Exploring potential reforms to address the high costs of medical malpractice litigation in South Africa

For many years, medical malpractice claims have threatened the effective governance of health care sectors the world over. South Africa is not exempt from the effects of this phenomenon. The effects of increasing medical malpractice claims and their associated costs threaten the effective governance of the private and public health care sectors, which results in a vicious cycle of resource depletion, poor service delivery and constantly increasing rates of medical malpractice incidents. This research aims to add to the body of work in South Africa concerning the adverse effects of medical malpractice claims. This dissertation provides a theoretical discussion on whether periodic payments and alternative dispute resolution are satisfactory responses to combat both the rising cost of damages and the procedural backlogs present within the law of delict and medical malpractice litigation in South Africa to achieve comprehensive reform in the law of delict. Ultimately, this dissertation examines the practical legal issues that have led to the current medical malpractice crisis in South Africa. The dissertation examines the role of aspirational health care policies, goals and agendas (specifically section 27 of the Constitution of the Republic of South Africa) that have been implemented on a national level, and it also examines the ability to implement comprehensive reform to address the medical malpractice crisis to hopefully break the vicious cycle that is keeping South Africa from achieving its national and constitutional health care goals

The impact of natural disasters on development : an assessment of the role and functions of the national disaster management organization (NADMO): a case study of the Nawuni and Buipe communities, northern region of Ghana

Master thesis in development management- University of Agder 2011The objective of this thesis is to examine the impact of natural disasters on development through a study of the role and functions of the National Disaster Management Organisation (NADMO) in Ghana. Such a study has become necessary because currently natural disasters have gained international attention due to its impact on economic development. A key reflection on the causes, effects and vulnerability of individuals to natural disasters shows an interesting linkage between environmental, developmental and managerial failures. For instance, it has been continually emphasised that natural disasters are failures of development because economic development policies have not fully given consideration to disaster possibilities. A key argument of this study is that an over emphasis on the traditional methods of disaster management, namely relief and rescue responses, by NADMO reduces local capacities to manage effectively the challenge that current disasters such as floods present to local communities. The contention of this study is that there is a need for a paradigm shift from relief responses to disaster risk reduction through Community Based Disaster Management (CBDM) which seeks to build local capacities and disaster resilient communities for development

Advanced breast cancer care: the current situation and global disparities

Objectives: Advanced breast cancer (ABC) is an incurable disease. The number of people living with ABC has increased globally. Disparities in ABC care exist at both individual and system levels. ABC cases in most low- and middle-income countries (LMICs) are underreported due to a lack of national cancer registries. Harmonized guidelines for resource stratification and capacity building in LMICs are under way. Data sources: MEDLINE, Cochrane, and Google Scholar databases were used. Conclusion: To improve ABC outcomes and resolve disparities, more robust health systems or pathways need to be developed across the cancer continuum in addition to social education. Implications for nursing practice: So far, the ABC specialist nurse role has been variable globally, and to conquer such variability, an international online nurse education and training program is in practice

Utilization of Healthcare Services by the Elderly Patients at Korle-Bu Teaching Hospital, Accra

Objective: The study assessed the association between predisposing, enabling and need factors on utilization of healthcare services by the elderly attending the Korle-Bu Teaching Hospital. Methods: The study was a descriptive cross-sectional survey using a mixed method approach. Simple random sampling was used to sample three hundred and sixty-one elderly patients from seven (7) Out-Patient Departments in the Korle-Bu Teaching Hospital who responded to a structured questionnaire. Ordinal Logistic Regression was used to determine the association between the predisposing, enabling and need factors of the elderly and variables measuring utilization of healthcare. In the qualitative study, purposive and convenient samplings were used to select 76 elderly persons from the seven Out-Patient Departments of the hospital. Content analysis was used to analyze the voice recorded qualitative interview data and explained using an appropriate theory. Quantitative findings: The elderly who obtained above secondary school education were 0.49 times less likely to rate accessibility of healthcare on a higher scale compared with the elderly with pre-secondary education (OR=0.49, 95% CL; 0.28-0.85, p=0.11). The elderly who were beneficiaries of NHI were 0.42 times less likely (OR=0.42, 95% CI; 0.18-0.97) to rate accessibility of healthcare services on a higher scale compared with the elderly who were non-beneficiaries (p=0.042).  The elderly with multiple chronic conditions were 1.56 times more likely to rate the cost of healthcare on a higher scale compared with the elderly with one chronic condition (OR=1.56, 95% CI=1.04-2.34, p=0.03).  Qualitative findings: The elderly persons described the waiting time as long and stressful. They developed swollen feet and bodily pains due to the long waiting time. They clarified that the diagnostic investigation, medication and consultation fees were expensive, leading to postponement of their subsequent visits and deterioration of their health. Conclusion: Cost was a determining factor in utilizing healthcare. The study recommends that policy makers should include elderly persons from age 60 years to 69 years in the National Health Insurance exemption policy to enable the majority of them to utilize healthcare. Additionally, there is the need to review visits to the healthcare units to schedule time appointments to reduce the long and stressful waiting time

Determinants of tuberculosis treatment support costs to the treatment supporters in rural Ghana

Background: The Ghana Health Service has been implementing the Directly Observed Therapy Short Course (DOTS) strategy for decades now, to cure and reduce the transmission of tuberculosis. DOTS strategy requires TB patients and their treatment supporters to make multiple clinic visits in the course of treatment, and this may place financial burden on treatment supporters with low socio-economic status. However, the determinants of tuberculosis treatment support costs to treatment supporters are unknown in Ghana. Objectives: This study determined the costs associated with treatment support to the treatment supporters in Bono Region, Ghana. Methods: In a cross-sectional study using cost-of-illness approach, 385 treatment supporters were selected and interviewed. A validated questionnaire for the direct and indirect costs incurred was used. Descriptive statistics and bivariate techniques were used for data analysis. Results: Averagely, each treatment supporter spent GHS 122.4 (US$ 21.1) on treatment support activities per month, which is about 19% of their monthly income. The findings also revealed that highest level of education, household size, monthly income and district of residence were significant predictors of the direct costs. On the other hand, gender of the respondents, highest level of education, ethnicity, household size, income level and relationship with patient were some of the factors that significantly influenced the indirect costs. The significance levels were set at a 95% confidence interval and p < 0.05. Conclusion: The study concludes that the estimated cost associated with assisting tuberculosis patients with treatment is significant to treatment supporters. If these costs are not mitigated, they have the tendency of affecting the socio-economic status and welfare of individuals assisting tuberculosis patients with treatment

Spectrum of anxiety and depression reported in reproductive-aged women diagnosed with gynaecological disorders at a tertiary healthcare facility in Ghana

Background: Patients with gynaecological disorders often suffer from psychological disorders including anxiety and depression. Although depression and anxiety have been studied in Ghana, data regarding the prevalence of these disorders in patients with gynaecological disorders is non-existent. The aim of the study was to investigate the prevalence of anxiety and depression in reproductive-aged women diagnosed with gynaecological disorders.Methods: Cross-sectional observational study was conducted at the Gynaecology Clinic of Korle-Bu Teaching Hospital, a tertiary health facility in Accra, Ghana. Patients of reproductive age seeking gynaecological care at the facility from December 2018 to January 2019 were assessed for anxiety and depression using the Generalized anxiety disorder (GAD) questionnaire and the Beck depression inventory (BDI) respectively. Sociodemographic and clinical information was gathered as well.Results: Of the 120 patients interviewed (mean age 34.33±0.66), 36.7% were depressed while 51.6% were reported anxiety disorders. Patients aged 35-45 years had the highest prevalence of anxiety (24.58%) and depression (29.18%). Again, prevalence rates were highest among respondents with senior high school as the highest educational qualification, (anxiety (22.15%); depression (24.20%). Patients suffering from pelvic floor disorder recorded the highest prevalence of anxiety (11.40%) and depression (13.77%). There was a significant association between depression and gynaecological disorders [χ2(25) =53.915, p=0.001, CI=95%], but there was not enough evidence of an association between anxiety and gynaecological disorders [χ2(15) =22.791, p=0.089, CI=95%].Conclusions: Anxiety and depression are prevalent amongst women in their reproductive age diagnosed presenting with gynaecological disorders and there is a significant association between gynaecological disorders and the prevalence of depression