Access to substance abuse treatment services for black South Africans: findings from audits of specialist treatment facilities in Cape Town and Gauteng: original article

Background: The increased demand for substance abuse treatment has led to concern about the accessibility of existing services to black South Africans. To date, research has not examined the accessibility of services, even though access has been shown to impact on retention and treatment outcomes. Method: Cross-sectional audits of substance abuse treatment facilities were conducted in Cape Town (2002) and Gauteng (2003). Data on client characteristics, facility characteristics, and service delivery characteristics were collected using the Treatment Services Audit questionnaire. Aims: To describe the extent to which substance abuse treatment services are accessible to black clients and the extent to which facilities target barriers that restrict black clients from accessing substance abuse treatment. Results: At both sites, black clients are under-represented at treatment facilities. Private non-profit, outpatient facilities serve the highest proportion of black clients. Compared to private for-profit and state facilities, private non-profit facilities are the most likely to provide services that address the logistical, cultural and linguistic barriers that restrict black clients from accessing treatment. Outpatient facilities are more likely than inpatient facilities to address these barriers. Conclusions: Based on the above findings, a number of recommendations are made to improve the accessibility of treatment services for black clients, such as establishing state outpatient treatment facilities and addressing the indirect costs associated with treatment. Key Words: Alcohol, Public policy, Evidence-based intervention strategies South African Psychiatry Review Vol.8(1) 2005: 15-1

Free and simple GIS as appropriate for health mapping in a low resource setting: a case study in eastern Indonesia

Background: Despite the demonstrated utility of GIS for health applications, there are perceived problems in low resource settings: GIS software can be expensive and complex; input data are often of low quality. This study aimed to test the appropriateness of new, inexpensive and simple GIS tools in poorly resourced areas of a developing country. GIS applications were trialled in pilot studies based on mapping of health resources and health indicators at the clinic and district level in the predominantly rural province of Nusa Tenggara Timur in eastern Indonesia. The pilot applications were (i) rapid field collection of health infrastructure data using a GPSenabled PDA, (ii) mapping health indicator data using open source GIS software, and (iii) service availability mapping using a free modelling tool. Results: Through contextualised training, district and clinic staff acquired skills in spatial analysis and visualisation and, six months after the pilot studies, they were using these skills for advocacy in the planning process, to inform the allocation of some health resources, and to evaluate some public health initiatives.Conclusions: We demonstrated that GIS can be a useful and inexpensive tool for the decentralisation of health data analysis to low resource settings through the use of free and simple software, locally relevant training materials and by providing data collection tools to ensure data reliability

“Not on the agenda”: A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa

Poor young women who use alcohol and other drugs (AODs) in Cape Town, South Africa, need access to health services to prevent HIV. Efforts to link young women to services are hampered by limited information on what influences service initiation. We explored perceptions of factors that influence poor AOD-using young women’s use of health services

Access to alcohol and drug treatment for people from historically disadvantaged communities in the Cape Town metropole

Includes bibliographical references (p. 279-327).This study examined factors associated with access to alcohol and drug treatment for people from historically disadvantaged communities in Cape Town, South Africa. The Behavioural Model of Health Services Utilisation was used as a conceptual framework for variable selection, data analysis and the interpretation of findings. A mixed methods design was used that comprised a case-control study and qualitative in-depth interviews. For the case-control study, data were gathered from 434 cases who had accessed treatment and 555 controls who had alcohol or drug problems but had not accessed services. An interviewer-administered questionnaire was used to gather data on socio-demographic variables, indicators of treatment need, and barriers to service use

Methamphetamine abuse, psychosis and your patient

Recent findings from the MRC-led South African Community Epidemiology Network on Drug Use (SACENDU) Project(which collects data on treatment episodes from substance abuse treatment centres) point to a significant and unprecedented increase in the proportion of clients reporting methamphetamine (MA) as their primary and/or secondary drug of abuse at these specialist substance abuse treatment centres in the Western Cape. For example, the proportion of clients reporting methamphetamine-related problems has increased from 5% of the total treatment population at Cape Town Drug Counselling Centre (the largest non-profit outpatient treatment centre in Cape Town) in 2003 to between 44% and 48% of the treatment population in 2004.1For full text, click here:SA Fam Pract 2006;48(2):56-5

Beyond the rhetoric: Towards a more effective and humane drug policy framework in South Africa

The March 2011 Anti-Substance Abuse Summit in Durban continued the outdated approach to policy around illicit drugs in South Africa. It missed opportunities for discussing how to impact significantly on the health and social harms associated with problematic drug use and reduce the burden of drug-related cases in the criminal justice system. The government needs to move away from the political rhetoric of a ‘drug-free society’ and start the real work of formulating and implementing an evidence-based drug policy that learns from the experiences of other countries around decriminalising drug use; takes into account differences in the harms resulting from different classes of drugs; adopts a rights-based, public health approach to policy; and identifies a single (accountable) agency that has the authority to oversee policy implementation. In addition, consensus is needed on the short-, medium- and long-term priorities for drug policy implementation. The 17 evidence-based drug policy strategies identified by Babor et al. may serve as a useful starting point for policy development

Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia<br />

The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering emergency obstetric care (EmOC) and population distribution were modelled for a district in eastern Indonesia. As an index of remoteness, the proportion of the population more than two hours estimated travel time from EmOC was calculated. For the best case scenario (transport by ambulance in the dry season), modelling estimated more than 10,000 fertile aged women were more than two hours from EmOC. Maternal mortality ratios were positively correlated with the remoteness index, however there was considerable variation around this relationship. In a companion study, ethnographic research in a subdistrict with relatively good access to health care and high maternal mortality identified factors influencing access to EmOC, including some that had not been incorporated into the travel time model. Ethnographic research provided information about actual travel involved in requesting and reaching EmOC. Modeled travel time could be improved by incorporating time to deliver request for care. Further integration of social and spatial methods and the development of more dynamic travel time models are needed to develop programs and policies to address these multiple factors to improve maternal health outcomes

Moving beyond access: Towards a quality-orientated substance abuse treatment system in South Africa

There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes