Browsing by Author "Haricharan, Hanne Jensen"

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    Community participation and the right to health for people with disability: a qualitative study into Health Committees' understanding and practise of their governance role in relation to disability
    (2015) Abrahams, Theodore William John; Haricharan, Hanne Jensen; London, Leslie
    BACKGROUND: People with disabilities encounter major barriers that prevent them realising their right to health in South Africa. Health committees are legislated structures for community participation in health at a local level. This study investigated how health committee members understand and practise their role in community participation and how this advances the right to health for persons with disability. METHODS: A qualitative study was conducted with three health committees in the Cape Town Metropole in the Western Cape province of South Africa purposively selected for the study. Three facility managers and eight health committee members took part in focus group discussions and semi-structured interviews, supplemented by participant observations of committee meetings. Additionally, semi-structured interviews were conducted with 2 disability activists. These methods were used to gain a rich understanding of health committees’ roles and practises in relation to persons with disabilities. Thematic analysis was used to analyse the data. RESULTS: The main research findings were: (i) health committees did not prioritise disability on their respective agendas; (ii) persons with disabilities were not adequately represented on health committees; (iii) health committees exhibited poor understanding of disability barriers relating to health; (iv) lack of egalitarian values led to persons with disabilities not trusting the health committee, and distrust amongst health committee members; lastly (v) health committees augment health facility operations instead of fulfilling their governance and oversight function. These factors may have contributed to health committees not helping to advance the right to health for persons with disabilities. CONCLUSIONS: Health committees should include mandated representation of persons with disabilities, whilst addressing marginalisation directed toward persons with disabilities on committees. Training of health committees, as well as networking with disabled organisations, could help improve their limited understanding of disability. Health committees should consider addressing disability a human rights issue, which critically involves community mobilisation, raising awareness around issues of disability and promoting agency amongst persons with disabilities to claim their rights.
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    Health committees in South Africa: the Influence of power on invited participation in policy and practice
    (2019) Haricharan, Hanne Jensen; Colvin, Christopher J.; London, Leslie
    This study explores how the presence of multiple forms of power impact health committee participation in South Africa’s Western Cape Province in policy and practice. A qualitative case study with a rural and an urban committee is used to explore the research question. The study’s conceptual framework views health committees as invited spaces where citizens are invited to participate, in contrast to closed spaces without citizen involvement and claimed spaces where citizens claim participation. The study considers the impact of three different forms of power, namely: a) countervailing power, an external form of power, which neutralises power differentials between officials and community members; b) constraining power, which limits influence; and c) enabling power, which promotes agency. Three models for invited participation are identified: 1) Appointed participation, envisioned in the Western Cape Health Facility Boards and Committees Act (2016); 2) An organisational model, preferred by the health committees; and 3) An election model, considered in policy documents. The study found that the health committee Act provides health committees with countervailing power in the form of a mandate. However, the content of the Act ensures that the Health Department controls who participates through ministerial appointments and limits health committees’ influence through stipulating narrow roles. The practiced organisational model generates countervailing power through a claim to represent communities, but this claim is challenged by weak community links and accountability mechanisms and the fact that only organised sections are represented. Furthermore, the study demonstrates that absence of countervailing power and presence of constraining forms of power limit health committees’ influence, though they also draw on enabling forms of power. In addition, the study demonstrates that when citizens have limited influence in invited spaces, they consider creating claimed spaces. Finally, the study argues that a model with elected community representatives may provide stronger countervailing power as elections may enable health committee representatives to claim to represent the entire community. The thesis concludes that invited participation may generate sufficient countervailing power when it is legislated and based on a human rights approach, which positions committees as claim-makers and the state as duty-bearer. Furthermore, it concludes that both countervailing power and enabling power is necessary for effective substantive participation.
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    Health promotion via SMS improves hypertension knowledge for deaf South Africans
    (BioMed Central, 2017-08-18) Haricharan, Hanne Jensen; Heap, Marion; Hacking, Damian; Lau, Yan Kwan
    Background: Signing Deaf South Africans have limited access to health information. As a result, their knowledge about health is limited. Cell phone usage in South Africa is high. This study aimed to assess whether a short message service (SMS)-based health promotion campaign could improve Deaf people’s knowledge of hypertension and healthy living. Additionally, the study aimed to assess the acceptability of using SMSs for health promotion targeting Deaf people. Methods: A baseline questionnaire assessed participants’ knowledge about hypertension before an SMS-based information campaign was conducted. After the campaign, an exit questionnaire was conducted, containing the same questions as the baseline questionnaire with additional questions about general acceptability and communication preferences. Results were compared between baseline and exit, using McNemar’s test, paired t-test and Wilcoxon signed-rank test. Focus groups aimed to get further information on the impact and acceptability of SMSs. The focus groups were analysed using inductive thematic analysis. Results: The campaign recruited 82 participants for the baseline survey, but due to significant loss-to-follow-up and exclusions only 41 participants were included in the analysis of the survey. The majority (60%) were men. Eighty percent were employed, while 98% had not finished high school. The campaign showed a statistically significant improvement in overall knowledge about hypertension and healthy living amongst participants. Six individual questions out of 19 also showed a statistically significant improvement. Despite this, participants in focus groups found the medical terminology difficult to understand. Several ways of improving SMS campaigns for the Deaf were identified. These included using using pictures, using ‘signed’ SMSs, combining SMSs with signed drama and linking SMS-campaigns to an interactive communication service that would enable the Deaf to pose questions for clarification. Focus groups suggested that participants who were hypertensive during the campaign adopted a healthier lifestyle. Conclusion: SMSs were effective in improving Deaf people’s knowledge of hypertension and healthy living. However, SMS-campaigns should be cognizant of Deaf people’s unique needs and communication preference and explore how to accommodate these. Trial registration: The research was registered with the Pan African Clinical Trial Registry on December 1, 2015. Identification number: PACTR201512001353476.
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    Let me be quiet' : HIV disclosure, stigma and denial in Imizamo Yethu, Cape Town
    (2008) Haricharan, Hanne Jensen; Levine, Susan
    Includes abstract. Includes bibliographical references (leaves 81-86).
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    'Let Me Be Quiet': The Dilemma of HIV Disclosure
    (2010) Haricharan, Hanne Jensen
    This paper argues for a differentiated approach to understanding disclosure of HIV status in a South African township. It suggests that there are two models of disclosure: partial and full. There are benefits for PLHA in both forms of disclosure resulting in improved health and well-being. Disclosure can also play a role in prevention as it can facilitate initiation of safe sex practices. However, the benefits are limited in the partial disclosure as there are challenges related to health-seeking behaviour, stress release and initiation of safe-sex practices. The paper describes partial disclosure as a dilemma between, on one hand, feeling free from secrecy, improved health and well-being and being able to solicit support, and on the other, fear of stigma and discrimination. It argues that a crucial aspect in the choice between partial and full disclosure is how PLHA deal with stigma and self-stigmatisation, related to a conceptualisation of HIV as a disease the bearers bring unto themselves through 'immoral' behaviour. It suggests that those who chose partial disclosure dealt with stigma through managing their disclosure by seeking out people who were unlikely to stigmatise and likely to be supportive. They dealt with self-stigma through 'insisting on innocence', repositioning themselves within the 'guilty'/'innocent' binary as 'innocent' without challenging the discourse of illness as personal responsibility. For the majority of those who disclosed fully, disclosure was experienced as a dilemma in the same way as for those who disclosed partially. In these cases, the dilemma was resolved by confronting stigma and refuting the stigmatising discourses that link HIV with personal responsibility and morality. Some informants who disclosed fully shortly after the diagnosis did not experience self-stigma and did not fear external stigma because they did not associate HIV with personal responsibility. Finally, this paper concludes that improved disclosure rates as well as a change from partial to a more inclusive or full disclosure is essential to realise the full benefits of disclosure, a change that is linked to challenging the conceptualisation of HIV as a condition linked to personal responsibility and 'immorality'.
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    Training clinic health committees: a vehicle for improving community participation in health
    (2017) Chikonde, Nkandu; Stuttaford, Maria; Haricharan, Hanne Jensen
    Objectives: In South Africa, and globally, community participation has become a key feature in the health system. In order for meaningful participation to occur within the health system several mechanisms have been identified as critical and this includes formation of health committees (HCs) at health facility level. Previous research indicates that health committees are imperative in both actualizing community participation and realisation of right to health. However, few studies have been undertaken to understand the impact training health committees has on community participation and right to health. This study sought to evaluate the impact training clinic health committees in community participation, health and human rights has on participation and right to health. The training been evaluated was led by Learning Network on Health and Human Rights and targeted four clinics in Cape Town Metropole of Western Cape, South Africa. The Learning Network is a grouping of five civil society organisations (CSOs) in Western Cape, South Africa at four universities which was launched in 2008 after the recognition of a gap in documented knowledge that CSOs had on health and human rights. The study explored health committees' changes in knowledge, perceived competencies, documented member's understanding of roles and HCs sustainability as well as the trainings impact on relationship between HCs and health service providers. Methods: The study was a multiple case study with multiple qualitative methods for data collection. Narrative data was collected through twelve in-depth interviews with health committee members, one facility manager, two focus group discussions and three physical observations across four health facilities. Health facilities were purposively selected from a list of health facilities trained by the Learning Network in 2014. Inclusion criteria also included English speaking health facilities and those in close proximity to each other. 2 Results: The study revealed that training HCs contributed to improved competencies, awareness and knowledge of community participation and the right to health. After the training, HC members were perceived to be more aware and responsive to their roles and responsibilities at the health facility. It was also noted that the training aided improved HCs perspectives on sustainability and roles, improved interpersonal skills and self-esteem. Conversely, the study revealed that despite the training improving participation and right to health, power imbalances between HC members and facility staff/managers who hold authority has a bearing on when and how participation occurs. Conclusion: The study demonstrates that training health committees contributed to improving the levels of community participation such as planning, consultation and advise [Arnstein, Rifkin and Loewenson] in the realisation of right to health. It is recommended for wider community participation that trainings of such magnitude are conducted together with facility managers/staff.