Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

Background. In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. Objectives. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021.Methods. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. Results. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached ­ suggesting a slow recovery and continuing impact of the pandemic. Conclusions. TheCOVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets

A cross-sectional survey of burnout amongst doctors in a cohort of public sector emergency centres in Gauteng, South Africa

Introduction:Working in emergency care is commonly regarded as highly stressful. This is also true in the African setting characterised by high patient loads and limited resources. As in other similarly demanding occupations, burnout can be anticipated. The aim of this study was to examine the level of burnout amongst doctors in a cohort of public sector emergency centres in Gauteng, South Africa.Methods:An observational, cross-sectional design was employed, using the Maslach Burnout Inventory-Human Services Survey (which has been tested and validated in similar settings elsewhere). The study included a cohort of doctors working in the emergency centres of public sector hospitals in Gauteng, South Africa.Results:One hundred participants completed the questionnaire out of a possible 124 doctors working at the five centres. Ninety-three met the inclusion criteria and was further analysed. Seven respondents were specialist emergency physicians (7.5%), 36 were emergency medicine registrars (38.7%) and 50 were medical officers (53.8%). Fifty one respondents were female (55.0%). Analysis of burnout component scores showed a mean emotional exhaustion score of 31.69 (standard deviation, SD = 10.32), with 62 respondents (66.7%) in the high-risk group ­ from 86 (92.5%) at moderate to high risk. The mean de-personalisation score was 13.39 (SD = 6.21), with 50 respondents (53.8%) in the high-risk group ­ from 75 (80.7%) at moderate to high risk of burnout. The mean personal accomplishment score was 34.87 (SD = 6.54), with 21 respondents (22.6%) in the high-risk group ­ from 65 (69.9%) at moderate to high risk of burnout.Discussion:The results indicate that a large proportion of the doctors who work in these emergency centres are at moderate to high risk of burnout. Based on our findings we recommend that interventions be introduced at the work place to reduce burnout in doctors and improve their mental well-being. This will ensure better service delivery to patients with emergencies. Further research into the causes of occupational burnout should be explored

Awareness and coverage of the national health insurance scheme among formal sector workers in Ilorin, Nigeria

A prepayment scheme for health through the National Health Insurance Scheme (NHIS) was commenced in Nigeria about ten years ago. Nigeria operates a federal system of government. Sub-national levels possess a high degree of autonomy in a number of sectors including health. It is important to assess the level of coverage of the scheme among the formal sector workers in Nigeria as a proxy to gauge the extent of coverage of the scheme and derive suitable lessons that could be used in its expansion. This is a cross-sectional; descriptive survey carried out among formal sector workers in Ilorin Kwara State; Nigeria. A stratified sampling technique was used to select study participants. A self-administered questionnaire was used to collect data from respondents. Data was analysed with the SPSS. Ethical approval to conduct the study was obtained from the Bowen University Teaching Hospital Research Ethics Committee. A total of 370 people participated in the study. Majority; (78.9%) of the respondents were aware of the NHIS; however only 13.5 % paid for health care services through the NHIS. Logistic regression analysis shows that respondents with post-secondary education (OR = 9.032; CI = 2.562 - 31.847; p = 0.001) and in federal civil service (OR = 2.679; CI = 1.036 - 6.929; p = 0.042) were over nine and three times more likely to be aware of the scheme than others. Coverage of the scheme among the respondents was unimpressive. A lot still need to be done to fast-track the expansion of the scheme among this sector of the population

The Burden of Diabetes Mellitus in Kwazulu-Natal' S Public Sector : A Year Perspective

Background: The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN); South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility. Objective: To investigate the distribution; incidence and prevalence of diabetes in the public healthcare sector of KZN. Methods: Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected. Results: The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes; the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment). Conclusions: Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN; who have a genetic predisposition to diabetes mellitus. However; allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education; particularly in the public healthcare domain

Tuberculosis among Public Sector Healthcare Workers in eThekwini District; KwaZulu-Natal

Background: South Africa has one of the highest burdens of tuberculosis globally. Transmission of tuberculosis in health-care settings is common and healthcare workers face an increasing threat of becoming infected. Objective: The aim of this study was to calculate the incidence of tuberculosis reported among healthcare workers in public sector hospitals and clinics within eThekwini Health District in KwaZulu-Natal; South Africa; from 2006 to 2010. Methods: A retrospective review of tuberculosis registers at occupational health clinics was conducted in 11 hospitals andfour community health centres in the District. All healthcare workers who were diagnosed and treated for tuberculosis at these facilities were included in the study.Results: Six hundred and eighteen healthcare workers were diagnosed with tuberculosis during the study period; a total of 67 562 healthcare workers were employed. The mean incidence of tuberculosis over the study period was 908 cases per 100 000 (95% CI 771 - 1 046). The incidence of tuberculosis in healthcare workers was higher than that in the general population but lower than in the provincial and district populations. Conclusion: Tuberculosis among healthcare workers remains an important occupational health issue. The high burden of tuberculosis in KwaZulu-Natal; and under-reporting of tuberculosis among healthcare workers are likely to have masked the high incidence among healthcare workers

Current State of Public Cemeteries in River State; Nigeria

Cemeteries or 'sleeping places' are where bodies or cremated remains are buried. Dead bodies are essentially 'wastes' and their improper disposal in the form of burial may come with health implications. This is particularly apt in Nigeria and indeed Rivers State where unsupervised burials are carried out in homes (houses); compounds and community-based cemeteries. A walk through survey of five functional public cemeteries in Rivers State appraised their current state and their possible health implications. This on-the-spot site visit revealed infrastructural; operational and maintenance challenges which have further stressed the need for better managed public cemeteries and more objective studies on the subject

Evidence of Strategic Human Resource Management Practice in a Public Sector Organisation: a Content Analysis of the HRM Policy and Strategy of the Ministry of Health of Ghana; 2007- 2011

Competitive forces coupled with new and continuing demands require public sector organisations to be increasingly careful in thinking about their strategies. This is complicated especially for the health sector because it must do so in a multi-sectoral environment where system complicate decision making. This paper examines the evidence of Human Resource Management Strategies and practices in a public sector organization; the Ministry of Health of Ghana. The paper examines strategies of the Human Resources of the Ministry of Health of Ghana to achieve the objectives of reforms which are largely to make quality health care accessible and affordable to the people of Ghana with the right staff doing the right job at the right place. It is an established fact that the success of every organization depends greatly on its human resource. However having the right quantity and quality of employees at the right place is the problem. HRM strategy is about providing the right numbers and calibre of staff; as well as retaining and motivating staff to enhance productivity. There are difficulties in developing appropriate HRM strategies to enable especially public sector organisations achieve their objectives. There is no perfect solution as to how to evolve an effective HRM strategy. Nonetheless there are some general principles of best practice that policy makers should keep in mind. Where these principles are not considered and a balance is not achieved; a policy may be impotent at birth and not facilitate organisational success

Clinical Waste Management in the Context of the Kanye Community Home-Based Care Programme; Botswana

This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye; southern Botswana . This qualitative study involved 10 focus group discussions with a total of 82 HIV/AIDS primary caregivers in Kanye; one-to-one interviews with the five nurses supervising the programme; and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme; namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers; including burning and burying the healthcare wastes; and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste

Dietary and Fluid Adherence among Haemodialysis Patients Attending Public Sector Hospitals in the Western Cape

Objective There has been considerable debate about the extent to which social cognitive models of health behaviour apply in developing countries. The purpose of this paper was to determine the applicability of the Theory of Planned Behaviour (TPB) in predicting dietary and fluid adherence among a sample of haemodialysis patients attending public sector hospitals in the Western Cape.Design and methods A sample of 62 historically disadvantaged patients undergoing haemodialysis completed a battery of psychometric instruments measuring attitudes; subjective norms; perceived behavioural control regarding dietary and fluid adherence; health literacy; perceived social support; and self-reported dietary and fluid adherence. Interdialytic weight gain (IDWG); predialytic serum potassium levels; and predialytic serum phosphate levels served as biochemical indicators of dietary and fluid adherence.Results Regression analyses indicated that the linear combination of attitudes and perceived behavioural control significantly accounted for 15.5of the variance in self-reported adherence (a medium-effect size) and 11.4of the variance in IDWG (a modest-effect size). No significant predictors were identified for predialytic serum potassium and predialytic serum phosphate levels. Interpretation and conclusions The results indicate that; while the TPB may not function in the same manner as it does in Western samples; it may have some nuanced applicability among haemodialysis patients attending public sector hospitals in the Western Cape

The Human Resource Crisis in the Zambian Health Sector a Discussion paper

Objectives: The human resource crisis facing the Zambian health sector has potential to derail existing health programs including millennium development goals. This paper will highlight the underpinning factors; analyze current interventions and propose alternative solutions to this crisis. Design: The study was done through a review of articles and reports covering the topic. Main outcomes/results: The human resource crisis has been recognized by the Zambian government; Zambian organizations and the international community as the greatest challenge that threatens the entire healthcare system. The situation is getting worse and solutions implemented thus far have neither been totally effective nor comprehensive in arresting; let alone reversing the trend. Conclusion: The human resource crisis in Zambia has reached a disastrous stage with the health system at breaking point. Corrective measures have been started but these need to be strengthened and as comprehensive as can be. There is also need for innovation to consider other solutions that have not been tried before. This is important in order to safeguard Zambia's development and all the other investments that the country has made into its future through programs such as the fight against HIV/ AIDS. Although there is need for stronger international cooperation; the primary solutions can and must come from within Zambia

Challenges to creating primary care teams in a public health centre: a co-operative inquiry

"Background: Effective teamwork between doctors and clinical nurse practitioners (CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) is situated in a large town and offers primary care to the rural Breede Valley Sub-District of the Western Cape. The management of the CHC decided to create dedicated practice teams offering continuity of care; family-orientated care; and the integration of acute and chronic patients. The teams depended on effective collaboration between the doctors and the CNPs.Methods: A co-operative inquiry group; consisting of two facility managers; an administrator; and medical and nursing staff; met over a period of nine months and completed three cycles of planning; action; observation and reflection. The inquiry focused on the question of how more effective teams of doctors and clinical nurse practitioners offering clinical care can be created within a typical CHC.Results: The CHC had established three practice teams; but met with limited success in maintaining the teams over time. The group found that; in order for teams to work; the following are needed: A clear and shared vision and mission amongst the staff. The vision was championed by one or two leaders rather than developed collaboratively by the staff. Continuity of care was supported by the patients and doctors; but the CNPs felt more ambivalent. Family-orientated care within practices met with limited success. Integration of care was hindered by physical infrastructure and the assumptions regarding the care of ""chronics"". Enhanced practitioner-patient relationships were reported by the two teams that had staff consistently available. Significant changes in the behaviour and roles of staff. Some doctors perceived the nurse as an ""assistant"" who could be called on to run errands or perform tasks. Doctors perceived their own role as that of comprehensively managing patients in a consultation; while the CNPs still regarded themselves as nurses who should rotate to other duties and perform a variety of tasks; thus oscillating between the role of practitioner and nurse. The doctors felt responsible for seeing a certain number of patients in the time they were available; while the CNPs felt responsible for getting all the patients through the CHC. The doctors did not create space for mentoring the CNPs; who were often seen as an intrusion and a threat to patient privacy and confidentiality when requesting a consultation. For the CNPs; however; the advantage of practice teams was considered to be greater accessibility to the doctor for joint consultation. The identification of doctors and CNPs with each other as part of a functioning team did not materialise. Effective management of the change process implied the need to ensure sufficient staff were available to allow all teams to function equally throughout the day; to be cognisant of the limitations of the building design; to introduce budgeting that supported semi-autonomous practice teams and to ensure that the staff were provided with ongoing opportunities for dialogue and communication. The implications of change for the whole system should be considered; and not just that for the doctors and nurses.Conclusions: Key lessons learnt included the need to engage with a transformational leadership style; to foster dialogical openness in the planning process and to address differences in understanding of roles and responsibilities between the doctors and the CNPs. The unreliable presence of doctors within the practice team; due to their hospital duties; was a critical factor in the breakdown of the teams.. The CHC plans to further develop practice teams; to learn from the lessons so far and to continue with the co-operative inquiry."

The Involvement of Private General Practitioners in Visiting Primary Healthcare Clinics

Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.Methods: A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits.Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level

Hidden agenda and self-interest: Is SWAP the answer to health sector development?

The sector-wide approach (SWAP) arose out of dissatisfaction with the project approach that was characterised by externally funded health sector development. Project funding involves an agreement between development partners government to fund specific activities. A project has its own management with the Government to fund specific activities. A project would have its own management structure; project documents; workplan; project manager; reporting format; rules and expenditure procedures. The development partner funding the project can influence activities being (Walford; 1998)