A point-prevalence survey of public hospital inpatients with palliative care needs in Cape Town, South Africa

Objectives. To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town metropole.Methods. A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients.Results. The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted.Conclusions. This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes

The application of social innovation in healthcare: a scoping review.

BACKGROUND: Social innovation has been applied increasingly to achieve social goals, including improved healthcare delivery, despite a lack of conceptual clarity and consensus on its definition. Beyond its tangible artefacts to address societal and structural needs, social innovation can best be understood as innovation in social relations, in power dynamics and in governance transformations, and may include institutional and systems transformations. METHODS: A scoping review was conducted of empirical studies published in the past 10 years, to identify how social innovation in healthcare has been applied, the enablers and barriers affecting its operation, and gaps in the current literature. A number of disciplinary databases were searched between April and June 2020, including Academic Source Complete, CIHAHL, Business Source Complete Psych INFO, PubMed and Global Health. A 10-year publication time frame was selected and articles limited to English text. Studies for final inclusion was based on a pre-defined criteria. RESULTS: Of the 27 studies included in this review, the majority adopted a case research methodology. Half of these were from authors outside the health sector working in high-income countries (HIC). Social innovation was seen to provide creative solutions to address barriers associated with access and cost of care in both low- and middle-income countries and HIC settings in a variety of disease focus areas. Compared to studies in other disciplines, health researchers applied social innovation mainly from an instrumental and technocratic standpoint to foster greater patient and beneficiary participation in health programmes. No empirical evidence was presented on whether this process leads to empowerment, and social innovation was not presented as transformative. The studies provided practical insights on how implementing social innovation in health systems and practice can be enhanced. CONCLUSIONS: Based on theoretical literature, social innovation has the potential to mobilise institutional and systems change, yet research in health has not yet fully explored this dimension. Thus far, social innovation has been applied to extend population and financial coverage, principles inherent in universal health coverage and central to SDG 3.8. However, limitations exist in conceptualising social innovation and applying its theoretical and multidisciplinary underpinnings in health research

Universities as catalysts of social innovation in health systems in low-and middle-income countries: a multi-country case study.

BACKGROUND: Social innovation (SI) in health holds potential to contribute to health systems strengthening and universal health coverage (UHC). The role of universities in SI has been well described in the context of high-income countries. An evidence gap exits on SI in healthcare delivery in the context of low- and middle-income countries (LMICs) as well as on the engagement of universities from these contexts. There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities. The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa, Asia and Latin America. The objectives were to describe the model, components and implementation process of the hubs; identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI. METHODS: A case study design was adopted to study the implementation process of a network of university hubs. Data from documentation, team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework. RESULTS/DISCUSSION: SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms, established to catalyse SI within the local health system through four core activities: research, community-building, storytelling and institutional embedding, and adhering to values of inclusion, assets, co-creation and hope. Hubs were implemented as informal structures, managed by a small core team, in existing department. Enablers of hub implementation and functioning were the availability of strong in-country social networks, legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages. Barriers encountered were internal institutional resistance, administrative challenges associated with university bureaucracy and annual funding cycles. CONCLUSIONS: This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC

Crowdsourcing to identify social innovation initiatives in health in low- and middle-income countries.

BACKGROUND: Crowdsourcing is a distributed problem-solving and production mechanism that leverages the collective intelligence of non-expert individuals and networked communities for specific goals. Social innovation (SI) initiatives aim to address health challenges in a sustainable manner, with a potential to strengthen health systems. They are developed by actors from different backgrounds and disciplines. This paper describes the application of crowdsourcing as a research method to explore SI initiatives in health. METHODS: The study explored crowdsourcing as a method to identify SI initiatives implemented in Africa, Asia and Latin America. While crowdsourcing has been used in high-income country settings, there is limited knowledge on its use, benefits and challenges in low- and middle-income country (LMIC) settings. From 2014 to 2018, six crowdsourcing contests were conducted at global, regional and national levels. RESULTS: A total of 305 eligible projects were identified; of these 38 SI initiatives in health were identified. We describe the process used to perform a crowdsourcing contest for SI, the outcome of the contests, and the challenges and opportunities when using this mechanism in LMICs. CONCLUSIONS: We demonstrate that crowdsourcing is a participatory method, that is able to identify bottom-up or grassroots SI initiatives developed by non-traditional actors

Centre for the Development of Scientific Research (CEDIC), Paraguay: A community-centred research approach inviting inclusive participation of all stakeholders to develop new context-specific solutions to address Chagas disease in the Chaco region of Paraguay

The Centre for the Development of Scientific Research (CEDIC) is a nongovernmental organization in Paraguay that adopts a community-centred research approach, inviting inclusive participation of all stakeholders to develop new context-specific solutions to address Chagas disease in the Chaco region. Chagas disease is a potentially life-threatening illness affecting between six and seven million people worldwide. It is responsible for 21 000 deaths annually (World Health Organization, 2016). In Paraguay, Chagas disease is endemic to the Gran Chaco region. The Chaco is a vast semi-arid geographic area in western Paraguay.CONACYT – Consejo Nacional de Ciencia y Tecnologí

Subjective experience of depressed mood among medical students at the University of Pretoria

Introduction. Following the suicide of a 4th-year medicalstudent, questions were raised as to whether medicalstudents are more vulnerable to depression and suicide thantheir counterparts studying other courses at the University ofPretoria. A literature search revealed that medical students anddoctors run a higher risk for suicide than other students andprofessions. Method. A questionnaire was devised and distributed tomedical students and a control group of other students, askingabout feelings of despair/hopelessness, suicide ideation andprevious attempts, knowledge regarding support structuresprovided by the university, and willingness to use thesestructures. Results. Both groups of students responded similarly to allquestions. Frequency of diagnosed psychiatric illness, use ofmedication, and suicidal thoughts and attempts did not differsignificantly. Both groups of students were unaware of supportservices offered by the university, and both were unwilling toutilise such services. The students seemed to have high ratesof depression in comparison with prevalence data from othercountries. Conclusion. Attempts to improve support for medical studentsshould address students’ awareness of available supportstructures and their willingness to utilise them

Social innovation in health: strengthening Community Systems for Universal Health Coverage in rural areas

Abstract Background In seeking the attainment of Universal Health Coverage (UHC), there has been a renewed emphasis on the role of communities. This article focuses on social innovation and whether this concept holds promise to enhance equity in health services to achieve UHC and serve as a process to enhance community engagement, participation, and agency. Methods A cross-country case study methodology was adopted to analyze three social innovations in health in three low- and middle-income countries (LMICs): Philippines, Malawi, and Colombia. Qualitative methods were used in data collection, and a cross-case analysis was conducted with the aid of a simplified version of the conceptual framework on social innovation as proposed by Cajaiba-Santana. This framework proposes four dimensions of social innovation as a process at different levels of action: the actors responsible for the idea, the new idea, the role of the institutional environment, and the resultant changes in the health and social system. Results The study found that each of the three social innovation case studies was based on developing community capacities to achieve health through community co-learning, leadership, and accountability. The process was dependent on catalytic agents, creating a space for innovation within the institutional context. In so doing, these agents challenged the prevailing power dynamics by providing the communities with respect and the opportunity to participate equally in creating and implementing programs. In this way, communities were empowered; they were not simply participants but became active agents in conceptualizing, implementing, monitoring, and sustaining the social innovation initiatives. Conclusion The study has illustrated how three creative social innovation approaches improved access and quality of health services for vulnerable rural populations and increased agency among the intervention communities. The processes facilitated empowerment, which in turn supported the sustained strengthening of the community system and the achievement of community goals in the domain of health and beyond

Social innovation in health, community engagement, financing and outcomes: qualitative analysis from the social innovation in health initiative.

BACKGROUND: Social innovation in health is a community-engaged process that links social change and health improvement, drawing on the diverse strengths of local individuals and institutions. However, there are few studies that examine community engagement, financing and outcomes. The purpose of this study is to use a qualitative descriptive analysis to assess 40 social innovations in health identified through a global open call. METHODS: This qualitative analysis examined social innovation case studies from low- and middle-income countries identified by a global social innovation network. A crowdsourcing open call identified projects and key components of each social innovation were evaluated by an independent panel. We used a US Centers for Disease Control and Prevention framework to measure community engagement as shared leadership, collaboration, involvement, consultation or informing. We used descriptive statistics to examine key aspects of community engagement, financing, health outcomes and non-health outcomes. RESULTS: Data from 40 social innovations were examined. Social innovations were from Africa (21/40), Asia (11/40), and Latin America and the Caribbean (8/40). Community engagement was diverse and robust across the cases and 60% (24/40) had either shared leadership or collaboration. Financing for social innovation came from research grants (23), national or provincial government support (15), revenues from sales (13), donations (13) and local government support (10). Social innovations reported health and non-health outcomes. CONCLUSION: Our data demonstrate social innovations had robust community engagement. Innovative financing mechanisms provide mechanisms for sustaining social innovations. Further research on health and non-health outcomes of social innovation is needed

A Hospital-Based Palliative Care Service for Patients With Advanced Organ Failure in Sub-Saharan Africa Reduces Admissions and Increases Home Death Rates and cost-effective model for such settings. J Pain Symptom

Abstract Context. Despite emerging data of cost savings under palliative care in various regions, no such data have been generated in response to the high burden of terminal illness in Africa. Objectives. This evaluation of a novel hospital-based palliative care service for patients with advanced organ failure in urban South Africa aimed to determine whether the service reduces admissions and increases home death rates compared with the same fixed time period of standard hospital care. Methods. Data on admissions and place of death were extracted from routine hospital activity records for a fixed period before death, using standard patient daily expense rates. Data from the first 56 consecutive deaths under the new service (intervention group) were compared with 48 consecutive deaths among patients immediately before the new service (historical controls). Results. Among the intervention and control patients, 40 of 56 (71.4%) and 47 of 48 (97.9%), respectively, had at least one admission (P < 0.001). The mean number of admissions for the intervention and control groups was 1.39 and 1.98, respectively (P < 0.001). The mean total number of days spent admitted for intervention and control groups was 4.52 and 9.3 days, respectively (P < 0.001). For the intervention and control patients, a total of 253 and 447 admission days were recorded, respectively, with formal costs of $587 and$1209, respectively. For the intervention and control groups, home death was achieved by 33 of 56 (58.9%) and nine of 48 (18.8%), respectively (P # 0.001). Conclusion. These data demonstrate that an outpatient hospital-based service reduced admissions and improved the rate of home deaths and offers a feasibl