Friday 8 August 2008

Task shifting

Back in 1996, when we first heard about the success of the new Highly Active Antiretroviral Therapy (HAART), I remember Suzana saying that if the heavens opened and the drugs rained down on us, we wouldn't be ready to use them. "It's not just a matter of money, it's human reasources," she said.

Now, more than ten years on, we're still learning the lesson. There're more and more reports that it's not lack of drugs that's the problem in the developing world, it's that the health systems just cannot cope. The WHO is promoting task shifting, proposing that some of the doctors duties could be done by nurses, and some of the load taken off nurses by community members, particularly people with HIV. But even though patients in Indonesia are lucky if they get to see their doctor for more than five minutes, the medical profession here seems to be in total opposition to the idea of task shifting. They ignore the fact that many puskesmas (community health centres) have no doctor, so the nurses are forced to prescribe.

And now comes news that Indonesia is planning to export 1000 nurses to Japan over the next year; the first 205 have just left. Of course, African countries have put up with this kind of 'brain drain' for years, but it seems new for Indonesia to be exporting other than servants and nannies. Of course, in many hospitals the nurses are viewed more as servants and nannies, so perhaps it's not so new. Let's hope they come back after a couple of years with new skills and understanding of what the real task of a nurse really is.

Babé

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