Health Exchange

Wellness Centres for health care workers and their families

Nurse Counsellor Selby Sukati provides services to colleagues and their families in an atmosphere of trust and confidentiality

Stark numbers demonstrate the vast undersupply of health care workers to serve local populations: Sub-Saharan Africa has 75 per cent of the world population of people living with HIV, yet it employs only three per cent of the global health workforce. Very few innovations look at providing services for health care workers and the creation of Wellness Centres is a real innovation.

The International Council of Nurses shares the experience.

The shortage of health workers is the one of the most fundamental health system challenges facing Africa today. Sub-Saharan nations are experiencing a large and steady decline in the number of already scarce health workers due to death and disease, under-investment and poor retention practices. The International Council of Nurses (ICN), in regular consultation with nurses around the world, found that a primary ’push’ factor motivating health workers to migrate is that they feel overstressed and undervalued.

“Most people in the country (Swaziland) are so sick, so they flood these hospitals where these health workers are working and in some of them you find that even the wards are so full that other patients are on the floor. Beds are full of sick people that you cannot send home. That is traumatising to the health care worker,” said Phetsile Mamba, a registered nurse at the Swaziland Wellness Centre.

These conditions are difficult to overcome alone. Sisana Nhlabatsi, a nursing sister said, “It affects you physically; you become very tired, psychologically; and spiritually you are affected. Seeing people complaining when you are trying to give out the best to them and you cannot match their expectations because of the number that you are on the ground. Your morale becomes low.”

To make matters worse, the relatively few health workers on the scene function under hazardous working conditions and experience a high prevalence of infectious diseases, including HIV and AIDS, tuberculosis (TB) and malaria.
“The nature of the work done by health workers – especially those who are in touch with patients 24 hours a day – exposes them to stress, depression and various infections that, if not attended to immediately, affects their health grossly,” said Margaret Chota, Ugandan Commissioner for Health Services/Nursing.  “Many health workers are sick but cannot access health care easily.”

Those who contract an infectious disease face the same treatment access challenges as the general population. In addition, they have to queue with their patients for services and treatment, something they are reluctant to do.

Speaking about HIV, Sisana Nhlabatsi said; “If I want to go for voluntary testing, which is the thing now, that every person must be aware of  his or her own status, it means I must join the queue of the people that I service as a nurse. So it becomes so frightful and you feel like, ‘No, I should not do this. I would rather stay without knowing my status  than joining the same queue as the people I serve every day.’ But now, here comes the Wellness Centre.”

There is new hope in the form of several recently established “Wellness Centres for Health Care Workers®” in Swaziland, Lesotho and other sub-Saharan nations with fragile, under-staffed healthcare systems. The centres were originally conceived by the ICN in collaboration with its member national nurses associations (NNAs) in sub-Saharan Africa and with support from sister NNAs in the North.

ICN and the Swaziland Nurses Association created the first Wellness Centre for Health Care Workers and their families in Swaziland, in September 2006. The Lesotho Wellness Centre followed in 2007 and centres will open later this year in Malawi and Zambia, with Uganda on track for 2010.

The centres have opened the door to improved retention practices, better health and an increased sense of being valued for African health workers, who toil daily on the front lines of the battle against HIV and AIDS, TB and other infectious diseases.
Managed by nurses and supported by inter-sectoral partnerships, the centres provide a number of dedicated services for health workers and their families, including HIV and TB prevention, treatment and care in a discreet setting, psychological counselling and stress management,  occupational safety training and continuing professional development.

Julie Mayni, an assistant nurse in Swaziland said; “At times I feel quiet and I weep because you know, when you are an HIV woman, or an HIV positive person, you go up and down the ladder. The Wellness Centre is benefitting me. I have been on medication for some time now, but I still have the psychological problems. But with the Wellness Centre, I just go there, they give me continuity of care, which is counselling, and I come back to work. I don’t feel down like I used to be, we are being treated in a way that we are professionals.”

The Swaziland Wellness Centre for Health Care Workers  is situated in a country with a 26 per cent HIV prevalence rate, the highest in the world. National life expectancy is 32 years.

The centre’s land and building were provided by the Swaziland Nurses Association. The site, the first of its kind in the region, is accredited as an official antiretroviral therapy (ART) facility.

The global health community has been highly encouraged by the results of the Swaziland centre to date. According to its most recent report, the site has served more than 7,500 health care workers, or approximately 85 per cent of the country’s total health workforce.

The centre launched a TB and multi-drug resistant -TB training programme for nurses, and also provides HIV and TB training for support workers, including kitchen, maintenance and cleaning personnel. Swaziland also started hepatitis B immunisations for health care workers and has been conducting public education programmes via radio broadcasts.

As one of the most promising outcomes to date, the president of the Swaziland Nurses Association reported no cases of nurse migration during 2007-2008.

Wellness Centres play a vital role in addressing the large and steady decline in the number of scarce health workers and ultimately allow the rest of the population to receive proper health care services.

International Council of Nurses (ICN)
ICN is a federation of 133 national nurses associations representing more than 13 million nurses working worldwide.
http://www.icn.ch/

Watch a video about the Wellness Centres here: http://www.icn.ch/wellness-centre-video.htm

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