Browsing by Subject "Delivery of health care"
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- ItemOpen AccessClosing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions(2015) Shidhaye, Rahul; Lund, Crick; Chisholm, DanThis paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framework of self-care, primary care, and specialist care have been identified; the main challenge lies in the translation of that evidence into practice. The delivery of these interventions requires an approach that puts into practice key principles of public health, adopts systems thinking, promotes whole-of-government involvement and is focused on quality improvement. Key strategies for effective translation of evidence into action include collaborative stepped care, strengthening human resources, and integrating mental health into general health care. In order to pursue these principles and strategies using a platform-wide approach, policy makers need to engage with a wide range of stakeholders and make use of the best available evidence in a transparent manner.
- ItemOpen AccessCommunity 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, LeslieBACKGROUND: 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.
- ItemOpen AccessDelivery of health care for cardiovascular and metabolic diseases among people living with HIV/AIDS in African countries: a systematic review protocol(BioMed Central, 2016) Watkins, David A; Tulloch, Nathaniel L; Anderson, Molly E; Barnhart, Scott; Steyn, Krisela; Levitt, Naomi SBackground: People living with HIV (PLHIV) in African countries are living longer due to the rollout of antiretroviral drug therapy programs, but they are at increasing risk of non-communicable diseases (NCDs). However, there remain many gaps in detecting and treating NCDs in African health systems, and little is known about how NCDs are being managed among PLHIV. Developing integrated chronic care models that effectively prevent and treat NCDs among PLHIV requires an understanding of the current patterns of care delivery and the major barriers and facilitators to health care. We present a systematic review protocol to synthesize studies of healthcare delivery for an important subset of NCDs, cardiovascular and metabolic diseases (CMDs), among African PLHIV. Methods/design: We plan to search electronic databases and reference lists of relevant studies published in African settings from January 2003 to the present. Studies will be considered if they address one or both of our major objectives and focus on health care for one or more of six interrelated CMDs (ischemic heart disease, stroke, heart failure, hypertension, diabetes, and hyperlipidemia) in PLHIV. Our first objective will be to estimate proportions of CMD patients along the “cascade of care”—i.e., screened, diagnosed, aware of the diagnosis, initiated on treatment, adherent to treatment, and with controlled disease. Our second objective will be to identify unique barriers and facilitators to health care faced by PLHIV in African countries. For studies deemed eligible for inclusion, we will assess study quality and risk of bias using previously published criteria. We will extract study data using standardized instruments. We will meta-analyze quantitative data at each level of the cascade of care for each CMD (first objective). We will use meta-synthesis techniques to understand and integrate qualitative data on health-related behaviors (second objective). Discussion: CMDs and other NCDs are becoming major health concerns for African PLHIV. The results of our review will inform the development of research into chronic care models that integrate care for HIV/AIDS and CMDs among PLHIV. Our findings will be highly relevant to health policymakers, administrators, and practitioners in African settings.
- ItemOpen AccessDiscontinuation of follow-up care for young people with complex chronic conditions: conceptual definitions and operational components(BioMed Central, 2021-12-15) Skogby, Sandra; Bratt, Ewa-Lena; Johansson, Bengt; Moons, Philip; Goossens, EvaBackground A substantial proportion of young people with Complex Chronic Conditions (CCCs) experience some degree of discontinuation of follow-up care, which is an umbrella term to describe a broken chain of follow-up. Discontinuation of follow-up care is not clearly defined, and the great plethora of terms used within this field cannot go unnoticed. Terms such as “lost to follow-up”, “lapses in care” and “care gaps”, are frequently used in published literature, but differences between terms are unclear. Lack of uniformity greatly affects comparability of study findings. The aims of the present study were to (i) provide a systematic overview of terms and definitions used in literature describing discontinuation of follow-up care in young people with CCC’s; (ii) to clarify operational components of discontinuation of follow-up care (iii); to develop conceptual definitions and suggested terms to be used; and (iv) to perform an expert-based evaluation of terms and conceptual definitions. Methods A systematic literature search performed in PubMed was used to provide an overview of current terms used in literature. Using a modified summative content analysis, operational components were analysed, and conceptual definitions were developed. These conceptual definitions were assessed by an expert panel using a survey. Results In total, 47 terms and definitions were retrieved, and a core set of operational components was identified. Three main types of discontinuation of follow-up care emerged from the analysis and expert evaluation, conceptually defined as follows: Lost to follow-up care: “No visit within a defined time period and within a defined context, and the patient is currently no longer engaged in follow-up care”; Gap in follow-up care: “Exceeded time interval between clinic visits within a defined context, and the patient is currently engaged in follow-up care”; and Untraceability: “Failure to make contact due to lack of contact information”. Conclusion By creating a common vocabulary for discontinuation of follow-up care, the quality of future studies could improve. The conceptual definitions and operational components provide guidance to both researchers and healthcare professionals focusing on discontinuation of follow-up care for young people with CCCs.
- ItemOpen AccessMental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia(BioMed Central Ltd, 2010) Omar, Maye; Green, Andrew T; Bird, Philippa K; Mirzoev, Tolib; Flisher, Alan J; Kigozi, Fred; Lund, Crick; Mwanza, Jason; Ofori-Atta, Angela J; Mental Health and Poverty Research Programme Consortium (MHaPP)BACKGROUND: Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. METHODS: The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. RESULTS: Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. CONCLUSIONS: Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.
- ItemOpen AccessAn organisational typology of public private engagement for health in Southern Africa: A systematic review(2015) Whyle, Eleanor Beth; Olivier, JillIn Southern Africa, as elsewhere, public-private engagement (PPE) for the provision and financing of healthcare is considered a pervasive and valuable mechanism for meeting the health needs of the population. A wide range of mechanisms for engagement are available, each with organisational models that make them suited to overcoming particular barriers in particular health system contexts. The extent to which a PPE initiative produces the desired outcome is largely dependent on the organisational structure of the collaboration. This study uses scoping and systematic review methods to develop a typology of PPE models visible in Southern Africa and investigate the organisational variations between them. While a variety of PPE models are utilised in the current Southern African context, donor-dependency remains high and there is room to expand engagement of this sort by adopting more innovative mechanisms for engagement and organisational models. An account of the models of PPE being initiated in the Southern African context constitutes a first step toward an analysis of the effectiveness of various mechanisms, and points the way to areas of possible expansion of efforts to engage with the non-state health sector to more effectively align goals in the interest of public health. To some extent, possible models are determined by country context and state capacity. Nonetheless private resources for health, including capital, human resources and technical capacity of for-profit and not-for-profit non-state health sector organisations, represent a rich source of health systems resources that could be more fully utilised through more innovative PPE initiatives for delivery and financing of health care.
- ItemOpen AccessStrengthening mental health systems in low- and middle-income countries: the Emerald programme(2015-04-10) Semrau, Maya; Evans-Lacko, Sara; Alem, Atalay; Ayuso-Mateos, Jose L; Chisholm, Dan; Gureje, Oye; Hanlon, Charlotte; Jordans, Mark; Kigozi, Fred; Lempp, Heidi; Lund, Crick; Petersen, Inge; Shidhaye, Rahul; Thornicroft, GrahamAbstract There is a large treatment gap for mental health care in low- and middle-income countries (LMICs), with the majority of people with mental, neurological, and substance use (MNS) disorders receiving no or inadequate care. Health system factors are known to play a crucial role in determining the coverage and effectiveness of health service interventions, but the study of mental health systems in LMICs has been neglected. The ‘Emerging mental health systems in LMICs’ (Emerald) programme aims to improve outcomes of people with MNS disorders in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda) by generating evidence and capacity to enhance health system performance in delivering mental health care. A mixed-methods approach is being applied to generate evidence on: adequate, fair, and sustainable resourcing for mental health (health system inputs); integrated provision of mental health services (health system processes); and improved coverage and goal attainment in mental health (health system outputs). Emerald has a strong focus on capacity-building of researchers, policymakers, and planners, and on increasing service user and caregiver involvement to support mental health systems strengthening. Emerald also addresses stigma and discrimination as one of the key barriers for access to and successful delivery of mental health services.
- ItemOpen AccessTransexual woman on the journey of sexual re-alignment in a hetero-normative healthcare system in the Western Cape(2015) Newman-Valentine, Douglas David-John; Duma, SineguguThe purpose of this study was to understand the life-world of transsexual women in relation to their awareness of their unique health needs as a direct result of sexual realignment treatment, and their health-seeking behaviours, practices and experiences of responses in negotiating health care for their transgender-related health needs in the healthcare system. The overarching question asked in this research was: What are the lived experiences, and meaning of these experiences, for transsexual women during the sexual-realignment process when negotiating health care for their transgender-related healthcare needs in the healthcare system? Participants in this study were selected through purposive and snowball sampling. In-depth interviews were conducted with ten participants selected from urban, peri-urban, and rural areas of the Western Cape. Theoretical saturation was reached with the tenth participant, and further selection of participants was ceased. The data was viewed through a trans-inclusive feminist lens with a concurrent collection and analysis process as guided by the steps of analysis of Interpretative Phenomenological Analysis (IPA), as developed by Smith (2010). IPA is a modern qualitative approach to research inquiry which harnesses the strengths of phenomenology, hermeneutics, and ideography. The analysed data were illustrated in a master theme graphic which contained one superordinate theme, two subordinate themes and various categories. The superordinate theme of this study was named "Towards organic Womanhood", while the two subordinate themes were coined "Embracing Womanhood", and "Facing the Giant in order to Become". The subordinate theme Embracing Womanhood gives insight into aspects of transsexual women's journey of moving towards a state of organic womanhood, whereas the subordinate theme Facing the Giant in order to Become maps out powers in the healthcare system which prevent transsexual women from having a smooth transition journey. This study illustrates that transsexual women have a need to align their bodies with their gender identities, but even though South Africa has legislation which protects the health and rights of transsexual women, transsexual women find it challenging to make the transition. Health practitioners are ill-equipped to manage transsexual women, the care which they receive in the government-funded healthcare system is of a poor standard, and they are4subjected to extremely long waiting periods to have access to surgical sexual realignment services. Recommendations are made for the healthcare system, policy makers and educational institutions in order to stimulate the South African healthcare system to become inclusive and affirming to the needs of transsexual women. Furthermore, recommendations for researchers are made to stimulate the debate around transsexual health care in the scientific literature.