Indigenous identities and the politics of authenticity

The very question of Indigenous authenticity, as Jeffrey Sissons reminds us, ‘‘…has deep roots within colonial racism’’ (2005, 43). Racialisation and the practice of creating and imbuing racial categories with seemingly impermeable boundaries and indestructible meanings has, after all, underpinned a range of colonial practices from the systematic alienation of Indigenous land and resources to child abduction. Regimes of biological and cultural authenticity continue to shape state policies and practices that regulate the everyday lives of Indigenous people around the world. Indeed, in some contexts, expectations of Indigenous cultural purity or environmental naturalness exist alongside the imposition of varying degrees of blood quantum as criteria for citizenship, political recognition and access to resources and services

Prerequisites for National Health Insurance in South Africa: Results of a national household survey

Background. National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals. Objectives. To explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and whether South Africans are ready for a change in the health system. Methods. A cross-sectional nationally representative survey of 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. Results and conclusions. There is dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services

Gender differences in experiences of ART services in South Africa: a mixed methods study

Objectives: A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa. methods Structured exit interviews (n = 1266) combined with in-depth interviews (n = 20) of women and men enrolled in ART care. results Men attending ART services were more likely to be employed (29% vs. 20%, P = 0.001) and were twice as likely to be married ⁄ co-habiting as women (42% vs. 22% P = 0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P = 0.021) and were also less likely to disclose their status to non-family members (17% vs. 26%, P = 0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access. conclusions Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men.Web of Scienc

Patients’ perspectives of acceptability of ART, TB and maternal health services in a subdistrict of Johannesburg, South Africa

Abstract: Background: The field of acceptability of health services is emerging and growing in coherence. But there are gaps, including relatively little integration of elements of acceptability. This study attempted to analyse collectively three elements of acceptability namely: patient-provider, patient-service organisation and patient-community interactions. Methods: Mixed methods were used to analyse secondary data collected as part of the Researching Equity in Access to Health Care (REACH) study of access to tuberculosis (TB) treatment, antiretroviral therapy (ART) and maternal health (MH) services in South Africa’s public health sector. Results: Provider acceptability was consistently high across all the three tracer services at 97.6% (ART), 96.6% (TB) and 96.4% (MH). Service acceptability was high only for TB tracer (70.1%). Community acceptability was high for both TB (83.6%) and MH (96.8%) tracers. Conclusion: Through mixed methods, this paper provides a nuanced view of acceptability of health services

The Development of a Student Focused Model for Transition to University

The transition to university is a well recognised challenge, especially for non-traditional students. This paper presents a student-focused model for the transition to university, developed through an extensive literature review, discussions with a range of professionals nationally and internationally, and first year teaching practice. The model was applied to the development of a range of strategies to be implemented at one institution. The use of the model may facilitate the development of a university-wide approach to the issues of student transition to university and the first year in higher education experience. The model will allow a balanced approach to be developed

Moving towards universal coverage in South Africa? Lessons from a voluntary government insurance scheme

BackgroundIn 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues.ObjectivesThis study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment.MethodsMulti-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression.ResultsNotwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs.ConclusionBarriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms

Systematic review of educational interventions to improve the menstrual health of young adolescent girls

Objectives: To systematically review interventions that include an element of menstrual education delivered to young adolescent girls. Design: This was a systematic review and meta-analysis. Selected articles were quality assessed using the Mixed Methods Appraisal Tool quality appraisal checklist. A meta-analysis was conducted on a subset of articles, and the effect size of the intervention was calculated using Cohen’s d. A logic model was constructed to frame the effect of menstrual education interventions on menstrual health. Setting: Papers reporting on interventions in high-income and low-income and middle-income countries were sought. Information sources: Seven electronic databases were searched for English-language entries that were published between January 2014 and May 2020. Participants: The interventions were aimed at younger adolescent girls aged 10–14 years old. Interventions: The interventions were designed to improve the menstrual health of the recipients, by addressing one or more elements of menstrual knowledge, attitude or practices (KAP). Eligibility criteria: Interventions that had not been evaluated were excluded. Primary and secondary outcomes: The most common type of output was a difference in knowledge or skill score ascertained from a pre and post test. Some studies measured additional outcomes, such as attitude or confidence. Results: Twenty-four eligible studies were identified. The number of participants varied from 1 to 2564. All studies reported improvements in menstrual KAP. The meta-analysis indicates that larger effect sizes were attained by those that encouraged discussion than those that distributed pamphlets. Conclusions: Education interventions are effective in increasing the menstrual knowledge of young adolescent girls and skills training improves competency to manage menstruation more hygienically and comfortably. Interactive interventions are more motivating than didactic or written. Sharing concerns gives girls confidence and helps them to gain agency on the path to menstrual health. Trial registration number: For this review, a protocol was not prepared or registered

Serial Observations and Mutational Analysis of an Adoptee with Family History of Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease with an autosomal dominant mode of transmission. Comprehensive genetic screening of several genes frequently found mutated in HCM is recommended for first-degree relatives of HCM patients. Genetic testing provides the means to identify those at risk of developing HCM and to institute measures to prevent sudden cardiac death (SCD). Here, we present an adoptee whose natural mother and maternal relatives were known be afflicted with HCM and SCD. The proband was followed closely from age 6 to 17 years, revealing a natural history of the progression of clinical findings associated with HCM. Genetic testing of the proband and her natural mother, who is affected by HCM, revealed that they were heterozygous for both the R719Q and T1513S variants in the cardiac beta-myosin heavy chain (MYH7) gene. The proband's ominous family history indicates that the combination of the R719Q and T1513S variants in cis may be a “malignant” variant that imparts a poor prognosis in terms of the disease progression and SCD risk

The University of Pretoria archives virtual classroom : connecting the community's past with the virtual future

Recent technological changes, as well as higher expectations from the constituencies they serve, have had major impacts on the realm of museums. The virtual environment and all it has to offer, along with the perception by a more democratic society that museums are community property, have made traditional museums reconsider their positions in order to remain viable. Within the financial and resource constraints of the museum domain, this article will focus on a response to these challenges, which utilises the new technology, works more closely with the broader museum audience and collaborates with other information-related institutions such as archives and libraries. It looks specifically at an exhibition project devised and developed by the University of Pretoria Archives, the "Virtual Classroom", as a practical and viable solution to the challenges posed.http://www.journals.co.za/ej/ejour_mousaion.html or http://www.unisa.ac.za/default.asp?Cmd=ViewContent&ContentID=20129am2013cp201

Pre-requisites for National Health Insurance in South Africa: Results of a national household survey

Background: National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key pre-requisites that need to be in place before NHI can achieve these goals. Objectives: To explore: • public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and • whether South Africans are ready for a change in the health system. Methods: A cross-sectional nationally representative survey of 4,800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. Results and conclusions: There is dis-satisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted nor generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services