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Razzaq A, Stephenson N, Raynes-Greenow C, Travaglia J, Alam NA. Understanding the relationship between the public sector healthcare workers and NGO-based HIV counsellors while providing HIV counselling and testing services to pregnant women: A Qualitative Study in Suva, Fiji. Midwifery 2023; 120:103634. [PMID: 36842250 DOI: 10.1016/j.midw.2023.103634] [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: 08/14/2021] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
Human immunodeficiency virus (HIV) counselling and testing plays a significant role in the prevention of mother-to-child transmission of HIV. HIV counselling and testing during pregnancy is an essential gateway for HIV prevention, timely treatment, and care services. Lack of proper counselling could jeopardise the quality of services. This paper aims to understand the relationship between the government employed hospital healthcare workers and the Non-Governmental Organisation based counsellors while providing HIV counselling and testing services to pregnant women attending antenatal clinic in one of the main hospitals in Suva, Fiji. Data were collected via individual, in-depth, interviews held in a single hospital and an associated reproductive health centre in Suva in April-May 2013. A total of 15 healthcare providers including doctors (n = 4), midwives (n = 5), nurses (n = 4), and counsellors (n = 2) were interviewed. The data were analysed using thematic analysis. Ethical approvals were obtained. We found that there was tension between the government employed hospital healthcare workers and the Non-Governmental Organisation based counsellors involved in the provision of HIV counselling and testing services to pregnant women. The predominant causes of tension were poor referral for HIV test counselling, long counselling time, lack of cooperation and conflict due to the differences in counselling approaches. Tension between the government employed hospital healthcare workers and the Non- Governmental Organisation based HIV counsellors appear to be the main challenge to effective provision of HIV test counselling services in the hospital. Ongoing tension between both groups could restrict healthcare workers abilities to provide quality HIV counselling services. Our findings would be useful in developing strategies to overcome tension amongst healthcare workers as it would be an imperative step in providing streamlined HIV counselling services to women attending antenatal clinic in Fiji.
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Affiliation(s)
- Amina Razzaq
- Sydney School of Public Health, The University of Sydney, Faculty of Medicine and Health, Sydney Australia; School of Public Health and Community Medicine, Samuels Building (F25), University of New South Wales, Kensington, NSW 2033, Australia.
| | - Niamh Stephenson
- School of Public Health and Community Medicine, Samuels Building (F25), University of New South Wales, Kensington, NSW 2033, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Faculty of Medicine and Health, Sydney Australia
| | - Joanne Travaglia
- School of Public Health and Community Medicine, Samuels Building (F25), University of New South Wales, Kensington, NSW 2033, Australia
| | - Neeloy Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Faculty of Medicine and Health, Sydney Australia
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Nayak PR, Oswal K, Pramesh CS, Ranganathan P, Caduff C, Sullivan R, Advani S, Kataria I, Kalkonde Y, Mohan P, Jain Y, Purushotham A. Informal Providers-Ground Realities in South Asian Association for Regional Cooperation Nations: Toward Better Cancer Primary Care: A Narrative Review. JCO Glob Oncol 2022; 8:e2200260. [PMID: 36315923 PMCID: PMC9812474 DOI: 10.1200/go.22.00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE South Asian Association for Regional Cooperation (SAARC) nations are a group of eight countries with low to medium Human Development Index values. They lack trained human resources in primary health care to achieve the WHO-stated goal of Universal Health Coverage. An unregulated service sector of informal health care providers (IPs) has been serving these underserved communities. The aim is to summarize the role of IPs in primary cancer care, compare quality with formal providers, quantify distribution in urban and rural settings, and present the socioeconomic milieu that sustains their existence. METHODS A narrative review of the published literature in English from January 2000 to December 2021 was performed using MeSH Terms Informal Health Care Provider/Informal Provider and Primary Health Care across databases such as Medline (PubMed), Google Scholar, and Cochrane database of systematic reviews, as well as World Bank, Center for Global Development, American Economic Review, Journal Storage, and Web of Science. In addition, citation lists from the primary articles, gray literature in English, and policy blogs were included. We present a descriptive overview of our findings as applicable to SAARC. RESULTS IPs across the rural landscape often comprise more than 75% of primary caregivers. They provide accessible and affordable, but often substandard quality of care. However, their network would be suitable for prompt cancer referrals. Care delivery and accountability correlate with prevalent standards of formal health care. CONCLUSION Acknowledgment and upskilling of IPs could be a cost-effective bridge toward universal health coverage and early cancer diagnosis in SAARC nations, whereas state capacity for training formal health care providers is ramped up simultaneously. This must be achieved without compromising investment in the critical resource of qualified doctors and allied health professionals who form the core of the rural public primary health care system.
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Affiliation(s)
- Prakash R. Nayak
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Priya Ranganathan
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
| | | | - Ishu Kataria
- Public Health Centre for Global Non-communicable Diseases, RTI International, New Delhi, India
| | - Yogeshwar Kalkonde
- Sangwari-People's Association for Equity and Health, Ambikapur, Chhattisgarh, India
| | | | | | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom,Arnie Purushotham, MD, 3rd Floor Bermondsey Wing, Guy's Hospital, School of Cancer and Pharmaceutical Sciences, King's College London, Great Maze Pond, London SE1 9RT, United Kingdom; e-mail:
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Gabster A, Socha E, Pascale JM, Cabezas Talavero G, Castrellón A, Quiel Y, Gantes C, Mayaud P. Barriers and facilitators to antiretroviral adherence and retention in HIV care among people living with HIV in the Comarca Ngäbe-Buglé, Panama. PLoS One 2022; 17:e0270044. [PMID: 35709223 PMCID: PMC9202867 DOI: 10.1371/journal.pone.0270044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Panama’s HIV epidemic is far from under control. One of the populations with the fastest-growing epidemic among the Indigenous peoples of the Comarca Ngäbe-Buglé (CNB). The CNB is an administratively autonomous Indigenous region in Western Panama that is home to over 200,000 individuals of Ngäbe and Buglé ethnicities. This population is unique and, in several ways, represents the early stages of the AIDS epidemics in high-income countries. The CNB is the most impoverished region in Panama and is relatively isolated from outside influences, with limited roads, electricity, and an internet connection, including medical assistance. Around 1.5% of all rapid HIV tests are positive, compared to a national prevalence of 0.9%; in CNB, diagnosis tends to be late. In CNB, 56.3% of individuals had an initial CD4 count of <350 cells/mm3. Antiretroviral treatment (ART) dropout in this region is five times higher than the national average; there is high early mortality due to opportunistic infections. Using the Social-Ecological Theory for Health as a framework, this study aims to describe the facilitators and barriers associated with ART adherence and retention in HIV care among people living with HIV (PLHIV) in the CNB. A better understanding of factors that obstruct adherence could lead to more effective HIV care and prevention in CNB. Methods We conducted 21 semi-structured interviews with PLHIV who reside across all three regions of the CNB and have attended an antiretroviral (ART) clinic at least once. Deductive thematic analysis was used to uncover themes related ART adherence and retention in HIV care at the individual, social and structural levels. Discussion This unique, isolated population of rural Indigenous peoples has high infection rates, late diagnosis, poor ART adherence, and high AIDS-related death rates. The CNB is an important region to examen ART adherence and retention in care. We determined that psychological health, social support, and discrimination acted as individual-level facilitators and barriers to adherence and retention. Notably, structural barriers included difficult access to ART care due to travel costs, ART shortages, and uncooperative Western/Traditional medical systems. Recommended interventions used in other Low- and Middle-Income settings include increasing peer and family-level support and community knowledge and understanding of HIV infection. Additionally, our study suggests structural interventions, including decreasing the cost and distance of traveling to the ART clinic, by decentralizing services, decreasing food scarcity, and increasing collaboration between Western and Traditional providers.
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Affiliation(s)
- Amanda Gabster
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panamá
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sistema Nacional de Investigación, Secretaría Nacional de Ciencia, Tecnología e Innovación, Panamá, Panamá
- * E-mail: ,
| | - Eliana Socha
- Community Development Network of the Americas, Panamá, Panamá
| | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, Panamá
- Facultad de Medicina, Universidad de Panamá, Panamá, Panamá
| | | | | | - Yaremis Quiel
- Ministerio de Salud, Comarca Ngäbe-Buglé, Panamá, Panamá
| | - César Gantes
- Ministerio de Salud, Comarca Ngäbe-Buglé, Panamá, Panamá
| | - Philippe Mayaud
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Pham TV, Koirala R, Wainberg ML, Kohrt BA. Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness? Community Ment Health J 2021; 57:777-791. [PMID: 32894398 PMCID: PMC7936992 DOI: 10.1007/s10597-020-00705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Durham, NC, 27705, USA.
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA.
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
| | - Rishav Koirala
- University of Oslo, Problemveien 7, 0315, Oslo, Norway
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, USA
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal
- George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA
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Ampomah IG, Malau-Aduli BS, Malau-Aduli AE, Emeto TI. Effectiveness of Integrated Health Systems in Africa: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E271. [PMID: 32486110 PMCID: PMC7353894 DOI: 10.3390/medicina56060271] [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] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Abstract
Background and objective: Traditional medicine (TM) was integrated into health systems in Africa due to its importance within the health delivery setup in fostering increased health care accessibility through safe practices. However, the quality of integrated health systems in Africa has not been assessed since its implementation. The objective of this paper was to extensively and systematically review the effectiveness of integrated health systems in Africa. Materials and Methods: A systematic literature search was conducted from October, 2019 to March, 2020 using Ovid Medline, Scopus, Emcare, Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar, in order to retrieve original articles evaluating the integration of TM into health systems in Africa. A quality assessment of relevant articles was also carried out using the Quality Assessment Tool for Studies with Diverse Designs (QATDSS) critical appraisal tool. Results: The results indicated that the formulation and execution of health policies were the main measures taken to integrate TM into health systems in Africa. The review also highlighted relatively low levels of awareness, usage, satisfaction, and acceptance of integrated health systems among the populace. Knowledge about the existence of an integrated system varied among study participants, while satisfaction and acceptance were low among orthodox medicine practitioners. Health service users' satisfaction and acceptance of the practice of an integrated health system were high in the countries assessed. Conclusion: The review concluded that existing health policies in Africa are not working, so the integration of TM has not been successful. It is critical to uncover the barriers in the health system by exploring the perceptions and experiences of stakeholders, in order to develop solutions for better integration of the two health systems.
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Affiliation(s)
- Irene G. Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville QLD 4811, Australia;
| | - Aduli E.O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville QLD 4811, Australia; (I.G.A.); (A.E.O.M.-A.)
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James PB, Wardle J, Steel A, Adams J, Bah AJ, Sevalie S. Traditional and complementary medicine use among Ebola survivors in Sierra Leone: a qualitative exploratory study of the perspectives of healthcare workers providing care to Ebola survivors. BMC Complement Med Ther 2020; 20:137. [PMID: 32375765 PMCID: PMC7201764 DOI: 10.1186/s12906-020-02931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Considerable number of patients, including Ebola survivors, in Sierra Leone, are using traditional and complementary medicine (T&CM). Healthcare providers' (HCPs) views about T&CM is crucial in addressing the increased need for T&CM among patients. However, healthcare providers' views about T&CM in Sierra Leone is unknown. Our study explores healthcare providers' knowledge of and perception towards T&CM and how that influence their personal and professional T&CM use, communication with Ebola survivors about T&CM as well as its integration into the healthcare system in Sierra Leone. METHODS We employed a qualitative exploratory study design using semi-structured interviews to collect data from 15 conveniently sampled HCPs in all four geographical regions of Sierra Leone. We analysed our data using thematic network analysis framework. RESULTS Healthcare providers perceived their knowledge about T&CM to be low and considered T&CM to be less effective and less safe than conventional medicine as well as not evidence-based. HCPs perception of T&CM as non-scientific and their lack of knowledge of T&CM were the key barriers to HCPs' self-use and recommendation as well as their lack of detailed discussion about T&CM with Ebola survivors. HCPs are open to T&CM integration into mainstream healthcare in Sierra Leone although at their terms. However, they believe that T&CM integration could be enhanced by effective professional regulation of T&CM practice, and by improving T&CM evidenced-based knowledge through education, training and research. CONCLUSION Changing HCPs' negative perception of and increasing their knowledge about T&CM is critical to promoting effective communication with Ebola survivors regarding T&CM and its integration into the healthcare system in Sierra Leone. Strategies such as educational interventions for HCPs, conducting rigorous T&CM research, proper education and training of T&CM practitioners and effective professional regulation of T&CM practice could help in that direction.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Connaught Teaching Hospital Freetown, First floor Administrative Building, Freetown, Sierra Leone
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW 2480 Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007 Australia
| | - Abdulai Jawo Bah
- Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Institute for Global Health and Development, Queen Margaret University Edinburg, Musselburgh, Scotland, UK
| | - Stephen Sevalie
- Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Joint Medical Unit, Republic of Sierra Leone Armed Forces, 34 Military Hospital Wilberforce Freetown, Freetown, Sierra Leone
- Sustainable Health Systems, Freetown, Sierra Leone
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Street R, Falkenberg T, Sundberg T, Balakrishna Y, Abrams A, Kredo T. Participation of traditional, complementary and alternative health practitioners in conventional health systems in low‐ and middle‐income countries. Cochrane Database Syst Rev 2019; 2019:CD013391. [PMCID: PMC6685052 DOI: 10.1002/14651858.cd013391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Main objective To assess the effectiveness of interventions to increase participation of TCAM practitioners to improve healthcare, healthcare delivery and practice in LMICs. Secondary objective(s) To assess whether the effects of TCAM practitioners' interventions differ according to:
disease type; regulatory status of TCAM practitioners; geographic location (country); specific role of TCAM practitioners (e.g. traditional surgeon vs herbalist vs acupuncturist).
To assess costs and cost effectiveness of traditional healthcare practitioners' interventions
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Affiliation(s)
- Renée Street
- South African Medical Research CouncilEnvironment and Health Research UnitDurbanSouth Africa
| | | | - Tobias Sundberg
- Karolinska InstitutetIntegrative Health Care, Division of Nursing, Department of Neurobiology, Care Sciences and SocietyHuddingeSweden
| | - Yusentha Balakrishna
- South African Medical Research CouncilBiostatistics Unit491 Ridge Road, OverportDurbanSouth Africa4001
| | - Amber Abrams
- South African Medical Research CouncilEnvironment and Health Research UnitDurbanSouth Africa
| | - Tamara Kredo
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
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Mabou Tagne A, Biapa Nya PC, Tiotsia Tsapi A, Edingue Essoh AK, Pembouong G, Ngouadjeu Ngnintedem MA, Marino F, Cosentino M. Determinants, Prevalence and Trend of Use of Medicinal Plants Among People Living with HIV: A Cross-Sectional Survey in Dschang, Cameroon. AIDS Behav 2019; 23:2088-2100. [PMID: 30607756 DOI: 10.1007/s10461-018-02388-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
People living with HIV (PLHIV) in Cameroon often seek care from traditional health practitioners (THPs) and use medicinal plants (MP). Most MP, however, still lacks evidence for their efficacy and safety, and their use, often undisclosed to referring physicians, may interfere with standard therapies. Therefore, we conducted a survey of 247 PLHIV in Dschang to assess the determinants, prevalence and trend of MP use. Besides, we surveyed 16 THPs about the use of MP in PLHIV and HIV-related knowledge. 54.9% PLHIV declared using in total 70 plants, 91.3% users were satisfied with MP, and unwanted effects were reported in 2 cases. MP users were less educated than nonusers, had longer disease duration and were more often unemployed. Only 3 THPs used MP in PLHIV, and most of them had insufficient knowledge of HIV. Results may be useful for education on HIV and integration of traditional medicines with conventional therapeutics.
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Thapa S, Aro AR. Strategies to integrate community-based traditional and complementary healthcare systems into mainstream HIV prevention programs in resource-limited settings. Global Health 2018; 14:64. [PMID: 29973230 PMCID: PMC6032556 DOI: 10.1186/s12992-018-0383-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/15/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Global spending for HIV prevention has been decreasing over the years. As a result, several low-income countries, including Nepal, are increasingly facing the challenge to minimize the funding gap to continue providing HIV prevention services to the people. In this paper, we have attempted to clarify why it is important to integrate community-based traditional and complementary healthcare systems and mobilize them into the mainstream HIV programs to ensure access to HIV prevention messages, HIV testing, and treatment in resource-limited settings. MAIN BODY First, we argue that the traditional and complementary healthcare practitioners can be mobilized to routinely provide HIV prevention messages to their clients, and, next, some of them can be trained to build their capacity to work as counselors or educators for HIV prevention in the community. CONCLUSION These approaches, if implemented, can help continue HIV prevention initiatives and contain the HIV epidemic at the local level in the rural communities with limited cost and resources.
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Affiliation(s)
- Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Arja R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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Thapa S, Hannes K, Buve A, Bhattarai S, Mathei C. Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study. BMC Public Health 2018; 18:162. [PMID: 29351785 PMCID: PMC5775526 DOI: 10.1186/s12889-018-5073-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background HIV disclosure is an important step in delivering the right care to people. However, many people with an HIV positive status choose not to disclose. This considerably complicates the delivery of adequate health care. Methods We conducted a grounded theory study to develop a theoretical model explaining how local contexts impact on HIV disclosure and what the mechanisms are that determine whether people choose to disclose or not. We conducted in-depth interviews among 23 people living with HIV, 8 health workers and 5 family and community members, and 1 community development worker in Achham, Nepal. Data were analysed using constant-comparative method, performing three levels of open, axial, and selective coding. Results Our theoretical model illustrates how two dominant systems to control HIV, namely a community self-coping and a public health system, independently or jointly, shape contexts, mechanisms and outcomes for HIV disclosure. Conclusion This theoretical model can be used in understanding processes of HIV disclosure in a community where HIV is concentrated in vulnerable populations and is highly stigmatized, and in determining how public health approaches would lead to reduced stigma levels and increased HIV disclosure rates.
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Affiliation(s)
- Subash Thapa
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Karin Hannes
- Centre for Sociological Research, Faculty of Social Sciences, KU Leuven, Parkstraat 45, 3000, Leuven, Belgium
| | - Anne Buve
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Shivani Bhattarai
- Department of Public Health, Nobel College Pokhara University, Kathmandu, 44601, Nepal
| | - Catharina Mathei
- Department of Public Health and Primary care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
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Hitziger M, Berger Gonzalez M, Gharzouzi E, Ochaíta Santizo D, Solis Miranda R, Aguilar Ferro AI, Vides-Porras A, Heinrich M, Edwards P, Krütli P. Patient-centered boundary mechanisms to foster intercultural partnerships in health care: a case study in Guatemala. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2017; 13:44. [PMID: 28789670 PMCID: PMC5549296 DOI: 10.1186/s13002-017-0170-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Up to one half of the population in Africa, Asia and Latin America has little access to high-quality biomedical services and relies on traditional health systems. Medical pluralism is thus in many developing countries the rule rather than the exception, which is why the World Health Organization is calling for intercultural partnerships to improve health care in these regions. They are, however, challenging due to disparate knowledge systems and lack of trust that hamper understanding and collaboration. We developed a collaborative, patient-centered boundary mechanism to overcome these challenges and to foster intercultural partnerships in health care. To assess its impact on the quality of intercultural patient care in a medically pluralistic developing country, we conducted and evaluated a case study. METHODS The case study took place in Guatemala, since previous efforts to initiate intercultural medical partnerships in this country were hampered by intense historical and societal conflicts. It was designed by a team from ETH Zurich's Transdisciplinarity Lab, the National Cancer Institute of Guatemala, two traditional Councils of Elders and 25 Mayan healers from the Kaqchikel and Q'eqchi' linguistic groups. It was implemented from January 2014 to July 2015. Scientists and traditional political authorities collaborated to facilitate workshops, comparative diagnoses and patient referrals, which were conducted jointly by biomedical and traditional practitioners. The traditional medical practices were thoroughly documented, as were the health-seeking pathways of patients, and the overall impact was evaluated. RESULTS The boundary mechanism was successful in discerning barriers of access for indigenous patients in the biomedical health system, and in building trust between doctors and healers. Learning outcomes included a reduction of stereotypical attitudes towards traditional healers, improved biomedical procedures due to enhanced self-reflection of doctors, and improved traditional health care due to refined diagnoses and adapted treatment strategies. In individual cases, the beneficial effects of traditional treatments were remarkable, and the doctors continued to collaborate with healers after the study was completed. Comparison of the two linguistic groups illustrated that the outcomes are highly context-dependent. CONCLUSIONS If well adapted to local context, patient-centered boundary mechanisms can enable intercultural partnerships by creating access, building trust and fostering mutual learning, even in circumstances as complex as those in Guatemala. Creating multilateral patient-centered boundary mechanisms is thus a promising approach to improve health care in medically pluralistic developing countries.
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Affiliation(s)
- Martin Hitziger
- Section of Epidemiology, University of Zurich, Winterthurerstrasse 270, 8057 Zurich, Switzerland
| | | | - Eduardo Gharzouzi
- Surgical Oncologist, Head of Education and Research, Instituto de Cancerología, 6a Avenida 6-58 Zona 11, 01011 Guatemala, Guatemala
| | - Daniela Ochaíta Santizo
- Universidad del Valle de Guatemala, 18 Avenida 11-95, Zona 15,V.H. III, Guatemala, Guatemala
| | - Regina Solis Miranda
- Universidad del Valle de Guatemala, 10 Avenida 7-62, Zona 1, Guatemala, Guatemala
| | | | - Ana Vides-Porras
- Department of Anthropology, University of Wyoming, 25 Calle 13-55 Zona 16. Ensenada de San Isidro Casa 19D, Guatemala, Guatemala
| | - Michael Heinrich
- Research Cluster Biodiversity and Medicines/Centre for Pharmacognosy and Phytotherapy, UCL School of Pharmacy, London, WC1N 1AX UK
| | - Peter Edwards
- Singapore-ETH Centre, 1 CREATE Way, #06-01 CREATE Tower, Singapore, 138602 Singapore
| | - Pius Krütli
- ETH Zurich, TdLab, Universitätsstrasse 22, CHN, 8092 Zurich, Switzerland
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Ngunyulu RN, Peu MD, Mulaudzi FM, Mataboge MLS, Phiri SS. Collaborative HIV care in primary health care: nurses' views. Int Nurs Rev 2017; 64:561-567. [PMID: 28181218 DOI: 10.1111/inr.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. AIM To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. METHOD A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. RESULTS Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. DISCUSSION The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. CONCLUSION It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. IMPLICATIONS FOR NURSING AND HEALTH POLICY Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care.
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Affiliation(s)
- R N Ngunyulu
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - M D Peu
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - F M Mulaudzi
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - M L S Mataboge
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - S S Phiri
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
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Leclerc-Madlala S, Green E, Hallin M. Traditional healers and the "Fast-Track" HIV response: is success possible without them? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:185-93. [PMID: 27399048 DOI: 10.2989/16085906.2016.1204329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rapid scale-up of effective HIV prevention strategies is a central theme of the post-2015 health and development agenda. All major global HIV and AIDS funders have aligned their policies and plans to achieve sharp reductions in new HIV infections and reach epidemic control by 2030. In these "fast-track" plans, increased antiretroviral treatment coverage and the attainment of viral suppression are pivotal, and there is firm recognition of the need for countries to mobilise more domestic resources and build stronger community clinic systems. There is little in these bold plans, however, to suggest that the now 30-year-old call by the World Health Organization (WHO) and other organisations to establish systematic collaborations with the traditional health sector will finally be heeded. In the context of sub-Saharan Africa's HIV epidemic, a significant body of literature demonstrates the critical role that traditional healers can play in improving the success of health programmes, including those for HIV prevention. This paper provides a brief history of collaboration with traditional healers for HIV followed by a description of several successful collaborations and discussion of key elements for success. We argue that the traditional health sector is a major resource that has yet to be sufficiently mobilised against HIV. As we shift from a short-term HIV response to a longer-term and more sustainable response, there is an urgent need to accelerate efforts to leverage and partner with the hundreds of thousands of traditional health practitioners who are already providing health services in communities. Failure to better attune our work to the medical pluralism of communities affected by HIV will continue to hinder HIV programming success and help assure that ambitious post-2015 HIV prevention and control goals are not realised.
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Affiliation(s)
- Suzanne Leclerc-Madlala
- a Office of HIV and AIDS, Global Health Bureau , US Agency for International Development , Washington , DC , USA
| | - Edward Green
- b Department of Anthropology , The George Washington University , Washington , DC , USA
| | - Mary Hallin
- c College of Business Administration , University of Nebraska at Omaha , Omaha , Nebraska , USA
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Nemutandani SM, Hendricks SJ, Mulaudzi MF. Perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Afr J Prim Health Care Fam Med 2016; 8:e1-8. [PMID: 27380856 PMCID: PMC4926717 DOI: 10.4102/phcfm.v8i2.1007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/13/2022] Open
Abstract
Background The indigenous health system was perceived to be a threat to the allopathic health system. It was associated with ‘witchcraft’, and actively discouraged, and repressed through prohibition laws. The introduction of the Traditional Health Practitioners Act No 22 of 2007 brought hope that those centuries of disrespect for traditional health systems would change. The study examined the perceptions and experiences of allopathic health practitioners on collaboration with traditional health practitioners in post-apartheid South Africa. Methods Qualitative descriptive research methodology was used to collect data from allopathic health practitioners employed by Limpopo’s Department of Health. In-depth focus group discussions and meetings were conducted between January and August 2014. Perceptions and experiences of working with traditional health practitioners were explored. Ethical clearance was obtained from the University of Pretoria and approval from the Department’s Research Committee. Results Dominant views were that the two health systems were not compatible with respect to the science involved and the source of knowledge. Overall, quality of health care will be compromised if traditional health practitioners are allowed to work in public health facilities. Conclusion Allopathic health practitioners do not appear ready to work with traditional health practitioners, citing challenges of quality of health care, differences regarding concept of sciences and source of knowledge; and lack of policy on collaboration. Lack of exposure to traditional medicine seems to impede opportunities to accept and work with traditional healers. Exposure and training at undergraduate level regarding the traditional health system is recommended. Policy guidelines on collaborations are urgently required.
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Andermo S, Sundberg T, Forsberg C, Falkenberg T. Capitalizing on synergies-a discourse analysis of the process of collaboration among providers of integrative health care. PLoS One 2015; 10:e0122125. [PMID: 25793967 PMCID: PMC4367985 DOI: 10.1371/journal.pone.0122125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/07/2015] [Indexed: 11/18/2022] Open
Abstract
Background Integrative health care (IHC) combines therapies and providers from complementary and conventional health care. Previous studies on IHC have shown power relations between providers but few studies have explored how the interaction develops over time. The objective of this study was to explore the development of IHC collaboration and interaction among participating providers during a series of consensus case conferences for managing patients with back and neck pain. Methods This qualitative study was conducted within a pragmatic randomized controlled clinical trial in primary care. Patients' treatment plans were developed based on IHC provider consensus conferences (n = 26) of which 15 (5 of the first, 5 in the middle, and 5 of the last in the clinical trial) were selected for analysis. Findings were derived by means of discourse analysis, focusing on the participants’ use of subject positions during the conferences. Findings The IHC team in this study gradually formed a group identity, moving their subject positions from individual treating subjects to members of a team and were able to make consensus-based decisions about patients’ individual treatment plans. In the discourse, the IHC team identified collaborative shortcomings and problematized the provision of IHC. They were able to capitalize on the synergies in their collaboration and developed a shared vision of IHC provision. Conclusions The process of IHC collaboration involved the gradual formation of an IHC team identity, which facilitated interdisciplinary, non-hierarchical consensus-based decision-making in the team. The discourse further suggests that a reform of some legal and organizational health sector barriers might be needed to realize sustainable implementation of IHC services in Sweden.
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Affiliation(s)
- Susanne Andermo
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden
- * E-mail:
| | - Tobias Sundberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden
- I C—The Integrative Care Science Centre, 153 91, Järna, Sweden
| | - Christina Forsberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden
| | - Torkel Falkenberg
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, 141 83, Huddinge, Sweden
- I C—The Integrative Care Science Centre, 153 91, Järna, Sweden
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Fisher B, Lewith G, Falkenberg T, Jonas WB. Fostering Health Creation: Community Development to Address Long-term Conditions. Glob Adv Health Med 2015; 3:29-36. [PMID: 25568822 PMCID: PMC4268603 DOI: 10.7453/gahmj.2014.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brian Fisher
- Health Empowerment Leverage Project, United Kingdom (Dr Fisher)
| | - George Lewith
- University of Southampton, Southampton, United Kingdom (Dr Lewith)
| | - Torkel Falkenberg
- Karolinska Institutet, Department of Neurobiology Care Sciences and Society, Division of Nursing, Research Group Integrative Care, Huddinge, and The Integrative Care Science Center (IC), Järna, Sweden (Mr Falkenberg)
| | - Wayne B Jonas
- Samueli Institute, Alexandria, Virginia (Dr Jonas), United States
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Uwakwe R, Otakpor A. Public Mental Health - Using the Mental Health Gap Action Program to Put all Hands to the Pumps. Front Public Health 2014; 2:33. [PMID: 24795874 PMCID: PMC4000990 DOI: 10.3389/fpubh.2014.00033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/31/2014] [Indexed: 11/19/2022] Open
Abstract
Although mental ill health constitutes a huge portion of the Global Burden of Disease (GBD), the majority of people with mental health problems do not receive any treatment, a scenario much worse in developing countries where mental health personnel are in gross short supply. The mhGAP was launched to address this gap, especially by training non-mental health professionals to deliver effective services for selected priority mental health problems. Especially in developing countries, many people with mental health problems consult traditional healers either as a first step in the pathway to biomedical mental health care or as the sole mental health service providers. Bridging the gap between mental health needs and available services in developing countries needs to incorporate traditional healers, who are ubiquitously available, easily accessible, and acceptable to the natives. Even though there are barriers in forging collaborations between traditional and biomedical mental health care providers, with mutual respect, understanding, and adapted training using the mhGAP intervention guide, it should be possible to get some traditional healers to understand the core principles of some priority mental health problems identification, treatment, and referral.
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Affiliation(s)
- Richard Uwakwe
- Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Alex Otakpor
- Department of Mental Health, University of Benin, Benin City, Nigeria
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George G, Chitindingu E, Gow J. Evaluating traditional healers knowledge and practices related to HIV testing and treatment in South Africa. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:45. [PMID: 24152384 PMCID: PMC4015557 DOI: 10.1186/1472-698x-13-45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/16/2013] [Indexed: 11/15/2022]
Abstract
Background In a context of inadequate human resources for health, this study investigated whether traditional healers have the knowledge and skill base which could be utilised to assist in the scaling up of HIV prevention and treatment services in South Africa. Methods Using a cross-sectional research design a total of 186 traditional healers from the Northern Cape province were interviewed. Responses on the following topics were obtained: socio-demographic characteristics; HIV training, experience and practices; and knowledge of HIV transmission, prevention and symptoms. Descriptive statistics and chi square tests were used to analyse the responses. Results Traditional healers’ knowledge of HIV and AIDS was not as high as expected. Less than 50% of both trained and untrained traditional healers would treat a person they suspected of being HIV positive. However, a total of 167 (89%) respondents agreed using a condom can prevent HIV and a majority of respondents also agreed that having one sexual partner (127, 68.8%) and abstaining from sex can prevent HIV (145, 78.8%). Knowledge of treatment practices was better with statistically significant results being obtained. Conclusion The results indicate that traditional healers could be used for prevention as well as referring HIV positive individuals for treatment. Traditional healers were enthusiastic about the possibility of collaborating with bio-medical practitioners in the prevention and care of HIV and AIDS patients. This is significant considering they already service the health needs of a large percentage of the South African population. However, further development of training programmes and materials for them on HIV and AIDS related issues would seem necessary.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
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Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D. What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One 2013; 8:e54978. [PMID: 23405101 PMCID: PMC3566158 DOI: 10.1371/journal.pone.0054978] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/22/2012] [Indexed: 11/29/2022] Open
Abstract
Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed.
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Affiliation(s)
- May Sudhinaraset
- Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
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Littlewood RA, Vanable PA. A global perspective on complementary and alternative medicine use among people living with HIV/AIDS in the era of antiretroviral treatment. Curr HIV/AIDS Rep 2012; 8:257-68. [PMID: 21822625 DOI: 10.1007/s11904-011-0090-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across medical populations, and is particularly relevant in the global HIV epidemic. Use of antiretroviral therapy (ART) to treat HIV is ubiquitous in high-resource areas and efforts to increase coverage in low-resource areas are underway. To better understand the role of CAM in HIV treatment and the implications of CAM use for ART uptake and adherence, we review international research published between 2007 and 2011. Findings confirm that CAM is commonly used as an adjunct to ART; however, in countries where ART is less accessible, many HIV-positive individuals take a pluralistic approach to health care, incorporating both traditional and, when available, conventional medicine. The reviewed studies provide no consensus on whether the use of CAM interferes with ART uptake or adherence; instead, research suggests that illness-related behaviors are driven by multiple factors and determined, at least in part, by the availability and accessibility of ART.
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Vandebroek I, Reyes-García V, de Albuquerque UP, Bussmann R, Pieroni A. Local knowledge: who cares? JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2011; 7:35. [PMID: 22113005 PMCID: PMC3286427 DOI: 10.1186/1746-4269-7-35] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/23/2011] [Indexed: 05/08/2023]
Affiliation(s)
- Ina Vandebroek
- Institute of Economic Botany, The New York Botanical Garden, 2900 Southern Boulevard, 10458 Bronx, New York, USA
| | - Victoria Reyes-García
- ICREA and Institut de Ciència i Tecnologia Ambientals, Universitat Autònoma de Barcelona, 08193 Bellatera, Barcelona, Spain
| | - Ulysses P de Albuquerque
- Universidade Federal Rural de Pernambuco, Departamento de Biologia, Área de Botânica, R. Dom Manoel de Medeiros, S/N, Dois Irmãos, Recife, Pernambuco, 52171-900, Brazil
| | - Rainer Bussmann
- William L. Brown Center, Missouri Botanical Garden, St. Louis, MO 63110, USA
| | - Andrea Pieroni
- University of Gastronomic Sciences, Via Amedeo di Savoia 8, I-12060 Pollenzo/Bra, Italy
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Falkenberg T. From traditional medicine to integrative care—A global research perspective. Eur J Integr Med 2011. [DOI: 10.1016/j.eujim.2011.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fullerton JT, Thompson JB, Severino R. The International Confederation of Midwives essential competencies for basic midwifery practice. an update study: 2009-2010. Midwifery 2011; 27:399-408. [PMID: 21601321 DOI: 10.1016/j.midw.2011.03.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 03/16/2011] [Accepted: 03/21/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE a 2-year study was conducted to update the core competencies for basic midwifery practice, first delineated by the International Confederation of Midwives in 2002. A competency domain related to abortion-related care services was newly developed. DESIGN a modified Delphi survey process was conducted in two phases: a pilot item affirmation study, and a global field survey. SETTING a global survey conducted in 90 countries. PARTICIPANTS midwifery educators or clinicians associated with midwifery education schools and programmes located in any of the ICM member association countries. Additional participants represented the fields of nursing, medicine, and midwifery regulatory authorities. A total of 232 individuals from 63 member association and five non-member countries responded to one or both of the surveys. The achieved sample represented 42% of member association countries, which was less than the 51% target. However, the sample was proportionally representative of ICM's nine global regions. MEASUREMENTS survey respondents expressed an opinion whether to retain or to delete any of 255 statements of midwifery knowledge, skill, or professional behaviour. They also indicated whether the item should be a basic (core) item of midwifery knowledge or skill that would be included as mandatory content in a programme of midwifery pre-service education, or whether the item could be added to the fund of knowledge or acquired as an additional skill by those who would need or wish to include the item within the scope of their clinical practice. FINDINGS a majority consensus of .85 was required to accept the item without further deliberation. An expert panel made final decisions in all instances where consensus was not achieved. The panel also amended the wording of selected items, or added new items based on feedback received from survey respondents. The final document contains 268 items organised within seven competency domains.
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Konde-Lule J, Gitta SN, Lindfors A, Okuonzi S, Onama VO, Forsberg BC. Private and public health care in rural areas of Uganda. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2010; 10:29. [PMID: 21106099 PMCID: PMC3003635 DOI: 10.1186/1472-698x-10-29] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Accepted: 11/24/2010] [Indexed: 11/03/2022]
Abstract
Background In many low and middle income countries, the private sector is increasingly becoming an important source of health care, filling gaps where no or little public health care is available. However, knowledge on the private sector providers is limited The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda. Methods The study was carried out in three rural districts. Methods included (1) mapping of health care providers; (2) a household survey to determine morbidity and health care utilization; (3) a health facility survey to assess quality of care; (4) focus group discussions to get qualitative information on providers and provider choice; and (5) key informant interviews to further explore service characteristics. Results 95.7% of all 445 facilities surveyed were private while 4.3% were public. Traditional practitioners and general merchandise shops that sold medicines comprised 77.1% of all providers. They had limited infrastructure and skills but were often located in the villages and therefore easily accessible. Among the formal providers there were 4 times as many private for profit providers than public, 76 versus 18. However, most of the private units were one-person drug shops. In the household survey, 2580 persons were interviewed. 1097 (42%) had experienced illness during the preceding month. Care was sought in 54.1% of the cases. 35.6% were given self-treatment and in 10.3% no action was taken. Of the episodes for which people sought care at a health care facility, 37.0% visited a public health care provider, 39.7% a for profit provider, 11.8% a private not for profit provider, and 10.6% a traditional practitioner. Private for profit facilities were the most popular for ambulatory health care, while public facilities were preferred for more serious conditions and for hospitalization. Traditional practitioners were many but saw relatively few patients. They were mostly used for social problems and limited medical specific conditions. Conclusions Private providers play a major role in health care delivery in rural Uganda; reaching a wide client base. Traditional practitioners are many but have as much a social as a medical function in the community. The significance of the private health care sector points to the need to establish a policy that addresses quality and affordability issues and creates a strong regulatory environment for private practice in sub-Saharan Africa.
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Affiliation(s)
- Joseph Konde-Lule
- Division of Global Health (Ihcar), Dept of Public Health Sciences, Karolinska Institutet, S-171 77 Stockholm, Sweden.
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