A novel cash-plus intervention to safeguard sexual reproductive health and HIV vulnerabilities in young women in Cape Town, South Africa

Background Cash plus interventions augment cash transfers with other empowering interventions to influence behaviours. This research assesses the Women of Worth (WoW) program and evaluates the effectiveness of a cash transfer (CT) of ZAR300 ($22USD22) conditional on attending 12-session customised empowerment interventions to improve SRH/HIV outcomes in young women (19-24yrs) in Cape Town, South Africa. Methods A multiphase, mixed-methods, experimental study targeting 10 000 Participants in two subdistricts was conducted. Participants were randomised 1:1 to receive the interventions with CT ("cash + care" or C+C) or without CT (“Care”). Phase 1a piloted the interventions, Phase 1b implemented an adapted intervention, and Phase 2 was an open label C+C only scale up demonstration phase. Logistic regression models were fitted with subject-specific random mixed effects, to estimate changes in self-reported HIV, behavioural and structural SRH risks from baseline to (a) end of WoW and (b) follow up (6-30months post-exposure) irrespective of WoW completion. Mixed research methods were used to optimise engagement, evaluate implementation fidelity and determine the pathways of effectiveness for the interventions. Results The Women of Worth empowerment programme was implemented with adequate fidelity however adaptative research methods were essential for ensuring a sustained programme. 8765 (87,7%) of the 9995 WoW initiators were evaluated with 904 (10,3%); 4212 (48,1%) and 3649 (41,6%) women in Phases 1a, 1b and 2 respectively. In Phase 1a & 1b, participants in the “C+C” group were 60 times (OR 60.37; 95%CI: 17.32; 210.50.

The importance of identified cause-of-death information being available for public health surveillance, actions and research

An amendment to the South African Births and Deaths Registration Act has compromised efforts to strengthen local mortality surveillance to provide statistics for small areas and enable data linkage to provide information for public health actions. Internationally it has been recognised that a careful balance needs to be kept between protecting individual patient confidentiality and enabling effective public health intelligence to guide patient care and service delivery and prevent harmful exposures. This article describes the public health benefits of a local mortality surveillance system in the Western Cape Province, South Africa (SA), as well as its potential for improving the quality of vital statistics data with integration into the national civil registration and vital statistics system. It also identifies other important uses for identifiable cause-of-death data in SA that have been compromised by this legislation

Adverse drug reactions in South African patients receiving bedaquiline-containing tuberculosis treatment: an evaluation of spontaneously reported cases

Background Bedaquiline was recently introduced into World Health Organization (WHO)-recommended regimens for treatment of drug resistant tuberculosis. There is limited data on the long-term safety of bedaquiline. Because bedaquiline prolongs the QT interval, there are concerns regarding cardiovascular safety. The Western Cape Province in South Africa has an established pharmacovigilance programme: a targeted spontaneous reporting system which solicits reports of suspected adverse drug reactions (ADRs) in patients with HIV-1 and/or tuberculosis infection. Since 2015, bedaquiline has been included in the treatment regimens recommended for resistant tuberculosis in South Africa. We describe ADRs in patients on bedaquiline-containing tuberculosis treatment that were reported to the Western Cape Pharmacovigilance programme. Methods We reviewed reports of suspected ADRs and deaths received between March 2015 and June 2016 involving patients receiving bedaquiline-containing tuberculosis treatment. A multidisciplinary panel assessed causality, and categorised suspected ADRs using World Health Organisation-Uppsala Monitoring Centre system categories. “Confirmed ADRs” included all ADRs categorised as definite, probable or possible. Preventability was assessed using Schumock and Thornton criteria. Where a confirmed ADR occurred in a patient who died, the panel categorised the extent to which the ADR contributed to the patient’s death as follows: major contributor, contributor or non-contributor. Results Thirty-five suspected ADRs were reported in 32 patients, including 13 deaths. There were 30 confirmed ADRs, of which 23 were classified as “possible” and seven as “probable”. Bedaquiline was implicated in 22 confirmed ADRs in 22 patients. The most common confirmed ADR in patients receiving bedaquiline was QT prolongation (8 cases, 7 of which were severe). A fatal arrhythmia was suspected in 4 sudden deaths. These 4 patients were all taking bedaquiline together with other QT-prolonging drugs. There were 8 non-bedaquiline-associated ADRs, of which 7 contributed to deaths. Conclusions Confirmed ADRs in patients receiving bedaquiline reflect the known safety profile of bedaquiline. Quantifying the incidence and clinical consequences of severe QT-prolongation in patients receiving bedaquiline-containing regimens is a research priority to inform recommendations for patient monitoring in treatment programmes for drug resistant tuberculosis. Pharmacovigilance systems within tuberculosis treatment programmes should be supported and encouraged, to provide ongoing monitoring of treatment-limiting drug toxicity

The importance of identified cause-of-death information being available for public health surveillance, actions and research

An amendment to the South African Births and Deaths Registration Act has compromised efforts to strengthen local mortality surveillance to provide statistics for small areas and enable data linkage to provide information for public health actions. Internationally it has been recognised that a careful balance needs to be kept between protecting individual patient confidentiality and enabling effective public health intelligence to guide patient care and service delivery and prevent harmful exposures. This article describes the public health benefits of a local mortality surveillance system in the Western Cape Province, South Africa (SA), as well as its potential for improving the quality of vital statistics data with integration into the national civil registration and vital statistics system. It also identifies other important uses for identifiable cause-of-death data in SA that have been compromised by this legislation.

Innovative Finance Week 5 Video 6 - Designing for Impact - Western Cape Government

This video focuses on the Western Cape Government's case study. The video discusses how they sought to change the way they did their community based program. It goes onto discuss how the process was originally conducted before going into how they have changed how they ran their community based programs. The video then focuses on why they were interested in the social impact bond. It touches on how it decreases the risk for those investing in the community based programs. It also discusses how the social impact bonds created incentives for those running the projects to ensure the programs succeeded. The video then discusses how the outcome based approaches resulted in them gaining private partners to assist in funding the projects. This is video 6/8 in week 5 of the Innovative Finance: Hacking Finance to Change the World course

Health research in the Western Cape province, South Africa: Lessons and challenges

Background: Health research can play a critical role in strengthening health systems.However, little monitoring of health research is conducted in African countries to identify whether research contributes to addressing local health priorities. Aim/Setting: To review the profile of research on the health service platform in the Western Cape province of South Africa which was approved by the health authorities over the period January 2011 to December 2012. Methods: Databases held by both the Provincial and City of Cape Town health departments were reviewed. Descriptions of research institution, location of research, topic and funding size and source were analysed. Results: Of the health research approved in the province, 56% of projects were located on the District Health Services platform and 70% were based in the Cape Metropolitan area. For projects reporting budgetary information, the total funding was US $29.2 million. The primary focus of research was on HIV and tuberculosis (TB), whilst relatively few studies addressed nutrition, mental health or injury and there was little health systems research. Research funding was dominated by very large grants from foreign funders for HIV and/or TB research. South African government sources comprised less than 8% of all health research funding. Conclusion: There is a partial mismatch of donor funding to local health priorities. Greater focus on neglected areas such as mental health, trauma, nutrition and non-communicable disease, as well as greater investment in health systems research, is needed. Unless governments increase funding for research and a culture of research translation is achieved, health research will have limited impact on both local and national priorities

Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

CITATION: Swanepoel, M., Mash, B. & Naledi, T. 2014. Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa. African Journal of Primary Health Care & Family Medicine, 6(1): 1-8, doi: 10.4102/phcfm.v6i1.695.The original publication is available at http://www.phcfm.orgBackground: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape. Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method. Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers. Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.Evaluation de l’impact des médecins de famille dans le système de santé du district du Western Cape, en Afrique du Sud. Contexte: En 2007, l’Afrique du Sud a institué une nouvelle spécialité, la médecine de famille. Les médecins de famille qui se sont spécialisés dans cette nouvelle discipline sont employés dans le système de santé de district depuis 2011. L’objet de cette étude était d‘étudier les perceptions des gestionnaires de district sur l’impact que les des médecins de famille avaient sur les processus cliniques, la performance du système de santé et les résultats des systèmes de santé des districts (DHS) du Western Cape. Méthodes: On a effectué neuf entrevues approfondies: sept avec les gestionnaires de district et deux avec les directeurs principaux du DHS rural et métropolitain. On a enregistré, transcrit et analysé les entrevues en utilisant ATLAS-ti et la méthode de structure. Résultats: Il y a eu un effet positif sur les processus cliniques du VIH et/ou du SIDA, la Tuberculose, le traumatisme, les maladies chroniques non-contagieuses, la santé mentale, et la santé de la mère et de l’enfant. La performance du système de santé a été positivement affectée en termes d’accès, coordination, exhaustivité et efficacité. On s’attendait à un impact sur les résultats en matière de santé. L’impact n’était pas uniforme dans toute la province en raison du nombre différent de médecins de famille et des différentes capacités à fonctionner de manière optimale. On avait aussi l’impression que l’impact positif des médecins de famille en était aux premiers stades de développement. Les effets inattendus comprenaient leurs inquiétudes d’avoir à gérer et à former les étudiants, ainsi que les tensions avec les médecins de carrière. Conclusion: Les premiers commentaires des directeurs de district indiquent que quand on emploie des médecins de famille qui ont la possibilité de fonctionner d’une manière optimale, ils ont un impact important sur la performance du système de santé et la qualité du processus clinique. Cela aura probablement un impact sur la santé, à long terme.http://www.phcfm.org/index.php/phcfm/article/view/695Publisher's versio