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While literature extensively examines waste management issues in urban areas, limited attention has been given to rural developing waste contexts. This paper aims to understand the policy/implementation nexus between national and local government within the rural waste management context in two rural municipalities in KwaZulu-Natal, South Africa. The research utilizes a directed deductive content analysis applying a framework proposed by Pollans. Originally designed for urban contexts, this framework has proven valuable for comprehending solid waste management policy implementation challenges in rural settings. This paper proposes an adjustment to this framework, differentiating the disposal mode of governing into government-based and self-reliant-based approaches. The authors found a significant implementation gap in both municipalities, characterized by a predominant, incremental disposal-oriented governing mode. This contrasts with the visionary and aspirational modes of governing promoted by the national government, focusing on diversion and eco-efficient waste strategies. These divergent modes of governing influence current waste management practices, especially in rural municipalities. We recommend strategies towards narrowing the implementation gap by formulating policies tailored to local development needs. Finally, the research sheds light on the challenges and disparities in rural waste management policy implementation and provides insights into how rural areas can transition towards sustainable waste management practices. [ABSTRACT FROM AUTHOR]

Purpose: Municipalities, as the front lines of service delivery, use websites as one of the tools to communicate information to the public. While it is considered a record, many organisations, including municipalities, do not manage websites as such. This study aims to explore the archiving of websites as records in the municipalities of KwaZulu-Natal (KZN) Province in South Africa by using the web archiving life cycle model. Design/methodology/approach: This study used a mixed-methods research with an explanatory design, with quantitative data collected first through content analysis of websites and qualitative data collected through interviews. Researchers used multilevel sampling, first quantitatively analysing all available websites of the municipalities (52) in KZN, and then qualitatively selecting only records managers, information managers, web administrators, communication managers and website managers or designers from municipalities because of their understanding and involvement with websites in some way. Findings: This study established that some records on municipal websites are often in paper format in record-keeping systems, whereas others are born digital and are not captured in the systems. Municipalities lack a dedicated web online harvesting tool as well as an archiving policy or strategy to guide website archiving. Furthermore, municipalities placed a high reliance on service providers to keep their websites operational. Research limitations/implications: It became clear during the interviews that most of the participants were unfamiliar with web archiving. As a result, only 12 of the 56 selected participants from the municipalities provided the required information in relation to the current study as others could not provide answers. Data for other participants were not analysed. Originality/value: Due to a lack of infrastructure for ingesting digital records into archival custody, a framework for harvesting web content of value is proposed both internally in municipalities and externally to an archive repository. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are central to the global health response to crises like the AIDS epidemic. Yet community health work remains undervalued and undercompensated worldwide owing in large part to the gendered and racialized contexts of care work. This paper investigates the possibility of occupational security for CHWs by comparing two cases from South Africa's response to AIDS. The first draws on ethnographic research (2007–2009) in rural KwaZulu‐Natal province and documents the fraught formation of a union representing CHWs. The second examines legal action in the Free State province for a group of CHWs known as the Bophelo House 94, who were arrested and criminally charged in June 2014 after protesting their sudden dismissal by the government. This case comparison finds that collective action has thus far had limited effects on CHWs' position as a nascent occupation. The South African Ministry of Health has obstructed CHW professionalization, and non‐state actors' involvement has been a mixture of benefit and impediment: some social justice agencies have facilitated CHW advocacy, while many AIDS service organizations have cooperated with the state and exacerbated the precarity of CHWs' working conditions. However, the consolidation of CHW work roles—owing to advances in AIDS prevention and treatment—holds promise for future CHW collective organization. [ABSTRACT FROM AUTHOR]

Introduction: The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of tasksharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). Methods: The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention. MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Results: Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. Conclusions: The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC. [ABSTRACT FROM AUTHOR]

Background: Electronic clinical decision-making support systems (eCDSS) aim to assist clinicians making complex patient management decisions and improve adherence to evidence-based guidelines. Integrated management of Childhood Illness (IMCI) provides guidelines for management of sick children attending primary health care clinics and is widely implemented globally. An electronic version of IMCI (eIMCI) was developed in South Africa. Methods: We conducted a cluster randomized controlled trial comparing management of sick children with eIMCI to the management when using paper-based IMCI (pIMCI) in one district in KwaZulu-Natal. From 31 clinics in the district, 15 were randomly assigned to intervention (eIMCI) or control (pIMCI) groups. Computers were deployed in eIMCI clinics, and one IMCI trained nurse was randomly selected to participate from each clinic. eIMCI participants received a one-day computer training, and all participants received a similar three-day IMCI update and two mentoring visits. A quantitative survey was conducted among mothers and sick children attending participating clinics to assess the quality of care provided by IMCI practitioners. Sick child assessments by participants in eIMCI and pIMCI groups were compared to assessment by an IMCI expert. Results: Self-reported computer skills were poor among all nurse participants. IMCI knowledge was similar in both groups. Among 291 enrolled children: 152 were in the eIMCI group; 139 in the pIMCI group. The mean number of enrolled children was 9.7 per clinic (range 7-12). IMCI implementation was sub-optimal in both eIMCI and pIMCI groups. eIMCI consultations took longer than pIMCI consultations (median duration 28 minutes vs 25 minutes; p = 0.02). eIMCI participants were less likely than pIMCI participants to correctly classify children for presenting symptoms, but were more likely to correctly classify for screening conditions, particularly malnutrition. eIMCI participants were less likely to provide all required medications (124/152; 81.6% vs 126/139; 91.6%, p= 0.026), and more likely to prescribe unnecessary medication (48/152; 31.6% vs 20/139; 14.4%, p = 0.004) compared to pIMCI participants. Conclusions: Implementation of eIMCI failed to improve management of sick children, with poor IMCI implementation in both groups. Further research is needed to understand barriers to comprehensive implementation of both pIMCI and eIMCI. (349) Clinical trials registration: Clinicaltrials.gov ID: BFC157/19, August 2019. [ABSTRACT FROM AUTHOR]