Global health in foreign policy in South Africa – evidence from state actors

AIM : There are currently debates about why South Africa integrates global health into its foreign policy agendas. This study aimed at exploring motivation and interests’ South African policy actors pursue to advance global health and the processes that lead to such integration. METHODS : The study utilized a mixed-method design from a sample of state policy actors at the National Department of Health of South Africa. Participants were selected purposively and had experience of more than three years participating in various international health activities. All participants completed semi-structured questionnaires. Quantitative data was analysed to determine frequencies and transcribed text was analyzed using qualitative content analysis. RESULTS : A total of 40 people were invited, of whom 35 agreed to participate. Of the respondents, 89.7% (n=32) strongly argued that health should facilitate ‘free movement of people, goods and services’. Majority (79.0%, n= 29) agreed that ‘development and equality’ are the main elements of foreign policy. Of the respondents, majority 77.1% (n=27) agreed that ‘moral and human rights’ are the main elements of foreign policy. Furthermore, 82.8% (n=29) agreed that the country should advance ‘Africa regionalism and south-south cooperation’ and 85.7% (n=30) strongly argued for a ‘whole-government approach’ in addressing global health challenges. ‘HIV/AIDS’ and ‘access to medicines agenda’ were the main policy issues advanced. The main domestic factors shaping South Africa’s involvement in global health were its ‘political leadership’ and ‘capacity of negotiators’. CONCLUSION : It is evident that within South Africa, state policy actors are largely concerned with promoting global health interest as a normative value and a goal of foreign policy, namely, human dignity and development cooperation. Furthermore, South Africa drives its global health through building coalition with other state and non-state actors such as civil society. HIV/AIDS, as a policy issue, presents a potential entry point for engagement in global health diplomacy.National Department of Health, South Africahttp://www.banglajol.info/index.php/SEAJPHam2016School of Health Systems and Public Health (SHSPH

Health personnel retention strategies in a peri-urban community : an exploratory study on Epworth, Zimbabwe

BACKGROUND : The need to retain health personnel is a policy challenge undermining health system reform of the 21st century. The need to resolve this global health workforce crisis resulted in the First Global Forum on Human Resources for Health in 2008 from which the Kampala Declaration and Agenda for Global Action was formulated. However, whilst there have been several studies exploring the retention of health personnel towards this end, available literature does not provide a detailed narrative on strategies used in peri-urban communities. The aim of this study was to explore retention strategies implemented in a Zimbabwean peri-urban community between 2009 and 2014 and implications for peri-urban communities towards the health system reform agenda. METHODS : The study was carried out in Epworth, a peri-urban community in Harare, Zimbabwe. The research design was a cross-sectional survey, in which qualitative methods were used in sampling, data collection, reporting and analysis. Qualitative tools were used to collect data through in-depth interviews with purposively selected health personnel managers at 10 local clinics and sample interviews with purposively selected healthcare workers who included registered general nurses, state-certified nurses, midwives, environmental health technicians, nurse aids and community health volunteers at each clinic. Two focus group discussions were carried out with community health volunteers. Qualitative data was subjected to thematic analysis, with coding being performed manually. RESULTS : A programme-specific strategic partnership between the government and donor community contributed towards the mobilisation of more health personnel, health facilities, worker development and remuneration. To complement this, the Ministry of Health intervened through the review and payment of salaries, support towards post-basic training and development, and protection. The local board, mission and donors contributed through the payment of top-up allowances and provision of non-monetary incentives. CONCLUSIONS : The review of salaries, engagement of international strategic partners, payment of top-up allowances, support towards post-basic training and development, mobilisation of more health personnel, non-monetary incentives and healthcare worker protection were critical towards the retention of health personnel in the Epworth peri-urban community between 2009 and 2014.We are most grateful to the African Doctoral Dissertation Research Fellowship Award (ADDRF 2015-2017 ADF 002) offered by the African Population and Health Research Centre in partnership with the International Development Research Centre which made this research possible. We are also grateful to the University of Pretoria Postgraduate Research Bursary (10443925) which also made this study possible.http://www.human-resources-health.comam2016School of Health Systems and Public Health (SHSPH

Human resource for health policy interventions towards health sector reform in a Zimbabwean peri-urban community : a decision space approach

BACKGROUND : Human Resources for Health (HRH) are important towards attainment of the health sector reform goal of universal health coverage in resource-constrained health systems. We used the Decision Space Approach to analyse decision space, innovation, and change in HRH reform policy interventions in Epworth, a peri-urban community in Zimbabwe. METHODS : The study design was exploratory and cross-sectional. In this, we firstly explored the healthcare worker reform policy at the principal level to determine the main policy result areas. Findings enabled us to develop an HRH Decision Space Mapping Analysis Conceptual Tool consisting of six main policy result areas. We then used it to analyse decision space, innovation, and outcomes towards healthcare worker reform at the agent level in Epworth. Interpretive thematic analysis and descriptive statistics were used to facilitate analysis. FINDINGS : Narrow decision space and functional innovation in the context of moderate decision space helps not only initiate healthcare worker reform interventions but also mitigate local incapacities to sustain the process. Future research may adopt the Conceptual Tool developed to facilitate analysis of decision space, innovation, and outcomes in local health systems focusing on the six policy result areas towards the health system reform goal of universal health coverage.The African Population and Health Research Centre (APHRC) [Grant award number ADDRF 2015-2017 ADF 002].http://www.tandfonline.com/loi/yjhm20hj2019School of Health Systems and Public Health (SHSPH

HIV/AIDS and TB knowledge and beliefs among rural traditional health practitioners in Limpopo Province, South Africa

HIV/AIDS and TB infections are major health problems in South Africa. Approximately two thirds of infected patients consult traditional health practitioners (THPs) to manage opportunistic infections. This study seeks to assess HIV/AIDS and TB related knowledge and beliefs among traditional health practitioners in Limpopo Province. A quantitative cross-sectional study was conducted to assess knowledge and beliefs on HIV/AIDS and TB infections among group of THPs attending training workshops in Limpopo Province, between December 2013 and May 2014. Structured questionnaire was used to collect data. Most THPs were not educated. Majority were women at senior citizens level with more than two decades of working experience. They had adequate knowledge of HIV/AIDS and TB transmission, signs and symptoms. Of great concern were the prevailing myths and beliefs that HIV/AIDS and TB patients were bewitched; there is cure for HIV/AIDS and THPs have muthi (traditional medicine) and herbs capable of curing it. We recommend that tailor-made HIV/AIDS and TB health education targeting THPs beliefs; and training workshops on signs and symptoms of HIV/AIDS and TB be initiated urgently.South African Medical Research Council (SAMRC) and National Health Scholarship Programme (NHSP).http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-10-31hb201

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

BACKGROUND : Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. OBJECTIVE : This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. METHOD : An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. RESULTS : Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. CONCLUSION : Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.http://www.curationis.org.zaam201

Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa

BACKGROUND : The indigenous health system was perceived to be a threat to the allopathic health system. It was associated with ‘witchcraft’, and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. METHODS : Qualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo’s Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department’s Research Committee. RESULTS : Dominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities. CONCLUSION : Allopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required.National Health Scholarship Program and South African Medical Research Council.http://www.phcfm.orgam2016Nursing ScienceSchool of Health Systems and Public Health (SHSPH

Knowledge and beliefs about oral pseudomembranous candidiasis among traditional health practitioners in Limpopo Province, South Africa

INTRODUCTION : Oral pseudomembranous candidiasis (OPC) is commonly associated with immunosuppression caused by HIV/AIDS and TB infections. The knowledge and beliefs about OPC among traditional health practitioners in South Africa are not well explored. PURPOSE : To investigate this concern. METHODS : A cross-sectional descriptive survey was conducted in the rural Vhembe district of the Limpopo Province. Data were collected from 427 traditional health practitioners who were to attend training workshops on HIV/AIDS and TB diseases. An open-ended semistructured questionnaire with an A4 colour picture of oral pseudomembranous candidiasis was presented to assess their previous exposure to, and their knowledge and beliefs about, the etiology and management of OPC. FINDINGS AND CONCLUSION : Only thirteen percent correctly identified the lesion. More than 64% were uncertain on etiology, and 24% blamed witchcraft and supernatural powers. Almost two thirds (60%) were confused about the relationship between HIV/AIDS and OPC lesions. The belief that witchcraft and ancestors could cause OPC could increase the risk of HIV infections and result in delays in seeking treatment. The outcomes of this study should be incorporated in the training of the traditional health practitioners on oral signs and symptoms of HIV/ AIDS diseases.The South African Medical Research Council (SAMRC) and National Health Scholarship Programme (NHSP).http://www.sada.co.zaam2016Nursing ScienceSchool of Health Systems and Public Health (SHSPH

Decentralisation in South Africa : options for District Health Authorities in South Africa

The transfer of authority and responsibility for some public functions from one level of government, especially national government, to a second sphere (provincial) or a third sphere (local governments) has been adopted by many countries with the understanding that such health system decentralisation can help to address political, managerial and operational issues in terms of systemic efficiency and cost-effectiveness. While South Africa’s health system is already structured with a certain degree of decentralisation, the implementation of National Health Insurance (National Health Insurance) and the proposed creation of District Health Authorities as outlined in the Green Paper on NHI, implies that the country will now have to undertake several further steps in decentralising its health system. If poorly designed or ineffectively implemented , decentralisation can exacerbate existing inequalities and inefficiencies and create new challenges and problems. This chapter explores several possibilities for the implementation of a coherent decentralisation system which addresses the health needs of the population. The authors also provide an extensive overview of the various forms and decentralisation and then offer some lessons, caveats and important issues that must be taken into account in the country’s journey to further decentralisation. The potential role of the National Department of Health in a new decentralised system is considered, and several criteria to guide and stagger the decentralisation process are offered. The authors conclude that while decentralisation is not without its disadvantages, decentralisation of health care services in South Africa can make a phenomenal impact on the quality and access to much-needed health services for the most vulnerable populations, particularly women and children and further note that ongoing monitoring and evaluation against set targets will be needed in order to achieve successful implementation of the envisaged NHI-funded health system.http://reference.sabinet.co.za/sa_epublication/healthram2016School of Health Systems and Public Health (SHSPH

Health system constraints affecting treatment and care among women with cervical cancer in Harare, Zimbabwe

BACKGROUND : Cervical cancer is a major cause of morbidity and mortality among women yet access to treatment and care remains a huge challenge in Zimbabwe. The objective of this study was to investigate health system constraints affecting engagement into treatment and care by women with cervical cancer in Harare, Zimbabwe. METHODS : A sequential explanatory mixed methods design was used for this study. Phase 1 comprised of two surveys namely: patient and health worker surveys with sample sizes of 134 and 78 participants respectively. Validated structured questionnaires programmed in Android tablet with SurveytoGo software were used for data collection during the surveys. Univariate analyses were conducted using STATA® version 14 to generate descriptive statistics. In phase 2, 16 in-depth interviews, 20 key informant interviews and 6 focus groups were conducted to explain survey results. Participants were purposively selected and sample sizes were informed by saturation principle. Participants in phase 1 and 2 were different. English transcripts were manually coded line by line in Dedoose software using the thematic codes that had been established from the survey data. The final codes were used to support and explain the survey data at the interpretation stages. RESULTS : Health system constraints identified in surveys were: limited or lack of training for health workers, weakness of surveillance system for cervical cancer, limited access to treatment and care, inadequate health workers, reliance of patients on out-of-pocket funding for treatment services, lack of back-up for major equipment. Qualitative inquiry revealed the following barriers to treatment and care: high costs of treatment and care, lack of knowledge about cervical cancer and bad attitudes of health workers, few screening and treating centres located mostly in urban areas, lack of clear referral system resulting in bureaucratic processes, and limited screening and treating capacities in health facilities due to lack of resources. CONCLUSION: The results of this study show that health system and its organization present barriers to access of cervical cancer treatment and care among women. Strong political will, mobilization of resources both domestically and from partners in addition to sound policies are imperative to address key health system challenges.Additional file 1. Validated structured questionnaire for healthy women and cervical cancer patients [English & Shona].Additional file 2. Validated structured questionnaire for health workers [English].Additional file 3. In-depth interview guide [English and Shona].The Letten Foundation, Norwayhttps://bmchealthservres.biomedcentral.comam2020Obstetrics and GynaecologySchool of Health Systems and Public Health (SHSPH

Decolonising the mindsets, attitudes and practices of the allopathic and indigenous health practitioners in postcolonial society : an exploratory approach in the management of patients

BACKGROUND : The indigenous health care system continues in the postcolonial era to be perceived by antagonists as a threat to Western medicine. It has been associated with ‘witchcraft’, actively discouraged and repressed through official government prohibition laws. Despite that, human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) patients consult both allopathic and indigenous health practitioners. AIM : The study explored a collaboration model between allopathic and traditional health practitioners in the management of patients living with HIV and AIDS in postcolonial South Africa. SETTING : We conducted six combined focus group discussions and four separate group discussions with each category of co-researchers. Methods: Combined and separate focus group discussions were conducted with community members, allopathic and indigenous health practitioners, applying the cyclical method in the decolonisation process. Their perceptions and experiences in the management of HIV and AIDS patients were explored, and finally decolonisation strategies suitable for collaboration in their context were identified. RESULTS : The two health systems were rendering services to the same HIV and AIDS communities. Lack of communication created confusion. Collaboration was long overdue. A change in mindsets, attitudes and practices among practitioners was critical, with an acknowledgement that ‘neither health system is better than the other, but the two should be complementary, recognising that the culture and beliefs of patients influence their health-seeking behaviour’. CONCLUSION : Co-researchers were committed to working together in the fight against HIV and AIDS infections. Their model for collaboration addresses the challenges of patients’ secrecy, treatment overdose and the abandonment of antiretroviral treatment. Through the application of a decolonisation process, their mindsets, attitudes and practices towards each other were changed, enabling the joint development of a custom model for collaboration between allopathic health practitioners and indigenous health practitioners in the management of patients living with HIV and AIDS.The South African Medical Research Council (SAMRC), Deputy VC Research Office, University of Pretoria, and the National Health Scholarship Programme (NHSP).http://www.phcfm.orgam2019Nursing ScienceSchool of Health Systems and Public Health (SHSPH