Enabling mental health task-sharing: a collective case study of undergraduate clinical associate training programmes in South Africa.

BACKGROUND: There is a shortage of the human resources needed to deliver mental health services which is likely to be exacerbated by COVID-19. Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in a number of countries. Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared. This study explored the mental health curriculum content of the undergraduate clinical associate training programmes in South Africa and the views of key informants of the adequacy of training in mental health. METHODS: A qualitative collective case study approach was utilised for this multisite study at the three universities in South Africa offering clinical associate degrees. The study consisted of in-depth interviews utilising videoconferencing of individuals involved in each programme and a document review. Thematic analysis of the data was conducted. RESULTS: Nineteen interviews were conducted. Mental health formed part of the curriculum in all three programmes with the bulk of the training taking place in the final year of the three-year degree. Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive. The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets. CONCLUSION: There is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardisation, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.

We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum.

The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.

Risk and reward: Experiences of healthcare professionals caring for drug-resistant tuberculosis patients

Orientation: Multi-drug-resistant tuberculosis (MDR-TB) continues to be a global public health challenge. Healthcare professionals caring for MDR-TB patients face the occupational risk of being infected. Research purpose: To describe the experiences of healthcare professionals caring for MDR-TB patients at one TB hospital. Motivation for this study: Managers of healthcare settings, which posed a specific occupational risk, struggle with recruitment, retention and a high turnover. What is not known is what can be performed in these settings to mitigate these human resource challenges. Research approach/design and method: This study used a qualitative research design. A fieldworker collected data via in-depth individual interviews from 20 participants. A purposive sampling technique was used. Main findings: Six themes emerged: Infrastructure challenges, Human Resource Challenges, Lack of Equipment and Supplies, Support, Risk and Reward and Emotions. This environment led to additional risk-taking with regard to working outside the scope of practice and feelings of burnout. Participants valued the opportunity to develop relationships with patients in their journey of recovery in an atmosphere that was not characterised by urgency. Practical and managerial implications: This study offered managers some insight on how to create a rewarding working environment and atmosphere that were favourable to deliver quality patient care services to MDR-TB patients. Participants provided insight into the previously unknown risks in the workplace, which can be ameliorated. Contribution/value-add: This study identified the key interventions – some of which can receive immediate attention – to ensure recruitment and retention of this specialised workforce.