Implementation of primary health care - package or process?

After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with national, provincial, district and facility health managers, various 'core packages' of services to be delivered at community, clinic/mobile and community health centre levels have been proposed. For example, undernutrition, which affects more than 1 in 4 young South African children,' is to be dealt with through treatment protocols, clinic-based growth monitoring and marketing messages about breastfeeding. The core package initiative seems to offer a pragmatic approach with its outlines of tasks and timetables and has been justified as a 'planning tool to move towards comprehensive services'.' In contrast, we believe there is a danger that it may have the opposite effect

The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts

This analysis reflects on experiences and lessons from four country settings - Zambia, India, Sweden and South Africa - on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions

Towards equity : a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017

CITATION: Van Zyl, B. C., et al. 2021. Towards equity : a retrospective analysis of public sector radiological resources and utilization patterns in the metropolitan and rural areas of the Western Cape Province of South Africa in 2017. BMC Health Services Research, 21:991, doi:10.1186/s12913-021-06997-x.The original publication is available at https://bmchealthservres.biomedcentral.comPublication of this article was funded by the Stellenbosch University Open Access FundBackground: The reduction of inequality is a key United Nations 2030 Sustainable Development Goal (WHO, Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda, 2014; Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020). Despite marked disparities in radiological services globally, particularly between metropolitan and rural populations in low- and middle-income countries, there has been little work on imaging resources and utilization patterns in any setting (Transforming our world: the 2030 Agenda for Sustainable Development .:. Sustainable Development Knowledge Platform, 2020; WHO, Local Production and Technology Transfer to Increase Access to Medical Devices, 2019; European Society of Radiology (ESR), Insights Imaging 6:573-7, 2015; Maboreke et al., An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity, 2020; Kabongo et al., Pan Afr Med J 22, 2015; Skedgel et al., Med Decis Making 35:94-105, 2015; Mollura et al., J Am Coll Radiol 913-9, 2014; Culp et al., J Am Coll Radiol 12:475-80, 2015; Mbewe et al., An audit of licenced Zambian diagnostic imaging equipment and personnel, 2020). To achieve equity, a better understanding of the integral components of the so called “imaging enterprise” is important. The aim was to analyse a provincial radiological service in a middle-income country. Methods: An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province of South Africa for 2017, utilizing provincial databases. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the whole province, the metropolitan and the rural areas. Results: Metropolitan population density exceeds rural by a factor of ninety (1682 vs 19 people/km²). Rural imaging facilities by population are double the metropolitan (20 vs 11/10⁶ people). Metropolitan imaging personnel by population (112 vs 53/10⁶ people) and equipment unit (1.7 vs 0.7/unit) are more than double the rural. Overall population-based utilization of imaging services was 30% higher in the metropole (289 vs 214 studies/10³ people), with mammography (24 vs 5 studies/10³ woman > 40 years) and CT (21 vs 6/10³ people) recording the highest, and plain radiography (203 vs 171/10³ people) the lowest differences. Conclusion: Despite attempts to achieve imaging equity through the provision of increased facilities/million people in the rural areas, differential utilization patterns persist. The achievement of equity must be seen as a process involving incremental improvements and iterative analyses ne progress towards the goal.https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06997-xPublisher's versio

Powers, inequalities and vulnerabilities

This research addresses the gap that is present in both missiology and family and youth ministry. Missiology does not focus on children and youth specifically, while this is the largest population in the developing world. On the other hand, family and youth ministry has a more pastoral than missional approach, not always taking cognisance of contexts like globalisation. Thus, the purpose of the book is to address the sometimes unintended and unnoticed influence of globalisation on the mission of the church, with a specific focus on children, youth and family. For this purpose, the International Association for Mission Studies study group for children, youth and families coming from different parts of the world decided to describe the powers, inequalities and vulnerabilities of children, youth and families in a globalised world from their specific contexts. Although the most prominent research methodology was critical literature studies, methods like autoethnographic, and empirical methods were also used. No decisions were made on a specific method of research for this publication. This publication can be viewed as an interdisciplinary and intra-disciplinary, because it deals with social sciences, anthropology, psychology, missiology, systematic theology and practical theology

Powers, inequalities and vulnerabilities

This research addresses the gap that is present in both missiology and family and youth ministry. Missiology does not focus on children and youth specifically, while this is the largest population in the developing world. On the other hand, family and youth ministry has a more pastoral than missional approach, not always taking cognisance of contexts like globalisation. Thus, the purpose of the book is to address the sometimes unintended and unnoticed influence of globalisation on the mission of the church, with a specific focus on children, youth and family. For this purpose, the International Association for Mission Studies study group for children, youth and families coming from different parts of the world decided to describe the powers, inequalities and vulnerabilities of children, youth and families in a globalised world from their specific contexts. Although the most prominent research methodology was critical literature studies, methods like autoethnographic, and empirical methods were also used. No decisions were made on a specific method of research for this publication. This publication can be viewed as an interdisciplinary and intra-disciplinary, because it deals with social sciences, anthropology, psychology, missiology, systematic theology and practical theology

Estimated severe pneumococcal disease cases and deaths before and after pneumococcal conjugate vaccine introduction in children younger than 5 years of age in South Africa

INTRODUCTION : Streptococcus pneumoniae is a leading cause of severe bacterial infections globally. A full understanding of the impact of pneumococcal conjugate vaccine (PCV) on pneumococcal disease burden, following its introduction in 2009 in South Africa, can support national policy on PCV use and assist with policy decisions elsewhere. METHODS : We developed a model to estimate the national burden of severe pneumococcal disease, i.e. disease requiring hospitalisation, pre- (2005±2008) and post-PCV introduction (2012± 2013) in children aged 0±59 months in South Africa. We estimated case numbers for invasive pneumococcal disease using data from the national laboratory-based surveillance, adjusted for specimen-taking practices. We estimated non-bacteraemic pneumococcal pneumonia case numbers using vaccine probe study data. To estimate pneumococcal deaths, we applied observed case fatality ratios to estimated case numbers. Estimates were stratified by HIV status to account for the impact of PCV and HIV-related interventions. We assessed how different assumptions affected estimates using a sensitivity analysis. Bootstrapping created confidence intervals. RESULTS : In the pre-vaccine era, a total of approximately 107,600 (95% confidence interval [CI] 83,000±140,000) cases of severe hospitalised pneumococcal disease were estimated to have occurred annually. Following PCV introduction and the improvement in HIV interventions, 41,800 (95% CI 28,000±50,000) severe pneumococcal disease cases were estimated in 2012±2013, a rate reduction of 1,277 cases per 100,000 child-years. Approximately 5000 (95% CI 3000±6000) pneumococcal-related annual deaths were estimated in the prevaccine period and 1,900 (95% CI 1000±2500) in 2012±2013, a mortality rate difference of 61 per 100,000 child-years. CONCLUSIONS : While a large number of hospitalisations and deaths due to pneumococcal disease still occur among children 0±59 months in South Africa, we found a large reduction in this estimate that is temporally associated with PCV introduction. In HIV-infected individuals the scale-up of other interventions, such as improvements in HIV care, may have also contributed to the declines in pneumococcal burden.S1 Text. Supplementary material: Estimated severe pneumococcal disease cases and deaths before and after pneumococcal conjugate vaccine introduction in children younger than 5 years of age in South Africa.S1 Table. Population denominators from the Thembisa model for children <5 years of age in South Africa, 2005-2008 and 2012-2013.S2 Table. Sensitivity analysis for case numbers showing key variables altered in analysis, 2005-2008 and 2012-2013.S3 Table. Sensitivity analysis for numbers of deaths showing key variables altered in analysis, 2005-2008 and 2012-2013.S1 Fig. Initial step in estimating the burden of invasive and non-invasive pneumococcal cases in children aged <5 years in South Africa, 2005-2008 and 2012-2013.S2 Fig. Second step in estimating the burden of invasive and non-invasive pneumococcal cases in children <5 years in South Africa, 2005-2008 and 2012-2013.S3 Fig. Tornado sensitivity diagram representing change in pneumococcal case estimates in children <5 years of age in the pre-vaccine era, when values of key variables are modified.S4 Fig. Tornado sensitivity diagram representing change in pneumococcal death estimates in children <5 years of age in the pre-vaccine era, when values of key variables are modified.The National Institute for Communicable Diseases/National Health Laboratory Service (NICD/NHLS), South Africa and the Centers for Disease Control and Prevention (CDC) Global AIDS Program (GAP) Cooperative Agreement (U62/PSO022901).http://www.plosone.orgam2017Paediatrics and Child Healt

From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening.

Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS

Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond

Michael Peters and colleagues argue that concerted efforts to embed implementation research can improve health services, even in the most challenging operating environments

Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees

Fjeldheim, C. B. et al. Trauma exposure, posttraumatic stress disorder and the effect of explanatory variables in paramedic trainees. BMC Emergency Medicine, 14(1):11, doi:10.1186/1471-227X-14-11.The original publication is available at http://www.biomedcentral.com/1471-227X/14/11Publication of this article was funded by the Stellenbosch University Open Access Fund.Abstract Background: Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology. Methods: Paramedic trainees (n = 131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support. Results: 94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD criteria. A high rate of depression (28%), alcohol abuse (23%) and chronic perceived stress (7%) and low levels of social support was found. The number of previous trauma exposures, depression, resilience and social support significantly predicted PTSD status and depression had a mediating effect. Conclusion: There is a need for efficient, ongoing screening of depressive and PTSD symptomatology in trauma exposed high risk groups so that early psychological supportive interventions can be offered. Background Emergency healthcare workers, including trainees and individuals in related occupations are at heightened risk of developing posttraumatic stress disorder (PTSD) and depression owing to work-related stressors. We aimed to investigate the type, frequency, and severity of direct trauma exposure, posttraumatic stress symptoms and other psychopathology amongst paramedic trainees. In order to create a risk profile for individuals who are at higher occupational risk of developing PTSD, we examined risk and resilience factors that possibly contributed to the presence and severity of posttraumatic symptomatology. Methods Paramedic trainees (n&#8201;=&#8201;131) were recruited from a local university. A logistic regression analysis was conducted using the explanatory variables age, gender, population group, trauma exposure, depression, alcohol abuse, alcohol dependence, resilience and social support. Results 94% of paramedic trainees had directly experienced trauma, with 16% meeting PTSD criteria. A high rate of depression (28%), alcohol abuse (23%) and chronic perceived stress (7%) and low levels of social support was found. The number of previous trauma exposures, depression, resilience and social support significantly predicted PTSD status and depression had a mediating effect. Conclusion There is a need for efficient, ongoing screening of depressive and PTSD symptomatology in trauma exposed high risk groups so that early psychological supportive interventions can be offered.Publishers' Versio