11 research outputs found
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
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
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
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