Challenges and enablers for implementation of WHO 'Best buys' interventions targeting risk factors of diabetes and hypertension in South Africa: a mixed methods study.

Introduction: World Health Organization (WHO) recommends the implementation of 'Best buys', cost-effective interventions that address risk factors of non-communicable diseases (NCDs). However, country responses to the implementation of these have been slow and undocumented. The aim of this study was to identify and understand challenges and enablers for the implementation of WHO 'Best buys' for risk factors of diabetes and hypertension in South Africa (SA). Methods: a mixed methods research with a sequential dominant status design was used starting with a document review to take stock of WHO 'Best buys' in policy in SA. A qualitative study using key informant interviews was then done to identify and understand challenges and enablers for implementation. A triangulation approach for the analysis of both document review and qualitative data was used. Results: SA has made good progress in including the WHO 'Best buys' in the policy. However, several challenges hamper the successful implementation. Most challenges were related to upstream policy implementation processes such as competing interests of actors, lack of balance between economic vs health gains, and lack of funding. Enabling factors included multi-sectoral engagement and collaboration; community ownership and empowerment; building partnerships for co-creation of enabling environments; leveraging on the existing infrastructure of other health programs; contextualization of policies and programs; and political will and leadership. Conclusion: SA has made good progress in including WHO 'Best buys' targeting risk factors of diabetes and hypertension in policy, however, various contextual barriers influence effective implementation. Hence, there is a need to leverage enabling factors to foster the implementation of WHO 'Best buys' interventions targeting risk factors of diabetes and hypertension in South Africa.

The impact of faith-based organizations on maternal and child health care outcomes in Africa: taking stock of research evidence.

This evidence synthesis aimed at assessing the effectiveness of Faith-Based Organisations (FBOs) on Maternal and Child Health (MCH) outcomes; and explore the perceptions and experiences of the users and providers of MCH services delivered by FBOs in Africa. This review considered studies from African countries only. Both reviews and primary studies focusing on MCH services provided by FBOs were considered. Quantitative, qualitative, and mixed methods reviews were included with no restriction on the date and language. Primary outcomes included maternal mortality ratio, neonatal mortality, infant mortality, child mortality, quality of care, views, experiences, and perceptions of users of FBOs. We searched up to November 2020 in the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PROSPERO register, PDQ-evidence, Health Systems Evidence, CINAHL, EMBASE, and PubMed. We searched references cited by similar studies that may be potentially eligible for inclusion. We then updated the search for primary studies from December 2009 - October 2020. One systematic review and six primary studies met the eligibility criteria for inclusion. Methodological quality varied. These observational and qualitative studies found that FBOs offered the following MCH services - training of healthcare workers, obstetric services, health promotion, sexual education, immunization services, and intermittent preventive therapy for malaria. Maternal and Child Health (MCH) services provided by FBO suggest a reduction in maternal morbidity and mortality. Increased uptake of maternal healthcare services, and increased satisfaction were reported by users of care. However, costs of providing these services varied across the studies and users. This review shows that FBOs play an important role in improving access and delivery of MCH services and have the potential of strengthening the health system at large. Rigorous research is needed to ascertain the effectiveness of FBO-based interventions in strengthening the health systems in Africa.

Correction to: Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs): Protocol for a systematic review.

AbstractFollowing publication of the original article [1], the author reported that their family name was misspelled.