322 research outputs found
A conceptual framework for cost management training in the Limpopo Province of South Africa
This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres.Web of Scienc
Re-engineering of South Africa’s primary health care system: where is the pharmacist?
South Africa’s transition towards a district-based health system (DHS) aims to offer health promotion and prevention services
at community level, through re-engineered primary health care (PHC) services. Along with pharmacy workforce shortages and
service delivery challenges, health reform is a clarion call to strategically re-position the pharmacist’s role in DHS strengthening.
The pharmacist’s involvement in the three DHS streams, namely the clinical specialist support teams, school health services
and municipal ward-based PHC outreach teams, is pertinent. This paper contextualises pharmacists’ current peripheral role
in the health system, discusses a team-based approach and identifies opportunities to integrate pharmacy students into the
re-vitalised PHC framework. Re-positioning of pharmacists within district clinical specialist support and school health teams
could create opportunities for community-based and population-based services whereby a range of clinical and pharmaceutical
services could materialise. Pharmacy training institutions could strengthen the DHS through established partnerships with
the community and health services. Academic service learning programmes could integrate pharmacy students as part of the
PHC outreach teams to promote community health. Interdependence between the health services, pharmacy schools and
the community would create a platform to contextualise learning and dismantle existing silos between them. Multi-sectoral
engagement could enable pharmacy schools to design strategies to optimise pharmaceutical service delivery and align their
activities towards social accountability.DHE
HIV pre-exposure prophylaxis for female sex workers : ensuring women's family planning needs are not left behind
Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs.
Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed.
Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights
Ethical misconduct by registered physiotherapists in South Africa (2007– 2013): A mixed methods approach
Background: The role of ethics in a medical context is to protect the interests of patients. Thus,
it is critically important to understand the guilty verdicts related to professional standard
breaches and ethics misconduct of physiotherapists.
Aim: To analyse the case content and penalties of all guilty verdicts related to ethics misconduct
against registered physiotherapists in South Africa.
Methods: A mixed methods approach was followed consisting of epidemiological data analysis
and qualitative content analysis. The data documents were formal annual lists (2007–2013) of
guilty verdicts related to ethical misconduct. Quantitative data analysis focused on annual
frequencies of guilty verdicts, transgression categories and the imposed penalties. Qualitative
data analysis focused on content analysis of the case content for each guilty verdict.
Results: Relatively few physiotherapists (0.05%) are annually found guilty of ethical
misconduct. The two most frequent penalties were fines of R5000.00 and fines of R8000.00 –
R10 000.00. The majority of transgressions involved fraudulent conduct (70.3%), followed by
performance of procedures without patient consent (10.8%). Fraudulent conduct involved
issuing misleading, inaccurate or false medical statements, and false or inaccurate medical aid
scheme claims
Quality of home-based rapid HIV testing by community lay counsellors in a rural district of South Africa
INTRODUCTION: Lack of universal, annual testing for human immunodeficiency virus (HIV) in health facilities suggests that
expansion of HIV testing and counselling (HTC) to non-clinical settings is critical to the achievement of national goals for
prevention, care and treatment. Consideration should be given to the ability of lay counsellors to perform home-based HTC in
community settings.
METHODS: We implemented a community cluster randomized controlled trial of home-based HTC in Sisonke District,
South Africa. Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health
department at the time of the study (SD Bioline and Sensa). To monitor testing quality and counsellor skill, additional dry blood
spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay (ELISA) testing. Sensitivity and specificity
were calculated using the laboratory result as the gold standard.
RESULTS AND DISCUSSION: From 3986 samples, the counsellor and laboratory results matched in all but 23 cases. In 18 cases,
the counsellor judged the result as indeterminate, whereas the laboratory judged 10 positive, eight negative and three
indeterminate, indicating that the counsellor may have erred on the side of caution. Sensitivity was 98.0% (95% CI: 96.3 98.9%),
and specificity 99.6% (95% CI: 99.4 99.7%), for the lay counsellor field-based rapid tests. Both measures are high, and the lower
confidence bound for specificity meets the international standard for assessing HIV rapid tests.
CONCLUSIONS: These findings indicate that adequately trained lay counsellors are capable of safely conducting high-quality rapid
HIV tests and interpreting the results as per the kit guidelines. These findings are important given the likely expansion of
community and home-based testing models and the shortage of clinically trained professional staff.Department of HE and Training approved lis
South Africa's Health Promotion Levy: excise tax findings and equity potential
In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened
Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh
Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform
Therapeutic recreation as a developing profession in South Africa
South Africa experiences socio-economic challenges with a high prevalence of poverty resulting in disability and non-communicable diseases affecting the health and welfare of communities. Health services are not always accessible or available to citizens, especially those of previously disadvantaged or rural communities. The South African National Plan for Development 2030 aims to address these inequality and health issues. One focus area of this plan is the inclusion of recreation, leisure and sport as an important service sector to improve the health and well-being of all individuals. Therapeutic recreation could play an important role in this regard. In South Africa, therapeutic recreation is in its developmental stages. This paper aims to provide the reader with an overview of therapeutic recreation in South Africa as a developing profession. An overview of the current status of the profession is discussed in terms of standard of practice and as it relates to health professions and recreation service providers, programmes with therapeutic value and training needs. The study concludes that there is still groundwork to be done, calling for interested parties to embark on an aggressive advocacy and strategic planning process to develop therapeutic recreation as a profession in South Africa.Scopu
An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa
HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted
as an essential tool in scaling up and improving access to treatment, care and support especially in community settings.
Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT
coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-todoor
offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there
are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa,
including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT
trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores
comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic
observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and
post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous
score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%)
observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of
counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%)
clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned
about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the
service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor
quality of HCT after training
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