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Evaluation of the implementation of a PhD capacity-building program for nurses in South Africa. Nurs Res 2014; 64:13-23. [PMID: 25502057 DOI: 10.1097/nnr.0000000000000069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nursing is experiencing a significant deficit in research capacity needed to meet future global healthcare demands-there is a call to double the number of nurses and healthcare professionals with a doctorate. AIM The aim of this research was to evaluate the implementation of a national PhD capacity-building program for academic and practice-based nurses and other healthcare professionals in South Africa. METHODS An implementation science framework was used. Implementation of the program across two national, longitudinal cohorts of participants was studied. Evidence of enablers and barriers to implementation was obtained from multiple data sources, including the curriculum for the program, regular evaluation reports from program participants and program facilitators after each stage of the PhD curriculum delivery, and meeting notes. Supplementary sources included rates of PhD candidate recruitment, retention, and successful completion. RESULTS Evidence for the presence of enablers for successful implementation was found, including stakeholder consultation and buy-in, leadership, resources, staff capacity, and implementation teams. No evidence of an implementation plan, a supportive organizational culture, or effective ongoing communication at Stage 4 of the implementation process was found. Barriers to implementation included external environmental factors, resistance to change, and vested interests. DISCUSSION Within the context of a recognized worldwide shortage of nursing scientists, the application of an implementation science framework to evaluate the initial stages of a national PhD development program rollout provided information on how effective implementation can be strengthened and how barriers to success can be overcome.
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Lalloo UG, Bobat RA, Pillay S, Wassenaar D. A strategy for developing future academic leaders for South Africa in a resource-constrained environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:S55-9. [PMID: 25072580 PMCID: PMC4129462 DOI: 10.1097/acm.0000000000000354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A key challenge in addressing the shortage of health care workers in resource-constrained environments is ensuring that there is optimal academic capacity for their training. South Africa's University of KwaZulu-Natal has placed academic and research capacity building at the heart of its program with the Medical Education Partnership Initiative in a program called ENhancing Training and REsearch capacity and Expertise (ENTREE). The program aims to increase the quantity, quality, and retention of health care graduates. It is premised on the basis that research capacity development will lead to an increase in teachers who will be essential to improving the quality and quantity of health care workers needed to meet South Africa's health challenges. This is being achieved through four components of the program: (1) infusion of the undergraduate program with research modules; (2) attraction of academically talented students in the middle of their undergraduate program into a parallel track that has research capacity as its major thrust; (3) attraction of qualified health care personnel into a supported PhD program; and (4) providing strong research ethics training and mentorship. A significant proportion of the program is being executed in rural training sites, to increase the probability that trainees will return to the sites as mentors.
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Affiliation(s)
- Umesh G Lalloo
- Professor Lalloo is senior professor and head, Department of Pulmonology and Critical Care, University of KwaZulu-Natal, Durban, South Africa. Professor Bobat is associate professor and head, Pediatric Infectious Diseases, Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa. Dr. Pillay is honorary lecturer, Department of Pulmonology and Critical Care, and director, HIV Graduate Program, University of KwaZulu-Natal, Durban, South Africa. Professor Wassenaar is professor and director, South African Research Ethics Training Initiative, School of Applied Human Sciences, and chair, Biomedical Research Ethics Committee, University of KwaZulu-Natal, Durban, South Africa
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Abstract
Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2·0% of national health spending. However, large racial differentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens.
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Affiliation(s)
- Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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de Paula AP, Giozza SP, Pereira MZ, Boaventura PS, Santos LMP, Sachetti CG, Tamayo COC, Kowalski CCG, Elias FTS, Serruya SJ, Guimarães R. Clinical investigations for SUS, the Brazilian public health system. SAO PAULO MED J 2012; 130:179-86. [PMID: 22790551 PMCID: PMC10876198 DOI: 10.1590/s1516-31802012000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/25/2011] [Indexed: 04/07/2023] Open
Abstract
CONTEXT AND OBJECTIVE Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. DESIGN AND SETTING Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. METHODS The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. RESULTS The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. CONCLUSION The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.
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Affiliation(s)
- Ana Patrícia de Paula
- MD, PhD. Coordinator, Postgraduate Program, Escola Superior de Ciências da Saúde, Fundação de Ensino e Pesquisa em Ciências da Saúde, Federal District Health Department, Brasília, Federal District, Brazil.
| | - Silvana Pereira Giozza
- DDS, PhD. Consultant, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | - Michelle Zanon Pereira
- MSc. Consultant Nutritionist, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | - Patrícia Souza Boaventura
- Consultant Specialist Pharmacist, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | - Leonor Maria Pacheco Santos
- PhD. Chemist and Professor, Department of Public Health, Universidade de Brasília (UnB), Brasília, Federal District, Brazil.
| | - Camile Giaretta Sachetti
- MSc. Consultant Pharmacist, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | - César Omar Carranza Tamayo
- MD, PhD. Consultant, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | | | - Flavia Tavares Silva Elias
- MSc. Nutritionist, General Coordinator, Department of Science and Technology, Ministry of Health, Brasília, Federal District, Brazil.
| | - Suzanne Jacob Serruya
- MD, PhD. Consultant, Latin American Centre for Perinatology and Women and Reproductive Health, Pan-American Health Organization, Montevideo, Uruguay.
| | - Reinaldo Guimarães
- MD, MSc. Professor, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
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