Sufficient informed consent to medical treatment of adults legal and ethical perspectives from Malawi

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity

Analysis of the Burdens of Caregivers Providing Care to People Living with HIV/AIDS in Botswana

Background: Caregivers; when providing care under the community home-based care (CHBC) programme; experience many burdens of a physical; emotional; financial or social nature. However; these problems are hardly ever considered by the planners of CHBC programmes. A comprehensive overview of the experiences of caregivers is desirable to help policy makers and public health planners formulate intervention measures to address caregivers' burdens. Methods: The sample size calculator programme that allows for 95confidence (and an error margin of 4) was used: the estimated sample size for the study was 272. This number was derived from the eight sampled CHBC groups using probability proportional to size. Simple random sampling was employed in identifying the specific caregivers to be interviewed. Questionnaires were administered on this selected sample at their homes or CHBC headquarters by trained research assistants who ensured that all ethical considerations were observed. In the end; 169 caregivers responded within the study period. Results: The study shows that very little support is given to caregivers. In addition; while men's burdens are mainly economic; those of women are overwhelmingly emotional. Furthermore; there is an insignificant association between caregivers' expected and received support while providing care to people living with HIV/AIDS. Conclusion: The study concludes that; to reduce caregivers' burdens; a comprehensive CHBC programme; that will ensure that the role of CHBC caregivers is adequately recognised by the government and community; is needed

Using the Workload Indicator of Staffing Needs (WISN) Methodology to Assess Work Pressure among the Nursing Staff of Lacor hospital

In their effort to provide adequate and quality health services; health systems in both developed and the developing countries have to confront the challenges of an ever increasing population with limited or diminishing resources. This includes the human resource which constitutes a major input in health care delivery and a key determinant of the cost and quality of care. There is an increasing need therefore for health organizations to identify the most appropriate staffing levels and skill mix to ensure efficient use of the limited health personnel. This paper demonstrates the use of the workload indicator of staffing needs (WISN) methodology in determining staffing requirements for the nursing staff in a hospital setting. It shows how the results can be used to assess overstaffing and understaffing as well as determine the work pressure among the different categories of nurses thus providing a basis for effective nurse redistribution to exploit efficiency gains without compromising the quality of services

Workload-Based Indicators of Staffing Need (WISN) for Health Tutors in two Public Hearth Training Institutions in Uganda

Ugandan public Schools of Clinical Officers (SOCOs) face a serious problem of understaffing with qualified tutors; despite there being sufficient numbers in the country. Poor staffing of training institutions affects the quality of the graduates produced by the schools and eventually dictates poor quality provided by the health workers. This study set out to determine the workload-based staffing needs for two schools; determine the effects of understaffing and coping mechanisms adopted by the schools and the students. It was a descriptive cross-sectional study using the Workload Indicators of Staffing Need (WISN) methodology developed by the WHO; conducted in June 2006 in Mbale and Gulu SOCOs

Rationalising Human Resource Deployment in the Wake of Reforms : the Need for Measuring Health Workers Workload

The ongoing reforms that cut across various sectors in Tanzania encompass as one of the major changes; the disposition and remuneration of civil servants including health workers. Retrenchment of health workers that started in the early 1990s; staff allocation and relocation in the facilities and the introduction of incentive packages have been implemented without the guidance of information on the actual magnitude and distribution of workload among them. This paper presents findings of the outpatient workload for clinicians based on a review of routinely available data from two districts in Tanzania. It was revealed that the average workload was 29 outpatients per clinician per day in health centres and 20 in dispensaries. Workload was found to be higher in Government dispensaries (20 outpatients/clinician/day) compared to private for profit owned facilities (8 per clinician/day). It was concluded from the study that there is an enormous variation in workload among facilities of the same type and between districts. It was therefore recommended that future plans on staff disposition and incentive schemes should take into consideration the burden of work shouldered by health workers at their respective working places. Further research should be conducted in order to establish workload among health workers of other cadres that will encompass services other than OPD