The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 65
a balance needs to be achieved in physicians’ roles in
direct patient care and as supervisors or trainers to
others [454]. Task shifting should be implemented
within systems that contain checks and balances to
protect both workers and patients [455]. Task-shifting
should also not be seen as a substitute for tackling
some of the more fundamental issues relating to staff
shortages, as well-trained physicians (generalist and
specialist) and nurses are needed; it should be complemented,
for example, with other approaches such
as incentives for retention of health professionals and
improved working conditions.
Task shifting efforts can go beyond the health
workforce to include people with chronic diseases
themselves, their peers, and family members, as
seen in the ‘expert patients’ successfully used in a
number of countries in Africa for HIV/AIDS [434,
456-458]. Trained patients have been shown to be
as effective in imparting knowledge to their peers as
specialist health professionals if given appropriate
training. Also, peer support interventions for adults
with diabetes in low-resource settings can improve
symptom management and blood sugar and hypertension
control amongst participants [458-460].
Forming support groups for those living with disease
can contribute to success.
Equipping Health Workers
NCD care clearly needs a well-trained physician
(generalist and specialist) and nurse workforce.
Chronic disease management, disease prevention,
and health promotion need to be well introduced
into the education of health workers. Specializations
such as family medicine, palliative care, and trauma
care may need to be introduced in some countries.
There are opportunities to equip and expand
health workers from all fields to be agents for NCD
prevention and care; for example, training midwives
to identify and manage hypertensive disorders and
gestational diabetes in pregnant women can reduce
maternal mortality and have an impact on longer-term
conditions [396, 438].
Retain, Motivate, Raise Status
For a well-performing health workforce, entry and
exits need to be managed, as do the distribution
and performance of existing health workers [373].
Some roles may be perceived to have low status,
especially for nurses, midwives, and auxiliary staff.
To retain highly-trained staff, and redistribute the
health workforce, African countries need to offer
internally competitive wages and benefit packages.
Non-monetary incentives, such as training, professional
development, improved work environments,
and appropriate equipment, are also important
to improve motivation, quality and productivity
[443]. Partnerships are likely to be important to
support comprehensive human resources for health
strategies. WHO’s ‘Treat, train, and retain’ plan to
strengthen health workforces in countries greatly
affected by HIV recognizes the impact of HIV on
health workers and the need to overcome persistent
stigma and discrimination to be able to treat and
retain staff [461]. Given that many health workers
may also have NCDs such as diabetes there may be
further transferrable learning.
Telemedicine and Information
Communication Technology (ICT)
The application of ICT in health (eHealth), through,
for example, telemedicine and electronic medical
records, has the potential to facilitate better health
care delivery including in situations where health
services and human resources for health are scarce
[398, 462]. Telemedicine can, for example, offer remote
physician access, care, and diagnosis where
specialist opinions would be otherwise unavailable,
reduce the need for patient transfers and travel, facilitate
knowledge-sharing and collaboration across
boundaries, and provide professional support and
opportunities for continuing professional development
to rural practitioners. A WHO survey in 2009
found the African Region to have one of the lowest
proportions of countries with established telemedicine
services, with less than 10 percent of responding
countries having the four telemedicine fields
surveyed (teleradiology, telepathology, teledermatology,
telepsychiatry) [463].
While mobile phone use in Africa is growing, with
subscribers doubling to 500 million during 2008-11
[464], there are infrastructure challenges to e-health
such as technical expertise, interrupted power supplies,
insufficient communication networks, and