A review of the framework and strategy for disability and rehabilitation services in South Africa

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities

Mapping urban physical distancing constraints, sub-Saharan Africa: a case study from Kenya

With the onset of the coronavirus disease 2019 (COVID-19) pandemic, public health measures such as physical distancing were recommended to reduce transmission of the virus causing the disease. However, the same approach in all areas, regardless of context, may lead to measures being of limited effectiveness and having unforeseen negative consequences, such as loss of livelihoods and food insecurity. A prerequisite to planning and implementing effective, context-appropriate measures to slow community transmission is an understanding of any constraints, such as the locations where physical distancing would not be possible. Focusing on sub-Saharan Africa, we outline and discuss challenges that are faced by residents of urban informal settlements in the ongoing COVID-19 pandemic. We describe how new geospatial data sets can be integrated to provide more detailed information about local constraints on physical distancing and can inform planning of alternative ways to reduce transmission of COVID-19 between people. We include a case study for Nairobi County, Kenya, with mapped outputs which illustrate the intra-urban variation in the feasibility of physical distancing and the expected difficulty for residents of many informal settlement areas. Our examples demonstrate the potential of new geospatial data sets to provide insights and support to policy-making for public health measures, including COVID-19

Review of cancer control policy in Nigeria and comparison with selected African countries: implications for future policy making

Context: The public health importance of cancers in Nigeria is emerging. Robust cancer control policies are needed at all levels of government, especially the state. Objective: To review cancer control policies in Nigeria, especially regarding breast and cervical cancers, with emphasis on policy development process, scope and policy implementation. Also to compare Nigerian cancer control policy with selected African countries and suggest ways through which Nigerian states, such as Abia, can develop evidence-informed, patient-centered cancer control policy. Methods: A structured literature search was done using relevant subject headings and keywords. Boolean operators 'and'/'or' were used to refine the search. Databases searched were Pubmed/Medline, Embase, PsychInfo, Cinahl, Global Health and ERIC. The search included articles published between 2008 and 2018. Data was also collected from the International Cancer Control Plan portal as well as focused Google search. Results: Of the 194 abstracts retrieved, only 29 were included in this review. The 2018 Nigerian National Cancer Control plan (NCCP) showed significant improvement over the 2008 version, in terms of scope and policy development process. Literature search did not reveal any state-level comprehensive cancer control policy. The Nigerian policy lacked specific guidelines for breast cancer compared with the Ghanaian policy. Ghana allocated 12% of total budget to cancer research compared to 0.4% in Nigeria. The South African Breast Cancer policy was developed using more findings from local research and had the most encompassing, multiple perspectives approach. Conclusion: Review shows the content, process, pearls and pitfalls of cancer control policy from Nigeria and five other African countries. Findings will inform the strategy for developing cancer control framework states in Nigeria and other countries. As more Nigerian states work towards developing state cancer control plans, it is important to address the shortfalls identified in the current NCCP, especially regarding the use of multiple perspectives analysis

A policy and decision-making framework for South African doctors during the COVID-19 pandemic

Faced with a pandemic, doctors around the world are forced to make difficult ethical decisions about clinical, economic and politically charged issues in medicine and healthcare, with little time or resources for support. A decision-making framework is suggested to guide policy and clinical practice to support the needs of healthcare workers, help to allocate scarce resources equitably and promote communication among stakeholders, while drawing on South African doctors' knowledge, culture and experience

Advocacy for research evidence in academic public policy development

The World Ranking of Universities The impetus for this review came from reading the July 2019 Webometrics global survey of universities. The Webometrics survey is embraced widely in Africa, but it is less respected around the world when compared to more influential reviews like the Academic Ranking of World Universities, UK Times Higher Education World University Rankings and QS World University Rankings. The low prestige is because Webometrics consider primarily institution web-presence and activities instead of the quality of instruction, student learning, and research productivity; the central core functions of the universities. In the most recent Webometrics survey, the University of Cape Town is the first mentioned university in Africa but ranked number 274 in the world1. The study also revealed the dominance of South African universities, capturing nine of the top ten institutions in Africa. The University of Ibadan first listed Nigerian university, ranked number 17 in Africa and number 1,233 in the world; outperformed by the University of Ghana, which ranked 16 in Africa and 1,209 globally. After perusing through the report, I immediately called a colleague to share the bad news of the overall poor performance of African universities. We both agreed that the result of the survey is symbolic of the quality of education decline in Nigeria; a country with an educational system that was once the envy of most African nations. Given the dismal ranking of Nigerian universities, our conversation quickly shifted to another equally important academic topic - the recurring and apathetic lack of evidence when private and government establishments in Africa put forth public policies. As I begin to write this review, the motion picture by Jerry Maguire titled "Show me the Money" immediately came to mind. The film is a Hollywood romantic comedy-drama sports movie that grossed more than $273 million and ranked ninth highest in revenue in 1996. Cuba Gooding Jr. won the Academy Award for best-supporting actor role while Tom Cruise won the Golden Globes for best actor in a motion picture musical or comedy. He also bagged three other Guild Awards for his performance in the movie. But this review is not about Tinseltown, the land of make-believe. It is about the need to use empirical data when formulating public policies. For two decades now, evidence-based practice is globally accepted across different academic disciplines. Despite these developments, many academic policy decisions are still made in a vacuum without bibliometric research evidence by many science academies and government establishments in particular

HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making

The burden of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) on the elderly population in three divisions within the Northwest Region of Cameroon was examined. Data for this paper were extracted from a larger study which had been conducted concerning the burden of HIV infection and AIDS on the older adults in the Northwest Region of Cameroon. Using in-depth interviews (IDIs) and focus group discussions (FGDs), data were collected from 36 participants who were purposively selected from the three divisions which had been chosen randomly. 6 FGD sessions were held with 30 women aged 60 years and above and who were affected by HIV infection and AIDS, while IDIs sessions were held with 6 male community leaders. The results revealed that HIV infection and AIDS has added another dimension to the role of older persons. HIV infection and AIDS affects older people in diverse ways, as they have to look after themselves, their sick children and are often also left to look after their grandchildren orphaned by HIV infection and AIDS. These emerging issues in their lives make them vulnerable to health, social, economic and psychological challenges, and place a burden on them as caregivers instead of being cared for in their old age. Apart from increased direct expenditures, taking care of victims of HIV infection and AIDS requires older people to stay away from social, religious and community activities. The results showed that the loss of a child to HIV infection and AIDS affects the economic/financial well-being, participation in social/ religious interactions as well as the community activities of older people participants. The implications of these findings for caregiving and social policy are discussed

Resources, indicators, data management, dissemination and use in health information systems in Sub-Saharan Africa: results of a questionnaire-based survey

OBJECTIVE:To describe the status of health information systems in 14 sub-Saharan African countries of the World Health Organization African Region.DESIGN:A questionnaire-based survey.SETTING:Fourteen sub-Saharan African countries of the African Region.PARTICIPANTS:Key informants in the ministries of health, national statistics offices, health programmes, donors and technical agencies.MAIN OUTCOME MEASURES:State of resources, indicators, data sources, data management, information products, dissemination and use of health information.RESULTS:The highest average score was in the identification and harmonisation of indicators (73%), reflecting successful efforts to identify priority indicators and reach international consensus on indicators for several diseases. This was followed by information products (63%), which indicated the availability of accurate and reliable data. The lowest score (41%) was in data management, the ability to collect, store, analyse and distribute data, followed by resources - policy and planning, human and financial resources, and infrastructure (53%). Data sources (e.g. censuses, surveys) were on average inadequate with a score of 56%. The average score for dissemination and use of health information was 57%, which indicated limited or inadequate use of data for advocacy, planning and decision-making. CONCLUSIONS:National health information systems are weak in the surveyed countries and much more needs to be done to improve the quality and relevance of data, and their management, sharing and use for policy-making and decision-making