Accessibility of healthcare in rural Zimbabwe: the perspective of nurses and healthcare users

Background: Accessibility of healthcare in rural areas is globally impeded by physical, material, human, financial and managerial resources and societal barriers in the healthcare system. Developing countries like Zimbabwe are significantly affected. Aim: The aim of this article was to share the perspectives of nurses and healthcare users (HCUs) in the rural areas of Zimbabwe with regard to the accessibility of healthcare. Setting: The study was conducted at 45 rural health facilities in Chegutu district, Mashonaland West province and Masvingo district in Masvingo province, Zimbabwe. Methods: A self-administered questionnaire (for professional nurses) and a structured interview questionnaire (for HCUs) were utilised to gather data in a cross-sectional survey. Two districts were randomly sampled from 59 districts. All nurses working in 45 public health facilities in the selected two districts, who were willing and available to participate, were included. Ninety nurses participated in the study. The HCUs were selected through a multistage sampling technique. The sample size for HCUs was calculated by using Dobson's formula, and 445 HCUs were included via convenience sampling. Results: Nurses reported challenges such as work overload because of staffing shortages (55%) and the supply of necessary medical drugs that lacked consistency in both the quantity and type ordered(46.7%). The challenges faced by HCUs included long distances from villages to health facilities (86%), unaffordability of transport costs and lack of access to medical drugs (59.95%), causing them to seek assistance from traditional healers (43%). Conclusion: Both the nurses and HCUs perceived grave challenges regarding access to health facilities, health workers and medical drugs, all of which are bound to have an impact on the health of communities in rural Zimbabwe

Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: a scoping review

Background: The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers' heteronormative attitudes compromise the quality of care to the LGBT population. Aim: The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review. Setting: This is a secondary literature review. Methods: An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011. Results: Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised. Discussion: It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa

An audit of licensed Zimbabwean radiology equipment resources as a measure of healthcare access and equity

Introduction: approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources.Methods: the equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data.Results: public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure.Conclusion: there exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data

Evaluation of aesthetic outcome of single tooth implant borne restoration

Objective: Culture is the way of life of a people; and is an integral component of their day-to-day existence. It influences the daily routine of a people, including their diet, dressing, religious disposition, and surprisingly, the degree to which orthodox medical practices impact their daily lives. Appreciating underlying cultural context will help health care workers influence patient's perceptions, especially where cultural practices are not in tandem with medical best practices. This is important, for example, in administration of informed consent for surgery. This study explored cultural beliefs of patients in relation to some common maxillofacial practices in Kano Nigeria.Methods: Patient's perceptions on oral cancers, use of nasogastric tubes, and tooth extraction was conducted amongst patients attending maxillofacial outpatient clinic of a tertiary Nigerian hospital from January to December 2015 using a non-structured, interviewer-administered questionnaire.Results: Seventy-seven (77) patients were surveyed (52 males and 25 females), with ages ranging from 16 to 75 years. Most were aged 51-60 years (44.2%). Only 6.5% of respondents had higher than secondary education. Responses to the aetiology and treatment of oral cancers, use of nasogastric tubes for maxillofacial surgery patients and extraction of teeth showed cultural perceptions usually at variance with medical best practices.Conclusion: Patients' expectations and fears of maxillofacial surgery procedures are affected by their cultural beliefs. Proper acceptance of this, combined with targeted education and counselling may enhance patient's co-operation and acceptance of necessary surgical procedures when orthodox medical care is sought

Determinants of patient enablement at primary health care centres in central Ethiopia: a cross-sectional study

Background: Patient enablement is associated with behaviours like treatment adherence and self-care and is becoming a well-accepted indicator of quality of care. However, the concept of patient enablement has never been subjected to scientific inquiry in Ethiopia. Objectives: The aim of this study was to determine the degree of patient enablement and its predictors after consultation at primary health care centres in central Ethiopia. Method: Data were collected from 768 outpatients from six primary health care centres in central Ethiopia during a cross-sectional study designed to assess patient satisfaction. Consecutive patients, 15 years or older, were selected for the study from each health centre. Multinomial logistic regression was performed to identify predictors of patient enablement using SPSS (version 16.0). Results: The study showed that 48.4% of patients expressed an intermediate level of enablement, while 25.4% and 26.2% of the patients expressed low and high levels of patient enablement, respectively. Four models were developed to identify predictors of patient enablement. The first model included socio-demographic variables, showing that residence, educational status and occupational status were significantly associated with patient enablement (p < 0.05). This model explained only 20.5% of the variation. The second and third models included institutional aspects, and perceived doctor­patient interaction and information sharing about illness, respectively. They explained 31.1% and 64.9% of the variation. The fourth model included variables that were significantly associated with patient enablement in the first, second and third models and explained 72% of the variation. In this model, perceived empathy and technical competency, non-verbal communication, familiarity with the provider, information sharing about illness and arrangement for follow-up visits were strong predictors of patient enablement (p <0.05). Conclusion: The present study revealed specific predictors of patient enablement, which health care providers should consider in their practice to enhance patient enablement after consultation