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Moshabela M, Sips I, Barten F. Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa. Glob Health Action 2015; 8:29265. [PMID: 26689459 PMCID: PMC4685973 DOI: 10.3402/gha.v8.29265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 11/14/2022] Open
Abstract
Background Community care workers (CCWs) in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs), and other members of the social support network. Design We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC) encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social support network available to the client, and preferences of the clients remain central to the process of negotiating care.
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Affiliation(s)
- Mosa Moshabela
- Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa;
| | - Ilona Sips
- International Centre for Health Systems Research and Education, Department for Health Evidence, Radboud University, Nijmegen, Nijmegen, The Netherlands
| | - Francoise Barten
- International Centre for Health Systems Research and Education, Department for Health Evidence, Radboud University, Nijmegen, Nijmegen, The Netherlands
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Larye S, Goede H, Barten F. Moving toward universal access to health and universal health coverage: a review of comprehensive primary health care in Suriname. Rev Panam Salud Publica 2015; 37:415-421. [PMID: 26245177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 10/31/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To provide an overview of comprehensive primary health care (CPHC) development and implementation in Suriname in peer-reviewed literature. METHODS Building on work funded by the Teasdale-Corti Global Health Research Partnership Program/People's Health Movement, the authors searched MEDLINE, the Cochrane Library, and POPLINE for articles focused on CPHC within the Surinamese context. Two authors independently reviewed abstracts and then jointly reviewed the selected abstracts. The final selection was completed using a data extraction form. RESULTS The initial search resulted in 1 556 abstracts. The initial review identified 58 articles. Only three of the 58 articles met the inclusion criteria for the final review. The three selected articles provided partial overviews of CPHC in Suriname and examples of its implementation, with a focus on the service delivery network in the interior of the country, which was designed to improve rural access to basic health care services by training community members as service providers. They also included examples of how preparations for health reform in Suriname in the late 1990s and early 2000s, influenced by global neoliberal reforms, led to expectations that disparities in health status, design of health system components, and service provision related to differences in power and historical context (e.g., the influence of medical professionals, political parties/ethnic groups, and wealthier populations concentrated in urban areas) would be addressed. CONCLUSIONS Given the focus on primary health care in the Americas and the notable developments that have occurred in Surinamese health policy and health care, particularly in health care reform, the paucity of published research on CPHC in Suriname was an unexpected finding that may be partly due to prioritizing research on disease control rather than health policy and systems research. The limited amount of scientific literature on this topic 1) prevents clear understanding of CPHC development and implementation in Suriname and 2) underscores the need to strengthen the national health research system to better inform policies for moving the country toward universal health access and coverage to improve the health of all of its citizens.
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Affiliation(s)
| | | | - Francoise Barten
- Health Systems and Service Advisor, Pan American Health Organization, Paramaribo, Suriname,
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Sips I, Haeri Mazanderani A, Schneider H, Greeff M, Barten F, Moshabela M. Community care workers, poor referral networks and consumption of personal resources in rural South Africa. PLoS One 2014; 9:e95324. [PMID: 24781696 PMCID: PMC4004532 DOI: 10.1371/journal.pone.0095324] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/25/2014] [Indexed: 11/20/2022] Open
Abstract
Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data - CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.
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Affiliation(s)
- Ilona Sips
- Radboud UMC, Department of Primary and Community Care, International Health, Nijmegen International Center for Health Systems Research and Education (NICHE), Nijmegen, The Netherlands
| | - Ahmad Haeri Mazanderani
- University of Pretoria, Department of Medical Virology, Pretoria, South Africa
- National Health Laboratory Services, Tshwane Academic Division, Pretoria, South Africa
| | - Helen Schneider
- University of Western Cape, School of Public health, Cape Town, South Africa
| | - Minrie Greeff
- North–West University, Africa Unit for Transdisciplinary Health Research, Faculty of Health Science, Potchefstroom, South Africa
| | - Francoise Barten
- Radboud UMC, Department of Primary and Community Care, International Health, Nijmegen International Center for Health Systems Research and Education (NICHE), Nijmegen, The Netherlands
| | - Mosa Moshabela
- University of Witwatersrand, School of Public Health, Johannesburg, South Africa
- Earth Institute, Columbia University, New York City, United States of America
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Abstract
Objectives: To investigate the differences in antibiotic use and knowledge between adolescent and adult mothers of children under the age of 5 years in Ecuador. Methods: A cross sectional study was performed in four health centers and hospitals. Mothers of children under five years, seeking medical attention their child's upper respiratory tract infection (URI), were included. The data was collected through interviews, using a structured questionnaire. The questionnaire covered the topics knowledge of antibiotic treatment, risk and resistance. Results: 777 mothers were included in the study, of which 15.8% were adolescent and 84.1% adult mothers. There were significant differences in the social and economic characteristics of the mothers (p ≤ 0.05), with adolescent mothers being more likely to have an incomplete high school education and lack of basic services in their home. Significant differences between these groups were found in adherence to treatment, knowledge about risks associated with antibiotic use, and having heard of antibiotic resistance. Among the adult mothers, 83.5% reported correct adherence, 28.5% were knowledgeable about risks associated with antibiotic use, and 29.3% had heard of antibiotic resistance. Among the adolescent mothers, these numbers were 75.4%, 15.0%, and 19.8%, respectively. Conclusions: To develop successful interventions, it is crucial to understand the factors causing differences in antibiotic use and knowledge between mothers.
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Affiliation(s)
- Arturo Quizhpe P
- International Center for Health Systems Research and Education, Radboud University Nijmegen Medical Centre, 500 HB, Nijmegen, Netherlands ; Faculty of Medical Sciences, University of Cuenca, Cuenca, EC010107, Ecuador
| | - Martyna Gassowski
- Radboud University Nijmegen Medical Centre, 6500 HB, Nijmegen, Netherlands
| | - Lorena Encalada T
- Department of Internal Medicine, University of Cuenca, Cuenca, EC010107, Ecuador
| | - Francoise Barten
- Department of Primary and Community Healthcare, Radbound University Nijmegen Medical Centre, 6500 HB, Nijmegen, Netherlands
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Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health 2009; 7:49. [PMID: 19545398 PMCID: PMC2705665 DOI: 10.1186/1478-4491-7-49] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 06/21/2009] [Indexed: 05/21/2023]
Abstract
Ever since the 2006 World Health Report advocated increased community participation and the systematic delegation of tasks to less-specialized cadres, there has been a great deal of debate about the expediency, efficacy and modalities of task shifting. The delegation of tasks from one cadre to another, previously often called substitution, is not a new concept. It has been used in many countries and for many decades, either as a response to emergency needs or as a method to provide adequate care at primary and secondary levels, especially in understaffed rural facilities, to enhance quality and reduce costs. However, rapidly increasing care needs generated by the HIV/AIDS epidemic and accelerating human resource crises in many African countries have given the concept and practice of task shifting new prominence and urgency. Furthermore, the question arises as to whether task shifting and increased community participation can be more than a short-term solution to address the HIV/AIDS crisis and can contribute to a revival of the primary health care approach as an answer to health systems crises. In this commentary we argue that, while task shifting holds great promise, any long-term success of task shifting hinges on serious political and financial commitments. We reason that it requires a comprehensive and integrated reconfiguration of health teams, changed scopes of practice and regulatory frameworks and enhanced training infrastructure, as well as availability of reliable medium- to long-term funding, with time frames of 20 to 30 years instead of three to five years. The concept and practice of community participation needs to be revisited. Most importantly, task shifting strategies require leadership from national governments to ensure an enabling regulatory framework; drive the implementation of relevant policies; guide and support training institutions and ensure adequate resources; and harness the support of the multiple stakeholders. With such leadership and a willingness to learn from those with relevant experience (for example, Brazil, Ethiopia, Malawi, Mozambique and Zambia), task shifting can indeed make a vital contribution to building sustainable, cost-effective and equitable health care systems. Without it, task shifting runs the risk of being yet another unsuccessful health sector reform initiative.
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Affiliation(s)
- Uta Lehmann
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Francoise Barten
- International Health, Department of Primary Care and Community Care, Radboud University Nijmegen, the Netherlands
| | - David Sanders
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Labonté R, Pooyak S, Baum F, Schaay N, Packer C, Laplante D, Vega-Romero R, Viswanatha V, Barten F, Hurley C, Tujuba Ali H, Manolakos H, Acosta-Ramírez N, Pollard J, Narayan T, Mohamed S, Peperkamp L, Johns J, Ouldzeidoune N, Sinclair R, Sanders D. Implementation, Effectiveness and Political Context of Comprehensive Primary Health Care: Preliminary Findings of a Global Literature Review. Aust J Prim Health 2008. [DOI: 10.1071/py08037] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary health care (PHC) is again high on the international agenda. It was the theme of The World Health Report in 2008, thirty years after the Alma-Ata Declaration, and has been the topic of a series of significant conferences around the world throughout 2008. What have we learnt about its impact in improving population health and health equity? What more do we still need to know? These two questions frame a four-year international research/capacity-building project, 'Revitalizing Health for All' (RHFA), funded by the Canadian Global Health Research Initiative (http://www.idrc.ca/en/ev-108118-201-1-DO_TOPIC.html). The RHFA project is organised under the umbrella of the People?s Health Movement (http://www.phmovement.org/en) and the International People?s Health University (http://phmovement.org/iphu/), and involves researchers from over a dozen countries. Our project team?s understanding of PHC is of a comprehensive approach aimed at reducing health inequities that is based on meaningful community participation, multidisciplinary teams and action across sectors.
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Schermer T, van Weel C, Barten F, Buffels J, Chavannes N, Kardas P, Østrem A, Schneider A, Yaman H. Prevention and management of chronic obstructive pulmonary disease (COPD) in primary care: position paper of the European Forum for Primary Care. Qual Prim Care 2008; 16:363-377. [PMID: 18973718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a smoking-related, progressive lung disease that represents a substantial individual, societal and economic burden. Primary care professionals have an important role in healthcare provision for patients with COPD. In this position paper we summarise the current knowledge about, and management of patients with COPD. Next, we describe the role general practitioners and other primary care disciplines (should) have to prevent, diagnose and treat COPD. Finally, we explore differences in the way particular aspects of primary care COPD disease management are available or organised in a number of European countries, in order to identify barriers and provide examples of 'best practices' for optimal primary care management of patients with COPD.
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Affiliation(s)
- Tjard Schermer
- Department of General Practice, Radboud University Nijmegen Medical Centre, The Netherlands.
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Rongo LMB, Barten F, Msamanga GI, Heederik D, Dolmans WMV. Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis. Occup Med (Lond) 2004; 54:42-6. [PMID: 14963253 DOI: 10.1093/occmed/kqh001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Workers in informal small-scale industries (SSI) in developing countries involved in welding, spray painting, woodwork and metalwork are exposed to various hazards with consequent risk to health. Aim To assess occupational exposure and health problems in SSI in Dar es Salaam, Tanzania. METHODS Focused group discussions (FGD) were conducted among SSI workers. Participants were assessed for exposure to occupational and environmental hazards, the use of protective equipment and health complaints by interview. The findings were discussed with participants and potential interventions identified. RESULTS Three hundred and ten workers were interviewed (response rate 98%). There was a high level (>90%) of self-reported exposure to either dust, fumes, noise or sunlight in certain occupational groups. There was low reported use of personal protective equipment. There was a high level of self-reported occupational health problems, particularly amongst welders and metalworkers. Workers reported their needs as permanent workplaces, information on work related hazards, water and sanitation, and legislation for SSI. CONCLUSIONS In SSI in Tanzania, our study suggests that workers have high levels of exposure to multiple health hazards and that use of protective equipment is poor. This group of workers warrants improved occupational health and safety provision.
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Affiliation(s)
- L M B Rongo
- Community Health Department, Muhimbili University College of Health Sciences, Tanzania.
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