARLIAMENT, POLITICS, POLICY AND THE PEOPLE'S MAGAZINE. Retrieved from https://www.theparliamentmagazine.eu/articles/news/eu-must-support-and-improve-romanian-health-system
  19. Patricia W. Stone*, S. C.-d.-A. (2004, November 11). Nurses’ Working Conditions: Implications for Infectious Disease. International Conference on Women and Infectious Diseases (ICWID), 10. Retrieved from https://wwwnc.cdc.gov/eid/article/10/11/04-0253_article
  20. Sebai, J. (2015, 03). Evaluation of performance in the health care system. What do theories say? Retrieved from https://www.cairn.info/revue-sante-publique-2015-3-page-395.htm
  21. Stilwell B. (2001). Health Worker Motivation in Zimbabwe. WHO, Internal Report for the Department of Organization of Healthcare Delivery. GENEVA.
  22. Stone, P. W., Clarke, S. P., Cimiotti, J., & Correa-de-Araujo, R. (2004, DECEMBER ). Nurses' Working Conditions: Implications for Patient Safety. EMERGENCY MEDICINE NEWS , 26(12). Retrieved from http://journals.lww.com/em-news/Pages/ArticleViewer.aspx?year=2004&issue=12000&article=00049&type=Fulltext
  23. Suciu, Ş. M., Popescu, C. A., & Buzoianu, M. D. (2017, January 06). Physician migration at its roots: a study on the emigration preferences and plans among medical students in Romania. (H. R. Health, Ed.) BIOMED CENTRAL. Retrieved from https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-0181-8
  24. Swayne, L. E., Duncan, W. J., & Ginter, a. P. (2006). Strategic Management of Healthcare Organizations. Retrieved from http://gamel.fk.ugm.ac.id/pluginfile.php/42325/mod_resource/content/2/Swayne.pdf
  25. Vlădescu, C., & Scîntee, G. (2008). Health Systems in Transition. (E. O. Policies, Ed.) Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/95165/E91689.pdf
  26. Watkins, S. (2005, May). Migration of healthcare professionals: practical and ethical considerations. Retrieved from http://www.clinmed.rcpjournal.org/content/5/3/240.full.pdf
  27. Weerdta, C. V., & Baratta, R. (2005, April-June). Changes in working conditions for home healthcare workers and impacts on their work activity and on their emotions. National Research and Safety Institute, Vandoeuvre Les Nancy, França. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-65132015000200344
  28. WHO. (2009, AUGUST 29). World Health Organization. WHO guidelines on hand hygiene in health care. Clean care is safer care: The first global patient safety challenge. GENEVEA. Retrieved from http://www.who.int/infection-prevention/en/
  29. WHO. (2010, May). Managing health workforce migration - The Global Code of Practice. Retrieved from http://www.who.int/hrh/migration/code/practice/en/




























Discrimination Among the Roma Population in Romania

The Roma population is a diverse minority group culturally known for their peripatetic lifestyle. Although many of them have settled over the years (Ringold D, 2000), there is an approximate of 12 million Romans living worldwide. There is an entire Roma population in the Eastern region of Europe, estimating 3.3% of the Romans living in Romania (National Statistical Institute, 2011).  
The Romanian society has one of the worst cases of social stigma in Europe. This resulted from the reluctance and refusal of important public personalities of Romani origin to declare their membership or links to Romania’s Romani minority (Valeriu Nicolae and Hannah Slavik, 2003). Even though the Roma population has the biggest minority groups in Europe, they face extreme negligence and racism. Discrimination among the Roma population started from the 16th century of nationalism, which rendered them one of the most socially and financially excluded groups in Europe (Wilkin A, Derrington C, Foster B, 2009).


WHY IS DISCRIMINATION A PROBLEM:
To understand the experience of discrimination, is to understand the impact of stressors on health. Most stressful experience may not increase the vulnerability of illness, other types of stressors (those that are uncontrollable and unpredictable) are particularly harmful to health.
The Romans have higher mortality rates and lower life expectancy at birth than the majority population. In the year 2000, the age median for the Roma was 24.2years, compared to that of the general population 37.4 years (KISS TAMAS AND VERESS ILKA, 2010). Recent studies have conducted a representative sample that shows that more than half of the Roma population aged 45 and above are affected by chronic diseases and disabilities. Over an estimate of 60% of men and women have cavities, and are either overweight or obese (Health and the Roma Community, analysis of the situation in Europe, 2009).  

It has been proven that about 45.7% of the Roma children are not immunized or received vaccine. Half of the Roma women (12.2%) have neither seen gynecologist nor gynecologist during pregnancy (34.1%). Qualitative research revealed series of obstacles in accessing healthcare services, including absence of identity documents (which prevents people from legally enrolling with a general practitioner), lack of medical insurance, high cost of medical procedures, informal payments, family doctor’s leeway to accept or deny patient enrolment and the existence of discriminatory practices in the medical system, such as segregation in maternity ward, redirection of patients to other medical practitioners, separate time slots to receive Roma patients, usually towards the end of the work schedule and the use of derogatory language (Wamsiedel M, Vincze E, Ionescu I, 2012).

REFERENCES:


Health and the Roma Community, analysis of the situation in Europe. (2009). Retrieved from http://ec.europa.eu/justice/discrimination/files/roma_health_en.pdf
KISS TAMAS AND VERESS ILKA. (2010). WORKING PAPER IN ROMANIAN MINORITY STUDIES. ISPMN. Retrieved from http://www.ispmn.gov.ro/uploads/ISPMN_30_x_to_web.pdf
National Statistical Institute. (2011). 2011 Population Census Bulgaria. National Statistical Institute. Retrieved from http://www.nsi.bg/census2011/PDOCS2/Census2011final_en.pdf
Ringold D. (2000). Roma and the Transition in Central and Eastern Europe: Trends and Challenges.
Valeriu Nicolae and Hannah Slavik. (2003, MAY 10). Being a "Gypsy": The Worst Social Stigma in Romania. Retrieved from http://www.errc.org/article/being-a-gypsy-the-worst-social-stigma-in-romania/1385
Wamsiedel M, Vincze E, Ionescu I. (2012). Roma health: the perspective of actors involved in the health system – doctors,
Wilkin A, Derrington C, Foster B. (2009). Improving the Outcomes for Gypsy, Roma and Traveller Pupils: Literature Review. National Foundation for Educational Research, 1-73. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240804/#CR4

Outbreak of Yellow Fever in West African Countries

It is feared that the worst yellow fever outbreak in decades which lead to 250 deaths in Angola, and is straining global vaccine supplies, posing a dilemma for health officials, could spread in Africa and possibly into Asia.  According recent reports, the immediate concern is that the virus may extend to larger parts of African urban centers, as happened in previous outbreak which caused catastrophe in Nigeria in the beginning of the year 1986, and ultimately infected 116, 000 people and killed 24, 000 individuals (Chukwuma Muanya, 2016).

There has been an increase in the number of countries reporting yellow fever to WHO over the last 10 years, especially in West Africa. 93% of the countries notified cases in the past 4 years, a 30% increase compared to the period 1995-1999. This increases the circulation of the virus in non-immune human population (United Nations, Population Division, 2001).


Historically, when there was limited supply of vaccines for yellow fever, small outbreaks of yellow fever that occurred in a non-immune population in densely populated cities were often forerunners of large urban epidemics. Today, there are 12 countries with large non-immune populations which are at risk. For example: the last yellow fever outbreak in Nigeria occurred 14 years ago, but it took 10 years to control the transmission of the virus among the population. Given the low vaccine courage to children under the age of 14, the number of children at risk in Nigeria has been estimated at 23 million in the urban area. Immunizing the urban populations in these high-risk countries would require vaccinating approximately 100 million people (United Nations, World Urbanization prospects 1999).

Coordinator of the World Health Organization (Control of Epidemic Diseases Unit) in Geneva, Switzerland, William Perea, in the nature report noted: "For now, the area for the most immediate concern is Africa - where some countries such as Nigeria, have less than 50% yellow fever vaccination coverage. The availability of vaccines has to led to ill-founded complacency about the yellow fever threat. It is a neglected and forgotten disease".


But Executive Director, National Primary Health Care Development Agency (NPHCDA), which is in charge of immunization in Nigeria, Dr. Ado Gana Muhammad, told The Guardian that the country has critical stock to address any outbreaks of yellow fever and measles and there are plans for vaccination campaigns in high-risk states during third quarter of 2016.

Muhammad said: “Efforts are ongoing to sustain the improved national immunization coverage for yellow fever and measles. The country has critical stock to address any reported incidence of outbreaks, no matter how small, through reactive small-scale campaigns.

‘‘Additionally and based on our epidemiology we do conduct follow-up or catch up campaigns. In 2015, we had nationwide measles follow-up campaigns for the 19 northern states in November / December 2015 and for 17 Southern States in February / March 2016. Our national targets were 38.5 million under five-year-old children. At the end, we reached 22.9 million children in the northern states and 19.0 million in the southern cluster of the campaign giving a total of 41.9 million that is 108%.

“Based on the current risk assessment mapping and the recent campaign outcome, Local Government Areas (LGAs) with less than 95% coverage or greater 20% missed children, will be targeted for special patchy campaign to induce additional immunity to avert potential outbreaks.

“Yellow fever campaign is also being planned for the high-risk states during third quarter 2016. There is also active surveillance for the two diseases for early detection and prompt response.”

The NPHCDA boss had told The Guardian that the Federal Government in line with global best practices planned to resuscitate Yaba Yello Fever (YF) vaccine plant using a Public-Private Partnership arrangement. “Since 2005, an MoU was signed between the FMoH and a local pharmaceutical company (May & Baker) that was followed by the signing of a Joint Venture Agreement (JVA) in 2007. This shows how serious the country is committed to the production of YF vaccine both for our domestic use and subsequently for export,” he said.

Yellow fever is transmitted by the same mosquitoes that spread the Zika and dengue viruses, although it is a much more serious disease with death rates as high as 75 percent in severe cases requiring admission in hospital.The condition, which takes its name from the jaundiced color of some patients, has spread to the Democratic Republic of Congo and there is concern it could gain a foothold for the first time in Asia.Yellow fever, which is endemic in parts of South America and Africa, causes at least 60,000 deaths each year. Many people who become infected recover quickly and there are 84,000–170,000 annual infections, more than 90 % of them in Africa, but some develop jaundice, bleed from their orifices and sustain fatal organ damage. Some experts have called for a effective switch in strategy to use just one-tenth of the usual vaccine dose to conserve scarce stocks but the WHO says it cannot be sure this would work (Christina Faust).

A retired virologist who formerly worked for the WHO and the United States Center of Disease Control and Prevention (USCDC), Jack Woodall, in an article in The Lancet medical journal on April 16, said a short-term solution could be to slash the dose, since research suggests just one-tenth can produce the same immune response as a full dose.“We need to get a low-dose vaccine authorized as soon as possible because if we keep using full doses we will never catch up.” Woodall and colleagues laid out the case for the emergency use of a one-tenth dose.

The WHO says cases of yellow fever imported into China, which has close commercial ties with oil-rich Angola, show that “this outbreak constitutes a potential threat for the entire world.”And it is warning that further spread elsewhere in Africa and Asia would increase the squeeze on vaccine supplies and could interrupt routine immunization (Chukwuma Muanya, 2016).











Cases of Yellow Fever. Summary of cases of yellow fever reported to the World Health Organization between 1974 and 2014. . Data from WHO Global Health Observatory Data, figure from ECDC


REFERENCES

Chukwuma Muanya. Nigeria prepares as yellow fever spreads across Africa. WHO. April 27, 2016. https://guardian.ng/news/nigeria-prepares-as-yellow-fever-spreads-across-africa/

United Nations, Population Division, 2001. 
http://www.who.int/csr/disease/yellowfev/urbanoutbreaks/en/

Meeting the Urban Challenge, Population Reports Series M, number 16 United Nations, World Urbanization prospects, the 1999 revision http://www.who.int/csr/disease/yellowfev/urbanoutbreaks/en/

Christina Faust. Yellow Fever cases on the rise in West Africa. BMC, Blog Network. July 29, 2016. http://blogs.biomedcentral.com/bugbitten/2016/07/29/yellow-fever-cases-on-the-rise-in-west-africa/


The Nigerian Healthcare System

The Nigerian healthcare system experienced several down-falls (Health Reform Foundation of Nigeria, 2010). Although Nigeria has its strategic position in Africa, the country is greatly undeserved in the healthcare sphere. The Nigerian health facilities such as health institutions, personnel, and medical equipment are inadequate in the country (Maternal Mortality in Nigeria, 2010). Various reforms have encouraged the Nigerian government to address the rate of issues in the healthcare system which are yet to be implemented at the state and local government area levels (Menizibeya Osain, 2011).

In 2009, according to the Nigerian National Health Conference, the healthcare system remains weak as proved by lack of coordination, fragmentation of services, resources (including drugs and medical supplies), inadequate and decay in the infrastructure, inequity in resource distribution, and access to care, and poor quality of care (Nigeria National Health Conference, 2009) .

The performance of the Nigerian healthcare system has been undermined after the two decades of the Military rule. For example, between the year 1985 and 1993 per capita investment in health had stagnated at about $1.00 per person compared to the international recommended level of $34 per person. The most devastating overall performance of the Nigeria's healthcare system was in 2005, Uganda allocated 11% of its total budget to healthcare, while Nigeria, in 2006, budgeted just 5.6%. Despite its high rate of HIV+ patients, Uganda was ranked 149/191 countries and came 39 steps ahead of Nigeria at 187/191 in the WHO report 2000 (WHO, 2000).


Due to years of under investment in the healthcare system, there has been an increase in poor infrastructure, inadequate modern equipment, and technology, and lack of healthcare practitioners. These have resulted to the absence of specialist services, poor quality of care and loss of confidence in the general health services especially the management of non-communicable diseases. The Nigerian Medical Association (NMA) estimates about 25 consultant oncologists to about 160 million Nigerians and cancer patients can access specialist care only in seven states, Lagos, Oyo, Kaduna, Edo, Ondo, Sokoto and Abuja (Pharm Access Foundation, 2015).




References

1.      Health Reform Foundation of Nigeria. (2010, November 23). Health Reform Foundation of Nigeria. Retrieved from http://www.herfon.org/
2.       Maternal Mortality in Nigeria. (2010, December 16). Retrieved from http://reproductiverights.org/en/feature/maternal-mortality-in-nigeria
3.       Menizibeya Osain. (2011, 0ct-dec 3). The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249694/
4.       Nigeria National Health Conference. (2009). Nigeria National Health Conference 2009 Communique. Retrieved from http://www.ngnhc.org
5.       Pharm Access Foundation. (2015). Nigerian Health Sector, Market Study Report. Embassy of the Kingdom of the Netherlands in Nigeria, Abuja. Retrieved from https://www.rvo.nl/sites/default/files/Market_Study_Health_Nigeria.pdf
6.       WHO. (2000). The Nigerian Health System. Retrieved from http://www.who.int/pmnch/countries/nigeria-plan-chapter-3.pdf