Browsing by Subject "Access"

Now showing 1 - 13 of 13
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    Open Access
    Access to health care for persons with disabilities in rural South Africa
    (2017) Vergunst, R; Swartz, L; Hem, K-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    BACKGROUND: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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    Access to health care for persons with disabilities in rural South Africa
    (BioMed Central, 2017-11-17) Vergunst, R; Swartz, L; Hem, K.-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M
    Background: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.
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    A critical discourse analysis of practical problems in a foundation mathematics course at a South African university
    (2016) Le Roux, Kate; Adler, Jill
    Mathematical problems that make links to the everyday and to disciplines other than mathematics—variously referred to as practical, realistic, real-world or applied problems in the literature—feature in school and undergraduate mathematics reforms aimed at increasing mathematics participation in contexts of inequity and diversity. In this article, we present a micro- and macro-analysis of a prototypical practical problem in an undergraduate mathematics course at a South African university. This course offers an alternative route to a mathematics major for students considered disadvantaged by enduring educational inequalities in South Africa. Using a socio-political practice perspective on mathematics and critical discourse analysis—drawn from Norman Fairclough’s critical linguists—we describe what mathematics and mathematical identities practical problems make available to students and compare this to what is valued in school mathematics and other university mathematics courses. Our analysis shows that these practical problems draw in complex ways on sometimes contradictory practices in the wider context, requiring the student to work flexibly with the movement of meaning within and across texts. We raise for further consideration the possible consequences of this complexity and offer suggestions for practice that take into account issues of power.
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    Exploring the access and influence of Edu TV and radio programs on the learners' self-directed learning among the grade 12 learners enrolled on distance mode at Namibian College of Open Learning (NAMCOL )
    (2020) Nenghwanya, Erestine; Ismail, Salma
    This research study focused on the issue of access to flexible learning and the use of technology (radio and TV) to assist in the learning process. The study was aimed at measuring the influence of these technology services among grade 12 learners enrolled on distance mode at Namibia College of Open Learning (NAMCOL). The majority of distance education systems around the world have the same general structure of guiding students, which are based primarily on student-centered learning that demands a learner to work independently. Regular lecturing facilities for distance learners are only possible in scheduled workshops at study centers. These provisions are however, inconvenient since most distance learners are working people, as well as inadequate to provide the necessary educational guidance to distance learners. In situations where regular interaction between teacher and student is limited or not possible, the media plays a vital role in providing educational assistance to these learners. NAMCOL, as an institution, has embraced the concept of utilizing media to assist distance learners with programs such as Edu TV and Radio Programmes as well as Online resources. Self-directed learning theories and Malcolm Knowles's theory of Andragogy were used as the theoretical frameworks for the study. In exploring access and influence of Edu TV and radio program on the learner's self-directed learning among the grade 12 learners enrolled at distance mode at Namibian College of Open Learning (NAMCOL), the researcher employed several research strategies to measure the influence that flexible programs have on learners. The research strategies employed in the study included questionnaires and interviews, which were used to yield both qualitative and quantitative research data. The main findings of the study were that the flexible learning policy implemented by NAMCOL is proving successful in affording distance learners access to Edu TV and radio program services. All participants indicated that the lessons were informative. Furthermore, it helps learners to assume responsibility for their learning. However, additional efforts from all stakeholders are required to keep up with the ever-expanding demand for ODL platforms. The study further revealed that implementing appropriate Andragogy fostered self-directed learning. In light of the findings of the research and the Andragogy applied, even though learners have access to the Edu programs, the lack of physical and appropriate technologies can impact negatively. For example, you can be self-directed, but if there are physical constraints and challenges in the pedagogy, the learners are demotivated to be self-directed.
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    Factors associated with patient-reported experiences and outcomes of substance use disorder treatment in Cape Town, South Africa
    (2022-02-02) Myers, Bronwyn; Koch, J R; Johnson, Kim; Harker, Nadine
    Background Interventions are needed to improve the quality of South Africa’s substance use disorder (SUD) treatment system. This study aimed to identify factors associated with patient-reported suboptimal access, quality, and outcomes of SUD treatment to guide the design of targeted quality improvement initiatives. Method We analysed clinical record and patient survey data routinely collected by SUD services in the Western Cape Province, South Africa. The sample included 1097 treatment episodes, representing 32% of all episodes in 2019. Using multivariate logistic regression, we modelled socio-demographic, substance use and treatment correlates of patient-reported suboptimal access to, quality and outcomes of SUD treatment. Results Overall, 37.9% of patients reported substantial difficulties in accessing treatment, 28.8% reported suboptimal quality treatment, and 31.1% reported suboptimal SUD outcomes. The odds of reporting poor access were elevated for patients identifying as Black/African, in residential treatment, with comorbid mental health problems, and longer histories of substance use. Length of substance use, comorbid mental health problems, and prior SUD treatment were associated with greater likelihood of reporting suboptimal quality treatment. Patients with comorbid mental health problems, polysubstance use, who did not complete treatment, and who perceived treatment to be of poor quality were more likely to report suboptimal outcomes. Conclusion This study is among the first to use patient-reported experiences and outcome measures to identify targets for SUD treatment improvement. Findings suggest substantial room to improve South African SUD treatment services, with targeted efforts needed to reduce disparities in outcomes for patients of Black/African descent, for those with comorbid mental health problems, and for patients who have chronic substance use difficulties. Interventions to enhance the relevance, appropriateness, and acceptability of SUD services for these patient sub-groups are needed to improve system performance.
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    Growing inequities in maternal health in South Africa: a comparison of serial national household surveys
    (2016) Wabiri, Njeri; Chersich, Matthew; Shisana, Olive; Blaauw, Duane; Rees, Helen; Dwane, Ntabozuko
    Abstract Background Rates of maternal mortality and morbidity vary markedly, both between and within countries. Documenting these variations, in a very unequal society like South Africa, provides useful information to direct initiatives to improve services. The study describes inequalities over time in access to maternal health services in South Africa, and identifies differences in maternal health outcomes between population groups and across geographical areas. Methods Data were analysed from serial population-level household surveys that applied multistage-stratified sampling. Access to maternal health services and health outcomes in 2008 (n = 1121) were compared with those in 2012 (n = 1648). Differences between socio-economic quartiles were quantified using the relative (RII) and slope (SII) index of inequality, based on survey weights. Results High levels of inequalities were noted in most measures of service access in both 2008 and 2012. Inequalities between socio-economic quartiles worsened over time in antenatal clinic attendance, with overall coverage falling from 97.0 to 90.2 %. Nationally, skilled birth attendance remained about 95 %, with persistent high inequalities (SII = 0.11, RII = 1.12 in 2012). In 2012, having a doctor present at childbirth was higher than in 2008 (34.4 % versus 27.8 %), but inequalities worsened. Countrywide, levels of planned pregnancy declined from 44.6 % in 2008 to 34.7 % in 2012. The RII and SII rose over this period and in 2012, only 22.4 % of the poorest quartile had a planned pregnancy. HIV testing increased substantially by 2012, though remains low in groups with a high HIV prevalence, such as women in rural formal areas, and from Gauteng and Mpumalanga provinces. Marked deficiencies in service access were noted in the Eastern Cape ad North West provinces. Conclusions Though some population-level improvements occurred in access to services, inequalities generally worsened. Low levels of planned pregnancy, antenatal clinic access and having a doctor present at childbirth among poor women are of most concern. Policy makers should carefully balance efforts to increase service access nationally, against the need for programs targeting underserved populations.
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    The impact of mHealth interventions on health systems: a systematic review protocol
    (BioMed Central, 2016-11-25) Fortuin, Jill; Salie, Faatiema; Abdullahi, Leila H; Douglas, Tania S
    Background: Mobile health (mHealth) has been described as a health enabling tool that impacts positively on the health system in terms of improved access, quality and cost of health care. The proposed systematic review will examine the impact of mHealth on health systems by assessing access, quality and cost of health care as indicators. Methods: The systematic review will include literature from various sources including published and unpublished/grey literature. The databases to be searched include: PubMed, Cochrane Library, Google Scholar, NHS Health Technology Assessment Database and Web of Science. The reference lists of studies will be screened and conference proceedings searched for additional eligible reports. Literature to be included will have mHealth as the primary intervention. Two authors will independently screen the search output, select studies and extract data; discrepancies will be resolved by consensus and discussion with the assistance of the third author. Discussion: The systematic review will inform policy makers, investors, health professionals, technologists and engineers about the impact of mHealth in strengthening the health system. In particular, it will focus on three metrics to determine whether mHealth strengthens the health system, namely quality of, access to and cost of health care services. Systematic review registration: PROSPERO CRD42015026070.
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    Institutional inclusion in Higher Education: an analysis of the experiences of access, belonging and participation of international/ foreign students at the University Of Cape Town.
    (2021) Naidoo, David; Cliff, Alan
    Despite the ongoing global conflicts, wars, disputes and crises which face the world, education is one of the forces enabling global unity. Cultural enrichment, through ‘semesters away,' student exchange programmes and the marketing of ‘ivy-league' education online, have resulted in an explosion in student migration. However, international student migration is not a new concept, dating back to the twelfth and thirteenth centuries in Europe, where foreign students formed communities at recognized universities. The value of global migration in the realm of academics, has gained increasing attention in light of the tremendous value migrant students add to host countries' cultural, political and academic landscapes. However, the largest contribution relates to economic gain, which earns host countries billions of US dollars. While migrant students may be ‘welcome' into host communities, evidence points to issues surrounding homesickness, xenophobia, acculturative stress and social adjustment. One of the largest pull factors in student migration is the issue of university rankings. The University of Cape Town (UCT) is described as the ‘Harvard' of Africa due to its global and local ranking. The institution is ranked 1st in Africa and 136th in the world, in part for its international outlook (staff, students and research collaboration) (Times Higher Education, 2020). It is for this reason that students from across the globe traverse to South Africa to obtain a recognised qualification. The seductive power of UCT as a highly ranked university, exerts a tacit, subtle power over IS. Although there is this academic attraction, student experiences of access, participation and belonging may be questionable. Apart from seductive power, overt power, as seen in the application process for visas, study permits and inflated fees for IS, may create barriers to entry. Migrant student experiences may also be affected by the recent and continued volatility in the higher education landscape. Student mass action, centred on the calls for the #feesmustfall / #rhodesmustfall (‘fallist movements') and calls to decolonise higher education, have taken centre stage in the South African academic landscape. This begs the question of where and how IS fit into the struggle of the host nation. Students' ability to cope and acculturate into the host society is influenced by socio-cultural capital, determined largely by their country of origin (global north versus global south). In this regard IS may experience acceptance or marginalisation based on their social capital or by how they are viewed and accepted by the host nation. Students can also build resilience through assimilation, integration and self- marginalisation. The role of host societies and institutions in assisting migrant students to cope with the acculturation process and culture shock is globally, well documented. This researched is aimed at uncovering issues of access, participation and belonging of IS at the University of Cape Town. The aim of this study was explored by asking the following questions: What are the lived experiences of access, belonging and participation of international students at the University of Cape Town? Sub questions: i. What factors motivated students to migrate to South Africa? ii. How did IS experience and negotiate their experiences during the application process? iii. What were their experiences during registration and orientation? iv. What were their experiences academically and socially? v. How did they negotiate their transition from their home countries to South Africa? vi. What are the differences in experience between IS from varying socio-economic, cultural and geographic backgrounds? This qualitative research, using constructivist grounded theory, sought to uncover the experiences of IS through the lens of inclusive education, power, social capital, acculturation and voice research. Addressing issues of inclusive education is sometimes described as a conundrum in seeking to find solutions to, exactly ‘who is included, and into what?' Research indicates that inclusion is rather a layered, grey area rather than a binary of ‘who is in or who is out?' What inclusive education points to however, is the nature of power between students and institutions. The effects of the various types of power relations on IS are greatly influenced by class, culture, race and origin of students. This study captures the experiences of a cohort of 25 IS from various parts of the world and includes representation from both sexes and varying years of study. Findings of this study, relating to access, participation and belonging within the ambits of inclusive education, indicate varying degrees of inclusion. In the main, the political and geographical nature of the country of origin has a pronounced bearing on the experience of the IS. Similarly, the effects of the seductive power of western, coloniality play an integral role in choice of institution. The South African scenario is further complicated by student unrest/ #fallist movements which further alienates IS.
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    Local level inequalities in the use of hospital-based maternal delivery in rural South Africa
    (2014-07-15) Silal, Sheetal P; Penn-Kekana, Loveday; Bärnighausen, Till; Schneider, Helen
    Abstract Background There is global concern with geographical and socio-economic inequalities in access to and use of maternal delivery services. Little is known, however, on how local-level socio-economic inequalities are related to the uptake of needed maternal health care. We conducted a study of relative socio-economic inequalities in use of hospital-based maternal delivery services within two rural sub-districts of South Africa. Methods We used both population-based surveillance and facility-based clinical record data to examine differences in the relative distribution of socio-economic status (SES), using a household assets index to measure wealth, among those needing maternal delivery services and those using them in the Bushbuckridge sub-district, Mpumalanga, and Hlabisa sub-district, Kwa-Zulu Natal. We compared the SES distributions in households with a birth in the previous year with the household SES distributions of representative samples of women who had delivered in hospitals in these two sub-districts. Results In both sub-districts, women in the lowest SES quintile were significantly under-represented in the hospital user population, relative to need for delivery services (8% in user population vs 21% in population in need; p < 0.001 in each sub-district). Exit interviews provided additional evidence on potential barriers to access, in particular the affordability constraints associated with hospital delivery. Conclusions The findings highlight the need for alternative strategies to make maternal delivery services accessible to the poorest women within overall poor communities and, in doing so, decrease socioeconomic inequalities in utilisation of maternal delivery services.
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    Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme
    (BioMed Central, 2018-01-04) Goudge, Jane; Alaba, Olufunke A; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F
    Background: Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. Methods: Using a cross-sectional survey across four of South Africa’s nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. Results: A quarter of respondents remained uninsured, even higher among 20–29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. Conclusions: By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country’s financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.
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    Social health insurance contributes to universal coverage in South Africa, but generates inequities: survey among members of a government employee insurance scheme
    (2018) Goudge, Jane; Alaba, Olufunke A; Govender, Veloshnee; Harris, Bronwyn; Nxumalo, Nonhlanhla; Chersich, Matthew F
    Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC.
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    Symbolic access: medical students’ awareness of institutional culture and its influence on learning, a phenomenographic study
    (2024-01-04) Lulua, Dina-Ruth; Moch, Shirra
    Abstract Background The discussion of access in medical education has its focus largely on physical and epistemological access, leaving a qualitative gap regarding sociocultural factors which enable access in this context. This study introduces and defines symbolic access, a concept with a specific lens on sociocultural inclusion, and the influence it has on student learning within the South African medical education landscape. Methods A phenomenographic design was used to explore students’ conceptions of symbolic access and its impact on learning. One-on-one exploratory interviews were conducted with fifteen final year medical students at the University of Witwatersrand in Johannesburg. Interviews were analysed using Sjöström and Dahlgren‘s seven-step phenomenography model. Results Four categories of description were induced, which described students’ understanding of symbolic access, these were rejection, disregard, invalidation, and actualization. Four dimensions of variation were discovered expressing the diversity of events which informed the collectives’ understanding of the phenomenon. These dimensions were; interactions with educators, peer relationships, educational environment, and race. Categories of description and dimensions of variation formed the Outcome Space, a visual representation of the student experience of symbolic access. The outcome space had a double narrative related to symbolic access; exclusion (major) and actualization (minor). Medical student’s chief experience within the medical community was exclusion, however clinical immersion, meaningful participation, peer-relationships, and clinical skills lessons facilitated community enculturation, and impacted learning. Conclusion Despite deeply exclusionary experiences throughout their programme, medical students articulated a paradox of both awareness and no awareness of symbolic access. The awareness of symbolic access was predominantly influenced by clinical experiences and clinical immersion during the pre-clinical and clinical years of study. Further, descriptions of valuable learning experiences were connected to clinical events and the involvement with patient care. This study suggests that the actualization of symbolic access and description of meaningful learning experiences are linked. Medical educationalists should design undergraduate curricula with early clinical immersion at the fore and explore symbolic concepts pertaining to access, as they are linked to transformative learning experiences for the medical student.
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    Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level
    (BioMed Central Ltd, 2015) O'Connell, Thomas; Bedford, K.; Thiede, Michael; McIntyre, Di
    INTRODUCTION: A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. METHODS: We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. RESULTS: Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. CONCLUSIONS: To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.