Striving for equity: Life orientation resources in South African high schools

As a school subject, life orientation (LO) aims to improve learner well-being, but a lack of classroom resources may be a barrier. We investigated whether classroom resources were equally available for LO educators in fully funded (no-fee) and partially funded (fee-paying) high schools in Tshwane South, South Africa. In this analytical cross-sectional study, LO representatives completed questionnaires about the availability of resources in their schools. Sixty-seven LO representatives completed the questionnaire. No-fee and fee-paying schools had the same availability of government resources and textbooks, but no-fee schools had less access to audio-visual equipment and printed materials. Representatives from both categories of schools were least satisfied with the availability of resources for the topic: Health. In contrast, they thought that the resources for non-health related topics such as career and skills-development were adequate. Representatives from no-fee schools were less satisfied with physical education resources (U (56) = -2.29, p = 0.02). The government’s efforts to redress inequity is evident in the availability of basic resources. However, a lack of health resources is a source of concern in a society that has a quadruple burden of disease. Keywords: equity; health education; life orientation; resources; schoo

Agreeing on the minimum: An 11-year review of Prescribed Minimum Benefits appeals

Background. Prescribed Minimum Benefits (PMBs) in South Africa (SA) are a set of minimum health services that all members of medical aid schemes have access to regardless of their benefit options or depleted funds. Medical aid schemes are liable to pay for these services. However, ~40% of all complaints received by the Council for Medical Schemes (CMS) are in relation to PMBs. Individuals/stakeholders who are unsatisfied with judgments on their complaints are allowed to appeal.Objectives. To determine and describe the pattern of PMB appeals from 1 January 2006 to 31 December 2016.Methods. This was a descriptive cross-sectional study that utilised the CMS Judgments on Appeals database. Data for PMBs, levels of appeal, judgments, appellants, respondents and medical scheme types were extracted. The CMS’s lists of chronic conditions, PMBs and registered schemes were used to confirm PMBs and to categorise schemes as either open (i.e. to all South Africans) or restricted (i.e. only open to members of specific organisations). Data were extracted and frequencies were calculated using Stata software, version 14.Results. All eligible appeal reports (N=340) were retrieved and 123 PMB appeals were included in the study (36.2%). The median number of PMB appeals per year was 11 (interquartile range 9 - 27). Open schemes accounted for 82.1% of all the PMB appeals. Half of the total appeals (50.4%, 62/123) were by medical aid schemes appealing their liability to pay for PMBs, and of these 69.4% (43/62) were found in favour of members. The remaining half (49.6%, 61/123) were appeals by members appealing that schemes were liable to pay, and of these 80.3% (49/61) were found in favour of the medical aid schemes. Treatment options that were scheme exclusions constituted 34.4% (21/61) of reasons why schemes were found not liable to pay. Various types of cancers and emergency conditions constituted one-quarter of all PMB appeals.Conclusions. While the pattern is unclear and the extent of the problem is masked, this study shows that a quarter of the conflict resulting in PMB appeals was due to various types of cancers and emergency conditions. Medical schemes should revise their guidelines, policies and criteria for payment of these two services and improve their communication with healthcare providers and members.

Patient safety culture in a district hospital in South Africa: An issue of quality

Background: The Nursing Act 33 of 2005 holds nurse practitioners responsible for all acts and omissions in the delivery of quality patient care. But quality patient care is influenced by a number of factors beyond the control of nurse practitioners. Patient safety culture is one such factor and is seldom explored in hospitals in developing countries. This article describes the patient safety culture of a district hospital in South Africa. Objectives: The study identified and analysed the factors that influence the patient safety culture by using the Manchester Patient Safety Framework at the National District Hospital, Bloemfontein, Free State Province. Method: A descriptive cross-sectional study was conducted and included the total population of permanent staff; community service health professionals; temporarily employed health professionals and volunteers. The standard Manchester Patient Safety Framework questionnaire was distributed with a response rate of 61%. Results: Less than half of the respondents (42.4%; n = 61) graded their units as acceptable. Several quality dimensions were statistically significant for the employment profile: overall commitment to quality (p = 0.001); investigating patient incidents (p = 0.031); organisational learning following incidents (p < 0.001); communication around safety issues (p = 0.001); and team working around safety issues (p = 0.005). These same quality dimensions were also statistically significant for the professional profiles. Medical doctors had negative perceptions of all the safety dimensions. Conclusion: The research measured and described patient safety culture (PSC) amongst the staff at the National District Hospital (NDH). This research has identified the perceived inadequacies with PSC and gives nurse managers a clear mandate to implement change to ensure a PSC that fosters quality patient care

Risky sexual behaviour of university students : perceptions and the effect of a sex education tool

The increasing HIV incidence amongst people aged 15-24 years and the reported gaps in sexeducation received at school and reported risky sexual behaviour in South Africa justifies the importance of this study. This study examines the risky sexual behaviour and perceptions among first-year students enrolled at Monash South Africa in South Africa. This four-phased mixed methods pilot study explored whether a sex-education intervention tool positively influenced risky sexual behaviour. Phase 1 used self-administered questionnaires to obtain quantitative and qualitative baseline data. In Phase 2 a sex-education intervention tool was designed to address identified gaps. In Phase 3 a prospective cohort of 12 mixed-gender students participated in the sex-education intervention sessions and was followed up a month later (Phase 4) to evaluate the effectiveness of the tool. Phase 1 participants (139) were between 18- 21 years. The level of sexeducation knowledge amongst the participants was low and of a poor quality; this could be a result of poor preparation at school. The results suggest the necessity of sex-education programmes for university students considering the low proportion of students entering university with basic sex education. Of the 139 participants, 27 were identified with risky sexual behaviour and considered for an intervention. The intervention participants felt more able to be responsible for their behaviour after the intervention. The participants reported that the sexeducation intervention tool influenced their risky sexual behaviour positively. This pilot intervention study can be adopted by universities interested in engaging their students about their sexual health and augmenting school-level interventions.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-06-30am2016School of Health Systems and Public Health (SHSPH

Using research findings in my everyday practice: what is good evidence, where do I look, and how can I use it?

As a health care practitioner, you are not best serving your patients if you make decisions based only on your experience and what you learnt during training – especially if you trained some time ago! Although both these sources of learning are valuable, they are not enough. Modern health practitioners are expected to stay up to date with the latest knowledge relevant to their field and to practice evidence-based medicine

Clinical mentoring to improve quality of care provided at three NIM-ART facilities: A mixed methods study

Background: The South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences. Aim: This study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor. Setting: The study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected. Methods: A mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary. Results: NIM-ART nurses prescribed rationally and followed antiretroviral guidelines.Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges, excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints. Conclusion: Clinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care

An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa : the People Living with HIV Stigma Index

Background: The continued presence of stigma and its persistence even in areas where HIV prevalence is high makes it an extraordinarily important, yet difficult, issue to eradicate. The study aimed to assess current and emerging HIV/AIDS stigma and discrimination trends in South Africa as experienced by people living with HIV/AIDS (PLHIV). Methods: The PLHIV Stigma Index, a questionnaire that measures and detects changing trends in relation to stigma and discrimination experienced by PLHIV, was used as the survey tool. The study was conducted in 10 clinics in four provinces supported by the Foundation for Professional Development (FPD), with an interview total of 486 PLHIV. A cross-sectional design was implemented in the study, and both descriptive and inferential analysis was conducted on the data. Results: Findings suggest that PLHIV in this population experience significant levels of stigma and discrimination that negatively impact on their health, working and family life, as well as their access to health services. Internalised stigma was prominent, with many participants blaming themselves for their status. Conclusion: The findings can be used to develop and inform programmes and interventions to reduce stigma experienced by PLHIV. The current measures for dealing with stigma should be expanded to incorporate the issues related to health, education and discrimination experienced in the workplace, that were highlighted by the study.Psycholog

Promoting inclusivity in health professions education publishing

A taskforce established by Medical Education asks readers to engage in discussion about how the journal and field can do better to ensure that health professional education publishing is inclusive of diverse knowledge and perspectives.https://onlinelibrary.wiley.com/journal/13652923hj2023School of Health Systems and Public Health (SHSPH