Implementation of the ward based primary health care outreach teams in the Ekurhuleni health district: a process evaluation

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Community Health Johannesburg, November 2015Introduction: One of the aims of the re-engineering of primary health care in South Africa is to strengthen the health system and improve accessibility of health services through ward based outreach teams (WBOTs) comprising of nurses and community health workers. Aim: To evaluate the implementation of WBOTs against national guidelines and identify Community Health Worker (CHW) characteristics that influence adherence to guidelines regarding the referral and follow up of maternal and child health clients. Methodology: This cross-sectional study was conducted during 2013. All 9 WBOTs at the time were included in the study. Data were collected through: a questionnaire survey; key informant interviews and a review of records of pregnant, post-natal women and unimmunized children under five. A process evaluation was conducted to describe inputs (training, team composition, resources, and knowledge); processes (service delivery, referral linkages, support and supervision) and outputs (number of clients referred and followed up). Logistic regression was performed to identify CHW characteristics (Age, education, experience, training, and knowledge) associated with adherence to national guidelines. Results: WBOT had sufficient numbers of CHWs within the team; however lacked sufficient knowledge and resources required to conduct household visits. CHWs adhered to the guidelines regarding the follow up of maternal clients with 85% of CHW having conducted the required number of follow up visits for pregnant and postnatal women. However, only 29% of unimmunized children were appropriately followed up. Challenges identified included: lack of supervision, limited resources, and poor knowledge. There was no statistically significant association between CHW characteristics and adherence to guidelines. Conclusion and recommendations: This study highlights the challenges that need to be addressed around the WBOT implementation. It is recommended that there is improvement in resource availability, CHW supervision, capacity and training to improve the implementation process of future teams. Key words: Ward Based Outreach Teams, Primary Health Care re-engineering, Community Health Worke

The components of an effective employee health and wellness programme in healthcare workers

BACKGROUND. Healthcare workers (HCWs) are the predominant resource within any health system. Strengthening the health workforce requires ensuring optimum care of their health and wellbeing. This study will examine the published literature on this topic. OBJECTIVE. To identify the components of a workplace wellness programme for HCWs. METHODS. Major databases were searched for articles looking at components of health and wellness programmes for HCWs over a 10-year period. Selected articles were collated and summarised to form the basis of this review. RESULTS. This study found sparse literature on this topic. There are a number of legislative requirements related to occupational health services (OHSs). Employers should also explore opportunities to improve the health, wellbeing and lifestyle of workers within the working environment. This would require an adjustment of mindset to care for caregivers beyond the traditional OHS, and the inclusion of employee health and wellness programmes (EHWPs) within existing OHSs. Therefore, there is a need to generate evidence for the development of essential components of an EHWP to provide care for HCWs according to their needs. This would also provide insight into current EHWPs arising from policy and legislation, and would have the potential to transform them into more effective and efficient programmes by addressing the burden of disease and enhancing the benefits of providing healthcare services for HCWs. CONCLUSION. There remains a gap in evidence regarding health and wellness programmes targeted at HCWs that cater for their unique healthcare needs.http://www.samj.org.za/index.php/samjam2021School of Health Systems and Public Health (SHSPH

Preventive medicine as a specialty to support public health endeavours

There is a worldwide need for the transformation of primary healthcare to accommodate ageing, population growth, the rising burden of non-communicable diseases and technological advances. In this article, we discuss the role of preventive medicine as a medical specialty in the transformation of public healthcare systems. A paradigm is proposed within which different modes of medical practice support each other in accordance with their shared objective of disease prevention. The reinstitution of preventive medicine as a specialty, functioning in synergy with public health and incorporating other modalities of practice, will be of considerable benefit to healthcare in southern Africa.http://www.samj.org.za/index.php/samjam2021School of Health Systems and Public Health (SHSPH

Contributions to the study of the foetal development of physiological intimal thickening in the human uterine artery

The morphological study of the development of ifintimal thickeningsll of the human uterine artery in physiological condition was performed on 72 uterine arteries obtained from foetuses from the 12 th week of gestation up to birth. Our results indicate that intimal thickening is formed by the migration and displacement of mesenchymal cells around the site of origin of collateral vessel from uterine mesothelium. These cells firstly differentiate into the myoblasts and then into the myocites. During the development the internal limitans membrane separates the intimal thickening from the tunica media and the elastic fibres appearing inside possessing a muscle-elastic nature. The function of intimal thickenings is the regulation of local blood flow by means of the control of myocitic contractile capacity; these cells play a fundamental role in endothelium-intimal smooth muscle cell contact

Factors associated with sickness absence in healthcare workers in two public sector hospitals in Gauteng province, South Africa

BACKGROUND : The health workforce is key to service delivery and forms part of the World Health Organization’s six building blocks for health systems. It is therefore important to prioritise the health and wellbeing of healthcare workers (HCWs) to maintain their productivity. OBJECTIVE : We assessed the association of risk factors for cardiometabolic diseases, such as hypertension, diabetes, and obesity on sickness absence in HCWs, using routine medical surveillance records. METHODOLOGY : Six hundred HCWs’ health records were randomly selected from the occupational health clinic at two hospitals in Gauteng province, from 1 April to 30 June 2019. Backward stepwise logistic regression was used to assess the relationships between risk factors for cardiometabolic diseases, including body mass index (BMI), blood pressure, smoking, alcohol intake, regular exercise, and sickness absence. RESULTS : Four hundred and fifty records (75.0%) were for female HCWs. The overall median age was 37 years (IQR 30–47 years). Most HCWs were nurses (n = 290, 48.3%), followed by service workers (n = 124, 20.7%). Males had lower odds of sickness absence than females (AOR = 0.61; 95% CI 0.40, 0.94; p = 0.024). Compared to HCWs aged 30 years or younger, those aged 31 to 50 years and older than 50 years had significantly higher odds of sickness absence (AOR = 1.87; 95% CI 1.23–2.86; p = 0.004, and AOR = 2.25; 95% CI 1.30–3.89; p = 0.004). For each increasing unit of BMI, the odds of sickness absence increased by 3% (AOR = 1.03; 95% CI 1.00–1.06; p = 0.023). CONCLUSION : The presence of risk factors for cardiometabolic diseases and their association with productivity (measured as sick leave) highlight the importance of assessing lifestyle risk factors during medical surveillance for healthcare workers.http://www.occhealth.co.zaam2022Occupational Therap

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Background  Decision‐making processes and outcomes may be shaped by a range of non‐medical or ‘contextual’ factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide‐ranging research for health decision‐making purposes. Methods  To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision‐making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. Findings  We present an exploratory tool consisting of questions organized into four thematic domains – Bodies, Technologies, Place and Work (BTPW) – articulating wide‐ranging contextual factors relevant to health decision making. The BTPW tool encompasses health‐related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. Conclusions  These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health‐related research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86973/1/j.1369-7625.2010.00618.x.pd

Reimagining the language of engagement in a post-stakeholder world

Language matters in shaping perceptions and guiding behaviour. The term stakeholder is widely used, yet little attention is paid to the possibility that its use may inadvertently perpetuate colonial narratives and reinforce systemic inequities. In this article, we critically examine the limitations of the stakeholder concept and its ambiguity, normativity, and exclusionary implications. We emphasise the importance of using language that gives a voice to marginalised groups, promotes inclusion and equity, and fosters meaningful and reflexive participation in decision-making processes. In critiquing the use of the term and calling for alternative practices, we aim to contribute to the decolonisation of research norms and the creation of more inclusive and equitable societies. Therefore, rather than advocating a single alternative term, we suggest a focus on the people, places, and species affected by decisions, interventions, projects, and issues

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other

Professional Master's degree in Nursing: knowledge production and challenges

OBJECTIVE: to analyze the production of knowledge resulting from the professional master's degree programs in Nursing and to reflect about their perspectives for the area.METHOD: descriptive and analytical study. Data collected from the dissertations of three educational institutions that graduated students in programs of professional master's degree in Nursing between 2006 and 2012 were included.RESULTS: most of the 127 course completion studies analyzed were developed within hospital contexts; there was a focus on the organizational and healthcare areas, in the research fields care process and management, and predominance of qualitative studies. There are various products resulting from the course completion studies: evaluation of services/healthcare programs and development of processes, care or educational protocols.CONCLUSION: the programs of professional master's degree in Nursing, which are undergoing a consolidation stage, have recent production under development and there is a gap in the creation of hard technologies and innovation. They are essential for the development of innovative professional practices that articulate the healthcare and educational areas