Identification and management of chronic pain in primary care:a review

Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective in helping clinicians identify, stratify and manage both patients already living with chronic pain and those who are at risk of developing chronic pain from acute pain. Frequent assessment and reassessment are key to ensuring treatment is appropriate and safe, as well as minimizing and addressing side effects. Primary care management should be holistic and evidence-based (where possible) and incorporates both pharmacological and non-pharmacological approaches, including psychology, self-management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain-management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral

Redefining political–administrative relationships in South Africa

This article is an overview of shifting political–administrative relationships in South Africa, with particular reference to growing politicization (partisan control of the bureaucracy). Studies of politicization of public services are important because political involvement in management has often led to negative effects on service delivery. The article sets out a theoretical framework for political–administrative relationships, examining the growing politicization of public services, the impact of New Public Management (NPM) and political–administrative relationships in developing countries. It then looks at political–administrative relationships in South Africa, including the apartheid history, the development of a new framework in the democratic South Africa and politicization in the staffing of the public service. It examines three functional areas – the decentralization of powers, contract appointments and performance man- agement – and discusses the implications of this changing framework for service delivery. The methodology consisted of interviews with a number of senior government officials, including three current directors-general and a former Minister for the Public Service and Administration, an analysis of government legislation, Public Service Commission (PSC) data including surveys, unpublished data of the Department of Public Service and Administration (DPSA), policy papers of the African National Congress (ANC) and an Organisation for Economic Co-operation and Development (OECD) study of political involvement in bureaucracies. The article concludes that growing politicization of the public service has contributed to poor service delivery, and that the South African government needs to place greater emphasis on merit as the basis for appointments and promotions