ABSTRACT
Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science
Subject(s)
Comprehensive Health Care , Evidence-Based Practice , Mental Health Services , Primary Health Care , South AfricaABSTRACT
No member of [health] staff should undertake tasks unless they are competent to do so' is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001) document. In South Africa; primary clinical nurses (PCNs); traditionally known as primary health care nurses (PHCNs); function as 'frontline providers' of clinical primary health care (PHC) services within public PHC facilities; which is their extended role. This extended role of registered nurses (set out in section 38A of the Nursing Act 50 of 1978; as amended) demands high clinical competency training by nursing schools and universities. The objectives of the study were to explore and describe the perceptions of both clinical instructors and students; in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students' poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University)
Subject(s)
Clinical Competence , Comprehensive Health Care , Primary Health Care , Students , TherapeuticsABSTRACT
Comprehensive HIV/AIDS care in Uganda is delivered through hospitals and health Centre IVs and other designated centres of excellence. The government aims to scale-up comprehensive HIV/AIDS care in the country. However; lack of resources to provide services has delayed the scale-up of the programme. This study examined the availability of resources for delivering comprehensive HIV/AIDS care in lower health facilities in Masaka District; Uganda. The study was cross-sectional and descriptive. Information was collected from the entire 8-health centre IVs providing comprehensive HIV/AIDS care in the district. Information on HIV/AIDS related care provided; human resource availability; management of ARVs and medicine for opportunistic infections; infrastructure and management support functions was obtained from service providers. It was found that all the HC eight IVs already provided most of the components of comprehensive HIV/AIDS care and had the potential to provide the remaining components. Most of the facilities had the protocols for client protection and case management guidelines. Only one facility lacked all the protocols. Six of the eight facilities had optimal numbers of health workers required to provide HIV/AIDS care and support. One facility was grossly understaffed; with only 3 health workers covering all the components of care. Most health workers were not trained in home-based management of PLWHA and felt that they were overworked and had no additional incentives for the extra workload. They felt that the HIV/AIDS programme was under-resourced. Stock-outs were observed for medicines for the management of opportunistic infections but not for ARVs. Medicines for management of opportunistic infections were received through the routine drug management system while ARVs were provided by an NGO. The study recommended that the health workers should be given specific training in fields relevant for HIV/AIDS care and continuous updates on the latest information; the quality of care should be monitored and that HIV/AIDS care should be fully integrated to strengthen and increase sustainability of the health system