Staff capacity and resources at nine Free State clinics: shortcomings in the TB programme

South Africa faces a continuously escalating tuberculosis (TB) epidemic. This article explores the extent and nature of shortcomings in intra-clinic TB programme resources and staffing. Data was gathered by means of in-depth interviews and observations in nine clinics in the Free State. The main findings of the study include the following: not all TB programme co-ordinators or implementers in the nine clinics had been formally trained in the principles of the National TB Control Programme; knowledge of TB diagnosis was limited; the treatment volunteer system was not optimally managed or utilised; policy guidelines were not available at all facilities; the   recording and reporting infrastructure at some clinics was flawed; the drug, supply and equipment infrastructure at some clinics was lacking; the information, education and communication infrastructure was not utilised to its full extent, and management support was in need of improvement. The findings of this study should alert TB programme managers at the provincial, district, local and clinic levels to the existence and extent of problems at some primary health care (PHC) clinics and the urgent need to address them

Initial anticipations and experiences of antiretroviral therapy among managers at ART-assessment facilities in the Free State

Before the implementation of ART, and again seven months later, interviews were conducted with facility managers and nurses leading PHC programmes. Their perceptions of the impact of ART are discussed. A positive finding was that ART assessment site managers had been optimistic about ART from the outset, and by the end of the sevenmonth period even more so. Nurses leading other PHC programmes were initially concerned about overcrowding the facility due to ART, but this problem did not feature prominently during the follow-up survey. ART programme nurses’ perceptions of the problems at their facilities mostly related to staff and space. On the whole the data show that pessimism preceding the implementation of ART was in many respects allayed with   implementation

Development of a Sesotho health literacy test in a South African context

Background: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman–Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries

Tuberculosis control in South Africa: reasons for persistent failure

This study reviews the origins and spread of tuberculosis in South Africa in the international context. It shows that TB is far from being under control, despite the availability of effective technology. Five arguments offer   explanations for this failure. First, control strategies fail to eradicate the macro-conditions that create a breeding ground for TB. Secondly, new disease conditions — especially HIV/AIDS and MDRTB — confound efforts at control. Thirdly, the health system and its priorities are insufficiently focused and resourced to cope with TB. Fourthly, healthcare staff responsible for TB care are often weak links in the chain of control. Fifthly, TB patients fail due to ignorance, delay in seeking care, and non-adherence to treatment regimens. TB consequently remains a major public health challenge, today more than ever in its protracted history

Design and development process of a youth depression screening m-health application for primary health care workers in South Africa and Zambia : an overview of the MEGA project

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.http://www.tandfonline.com/loi/imhn20hj2020Psychiatr

Staff capacity and resources at nine Free State clinics: shortcomings in the TB programme

South Africa faces a continuously escalating tuberculosis (TB) epidemic. This article explores the extent and nature of shortcomings in intra-clinic TB programme resources and staffing. Data was gathered by means of in-depth interviews and observations in nine clinics in the Free State. The main findings of the study include the following: not all TB programme co-ordinators or implementers in the nine clinics had been formally trained in the principles of the National TB Control Programme; knowledge of TB diagnosis was limited; the treatment volunteer system was not optimally managed or utilised; policy guidelines were not available at all facilities; the   recording and reporting infrastructure at some clinics was flawed; the drug, supply and equipment infrastructure at some clinics was lacking; the information, education and communication infrastructure was not utilised to its full extent, and management support was in need of improvement. The findings of this study should alert TB programme managers at the provincial, district, local and clinic levels to the existence and extent of problems at some primary health care (PHC) clinics and the urgent need to address them

Initial anticipations and experiences of antiretroviral therapy among managers at ART-assessment facilities in the Free State

Before the implementation of ART, and again seven months later, interviews were conducted with facility managers and nurses leading PHC programmes. Their perceptions of the impact of ART are discussed. A positive finding was that ART assessment site managers had been optimistic about ART from the outset, and by the end of the sevenmonth period even more so. Nurses leading other PHC programmes were initially concerned about overcrowding the facility due to ART, but this problem did not feature prominently during the follow-up survey. ART programme nurses’ perceptionsof the problems at their facilities mostly related to staff and space. On the whole the data show that pessimism preceding the implementation of ART was in many respects allayed with   implementation

Tuberculosis control in South Africa: reasons for persistent failure

This study reviews the origins and spread of tuberculosis in South Africa in the international context. It shows that TB is far from being under control, despite the availability of effective technology. Five arguments offer   explanations for this failure. First, control strategies fail to eradicate the macro-conditions that create a breeding ground for TB. Secondly, new disease conditions — especially HIV/AIDS and MDRTB — confound efforts at control. Thirdly, the health system and its priorities are insufficiently focused and resourced to cope with TB. Fourthly, healthcare staff responsible for TB care are often weak links in the chain of control. Fifthly, TB patients fail due to ignorance, delay in seeking care, and non-adherence to treatment regimens. TB consequently remains a major public health challenge, today more than ever in its protracted history