“DOCTOR! Go for a course in HR Management"

A key principle of family medicine is the management of resources. Human Resource Management (HRM) underpins other principles of family medicine. It is not only the doctor but also the staff around him or her who enables and responds to the patient experience. South African private general practitioners struggle with staff management within an increasingly complex and regulated environment. Simple approaches, documents such as employment contracts and codes of conduct, and checklists highlighting statutory and best practise requirements can ensure good HRM. People-centred HRM contributes to a patient-centred practice. It can also address skills and incapacity in a fair manner, keeping the practice within the law and partnering in social transformation and primary health care delivery. SA Fam Pract 2004;46(8): 5-8

The consequences upon patient care of moving Brits Hospital: A case study

Background. In 2001, North West Province took the decisionto increase bed capacity at Brits Hospital from 66 beds to 267 beds. After careful consideration of costs and an assessment of available land, it was decided to demolish the existing hospital and rebuild the new hospital on the same site. It was planned that during this time clinical services would be moved to a temporary makeshift hospital andto primary health care clinics. This case study documents the consequences of this decision to move services to the makeshift hospital and how these challenges were dealt with.Methods. A cross-sectional descriptive study was undertaken. Ten key members of staff at management and service delivery level, in the hospital and the district, were interviewed. Key documents, reports, correspondence, hospital statistics and minutes of meetings related to the move were analysed.Results. The plan had several unforeseen consequences with serious effects on patient care. Maternity services were particularly affected. Maternity beds decreased from 30 beds in the former hospital to 4 beds in the makeshift hospital. As numbers of deliveries did not greatly decrease, this resulted in severe overcrowding, making monitoring and care difficult. Perinatal mortality rates doubled after the move. An increase in maternal deaths was noted. The lack of inpatient wardspace resulted in severe overcrowding in Casualty. The lack of X-ray facilities necessitated patients being referred to a facility 72 km away, which often caused a delay of 3 days before management was completed. After-hours X-rays were done in a private facility, adding to unforeseen costs. Although the initial plan was for the makeshift hospital to stabilise and refer most patients, referral routes were not agreed upon or put in writing, and no extra transportation resources were allocated. The pharmacy had insufficient space for storageof medication. In spite of all these issues, relationships andcapacity at clinics were strengthened, but not sufficiently tomeet the need.Discussion. Hospital revitalisation requires detailed planningso that services are not disrupted. Several case studies have highlighted the planning necessary when services are to be moved temporarily. Makeshift hospitals have been used when renovating or building hospitals. During war or disasters, plans have been made to decant patients from one facility to another. From the Brits case study, it would appear that not enough detailed planning for the move wasdone initially. This observation includes failure to appreciate the interrelatedness of systems and the practicality of the proposal, and to budget for the move and not just the new structure.Conclusion. The current service offered at the makeshift hospital at Brits is not adequate and has resulted in poor patient care. It is the result of a planning process that did not examine the consequences of the move, both logistic and financial, in adequate detail. Committed hospital staff have tried their best to offer good care in difficult circumstances

The practice of exclusive breastfeeding among mothers attending a postnatal clinic in Tswaing subdistrict, North West province

Objectives: The aim of this study was to determine reported infant  feeding practice with reference to exclusive breastfeeding, exclusive formula feeding and mixed feeding at six weeks postpartum among women attending a postnatal clinic in the Tswaing subdistrict of North West province, and the strength of the association between maternal human immunodeficiency virus (HIV) status and exclusive breastfeeding.Design: Three hundred and eighty-six randomly selected women from seven primary healthcare clinics in Tswaing subdistrict, who were in their sixth postnatal week between November 2009 and February 2010, were enrolled in this study. Data were collected using a researcher-formulated questionnaire to ascertain demographics, including HIV status, as well as reported infant feeding practice. Secondary analysis was carried out to determine the strength of the association between the HIV status of the subjects and exclusive breastfeedingSetting and subjects: This study was conducted among women over the age of 18 years attending their first six weeks postnatal visit in seven primary healthcare clinics that provide postnatal care in the rural Tswaing subdistrict of the North West Province.Outcome measures: The self-reported infant feeding practice at six weeks postpartum, demographic determinants of reported infant feeding practice, and the strength of the association between maternal HIV status and reported infant feeding practice, particularly exclusive breastfeeding, constituted the main outcome measures. Results: Comparatively, more HIV-negative (n = 157), than HIV-positive women (n = 43), reported that they were breastfeeding exclusively and had received infant feeding counselling (n = 258 vs. n = 65, p-value < 0.05). Exposure to infant feeding counselling and a negative HIV status were associated with higher exclusive breastfeeding rates.Conclusion: HIV-positive women are still at risk of transmitting HIV to their nursing infants on account of suboptimal infant feeding methods in the prevention of mother-to-child transmission (PMTCT) context. This calls for further research in this area, and in the interim, more support to pregnant and nursing HIV-positive mothers, with a view to achieving the aims ofthe PMTCT programm

Rural origin health science students in South African universities

Background. Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-topopulation ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. Objective. To determine the proportion of rural-origin students at all medical schools in South Africa. Design. A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%). Results. Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine – 27.4%, physiotherapy – 22.4%, occupational therapy – 26.7%, and dentistry – 24.8%. Conclusion. The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas. South African Medical Journal Vol. 99 (1) 2009: pp. 54-5

Exposure to primary healthcare for medical students: experiences of final-year medical students

Introduction: Recognising the importance of primary healthcare in the achievement of the 1997 White Paper for the Transformation of the Health System and the Millennium Development Goals, the Faculty of Health Sciences of the University of the Witwatersrand introduced an integrated primary care (IPC) block. In a six-week final year preceptorship, medicalstudents are placed in primary healthcare centres in rural and underserved areas. This article describes the experiences of medical students during their six weeks in the IPC block.Methods: The study was qualitative, based on data collected from the logbooks completed by the students during the IPC rotation. A total of 192 students were placed in 10 health centres in the North West and Gauteng provinces in the 2006 academic year. These centres included district hospitals, clinics and NGO community health centres.Results: The students reported that the practical experience enhanced their skills in handling patients in primary care settings. They developed an appreciation of primary healthcare as a holistic approach to healthcare. The students attained increased levels of confidence in handling undifferentiated patients, and became more aware of community health needs and problems in health service delivery.Conclusions: Exposure to the IPC block provided a valuable experience for final-year students, as it is critical for orienting students to the importance of primary healthcare, which is essential for the realisation of targets identified in the national health policy.Keywords: primary heath care; skills; practice; medical student

The involvement of private general practitioners in visiting primary healthcare clinics

BackgroundThe primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement.Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.MethodsA case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.ResultsThe visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits.ConclusionThe involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.For full text, click here:SA Fam Pract 2006;48(7):16-16

The role of clinic visits: perceptions of doctors

Background The aim of this study was to ascertain what doctors perceive to be their role in visiting district clinics.Methods Individual and focus group interviews were conducted with hospital doctors of different seniority and with doctors who work solely in the clinics.Results A range of important themes emerged from the interviews, relating to the intended function of the clinics and their resources, the operationalisation of doctors' visits, the varied roles that doctors play in clinics and the importance of teamwork and support. Doctors working full time in the clinics shared a more positive view.Conclusions There is a need for clear consensus policy and guidelines on the role of the doctor in primary care clinics, the involvement of the doctor in the management of clinics, structuring doctors' visits to ensure continuity, facilitating transport for doctors, and ensuring that dedicated doctors are available to visit clinics, to support community service doctors visiting the clinics and to train clinic nurses.Keywords: clinic visits; primary care; perceptions; doctors; team work; clinic nursesFor full text, click here:SA Fam Pract 2005;47(8):60-65

Understanding participation in a hospital-based HIV support group in Limpopo Province, South Africa

Background: Support groups are an appropriate way of delivering psychosocial support to people living with HIV/AIDS, especially in low-resource countries. The aim of the study was to understand why people with HIV attended psychosocial support groups.Methods: This was a qualitative study design using focus-group discussions in which support-group members volunteered to participate. Five focus groups were involved in the study.Results: The participants attended because they were referred by a health-care worker, wanted information, wanted emotional support, accompanied an ill relative or knew about the support group. Perceived benefits included receiving psychological support, accepting one’s HIV status, reducing stigma and isolation, increasing hope, forging new friendships, helping others, obtaining HIV-related information, developing strategies to change behaviour, gaining access to medical care at the adjoining HIV clinic and receiving food donations. Negative aspects of attending the support group included the large size of the support group, long queues at the HIV clinic, concerns about confidentiality and negative staff attitudes towards the participants. Leaders were concerned about conflict, burn-out and impractical protocols. Access to disability grants was also a concern.Conclusions: Support groups can assist members to cope with the various challenges associated with living with HIV/AIDS through offering structured emotional, informational, instrumental and material support. Support group sizes should be limited. A structured curriculum containing up-to-date information about ART should also be offered to support groups. Social workers should furthermore be involved to facilitate access to appropriate social grants. Finally, support group leaders should receive appropriate training and regular debriefing.Keywords: HIV; support groups; people living with HIV/AIDS (PLWHA); prevention of mother to child transmission (PMTCT

Key issues in clinic functioning - a case study of two clinics

Objective. The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management.Design. An in-depth case study was conducted. A range of qualitative information was collected at both clinics. Data collected in the two clinics were compared, to gain an understanding of the important issues.Setting. Data were collected in a government and an NGO clinic in North West province.Subjects. This report presents the findings from patient and staff  satisfaction surveys and in-depth individual interviews with senior staff.Results. Key findings included the following: (i) there are attitudinal  differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and  approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is  needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture.Conclusions. This research provides lessons regarding key issues in clinic functioning which can make a major difference to the way services are experienced. Arespectfuland caring approach to patients, and an  organisational culture which supports and enables staff, can achieve much of this without any additional resources

Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda

<p>Abstract</p> <p>Background</p> <p>Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training.</p> <p>Methods</p> <p>The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas.</p> <p>Results</p> <p>Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community.</p> <p>Conclusion</p> <p>Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.</p