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Mash R, Hirschhorn LR, Kakar IS, John R, Sharma M, Praveen D. Global lessons on delivery of primary healthcare services for people with non-communicable diseases: convergent mixed methods. Fam Med Community Health 2024; 12:e002553. [PMID: 39097405 DOI: 10.1136/fmch-2023-002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVE To extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD). DESIGN A convergent mixed methods study that extracted data using a standardised template from research projects funded by the GACD that focused on PHC. The strategies implemented in these studies were mapped onto the PHC Performance Initiative framework. Semistructured qualitative interviews were conducted with researchers from purposefully selected projects to understand the strategies and contextual factors in more depth. SETTING PHC contexts from low or middle-income countries (LMIC) as well as vulnerable groups within high-income countries. Projects came from all regions of the world, particularly East Asia and Pacific, sub-Saharan Africa, South Asia, Latin America and Caribbean. PARTICIPANTS The study extracted data on 84 research projects and interviewed researchers from 16 research projects. RESULTS Research projects came from all regions of the world, and mainly focused on diabetes (35.3%), hypertension (28.3%) and mental health (27.6%). Mapped onto the PHC Performance Initiative framework: 49.4% focused on high-quality PHC (particularly the comprehensiveness of NCD care, 41.2%); 41.2% on the availability of PHC services (particularly the competence of healthcare workers, 36.5%); 35.3% on population health management (particularly community-based services, 35.3%); 34.1% on facility organisation and management (particularly team-based care, 20.0%) and 31.8% on access (particularly digital technology, 23.5%). Most common strategies were task shifting and training to improve the comprehensiveness of NCD care through community-based services. Contextual factors related to inputs: infrastructure, equipment and medication, workforce (particularly community health workers), finances, health information systems and digital technology. CONCLUSION Key strategies and contextual factors to improve PHC service delivery for NCDs in LMICs were identified. These strategies should combine with other strategies to strengthen the PHC system as a whole, while improving care for NCDs.
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Affiliation(s)
- Robert Mash
- Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Renu John
- The George Institute for Global Health, Hyderabad, India
| | - Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
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Stansert Katzen L, Reid S, Laurenzi C, Tomlinson M. From the periphery to inclusion within the health system: promoting community health worker empowerment as a way forward. BMC PRIMARY CARE 2024; 25:272. [PMID: 39060967 PMCID: PMC11282798 DOI: 10.1186/s12875-024-02523-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment. METHODS We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study. RESULTS We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains-such as training, equipment, and supportive supervision-it is likely that the CHW cadre will continue to be seen as informal health care workers. CONCLUSIONS CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment.
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Affiliation(s)
- Linnea Stansert Katzen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa.
- Swedesd, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Steve Reid
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, 6023 Clinical Building, Francie van Zijl Drive, Tygerberg Campus, Cape Town, Tygerberg, 7505, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Lokotola CL, Mash R, Sethlare V, Shabani J, Temitope I, Baldwin-Ragaven L. Migration and primary healthcare in sub-Saharan Africa: A scoping review. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 39099278 PMCID: PMC11304195 DOI: 10.4102/phcfm.v16i1.4507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Migration in Africa is increasing and driven by a variety of inter-related socio-economic, conflict and climate-related causes. Primary healthcare (PHC) migration on PHC service will be in the forefront of responding to the associated health issues. AIM This study aimed to review the literature on the effect of migration on PHC service delivery in Africa and the challenges facing migrants in accessing PHC. METHOD A systematic approach (Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews) was applied across six databases and grey literature from African universities (2010 to 2021). Data were extracted and analysed quantitatively and qualitatively. RESULTS A total of 3628 studies were identified and 50 were included. Most studies were descriptive or used mixed methods. Publications came from 25 countries, with 52% of studies from South Africa, Uganda and Kenya. Most migrants originated from Zimbabwe, the Democratic Republic of Congo and Somalia. Population health management for migrant communities was challenging. Migration impacted PHC services through an increase in infectious diseases, mental health disorders, reproductive health issues and malnutrition. Primary healthcare services were poorly prepared for handling displaced populations in disaster situations. Access to PHC services was compromised by factors related to migrants, health services and healthcare workers. CONCLUSION Several countries in Africa need to better prepare their PHC services and providers to handle the increasing number of migrants in the African context.Contribution: The review points to the need for a focus on policy, reducing barriers to access and upskilling primary care providers to handle diversity and complexity.
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Affiliation(s)
- Christian Lueme Lokotola
- Department of Family and Emergency Medicine, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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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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Kamkuemah M, Ayo-Yusuf O, Oni T. Future proofing health in response to climate change and rapid urbanisation in Africa. BMJ 2024; 385:e076476. [PMID: 38589038 PMCID: PMC10996843 DOI: 10.1136/bmj-2023-076476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Monika Kamkuemah
- UrbanBetter Lab, Innovation Africa@UP, Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Olalekan Ayo-Yusuf
- Southern Africa Resilience Innovation Lab (SARiLab), School of Health Systems and Public Health, University of Pretoria, Pretoria
| | - Tolu Oni
- UrbanBetter Lab, Innovation Africa@UP, Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
- Research Initiative for Cities Health and Equity (RICHE), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Mash RJ, Von Pressentin K. Family practice research in the African region 2020-2022. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 38426783 PMCID: PMC10913144 DOI: 10.4102/phcfm.v16i1.4329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The African region produces a small proportion of all health research, including primary health care research. The SCOPUS database only lists the African Journal of Primary Health Care Family Medicine (PHCFM) and the South African Family Practice Journal (SAFP) in the field of family practice. AIM To review the nature of all original research (2020-2022) published in PHCFM and SAFP. SETTING African region. METHOD All 327 articles were included. Data were extracted into REDCap, using a standardised tool and exported to the Statistical Package for Social Sciences. RESULTS The median number of authors was 3 (interquartile range [IQR]: 2-4) and institutions and disciplines 1 (IQR: 1-2). Most authors were from South Africa (79.8%) and family medicine (45.3%) or public health (34.2%). Research focused on integrated health services (76.1%) and was mostly clinical (66.1%) or service delivery (37.9%). Clinical research addressed infectious diseases (23.4%), non-communicable diseases (24.6%) and maternal and women's health (19.4%). Service delivery research addressed the core functions of primary care (35.8%), particularly person-centredness and comprehensiveness. Research targeted adults and older adults (77.0%) as well as health promotion or disease prevention (38.5%) and treatment (30.9%). Almost all research was descriptive (73.7%), mostly surveys. CONCLUSION Future research should include community empowerment and multisectoral action. Within integrated health services, some areas need more attention, for example, children, palliative and rehabilitative care, continuity and coordination. Capacity building and support should enable larger, less-descriptive and more collaborative interdisciplinary studies with authors outside of South Africa.Contribution: The results highlight the strengths and weaknesses of family practice research in Africa.
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Affiliation(s)
- Robert J Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Scheffler E, Mash R. Evaluation of a stroke rehabilitation training programme for community-based primary healthcare. Afr J Disabil 2023; 12:1137. [PMID: 37794954 PMCID: PMC10546249 DOI: 10.4102/ajod.v12i0.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/06/2023] [Indexed: 10/06/2023] Open
Abstract
Background Family caregiver training is an integral part of stroke rehabilitation programmes and is associated with improved caregiver and stroke survivor outcomes. In the Cape Winelands District, a low-resourced rural community-based setting in South Africa, stroke survivors and family caregivers mostly rely on assistance from community health workers (CHWs), despite their lack of stroke-specific rehabilitation training. Objectives To evaluate the implementation and immediate effects of a bespoke, 16 session, 21 h stroke rehabilitation training programme for CHWs to better support family caregivers. Methods Two cooperative inquiry groups participated in participatory action research to design and develop the programme. This article reports on the implementation of this programme. Inquiry group members directly observed the training, obtained written and verbal feedback, interviewed CHWs and observed them in the community. Consensus on their learning was achieved after reflection on their experience and observations. Results Learning of the cooperative inquiry groups was categorised into the effect on community-based care, the training programme's design and development, how training was delivered and implications for service delivery. Community health workers empowered caregivers and stroke survivors and enabled access to care, continuity, coordination and person-centredness. The need for experiential learning and a spiral curriculum was confirmed. Therapists needed a different set of skills to deliver training. A systems approach and effective leadership were needed to enable community health workers to use their new skills. Conclusion The stroke rehabilitation training programme demonstrated potential for integration into service delivery and equipping CHWs to support family caregivers and stroke survivors. Further evaluation of the programme's effectiveness and scale-up is needed. Contribution Evidence of an intervention to train CHWs to support stroke survivors and family caregivers.
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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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Ohta R, Sano C. Overcoming Ethical Issues Surrounding the Relationships Between Physicians and Pharmaceutical Companies in Rural Hospitals. Cureus 2023; 15:e43320. [PMID: 37700941 PMCID: PMC10493002 DOI: 10.7759/cureus.43320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
Conflicts of interest (COIs), such as the relationships between pharmaceutical companies and patients and/or their families, can be a significant ethical issue in the field of medicine. The relationship between physicians and pharmaceutical company representatives is just one non-clinical ethical dilemma frequently encountered in medicine. For example, our family medicine department has a COI stemming from its relationship with pharmaceutical companies. We reflected on this COI and discussed a concrete approach from which we implemented evidence-based learning to overcome the challenges presented by this particular COI. This editorial reviews this case and demonstrates an effective approach to addressing COIs.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Hove J, Mabetha D, van der Merwe M, Twine R, Kahn K, Witter S, D'Ambruoso L. Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa. PLoS One 2023; 18:e0288524. [PMID: 37498863 PMCID: PMC10374036 DOI: 10.1371/journal.pone.0288524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders. METHODS Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure. RESULTS The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation. CONCLUSION The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders' level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.
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Affiliation(s)
- Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
- Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
| | - Denny Mabetha
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
| | | | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Scotland, United Kingdom
| | - Lucia D'Ambruoso
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
- Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Public Health, National Health Service (NHS) Grampian, Scotland, United Kingdom
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Benedict MOA, Steinberg WJ, Claassen FM, Mofolo N. Strategies to enhance the approach to prostate cancer screening of South African black men in the Free State: a Delphi study. J Public Health Afr 2023; 14:2333. [PMID: 37680870 PMCID: PMC10481904 DOI: 10.4081/jphia.2023.2333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/19/2022] [Indexed: 09/09/2023] Open
Abstract
Background The incidence and mortality rates of prostate cancer (PCa) are disproportionately on the increase among South African black men. Recent studies show a greater net benefit of prostate-specific antigen screening of black men compared with the general population. There are, however, knowledge, attitude, and practice (KAP) gaps among primary healthcare providers (HCPs) and users (black men) on PCa screening. Likewise, there is a scarcity of research on strategies to address these gaps. Objective This study sought to determine complementing strategies to enhance the approach to PCa screening of African men in the Free State, South Africa, from the perspectives of primary HCPs and users. Methods This study utilized a three-round modified Delphi survey to achieve its aim. Consensus was determined by an a priori threshold of ≥70% of agreement. Results The survey involved a multidisciplinary panel of 19 experts. The consensus was reached on 34 items (strategies) to enhance the approach to PCa screening in the study setting. Community health education strategies were proffered, relating to relevant topics, methods, venues of delivery, and persons to deliver the education. Continuing education topics and methods of instruction were suggested for primary HCPs. Conclusions In view of the existing KAP gaps in PCa screening among primary HCPs and users (black men), an expert consensus was determined, on complementing strategies to enhance the approach to PCa screening of South African black men in the study setting.
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Affiliation(s)
| | | | - Frederik M. Claassen
- Department of Urology, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - Nathaniel Mofolo
- School of Clinical Medicine, University of the Free State, Bloemfontein, South Africa
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Rodriguez JE, Guzmán CEV. Celebrating Family Medicine at the National Academy of Medicine. Ann Fam Med 2023; 21:294-296. [PMID: 37487725 PMCID: PMC10365875 DOI: 10.1370/afm.3000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 07/26/2023] Open
Affiliation(s)
- José E Rodriguez
- Office of the Associate Vice President for Health Equity, Diversity and Inclusion, University of Utah Health, Salt Lake City, Utah
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Elsey H, Abboah-Offei M, Vidyasagaran AL, Anaseba D, Wallace L, Nwameme A, Gyasi A, Ayim A, Ansah-Ofei A, Amedzro N, Dovlo D, Agongo E, Awoonor-Williams K, Agyepong I. Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why. Front Public Health 2023; 11:1105495. [PMID: 37435526 PMCID: PMC10332345 DOI: 10.3389/fpubh.2023.1105495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/11/2023] [Indexed: 07/13/2023] Open
Abstract
Background Despite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub-Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme. Methods We conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understand the different impacts and implementation lessons of the CHPS programme. Results N = 58 out of n = 117 full text studies retrieved met the inclusion criteria, of which n = 28 were quantitative, n = 27 were qualitative studies and n = 3 were mixed methods. The geographical spread of studies highlighted uneven distribution, with the majority conducted in the Upper East Region. The CHPS programme is built on a significant body of evidence and has been found effective in reducing under-5 mortality, particularly for the poorest and least educated, increasing use and acceptance of family planning and reduction in fertility. The presence of a CHPS zone in addition to a health facility resulted in increased odds of skilled birth attendant care by 56%. Factors influencing effective implementation included trust, community engagement and motivation of community nurses through salaries, career progression, training and respect. Particular challenges to implementation were found in remote rural and urban contexts. Conclusions The clear specification of CHPS combined with a conducive national policy environment has aided scale-up. Strengthened health financing strategies, review of service provision to prepare and respond to pandemics, prevalence of non-communicable diseases and adaptation to changing community contexts, particularly urbanization, are required for successful delivery and future scale-up of CHPS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214006, identifier: CRD42020214006.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Mary Abboah-Offei
- School of Health and Life Sciences, University of the West of Scotland (London Campus), London, United Kingdom
| | | | - Dominic Anaseba
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Lauren Wallace
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua Gyasi
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Andrews Ayim
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Nina Amedzro
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Delanyo Dovlo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Erasmus Agongo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Irene Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
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Mi Y, Zhou M, Zeng Y, Wang P, Gao L, Cheng F. Factors Associated With Delayed and Late Initiation of Antiretroviral Therapy Among Patients With HIV in Beijing, China, 2010-2020. Int J Public Health 2023; 68:1605824. [PMID: 37416802 PMCID: PMC10321558 DOI: 10.3389/ijph.2023.1605824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023] Open
Abstract
Objectives: To determine factors associated with late and delayed antiretroviral therapy (ART) initiation in China and provide evidence for HIV prevention. Methods: Logistics regression model was used to determine factors associated with three outcomes: late (CD4 cell count <200 cells/µL or clinical AIDS diagnosis prior to ART initiation), delayed (more than 1 month between HIV diagnosis date and ART initiation) and either late or delayed ART initiation. Results: Multivariable analysis revealed that male, heterosexual, HIV diagnosis before 2014, HBV/HCV seropositive, and tuberculosis were associated with increased odds of all three outcomes. Conversely, married or cohabiting patients were less likely to have delayed ART initiation and either late or delayed ART initiation, while people who inject drugs were more likely to have these two outcomes. Additionally, older age was associated with an increased risk of having either late or delayed ART initiation, but a decreased risk of delayed ART initiation. Conclusion: The proportion of late and delayed ART initiation decreased significantly after the release of the 2016 guidelines in China. To further improve late diagnosis and early treatment, precise interventions for key populations are required.
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Affiliation(s)
- Yuanqi Mi
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Mengge Zhou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Liangmin Gao
- Institute for International and Areas Studies, Tsinghua University, Beijing, China
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
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14
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Ordóñez CE, Marconi VC, Manderson L. Addressing coloniality of power to improve HIV care in South Africa and other LMIC. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1116813. [PMID: 37064826 PMCID: PMC10090665 DOI: 10.3389/frph.2023.1116813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/24/2023] [Indexed: 03/31/2023] Open
Abstract
We describe the appropriateness and potential for effectiveness of three strategic approaches for improving HIV care in South Africa: community-based primary healthcare, local/community-based stakeholder engagement, and community-engaged research. At their core, these approaches are related to overcoming health inequity and inequality resulting from coloniality of power's heterogenous structural processes impacting health care in many low- and middle-income countries (LMIC). We turn to South Africa, a middle-income country, as an example. There the HIV epidemic began in the 1980s and its ending is as elusive as achieving universal healthcare. Despite impressive achievements such as the antiretroviral treatment program (the largest in the world) and the country's outstanding cadre of HIV experts, healthcare workers and leaders, disadvantaged South Africans continue to experience disproportionate rates of HIV transmission. Innovation in global public health must prioritize overcoming the coloniality of power in LMIC, effected through the imposition of development and healthcare models conceived in high-income countries (HIC) and insufficient investment to address social determinants of health. We advocate for a paradigm shift in global health structures and financing to effectively respond to the HIV pandemic in LMIC. We propose ethically responsive, local/community-based stakeholder engagement as a key conceptual approach and strategy to improve HIV care in South Africa and elsewhere. We join in solidarity with local/community-based stakeholders' longstanding efforts and call upon others to change the current status quo characterized by global public health power concentrated in HIC.
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Affiliation(s)
- Claudia E. Ordóñez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Correspondence: Claudia E. Ordóñez
| | - Vincent C. Marconi
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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15
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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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16
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Malatji H, Griffiths F, Goudge J. Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000881. [PMID: 36962793 PMCID: PMC10021906 DOI: 10.1371/journal.pgph.0000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services' were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.
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Affiliation(s)
- Hlologelo Malatji
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frances Griffiths
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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17
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Mukora R, Thompson RR, Hippner P, Pelusa R, Mothibi M, Lessells R, Grant AD, Fielding K, Velen K, Charalambous S, Dowdy DW, Sohn H. Human resource time commitments and associated costs of Community Caregiver outreach team operations in South Africa. PLoS One 2023; 18:e0282425. [PMID: 36877676 PMCID: PMC9987772 DOI: 10.1371/journal.pone.0282425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION In South Africa, Community Caregivers (CCGs) visit households to provide basic healthcare services including those for tuberculosis and HIV. However, CCG workloads, costs, and time burden are largely unknown. Our objective was to assess the workloads and operational costs for CCG teams operating in different settings in South Africa. METHODS Between March and October 2018, we collected standardized self-reported activity time forms from 11 CCG pairs working at two public health clinics in Ekurhuleni district, South Africa. CCG workloads were assessed based on activity unit times, per-household visit time, and mean daily number of successful household visits. Using activity-based times and CCG operating cost data, we assessed CCG annual and per-household visit costs (USD 2019) from the health system perspective. RESULTS CCGs in clinic 1 (peri-urban, 7 CCG pairs) and 2 (urban, informal settlement; 4 CCG pairs) served an area of 3.1 km2 and 0.6 km2 with 8,035 and 5,200 registered households, respectively. CCG pairs spent a median 236 minutes per day conducting field activities at clinic 1 versus 235 minutes at clinic 2. CCG pairs at clinic 1 spent 49.5% of this time at households (versus traveling), compared to 35.0% at clinic 2. On average, CCG pairs successfully visited 9.5 vs 6.7 households per day for clinics 1 and 2, respectively. At clinic 1, 2.7% of household visits were unsuccessful, versus 28.5% at clinic 2. Total annual operating costs were higher in clinic 1 ($71,780 vs $49,097) but cost per successful visit was lower ($3.58) than clinic 2 ($5.85). CONCLUSIONS CCG home visits were more frequent, successful, and less costly in clinic 1, which served a larger and more formalized settlement. The variability in workload and cost observed across pairs and clinics suggests that circumstantial factors and CCG needs must be carefully assessed for optimized CCG outreach operations.
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Affiliation(s)
- Rachel Mukora
- The Aurum Institute, Aurum House, Johannesburg, South Africa
- The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan R. Thompson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Piotr Hippner
- The Aurum Institute, Aurum House, Johannesburg, South Africa
| | | | - Martha Mothibi
- The Aurum Institute, Aurum House, Johannesburg, South Africa
| | - Richard Lessells
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison D. Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine Fielding
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Salome Charalambous
- The Aurum Institute, Aurum House, Johannesburg, South Africa
- The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David W. Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail:
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18
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Family Physicians SAAO. The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians. S Afr Fam Pract (2004) 2022; 64:e1-e7. [PMID: 35384681 PMCID: PMC8991216 DOI: 10.4102/safp.v64i1.5473] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.
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19
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Visagie SJ, MacLachlan M, Scheffler E, Seymour N. Promoting regional coherence and cohesion amidst multiple assistive technology initiatives in Africa. Afr J Disabil 2022; 11:937. [PMID: 35280968 PMCID: PMC8905435 DOI: 10.4102/ajod.v11i0.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Appropriate provision of assistive technology services (ATS) and products are a global health issue and essential for achieving the Sustainable Development Goals (SDGs). The Sixth African Network for Evidence-to-Action on Disability (AfriNEAD) conference included a workshop on collaboration, cohesion and coherence in ATS delivery in Africa. Objective This article aimed to summarise the workshop proceedings and to provide some recommendations on how coherence and cohesion can be facilitated in assistive technology services in Africa. Method A round table and small group discussions on assistive technology were facilitated in the virtual space of the AfriNEAD conference. Organisations and role players in ATS and products in Africa participated as keynote speakers, round table members and in small group discussions. Results There was consensus amongst participants that cohesive collaboration must be facilitated. They further agreed that users must be central to future action. There are local, national and regional initiatives, but none of these have grown into an African assistive technology platform. World Health Organization (WHO) Africa can bring partners together and facilitate creation, officialisation and operationalising of a continental assistive technology platform, through building on the existing initiatives. The AfriNEAD disability research country working groups can act as in-country coordinating bodies for ATS and afford a possibility of a structured approach to assistive technology research. Conclusion It is time to break away from Western institutionalised biomedical ways of providing ATS in Africa. Africans must develop coherent, cohesive ATS driven by empowered users who build on Africa's strengths and addresses the continents' unique needs.
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Affiliation(s)
- Surona J Visagie
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Malcolm MacLachlan
- Department of Psychology and Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute, Palacký University, Olomouc, Czech Republic
| | - Elsje Scheffler
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nikola Seymour
- Centre for Disability and Rehabilitation Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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20
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Kioko PM, Kamau MW, Obungu NA, Khabure EA, Simmelink AM, Geoffrey K, De Meijer FO. HIV stigma in Kenya: A family medicine led community orientated primary care approach. Afr J Prim Health Care Fam Med 2021; 13:e1-e3. [PMID: 34797118 PMCID: PMC8603145 DOI: 10.4102/phcfm.v13i1.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
The Kenyan Ministry of Health envisages that family physicians should play an important role in the implementation of community orientated primary care (COPC) in collaboration with the community health team. The Kenyan Community Health Strategy forms a solid basis for the implementation of the COPC model. Residents and faculty of the Family Medicine department at the Aga Khan University Hospital Nairobi collaborated with the Kaloleni sub-county of Kilifi County government near Mombasa in a five-step COPC process to better understand and act against the high prevalence of HIV stigma in the coastal region. Firstly, a deeper understanding of human immunodeficiency virus (HIV) stigma was acquired through community visits and work in the comprehensive care clinic. Secondly, a collaborative implementation team was formed to design a targeted and feasible intervention. In a participatory approach, a two-step intervention was employed, firstly sensitising healthcare workers and community health volunteers (CHVs) on the high prevalence of HIV stigma in their community and educating them on HIV-related issues. Secondly, the information was disseminated to the community through home visits by CHVs, health talks and the set-up of an HIV support group at the facility. This short report illustrates the important contribution of family physicians to implementation of COPC and capacity building of the primary healthcare team.
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Affiliation(s)
- Peter M Kioko
- Department of Family Medicine, Medical College of East Africa, Aga Khan University, Nairobi.
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21
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Ankomah SE, Fusheini A, Ballard C, Kumah E, Gurung G, Derrett S. Patient-public engagement strategies for health system improvement in sub-Saharan Africa: a systematic scoping review. BMC Health Serv Res 2021; 21:1047. [PMID: 34610828 PMCID: PMC8491404 DOI: 10.1186/s12913-021-07085-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
Background Actively involving patients and communities in health decisions can improve both peoples’ health and the health system. One key strategy is Patient-Public Engagement (PPE). This scoping review aims to identify and describe PPE research in Sub-Saharan Africa; systematically map research to theories of PPE; and identify knowledge gaps to inform future research and PPE development. Methods The review followed guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 was conducted on Scopus, Medline (Ovid), CINAHL and Embase databases. Independent full text screening by three reviewers followed title and abstract screening. Using a thematic framework synthesis, eligible studies were mapped onto an engagement continuum and health system level matrix to assess the current focus of PPE in Sub-Saharan Africa. Results Initially 1948 articles were identified, but 18 from 10 Sub-Saharan African countries were eligible for the final synthesis. Five PPE strategies implemented were: 1) traditional leadership support, 2) community advisory boards, 3) community education and sensitisation, 4) community health volunteers/workers, and 5) embedding PPE within existing community structures. PPE initiatives were located at either the ‘involvement’ or ‘consultation’ stages of the engagement continuum, rather than higher-level engagement. Most PPE studies were at the ‘service design’ level of the health system or were focused on engagement in health research. No identified studies reported investigating PPE at the ‘individual treatment’ or ‘macro policy/strategic’ level. Conclusion This review has successfully identified and evaluated key PPE strategies and their focus on improving health systems in Sub-Saharan Africa. PPE in Sub-Saharan Africa was characterised by tokenism rather than participation. PPE implementation activities are currently concentrated at the ‘service design’ or health research levels. Investigation of PPE at all the health system levels is required, including prioritising patient/community preferences for health system improvement.
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Affiliation(s)
- Samuel Egyakwa Ankomah
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand. .,Center for Health Literacy and Rural Health Promotion, Accra, Ghana.
| | - Christy Ballard
- Health Sciences Library, University of Otago, Dunedin, New Zealand
| | - Emmanuel Kumah
- Department of Health Administration and Education, University of Education, Winneba, Ghana
| | - Gagan Gurung
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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22
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Calderon Gomez C, Betancurth Loaiza DP. Atención Primaria de Salud: una mirada global para orientarnos en lo local. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n5.85333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La atención sanitaria en general y la atención primaria de salud en particular necesi- tan ser pensadas y desarrolladas atendiendo a las cambiantes realidades sanitarias y sociales. Dichas realidades, complejas y diversas en función de las particularidades de cada país y la evolución de sus servicios de salud, presentan a su vez determinados retos comunes a los que también deberíamos responder de manera compartida.
El presente trabajo es una reflexión abierta acerca de las características básicas de la atención primaria desde una perspectiva internacional, elaborada y compartida en el contexto del II Simposio de Atención Primaria Social, organizado por la Universidad de Caldas en noviembre de 2019.
Utilizando la metáfora de la travesía por mar, se resitúan los principales atributos y condicionantes de la atención primaria a modo de carta de navegación y se sugieren los referentes de una posible brújula que puedan servirnos para sortear amenazas y avanzar conjuntamente hacia una atención primaria pública de calidad y al servicio de la salud de nuestras poblaciones.
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23
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Ponka D, Coffman M, Fraser-Barclay KE, Fortier RDW, Howe A, Kidd M, Lennon RP, Madaki JKA, Mash B, Mohd Sidik S, van Weel C, Zawaly K, Goodyear-Smith F. Fostering global primary care research: a capacity-building approach. BMJ Glob Health 2021; 5:bmjgh-2020-002470. [PMID: 32624501 PMCID: PMC7337619 DOI: 10.1136/bmjgh-2020-002470] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023] Open
Abstract
The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research—a core element of high-quality PHC—in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the micro (practice), meso (institutional) and macro (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and ‘brain drain’ may reduce available research support; however, we provide recommendations on how to deal with these tensions.
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Affiliation(s)
- David Ponka
- Besrour Centre for Global Family Medicine, College of Family Physicians of Canada, Mississauga, Ontario, Canada .,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan Coffman
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington DC, District of Columbia, USA
| | | | - Richard D W Fortier
- General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.,Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Amanda Howe
- Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| | - Michael Kidd
- Department of Family and Community Medicine, University of Toronto, Canada and Southgate Institute for Health, Toronto, Ontario, Canada
| | - Robert P Lennon
- Family and Community Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jeremiah K A Madaki
- Family Medicine, University of Jos, Jos, Plateau, Nigeria.,Family Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Bob Mash
- Family and Emergency Medicine, Stellenbosch University, Cape Town, South Africa.,Stellenbosch University, Cape Town, South Africa
| | - Sherina Mohd Sidik
- Psychiatry, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
| | - Chris van Weel
- Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
| | - Kristina Zawaly
- Family Medicine, McGill University, Montreal, Quebec, Canada.,General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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24
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Mash R, Gaede B, Hugo JF. The contribution of family physicians and primary care doctors to community-orientated primary care. S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 33764146 PMCID: PMC8378192 DOI: 10.4102/safp.v63i1.5281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/01/2022] Open
Abstract
South Africa envisages a community-orientated approach to primary health care (PHC). Family physicians and primary care doctors have important roles to play in leading, implementing, supporting and maintaining community-orientated primary care (COPC). In this article, we define COPC, its key principles and approaches to implementing it in health services. Following this we describe the key competencies expected of family physicians and primary care doctors in leading and supporting its implementation; providing clinical support to the PHC teams and linking these teams to other parts of the health system, other sectors and the community. The required knowledge and skills underlying these competencies are also discussed and some specific tools included.
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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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25
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Mash R, Goliath C, Mahomed H, Reid S, Hellenberg D, Perez G. A framework for implementation of community-orientated primary care in the Metro Health Services, Cape Town, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e5. [PMID: 33354980 PMCID: PMC7756660 DOI: 10.4102/phcfm.v12i1.2632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/28/2020] [Accepted: 10/14/2020] [Indexed: 11/04/2022] Open
Abstract
In South Africa, the national policy on re-engineering primary health care (PHC) supports the implementation of ward-based outreach teams with community health workers. In the Western Cape, a community-orientated primary care (COPC) approach has been adopted in provincial goals for 2030 and the key strategies for the improvement of district health services. This approach is expected to improve health and also save costs. A task team was established in the Metropolitan Health Services to develop an implementation framework for COPC. The framework was developed in an iterative process with four learning sites in the metropole over a period of 18 months. The framework consists of 10 inter-related elements: geographic delineation of PHC teams, composition of PHC teams, facility-based and community-based teamwork, partnership of government and non-government organisations, scope of practice, information system, community engagement, stakeholder engagement, training and development of PHC teams, system preparation and change management. This framework was implemented at the four learning sites and is now being taken to scale and further assessed in the metropole.
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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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26
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Mash R. What is the new normal? S Afr Fam Pract (2004) 2020; 62:e1-e2. [PMID: 33314939 PMCID: PMC8378011 DOI: 10.4102/safp.v62i1.5235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 12/04/2022] Open
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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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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Gaede B. Revisiting the doctor’s role at the primary healthcare clinic. S Afr Fam Pract (2004) 2020; 62:e1-e4. [PMID: 33179956 PMCID: PMC8377782 DOI: 10.4102/safp.v62i1.5242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/01/2022] Open
Abstract
With the growing evidence regarding the benefit of a primary healthcare (PHC) approach to both individual patients and for a healthier community, a number of policy initiatives in South Africa are aimed at strengthening services at subdistrict level. Historically, the role of the doctor in many PHC clinics in South Africa had been limited to a clinical role. However, in the context of wanting to have a greater impact on social determinants of health, the role of the doctor at the PHC clinic needs to be revisited. A wider role of the doctor, in the context of an expanded multidisciplinary team is being explored.
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Affiliation(s)
- Bernhard Gaede
- Department of Family Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban.
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Ajudua FI, Mash RJ. Implementing active surveillance for TB-The views of managers in a resource limited setting, South Africa. PLoS One 2020; 15:e0239430. [PMID: 33006993 PMCID: PMC7531829 DOI: 10.1371/journal.pone.0239430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. AIM To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. METHODS A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. RESULTS Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants. CONCLUSION A multifaceted facility- and community-based approach was seen as ideal for active surveillance. More resources should be targeted at strengthening teams of CHWs, for whom this would be part of a comprehensive and integrated service in a community-orientated primary care framework, and community engagement to strengthen community level interventions.
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Affiliation(s)
- Febisola I. Ajudua
- Department of Family and Emergency Medicine, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Robert J. Mash
- Department of Family and Emergency Medicine, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
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Mash B. National Health Insurance unpacked: Part 2: Accreditation of primary care facilities. S Afr Fam Pract (2004) 2020; 62:e1-e3. [PMID: 32634000 PMCID: PMC8377840 DOI: 10.4102/safp.v62i1.5140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Bob Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town.
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Brey Z, Mash R, Goliath C, Roman D. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med 2020; 12:e1-e4. [PMID: 32501022 PMCID: PMC7284162 DOI: 10.4102/phcfm.v12i1.2449] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/01/2022] Open
Abstract
The public sector primary care facilities in Cape Town serve a large number of patients with chronic diseases such as human immunodeficiency virus, tuberculosis, diabetes, hypertension, asthma and chronic obstructive pulmonary disease. Prior to the Coronavirus disease 2019 (COVID-19) epidemic, stable patients with chronic conditions attended the facility or support groups to obtain their medication. During the COVID-19 epidemic, these patients would be put at risk if they had to travel and gather in groups to receive medication. The Metropolitan Health Services, therefore, decided to offer home delivery of medication. A system of home delivery was rapidly established by linking the existing chronic dispensing unit system with the emerging approach to community-orientated primary care in the Metro. Medication was delivered as usual to primary care pharmacies, but then a variety of means were used to disseminate the parcels to local non-profit organisations, where they could be delivered by a city-wide network of community health workers (CHWs). Innovations included various ways of delivering the parcels, including via Uber, bicycles and electric scooters, as well as Google forms to monitor the success of the initiative. It was estimated that up to 200 000 parcels per month could be delivered in this way via 2500 CHWs. The new system was established throughout the Metropole, and its strengths, weaknesses, opportunities and threats are further discussed. The initiative may prevent COVID-19 amongst people with comorbidities who would be at risk of more severe diseases. It may also have de-congested primary care facilities ahead of the expected surge in COVID-19 cases.
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Affiliation(s)
- Zameer Brey
- Bill and Melinda Gates Foundation, Cape Town.
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Flinkenflögel M, Sethlare V, Cubaka VK, Makasa M, Guyse A, De Maeseneer J. A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems. HUMAN RESOURCES FOR HEALTH 2020; 18:27. [PMID: 32245501 PMCID: PMC7126134 DOI: 10.1186/s12960-020-0455-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/05/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps. METHODS A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018. RESULTS A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "all- round specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results. CONCLUSIONS FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.
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Affiliation(s)
- Maaike Flinkenflögel
- Health Unit, KIT Royal Tropical Institute, Amsterdam, the Netherlands.
- Department of Primary Health Care, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Primafamed-Network, Cape Town, South Africa.
| | - Vincent Sethlare
- Primafamed-Network, Cape Town, South Africa
- Department of Family Medicine and Public Health Medicine, University of Botswana, Gaborone, Botswana
| | - Vincent Kalumire Cubaka
- Primafamed-Network, Cape Town, South Africa
- Department of Research and Training, Partners In Health, Inshuti Mu Buzima, Kigali, Rwanda
- Department of Primary Health Care, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mpundu Makasa
- Primafamed-Network, Cape Town, South Africa
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Abraham Guyse
- Primafamed-Network, Cape Town, South Africa
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Primafamed-Network, Cape Town, South Africa
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Fair F, Raben L, Watson H, Vivilaki V, van den Muijsenbergh M, Soltani H. Migrant women's experiences of pregnancy, childbirth and maternity care in European countries: A systematic review. PLoS One 2020; 15:e0228378. [PMID: 32045416 PMCID: PMC7012401 DOI: 10.1371/journal.pone.0228378] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 01/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Across Europe there are increasing numbers of migrant women who are of childbearing age. Migrant women are at risk of poorer pregnancy outcomes. Models of maternity care need to be designed to meet the needs of all women in society to ensure equitable access to services and to address health inequalities. OBJECTIVE To provide up-to-date systematic evidence on migrant women's experiences of pregnancy, childbirth and maternity care in their destination European country. SEARCH STRATEGY CINAHL, MEDLINE, PubMed, PsycINFO and Scopus were searched for peer-reviewed articles published between 2007 and 2017. SELECTION CRITERIA Qualitative and mixed-methods studies with a relevant qualitative component were considered for inclusion if they explored any aspect of migrant women's experiences of maternity care in Europe. DATA COLLECTION AND ANALYSIS Qualitative data were extracted and analysed using thematic synthesis. RESULTS The search identified 7472 articles, of which 51 were eligible and included. Studies were conducted in 14 European countries and focused on women described as migrants, refugees or asylum seekers. Four overarching themes emerged: 'Finding the way-the experience of navigating the system in a new place', 'We don't understand each other', 'The way you treat me matters', and 'My needs go beyond being pregnant'. CONCLUSIONS Migrant women need culturally-competent healthcare providers who provide equitable, high quality and trauma-informed maternity care, undergirded by interdisciplinary and cross-agency team-working and continuity of care. New models of maternity care are needed which go beyond clinical care and address migrant women's unique socioeconomic and psychosocial needs.
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Affiliation(s)
- Frankie Fair
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Liselotte Raben
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Helen Watson
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
| | - Victoria Vivilaki
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Hora Soltani
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England, United Kingdom
- * E-mail:
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Kraef C, Kallestrup P. After the Astana declaration: is comprehensive primary health care set for success this time? BMJ Glob Health 2019; 4:e001871. [PMID: 31799000 PMCID: PMC6861067 DOI: 10.1136/bmjgh-2019-001871] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/07/2019] [Accepted: 10/12/2019] [Indexed: 10/26/2022] Open
Abstract
Primary health care (PHC) strengthening in order to achieve the Sustainable Development Goal has again, 40 years after the Alma-Ata declaration, been declared a priority by the global health community. Despite initial progress the Alma-Ata vision of Health for All by the year 2000 was not realised. In this analysis we (1) examine the challenges that comprehensive PHC faced after the Alma-Ata declaration, (2) provide an analysis of the current opportunities and threats to comprehensive PHC strengthening on the global, national and community level and (3) review the most important policy recommendations and related evidence to address these threats for success of the Astana declaration. Factors that are predominantly opportunities are the treasure of historical lessons from the past 40 years, the increased attention to social and environmental determinants of health, the global economic growth and new technologies, in particular digital medicine, which also have the potential to revolutionise community involvement. Factors that are currently predominantly threats are insecurity, conflicts and disease outbreaks; lack of sustained political commitment and inappropriate monitoring and evaluation structures; inappropriate and unsustainable financing models; insufficient health workforce recruitment, employment and retention; missing support of physicians and their professional organisations; inadequately addressing the needs of the community and not giving attention to gender equity. In contrast to the policy and evidence context in 1978 when Alma-Ata was passed there are today policy recommendations and a large body of evidence that can address the threats to comprehensive PHC-and turn them into opportunities.
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Affiliation(s)
- Christian Kraef
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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