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Doresha LM, Williams, Mash R. The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study. BMC PRIMARY CARE 2024; 25:176. [PMID: 38773378 PMCID: PMC11106914 DOI: 10.1186/s12875-024-02424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Community health workers (CHW) are an integral part of primary health care re-engineering in South Africa. Cape Town is developing community-orientated primary care, with a central role for CHWs. Their role in human immunodeficiency virus, tuberculosis, maternal and child health has been articulated, but is less clear for non-communicable diseases (NCDs). Non-communicable diseases are now a major contributor to the burden of disease. The aim was to explore the current role of CHWs regarding NCDs in the Eastern sub-district of Cape Town, South Africa. METHODS An exploratory descriptive qualitative study made use of non-participant observation and qualitative interviews with CHWs, their managers, and nurse coordinators. Data from nine semi-structured interviews and ten observations were analysed with the framework method and Atlas-ti. RESULTS The CHWs were embedded in their communities and provided services via support groups, household visits and delivery of medication. They linked people to care with assistance of nurse coordinators. They could also provide physical care in the home. They lacked the ability to counsel people on the risk factors for NCDs and their role in rehabilitation and palliative care was unclear. More nurse coordinators were needed to provide supportive supervision. Inter-sectoral collaboration was weak and hindered CHWs from addressing social issues. More standardised and comprehensive training should equip CHWs for health promotion and disease prevention during household visits. Data collected in the community needed to be analysed, reported on and integrated with data from the primary care facility. This should also contribute to a community diagnosis. Their relationship with facility-based members of the primary health care team needed to be improved. Attention needed to be given to the requirements for and conditions of employment, as well as working hours and remuneration. Some equipment was absent and hindered their services for NCDs. CONCLUSIONS CHWs have the potential to provide a comprehensive approach to NCDs, but community-orientated primary care needs to be strengthened in many of the key areas to support their activities. In relation to NCDs, they need training in basic and brief behaviour change counselling and risk factors as well as in the areas of rehabilitation and palliative care.
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Affiliation(s)
- Lize-Marie Doresha
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Williams
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Robert Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa.
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Scheffler E, Mash R. A stroke rehabilitation training program for community-based primary health care, South Africa. Afr J Disabil 2023; 12:1135. [PMID: 37065935 PMCID: PMC10091063 DOI: 10.4102/ajod.v12i0.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 03/05/2023] Open
Abstract
Background With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training. Objectives To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa. Method Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described. Results The CHWs' scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology. Conclusion The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article. Contribution The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Louw QA, Conradie T, Xuma-Soyizwapi N, Davis-Ferguson M, White J, Stols M, Masipa A, Mhlabane P, Mdaka L, Manzini C, Kekana I, Schutte M, Rabothata S, Kleinitz P. Rehabilitation Capacity in South Africa-A Situational Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3579. [PMID: 36834271 PMCID: PMC9961618 DOI: 10.3390/ijerph20043579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Rehabilitation in South Africa (SA) operates independently of major health services and reforms, despite the increasing rehabilitation need. With the introduction of National Health Insurance (NHI), SA is facing another major health reform. Evidence is needed on the current SA rehabilitation situation, regarding shortcomings, opportunities, and priority strategic strengthening actions. We aimed to describe the current rehabilitation capacity in the SA public health sector, which serves the majority and most vulnerable South Africans. A cross-sectional survey was conducted in five provinces, using the World Health Organisation's Template for Rehabilitation Information Collection (TRIC). Participants were purposively selected for their insights and experiences of rehabilitation in specific government departments, health sectors, organisations, and/or services. TRIC responses were analysed descriptively. Participants explained how timely and effective rehabilitation produced long-term health, social, and economic benefits. Positive initiatives were reported for rehabilitation data collection, service design, and innovation. Challenges included inadequacies in human resources, the integration of rehabilitation at primary care, guidelines, and specialised long-term care facilities. The continuity of care across levels of care was sub-optimal due to inefficient referral systems. Promoting and improving rehabilitation nationally requires concerted, innovative, collaborative, and integrated efforts from multiple stakeholders within, and outside, the health system.
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Affiliation(s)
- Quinette A. Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | - Thandi Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | | | - Megan Davis-Ferguson
- Disabilities and Rehabilitation, Western Cape Department of Health, Cape Town 8000, Western Cape, South Africa
| | - Janine White
- Western Cape Rehabilitation Centre, Western Cape Department of Health, Cape Town 7789, Western Cape, South Africa
| | - Marie Stols
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Andronica Masipa
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Pringle Mhlabane
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Lungisile Mdaka
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Claudina Manzini
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Ivy Kekana
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Marike Schutte
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Simon Rabothata
- Rehabilitation Service, Gauteng Department of Health, Pretoria 2001, Gauteng, South Africa
| | - Pauline Kleinitz
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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Kumurenzi A, Richardson J, Thabane L, Kagwiza J, Musabyemariya I, Bosch J. Provision and use of physical rehabilitation services for adults with disabilities in Rwanda: A descriptive study. Afr J Disabil 2022; 11:1004. [PMID: 36092478 PMCID: PMC9453115 DOI: 10.4102/ajod.v11i0.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Physical rehabilitation interventions address functional deficits caused by impairments that affect someone’s performance. Whilst rehabilitation is important, it is assumed that these services are either minimal or nonexistent in low-resource settings. Our data expand on the data from the Situation Assessment of Rehabilitation in the Republic of Rwanda report to describe rehabilitation services and who access them at public and semiprivate facilities (primarily funded by the private sector). Objectives This article describes the use of the outpatient physical rehabilitation services across nine health facilities, the characteristics of adults attending these health facilities and some of the facilitators and barriers they encounter when attending rehabilitation. Method Data were collected between September and December 2018 from the heads of departments and adult patients attending outpatient rehabilitation services funded by the government, international nongovernmental organisations or faith-based organisations. Results Two hundred and thirteen adults were recruited from nine facilities. There is a sixfold difference in the number of rehabilitation personnel between public and semiprivate hospitals in these facilities’ catchment areas. However, most participants were recruited at public facilities (186 [87%]), primarily with physical disorders. Patients reported that family support (94%) was the most crucial facilitator for attending rehabilitation, whilst transportation cost (96%) was a significant barrier. Conclusion Rehabilitation service availability for Rwandan adults with disabilities is limited. Whilst family support helps patients attend rehabilitation, transportation costs remain a significant barrier to people attending rehabilitation. Strategies to address these issues include developing triage protocols, training community health workers and families. Contribution Data on rehabilitation service provision in Rwanda and most African countries are either non-existent or very limited. These data contain important information regarding the services provided and the people who used them across different health facilities (public versus private) and urban versus rural settings). To improve rehabilitation service provision, we first need to understand the current situation. These data are an important step to better understanding rehabilitation in Rwanda.
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Affiliation(s)
- Anne Kumurenzi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Physiotherapy, Faculty of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Julie Richardson
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Jeanne Kagwiza
- Department of Physiotherapy, Faculty of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Ines Musabyemariya
- Functional Rehabilitation Programme, Humanity and Inclusion, Kigali, Rwanda
| | - Jackie Bosch
- Department of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Population Health Research Institute, McMaster University, Hamilton, Canada
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Nash J, Krüger E, Vorster C, Graham MA, Pillay BS. Psychosocial care of people with aphasia: Practices of speech-language pathologists in South Africa. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:330-340. [PMID: 34637656 DOI: 10.1080/17549507.2021.1987521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: The study aimed to explore the practices of a sample of South African speech-language pathologists (SLPs) in providing psychosocial care to people with aphasia. People with aphasia are at risk of adverse psychosocial disruptions and access to appropriate support may be particularly challenging for individuals with compromised communication abilities. The study considered the multilingual and multicultural context of South Africa. By understanding current practices, direction for improved psychosocial care to clients as well as support to SLPs is highlighted.Method: A 20-item previously published online survey was completed by 56 South African SLPs. Purposive and snowball sampling were used to recruit participants. Descriptive and inferential statistics, and qualitative content analysis, were used.Result: Respondents recognised addressing psychosocial wellbeing to be very important. A variety of psychosocial approaches were used in practice. However, 67.9% of the sample felt ill-equipped to provide psychosocial care to people with aphasia. Further barriers included: time/caseload pressures (60.7%) and feeling out of their depth (48.2%). Enablers were: access to more training opportunities (89.3%), adequate time (62.5%), and ongoing support from skilled professionals (55.4%). The majority of respondents also perceived mental health professionals to have limited expertise in working with people with aphasia, making onward referral challenging.Conclusion: Respondents support people with aphasia's psychosocial wellbeing by employing counselling strategies, including family, and person-centred goal-setting. However, many challenges to the provision of psychosocial care to people with aphasia were identified. To improve services, more training opportunities, improved role definition and interprofessional collaboration, are required.
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Affiliation(s)
- Jordan Nash
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Carlien Vorster
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Bhavani Sarveshvari Pillay
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Smythe T, Inglis-Jassiem G, Conradie T, Kamalakannan S, Fernandes S, van-Niekerk SM, English R, Webster J, Hameed S, Louw QA. Access to health care for people with stroke in South Africa: a qualitative study of community perspectives. BMC Health Serv Res 2022; 22:464. [PMID: 35395847 PMCID: PMC8993457 DOI: 10.1186/s12913-022-07903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Incidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures. Methods In-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective. Results PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS. Conclusions Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07903-9.
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Affiliation(s)
- T Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - T Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Kamalakannan
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.,Public Health Foundation of India, Indian Institute of Public Health Hyderabad, SACDIR, Hyderabad, India
| | - S Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - S M van-Niekerk
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - R English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Webster
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Tropical Health and Medicine, London, UK
| | - S Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Q A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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van Niekerk SM, Kamalakannan S, Inglis-Jassiem G, Charumbira MY, Fernandes S, Webster J, English R, Louw QA, Smythe T. Towards universal health coverage for people with stroke in South Africa: a scoping review. BMJ Open 2021; 11:e049988. [PMID: 34824111 PMCID: PMC8627414 DOI: 10.1136/bmjopen-2021-049988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA). SETTING SA. DESIGN Scoping review. SEARCH METHODS We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results. RESULTS Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available. CONCLUSION This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.
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Affiliation(s)
- Sjan-Mari van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Sureshkumar Kamalakannan
- SACDIR Indian Institute of Public Health Hyderabad, Public Health Foundation of India, New Delhi, India
- International Center for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Maria Yvonne Charumbira
- Rehabilitation Sciences, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Silke Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Tropical Health and Medicine, London, UK
| | - Rene English
- Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Tracey Smythe
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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Watkins KE, Levack WMM, Rathore FA, Hay-Smith EJC. What would 'upscaling' involve? A qualitative study of international variation in stroke rehabilitation. BMC Health Serv Res 2021; 21:399. [PMID: 33926440 PMCID: PMC8082958 DOI: 10.1186/s12913-021-06293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/18/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Demand for stroke rehabilitation is expected to grow dramatically; with the estimated prevalence of stroke survivors rising to 70 million worldwide by 2030. The World Health Organization's (WHO) report - Rehabilitation 2030: A call for action - has introduced the objective of 'upscaling' rehabilitation globally to meet demand. This research explored what upscaling stroke rehabilitation might mean for health professionals from countries at different stages of economic development. METHODS Qualitative descriptive study design using semi-structured interviews was employed. Purposively sampled, clinical leaders in stroke rehabilitation were recruited for interviews from low through to high-income countries. RESULTS Twelve rehabilitation professionals (medicine, physical therapy, occupational therapy, and speech and language therapy) from high (United States of America, Germany, United Kingdom, United Arab Emirates, New Zealand), upper-middle (Colombia and Turkey), lower-middle (Vietnam, Pakistan, Ghana), and low-income countries (Nepal and Sierra Leone) were interviewed. Upscaling was seen as a necessity. Successful scaling up will require initiatives addressing: political governance and managerial leadership, increasing knowledge and awareness of the value of rehabilitation, financial support, workforce developments, physical space and infrastructure, and the development of community services and reintegration. CONCLUSION Although there have been many gains within the development of stroke rehabilitation internationally, further investment is required to ensure that this patient population group continues to receive the best quality services. For the WHO to be successful in implementing their objective to upscale rehabilitation, specific attention will need to be paid to political, professional, economic, and sociocultural issues at global and local levels.
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Affiliation(s)
- Kimberley Elizabeth Watkins
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
| | - William Mark Magnus Levack
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine PNS Shifa Hospital DHA-II, Karachi, Pakistan
| | - Elizabeth Jean Carleton Hay-Smith
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand
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Mash R, Du Pisanie L, Swart C, Van der Merwe E. Evaluation of household assessment data collected by community health workers in Cape Town, South Africa. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 33314942 PMCID: PMC8378136 DOI: 10.4102/safp.v62i1.5168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 09/18/2020] [Indexed: 11/09/2022] Open
Abstract
Background South Africa has implemented ward-based outreach teams as part of re-engineering primary health care with teams of community health workers (CHWs). In Cape Town, such a community-orientated primary care (COPC) approach was developed at four learning sites. Community health workers registered and assessed the households they were responsible for, but a year later the data were not analysed or converted into useful information. The aim was to analyse the household data and evaluate its contribution to a community diagnosis, its quality and any implications for the performance of CHWs. Methods This article used descriptive secondary analysis of household data collected by CHWs at three COPC learning sites in Cape Town (Nomzamo, Eastridge and Mamre). Results Data were analysed for 16 852 people from Eastridge, 1338 people from Mamre and 1008 people from Nomzamo. Data were compared in terms of household composition and demographics, type of dwelling, identification of people on treatment for chronic conditions, identification of health risks (e.g. tuberculosis symptoms, tobacco smoking, missed immunisations, missed vitamin A prophylaxis, need for human immunodeficiency virus (HIV) testing or family planning, pregnant or postnatal, and wound care) and for referrals. Conclusion Household assessment visits have great potential. Data collected is currently of poor quality, inconsistent or not captured, infrequently analysed and not comprehensive. There is a need to introduce an electronic m-health solution to assist the health information system, to revise the contents of the household assessment form and to ensure that CHWs are competent to identify risks and respond appropriately.
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Affiliation(s)
- Robert Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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van Niekerk SM, Inglis-Jassiem G, Kamalakannan S, Fernandes S, Webster J, English R, Smythe T, Louw QA. Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review. BMJ Open 2020; 10:e041221. [PMID: 33046479 PMCID: PMC7552861 DOI: 10.1136/bmjopen-2020-041221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. METHODS AND ANALYSIS The scoping review will follow the approach recommended by Levac, Colquhoun and O'Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review, as it will only include published and publicly available data. The findings of this review will be published in an open-access, peer-reviewed journal and we will develop an accessible summary of the results for website posting and stakeholder meetings.
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Affiliation(s)
- Sjan-Mari van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, Gurgaon, India
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Silke Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, Stellenbosch University, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, London, UK
| | - Tracey Smythe
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Q A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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Scheffler E, Mash R. Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e12. [PMID: 33054273 PMCID: PMC7565662 DOI: 10.4102/phcfm.v12i1.2629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In less resourced settings, formal rehabilitation services for stroke survivors were often absent. Stroke survivors were referred to community health workers (CHWs) who were untrained in rehabilitation. AIM To describe the experience and perceived needs of stroke survivors, their caregivers and CHWs in a context with limited access to and support from formal rehabilitation services. SETTING The Breede Valley subdistrict, Western Cape, South Africa, a rural, less resourced setting. METHODS A descriptive exploratory qualitative study. Four focus group interviews were held with purposively selected stroke survivors and caregivers and four with CHWs. A thematic approach and the framework method were used to analyse the transcripts. FINDINGS A total of 41 CHWs, 21 caregivers and 26 stroke survivors participated. Four main themes and 11 sub-themes were identified. Because of the lack of knowledge, training and rehabilitation services, the main theme for all groups was having to 'figure things out' independently, with incontinence management being particularly challenging. Secondly was the need for emotional support for stroke survivors and caregivers. Thirdly, contextual factors such as architectural barriers and lack of assistive products negatively impacted care and function. Lastly, the organisation of health and rehabilitation services negatively impacted home-based services and professional support. CONCLUSIONS With appropriate training, the CHWs can be pivotal in the training and support of family caregivers and stroke survivors. Care pathways and the role and scope of both CHWs and therapists in home-based stroke rehabilitation should be defined and restructured, including the links with formal services.
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Affiliation(s)
- Elsje Scheffler
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Visagie S, Mji G, Scheffler E, Ohajunwa C, Seymour N. Exploring the inclusion of teaching and learning on assistive products in undergraduate curricula of health sciences faculties at three South African Universities. Disabil Rehabil Assist Technol 2019; 16:722-729. [PMID: 31835925 DOI: 10.1080/17483107.2019.1701104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Providers must be knowledgeable on policy, systems and products to provide a person centred service and prescribe the most appropriate assistive product for each user. AIM This study aimed to determine to what extent teaching and learning on assistive products are included in undergraduate curricula of the Health science faculties at three universities in the Western Cape Province of South Africa. METHODS Data were gathered through a cross sectional survey. Fifteen programmes were approached of whom eight participated. Information on teaching on assistive products was sourced from purposively identified key informants, through e-mail questionnaires. Descriptive analysis was done. RESULTS A total of 104 assistive products were included in the eight programmes. Manual wheelchairs were the only product for which teaching was underscored by policy guidelines. Handheld mobility devices and wheelchairs were covered by five programmes. Teaching on assistive products for self-care, participation in domestic life, indoor and outdoor activities, employment and leisure was limited. Thirty seven products listed on the GATE List of 50 were taught by at least one of the programmes. Teaching and examination were theoretical in nature and occurred in professional silos. Clinical exposure was often incidental. For many products none of the four service delivery steps were covered. CONCLUSION Assistive products were included in all the participating undergraduate programmes. The range of included products and the level of training were insufficient to prepare graduates to effectively address user's needs. Newly appointed graduates will require early in-service training to ensure appropriate assistive product service delivery.Implications for rehabilitationUndergraduate teaching on assistive products is provided in professional silos.Not all products on the GATE APL of 50 are included in under graduate teaching.Teaching does not always ensure a proficiency level that will support graduates to provide an independent AT service.
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Affiliation(s)
- Surona Visagie
- Center for Disability and Rehabilitation, Stellenbosch University, Cape Town, South Africa
| | - Gubela Mji
- Center for Disability and Rehabilitation, Stellenbosch University, Cape Town, South Africa
| | - Elsje Scheffler
- Center for Disability and Rehabilitation, Stellenbosch University, Cape Town, South Africa
| | - Chioma Ohajunwa
- Center for Disability and Rehabilitation, Stellenbosch University, Cape Town, South Africa
| | - Nicky Seymour
- Motivation Charitable Trust, Cape Town, South Africa
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Hartley T, Burger M, Inglis-Jassiem G. Post stroke health-related quality of life, stroke severity and function: A longitudinal cohort study. Afr J Disabil 1970; 11:947. [PMID: 35169551 PMCID: PMC8831922 DOI: 10.4102/ajod.v11i0.947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Health related quality of life (HRQoL) is a determinant of physical, social and emotional well-being post-stroke. Objectives This study aimed to correlate self-reported HRQoL with activities of daily living (ADL) and stroke severity. Method A longitudinal observational study was conducted at a rehabilitation centre in the Western Cape, South Africa. Stroke inpatients were sampled over 6 months. The Euro-QoL Five Dimensions instrument (EQ5D-3L) for self-reported HRQoL, Barthel Index (BI) for function and independence in ADL, and modified Rankin Scale (mRS) for stroke severity were administered on admission and discharge. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Results Of the 54 potential participants, 49 met inclusion criteria and 41 completed reassessments (median age 48 years [interquartile range {IQR} 39–60]; median length of stay 53 days [IQR 46–60]). Most participants had infarctions (89.90%); with hypertension or diabetes risk factors (73.47% and 28.57%, respectively). The BI and mRS scores improved significantly (p < 0.001) with very strong correlation between scores (rs = -0.874, p < 0.001); indicating a trend of decreased stroke severity as function improved. The EQ5D Visual Analog Scale (VAS) scores (p < 0.001) and domains mobility, self-care, usual activities (p < 0.001) and pain/discomfort (p = 0.034) improved significantly. The anxiety/depression domain showed a non-significant change (p = 0.378). A weak negative significant correlation existed between EQ5D VAS and mRS scores (rs = -0.362; p = 0.02); indicating a trend that HRQoL was not improving to the degree stroke severity decreased. A weak positive significant correlation was seen between EQ5D VAS and BI scores (rs = 0.329; p = 0.036). Conclusion Although an improvement was noted in HRQoL, EQ5D VAS scores tended not to improve as strongly, despite significant improvements in function and stroke severity. These findings demonstrate the need for psychological support and pain management interventions for adjustment post-stroke.
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Affiliation(s)
- Tasneem Hartley
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Marlette Burger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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