Browsing by Subject "healthcare"

Now showing 1 - 11 of 11
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    Analysing the structure and nature of medical scheme benefit design in South Africa
    (2015) Kaplan, Josh Tana; Ramjee, Shivani
    This dissertation intends to shed light on open-membership medical scheme benefit design in South Africa. This will be done by analysing the benefit design of 118 benefit options, so as to provide an overview of the structure and nature of the benefit offerings available in the market in 2014. In addition, affordability of these benefit options was analysed in order to identify whether or not there exist connections between the benefits on offer and the price of cover. This paper will argue that at present, the large number of benefit options available in the market, the lack of standardisation between benefit options, together with the mosaic of confusing terminology employed in scheme brochures, creates a highly complex environment that hampers consumer decision making. However, this implicit complexity was found to be necessary owing to the incomplete regulatory environment surrounding medical schemes. The findings of this investigation show that benefit design requires significant attention in order to facilitate equitable access to cover in South Africa.
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    Assessing the impact of mHealth on the autonomy of diabetic patients: a systematic review
    (2023) Pincus, Shannon; Conrad, Nailah; Mthoko, Hafeni
    Background mHealth has emerged as a major modality for the provision of healthcare and it is generally proposed that mHealth interventions improve patient autonomy. Diabetes mellitus requires chronic management to mitigate a myriad of serious complications. mHealth uses features such as regular reminders to encourage patient engagement with health treatments. This may assist with chronic diabetes management. This systematic review aims to answer the research question: What is the impact of mHealth interventions on patient autonomy? Methods A systematic review was conducted, in accordance with the PRISMA-P 2020 checklist, to critically assess the literature from the following databases: PubMed, Scopus, Cochrane Library, Web of Science, EBSCO, Africawide, Academic Search Premier, CINAHL and APA PsycInfo. Both free text words and medical subject heading terms [MeSH] were used as required. Both randomised and nonrandomised studies were reviewed, and studies were considered eligible if they met the predetermined inclusion criteria as follows: populations over 18 years of age and diagnosed with diabetes mellitus type 1, diabetes mellitus type 2 or gestational diabetes, using an mHealth intervention where the outcome related to patient autonomy. A thematic analysis was conducted to critically assess the articles. Results Eighteen studies that met the eligibility criteria were included in this systematic review. 12 of the articles focused on patients with diabetes mellitus type 2, 3 focused on both types 1 and 2, 1 focused on gestational diabetes and 2 articles were unclear on the type of diabetes considered. The interventions used included interactive voice response interventions, text messages, phone calls and mHealth applications. Outcomes primarily focused on health literacy and various health outcomes such as medication adherence, healthy eating, exercise, and glycated haemoglobin (HbA1c). The thematic analysis revealed that there were challenges with conceptualising autonomy and mHealth, rather focusing on what seem to be components of autonomy, such as self-management. Despite this, the articles seem to suggest mHealth may have some value in improving patient autonomy. Discussion In critically assessing the literature it seemsthat mHealth does promote the components of autonomy of diabetic patients, especially through text-messaging based interventions that act as reminders and support patients. However, this is tempered by the issues surrounding the concept of autonomy. There is a lack of critical thought and interrogation around autonomy. The articles do not define autonomy or measure autonomy, rather focussing on the components of autonomy such as selfmanagement, health literacy and improved health outcomes. The complexities surrounding the concept of autonomy, such as the focus on rationality, diminish its utility in a healthcare setting. Instead, it is the components of autonomy that offer a better tool for driving behaviour change in diabetic patients. Conclusion mHealth may improve the components of autonomy (such as self-management, health literacy and improved health outcomes) in diabetic patients. Text-message based systems especially, are useful in promoting self-care behaviours as part of a self-management scheme. A deeper understanding of the concept of autonomy is essential to mitigate against the limitations of autonomy in its current state, namely the centrality of rationality. A discussion around alternative terminology and ways to measure improvements may be useful. This can then inform new mHealth designs that generate the best patient outcomes.
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    Assessment of access to health care systems in Tanzania with emphasis on social health insurance and micro -insurance schemes
    (2010) Themba, Ferdinand Marcel; Kalula, Evance
    Health care services in Tanzania vary according to geographical location and the provisioning of health services is relatively poor. This is true when one considers the fact that about 25 % of Tanzanians live below the poverty line. Other factors include the lack of human resources personnel and the problems in drugs supply. This study examines the efforts of the government on health care provision and administration since 1961. The study critically discusses the current health care services financing system by way of insurance both statutory and the micro insurance schemes. The study reveals that the government allowed private health care services which have a good partnership with public sector in the provision of health care services. Besides, in 2002 the government allowed traditional and alternative health practices. Also, the study describes the effectiveness of health sector reforms which led to the decentralisation of the provision of health services to the local government and the adoption of primary health care services which focused on the improvement of health care services in the village and ward level. The government introduces alternative means of financing health care services after it became impossible to provide free health care services. On this footing the study examines the challenges and effectiveness of the National Health Insurance Fund (NHIF) which provides health care insurance to public service employees. In addition, the Social Health Insurance Benefits offered by the National Social Security Fund (NSSF), Community Health Fund (CHF), Community Based Health Financing (CBHF) and private insurance are examined on the basis of their achievement and challenges in financing health care services. Initiatives of providing health care assistance for the identified groups of people as per the National Health Policy 2007 attract attention of the researcher. The study makes a number of recommendations including the need to amend the Constitution to provide for right to health. Also the study recommends on the need to increase the public budget on health services which would solve the problem of inequalities of health care facilities in some districts and sponsor education to medical personnel. The study further recommends on the improvement on drugs supply and legal control of private health providers. The fact that the provisioning of health care services has taken the dimension of health care financing by way of either statutory insurance or micro insurance schemes the study recommends on the need to increase the coverage of health insurance schemes and further that the government need to address the issue of regulation of private health insurance schemes. On the part of micro insurance schemes there is need to adopt the means of collaboration as between the informal health insurance schemes and formal health insurance schemes so as to attain solidarity.
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    Comparing health outcomes in infants born to mothers initiated on ART during pregnancy and randomised to receive postpartum ART services from primary healthcare facilities or adherence clubs
    (2026) Dinkele, Ryan; Odayar, Jasantha
    Introduction: Adherence clubs (ACs) increase retention in care among postpartum women living with HIV. However, the effect of maternal antiretroviral therapy (ART) provision through ACs on infant health remains unknown. Methods: This study utilised data from a parallel-arm randomised controlled trial that enrolled women who initiated ART during pregnancy, were within 70 days postpartum, and who met standard AC eligibility criteria (clinically stable and viral load <400 copies/mL). Consenting women were randomised to community-based ACs (n = 201) or routine primary healthcare (PHC) clinics (n = 194) for ART service delivery and followed for two years. Infant care was provided separately at “well baby” clinics. Outcome frequencies were calculated by summing the number of visits at which lower respiratory tract infection, diarrhoeal illness, care-seeking, and overnight hospitalisation were self-reported. Multivariate Poisson regression was then used to quantify the associations between each trial arm and study outcome, controlling for various maternal demographic and infant health covariates. Results: Data were available for 395 mother-infant pairs, representing 1681 visits. There were 27 and 20 instances of lower respiratory tract infection and 60 and 55 occurrences of diarrhoeal illness in PHC and AC trial arms, respectively. Lower respiratory tract infection (aIRR 0.73; 95% CI 0.39–1.32) and diarrhoeal illness (aIRR 0.87; 95% CI 0.60–1.27) were self-reported at equivalent rates between trial arms. Mothers attending ACs were less likely to report seek care (205 vs. 247 times) for their infants compared to mothers receiving ART from PHC clinics (aIRR 0.80; 95% CI 0.66–0.97). Infants of mothers attending ACs were reported as being hospitalised less frequently (15 vs. 26 times) compared to those within the PHC study arm (aIRR 0.55; 95% CI 0.28–1.07; p value = 0.083) but this was not statistically significant. Conclusions: Occurrence of illness was similar in both groups. However, mothers receiving ART from ACs were less likely to access care for their infants than those receiving ART from PHC clinics. While this may reflect the increased care demands associated with community-based ART service delivery, further research is needed to clarify the mechanisms underlying these differences in care-seeking behaviour.
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    Gender and Access to Antiretroviral Treatment in South Africa.
    (Taylor & Francis, 2008) Nattrass, Nicoli
    This paper explores the gender dimensions of access to highly active antiretroviral therapy (HAART) in South Africa. It shows that women are more vulnerable to HIV infection than men, but that women access HAART in disproportionately large numbers. Regression analysis on data from the South African Demographic and Health Survey suggests that men in general access health services less readily than women. This 'masculinity factor' accounts for most of the difference between men and women when it comes to accessing HAART. Although men were more likely to favor traditional medicine than women, this was not a statistically significant factor, and it appears that visiting a traditional healer is complementary to, rather than a substitute for, accessing HAART. In short, it seems that gendered norms that make it difficult for men to admit weakness and seek medical attention are the main probable cause for the low proportions of men accessing HAART.
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    Human rights key: lesbian, gay, bisexual, transgender and intersex themed key
    (2013) Mitchell, Veronica
    This resource aims to provide information to promote the health of sexual and gender minorities. The LGBTI Key is a new theme on the Human Rights Key with links to numerous multimedia resources. It can be a useful teaching and learning tool for educators, students and healthcare providers. It can also assist individuals who may experience discrimination and stigma when wishing to access health care.
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    Hunger meets healthcare: investigating the barriers to public healthcare access for food insecure patients in a low-resourced Cape Town suburb
    (2026) Weaver, Shannon Beth; Battersby, Jane
    Food insecurity is a significant barrier to public healthcare in South Africa, affecting childhood development, non-communicable disease (NCD) management, and the complexities of HIV/AIDS and Tuberculosis (TB) care. Addressing the social variables impacting health within South Africa remains a challenge for the formal health system. Low-income neighbourhoods, affected by rapid urban development and historical marginalisation, continue to grapple with poverty, hunger, housing instability, and poor health outcomes. Inadequate access to nutritious food creates profound challenges within public healthcare. Addressing these challenges necessitates not only targeted interventions, but also systemic changes in healthcare policies and enhanced collaboration between community support services and the formal health system. This study aims to examine the perspectives of healthcare workers regarding hunger as a barrier to healthcare. It investigates how a community clinic and social support services collaborate to address issues related to hunger, malnutrition, food insecurity, and health equity. This thesis is contextualised through two conceptual frameworks: UNICEF's systems-thinking approach to maternal and child nutrition, and the World Health Organisation's (WHO) Social Determinants of Health (SDOH) framework. Key findings from this case study reveal that food insecurity significantly impedes patients' adherence to TB and HIV/AIDS medication regimens. Diet-related issues contribute to the lack of improvement in patients with high blood pressure and diabetes who are on medication, demonstrating a direct link between poor diets and the ineffectiveness of standalone treatment. Additionally, there is a disconnect in basic health information, limiting patients' understanding and agency over their illnesses. Health stigma is prevalent, underscoring the need for support groups, and the absence of socio-economic context in medical staff training affects their initial contextual knowledge on the social issues faced by patients within the area as well as knowledge on available social services offered in the area. Addressing food insecurity and related barriers is crucial for improving healthcare access and outcomes. Effective communication and integration within healthcare and community support systems are essential to address the complex nature of these issues. This research highlights the need for healthcare models that incorporate a social perspective to effectively address the challenges faced by individuals in low-income areas.
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    Innovative Finance Week 1 Video 5 - Impact healthcare
    (2019) Ngoepe, Tsakane
    In this video we focus on the issues concerning the health sector. We highlight that unlike the rest of the world, many countries in emerging markets continue to suffer many communicable diseases, which in turn reduces the life excpectancy of their population. we highligh that the gap in financing health outcomes gives an opportunity fr private investment to meet the world's healthcare needs. This is video 5/11 in week 1 of the Innovative Finance: Hacking Finance to change the World course.
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    Medicine and the Arts Week 1 - Interdisciplinarity in the medical humanities
    (2015-01-21) Reid, Steve
    In this video, Professor Steve Reid describes how when looking at the practices of healthcare and medicine there are two perspectives we could consider, namely from the outside-in and from the inside-out. He explains how the outside-in perspective comes from the social sciences and arts while the inside-out represents the medical sciences. This is the eighth video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 1 - Welcome to the course
    (2015-01-21) Reid, Steve; Levine, Susan
    In this video, Associate Professor Susan Levine and Professor Steve Reid from the University of Cape Town introduce the purpose and design of the Medicine and the Arts Massive Open Online Course. They introduce the concept of medical humanities as a pedagogy to assist in the education and training of medical students in South Africa, addressing the specific social and cultural experiences of healthcare in South Africa and how an interdisciplinary approach between the humanities and medical science can provide a useful lens for addressing the healthcare needs of the country. This is the first video in Week 1 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 2 - In dialogue about children's voices
    (2015-01-21) Levine, Susan; Callaghan, Nina; Abney, Kate; Hendricks, Marc
    In this video, Associate Professor Susan Levine pose questions to Dr. Hendricks, Dr. Kate Abney, as well as Nina Callaghan in an attempt to unlock some of the synergies that brings their various perspectives into focus. Marc Hendricks is asked how doctors take care of themselves in dealing with the deaths, illness and victories of their patients’ stories. Kate talks about how she has used art as part of her research methodology and discusses how the issue of time surfaced in her work at the TB hospital. Nina provides an example of a child she had worked with. This is the fifth video in Week 2 of the Medicine and the Arts Massive Open Online Course.