The grief and trauma project: a group work approach to restoring emotional and spiritual health to women in bereaved and traumatised indigent communities in the Western Cape, South Africa

The extreme levels of grief and trauma experienced in resource-poor communities in South Africa are well documented. The concept of grief or trauma being experienced and managed as an isolated incident and access to psychological therapeutic support being available is assumed in much of Western literature. This study describes a response to the multiple grief and loss experiences of indigent South African communities, its continual nature and the paucity of help available. A group work approach to providing psychosocial and spiritual support was developed and implemented. Improved mental health, physical health and interpersonal relationship outcomes are described

Community engagement for quality care : a health workers training manual

Annex 9a of Final technical reportCooperation and collaboration between health workers and community members is a foundational principle of the primary health care approach. This manual provides information about health committees, community participation, democracy, health and human rights, leadership, power, partnership and engagement between the health care providers and communities. Appendices provide links to relevant legislation, policy and other resources

Sexual and reproductive health knowledge of postgraduate students at the University of Cape Town, in South Africa

Globally and in South Africa, university students’ knowledge of sexual and reproductive health (SRH) is low. This study was conducted in response to the dearth of information about the sexual and reproductive health knowledge of postgraduate students. Research conducted to explore the SRH knowledge of undergraduate students suggests that the level of SRH knowledge among undergraduate students is low. The aim of this study was to determine the SRH knowledge of postgraduate students with regards to contraceptives, sexually transmitted illnesses (STI), human immunodeficiency virus (HIV), Pap smear and clinical breast examination at University of Cape Town (UCT), in South Africa. A cross sectional survey design was utilized, using an adapted and pretested online questionnaire. The aim of this study was to determine the SRH knowledge of postgraduate students at the UCT. Minor adjustments were made to the questionnaire to suit the South African context. Selected aspects of SRH were included in the current study: knowledge and use of contraceptives, Pap smear, clinical breast examination, STIs and HIV. These variables were considered to be general enough to be answerable by male and female respondents and are the most important considerations in reproductive health care in South Africa, as there is a high prevalence of STIs, HIV and cervical and breast cancers

Quality of asthma care: Western Cape Province, South Africa

Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care

Quality of asthma care : Western Cape Province, South Africa

ArticleThe original publication is available at http://www.samj.org.zaBackground. Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.Publishers' versio

Mental health leadership and patient access to care: a public–private initiative in South Africa

BACKGROUND: Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. METHODS: A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. RESULTS: Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum for specialist training. CONCLUSIONS: Despite the significant adverse social and economic costs of mental illness, psychiatric and related services receive a low level of priority within the health care system. Ensuring that mental health receives the recognition and the resources it deserves requires that mental health care professionals become effective advocates through mental health leadership

Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

Background: Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention: The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention: The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion: Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout

Factors determining the vulnerability of woman to sexually transmitted HIV : a literature review

The original publication is available at http://www.hsag.co.za/ENGLISH ABSTRACT: Gender-related vulnerability is described as a crucial factor contributing to increased susceptibility of women to HIV, accounting for more women than men being infected. At the same time, empowerment interventions are being promoted as effective strategies for increasing the ability of women to adopt protective behaviours. The aim of the review was to identify, collate and categorise the factors determining the gender-related vulnerability of women to sexually transmitted HIV. A review of literature from theoretical and empirical studies using diverse methodologies was undertaken. Reports included those identified through electronic and manual searching. Twenty factors, forming five clusters, were identified as influencing the ability of women to adopt protective behaviours. Each factor was analysed to describe its component parts and the relationship between a factor, gender-related vulnerability, HIV risk level and empowerment status. Further analysis provided a description of markers named predictors and indicators. The literature portrays markers that can be identified and used to describe gender equality status, HIV risk level and related empowerment. This provides the potential to identify factors in gender equality status and HIV risk level to address in programmes designed to empower women in order to lower their risk to sexually transmitted HIV.AFRIKAANSE OPSOMMING: Geslagsverwante kwesbaarheid word beskryf as ‘n kritieke faktor wat tot verhoogde vatbaarheid van vroue vir MIV bydra, wat die verhoogde besmetting van vroue teenoor mans verklaar. Terselfdertyd word bemagtigingsintervensies aangemoedig as geskikte strategieë om vroue se vermoë om beskermende gedragspatrone aan te neem, te verhoog. Die doel van hierdie oorsig was om die faktore wat geslagsverwante vatbaarheid van vroue vir seksueel oordraagbare MIV bepaal, te identifiseer, vergelyk en kategoriseer. ‘n Literatuurstudie van teoretiese en empiriese studies wat ‘n verskeidenheid metodologieë gebruik het, is onderneem. Verslae bekom deur elektroniese en handsoektogte is ingesluit. Twintig faktore, wat in vyf groepe verdeel is, is geïdentifiseer as dié wat die vermoë van vroue om beskermende gedragspatrone aan te neem, beïnvloed. Elke faktor is ontleed om die samestellende dele en die verband tussen ‘n faktor, geslagsverwante kwesbaarheid, MIV-risikovlak en bemagtigingstatus te beskryf. Verdere analise het ‘n beskrywing van merkers, genoem voorspellers en aanwysers, opgelewer. Die literatuur beskryf merkers wat geïdentifiseer en gebruik kan word om geslagsgelykheidstatus, MIV-risikostatus en verwante bemagtiging te beskryf. Dit bied die moontlikheid om faktore in geslagsgelykheidstatus en MIV-risikostatus te identifiseer wat aandag moet geniet in programme wat ontwerp is om vroue te bemagtig om hul risiko van seksueel oordraagbare MIV te verlaag.Publisher's Versio