2.14.1 Develop and implement mechanisms for monitoring the availability of these TREAT policy guidelines at the national level, as well as the dissemination of these policies and their application in the healthcare setting.

Existing guidelines regarding monitoring and evaluation, such as the following, do not specifically address HIV programmes for healthcare workers, nor even the workplace setting generally however WHO does provide some guidance on monitoring and evaluation generally (e.g. WHO's Monitoring and Evaluation Toolkit HIV/AIDS, Tuberculosis and Malaria 2004; FHI/Impact/UNAID. Evaluating Programmes for HIV/AIDS Prevention and Care in Developing Countries, A Handbook for Programme Managers and Decision Makers. 2006.)

The desirability of monitoring the development, dissemination and impact (or structure, process and outcome measures, as are more usually evaluated) of any policy or programme, is well-established and needs little elaboration.

The need for surveillance of work-related disease and injury on a national basis to detect trends and emerging threats which may not be perceived at the individual facility level has also been discussed. This point was also highlighted by Wheeler, citing the work of Dement et al. (2004), and Hood and Larranaga (2007), with respect to the value of surveillance systems, and expanding on the findings of Yassi (1998) who reported on surveillance systems established at the Winnipeg Health Sciences Centre in Canada, where data on 6000 employees were collected which helped to prioritize, monitor and improve occupational health services. As noted by Wheeler, this article noted how using the databases permitted the targeting of groups requiring immunization, thereby increasing coverage; a return-to-work post injury programme was found to be particularly cost-beneficial; and over the five years following the implementation of occupational health programmes, savings in workers' compensation assessments were more than half a million dollars annually.

The study by Dement and colleagues (2004) discussed the creation of an occupational surveillance system for health workers at Duke University in the United States. The system was designed to study consequences of work-related stress, hearing conservation programme evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids. This study re­iterates the need to focus resources on this high risk population. The authors also demonstrate that high quality data is necessary to effectively create and evaluate intervention programmes.

As described by Yassi and colleagues, the experience of piloting the Occupational Health And Safety Information System at Pelonomi Hospital in Free State, South Africa, has drawn attention to the need to build capacity of health and safety committees as well as occupational health personnel if monitoring is to be effective (Yassi et al., 2009b). Recently Yassi and colleagues noted that having worldwide standards for monitoring workplace and workforce health in the healthcare sector would be well-warranted, to allow comparison across jurisdictions and sharing of resources (Yassi et al., 2009c )

In the systematic review of the literature on HIV workplace policies and programmes in southern Africa, Mahajan and colleagues (2007) noted that challenges of implementing the needed policies and programmes included the lack of monitoring and evaluation methodologies for workplace HIV prevention programmes, and called for more research, facilitated by the development and implementation of monitoring and evaluation strategies, is urgently needed.

Wheeler also highlights the fact that some higher level of oversight is required because there may be undue pressure brought to bear on occupational health service personnel by their employer in order to escape the costs of compliance with safety or disease prevention measures. Wheeler notes that the existence of an external body with powers to set standards and enforce them reinforces the authority of the occupational health staff and protects the workforce from employer negligence. He further noted that to guarantee the professional autonomy of the external body, it is desirable that it is removed from the direct control of service providers (such as the Ministry of Health).

This statement was only partially addressed in the WHO multi-country survey, however, several respondents did reveal that the management and enforcement process was lacking. It is noteworthy, though, that in many jurisdictions such independent enforcement bodies do exist (often in Ministries of Labour), although there is a dearth of literature on the effectiveness of such oversight regulatory bodies. (Robson, 2007)

As discussed at length previously, trade unions and health professional associations have an important role to play in this regard and there are good arguments that involvement of representatives of the health workforce, independent experts, public and private sector employers, and regulatory bodies on such oversight committees should be encouraged.

Thus it can be concluded that there is value in monitoring the development, dissemination and application as well as impact of programmes and policies in general; there have been some studies attesting to the value of monitoring and surveillance systems for occupational health, and in healthcare specifically;.the need for capacity-building in order to implement effective monitoring is noteworthy; achieving international consensus on the elements to be monitored and how these are to be evaluated is likely an important step before calling for widespread implementation of a monitoring programme; and finally oversight is needed to ensure that policies are implemented, and this oversight needs involvement of all the key stakeholders.

The GG stressed that:

  • Oversight is needed to ensure that policies are implemented, and this oversight needs involvement of all the key stakeholders.
  • Mechanisms for monitoring should involve representatives of the health workforce, independent experts, public and private sector employers, and regulatory bodies.
  • There should be involvement of people living with HIV in the monitoring process.
  • A set of key monitoring indicators specific to health workers should be developed, and targets set.
  • Data collection and analysis should be organized both locally and as part of a national database.
  • Confidentiality of data collected must be ensured; and
  • Capacity-building should be provided in order to implement effective monitoring.
  • Monitoring should be disaggregated (e.g. gender, age, staff level)

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