Greener grass? : international students' experiences at universities in the Western Cape

Bibliography: leaves 103-107.Literature has indicated that international students may experience difficulties when entering their country of sojourn. Previous studies have not addressed the experience of these students in South Africa. Given the unique social and historical context of the country, students may encounter issues dissimilar to other countries. The objective of this study was to explore the experiences of international students in South Africa, in terms of the social, academic and general experience. Additionally, students' motivations and expectations were explored. For this purpose, a survey was conducted via e-mail to students at three Western Cape universities. The final sample comprised 142 postgraduate international students from three universities. The participants were from a variety of faculties, and originated from a variety of countries, most of them coming from the African continent.( A questionnaire, comprising closed-and open-ended questions, was constructed from findings in international research. The collected data were analysed both quantitatively and qualitatively. The quantitative analysis included chi-squares, Fischer's exact tests and logistic regression. The qualitative data were analysed using thematic content analysis. The main finding of this study was that students, although in most respects faring well, experienced problems in social interaction with South Africans.) Specifically, students reported having experienced discrimination. Their worst experiences were crime and social problems, and the experiences they enjoyed the most were mainly sightseeing and social activities, as well as faring well socially. Most students had arrived in the country in search of education, and with realistic expectations. The academic lives of most students were satisfactory. However, most students did not wish to remain in South African after the completion of their studies. Thus, there was no brain gain in favour of South Africa

Including mixed methods research in systematic reviews: Examples from qualitative syntheses in TB and malaria control.

BACKGROUND: Health policy makers now have access to a greater number and variety of systematic reviews to inform different stages in the policy making process, including reviews of qualitative research. The inclusion of mixed methods studies in systematic reviews is increasing, but these studies pose particular challenges to methods of review. This article examines the quality of the reporting of mixed methods and qualitative-only studies. METHODS: We used two completed systematic reviews to generate a sample of qualitative studies and mixed method studies in order to make an assessment of how the quality of reporting and rigor of qualitative-only studies compares with that of mixed-methods studies. RESULTS: Overall, the reporting of qualitative studies in our sample was consistently better when compared with the reporting of mixed methods studies. We found that mixed methods studies are less likely to provide a description of the research conduct or qualitative data analysis procedures and less likely to be judged credible or provide rich data and thick description compared with standalone qualitative studies. Our time-related analysis shows that for both types of study, papers published since 2003 are more likely to report on the study context, describe analysis procedures, and be judged credible and provide rich data. However, the reporting of other aspects of research conduct (i.e. descriptions of the research question, the sampling strategy, and data collection methods) in mixed methods studies does not appear to have improved over time. CONCLUSIONS: Mixed methods research makes an important contribution to health research in general, and could make a more substantial contribution to systematic reviews. Through our careful analysis of the quality of reporting of mixed methods and qualitative-only research, we have identified areas that deserve more attention in the conduct and reporting of mixed methods research

Improving adherence: An evaluation of the enhanced tuberculosis adherence model in Cape Town, South Africa

BACKGROUND: Patient adherence to tuberculosis (TB ) treatment continues to be problematic despite the wide implementation of directly observed therapy (DOT ). In many settings with high HIV and TB co-infection, the two diseases continue to be treated differently: antiretroviral (ARV) programmes often use a patient support and empowerment approach to treatment, while TB programmes use DOT . AIM: To evaluate changing a TB treatment model from DOT to an approach based on the community antiretroviral therapy (ART) model in Cape Town, South Africa. METHODS: Four studies were conducted as part of the evaluation of a new model called the Enhanced Tuberculosis Adherence (ETA ) programme in primary health clinics. A mixed method approach was used. Study I: Seven key informants involved in the development or implementation of the ETA , or knowledgeable of TB treatment policies in South Africa, were interviewed. Data were analysed using thematic content analysis, and examined for their relation to the Kingdon framework of agenda setting to explore why the ETA was developed. Study II : Six nurses and five adherence counsellors were interviewed, and 64 treatment supporters were included in focus group discussions in order to explore their experiences of the ETA . Data were analysed using thematic content analysis and examined for their relation to the normalization process model. Study III : 28 patients on the ETA intervention and 31 patients in comparison clinics were included in focus group discussions in order to explore their experiences of TB treatment. Two non-adherent patients were interviewed. Data were analysed using thematic content analysis. Study IV : Using a time series design, TB treatment outcome data on 19 357 patients from five intervention and five comparison clinics were collected from the electronic TB register from 1 January 2005 to 31 March 2008. Outcomes were analysed using Poisson regression. FINDINGS: Study I: The intervention was developed due to problems in TB management, the availability of an alternative model in the community ART treatment programme, political changes (including a focus on empowerment), and impending large-scale ART roll-out. The change was facilitated by key individuals. Study II : The main issues hindering the normalization of the programme within clinics related to hierarchical relationships, teamwork, training needs, insufficient internalisation of the empowerment approach by staff, and logistical and management issues. Study III : Intervention patients seemed to have more positive opinions of TB treatment than comparison clinic patients. There was some indication that ETA patients were more ready to take control over their health, although there was little evidence of patient empowerment. Study IV : There was a significant improvement in smear conversion rates at 2 and 3 months in intervention clinics relative to comparison clinics. There was no significant difference in TB cure or treatment success rates. CONCLUSION: The ETA seems to be an approach that is feasible to implement in primary health clinics. It achieved results not significantly different from those of DOT, but was appreciated by patients. Further efforts are needed to empower TB patients. Overall, the ETA is a promising approach that now needs to be tested on a wider scale, and that could pave the way towards integrating TB treatment programmes with ART programmes in South Africa and other highburden settings

‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study

Objective: To explore experts’ views on factors influencing national and global active case-finding (ACF) policy development and implementation, and the use of evidence in these processes. Design: This is an exploratory study based on semistructured expert interviews. Framework analysis was applied. Participants: The study involved a purposive sample of 39 experts from international, non-governmental and non-profit organisations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Results: This study highlighted the perceived need among experts for different types of evidence for ACF policy development and implementation, and for stakeholder engagement including researchers and policymakers to foster evidence use. Interviewees stressed the influence of government, donor and non-governmental stakeholders in ACF policy development. Such key stakeholders also influence ACF policy implementation, in addition to available systems and processes in a given health system, and implementers’ motivation and incentives. According to the interviewees, the World Health Organization (WHO) guidelines for systematic screening face the innate challenge of providing guidance to countries across the broad area of ACF in terms of target groups, settings and screening algorithms. The guidelines could be improved by focusing on what should be done rather than what can be done in ACF, and by providing howto examples. Leadership, integration into health systems and long-term financing are key for ACF to be sustainable. Conclusions: We provide new insights into ACF policy processes globally, particularly regarding facilitators for and barriers to ACF policy development, evidence need and use, and donor organisations’ influence. According to expert participants, national and global ACF policy development and implementation can be improved by broadening stakeholder engagement. Meanwhile, using diverse evidence to inform ACF policy development and implementation could mitigate the ‘power plays plus push’ that might otherwise disrupt and mislead these policy processes

“I’m suffering for food” : Food insecurity and access to social protection for TB patients and their households in Cape Town, South Africa

Background Tuberculosis (TB) is a major health concern and the number one cause of death in South Africa. Social protection programmes can strengthen the resilience of TB patients, their families and households. This study aimed to get a better understanding of the role of social protection and other forms of support in relation to the burden of TB on patients and their households in South Africa. Methods This is a cross-sectional exploratory qualitative study using a phenomenological approach to focus on the lived experiences and perceptions of TB patients and healthcare workers. We interviewed 16 patients and six healthcare workers and analysed data thematically. Results The challenges faced by participants were closely related to household challenges. Participants reported a heavy physical burden, aggravated by a lack of nutritious food and that households could not provide the food they needed. Some needed to resort to charity. At the same time, households were significantly affected by the burden of caring for the patient—and remained the main source of financial, emotional and physical support. Participants reported challenges and costs associated with the application process and high levels of discretion by the assessing doctor allowing doctors’ opinions and beliefs to influence their assessment. Conclusion Access to adequate nutritious food was a key issue for many patients and this need strained already stretched households and budgets. Few participants reported obtaining state social protection support during their illness, but many reported challenges and high costs of trying to access it. Further research should be conducted on support mechanisms and interventions for TB patients, but also their households, including food support, social protection and contact tracing. In deciding eligibility for grants, the situation of the household should be considered in addition to the individual patient.publishedVersionPeer reviewe

Falling through the cracks : Increased vulnerability and limited social assistance for TB patients and their households during COVID-19 in Cape Town, South Africa

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Implementing a Public Policy to Extend Social Security to Informal Economy Workers in Zambia

This article analyses the strengths and bottlenecks of institutional capacity between social security institutions implementing the reform in Zambia, which focuses to provide social security to small-scale dairy farmers, a group of informal economy workers. Zambia’s informal economy workers absorb over 80 per cent of the labour force. This is a qualitative study of institutional capacity in the extension of social security. Twenty-one interviews were conducted with participants from Farmers’ Cooperatives (MCC), National Pension Scheme Authority (NAPSA), and Dairy Association of Zambia (DAZ). We selected participants through a purposive sampling technique. We reflected on data using a Consolidated Framework for Implementation Research (CFIR) built on thematic analysis. Analysis suggests that the institutions of the partnership are committed towards extending social security to informal economy workers. There was low involvement of local NAPSA officers in the project design and their role during implementation of the pension extension was unclear. This contributed to a lack of trust by some non-NAPSA members towards social security institutions. Knowledge and beliefs about the capabilities of implementers were essential in the activities for implementing the public policy on the extension of social security. However, there are several implementation lacunas concerning the process, its overarching infrastructure, and adequate human resources. There is a critical need to address gaps in process and procedures, equipment and materials, infrastructure, human resource, trust, and knowledge of context for the extension of social security to informal economy workers in Zambia. This could make the new public policy scheme more attainable.Peer reviewe

Case study M : Extension of the contributory pension scheme to small-scale farmers in Zambia

Zambia embarked on an ambitious plan to extend pension schemes to informal economy workers, including small scale farmers, who are traditionally excluded from pension schemes. The extension of coverage is aided by enactment of statutory instrument that enables design of a scheme with peculiar financing such as reduced contribution rates, and benefit package including short-term benefits such as maternity benefits, family funeral grant, and access to credit. Administratively a mixed approach of public-private model has been embraced through partnerships between the National Pension Scheme Authority (NAPSA) and informal economy worker associations, and the private sector. This chapter presents considerations for the implementation of pension schemes to small scale farmers.publishedVersionPeer reviewe

The informal sector and social protection

In recent years, there has been growing interest to extend social protection coverage to people working in the informal economy. Informal economy workers constitute substantial workforce in most countries and form a base for most economies. However, they are largely excluded from formal social protection coverage. Reasons for exclusion include inadequate legal coverage, lack of compliance and adequate monitoring mechanisms, lack of knowledge about social protection, high contribution rates, unattractive benefit package and mistrust. There are a range of policy options and modes of delivery that can be used to extend coverage. Coverage for informal economy workers in social protection is important. Contributions, benefit package and vesting period should all be tailored to attract people in the informal economy, according to each country setting, in order to protect people from social and economic risks.publishedVersionPeer reviewe