ABSTRACT
The objective of this study was to assess home-based care (HBC) kits and programs in South Africa to evaluate the feasibility of scaling up kit production and distribution. South African HBC organizations received structured questionnaires; key informant interviews and a literature review were completed to assess systems for production, distribution and supply of HBC kits. Meetings with stakeholders were held in two Provinces to share and analyze the study findings. The study team distributed questionnaires to 466 organizations and conducted interviews with representatives from 45 organizations, the Provincial Department of Health (DoH) and manufacturers of kits. All identifiable HBC organizations in South Africa were included in the survey. As a result 215 HBC organizations returned questionnaires; including non-governmental organizations (56%), community-based organizations (32%) and organizations affiliated with government health departments. Two types of kits were available: a home kit and a professional kit. The demand for HBC kits exceeded availability, kit contents and availability varied considerably and the supply chain was irregular. Kit production and distribution systems were fragmented. Replenishment of kit items was problematic. End-users are mostly caregivers who have not received adequate training on their use. The study shows that substantial work has been done by HBC organizations in South Africa to respond to the need for palliative care supplies within resource constraints. The growing demand for kits exceeds the supply. There is a need to improve the supply chain management of HBC kits, strengthen referral systems and links between community-based organizations and government departments, expand training opportunities for care givers, and develop monitoring and evaluation systems.
Subject(s)
Equipment and Supplies/standards , HIV Infections/therapy , Home Care Services/organization & administration , Palliative Care/methods , Equipment and Supplies/economics , Equipment and Supplies/supply & distribution , HIV Infections/economics , Home Care Services/economics , Home Care Services/supply & distribution , Humans , South AfricaABSTRACT
In the brachiopod Terebratalia transversa, each ovarian follicle consists of (i) a prophase-arrested oocyte with an enlarged nucleus (= the germinal vesicle, or GV), and (ii) a surrounding sheath of follicle cells that attach to the oocyte by means of junctional complexes. Within about 80 min after removing a follicle from the ovary, the follicular sheath undergoes a microfilament-mediated retraction, and the ovulated oocyte that emerges from the retracted sheath subsequently completes germinal vesicle breakdown (GVBD). Based on the experimental manipulations reported here, it appears that the follicle must be detached from the ovary for such ovulation and GVBD to occur. Moreover, GVBD can be prevented if the oocytes are mechanically stripped of their follicle cells up to 30 min after being isolated from the ovary. GVBD proceeds normally, however, if follicle cells are removed more than 40 min after the follicle is obtained from the ovary. The percentage of oocytes that undergo GVBD is also diminished following treatment with drugs that uncouple gap junctions. Collectively, these data suggest that removing a follicle from the ovary stimulates follicle cells to produce a maturation-inducing factor that uses the follicle cell-oocyte junctional complexes to reach the oocyte within about 30-40 min after follicular removal. The significance of these findings is discussed relative to previous reports on oocyte maturation in brachiopods and other animals.
