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Objective To study the attitudes, concerns, perceived impact, coping strategies, knowledge on avian influenza (AI) and personal protection measures, and institutional and personal preparedness for AI among all Indonesian primary healthcare workers (PHW). Methods Questionnaire survey of PHW from four public primary healthcare clinics in South Jakarta ( n = 333), with Singaporean PHW from 18 such clinics as controls ( n = 1321). Twelve focus group discussions with 51 South Jakarta PHW were also conducted. Quantitative and qualitative data were analysed separately with statistical and thematic analysis, respectively, then combined. Results South Jakarta PHW had positive attitudes but major concerns about contracting AI, difficulties in diagnosing human AI and inadequacy of personal protection provided. South Jakarta PHW are less knowledgeable about AI and use of personal protection equipment, and reported poorer awareness, availability and participation in AI preparation activities. Only 3% of South Jakarta PHW received influenza vaccination in the preceding 6 months and few felt prepared for AI. Conclusions South Jakarta primary healthcare workers are not well prepared for avian influenza. There is an urgent need to build their primary healthcare capacity to protect them and contain this global health threat. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects. Methods Exploratory interviews with health managers and senior clinical staff were used to identify locally relevant work environment indicators. A self -reported Likert scale questionnaire was administered to a randomly selected cohort of 269 health professionals at health facilities in KwaZulu Natal and Western Cape provinces of South Africa that included ART delivery sites. The cohort was disaggregated into ART and non-ART groups and differences between the two compared with Fisher’s exact test and the non-parametric Mann–Whitney U-test. Results The ART sub-cohort reported: (i) a lighter workload ( P = 0.013), (ii) higher level of staffing ( P = 0.010), (iii) lower sickness absence ( P = 0.032), (iv) higher overall job satisfaction ( P = 0.010), (v) poorer physical state of their work premises ( P = 0.003), and (vi) higher staff turnover ( P = 0.036). Conclusion Scale-up affects the work environment in ways that influence workers’ motivation both positively and negatively. A net negative balance is likely to drive staff out-migration, undermine the quality of care and compromise the capacity of the programme to achieve significant scale. As health workers are the most important element of the health system, a comprehensive and systematic understanding of scale-up impacts on their working conditions and motivation needs to be an integral part of any delivery strategy. [ABSTRACT FROM AUTHOR]