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Rationalisation and deployment have become features of organisational restructuring in South African academic hospitals, and might be sources of dissatisfaction and stress among nurses. Job satisfaction levels and work-related burnout are important determinants of nurses' retention and turnover rates and might adversely affect their work performance and the quality of nursing care rendered. The purpose of this study was to determine registered nurses' (RNs) satisfaction with factors in their work environment and whether these correlated with burnout experiences. Quantitative data were collected from a random sample of RNs (N = 165), using a Job Satisfaction Scale and the Maslach Burnout Inventory (MBI). Data were analysed using Chi-square (X2) and Fisher's Exact tests to determine the significance (at 0.05) of associations between job satisfaction variables and the dimensions of burnout, namely, emotional exhaustion, depersonalisation and personal accomplishment. Most RNs reported low levels of satisfaction with both extrinsic and intrinsic job factors. Levels of emotional exhaustion were moderate to high (75.8%) with correspondingly high levels of depersonalisation (71.5%). Despite these findings, high levels of personal accomplishment were reported by most RNs (77.0%). There was a significant, inverse relationship between job satisfaction and two dimensions of burnout: emotional exhaustion and depersonalisation. Despite low satisfaction levels and some degree of burnout, the majority of RNs derived a sense of personal accomplishment from their jobs. Specific measures should be explored and implemented to improve nurses' physical work conditions, industrial relations, institutional management, promotion opportunities and recognition for good work to enhance nurses' levels of job satisfaction, and possibly also nurses' retention rates.

Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking.This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level.Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level.Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III.Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.

The New Partnership for Africa’s Development (NEPAD) Project on Nursing and Midwifery Education in Africa is designed to respond to critical health skill concerns and a pledge made by the Heads of State and Government of the African Union (AU) in Uganda in 2010 (AU 2010). Ten years later, the State of the World’s Nursing Report (SoWN) (WHO 2020) estimates a shortage of 5.9 million nurses, with the greatest gap (89%) found in low- and lower middle-income countries. To achieve the Sustainable Development Goals (SDGs) relating to health and well-being, World Health Organisation (WHO) member states would have to educate enough nurses to eliminate global shortages and to meet changing healthcare needs. In low- and lower middle-income countries, addressing nursing shortages requires an average increase in the number of graduates of 8.8% per year from 2018 to 2030 and an uptake of at least 70% into the workforce. The production and uptake burden facing southern Africa is a double-edged sword; a project such as this attempts to address this dual burden by adopting a novel approach to build nursing and midwifery capacity that espouses the values of collaboration, self-reliance and humanness. In this paper, we report on South-South collaboration as one of the strategies to develop nursing and midwifery education in the context and challenges of universities in southern Africa. The paper outlines the principles and values of the project; rooted in Ubuntu as a theoretical framework, it articulates the project vision, goals, objectives and implementation methodology, concluding with the profile of six NEPAD projects.

Background: The lack of a national intervention coding system and the current intervention coding in South Africa through the use of multiple billing and coding systems does not support quality intervention data collection and patient outcomes reporting for general surgery. This presents difficulties in the understanding of the different types of general surgical interventions performed in hospitals, the associated resources, risks, complications, outcomes reporting, public healthcare delivery, and determination of barriers to care. This study illustrates the use of accurate data on health interventions in South Africa’s acute care general surgery coding to assist in improved resource allocation, using the new WHO International Classification of Health Interventions (ICHI). ICHI has over 8000 codes and consists of three axes: Target (the entity on which the Action is carried out), Action (a deed performed by an actor to a target), and Means (the processes and methods by which the Action is carried out). A key benefit of ICHI is that it can be used collectively with the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF). Objectives: to evaluate the suitability of ICHI for general surgery interventions by coding intervention descriptions to ICHI codes; to identify gaps in the ICHI system; and to provide a rationale for ICHI to be a nationally regulated system. Methods: This study adopted a retrospective, descriptive design; in total, 3000 in-patient intervention data files, captured in an electronic database from April 2013 to August 2019 at three academic hospitals in Johannesburg, were extracted randomly, and coded using ICHI. Quantitative data analysis techniques were utilized to assess the overall degree of match between ICHI codes and the intervention descriptions. Results: Of the 3000 patient case entries that were coded, there was an agreement of 67.6% of the coded data amongst the three coders, leaving a variability of 32.4%. The variability was largely due to the coders’ experience and the quality of healthcare documentation. Conclusions: ICHI has the ability to cater for the broad range of general surgery interventions, thus indicating that ICHI is suitable for general surgery coding.

Background The National Benchmark Test (NBT) that determines academic readiness is widely used by Faculties as an additional measure to select students for the study of medicine. Despite this, many students continue to experience academic challenges that culminate in delayed graduation and sometimes academic exclusion or discontinuation of studies. Aim This study aimed to understand academic and non-academic variables linked with academic difficulties in the first three years of medical education. Methods The study sample consisted of six cohorts of medical students for the period 2011 to 2016 (n = 1392). Only the first three of the six-year medical programme were selected for analysis. Survival analysis and Cox Proportional Hazard (CPH) was used to identify academic and non-academic variables associated with academic difficulties. Results A total of 475 students (34%) experienced academic difficulty; 221 (16%) in the first year of study, 192 (14%) in the second year and 62 (5%) in the third year of study. The results show that Intermediate Upper, Lower and Basic levels for all NBT domains, living in university residence, rurality and male gender were risk factors for academic difficulty. Conclusion In mitigating these factors, the NBT must inform the type of support programmes to augment the students' skills and promote academic success. Additionally, existing support programmes should be evaluated to ascertain if they reach students at risk and whether participating in these programmes yield positive academic outcomes.

There is a dearth of literature about the career life courses and voices of Deputy and Assistant Headteachers in secondary schools. This thesis examines the career trajectories and the experiences of Headship from 14 Deputy and Assistant Headteachers in secondary schools in Birmingham, England. A two-phase, mixed-method study (survey and semi-structured life history interviews) was employed as part of an explanatory sequential design. This research builds upon previous work in life history studies along with career phases and stages research. The findings from this study add new insights to the senior leadership role and the perception of Headship in that the Deputy and Assistant Headteacher career stage and socialization experiences can determine whether they stay, leave or climb the career ladder to Headship. This thesis tentatively suggests that Deputy and Assistant Headteachers lean towards displaying mainly Bonder, Bridger or Leaver characteristics that contribute to aspiration and how they utilize their social capital in their career journeys. A new career stages and phases framework pertaining to Deputy and Assistant Headship in secondary schools has been forwarded which draws on the distinction between bonding and bridging social capital and career transition in school leadership and management.

The Intentional Design guide is a sourcebook that offers step-wise technical guidance for utilizing the Intentional Design approach, an evidence-based model for the design of girl-centered programs that generates a cycle of information collection and analysis. The tools outlined in this guide have been applied in sites in 44 countries. Twenty-one detailed field reports—including an extensive discussion of the Abriendo Oportunidades program in Guatemala—set the scene in each context by describing key challenges and problems faced, present how tools were used, and explain the eventual resolutions of the Intentional Design process.

The Population Council and its partners have applied a targeted, evidence-based approach to adolescent girl programming in over 20 countries, prioritising neglected (Bruce & Hallman, 2008) and exce...

HIV and AIDS prevention efforts have relied heavily on providing information, and have sometimes provided a weak link to services, without perceiving or addressing the factors which make adolescent girls particularly vulnerable. Social factors, such as friendship networks, and economic factors, such as financial literacy and financial goals, independently but synergistically decrease girls’ risk of coerced sex or exchanges of sex for money, and increase their ability to cope in HIV-affected households. Current work focusing on HIV and youth is failing to reach many of the most vulnerable girls. This article discusses innovative interventions in four African countries, which explicitly address the distinctive social, economic, and cultural factors that shape girls’ vulnerability, and build up their health, social, and economic assets.

For too many girls worldwide, an emergency begins as an "event" and transforms into a lifetime. The adolescent girl is already at a triple disadvantage pre-emergency: her age, her sex, and her economic status all put her at risk. Her thin (or absent) friendship network, fragile access to safe public space, and tenuous claim on schooling are further strained or erased by displacement. Girls are maltreated and exploited, even before childbearing age; puberty dramatically elevates their risk for sexual violence, pregnancy, and HIV infection. Many bear or inherit children while still children themselves. Social norms travel with the girl, generating a paradox: Girls are controlled under the guise of protection while their rights are violated and their goodwill and capacities are drawn on to mitigate scarcities and family trauma. In the severest moments of an emergency, adolescent girls function as a default safety net or virtual credit card. A girl's assets--labor, time, integrity, and safety--can be deployed to underwrite the risks and to "smooth" others' material needs. She is the last to access survival resources, but the first expected to provide; she actively seeks out food, fuel, and water for her family. She may be encouraged or driven by circumstances to trade sex for goods or money; she may be forced into child marriages or short-term sexual liaisons for which her family (and intermediaries) receives money. Her lack of education undermines her own ability to obtain accurate information, discern dangers, or define realistic choices. Without a place to meet other girls and develop her voice and agency, she may doubt her abilities or blame herself for her circumstances. Sexual access to girls, promoted or simply not prevented, is not only a human rights abuse but an injustice that extends her crisis, whether through life-crippling pregnancies or disease (HIV, other sexually transmitted infections, and now, Ebola). he Girls in Emergencies (GIE) Collaborative--a group representing several major emergency response organizations--focuses on the adolescent girl because evidence reveals that she not only faces a multiplicity of risks during a crisis, but also because she remains invisible, unprotected, and unengaged, particularly in the crucial first 45 days of a crisis. Current practice lags behind field realities. To the extent that we identified "good practices," these are small in scale and implemented too late.... Language: en

In recent history, the number and scale of natural disasters, one of the major causes of humanitarian emergencies, have increased markedly. From 2000 to 2009, compared with the period from 1980 to 1989, there were 3 times more natural disasters across the globe, with climate-related events accounting for nearly 80% of the increase. Since 2008, natural disasters such as floods, storms, and earthquakes have displaced an average of 26.4 million people per year. Even after adjusting for growth in population, the likelihood of being displaced by a disaster today is 60% higher than it was 40 years ago. In 2013 alone, 97 million people were affected by natural disasters. Man-made disasters, the other major cause of humanitarian emergencies (by means, for example, of violence and conflict), remain a leading driver of displacement as well. According to the UN High Commissioner of Refugees (UNHCR), mass displacement reached unprecedented levels in 2014: "59.5 million individuals were forcibly displaced worldwide as a result of persecution, conflict, generalized violence, or human rights violations." Particularly in fragile and conflict-affected states, a complex mix of overlapping hazards--both armed conflict and natural disasters--plays a role in creating humanitarian crises, one that climate change is expected only to exacerbate. The University College London-Lancet Commission, in its landmark 2009 report, said, "Climate change is the biggest global health threat of the 21st century. Effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk." Among the billions of people at increased risk are adolescents (10- to 19-year-olds), who account for 1 in 5 people in the world, or about 1.2 billion. The vast majority--90%--of adolescents live in developing countries (including China), and approximately 510 million of this group are girls. The poorest adolescent girls living in the poorest communities--roughly more than 200 million girls living in households in the bottom 2 wealth quintiles--are at special risk for being deleteriously affected by climate change. Nonetheless, adolescent girls are not currently a specifically targeted, high-risk group in humanitarian relief efforts during emergencies, nor are they specifically engaged as a population whose involvement could advance national adaptation plans to mitigate the effects of climate change. In 2011, Plan Internationali published a valuable monograph entitled "Weathering the Storm: Adolescent Girls and Climate Change," that called attention to the particular vulnerability of adolescent girls to the effects of climate change. It was a prescient analysis. In the intervening 4 years, the effect of climate change has become more pronounced, and there is a clearer vision of its consequences. The human rights community has more urgently addressed the effect of climate change, especially on socially excluded groups, and practitioners have begun to organize an increasingly accelerated response to the plight of adolescent girls in humanitarian emergencies, both those caused by natural disasters and armed conflicts. The overall reaction to the cataclysm suffered by adolescent girls, however, has been slower than the data warrant. Language: en

In most developing countries, the majority of sexually active female adolescents are married. Although married adolescents are often assumed to be at low risk for HIV infection, little is known about the actual HIV risks these adolescents face or about ways to minimize these risks.Demographic and Health Survey data from 29 countries in Africa and Latin America were used to examine the frequency of factors that may increase HIV risk in married women aged 15-19.Several behavioral and social factors may increase the vulnerability of married female adolescents to HIV infection. First, these young women engage in frequent unprotected sex: In most countries, more than 80% of adolescents who had had unprotected sex during the previous week were married. Second, women who marry young tend to have much older husbands (mean age difference, 5-14 years) and, in polygamous societies, are frequently junior wives, factors that may increase the probability that their husbands are infected and weaken their bargaining power within the marriage. Third, married adolescents have relatively little access to educational and media sources of information about HIV. Finally, the most common AIDS prevention strategies (abstinence, condom use) are not realistic options for many married adolescents.New policies and interventions, tailored to the sexual and behavioral profiles of women in each country, are needed to address the vulnerabilities of adolescent wives. In some countries, delaying age at marriage may be an important strategy; in others, making intercourse within marriage safer may be more valuable.

The inspiration for this report was the rising interest in investing in the poorest girls in the poorest communities as a vital strategy for interrupting intergenerational poverty promoting positive health (maternal child HIV reduction) and achieving fertility goals. Investment in the most disadvantaged girls does not have to cost a lot to realize positive outcomes for girls and benefits for whole communities especially once effective programs have been established and expanded. This report is intended to assist programmatic officers technically involved donors and policy analysts in making program and policy decisions on investments in adolescent girls. It does so by providing an understanding of the appropriate expectations and frameworks through which to consider the costs of adolescent girls’ programs.

In the past decade there have been expanding resources to address the underlying gender dimensions of HIV. This has been particularly urgent in sub-Saharan Africa as the female-to-male infection ratios in young populations has reached 3 to 1 and sometimes above. The phrase "gender and HIV" has become commonplace yet does not provide any specific guidance as to target audiences content or measurable results. It can include everything from microcredit programs for HIV-positive women to workplace programs seeking to change negative male norms to efforts to increase respect for diverse sexual and gender identities. This review mines the first generation of programs to provide an empirical foundation to inform a next generation. We examined 63 illustrative (and among the largest and best known) "gender and HIV programs." Data were obtained via programs own reports (garnered largely through interactive interviews) of how they selected their populations and targeted their interventions; whether and to what degree they conceptualize and address the distinct needs of males and females. It also inquired as to whether there were explicit links between populations of males and females in program design and in measurement of results. Pressing for clarity and answers to these questions will assist in translating the current interest in "gender" into more precise tailoring of interventions to specific age gender and partnership-status profiles. We conclude this program review with several recommendations: (1) redirecting HIV programs to primary prevention building the protective assets of those most at risk particularly the youngest of those who face the highest risk -- adolescent girls and young women deserve a larger share of resources and policy attention than they have been receiving; (2) locating populations of males for intervention guided by the needs of the most at-risk females; (3) defining gender-specific goals for females and males as separate but linked "social accounts" resulting in (a) safer and more confident girls and women who are able to claim their rights act on their own behalf and have opportunities and choices and (b) men and boys who will benefit from less rigid gender roles and who recognize the full humanity of others and treat them with respect.

Tap and Reposition Youth (TRY) was a multiphase initiative undertaken by the Population Council and K-Rep Development Agency (KDA) the oldest and largest microfinance institution in Kenya. The overall aim of the project was to reduce adolescents vulnerabilities to adverse social and reproductive health outcomes including HIV infection by improving their livelihoods options. The project was launched in low-income and slum areas of Nairobi Kenya where rates of HIV infection are alarming and where young women are disproportionately affected. TRY targeted out-of-school adolescent girls and young women aged 16-22. Initially the microfinance model was an adaptation of the adult juhudi group-based savings and lending model. The TRY model evolved over the course of the experiment moving from a minimalist savings and credit model to one that expanded upon social support and eventually responded to the particular needs of its vulnerable clientele. (excerpt)