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Msomi NL, Ross AJ. Social accountability challenges and recommendations by community service rehabilitation therapists. S Afr Fam Pract (2004) 2024; 66:e1-e9. [PMID: 38949449 PMCID: PMC11219701 DOI: 10.4102/safp.v66i1.5936] [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: 02/16/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Social accountability entails providing equitable and accessible services that are tailor-made for the community's healthcare needs and enable rehabilitation therapists to improve the efficiency and efficacy of healthcare delivery and their response. Enabling them to provide optimal care during their community service year requires understanding the gaps in their knowledge, experience and the support they provide to the communities they service. METHODS Four in-depth individual interviews and four focus group discussions were conducted via Zoom. The qualitative responses to the questions related to the challenges and recommendations associated with social accountability in clinical settings were analysed using an inductive thematic approach via NVIVO. RESULTS Four sub-themes emerged for each of the two areas of interest: the challenges relating to (1) budget and equipment constraints, (2) staff shortages, (3) cultural and language barriers and (4) scope of practice limitations. The recommendations related to (5) collaboration with community caregivers, (6) service inclusion in primary health care clinics, (7) improved executive management support and (8) continuing professional development. CONCLUSION Equipping graduates with the knowledge, skills and support needed to work in an under-resourced setting is essential for community service rehabilitation therapists to ensure social accountability, given that they often work alone, specifically in rural settings.Contribution: Being aware of the challenges that face community service rehabilitation therapists, having the necessary tools and health facility management support will enable ongoing improvements in their ability to provide socially accountable services.
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Affiliation(s)
- Ntandoyenkosi L Msomi
- Department of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Ngxongo TSP, Zulu M. Nurses experiences regarding ideal clinic project implementation in eThekwini district. Health SA 2024; 29:2407. [PMID: 38841345 PMCID: PMC11151377 DOI: 10.4102/hsag.v29i0.2407] [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: 04/12/2023] [Accepted: 11/14/2023] [Indexed: 06/07/2024] Open
Abstract
Background The South African National Department of Health introduced the ideal clinic realisation and maintenance (ICRM) programme in response to primary health care (PHC) services and to lay a strong foundation for the National Health Insurance implementation. The progress report 2015-2016 on the implementation of this programme indicated that achieving the 50% target in selected vital areas such as staffing, resource allocation, and utilisation was not achieved. Aim The study aimed to explore and describe nurses' experiences regarding the ideal clinic project (ICP) implementation. Setting The study was conducted in 18 PHC clinics in eThekwini district, KwaZulu-Natal. Methods An exploratory descriptive, contextual qualitative design was employed guided by Donabedian's structure, process, and outcomes model. Data were collected using semi-structured interviews with 24 nurses between 15 September and 25 October 2020 following receipt of ethics and analysed using Tesch's open coding approach. Results The three themes that emerged included structural limitations, processes involved in running the clinic, and support offered to the PHC clinics. These were highlighted as challenges experienced by nurses during the implementation of an ICP. Conclusion Nurses' negative experiences and perceptions made it difficult for them to accomplish the ICP standards. Contribution The findings from the study highlighted critical actions by the health care institution management which if instituted, could facilitate improved implementation of the ICP and achievement of the 50% target in selected vital areas.
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Affiliation(s)
- Thembelihle S P Ngxongo
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Mthokozisi Zulu
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Cockburn N, Flood D, Seiglie JA, Manne-Goehler J, Aryal K, Karki K, Damasceno A, Atun R, Vollmer S, Bärnighausen T, Geldsetzer P, Mayige M, Hirschhorn L, Davies J. Health service readiness to provide care for HIV and cardiovascular disease risk factors in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002373. [PMID: 37738224 PMCID: PMC10516419 DOI: 10.1371/journal.pgph.0002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
Cardiovascular disease risk factors (CVDRF), in particular diabetes and hypertension, are chronic conditions which carry a substantial disease burden in Low- and Middle-Income Countries. Unlike HIV, they were neglected in the Millenium Development Goals along with the health services required to manage them. To inform the level of health service readiness that could be achieved with increased attention, we compared readiness for CVDRF with that for HIV. Using data from national Service Provision Assessments, we describe facility-reported readiness to provide services for CVDRF and HIV, and derive a facility readiness score of observed essential components to manage them. We compared HIV vs CVDRF coverage scores by country, rural or urban location, and facility type, and by whether or not facilities reported readiness to provide care. We assessed the factors associated with coverage scores for CVDRF and HIV in a multivariable analysis. In our results, we include 7522 facilities in 8 countries; 86% of all facilities reported readiness to provide services for CVDRF, ranging from 77-98% in individual countries. For HIV, 30% reported of facilities readiness to provide services, ranging from 3-63%. Median derived facility readiness score for CVDRF was 0.28 (IQR 0.16-0.50), and for HIV was 0.43 (0.32-0.60). Among facilities which reported readiness, this rose to 0.34 (IQR 0.18-0.52) for CVD and 0.68 (0.56-0.76) for HIV. Derived readiness scores were generally significantly lower for CVDRF than for HIV, except in private facilities. In multivariable analysis, odds of a higher readiness score in both CVDRF or HIV care were higher in urban vs rural and secondary vs primary care; facilities with higher CVDRF scores were significantly associated with higher HIV scores. Derived readiness scores for HIV are higher than for CVDRF, and coverage for CVDRF is significantly higher in facilities with higher HIV readiness scores. This suggests possible benefits from leveraging HIV services to provide care for CVDRF, but poor coverage in rural and primary care facilities threatens Sustainable Development Goal 3.8 to provide high quality universal healthcare for all.
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Affiliation(s)
- Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David Flood
- Department of Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jacqueline A. Seiglie
- Department of Medicine, Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Krishna Aryal
- Public Health Development Organization, Kathmandu, Nepal
| | - Khem Karki
- Department of Community Medicine, Maharajganj Medical College, Institute of Medicine, Kathmandu, Nepal
| | | | - Rifat Atun
- Department of Global Health & Population, Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Center for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Medicine, Division of Primary Care and Population Health, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Lisa Hirschhorn
- Ryan Family Center on Global Primary Care, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois, United States of America
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Kordom A, Daniels F, Chipps J. Training needs of professional nurses in primary health care in the Cape Metropole, South Africa. Afr J Prim Health Care Fam Med 2022. [DOI: 10.4102/phcfm.v14i1.3741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Odland ML, Ismail S, Sepanlou SG, Poustchi H, Sadjadi A, Pourshams A, Marshall T, Witham MD, Malekzadeh R, Davies JI. Multimorbidity and associations with clinical outcomes in a middle-aged population in Iran: a longitudinal cohort study. BMJ Glob Health 2022; 7:bmjgh-2021-007278. [PMID: 35550337 PMCID: PMC9109019 DOI: 10.1136/bmjgh-2021-007278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/19/2022] [Indexed: 12/05/2022] Open
Abstract
Background As the populations of lower-income and middle-income countries age, multimorbidity is increasing, but there is little information on its long-term consequences. We aimed to show associations between multimorbidity and outcomes of mortality and hospitalisation in Iran, a middle-income country undergoing rapid economic transition. Methods We conducted a secondary analysis of longitudinal data collected in the Golestan Cohort Study. Data on demographics, morbidities and lifestyle factors were collected at baseline, and information on hospitalisations or deaths was captured annually. Logistic regression was used to analyse the association between baseline multimorbidity and 10-year mortality, Cox-proportional hazard models to measure lifetime risk of mortality and zero-inflation models to investigate the association between hospitalisation and multimorbidity. Multimorbidity was classified as ≥2 conditions or number of conditions. Demographic, lifestyle and socioeconomic variables were included as covariables. Results The study recruited 50 045 participants aged 40–75 years between 2004 and 2008, 47 883 were available for analysis, 416 (57.3%) were female and 12 736 (27.94%) were multimorbid. The odds of dying at 10 years for multimorbidity defined as ≥2 conditions was 1.99 (95% CI 1.86 to 2.12, p<0.001), and it increased with increasing number of conditions (OR of 3.57; 95% CI 3.12 to 4.08, p<0.001 for ≥4 conditions). The survival analysis showed the hazard of death for those with ≥4 conditions was 3.06 (95% CI 2.74 to 3.43, p<0.001). The number of hospital admissions increased with number of conditions (OR of not being hospitalised of 0.36; 95% CI 0.31 to 0.52, p<0.001, for ≥4 conditions). Conclusion The long-terms effects of multimorbidity on mortality and hospitalisation are similar in this population to those seen in high-income countries.
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Affiliation(s)
- Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK .,Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.,Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
| | - Samiha Ismail
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sadaf G Sepanlou
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sadjadi
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Reza Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
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