Promoting Health Equity by Addressing the Needs of International Health Workers

The HIV epidemic puts enormous strain on this workforce globally - especially in Africa, where work overload and inadequate supplies contribute to burnout, driving health workers out of the public health sector; HIV infection amongst health care workers themselves causes significant morbidity and mortality and also further perpetuates the problem of understaffing^. Moreover, the occupational risk of TB, including multi-drug and extremely-drug resistant TB, poses further serious risk to health workers. Additionally, one of the greatest challenges in implementing programs to reduce the scourge of these diseases in the healthcare workforce is overcoming stigma.

The WHO and ILO, concerned about the health workforce, developed guidelines to improve HIV and TB programs for health workers. These guidelines, also endorsed by the Joint United Nations Programme on HIV/AIDS, were launched in November 2010, albeit high quality evidence to guide implementation of the WHO-ILO-UNAIDS guidelines was lacking.  We therefore began a research programme to fill the identified gaps.

In 2011-2012 we conducted a baseline survey of 1,000 healthcare workers in three large public hospitals in the Free State province of South Africa. We also conducted comprehensive workplace audits for infection control and occupational health hazards. Numerous workplace health concerns were documented. The questionnaire survey, as well as several smaller workplace research projects we conducted as part of our capacity-building efforts with Free State Health personnel, also found a perception among health workers that HIV stigma in the workplace was unacceptably high. In working towards a valid and reliable survey instrument, a pilot questionnaire was developed and administered to 200 healthcare workers - from management and administration, through different types of professional health workers, to non-professional support staff- in one large Free State hospital. Based on the results of the various preliminary assessments, we designed and implemented a trial across the 27 Free State hospitals (all but our pilot hospital) to implement and evaluate a workplace TB-HIV prevention, diagnosis and treatment programme for health workers, including a stigma reduction campaign.

This presentation describes the findings of the various baseline assessments, the tools that were developed, the training conducted, and the protocol of the trial. It will also discuss the work we are conducting in conjunction in other countries with the World Health Organization to address this worldwide concern.