WORKSHOP AT COMMONWEALTH PEOPLE’S FORUM, KAMPALA, UGANDA – 19/20 NOVEMBER 2007

1.     WORKSHOP TITLE 

 Prioritise Health - Realise Potential 

2.     ORGANISING INSTITUTIONS           

A collaboration between the Commonwealth Dental Association, the Commonwealth Medical Association, the Commonwealth Nurses Federation, the Commonwealth Pharmaceutical Association, the BasicNeeds Trust and member organisations in Uganda. 

3.     CONTACT PERSON           

Betty FALCONBRIDGE

betty.falconbridge@rpsgb.org

4.     RAPPORTEUR           

Jill ILIFFE

jill@commonwealthnurses.org

 5.     INTRODUCTION 

The workshop: Prioritise Health - Realise Potential reflects the theme of CHOGM: Realising People’s Potential. 

The workshop was organised by five international health non-government organisations representing all the major health professions. The workshop addressed five key health issues: human resources; maternal and child health; lifestyle diseases; safe health practices; and mental health and development. The workshop brought together speakers with a wide range of expertise from a broad spectrum of countries across the Commonwealth. 

The purpose of the workshop was to identify issues and develop strategies around five key health issues to present to the Commonwealth Heads of Government meeting (CHOGM) with a view to influencing government policy and processes in order to improve the health of Commonwealth peoples. 

The specific objectives of the workshop were: 

(1)     To advocate to Heads of Government for the investment of greater resources in health systems and programmes in order to improve the health of the people in Commonwealth countries.

(2)     To draw the attention of stakeholders to aspects of the five health areas covered by the workshop, which have the potential to transform the lives of people in the Commonwealth and improve their health, relieve their poverty and enable them to contribute to sustainable development.

(3)     To provide opportunities for NGOs, both international and national, to network with a view to strengthening capacity to engage in health policy development. 

Pursuing healthy individuals and communities makes economic sense. Good health is crucial to realising people’s full potential and to achieving sustainable development in Commonwealth countries. 

The workshop was dedicated to the memory of Julia Campion from the Commonwealth Dental Association who was one of the main organisers of the workshop who died recently after a short illness. The workshop commenced with a minute silence in tribute to and memory of Julia. 

6.         SUMMARY OF DISCUSSIONS 

6.1        HUMAN RESOURCES 

Without a health workforce that is adequate in numbers; well educated; appropriately distributed; motivated; productive; and matched to population needs most MDGs cannot be met. People are unable to benefit from education or decent work unless they are healthy. The health of people living in rural areas particularly suffers because of the shortage of health workers.

Health workers have become a scarce resource, which countries have to compete for, however the solution is simple. Governments must make a commitment to educating more health workers and becoming self sufficient in their health workforce. 

There has been a marked increase in migration within the health workforce, however migration is a symptom not a problem. Governments need to address the reasons people migrate rather than try to curb migration, such as improve standards of living, address gender equality, provide access to decent work and improve income levels. 

Governments need to attain self-sufficiency in their health workforces by educating sufficient health workers to meet demand and develop and implement improved strategies for the ethical recruitment, education, training and retention of their health workers. 

6.2        MATERNAL AND CHILD HEALTH 

Unless governments make an extraordinary effort, we are not going to meet the MDG targets for reducing maternal and infant mortality by 2015. The way we are going the goals will not be reached until 2045. Almost all maternal and infant mortality is preventable and it is unacceptable that so many women and children are dying when they should not be. 

Maternal and child health is not just a women’s issue. It is also an issue for men. 

There is a perception that, as a result of competition from other program areas (eg HIV/AIDS), program funding for maternal and child health has reduced. This needs to be investigated and if found to be correct, redressed. 

Improving the status of women will reduce maternal mortality. This requires attention to such things as providing education to women and girls and improving literacy levels. Women should be empowered to be able to make choices about childbearing, including deciding on the number of pregnancies they wish to have. 

Women need antenatal and postnatal services as well as birthing services, provided by qualified midwives. The number of women being delivered by qualified midwives needs to increase. Midwives should be located in the communities, supported by well-kept and well-resourced facilities. Midwifery services should be provided free to women. Postnatal care must be promoted. Women in the community should be provided with education to encourage them to use midwifery services. 

The status of midwives needs to be improved by better initial education and a program of continuing education when in the workforce. The number of midwives needs to be increased so that they can provide better care.  

The use of unskilled, poorly educated workers is putting maternal and child wellbeing at risk. Education should be provided to upskill traditional birth attendants so the care they provide to women is safe and supports the care provided by midwives. 

Governments must provide adequate funding and resources for maternal and child health care programmes and services, in order to achieve the MDGs relating to maternal and child health by 2015, including increasing the number and improving the education of qualified midwives; and improving access to maternal and child health services by making them available at the community level and making them free at point of delivery. 

6.3        LIFESTYLE DISEASES 

Lifestyle diseases increase with industrialisation and as people live longer. Governments need to focus on planning the built environment to encourage healthy lifestyles.

Lifestyle diseases add an additional burden to populations dealing concurrently with communicable diseases (such as HIV/AIDS, malaria and tuberculosis); injuries from violence, wars, and accidents; poverty; poor levels of education; inadequate health systems, particularly maternal and child health services; and the effects of climate change. 

Existing inequities as a result of gender, ethnicity, race, education, income and occupation, need to be addressed in conjunction with lifestyle diseases. 

Mental illness needs to be added to the ‘usual’ lifestyle diseases such as cardiovascular disease, diabetes, obesity, cancer, respiratory disease, and cerebro-vascular accidents. 

We need to replace the old paradigm (wait until symptoms occur to initiate investigations and treatment) with a new paradigm (prediction, prevention, screening and early intervention to prevent the development of disease). We need to replace the old method of service delivery (health professionals delivering service to) with new methods of service delivery based in the community with a focus on individual self care, care from family and friends, the development of self help networks, health professionals as facilitators and partners in the provision of care with only a small part of acute care being provided by health professionals as experts. 

We need accessible and integrated primary health care services and the availability of basic equipment and commodities at the primary health care level. Screening for lifestyle diseases should be promoted, particularly to women, eg screening for cervical and breast cancer. Health care should be free at point of care, including necessary medicines. Promoting healthy lifestyles should begin at an early age, eg introducing recreational activities in schools. 

Governments should refocus their health systems on primary health care services which provide health information, promote healthy lifestyles, and provide health screening, early detection and early intervention services in order to reduce lifestyle diseases such as diabetes, cardiovascular disease and cancer. Government should strengthen their education and planning systems and partner with and provide support for non governmental organisations to combat the impact of lifestyle diseases on individuals and communities. 

6.4        SAFE HEALTH PRACTICES 

Safe health practices involve preventing the acquisition and spread of infectious diseases by interfering with the chain of infection at as many points as possible. All health workers should always use standard precautions, as the infectious status of the person is usually unknown. 

Governments must provide underpinning legislation, policy, protocols and guidelines to support safe health practices; adequate facilities, equipment and infrastructure (including the provision of safe water and electricity); and a sufficient number of adequately trained healthcare workers to meet demand. Where there are not enough health workers to meet demand, safe health practices suffer. 

All health workers should be provided with free immunisation against a range of diseases. 

Health facilities should create a culture of safety that encourages and supports the reporting of any situation or circumstance that threatens, or potentially threatens, the safety of patients or care givers. Systems should be in place for the safe storage and dispensing of medicines. 

Heath workers must adopt safe practices, raise awareness and advocate for the adoption of safe health practices by their colleagues and by the community. 

The community should participate in safe health practices eg measles and polio campaigns, vaccination acceptance, frequent medical check, use of mosquito nets, avoiding lifestyle risks (obesity, smoking, excessive alcohol consumption). 

Individuals and communities need to be literate to benefit from safe health practices and safe use of medicines. Free education for communities to increase literacy levels will result in safer health practices. 

Governments should develop policies and guidelines and provide funding to support safe health practices, in order to reduce the transmission of infections in the home, schools, workplaces, hospitals and clinics. Governments should ensure health workers are provided with education, skills and training; adequate resources and equipment; and free immunisation; underpinned by government policies and funding.

6.5        MENTAL HEALTH AND DEVELOPMENT

Mentally ill people across the world are not reaching their potential. Mental illness is associated with stigma, discrimination and poverty, for both the mentally ill person and their family. 

It is difficult to access treatment as there is little care available at a community level.

There is too little focus on early diagnosis and early intervention and a lack of trained personnel eg psychiatrists and mental health nurses. 

The cost of drugs to treat mental illness, if available, is prohibitive. Government budgets to address mental illness are inadequate. 

Mental health care is burdened by old policies and legislation that do not reflect modern care practices. 

Governments need to recognise the relationship between mental ill health and development and pursue strategies that ensure people with a mental illness and their families are included in the development process and given the opportunity to realise their full potential.

7.         SUMMARY OF THE OUTCOMES OF THE WORKSHOP 

8.         RECOMMENDATIONS FOR FOLLOW UP ACTION BY CIVIL SOCIETY 

Civil society, if well organised, can make a difference. Civil society should: 

9.     RECOMMENDATIONS FOR FOLLOW UP ACTION BY THE COMMONWEALTH HEADS OF GOVERNMENT MEETING 

1.      Governments need to attain self-sufficiency in their health workforces by educating sufficient health workers to meet demand and develop and implement improved strategies for the ethical recruitment, education, training and retention of their health workers. 

2.     Governments must provide adequate funding and resources for maternal and child health care programmes and services, in order to achieve the MDGs relating to maternal and child health by 2015, including increasing the number and improving the education of qualified midwives; and improving access to maternal and child health services by making them available at the community level and making them free at point of delivery.

3.    Governments should refocus their health systems on primary health care services which provide health information, promote healthy lifestyles, and provide health screening, early detection and early intervention services in order to reduce lifestyle diseases such as diabetes, cardiovascular disease and cancer. Government should strengthen their education and planning systems and partner with and provide support for non governmental organisations to combat the impact of lifestyle diseases on individuals and communities.

4.    Governments should develop policies and guidelines and provide funding to support safe health practices, in order to reduce the transmission of infections in the home, schools, workplaces, hospitals and clinics. Governments should ensure health workers are provided with education, skills and training; adequate resources and equipment; and free immunisation; underpinned by government policies and funding.

5.   Governments need to recognise the relationship between mental ill health and development and pursue strategies that ensure people with a mental illness and their families are included in the development process and given the opportunity to realise their full potential. 

6.    Governments must develop mechanisms and commit to communicating with civil society when planning, developing and implementing health and other services, using civil society as a partner and as a resource. 

Solutions exist; we do not have to invent them, just implement them.

Governments, together with civil society and other agencies, need to make concerted efforts to achieve the Millennium Development Goals (MDGs) related to health and other international health targets. Failure to do so will have serious effects on political, economic and human development and the realisation of people's potential. 

10.        PRESENTATIONS 

10.1      Keynote Address            

Presented by Jyotsna Jha (Adviser, Education and Gender Section Social Transformation Programmes Division, Commonwealth Secretariat) on behalf of: Ms Ann Keeling (Director Social Transformation Programmes Division, Commonwealth Secretariat) 

10.2      Human Resources 

10.2.1    The International Viewpoint presented by Christine Hancock (European and African Director, Oxford Health Alliance) 

10.2.2    The African Viewpoint presented by Olga Makhubela-Nkondo (Vice-President, Democratic Nursing Organisation of South Africa) 

10.2.3    The Ugandan Viewpoint presented by Okuna Neville Oteba (Registrar, Pharmacist’s Council, Ministry of Health, Uganda) 

10.3      Maternal and Child Health 

10.3.1   The International Viewpoint presented by Atieno Ojoo (Technical Specialist, UNICEF Supply Division, Denmark) 

10.3.2   The African Viewpoint presented by Atieno Ojoo (Technical Specialist, UNICEF Supply Division, Denmark) on behalf of Peggy Vidot (Adviser, Health Section, Social Transformation Programmes Division, Commonwealth Secretariat) 

10.3.3    The Ugandan Viewpoint presented by Enid Mwebaza (Principal Nursing Officer, National Referral and Teaching Hospital, Mulago, Uganda) 

10.4      Lifestyle Diseases 

10.4.1    The International Viewpoint presented by Martin Bradley (Chief Nursing Officer, Department of Health and Public Safety, Northern Ireland, UK) 

10.4.2    The African Viewpoint presented by Clement Luhanga (President, Botswana Dental Association, Commonwealth Dental Association Regional Vice-President) 

10.4.3    The Ugandan Viewpoint presented by Richard Odoi (Head, Department of Pharmacy, Faculty of Medicine, Makerere University, Kampala, Uganda) 

10.5      Safe Health Practices 

10.5.1   The International Viewpoint presented by John Hunt (International Board Member, Organisation for Safety and Asepsis Procedures) 

10.5.2   The African Viewpoint presented by Jacob Kaimenyi (President, Commonwealth Dental Association, Deputy Vice-Chancellor Nairobi University) 

10.5.3   The Ugandan Viewpoint presented by Alice Lamwaka (Senior Clinical Pharmacist, Gulu Regional Referral Hospital, Uganda) 

10.6     Mental Health and Development 

10.6.1   The International Viewpoint Presented by Chris Underhill (Founder Director, BasicNeeds Trust UK) 

10.6.2   The African Viewpoint presented by Peter Badimak Yaro (BasicNeeds Ghana) on behalf of Christina Ntulo (Director for Africa, BasicNeeds Trust, Uganda) 

10.6.3   The Ugandan Viewpoint presented by Fred Kigozi (Executive Director, Butabika National Referral Hospital, Uganda)

The full report may be obtained from the following on request:

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