The informal sector and public participation in policy formulation in the informal economy: a case study of eThekwini metropolitan municipality.

Masters Degree. University of KwaZulu-Natal, Durban.The concept of public participation in policymaking is a complex phenomenon. The term has been used for different purposes, which extends its complexity in public sector. The complexity is experienced at different levels of engagement, contexts, and activities. Local government is central in facilitating public participation. The Constitution of South Africa and other legislative documents affirm the significance of public participation for accountability and transparency in government spheres. However, public participation with regard to policy related to informal trading exists in principle but its implementation is complicated. This study investigates street traders’ engagement in policymaking processes. The study employs a qualitative approach to examine informal sector actors’ participation in public policy-making in Durban. The empirical data were collected from in-depth interviews and through observation of Municipal Business Unit officials and street traders and through literature reviews. The total number of participants were twenty street traders, two government officials and one civil society participant. The data was interpreted and discussed thematically through a deductive approach. The study has three major findings. Firstly, we argue that street traders are not considered alone in decision-making processes. Secondly, this study claims that power dynamics contribute to shop owners and formal businesses receiving preferential treatment from the city council, at the expense of street traders. Lastly, the demand for urban public space for commercial trading is limited, while the role of the informal sector in income generation for poor and middle class households is increasing. This study finds that, if public participation is to be more sustainable, it must move beyond rhetoric to include integral inclusive participation measures

Supporting retention in HIV care through a holistic, patient-centred approach: a qualitative evaluation

Background HIV is a complex disease which affects different facets (social, economic, physical, emotional and spiral) of an individual’s life, making the goals of retention in care and adherence to treatment difficult to achieve. Holistic patient-centred approaches to providing care for people living with HIV bind together economic, social, emotional and physiological aspects and have the potential to improve retention in care and ART adherence. Case management is a holistic, patient-centred approach which is increasingly being implemented in the management of chronic illnesses. Methods We conducted a qualitative study based on semi-structured interviews with key informants (retention officers and social auxiliary workers) and patients. A total of 60 patients and 17 KIs (11 retention officers and 6 social auxiliary workers) participated in the study. The study was conducted in Johannesburg District, Gauteng province, South Africa. Key informants (KIs) and patients were drawn from 8 health facilities located in four management clusters of the district. Results The findings identified facilitators and barriers to adherence and retention in care, and demonstrated that case management offered holistic, patient-centred services which patients considered to be beneficial to their well-being and helped them overcome some of these barriers. The success of case management was driven by its holistic and patient-centred approach, which extended the focus to patients’ non-clinical needs which impact on their quality of life. Complex interacting barriers and facilitators at different levels influenced implementation of the model and its outcomes. Conclusion Holistic approaches such as case management have a strong potential to improve retention in care and adherence to ART. HIV is a complex disease which impacts different facets of an individual’s life, hence requires holistic care to address all facets. Health systems need to transition towards holistic care to ensure that some patients do not slip through the cracks, improve patient outcomes and efficiency

Workplace wellbeing among health care workers providing HIV services in primary care in Johannesburg: a mixed methods study

BackgroundBurnout among Health Care workers (HCWs) impacts on provider-patient relations and quality of care. Anova Health Institute (Anova) is a large South African non-profit organization and PEPFAR/USAID implementing partner. We conducted a study among HCWs providing HIV-related services in primary care settings in Johannesburg, South Africa, to examine levels of burnout, understand factors affecting workplace wellbeing, and explore strategies to prevent burnout.MethodsWe used a sequential mixed-method approach. Data were collected between February and April 2022. The first phase consisted of a survey using the Maslach Burnout Inventory Human Services Survey (MBI-HSS) to measure levels of burnout. We then interviewed a subset of survey participants to understand the experiences that may affect wellbeing. We used descriptive statistics to quantify burnout rates for each MBI dimension (emotional exhaustion, personal accomplishment, and depersonalization). Qualitative data analysis was guided by the Job Demands-Resources Framework that explores the interactions between demands and resources in the workplace.ResultsSurvey findings (n = 194) revealed that although depersonalization rates were low at 6%, 21% of participants had high emotional exhaustion and 24% reported low professional accomplishment. Less than half (41%, n = 80) had scores in the high category for any one of the three MBI-HSS dimensions. The MBI-HSS dimensions differed significantly by type of work and job title. Roving positions (HCW working in more than one health facility) were more likely to experience higher emotional exhaustion and lower professional accomplishment. Qualitative findings (n = 25) indicate that a number of job demands, including high workload, inadequate mental health support, and challenging relationships with stakeholders, had a negative effect on HCWs’ wellbeing. However, finding meaningfulness in their work, working as a team, and practicing autonomy were experienced as resources that reduced the negative effect of these demands.ConclusionWhile measured burnout syndrome rates were low, various experiences negatively impacted at least one in five HCW. We identified key resources that provided buffering against workplace stressors. We recommend that as well as addressing key drivers of burnout, access to these resources should be fostered, for example by strengthening interventions that offer recognition, and promoting team interactions through social activities and support groups