1. Getting Serious About Nurses: Health & Safety in the Workplace

2. Gregory Grevera, MSN, CRNP, AACRN Board of Directors, ANAC

3. Adele A. Webb, PhD, RN, ACRN, FNAP, FAAN Executive Director, ANAC

4. ICN Wellness Centres for Health Workers and their Families Presented at ANAC Satellite 6 August 2008 International AIDS Conference Mexico City Tesfamicael Ghebrehiwet,PhD, RN Consultant, Nursing and Health Policy International Council of Nurses

5. Wellness Centres for Health Care Workers and their Families

6. Wellness Centre rationale/concept Wellness Centre rationale/concept Since September 2006 the Wellness Centre provides dedicated health services - HIV, TB, prevention, treatment and care; PEP; stress management; occupational safety training; capacity building; for HCWs and families So that: Keep HCWs healthy, in their jobs and in the country Strengthen health systems under tremendous pressure Demonstrate health workers are valued Maintain the relationship of trust Build a catalogue of good practice

7. Wellness Centres for Health Care Workers in Swaziland Delivering health and wellness services to health workers & their families:

8. Swaziland Wellness Centre Services Prevention, education HIV & TB testing, counseling, treatment Stress management Training Occupational health and safety – injection safety, PEP Healing Garden PMTCT Work place services

9. Partners/funders

10. Implementation planning First-ever Wellness Centre opened in Swaziland in September 2006 Lesotho opened in fall 2007 Zambia and Malawi in 2008 Committed to Wellness Centres where locally requested across sub-Saharan Africa

11. Some results to date - Swaziland Reached 6,225 health care workers (HCWs), 77% of the total health workforce. Outreach programme brings staff to outlying health facilities. Zero reported cases of nurse migration over the past year. 65% increase in uptake of services per month. HTC increased among health workers.

12. Results cont’d TB and MDR-TB training programme for nurses initiated. Wellness for workers is now incorporated in government policy. 80% increase per month in clients seeking psycho-social services. Support workers (kitchen, maintenance, cleaning) receive training on HIV and TB. Wellness Centre educational programmes reach the public via radio broadcast.

13. Results Lesotho Opened in November 20007 More than 1 300 HCWs reached with services and training Training includes, stress management, behaviour change, PEP, IMAI Accredited for and delivering ART Nurse counselling and wellness checks

14. Identified gaps/needs Reliable access to mobile capacity for delivery of services and training in the work place & outlying areas Strengthened lab/monitoring capacity, including TB Increased capacity in: –Occupational health and safety –Financial & project management Development of services related to diabetes and other chronic diseases

15. View from Swaziland Video

16. Protecting health workers from occupational exposure to HIV through global campaigns Dr. Jorge R. Mancillas Public Services International 6 August 2008 International AIDS Conference

17. Health Worker risk of HIV infection Health workers are at high risk of occupational exposure to HIV The incidence of HIV infection amongst health workers is highest where the prevalence of HIV is highest

18. Global shortage of health workers Current global shortage: 4.3 million health workers (WHO) The infection of a HCW with HIV is not only another human tragedy, but also the loss of vital human resource needed to effectively fight the epidemic

19. The need for international structures ■ WHO and other intergovernmental organizations ■ Health workers unions & professional organizations Global and local perspective. Policy, advocacy, implementation & monitoring PSI structure : Congress ► EB, HSTF ► Weblog & publications 651 affiliates, 24 sub-regional and regional networks a) Survey, monitor and communicate to identify concerns of universal nature: integrate local (frontlines) to global (HSTF, sub-regional meetings and networks) b) Research or develop solutions: share resources c) Plan and implement campaigns

20. Protecting health workers: the process 1. Research solutions and tools of universal applicability and identify partners, goals and targets Sources: PSI affiliates, PSIRU, WHO, ILO, research institutes 2. Global campaigns: a. Implementation of preventive measures - AIDS guidelines: WHO/ILO b. Ensure treatment of infected health workers: PEP & ART - PEP guidelines: WHO/ILO c. Prevent workplace exposure by addressing major mode of transmission of BBPs: needlestick injuries

21. Needlestick injuries Healthcare workers suffer 2 million exposures to Hepatitis and HIV/AIDS per year due to needle stick injuries Needle stick injuries are the mode of transmission for over 30 other blood borne pathogens (Malaria, Ebola, Hep C)

22. Retractable syringes

23. Safe for health care workers Safe for waste collectors Safe for patients: non-reusable (Prevent 1.3 million deaths, $535 million) Benefits of a campaign to make safe devices the universal standard: Protection of health workers and patients, retain AIDS work force

24. WHO strategy

25. Safe devices campaign GOAL: Achieve widespread shift to safe devices by building economies of scale and eliminating price differential Retractable syringes a) Develop & disseminate information and materials to affiliates b) Negotiate with government or employers, build public support c) Negotiate lower prices with manufacturer – build sales volume First successes: a) Democratic Republic of Congo: decreed mandatory standard b) Nigeria c) Angola

26. Protecting health workers: the process a)Advocate at global bodies: WHO, Global Fund, IFIs ► Develop solutions ► Policy carry weight of international body (WHO SIGN) ► Involve multiple participants b) Pursue multiple mechanisms to change policy ► International organizations (WHO, World Bank)Financing and guidelines ► Regional bodies – EUDirectives ► National DRC, Nigeria, AngolaDecrees, agreement US, UKLegislation ► State/province Brazil: Rio, Santa CatarinaLegislation ► Employers Negotiations of CBAs c) Create conditions: Education, public relations, policy and financing

27. Thank you Dr. Jorge Mancillas PSI Health Services Officer Jorge.mancillas@world-psi.org +33 450 40 11 50 +33 617 54 38 74

28. Chisomo Zileni, RN Program Officer National Youth Council of Malawi

29. International AIDS Conference –Mexico 2008 ANAC Satellite: Getting Serious About Nurses; Health and Safety in the Workplace Christine Mutati Zambia Union of Nurses Organization ZUNO/NNO Nurses HIV/AIDS Project Zambia Sulwe Isaac Hamuchele Zambia Union of Nurses Organization ZUNO/NNO Nurses HIV/AIDS Project Zambia 29

30. Issues; Confidential access to health care for and health care workers Wellness centers for health care workers and development of supportive networks for nurses 30

31. Patient/Client Confidentiality Definition: A conscious effort by every healthcare worker to keep private all information revealed by the client while receiving healthcare, this include client’s identity, physical or psychological condition, emotional status and financial situation. 31

32. Patient/Client Privacy Definition: Privacy entails a state of being free from unauthorized intrusion ( a person’s right to privacy ) A state in which one is not observed or disturbed by unauthorized others The quality or condition of being secluded from the presence or view of others 32

33. Whose responsibility to maintain client privacy & confidentiality? Just like nurses provide privacy and confidentiality to their clients, they likewise deserve and are entitled to privacy and confidentiality when accessing healthcare from public and private care providers (all healthcare providers). Thus; Confidential pre/post exposure prophylaxis Confidential and accessible treatment(including ART) Confidential and fairly distributed care and support which include follow-up services 33

34. Observation Nurses by nature of their work are mostly stigmatized especially when it comes to seeking health care services from public institutions. This is despite them being human beings who get sick just like any other humans with rights to accessing confidential and affordable health care services from any sources available. 34

35. Call for Action It is a requirement for any government in any country to avail nurses with accessible confidential and affordable health care services. It is prudent for any government and many other stakeholders to formulate and implement policies that will promote equitable distribution of care and support to all health care workers. Countries/Governments should adopt the “wellness centre concept” for assured comprehensive provision of healthcare package tailored specifically for nurses and other health workers. 35

36. Wellness Centres for Health care workers Wellness centers are intended to provide a comprehensive healthcare package well tailored for health care providers. Proved useful and successful in; Swaziland Lesotho Zambia 36

37. Wellness centres comprehensive services include; Counseling ART,TB and Malaria clinics Laboratory services Compliance and community follow-ups/outreaches Skills building trainings Stress management Care and support programs Recreation Drug supplies etc 37

38. Support groups/networks for nurses = local support group 38

39. Nurses support/networks activities Retired Nurses Orphans Piggery Sick nurses 39

40. Support networks 40 Wellness centre activities are linked with nurses local support groups for assured coverage of nurses in remote areas NB- Nurses are availed the necessary privacy and confidential, accessible and affordable healthcare services through wellness centre/local support groups linked service package.

41. 41 ACTION SHOULD BE NOW THANK YOU FOR YOUR LISTENING

42. Carl A. Kirton, RN, MA, ACRN, ANP-BC President, ANAC

43. Pat Daoust, MSN, RN Health Action AIDS Campaign Director

44. A Global Call Please support our statement on the rights of all health workers to a safe and healthy work environment