Migration of health workers

Fact sheet N 301

Updated July 2010

Key facts
There are about 60 million health workers worldwide.
Many health workers migrate to high-income countries for greater income, job
satisfaction, career opportunities and management quality.
Demand for health workers is increasing in high-income countries, where health systems
can depend heavily on doctors, nurses and other health workers who have been trained
abroad.
Migration of health workers may result in financial loss and weakens health systems in
the countries of origin.
WHO has developed a Global Code of Practice on the International Recruitment of
Health Personnel to achieve an equitable balance of the interests of health workers,
source countries and destination countries.

Health workers are people engaged in actions whose primary intent is to enhance health. These
include people who provide health services such as doctors, nurses, midwives, pharmacists,
laboratory technicians as well as management and support workers such as hospital
managers, financial officers, cooks, drivers and cleaners.
Worldwide, there are around 60 million health workers. About two-thirds provide health
services; the other one-third are management and support workers. Without them, prevention and
treatment of disease and advances in health care cannot reach those in need.
Why health workers migrate
Health workers, like workers in all sectors, tend to go where the working conditions are best.
Income is an important motivation for migration, but not the only one. Other reasons include:
greater job satisfaction
career opportunities
the quality of management and governance
moving away from political instability, war, and the threat of violence in the workplace.
Migration is often stepwise. People tend to move from the poorest regions to richer cities within
a country, and then to high-income countries. In most countries, there is also movement from the
public to the private sector, particularly if there are considerable differences in income levels.
Globalization has helped to drive international migration. At the same time, demand for health
workers has increased in high-income countries where not enough health workers are being
trained locally and where the existing workforce is ageing. Demand for health services is also
increasing because of ageing populations and the rise of chronic illnesses like diabetes and heart
disease, especially in rural areas.
In a number of middle-income countries with good health education systems such as Fiji,
Jamaica, Mauritius and the Philippines a significant proportion of students, especially in
nursing school, begin their education with the intention of migrating, usually in search of a better
income. Some countries, notably the Philippines, are seeking to capitalize on the demand for
imported health workers by deliberately training graduates for international careers.
Impact of migration
The movement of health workers abroad has both negative and positive consequences.
When significant numbers of doctors and nurses leave, the countries that financed their education
lose the return on their investment.
Financial loss is not the most damaging outcome, however. When a country has a fragile health
system, the loss of its health workforce can bring the whole system close to collapse, with the
consequences measured in lives lost.
On the positive side, each year, migration generates billions of dollars in remittances (the money
sent back to home countries by migrants) to low-income countries and has been associated with a
decline in poverty. Health workers also may return and bring significant skills and expertise back
to their home countries.
Scope of migration
Health systems in a number of high-income countries depend heavily on doctors and nurses who
have been trained abroad. Over the last 30 years, the number of migrant health workers increased
by more than 5% per year in many European countries. In countries of the Organisation for
Economic Co-operation and Development (OECD), around 20% of doctors come from abroad.
In some Gulf States, such as Kuwait or the United Arab Emirates, more than 50% of the health
workforce are migrants.
Nurses from the Philippines (110 000) and doctors from India (56 000) account for the largest
share of migrant health workforce in OECD countries. However, countries with smaller
populations than India and the Philippines may suffer from a larger impact in terms of
expatriation rates. Over 50% of highly-trained health workers leave for better job opportunities
abroad in some low-income countries. The graph below shows the top 10 countries with highest
expatriation rates for doctors.

Addressing the negative effects of health worker migration
Highly trained and skilled health workers from developing countries continue to emigrate at an
increasing rate to certain countries, thereby weakening health systems in the countries of origin.
The following actions are required to address the negative effects of migration.
In source countries:
better health workforce retention, especially in rural and remote areas;
stronger protection and fairer treatment of health workers, who may face difficult and
often dangerous working conditions and poor pay; and
improved domestic training of health workers and development of policies that facilitate
the return of migrants.
In destination/receiving countries:
reduced dependency on migrant health workers notably through educating and training of
more health workers domestically and by making better use of the existing health
workforce; and
responsible recruitment policies by destination/receiving countries and fair treatment of
migrant health workers.
WHO response
WHO has developed global recommendations on health workforce retention in remote and rural
areas, so that countries can see what options have worked in different settings around the world
to attract and retain health workers.
WHO Global Code of Practice on the International Recruitment of Health Personnel
In 2004, the World Health Assembly requested WHO to develop a code of practice on the
international recruitment of health personnel. In response, WHO initiated a global consultation
process to produce a draft code. The Code was adopted by the World Health Assembly in May
2010.
The Code of Practice is voluntary, global in scope and applies to all health workers and
stakeholders. It sets out principles and encourages the setting of voluntary standards. The
equitable balance of the interests of health workers, source countries and destination countries is
promoted, with a particular emphasis on redressing the negative effects of health worker
migration on countries experiencing a health workforce crisis. Key components of the Code
include:
greater commitment to assist countries facing critical health worker shortages with their
efforts to improve and support their health workforce;
joint investment in research and information systems to monitor the international
migration of health workers in order to develop evidence-based policies;
Member States should meet their health personnel needs with their own human resources
as far as possible and thus take measures to educate, retain and sustain their health
workforce; and
migrant workers' rights are enshrined and equal to domestically-trained health workers.






The top 10 causes of death
Fact sheet N310
Updated May 2014
The 10 leading causes of death in the world, 2000 and 2012
Ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease
have remained the top major killers during the past decade.
HIV deaths decreased slightly from 1.7 million (3.2%) deaths in 2000 to 1.5 million (2.7%)
deaths in 2012. Diarrhoea is no longer among the 5 leading causes of death, but is still among the
top 10, killing 1.5 million people in 2012.
Chronic diseases cause increasing numbers of deaths worldwide. Lung cancers (along with
trachea and bronchus cancers) caused 1.6 million (2.9%) deaths in 2012, up from 1.2 million
(2.2%) deaths in 2000. Similarly, diabetes caused 1.5 million (2.7%) deaths in 2012, up from 1.0
million (2.0%) deaths in 2000.
Major causes of death
Q: How many people die every year?
In 2012, an estimated 56 million people died worldwide.
Q: What kills more people: infectious diseases or noncommunicable diseases?
Noncommunicable diseases were responsible for 68% of all deaths globally in 2012, up from
60% in 2000. The 4 main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung
diseases. Communicable, maternal, neonatal and nutrition conditions collectively were
responsible for 23% of global deaths, and injuries caused 9% of all deaths.
Q: Are cardiovascular diseases the number 1 cause of death throughout the world?
Yes, cardiovascular diseases killed 17.5 million people in 2012, that is 3 in every 10 deaths. Of
these, 7.4 million people died of ischaemic heart disease and 6.7 million from stroke.
Q: Do most NCD deaths occur in high-income countries?
In terms of number of deaths, 28 million (about three quarters) of the 38 million of global NCD
deaths in 2012 occurred in low- and middle-income countries.
In terms of proportion of deaths that are due to NCDs, high-income countries have the highest
proportion 87% of all deaths were caused by NCDs followed by upper-middle income
countries (81%). The proportions are lower in low-income countries (37%) and lower-middle
income countries (57%).
Q: WHO often says that smoking is a top cause of death. Where does tobacco use affect
these causes of death?
Tobacco use is a major cause of many of the worlds top killer diseases including
cardiovascular disease, chronic obstructive lung disease and lung cancer. In total, tobacco use is
responsible for the death of about 1 in 10 adults worldwide. Smoking is often the hidden cause of
the disease recorded as responsible for death.
Q: What are the main differences between rich and poor countries with respect to causes of
death?
In high-income countries, 7 in every 10 deaths are among people aged 70 years and older. People
predominantly die of chronic diseases: cardiovascular diseases, cancers, dementia, chronic
obstructive lung disease or diabetes. Lower respiratory infections remain the only leading
infectious cause of death. Only 1 in every 100 deaths is among children under 15 years.
In low-income countries, nearly 4 in every 10 deaths are among children under 15 years, and
only 2 in every 10 deaths are among people aged 70 years and older. People predominantly die
of infectious diseases: lower respiratory infections, HIV/AIDS, diarrhoeal diseases, malaria and
tuberculosis collectively account for almost one third of all deaths in these countries.
Complications of childbirth due to prematurity, and birth asphyxia and birth trauma are among
the leading causes of death, claiming the lives of many newborns and infants.
Q: How has the situation changed in the past decade?
Ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease
have remained the top major killers during the past decade.
Noncommunicable diseases (NCDs) were responsible for 68% (38 million) of all deaths globally
in 2012, up from 60% (31 million) in 2000. Cardiovascular diseases alone killed 2.6 million
more people in 2012 than in the year 2000.
HIV deaths decreased slightly from 1.7 million (3.2%) deaths in 2000 to 1.5 million (2.7%)
deaths in 2012. Diarrhoea is no longer among the 5 leading causes of death, but is still among the
top 10, killing 1.5 million people in 2012.
Tuberculosis, while no longer among the 10 leading causes of death in 2012, was still among the
15 leading causes, killing over 900 000 people in 2012.
Maternal deaths have dropped from 427 000 in the year 2000 to 289 000 in 2013, but are still
unacceptably high: nearly 800 women die due to complications of pregnancy and childbirth
every day.
Injuries continue to kill 5 million people each year. Road traffic injuries claimed nearly 3500
lives each day in 2012 more than 600 more than in the year 2000 making it among the 10
leading causes in 2012.
Q: How many young children die each year, and why?
In 2012, 6.6 million children died before reaching their fifth birthday; almost all (99%) of these
deaths occurred in low- and middle-income countries. The major killers of children aged less
than 5 years were prematurity, pneumonia, birth asphyxia and birth trauma, and diarrhoeal
diseases. Malaria was still a major killer in sub-Saharan Africa, causing about 15% of under 5
deaths in the region.
About 44% of deaths in children younger than 5 years in 2012 occurred within 28 days of birth
the neonatal period. The most important cause of death was prematurity, which was responsible
for 35% of all deaths during this period.
Why do we need to know the reasons people die?
Measuring how many people die each year and why they died is one of the most important
means along with gauging how diseases and injuries are affecting people for assessing the
effectiveness of a countrys health system.
Cause-of-death statistics help health authorities determine their focus for public health actions. A
country where deaths from heart disease and diabetes rapidly rise over a period of a few years,
for example, has a strong interest in starting a vigorous programme to encourage lifestyles to
help prevent these illnesses. Similarly, if a country recognizes that many children are dying of
malaria, but only a small portion of the health budget is dedicated to providing effective
treatment, it can increase spending in this area.
High-income countries have systems in place for collecting information on causes of death in the
population. Many low- and middle-income countries do not have such systems, and the numbers
of deaths from specific causes have to be estimated from incomplete data. Improvements in
producing high quality cause-of-death data are crucial for improving health and reducing
preventable deaths in these countries.

WHO/UNICEF highlight need to further
reduce gaps in access to improved drinking
water and sanitation
Inequalities in access to improved drinking water and sanitation
facilities still persist around the world
Note for media
8 May 2014 | GENEVA - Since 1990, almost 2 billion people globally have gained access to
improved sanitation, and 2.3 billion have gained access to drinking-water from improved
sources. Some 1.6 billion of these people have piped water connections in their homes or
compounds, according to a new WHO/UNICEF report, entitled Progress on drinking water and
sanitation: 2014 update, which also highlights a narrowing disparity in access to cleaner water
and better sanitation between rural and urban areas.
More than half of the global population lives in cities, and urban areas are still better supplied
with improved water and sanitation than rural ones. But the gap is decreasing. In 1990, more
than 76% people living in urban areas had access to improved sanitation, as opposed to only 28%
in rural ones. By 2012, 80% urban dwellers and 47% rural ones had access to better sanitation.
In 1990, 95% people in urban areas could drink improved water, compared with 62% people in
rural ones. By 2012, 96% people living in towns and 82% of those in rural areas had access to
improved water.
Inequalities in access
Despite this progress, sharp geographic, socio-cultural, and economic inequalities in access to
improved drinking water and sanitation facilities still persist around the world.
The vast majority of those without improved sanitation are poorer people living in rural areas.
Progress on rural sanitation where it has occurred has primarily benefitted richer people,
increasing inequalities, said Dr Maria Neira, WHO Director for Public Health, Environmental
and Social Determinants of Health.
Too many people still lack a basic level of drinking water and sanitation. The challenge now is
to take concrete steps to accelerate access to disadvantaged groups. An essential first step is to
track better who, when and how people access improved sanitation and drinking water, so we
can focus on those who dont yet have access to these basic facilities, she added.
In addition to the disparities between urban and rural areas, there are often also striking
differences in access within towns and cities. People living in low-income, informal or illegal
settlements or on the outskirts of cities or small towns are less likely to have access to an
improved water supply or better sanitation.
When we fail to provide equal access to improved water sources and sanitation we are failing
the poorest and the most vulnerable children and their families, said Sanjay Wijesekera,
UNICEF Chief of Water, Sanitation and Hygiene. If we hope to see children healthier and
better educated, there must be more equitable and fairer access to improved water and
sanitation.
Poor sanitation and contaminated water are linked to transmission of diseases such as cholera,
diarrhoea, dysentery, hepatitis A, and typhoid. In addition, inadequate or absent water and
sanitation services in health care facilities put already vulnerable patients at additional risk of
infection and disease.
The report presents estimates for 1990-2012 and is based on data from nationally representative
household surveys and censuses for the same period. It reveals that by 2012, 116 countries had
met the Millennium Development Goal (MDG) target for drinking water, 77 had met the MDG
target for sanitation and 56 countries had met both targets. MDG 7.C aims to halve, by 2015, the
proportion of the population without sustainable access to safe drinking water and basic
sanitation.
Key findings of the report
1. By the end of 2012, 89% of the global population used improved drinking water sources, a rise
of 13 percentage points in 22 years or 2.3 billion people.
2. By the end of 2012, 64% of the global population used improved sanitation facilities, a rise of
15 percentage points since 1990. Some 2.5 billion people two-thirds of whom live in Asia, and
a quarter in sub-Saharan Africa still use unimproved sanitation facilities. There are 46
countries where at least half the population is not using an improved sanitation facility.
3. Although declining across all regions, open defecation is practised by 1 billion people, 82% of
whom live in 10 countries. Nine out of 10 people defecating in the open live in rural areas.
4. Wealthy people universally have higher access to sanitation than the poor. In some countries
this gap is narrowing. The gap is increasing, however, in rural areas of countries with low
coverage and for marginalized and excluded groups.
5. 748 million people 90% living in sub-Saharan Africa and Asia (43% in Sub-Saharan Africa,
and 47% in Asia) still use unimproved drinking water sources; 82% live in rural areas.
For more information please contact:
Nada Osseiran
WHO Geneva
Communications Officer
Telephone: +41 22 791 4475
Mobile: +41 79445 1624
E-mail:osseirann@who.int
Mr Tarik Jasarevic
WHO Geneva
Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 79367 6214
E-mail:jasarevict@who.int
Vector-borne diseases
Fact sheet N387
March 2014
Overview

Key facts
Vector-borne diseases account for more than 17% of all infectious diseases, causing more
than 1 million deaths annually.
More than 2.5 billion people in over 100 countries are at risk of contracting dengue alone.
Malaria causes more than 600 000 deaths every year globally, most of them children
under 5 years of age.
Other diseases such as Chagas disease, leishmaniasis and schistosomiasis affect hundreds
of millions of people worldwide.
Many of these diseases are preventable through informed protective measures.

Main vectors and diseases they transmit
Vectors are living organisms that can transmit infectious diseases between humans or from
animals to humans. Many of these vectors are bloodsucking insects, which ingest disease-
producing microorganisms during a blood meal from an infected host (human or animal) and
later inject it into a new host during their subsequent blood meal.
Mosquitoes are the best known disease vector. Others include ticks, flies, sandflies, fleas,
triatomine bugs and some freshwater aquatic snails.
Mosquitoes
Aedes
o Dengue fever
o Rift Valley fever
o Yellow fever
o Chikungunya
Anopheles
o Malaria
Culex
o Japanese encephalitis
o Lymphatic filariasis
o West Nile fever
Sandflies
Leishmaniasis
Sandfly fever (phelebotomus fever)
Ticks
Crimean-Congo haemorrhagic fever
Lyme disease
Relapsing fever (borreliosis)
Rickettsial diseases (spotted fever and Q fever)
Tick-borne encephalitis
Tularaemia
Triatomine bugs
Chagas disease (American trypanosomiasis)
Tsetse flies
Sleeping sickness (African trypanosomiasis)
Fleas
Plague (transmitted by fleas from rats to humans)
Rickettsiosis
Black flies
Onchocerciasis (river blindness)
Aquatic snails
Schistosomiasis (bilharziasis)
Vector-borne diseases
Vector-borne diseases are illnesses caused by pathogens and parasites in human populations.
Every year there are more than 1 billion cases and over 1 million deaths from vector-borne
diseases such as malaria, dengue, schistosomiasis, human African trypanosomiasis,
leishmaniasis, Chagas disease, yellow fever, Japanese encephalitis and onchocerciasis, globally.
Vector-borne diseases account for over 17% of all infectious diseases.
Distribution of these diseases is determined by a complex dynamic of environmental and social
factors.
Globalization of travel and trade, unplanned urbanization and environmental challenges such as
climate change are having a significant impact on disease transmission in recent years. Some
diseases, such as dengue, chikungunya and West Nile virus, are emerging in countries where
they were previously unknown.
Changes in agricultural practices due to variation in temperature and rainfall can affect the
transmission of vector-borne diseases. Climate information can be used to monitor and predict
distribution and longer-term trends in malaria and other climate-sensitive diseases.
WHO response
WHO responds to vector-borne diseases by:
providing the best evidence for controlling vectors and protecting people against
infection;
providing technical support and guidance to countries so that they can effectively manage
cases and outbreaks;
supporting countries to improve their reporting systems and capture the true burden of the
disease;
providing training on clinical management, diagnosis and vector control with some of its
collaborating centres throughout the world; and
developing new tools to combat the vectors and deal with the disease, for example
insecticide products and spraying technologies.
A crucial element in vector-borne diseases is behavioural change. WHO works with partners to
provide education and improve awareness so that people know how to protect themselves and
their communities from mosquitoes, ticks, bugs, flies and other vectors.
For many diseases such as Chagas disease, malaria, schistosomiasis and leishmaniasis, WHO has
initiated control programmes using donated or subsidized medicines.
Access to water and sanitation is a very important factor in disease control and elimination.
WHO works together with many different government sectors to control these diseases.

Dengue and severe dengue
Fact sheet N117
Updated March 2014

Key facts
Dengue is a mosquito-borne viral infection.
The infection causes flu-like illness, and occasionally develops into a potentially lethal
complication called severe dengue.
The global incidence of dengue has grown dramatically in recent decades.
About half of the world's population is now at risk.
Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and
semi-urban areas.
Severe dengue is a leading cause of serious illness and death among children in some
Asian and Latin American countries.
There is no specific treatment for dengue/ severe dengue, but early detection and access
to proper medical care lowers fatality rates below 1%.
Dengue prevention and control solely depends on effective vector control measures.

Dengue is a mosquito-borne infection found in tropical and sub-tropical regions around the
world. In recent years, transmission has increased predominantly in urban and semi-urban areas
and has become a major international public health concern.
Severe dengue (also known as Dengue Haemorrhagic Fever) was first recognized in the 1950s
during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most
Asian and Latin American countries and has become a leading cause of hospitalization and death
among children in these regions.
There are four distinct, but closely related, serotypes of the virus that cause dengue (DEN-1,
DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against
that particular serotype. However, cross-immunity to the other serotypes after recovery is only
partial and temporary. Subsequent infections by other serotypes increase the risk of developing
severe dengue.
Global burden of dengue
The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5
billion people over 40% of the world's population are now at risk from dengue. WHO
currently estimates there may be 50100 million dengue infections worldwide every year.
Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now
endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-
east Asia and the Western Pacific. The American, South-east Asia and the Western Pacific
regions are the most seriously affected.
Cases across the Americas, South-east Asia and Western Pacific have exceeded 1.2 million cases
in 2008 and over 2.3 million in 2010 (based on official data submitted by Member States).
Recently the number of reported cases has continued to increase. In 2013, 2.35 million cases of
dengue were reported in the Americas alone, of which 37 687 cases were severe dengue.
Not only is the number of cases increasing as the disease spreads to new areas, but explosive
outbreaks are occurring. The threat of a possible outbreak of dengue fever now exists in Europe
and local transmission of dengue was reported for the first time in France and Croatia in 2010
and imported cases were detected in three other European countries. In 2012, an outbreak of
dengue on Madeira islands of Portugal resulted in over 2000 cases and imported cases were
detected in 10 other countries in Europe apart from mainland Portugal.
In 2013, cases have occurred in Florida (United States of America) and Yunnan province of
China. Dengue also continues to affect several south American countries notably Honduras,
Costa Rica and Mexico. In Asia, Singapore has reported an increase in cases after a lapse of
several years and outbreaks have also been reported in Laos. In 2014, trends indicate increases in
the number of cases in the Cook Islands, Malaysia, Fiji and Vanuatu, with Dengue Type 3 (DEN
3) affecting the Pacific Island countries after a lapse of over 10 years.
An estimated 500 000 people with severe dengue require hospitalization each year, a large
proportion of whom are children. About 2.5% of those affected die.
Transmission

WHO/TDR/Stammers
The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to humans
through the bites of infected female mosquitoes. After virus incubation for 410 days, an
infected mosquito is capable of transmitting the virus for the rest of its life.
Infected humans are the main carriers and multipliers of the virus, serving as a source of the
virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can
transmit the infection (for 45 days; maximum 12) via Aedes mosquitoes after their first
symptoms appear.
The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers.
Unlike other mosquitoes Ae. aegypti is a daytime feeder; its peak biting periods are early in the
morning and in the evening before dusk. Female Ae. aegypti bites multiple people during each
feeding period.
Aedes albopictus, a secondary dengue vector in Asia, has spread to North America and Europe
largely due to the international trade in used tyres (a breeding habitat) and other goods (e.g.
lucky bamboo). Ae. albopictus is highly adaptive and therefore can survive in cooler temperate
regions of Europe. Its spread is due to its tolerance to temperatures below freezing, hibernation,
and ability to shelter in microhabitats.
Characteristics
Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but
seldom causes death.
Dengue should be suspected when a high fever (40C/ 104F) is accompanied by two of the
following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea,
vomiting, swollen glands or rash. Symptoms usually last for 27 days, after an incubation period
of 410 days after the bite from an infected mosquito.
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation,
respiratory distress, severe bleeding, or organ impairment. Warning signs occur 37 days after
the first symptoms in conjunction with a decrease in temperature (below 38C/ 100F) and
include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue,
restlessness, blood in vomit. The next 2448 hours of the critical stage can be lethal; proper
medical care is needed to avoid complications and risk of death.
Treatment
There is no specific treatment for dengue fever.
For severe dengue, medical care by physicians and nurses experienced with the effects and
progression of the disease can save lives decreasing mortality rates from more than 20% to less
than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.
Immunization
There is no vaccine to protect against dengue. Developing a vaccine against dengue/severe
dengue has been challenging although there has been recent progress in vaccine development.
WHO provides technical advice and guidance to countries and private partners to support
vaccine research and evaluation. Several candidate vaccines are in various phases of trials.
Prevention and control

WHO/TDR/Crump
At present, the only method to control or prevent the transmission of dengue virus is to combat
vector mosquitoes through:
preventing mosquitoes from accessing egg-laying habitats by environmental management
and modification;
disposing of solid waste properly and removing artificial man-made habitats;
covering, emptying and cleaning of domestic water storage containers on a weekly basis;
applying appropriate insecticides to water storage outdoor containers;
using of personal household protection such as window screens, long-sleeved clothes,
insecticide treated materials, coils and vaporizers;
improving community participation and mobilization for sustained vector control;
applying insecticides as space spraying during outbreaks as one of the emergency vector
control measures;
active monitoring and surveillance of vectors should be carried out to determine
effectiveness of control interventions.
WHO response
WHO responds to dengue in the following ways:
supports countries in the confirmation of outbreaks through its collaborating network of
laboratories;
provides technical support and guidance to countries for the effective management of
dengue outbreaks;
supports countries to improve their reporting systems and capture the true burden of the
disease;
provides training on clinical management, diagnosis and vector control at the regional
level with some of its collaborating centres;
formulates evidence-based strategies and policies;
develops new tools, including insecticide products and application technologies;
gathers official records of dengue and severe dengue from over 100 Member States;
publishes guidelines and handbooks for case management, dengue prevention and control
for Member States.


Tahun 2015, Tantangan Globalisasi dan TI
[Opini]
Tahun 2015, Tantangan Globalisasi dan TI

Oleh Hendrizal SIP

PERTEMUAN masyarakat informasi di Geneva beberapa waktu lalu telah menghasilkan rencana
aksi untuk mewujudkan masyarakat informasi pada tahun 2015. Indonesia juga terikat
komitmennya untuk memperluas akses masyarakat pada teknologi komunikasi informasi atau
sering disingkat teknologi informasi (TI).
Target untuk mewujudkan masyarakat informasi itu, menurut pihak kementerian komunikasi dan
informasi, pada tahun 2014 diharapkan seluruh desa, perguruan ting-gi, akademi, SD dan SMP,
perpustakaan, pusat kebudayaan, museum, kantor pos, arsip pusat kesehatan dan rumah sakit
telah terhubung dengan teknologi informasi. Dalam pertemuan itu ada target untuk mewujudkan
information seciety pada tahun 2015. Kalau melihat kondisi kita saat ini, bukan hanya
dibutuhkan kerja keras, tetapi kerja luar biasa, ungkap pihak tersebut.
Itulah target dan agenda pemerintah Indonesia terkait dengan pengembangan teknologi
komunikasi informasi. Selain sebagai peluang, tentu ini juga mengandung tantangan tersendiri
bagi berbagai komunitas di negeri kita, apalagi jika dikaitkan dengan akan semakin derasnya
arus globalisasi yang melanda umat manusia, termasuk kita di Indonesia sebagai warga global.
Salah satu hal penting yang menandai arus globalisasi itu adalah diterapkannya nilai-nilai
perdagangan bebas. Sekarang ini saja, nilai-nilai perdagangan bebas itu telah mulai dirasakan
membawa berbagai perubahan dan tuntutan. Di antaranya, jika di masa lalu persaingan
perdagangan lebih dipengaruhi oleh kualitas, harga maupun pelayanan, tapi di masa sekarang
(dan tentu apalagi di masa mendatang), selain faktor-faktor tersebut, persaingan perdagangan
salah satunya juga akan dipengaruhi oleh pemanfaatan dari aplikasi teknologi informasi.
Perlu diketahui, teknologi informasi merupakan kumpulan pengetahuan hasil riset yang
memberikan pemahaman dan informasi tentang bagaimana ilmu pengetahuan, teknik dan seni
digunakan untuk tujuan praktis, terutama untuk aktivitas produktif yang akan memberikan nilai
tambah bagi kesejahteraan manusia. Di sini pengembangan telekomunikasi merupakan ujung
tombak (spear head) bagi pengembangan informasi dan industri. Teknologi informasi itu dapat
didefinisikan sebagai konvergensi dari elektronika, pemrosesan data dan telekomunikasi.
Karena itu pula, infrastruktur telekomunikasi disebut pula sebagai high way dari abad informasi.
Di sini informasi telah menjadi komoditas bagi seluruh masyarakat dan bukan cuma milik
kalangan bisnis saja. Nyatanya, aktivitas ekonomi modern suatu bangsa bergantung kepada
kapasitas infrastruktur telekomunikasi yang tersedia di negara yang bersangkutan dan
kemampuan untuk menggunakan infrastruktur tersebut untuk berkomunikasi dengan dunia
internasional.
Dalam hal ini, teknologi informasi menjadi landasan yang lebih memudahkan gerakan bagi
layanan teknik, profesional dan finansial. Ia turut membantu sebagai sarana globalisasi ekonomi.
Selain itu, teknologi informasi turut pula mendorong internasionalisasi produksi dan pasar,
meningkatkan mobilitas layanan dan aliran moneter serta dana. Karenanya, sistem informasi
pada saat ini banyak digunakan untuk memperbaiki produktivitas, kualitas dan efisiensi bidang
keuangan, perbankan, manajemen usaha maupun administrasi publik.
Untuk mengatasi perubahan, beberapa organisasi terkemuka giat dalam mengelola pengetahuan
yang mereka kembangkan melalui riset, pengembangan, operasi, logistik, pemasaran, pelayanan
konsumen dan aktivitas sehari-hari lainnya. Investasi dalam pengetahuan melampaui e-mail,
halaman web internet, intranet dan groupware ke pengembangan dan penyebaran pengalaman
bahkan kebijakan, sehingga semua orang dalam organisasi, di manapun dan kapanpun, bisa
mengakses modal pengetahuan dari organisasi dan mengambil perspektif dari seluruh dunia ke
dalam pekerjaannya sehari-hari.
Perkembangan yang bisa membentuk masyarakat dan organisasinya merupakan penyusutan yang
terus-menerus dari ruang dan waktu melalui teknologi. Pada zaman Jefferson (presiden Amerika
Serikat yang paling berpikiran jauh ke depan), dibutuhkan waktu selama 6 minggu untuk
menyampaikan informasi dari Sungai Mississippi ke Washington DC. Pada saat Abraham
Lincoln mulai menjabat di Gedung Putih (kantor kepresidenan Amerika Serikat), kira-kira 60
tahun kemudian, informasi yang sama bergerak hampir sama cepatnya dengan telegram.
Demikian pula halnya dengan pengiriman barang-barang dengan menggunakan jasa kereta api
atau kapal uap yang cuma membutuhkan waktu selama satu jam, sedangkan pada masa Jefferson
diperlukan waktu satu hari. Seperti yang ditunjukkan oleh sejarawan Stephen Ambrose, Jefferson
dan Lincoln jelas memiliki persepsi yang amat berbeda mengenai ruang dan waktu.
Penciutan ruang dan waktu ini adalah inti dari perekonomian global. Dewasa ini, organisasi-
organisasi menerima era teknologi informasi sebagai suatu hal yang biasa. Organisasi-organisasi
menerima mesin facsimile sebagai alat baru dengan amat cepat. Dalam beberapa tahun, telepon
seluler terdapat di mana-mana. Meskipun demikian, organisasi-organisasi juga harus selalu
mengembangkan potensi sumberdaya manusianya agar tidak muncul ketimpangan maupun
ketidakseimbangan antara kemajuan ilmu pengetahuan dan teknologi (iptek) dengan sumberdaya
manusianya, sehingga mampu menggeser paradigma yang salah mengenai efisiensi individual
melalui teknologi.
Dengan begitu, organisasi-organisasi yang sanggup mengaplikasikan teknologi informasi ke
dalam semua bidang garapannya, akan mampu memperbaharui beberapa nilai yang berorientasi
pada masa depan, yaitu: (1) Nilai pemberdayaan. Maksudnya, jika diusahakan dengan sungguh-
sungguh, akan mampu menggerakkan suatu organisasi menuju model yang mutakhir.
(2) Nilai kecepatan, yakni akan mampu mendorong organisasi menuju penerapan yang efektif
dari teknologi dan metode yang baru. (3) Nilai kreativitas, yakni akan mampu menggerakkan
imajinasi para individu dalam organisasi, dan akan mampu mendorong pemikiran yang tidak
konvensional yang sangat dibutuhkan dalam dunia yang serba tidak menentu dan penuh dengan
persaingan ini.
Itu semua artinya, organisasi yang bisa sukses di abad 21 ini adalah organisasi yang bisa
mendekati pemecahan masalah dan pengambilan keputusan sebagai pencarian global untuk
belajar melampaui tapal batas internal dan eksternal. Pencarian global berarti semua tingkatan
dalam organisasi akan berupaya untuk mencari pasar, kemampuan dan ide dari berbagai macam
sumber. Bagi organisasi swasta, pemerintah maupun sosial, pencarian ide-ide, pengalaman dan
inovasi dari seluruh dunia tersebut akan menjadi suatu hal yang paling utama.
Agenda yang penting kita lakukan sekarang adalah menanamkan mentalitas pencarian global
tersebut ke dalam organisasi-organisasi kita. Artinya, mulai kini, berusahalah menanamkan nilai-
nilai dan memberi imbalan untuk berpikir global, melakukan pencarian secara global dan
bertindak secara global, meskipun organisasi dan konsumen masih bersifat domestik.
Jika hal itu dilakukan secara serius, besar kemungkinan akan tumbuh kemampuan membawa
kekuatan global untuk memecahkan masalah lokal. Hal terakhir ini akan menjadi salah satu tolak
ukur keberhasilan organisasi masa depan, termasuk tentunya di negeri kita. Itulah tantangan kita
sekarang.

Penulis adalah mahasiswa Pascasarjana S2 PIPS Universitas PGRI Yogyakarta, Research Fellow
di BRIE India
Edisi Senin, 16 Juni 2014


30 Mei 2014
Mengelola Kebijakan Keperawatan
o Oleh Dyah Wiji PS
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PEMENUHANkebutuhan tenaga perawat profesional diyakini makin dinamis seiring dengan
pengimplementasian Masyarakat Ekonomi ASEAN (MEA) tahun 2015. Kompetisi dan kualitas
tenaga perawat akan menjadi faktor daya saing utama pada pasar jasa keperawatan global.
Kegagalan mengelola tenaga keperawatan bisa menjadi langkah awal kegagalan mengambil
peluang pasar jasa perawat global.
Aroma kegagalan pengelolaan dalam sektor jasa perawat profesional di Indonesia salah satunya
tercium dari persoalan lisensi keperawatan nasional yang tak kunjung selesai. Sertifikat
kompetensi dan surat tanda registrasi (STR) yang menjadi lisensi syarat kerja profesi perawat
menimbulkan polemik berkepanjangan.
Dalam sistem registrasi keperawatan global, otoritas registrasi perawat dilakukan oleh suatu
badan atau konsil yang diamanatkan UU pada setiap negara. Otoritas registrasi tersebut bersifat
otonom dan independen sehingga badan atau konsil keperawatan memiliki posisi yang strategis
di setiap negara. Di Indonesia, saat ini konsil yang dimaksud diejawantahkan dalam bentuk
Majelis Tenaga Kesehatan Indonesia (MTKI).
Majelis itu dibentuk dengan dasar hukum setingkat peraturan menteri (permen) sehingga
berderajat legalitas rendah. Surat tanda registrasi yang diterbitkan oleh MTKI menjadi sulit
diakui di level internasional karena lembaga penerbit tak sesuai dengan standar global
keperawatan. Berkait kebijakan sertifikasi kompotensi terjadi dualisme kebijakan. Kemenkes
melalui Permenkes Nomor 1796 Tahun 2011 menilai sertifikat kompetensi dikeluarkan oleh
MTKI yang merupakan organisasi di bawah naungan Kemenkes.
Sertifikat kompetensi kemudian menjadi syarat untuk penerbitan STR sebagai syarat wajib
perawat menjalankan profesinya. Sementara Kemendikbud melalui Permendikbud Nomor 83
Tahun 2013 menilai sertifikat kompetensi merupakan surat tanda pengakuan kompetensi
terhadap lulusan dalam uji kompetensi yang diterbitkan oleh perguruan tinggi bersama lembaga
profesi.
Dalam hal pengakuan menjalankan praktik profesi, Kemendikbud menerbitkan sertifikat profesi
bersama dengan lembaga profesi dan kementerian lain. Polemik tersebut sedikit mereda dengan
ditekennya Peraturan Bersama Menkes dan Mendibud Nomor 1//IV/PB Tahun 2013 tentang Uji
Kompetensi Tenaga Kesehatan. Regulasi itulah yang mengislahkan kedua lembaga pemerintah
terkait tumpang-tindih uji dan sertifikasi kompetensi.
Kemenkes kemudian menerbitkan Permenkes Nomor 46 tahun 2013 yang kini menjadi rujukan
untuk registrasi perawat nasional. Rantai birokrasi dalam registrasi dan izin penyelenggaran
praktik keperawatan membuat kebijakan keperawatan saat ini inefisien dan cenderung
membebani perawat. Perawat harus mengikuti uji kompetensi setelah menyelesaikan proses
akademis. Uji kompetensi diajukan secara kolektif oleh institusi keperawatan Majelis Tenaga
Kesehatan Provinsi (MTKP) yang ditembuskan kepada organisasi profesi (PPNI). MTKPakan
melakukan uji kompetensi setelah mendapat rekomendasi MTKI.
Proyek Bancakan
Usai melaksanakan uji kompetensi, MTKP melaporkan ke MTKI dan institusi pendidikan
perawat, peserta yang dinyatakan kompeten (lulus). Institusi pendidikan perawat kemudian
mengajukan permohonan sertifikat kompetensi dan STR kepada MTKI melalui MTKPberdasar
hasil kelulusan uji kompetensi sebelumnya. MTKI kemudian memproses pembuatan STR bagi
perawat yang telah dinyatakan lulus uji kompetensi.
Setelah mendapat STR pun, perawat harus mengajukan surat izin praktik perawat (SIPP) bagi
yang menjalankan praktik keperawatan mandiri dan surat izin kerja perawat (SIKP) bagi yang
menjalankan tugas di luar praktik mandiri. Kedua surat izin ini dikeluarkan oleh pemda, tempat
perawat tersebut berdomisili. Perbedaan pandangan kebijakan dan rantai birokrasi panjang
tersebut juga menimbulkan kesan proses sertifikasi merupakan proyek bancakan yang
diperebutkan kedua belah pihak.
Masing-masing institusi mengambil peran dalam proses produksi lisensi perawat. Menata
kebijakan keperawatan nasional sebagai wajah kesehatan kita menjadi keharusan pemerintah.
Pemilu 2014 yang melahirkan wajah baru legislator, senator dan presiden harus menjadi
momentum meninjau ulang tata kelola perawat. Solusinya, dengan penyegeraan pengesahan
RUU Keperawatan.
Para pemerhati kesehatan menilai lambatnya pengesahan RUU Keperawatan karena kuatnya
tarikmenarik yang bersifat politis dan prestise. Politis disebabkan lemahnya daya tawar asosiasi
dan institusi keperawatan terhadap DPR dan pemerintah ataupun minimnya tawaran sponsor
yang mendukung pengesahan RUU itu.
Sementara persaingan prestisius antarprofesi kesehatan di lapangan ditarik dalam diskursus RUU
ini yang membuatnya terkatungkatung di meja Senayan. Mahasiswa, perawat, dosen, dan
organisasi profesi keperawatan harus mengambil langkah terdepan mendesak untuk mewujudkan
keterbentukan badan/konsil regulator keperawatan yang otonom dan independen.
Semangatnya adalah bila profesi dokter memiliki konsil kedokteran mandiri, mengapa profesi
perawat dengan SDM terbanyak belum memiliki konsil? Pasti bisa. (10)
Dyah Wiji Puspita Sari, dosen Fakultas Ilmu Keperawatn (FIK) Unissula Semarang,
mahasiswa Pascasarjana FIK UI Jakarta

Unand Adakan Sosialisasi Edukasi Publik Masyarakat Ekonomi
ASEAN 2015
Rabu, 11 Juni 2014 17:40 Berita Universitas | Dibaca : 383


Dalam rangka persiapan menyongsong Masyarakat Ekonomi ASEAN tahun 2014, Universitas Andalas
bekerjasama dengan Kementerian Perindustrian dan Perdagangan RI, Direktorat Jenderal Perdagangan Luar Negeri, dan
Pemerintahan Kota Padang mengadakan sosialisasi Edukasi Masyarakat Ekonomi ASEAN (MEA) dengan tema Think Big Think
ASEAN pada hari Jumat, 6 Juni 2014. Sosialisasi ini dilaksanakan dalam rangka mengajak para mahasiswa sebagai generasi
muda untuk siap dalam menghadapi pasar bebas di MEA nantinya.
Rektor Universitas Andalas, Dr. H. Werry Darta Taifur, SE, MA menyampaikan bahwa menghadapi
Masyarakat Ekonomi ASEAN itu harus dipikirkan dengan optimis. Kesiapan yang harus dipertimbangkan ke depan tidak hanya
ASEAN, tetapi harus merujuk pada kesiapan menghadapi era Asia. Masyarakat Ekonomi ASEAN sudah di depan mata, tinggal 15
bulan lagi dari sekarang. Kesiapan perguruan tinggi menghadapi pelaksanaan Masyarakat Ekonomi ASEAN tentu tidak lebih dari
fakta perguruan tinggi yang ada diseluruh Indonesia saat ini. Salah satu esensi penting dari implementasi Masyarakat Ekonomi
ASEAN adalah akan terjadi kebebasan aliran barang dan tenaga kerja di wilayah negara ASEAN. Kesiapan yang harus menjadi
pusat perhatian adalah bagaimana menangkal secara maksimal agar Indonesia tidak hanya menjadi pasar barang dan jasa tenaga
kerja dari negara ASEAN lainnya.
Perguruan tinggi mempunyai tanggungjawab untuk menghasilkan insan cerdas dan kreatif yang berdaya
saing serta pengembangan ilmu pengetahuan untuk melakukan inovasi, pengembangan teknologi untuk meningkatkan produktivitas
dan daya saing bangsa
Lebih lanjut Rektor mengatakan harus diakui bahwa tidak semua perguruan tinggi dapat melaksanakan tanggungjawab ini karena
menghadapi persoalan internal dan eksternal. Tapi perguruan tinggi Indonesia tidak akan bisa melaksanakan dan mengemban
tugas tersebut tanpa dukungan penuh semua pemangku kepentingan (stakeholders).
Kesiapan perguruan tinggi menghadapi Masyarakat Ekonomi Asia atau Era Asia dapat menjadi overestimate
atau underestimate seandainya tidak mengetahui fakta tentang perguruan tinggi Indonesia. Kesiapan perguruan tinggi dalam hal ini
Unand, harus merujuk dengan fenomena yang terjadi sekarang dan apa yang akan terjadi di masa mendatang. Indonesia akan
menjadi salah satu pemain bersama India dan Tiongkok pada era Asia. Perguruan tinggi harus menghasilkan lulusan yang
memenuhi kompetensi abad 21 dan melakukan inovasi yang dapat meningkat daya saing bangsa.
Drs. Syafrudin Yahya, MT, Sekretaris Direktorat Jenderal Perdagangan Luar Negeri mengatakan strategi
peningkatan daya saing harus dipersiapkan dan mendapatkan dukungan seluruh stekholders, tidak hanya di tingkat pusat tapi juga
peningkatan daya saing di daerah melalui peningkatan efisiensi produksi, mendorong hilirisasi/diversifikasi produk ekspor,
meningkatkan produktivitas tenaga kerja, serta meningkatkan harmonisasi kebijakan pusat-daerah, dan peran aktif dunia
pendidikan/universitas dalam kegiatan kajian untuk mendukung kebijakan dalam menyonsong AEC 2015.
Senada dengan itu, Eka Dian Dharma, SE, MM Direktorat Jenderal Kerjasama Perdagangan Internasional Kementerian
Perdagangan dalam paparannya yang berjudul Menjadi Pemenang Pada Masyarakat Ekonomi ASEAN Tahun 2015 mengatakan
bahwa pemerintah daerah harus mampu memanfaatkan otonomi untuk mengembangkan kebijakan yang inovatif, kreatif, dan
harmonisasi aturan hukum yang membuka ruang bagi tumbuhnya perekonomian daerah.
Dalam hal yang sama, Prof. Helmi, M.Sc selaku akademisi juga menyampaikan seharusnya para akademisi
lebih meningkatkan kegiatan research dan inovasi untuk mendukung perumusan kebijakan, program dan aktivitas dibidang keahlian
sendiri atau lintas disiplin ilmu. Serta menjalin networking dan join research dengan mitra akademisi dari perguruan tinggi di negara
ASEAN lainnya agar lebih memahami apa saja bentuk perkembangan yang terjadi di negara lain.
Setelah paparan dari para pemateri, acara dilanjutkan dengan sesi tanya jawab, serta malam harinya dilanjutkan dengan dialog
interaktif dengan tema Memanfaatkan Momentum Masyarakat Ekonomi ASEAN 2015 bersama Ditjen KPI.
Humas dan Protokol Unand