Health workforce crisis in Bangladesh

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Bangladesh is suffering from a severe human resources for  health crisis—in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution—which requires immediate attention from policy makers.

A study revealed that the density (per 10,000 population) of physicians and nurses in Bangladesh increased over the last decade (from 1.9 physicians and 1.1 nurses in 1998 to 5.4 physicians and 2.1 nurses in 2007), though it remains much lower than the estimated average for low-income countries in 1998. The density of dentists has increased, but remains very low (from 0.01 in 1998 to 0.3 in 2007).

The density of formally qualified health care professionals (doctors, nurses and dentists) is lower than other south Asian countries (7.7 in Bangladesh, compared to 21.9 in Sri Lanka, 14.6 in India and 12.5 in Pakistan) and falls far short of the estimate projected by World Health Organization (23) which would be needed for achieving targets for the Millennium Development Goals. During this time, the density of traditional birth attendants declined (from 55 in 1981 to 33 in 2007), presumably due to the stoppage of traditional birth attendant training by the Bangladeshi government in 1998.

The current nurse-doctor ratio of 0.4 (i.e., 2.5 times more doctors than nurses) is far short of the international standard of around three nurses per doctor. An estimate of shortage based on the doctor-population ratio currently prevalent in low-income countries revealed a shortage of over 60,000 doctors, 280,000 nurses and 483,000 health technologists in Bangladesh.

“The large-scale shortage of qualified healthcare providers, coupled with an inappropriate skill-mix (more doctors than nurses and technologists) needs urgent attention to cater to the healthcare needs of the population,” the study said.

1. Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Human Resources for Health 2011; 9: 3. (open access)

Tobacco industry tactics in the developing world

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Tobacco consumption has fallen over the past 20 years in the United States, Australia, Canada and most European countries; and so tobacco companies are turning their marketing efforts to low- and middle-income countries in Africa, Asia and Latin America to compensate for the loss of markets in high-income countries.

The tobacco industry has employed various strategies and tactics including cigarettes smuggling, recruiting of new and young smokers, denying the health consequences of smoking, manipulating governments to delay tobacco control legislations and the sponsoring of health professionals and academic institutions to act in their favor.

In addition to the negative health consequences, this focus has also fostered an economic dependence on tobacco in countries like Malawi and Brazil, who depend on tobacco exports.

Currently, there are over 1.2 billion tobacco users in the world. Around two-thirds of all smokers live in developing countries. Out of the total burden of tobacco-related diseases globally, 70 percent will occur in developing countries by 2030.

1. Doku D. The tobacco industry tactics—a challenge for tobacco control in low and middle income countries. African Health Sciences 2010; 10(2): 201-203. (open access)

Urban-rural inequities in knowledge of tuberculosis in Pakistan

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Knowledge of tuberculosis (TB) is poor especially in rural areas of Pakistan, according to a study conducted in Pakistan’s Punjab province. The study also found that people living in urban areas were more likely to seek treatment at a health facility, compared to rural folk. TB is re-emerging as a global public health problem and a better understanding of the urban and rural communities’ perception of the disease is needed to implement better prevention and control.

Knowledge regarding symptoms, transmission, prevention, duration of standard treatment and DOTS treatment was significantly higher in urban areas. Although more than 80 percent of both urban and rural people in the study were aware of the correct treatment for TB, less than half knew of the availability of the diagnostic facility and treatment free of cost.

People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient; however, they seem to be supportive in case their family member suffered from TB. Nearly half of the study respondents, irrespective of the area of residence, believed that the community rejects TB patients.

Television (urban 80 percent, rural 68 percent) and health workers (urban 31 percent, rural 41 percent) were the main sources for people to acquire TB-related information.

“Television can be recommended as a suitable medium for future campaigns provided that information should be tailored according to the needs of all people, and health workers can be involved in this regard especially in the rural areas,” the study suggested.

1. Mushtaq MU, Shahid U, Abdullah HM, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan’s Punjab province. International Journal for Equity in Health 2011; 10: 8. (open access)

Global epidemic of obesity in children, teens and adults

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Obesity is estimated to contribute more than 2.5 million deaths worldwide every year, making it a major global public health problem. Obesity is a risk factor for heart disease, cancer, diabetes and other chronic non-communicable diseases, and is linked to reduced life expectancy.

A study in the Indian Journal of Medical Research provides insights into the worldwide epidemiology of obesity, its determinants and the role of various preventive and treatment modalities used for the primordial, primary and secondary prevention of overweight and obesity.

Individual and community-based weight control strategies need to be reinforced to reverse alarming trends in the magnitude of overweight and obese children and adults. These approaches include limiting the intake of processed sugars and sodium in prepared foods and manufactured products, portion sizes and time spent watching television and using computers, as well as encouraging eating breakfast on a regular basis. Community level interventions include the creation and maintenance of nearby parks, child-friendly bike and walking paths, and physician encouragement of the importance of healthy diets and regular physical activity to children and parents alike.

1. Raj M, Kumar RK. Obesity in children & adolescents. Indian Journal of Medical Research 2010; 132: 598-607. (open access)

Task shifting may provide additional access to health services

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Task shifting–delegating tasks to existing or new health cadres with either less training or narrowly tailored training–is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost, a study finds.

For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynecologists.

Although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance.

“Task shifting is a policy option that should be considered to help achieve productive efficiency and provide access to services that otherwise might not be available,” the study concluded.

1. Fulton BD, Scheffler RM, Sparkes SP, et al. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Human Resources for Health 2011; 9: 1. (open access)