Consumers' perspectives on national health insurance in South Africa: using a mobile health approach.

BACKGROUND: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. OBJECTIVE: This research is based on a survey using Mxit as a mobile phone-based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. METHODS: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. RESULTS: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system's governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. CONCLUSIONS: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.

Listening to service users: young homeless people's experiences of a new mental health service.

The aim of this study was to investigate young homeless people's experiences of ;Strong Minded', a new mental health service set up within selected homeless shelters and run by a voluntary sector organization. Semi-structured interviews were conducted with 19 residents from five homeless shelters across the UK. All of the young people who had accessed Strong Minded had benefited from their engagement. The young people also identified several key inherent and important aspects of Strong Minded relating to both the practical, supportive therapeutic approach and the flexibility of the interventions offered, which contributed to the service's success. This service model of engaging vulnerable young people in transition could have useful implications for the future interface between voluntary and statutory mental health services.