Centre for Health Policy

Permanent URI for this collectionhttps://hdl.handle.net/10539/36980

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Start date: 2001Has files: Yes

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Now showing 1 - 10 of 11
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    Implementation process and quality of a primary health care system improvement initiative in a decentralized context A retrospective appraisal using the quality implementation framework
    (2018-09-14) Eboreime E; Eyles J; Nxumalo N
    Summary Background Effective implementation processes are essential in achieving desired outcomes of health initiatives. Whereas many approaches to implementation may seem straightforward, careful advanced planning, multiple stakeholder involvements, and addressing other contextual constraints needed for quality implementation are complex. Consequently, there have been recent calls for more theory‐informed implementation science in health systems strengthening. This study applies the quality implementation framework (QIF) developed by Meyers, Durlak, and Wandersman to identify and explain observed implementation gaps in a primary health care system improvement intervention in Nigeria. Methods We conducted a retrospective process appraisal by analyzing contents of 39 policy document and 15 key informant interviews. Using the QIF, we assessed challenges in the implementation processes and quality of an improvement model across the tiers of Nigeria's decentralized health system. Results Significant process gaps were identified that may have affected subnational implementation quality. Key challenges observed include inadequate stakeholder engagements and poor fidelity to planned implementation processes. Although needs and fit assessments, organizational capacity building, and development of implementation plans at national level were relatively well carried out, these were not effective in ensuring quality and sustainability at the subnational level. Conclusions Implementing initiatives between levels of governance is more complex than within a tier. Adequate preintervention planning, understanding, and engaging the various interests across the governance spectrum are key to improving quality.
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    Integrating community health workers into the formal health system to improve performance A qualitative study on the role of onsite supervision in the South African programme
    (2019) Tseng m; Grifiths f; De dadt j
    Abstract Objectives To explore the role of on-site supervision in community health worker (CHW) programmes and CHW integration into the health system. We compared the functioning of CHW teams reporting to a clinic-based nurse with teams supervised by a community-based nurse. We also consider whether a junior nurse can provide adequate supervision, given the shortage of senior nurses. Design A case study approach to study six CHW teams with different configurations of supervision and location. We used a range of qualitative methods: observation of CHW and their supervisors (126 days), focus group discussions (12) and interviews (117). Setting South Africa where a national CHW programme is being implemented with on-site supervision. Participants CHWs, their supervisors, clinic managers and staff, district managers, key informants from the community and CHW clients. Results Effective supervisors supported CHWs through household visits, on-the-job training, debriefing, reviewing CHWs’ daily logs and assistance with compiling reports. CHWs led by senior nurses were motivated and performed a greater range of tasks; junior nurses in these teams could better fulfil their role. Clinic-based teams with senior supervisors were better integrated and more able to ensure continuity of care. In contrast, teams with only junior supervisors, or based in the community, had less engagement with clinic staff, and were less able to ensure necessary care for patients, resulting in lower levels of trust from clients. Conclusion Senior supervisors raised CHW skills, and successfully negotiated a place for CHWs in the health system. Collaboration with clinic staff reduced CHWs’ marginalisation and increased motivation. Despite being clinic-based, teams without senior supervisors had lower skill levels and were less integrated into the health system. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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    The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study
    (Springer Nature, 2017-07-13) Wakeham, Katie; Harding, Richard; Levin, Jonathan; Parkes-Ratanshi, Rosalind; Kamali, Anatoli; Lalloo, David G
    Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.
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    Does expanding fiscal space lead to improved funding of the health sector in developing countries?: lessons from Kenya, Lagos State (Nigeria) and South Africa
    (Taylor & Francis, 2018-05-16) Doherty, Jane Tanya; Kirigia, Doris; Okoli, Chijioke; Chuma, Jane; Ezumah, N; Ichoku, Hyacinth; Hanson, Kara; McIntyre, Diane
    This article examines whether increased tax revenue in the three territories of Kenya, Lagos State (Nigeria) and South Africa was accompanied by improved resource allocation to their public health sectors, and explores the reasons underlying the observed trends.
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    Are South Africa’s new health policies making a difference?
    (2008-03-31T08:35:30Z)
    Since 1994 the South African government has placed equity at the heart of its health policy goals. Yet, how successful have the policies been in reducing inequity? This study provides some answers, based on evidence from household studies carried out between 1992 and 2003. Based on Gilson, L. and McIntyre, D. 2007) Post-apartheid challenges: household access and use of care. International Journal of Health Services 37(4): 673-691
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    The state of sexual assualt services: Findings from a situation analysis of services in South Africa
    (Centre for Health Policy - School of Public Health - University of the Witwatersrand, 2003-10) Christofides, Nicola; Webster, Naomi; Jewkes, Rachel; Penn-Kekana, Loveday; Martin, Lorna; Abrahams, Naeema; Kim, Julia
    Women often receive very poor quality medical care after sexual assault. This has been highlighted in work done by Human Rights Watch, Suffla and others that explored services in some provinces. No systematic investigation of services in all provinces had been carried out. In 2001, the National Department of Health prioritised improving sexual assault services and the research presented in this report was conducted to inform this process. The aim was to investigate sexual assault services provided by health sector in South Africa with an in-depth look at North West province. Two district hospitals; a regional hospital and a tertiary hospital (where they existed) were randomly sampled in all provinces. The total number of hospitals in the sampling frame varied from province to province. This was adjusted for in analysis through weighting. At each hospital, we interviewed two doctors and two nurses who examined or assisted in the management of a patient who presented at the hospital after rape. A primary health care clinic, which referred patients to the sampled hospital in each district, was identified and a nurse at the clinic was interviewed. A total of 155 providers were interviewed. A facility checklist was completed at each hospital. In North West Province, 199 nurses and doctors were interviewed from 20 hospitals and a primary health care clinic that referred patients to these hospitals. In addition, district managers, police, social workers and representatives of NGOs addressing gender-based violence were interviewed.
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    A rapid appraisal of maternal health services in South Africa
    (Centre for Health Policy - School of Public Health - University of the Witwatersrand, 2002) Penn-Kekana, Loveday; Blaauw, Duane
    This report is a rapid appraisal of maternal health services in South Africa. It reflects the first activity in a five-year research programme, funded by DFID. The research project is a multi-country project involving researchers from the London School of Hygiene and Tropical Medicine, (UK) Manchester University (UK) and research institutions in Uganda, Bangladesh, Russia as well as South Africa. The programme aims to develop theoretical frameworks and methodologies to better understand health system functioning in developing countries, and to apply these insights to strengthening health system development. As part of this project maternal health has been identified as a possible probe or tracer to illuminate particular features of health system functioning and performance.
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    The Integration of HIV/AIDS Care and Support into Primary Health Care in Gauteng Province
    (Centre for Health Policy - School of Public Health - University of the Witwatersrand, 2002-07) Modiba, P; Schneider, H; Weiner, R; Blaauw, D; Gilson, L; Zondi, T; Kunene, X; Brown, K
    This study aimed to assess the integration of HIV/AIDS care and support in Gauteng’s primary health care (PHC) services. With this aim in mind, the research sought to provide answers to three main sets of questions. Firstly, are care and support services for people with HIV/AIDS being provided at PHC clinics, what is the quality of these services, and to what extent are these services being utilised? Secondly, are the inputs (e.g. staff knowledge and attitudes) and support systems (e.g. drug supplies), necessary for good quality, accessible HIV/AIDS care, present in the PHC infrastructure? Thirdly, what if any, systems changes are required to improve the access and quality of PHC services for people living with HIV/AIDS? This research was conducted in collaboration with, and partly funded by, the Gauteng Provincial Department of Health which is in the process of disseminating primary health care clinical guidelines in the Province.
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    HIV Prevalence Study and Costing Analysis undertaken for the development of an HIV/AIDS Workplace Strategy for Buffalo City Municipality
    (Medical Research Council, 2005) Thomas, EP; Colvin, M; Rosen, SB; Zuccarini, C; Petzer, S
    In contrast to most private sector employers in South Africa, local government has been slow to put in place HIV workplace strategies. While general workplace policies are available, there is an absence of specific guidelines for local authorities in their response as employers and as service delivery agencies to HIV/AIDS. The Buffalo City Municipality (BCM) embarked upon an innovative approach involving research and an inclusive process to develop a response to HIV/AIDS. This response is advocated as good practice. The report outlines the steps taken towards the development and adoption of a Buffalo City Municipality HIV strategy in late 2004. Lessons learned are documented for the benefit of other local authorities in the development of their own HIV strategies. The success in the development of the Buffalo City Municipality HIV/AIDS strategy is based on two important legs. Firstly, the process adopted and secondly the research initiative to provide the data to inform the HIV strategy. The process: BCM is to be commended for its innovative and proactive stance. Key to the success has been the leadership of the initiative where political councillors, departmental heads, and all levels of managers have supported the process. The outcome of the political support has been shown in the high rate of HIV testing in the sampled group, the enthusiastic take-up of Voluntary Counseling and Testing (VCT) by the employees, and the commitment to the resultant BCM HIV/AIDS Cross-cutting Strategy. Further, the involvement of staff from human resources and engineering through to finance and planning in the development of the BCM strategy again attests to the recognition that addressing HIV in the workforce and the broader community must be treated as an inter-sectoral and cross-cutting issue. The success of the process added considerably to the value and accomplishment of the research. The SA Medical Research Council (MRC) (an external group) was commissioned to undertake an HIV prevalence study, as they were seen to be independent and authoritive, as well as to carry out a Knowledge, Attitudes and Practice study (KAP) and to facilitate a VCT process. In addition, a health economist was requested to assess the cost implications of HIV for BCM as an employer. A team of external researchers worked closely with a BCM staff team in the design and setting up of the studies. The fieldwork took place in June 2004 and the overall BCM strategy was completed within two months, in August 2004. From a sample of 20% of the employees, the study found that 10.3% were HIV infected. Key findings are that temporary employees had a higher prevalence (7.7%) than permanent staff (9.3%). Women had a higher prevalence rate than men (10,2 and 9% respectively). The highest prevalence was in the 20-29 year age group. All job bands were infected but levels of infection were highest amongst the lower skill levels (11.7%) and black Africans (12.6%). There was no difference in infection level between employees with different educational levels.