Browsing by Author "English, René"

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    An assessment of the ‘PHC Facility Governance Structures Trainer-of-Facilitator Learning Programme’ in Nkangala District, Mpumalanga Province
    (2018) Esau, Natasha; King, Maylene Shung; English, René
    Background In South Africa, as part of specified governance requirements, clinic committees were established to provide management oversight at Primary Health Care facilities. In order for them to better understand their roles they needed training. Facilitators in the district were selected to participate in the 'PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme’ in order to train the clinic committees. This study assessed the training of facilitators. Methods This retrospective single case study used qualitative methods and was guided by the Illuminative Evaluation Framework. It assessed whether the aims, objectives and methodology of the training programme was clearly conveyed by the trainers, whether this was understood by the participants and whether the participants were able to transfer the training programme as intended to the clinic committees. Qualitative data were collected through key informant interviews and focus group discussions, face to face and telephonically. These were complimented by a document and literature review. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Interviews were conducted in English, with semi-structured open ended questions pertaining to participants’ perceptions and understanding of the training, and whether the ToF Learning Programme was delivered to the clinic committees. After participants signed consent forms interviews were audio recorded and transcribed verbatim. Data analysis was done manually and guided by the methodology presented by Ritchie and Lewis. Results A total of 13 participants participated in the study and 23 (national, provincial and partner) documents were reviewed. Despite the different perceptions and understandings of the ToF Learning Programme its overall goal was achieved. Participants’ capacity was strengthened and they trained the clinic committees. The document review showed inconsistency across legislations with regards to clinic committees. Conclusion The ToF Learning Programme has reached its overall goal despite the deviation in the process of delivery and can be recommended for implementation
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    Emergence of three general practitioner contracting-in models in South Africa: a qualitative multi-case study
    (BioMed Central, 2018-10-05) Mureithi, Linda; Burnett, James M; Bertscher, Adam; English, René
    Background: The general practitioner contracting initiative (GPCI) is a health systems strengthening initiative piloted in the first phase of national health insurance (NHI) implementation in South Africa as it progresses towards universal health coverage (UHC). GPCI aimed to address the shortage of doctors in the public sector by contracting-in private sector general practitioners (GPs) to render services in public primary health care clinics. This paper explores the early inception and emergence of the GPCI. It describes three models of contracting-in that emerged and interrogates key factors influencing their evolution. Methods: This qualitative multi-case study draws on three cases. Data collection comprised document review, key informant interviews and focus group discussions with national, provincial and district managers as well as GPs (n = 68). Walt and Gilson’s health policy analysis triangle and Liu’s conceptual framework on contracting-out were used to explore the policy content, process, actors and contractual arrangements involved. Results: Three models of contracting-in emerged, based on the type of purchaser: a centralized-purchaser model, a decentralized-purchaser model and a contracted-purchaser model. These models are funded from a single central source but have varying levels of involvement of national, provincial and district managers. Funds are channelled from purchaser to provider in slightly different ways. Contract formality differed slightly by model and was found to be influenced by context and type of purchaser. Conceptualization of the GPCI was primarily a nationally-driven process in a context of high-level political will to address inequity through NHI implementation. Emergence of the models was influenced by three main factors, flexibility in the piloting process, managerial capacity and financial management capacity. Conclusion: The GPCI models were iterations of the centralized-purchaser model. Emergence of the other models was strongly influenced by purchaser capacity to manage contracts, payments and recruitment processes. Findings from the decentralized-purchaser model show importance of local context, provincial capacity and experience on influencing evolution of the models. Whilst contract characteristics need to be well defined, allowing for adaptability to the local context and capacity is critical. Purchaser capacity, existing systems and institutional knowledge and experience in contracting and financial management should be considered before adopting a decentralized implementation approach.
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    Longitudinal changes in COVID-19 vaccination intent among South African adults: evidence from the NIDS-CRAM panel survey, February to May 2021
    (2022-03-02) Burger, Ronelle; Köhler, Timothy; Golos, Aleksandra M; Buttenheim, Alison M; English, René; Tameris, Michele; Maughan-Brown, Brendan
    Background COVID-19 vaccine hesitancy has threatened the ability of many countries worldwide to contain the pandemic. Given the severe impact of the pandemic in South Africa and disruptions to the roll-out of the vaccine in early 2021, slower-than-expected uptake is a pressing public health challenge in the country. We examined longitudinal changes in COVID-19 vaccination intent among South African adults, as well as determinants of intent to receive a vaccine. Methods We used longitudinal data from Wave 4 (February/March 2021) and Wave 5 (April/May 2021) of the National Income Dynamics Study: Coronavirus Rapid Mobile Survey (NIDS-CRAM), a national and broadly representative panel survey of adults in South Africa. We conducted cross-sectional analyses on aggregate and between-group variation in vaccination intent, examined individual-level changes between waves, and modeled demographic predictors of intent. Results We analysed data for 5629 (Wave 4; 48% male, mean age 41.5 years) and 5862 (Wave 5; 48% male, mean age 41.6 years) respondents. Willingness to get a COVID-19 vaccine significantly increased from 70.8% (95% CI: 68.5–73.1) in Wave 4 to 76.1% (95% CI: 74.2–77.8) in Wave 5. Individual-level analyses indicated that only 6.6% of respondents remained strongly hesitant between survey waves. Although respondents aged 18–24 years were 8.5 percentage points more likely to report hesitancy, hesitant respondents in this group were 5.6 percentage points more likely to change their minds by Wave 5. Concerns about rushed testing and safety of the vaccines were frequent and strongly-held reasons for hesitancy. Conclusions Willingness to receive a COVID-19 vaccine has increased among adults in South Africa, and those who were entrenched in their reluctance make up a small proportion of the country’s population. Younger adults, those in formal housing, and those who trusted COVID-19 information on social media were more likely to be hesitant. Given that stated vaccination intent may not translate into behaviour, our finding that three-quarters of the population were willing to accept the vaccine may reflect an upper bound. Vaccination promotion campaigns should continue to frame vaccine acceptance as the norm and tailor strategies to different demographic groups.