South Africa: Solving treatment bottlenecks

The monthly Improvement Meeting at Qumbu Health Centre, 50km from the Eastern Cape province town of Mthatha, is supposed to start at 9am, but rarely starts before 10am. Many of the nurses attending work at remote rural clinics scattered across Mhlontlo District and have to travel along rudimentary roads using the mini-bus taxis system to reach the meeting, so no-one complains about late arrivals. Once seated, they begin calling out figures to Kholeka Mhlakaza, the HIV/AIDS treatment programme manager for Mhlontlo, who writes them on a whiteboard.

24-Hour Hospital Shifts Pose Higher Motor-Vehicle Risks for Interns

Medical interns who work a hospital shift up to or exceeding 24 consecutive hours are more than twice as likely to have a motor vehicle crash and five times as likely to report a near-miss incident than interns who do not work an extended shift, a study in the Jan. 13 issue of the New England Journal of Medicine finds. And, for every extended shift that an intern worked per month, the risk of any motor vehicle crash increased by 9%, while the likelihood of a crash on the commute home from work increased monthly to 16%, according to the nationwide, Web-based survey of 2,737 first-year medical residents. The study also found that interns averaged 70 hours per week in the hospital, during which time they reported being awake for 67 hours, or 96% of the time. Interns reported working an average of 3.9 extended work shifts each month, each with an average duration of 32 hours.

Strengthening Health Systems: The Role and Promise of Policy and Systems Research

The Alliance for Health Policy and Systems Research, an initiative of the Global Forum for Health Research in collaboration with the World Health Organization, has published its first biennial review of the emerging field of health policy and systems research.

Setting tomorrow's agenda: new directions for health policy in developing countries

This report documents much of the formal input and discussions of a three week course held in Boston, Massachusetts in October 1994. It is intended to reflect the inputs rather than to provide my own critique. Copies of listed articles and papers may be obtained from the Health Systems Trust.