Prerequisites for National Health Insurance in South Africa: Results of a national household survey

Background. National Health Insurance (NHI) is currently highon the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals.Objectives. To explore public perceptions on what changes inthe public health system are necessary to ensure acceptabilityand sustainability of an NHI, and whether South Africans areready for a change in the health system.Methods. A cross-sectional nationally representative surveyof 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10.Results and conclusions. There is dissatisfaction with bothpublic and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to bewell acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services

A review of shaped carbon nanomaterials

Materials made of carbon that can be synthesised and characterised at the nano level have become a mainstay in the nanotechnology arena. These carbon materials can have a remarkable range of morphologies. They can have structures that are either hollow or filled and can take many shapes, as evidenced by the well-documented families of fullerenes and carbon nanotubes. However, these are but two of the shapes that carbon can form at the nano level. In this review we outline the types of shaped carbons that can be produced by simple synthetic procedures, focusing on spheres, tubes or fibres, and helices. Their mechanisms of formation and uses are also described

From waste cooking oil to oxygen-rich onion-like nanocarbons for the removal of hexavalent chromium from aqueous solutions

Vegetable cooking oil is used in domestic and commercial kitchens owing to its ability to modify and enhance the taste of the food through the frying process. However, as the oil is used through several frying cycles, it changes colour to dark brown and acquires an unpleasant smell. At this point, the waste oil is usually discarded, thereby finding its way into freshwater streams due to poor disposal and thus becoming an environmental pollutant. To provide an alternative, ‘green’ route to waste oil disposal, herein we report on the metal-free synthesis of onion-like nanocarbons (OLNCs) made from waste cooking oil via flame pyrolysis. The OLNCs were then applied in the removal of hexavalent chromium ions from aqueous solutions. The as-synthesised OLNCs were found to have similar properties (size, quasi-spherical shape etc.) to those synthesised from pure cooking oils. The Fourier-transform infrared spectroscopy data showed that the OLNCs contained C-O-type moieties which were attributed to the oxygenation process that took place during the cooking process. The OLNCs from waste oil were applied as an adsorbent for Cr(VI) and showed optimal removal conditions at pH = 2, t = 360 min, Co = 10 mg/L and Q0max = 47.62 mg/g, superior to data obtained from OLNCs prepared from pristine cooking oil. The results showed that the OLNCs derived from the waste cooking oil were effective in the removal of hexavalent chromium. Overall, this study shows how to repurpose an environmental pollutant (waste cooking oil) as an effective adsorbent for pollutant (Cr(VI)) removal. Significance: • Waste cooking oil outperformed olive oil as a starting material for the production of OLNCs for the removal of toxic Cr(VI) from water. • The superior performance of the OLNCs from waste cooking oil was attributed to the higher oxygen content found on their surface and acquired through the cooking process. • Not only are the OLNCs produced from waste cooking oil effective in the removal of Cr(VI), but they can be used multiple times before replacement, which makes them sustainable

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

BACKGROUND: The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases. METHODS: We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution. FINDINGS: Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis. INTERPRETATION: Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority. FUNDING: Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust. TRANSLATION: For the isiZulu translation of the abstract see Supplementary Materials section

Leadership and governance of community health worker programmes at scale: a cross case analysis of provincial implementation in South Africa

BACKGROUND: National community health worker (CHW) programmes are returning to favour as an integral part of primary health care systems, often on the back of pre-existing community based initiatives. There are significant challenges to the integration and support of such programmes, and they require coordination and stewardship at all levels of the health system. This paper explores the leadership and governance tasks of large-scale CHW programmes at sub-national level, through the case of national reforms to South Africa’s community based sector, referred to as the Ward Based Outreach Team (WBOT) strategy. METHODS: A cross case analysis of leadership and governance roles, drawing on three case studies of adoption and implementation of the WBOTs strategy at provincial level (Western Cape, North West and Gauteng) was conducted. The primary case studies mapped system components and assessed implementation processes and contexts. They involved teams of researchers and over 200 interviews with stakeholders from senior to frontline, document reviews and analyses of routine data. The secondary, cross case analysis specifically focused on the issues and challenges facing, and strategies adopted by provincial and district policy makers and managers, as they engaged with the new national mandate. From this key sub-national leadership and governance roles were formulated. RESULTS: Four key roles are identified and discussed: 1. Negotiating a fit between national mandates and provincial and district histories and strategies of community based services 2. Defining new organisational and accountability relationships between CHWs, local health services, communities and NGOs 3. Revising and developing new aligned and integrated planning, human resource, financing and information systems 4. Leading change by building new collective visions, mobilising political, including budgetary, support and designing implementation strategies. CONCLUSION: This analysis, from real-life systems, adds to understanding of the processes involved in developing CHW programmes at scale, and specifically the negotiated and multilevel nature of leadership and governance in such programmes, spanning analytic, managerial, technical and political roles.IS

Correlates of Out-of-Pocket and Catastrophic Health Expenditures in Tanzania: Results from a National Household Survey.

Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania