Search

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice. [ABSTRACT FROM AUTHOR]

Background: Maternal and child health (MCH) remains a significant public health concern globally despite previous efforts made to improve MCH services. Initiatives such as antenatal care, postnatal care services exclusive breastfeeding, child vaccination and supplements have been rolled out to improve MCH outcomes. However, inadequate maternal healthcare, socioeconomic factors, obstetric haemorrhaging, complications of hypertension during pregnancy, lack of maternal information, poor universal health coverage and uptake of MCH services exacerbate maternal mortality and child mortality rates, especially in resource-constrained areas in many sub-Saharan African countries including South Africa. Objective: This study aimed to review mobile health (mHealth) interventions deployed to improve maternal and child health outcomes. Methods: The study adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses model to search and retrieve relevant literature from reputable, prominent electronic databases (Google Scholar, Scopus, PubMed, Embase, CINAHL, Web of Science, etc.). A total of 26 papers were selected and analyzed. Results: The findings revealed several mHealth interventions such as MomConnect, Mobile Alliance for Maternal Action, NurseConnect, ChildConnect, CommCare, Road to Health Application and Philani Mobile Video Intervention for Exclusive Breastfeeding have been utilized by healthcare workers and women to improve access to MCH services. However, inadequate digital infrastructure, digital divide, resistance to change, inadequate funding, language barriers, short message service and data costs, lack of digital skills and support, compatibility, scalability and interoperability issues, legislative and policy compliance, lack of mHealth awareness, data security and privacy concerns hinder uptake and utilisation of mHealth interventions. There is a need to scale up and sustain mHealth interventions and update existing regulatory framework, policies and strategies. Conclusion: mHealth interventions offer unprecedented opportunities to improve access to maternal information and substantially improve maternal and child health services. Stakeholder engagement and the development of sustainable funding strategies are important for successfully implementing and scaling mHealth projects while addressing existing and emerging key issues. [ABSTRACT FROM AUTHOR]

Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

Widowhood in Africa presents unique challenges for women due to cultural and social factors. This paper discusses the challenges of widowhood in African contexts with a view that various social, cultural, legal, financial, and economic issues are at the centre of the challenges widows face in Africa. A thematic literature review was used to examine the multifaceted challenges faced by widows in African societies. Findings show that widows in Africa face multiple challenges, including limited healthcare access, property rights, social support, and harmful traditional practices, impacting their well-being across various dimensions. Cultural attitudes, legal barriers, resource constraints, limited awareness, and the complex interplay of these factors hinder effective interventions. The literature review also found that changing cultural norms, improving access to education and economic opportunities, and strengthening social protection systems are crucial steps towards creating a more inclusive and equitable society for widows. The paper concludes that comprehensive and coordinated strategies are necessary to address these multifaceted challenges, including legal reforms, economic empowerment, awareness campaigns, and the provision of essential resources. Further, collaborative implementation of these strategies can promote gender equality, reduce poverty, and enhance the lives of widows in African countries. Further, there is a need for the urgency of comprehensive interventions and support systems to alleviate the hardships faced by widows in African societies. [ABSTRACT FROM AUTHOR]

Research studies as well as anecdotal evidence suggest that there are challenges regarding the NHI plan implementation. These include problems such as an increase in illnesses and a shortage of personnel to drive the project in South African public hospitals. This is exacerbated by the existing situation of most government-funded healthcare institutions, which are characterized by bad administration, insufficient budget, inadequate infrastructure, and insufficient drug supply, as highlighted in several studies. The hospital under investigation is one such facility, with a history of patients sleeping on the floor and people being turned away owing to a shortage of experts and an overburdened staff. This situation is concerning, given that the government claims to be providing appropriate funds to the institution. The hospital under research is highly regarded by the surrounding community. However, a visit by the Health MEC in 2014 revealed that the facility had insufficient sanitary standards and a high complaint rate. Based on the foregoing, as well as the difficulties that both employees and patients are confronted with at the  selected hospital, the question that emerges is whether the hospital is fit for the implementation of the NHI.Aim: The aim of this study was to assess the preparation for the launch of the national health insurance scheme at a Johannesburg hospital.Setting: The study was conducted at a hospital situated in eastern suburbs of Johannesburg, Gauteng, South Africa.Method: The study employed a qualitative method with an explorative, descriptive, qualitative study design. The population consisted of selected hospital employees, such as doctors, dispensary officers, hospital managers, human resources workers, facility managers, and administration record officials who were employed at the selected hospital. Purposive sampling was used to select participants.Sample Size: Category saturation was used to determine the sample size. The participants for the study were chosen using purposeful sampling, with the researcher aiming for those who were familiar with the NHI scheme at the institution. Semi structured interviews and a focus group discussion were used to gather data. The data from the focus group discussion and semi-structured interviews were analysed using thematic analysis.Results: The investigation found that the hospital was preparing to for the NHI implementation, but that was riddled with lack of resources, poor infrastructure, lack of training, delays in development and poor technological advances.Recommendations: The paper suggests that human resources be increased, infrastructure be upgraded, medicines and equipment be increased, and enough training on NHI implementation be provided.Contribution: The paper adds to the body of knowledge regarding the NHI in South Africa. [ABSTRACT FROM AUTHOR]

Background: Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment. Methods: We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study. Results: We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains—such as training, equipment, and supportive supervision—it is likely that the CHW cadre will continue to be seen as informal health care workers. Conclusions: CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment. [ABSTRACT FROM AUTHOR]

Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). Methods: Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings. [ABSTRACT FROM AUTHOR]

Analytics is increasingly becoming a key tool to support informed management decisions in organisations. An organisation's capability to make use of data analytics can enhance efficiencies and increase competitive differentiation and advantage. In the context of healthcare, analytics can support improved health outcomes and hence stakeholder value that enhances affordability and access to care. A deep understanding of analytics applications and techniques lends itself to identification of opportunities where analytics techniques are best applied. This paper introduces analytics maturity models as a tool to inform proportionally appropriate analytics applications. In this paper, a broader perspective is provided through consideration of the position on the analytics maturity curve of current techniques utilised in the healthcare system. The relationship between analytics maturity and analytics techniques in the healthcare space is then explored to demonstrate that there are opportunities for applying more sophisticated techniques to more advanced applications and hence enhance the efficiency of healthcare outcomes and health risk management [ABSTRACT FROM AUTHOR]

Background: Ward-Based Outreach Teams' (WBOTs) use of mobile technologies can promote better quality and improved health services for populations in low- and middle-income countries. However, the implementation of such systems is fraught with threats to sustainability. Purpose: The purpose of this study was to gain a deeper understanding of users' views and experiences of the implementation of mHealth in a selected sub-district in North West Province, South Africa. Methods: The study was qualitative, exploratory and descriptive. Data were collected from community health workers (CHWs) (n = 24) and outreach team leaders (OTLs) (n = 4) who used mobile devices loaded with the Mobenzi application through semi-structured focus group interviews, using an interview guide. Creswell's stages of thematic analysis were used for data analysis, and codes, categories and themes were validated with the participants. Results: Three themes emerged from the findings, namely the transition from a paper-based system to an electronic system; the use of the application; and reverting to paper-based documentation. The findings revealed that WBOTs considered the mHealth application as useful, easy to use, and supportive to their workflow. They experienced some technical challenges and lamented the inaccessibility of technicians. The mobile initiative's termination caused distress among the participants, especially CHWs who had to revert to paper-based documentation to capture community health data. OTLs were concerned about the quality of health data being captured in the absence of the application. Conclusions: The study concluded that community-based health care programmes that use WBOTs and mHealth technologies are essential in strengthening the health care system. WBOTs are facilitators for improving access to health care. Policy-makers and district managers will gain useful insights if they engage application users in discussions regarding future mobile health interventions for household and community-based care. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic necessitated that speech–language therapists (SLTs) make a radical change to provide services to their clients safely via telepractice. For many practitioners, telepractice was an unfamiliar mode of practice that had to be implemented under emergency conditions. Limited literature on SLTs' experiences of implementing telepractice in the Global South during this time is available. Aims: To explore the experiences of South African SLTs (N = 45) who implemented telepractice services during the COVID‐19 pandemic. Methods & Procedures: SLTs across the country were invited via professional bodies to participate in an online qualitative survey distributed in 2021. Data were analysed using thematic analysis principles. Outcomes & Results: We describe participants' reports of their current telepractices, discuss their perspectives on accessibility to telepractice for SLTs, clients and caregivers, and working with specific diagnoses, and consider the support needs of SLTs to enhance telepractice services. Most participants work in private practice or school settings with primarily paediatric caseloads. They reported telepractice as a positive experience and felt it was effective, although they judged that some clients were not well served by telepractice. SLTs felt underprepared for the rapid switch to telepractice and the flexibility required, especially given the limited availability of guidelines given the pandemic crisis. Greater preparation is required for telepractice sessions and more attention needs to be paid to supporting caregiver involvement online. Conclusions & Implications: Telepractice involves various barriers and facilitators, many of which seem common across Global North and South contexts. Support is required to enhance current telepractices in terms of computer literacy, technical education, different telepractice methods and caregiver coaching. Our findings have the potential to enable the development of support, training and guidelines to improve SLTs' confidence in providing telepractice whilst delivering quality services in an accessible and safe manner. WHAT THIS PAPER ADDS: What is already known on the subject: Many SLTs had to transition quickly to telepractice service provision during COVID‐19, with limited existing guidelines and support. Although there is some literature available on SLTs' experiences of implementing telepractice in the Global North, perspectives from the Global South during this time are limited. It is important to understand experiences, barriers and facilitators to telepractice provision to provide tailored support to practitioners. What this paper adds to existing knowledge: Telepractice provides a viable alternative to in‐person therapy for specific clients and contexts. Telepractice presents both benefits and barriers for effective clinical practice across Global North and South contexts. Greater preparation is required for telepractice sessions and more attention needs to be paid to enhancing caregiver involvement online, especially since many practitioners are likely to continue offering telepractice services post‐pandemic. What are the potential or actual clinical implications of this work?: Clinicians felt underprepared for the rapid switch from service delivery mode to telepractice. Greater support, training and guidelines for students and practitioners are required to enhance current practices and ensure practitioners are equipped to provide effective telepractice in the future. In particular, support should cover technological aspects, caregiver coaching and online assessment options, especially for paediatric clients. [ABSTRACT FROM AUTHOR]

Collaboration between midwives and traditional birth attendants for maternal and child healthcare is a challenge in rural South African communities due to the absence of a guiding framework. To address this, this study sought to develop and validate an inclusive framework informed by the Donabedian structure–process–outcome (SPO) framework for collaboration between these healthcare professionals. Method: Key stakeholders were invited to participate in a co-creation workshop to develop the framework. Twenty (20) participants were purposively sampled based on their maternal and child healthcare expertise. A consensus design using the nominal group technique was followed. Results: Participants identified the components needed in the framework, encompassing (i) objectives, (ii) structures, (iii) processes, and (iv) outcomes. Conclusion: This paper will contribute to the development of an inclusive healthcare framework, providing insights for stakeholders, policymakers, and practitioners seeking to improve maternal and child healthcare outcomes in resource-constrained, rural settings. Ultimately, the proposed framework will create a sustainable and culturally sensitive model that optimises the strengths of midwives and TBAs and fosters improved healthcare delivery to rural South African communities. [ABSTRACT FROM AUTHOR]

Background: The global Human Resources for Health (HRH) strategy emphasizes the need to invest in HRH to meet population needs and improve the provision of quality health care services. In South Africa, dietitians are recognized as registered professionals who provide nutrition services. In this paper, we used 2 key steps (3 and 4) of the eight step World Health Organization (WHO) Workload Indicators of Staffing Need (WISN) methodology to determine the workload components and activity standards for dietitians at South African central and tertiary public hospitals. Methods: All (9) provincial nutrition managers (phase one) and 21 out of a total 22 head dietitians at central and tertiary public hospitals (phase two) participated in an online survey. In phase one, the provincial managers provided the job descriptions (JDs) of dietitians in their provinces, and the JDs were analyzed to determine the baseline workload components. In phase two, dietitians participated in a multi-stage Delphi process to reach consensus on workload components and activity standards. Consensus was deemed to be agreement of 70% or more, while the median of participants' responses was used to obtain consensus on the activity standards. Results: The JDs of dietitians were a useful baseline for the consensus exercise as there were no other suitable source documents. The response rate was 100% for all three rounds of the Delphi survey. Dietitians reached agreement (consensus ≥ 70%) on 92% of proposed workload components and activity standards. Following the removal of duplicate and certain administrative activities, a total of 15 health, 15 support and 15 additional service activities with aligned activity standards resulted from the consensus exercise. Conclusion: The Delphi technique was a suitable method for reaching agreement on workload components and activity standards for dietitians at South African central and tertiary public hospitals. The findings from this study can now be used to compile a standardized list of workload components and activity standards and ultimately to determine dietetic staffing needs for the central and tertiary public hospital level of care. [ABSTRACT FROM AUTHOR]

South Africa by international standards has a poor public healthcare system. There has been a substantial increase in the literature on reforms such as austerity measures to improve healthcare service delivery in government health institutions. The global crisis of 2008/2009 forced the government to implement cost-cutting measures to reduce public expenditure and resolve budgetary pressures, including in the health sector. This paper adopted a mixed method to investigate the impact of staffing moratoria in the delivery of healthcare services in the Department of Health. 177 survey questionnaires were distributed to healthcare workers and 9 key informants were interviewed regarding staffing moratoria. Quantitative data was analysed using descriptive statistics, Chi-square tests of association and the Cramer's V test whilst qualitative data was analysed thematically. The results showed that staffing moratoria resulted in severe staff shortages and the deterioration of working conditions as a result of excessive working hours, job enlargement, and limited personal development opportunities. Staffing moratoria also promoted distrust between employees and management that furthered job dissatisfaction at the workplace. The paper concludes that staffing moratoria should be supported by a decentralised multi-dimensional approach in planning and implementation to ensure a collective consultative process involving all relevant stakeholders. [ABSTRACT FROM AUTHOR]

Background: Medical xenophobia of migrant (either in-migrants or immigrants) youths is an ongoing problem in contemporary South African society. Medical mistreatment by healthcare workers and social phobia from migrant youths have been attributed to major obstacles to healthcare utilization as well as health services satisfaction. This study aimed to determine the prevalence and factors contributing to health services satisfaction and medical exclusion among migrant youths in Gauteng province in South Africa. Methods: The Round 5 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey was conducted in 2017‒2018, a nationally representative survey piloted every two years in South Africa, was utilized in this study. A 2-year cohort study of 24,889 respondents aged 18 to 29 and a baseline data consisted of 4,872 respondents, comprising non-migrants, in-migrants and immigrants, from where 2,162 in-migrants and immigrants were utilized as the sample size. The data was analysed using descriptive statistics, Chi-Square analysis and logistic regression. Results: A total of 2,162 migrants, comprising 35.4% in-migrants and 9.0% of immigrants, from the 4,872 respondents, were included in the analysis. The prevalence of medical exclusion of in-migrant and immigrant youths were 5.5% and 4.2%, and the majority of them reported the use of public health facilities (in-migrants ‒ 84.3% vs. immigrants ‒ 87.1%). At the bivariate level, demographic (age, sex, and population group), economic (employed and any income) and health-related (no medical aid and household member with mental health) factors were significantly associated with medical exclusion (ρ≤0.05). The adjusted odds ratio showed that only female gender (AOR: 1.07, 95% CI: 0.678, 1.705), no medical aid cover (AOR: 1.23, 95% CI: 0.450, 3.362), and neither (AOR: 1.59, 95% CI: 0.606, 4.174) or dissatisfied (AOR: 4.29, 95% CI: 2.528, 7.270) were independent predictors of medical exclusion. Conclusion: Having no medical aid cover, being a female and dissatisfied, or neither satisfied nor dissatisfied with health services significantly increased the odds of medical exclusion among migrant youths. To increase healthcare utilization and ensuring adequate medical care of migrant youths, opting for medical aid insurance without increasing costs should be guaranteed. Therefore, there should be no consequences for lack of residence status or correct documentation papers when accessing healthcare services among migrant youths in South Africa. [ABSTRACT FROM AUTHOR]

Database right, as a subcategory of copyright law, rewards the creative exploits, labour and skill expended in compiling, arranging and organising a set of information for ease of use. When humans create, the labour and ingenuity exerted in reaching completion is compensated by the law by bestowing exclusive rights of exploitation on creators and their assigns. In the sphere of Electronic Health Record databases, data (which are mainly inputted by clinicians) are obtained from various sources, including clinician deduction, patients and caregivers’ observations and reports, and family-reported or community-reported traits. Using the doctrinal research method and writing primarily from a South African legal standpoint with insights drawn from other countries, the author considers the dynamics of navigating ownership rights in Electronic Health Record databases and the associated challenges when AI is involved. In summary, this paper examines the Electronic Health Record ownership rights of humans and machines, particularly in the South African context. [ABSTRACT FROM AUTHOR]

Informed consent for medical treatment is a developed legal concept in South African common law; the elements of which have been clearly set out by our courts. The overarching principle is viewed as a collaboration between medical practitioner and patient to understand the medical prognoses, medical advice and recommended treatment as well as the risk associated with such treatment. It should be done in such a way that the medical practitioner is not viewed as the "gatekeeper" of the medical treatment, but that the practitioner has confidence that they have provided the necessary information to enable the patient to decide. Where children are concerned, there is a greater duty to ensure informed consent for medical treatment is obtained in a manner that safeguards the short-term and long-term, best interests of the child, while also respecting the evolving capacities of the child. This paper examines the rights of children to consent to gender-affirming treatment and explores how this issue could be dealt with in an approach that recognises the autonomy of children while ensuring that their short-term and long-term best interests are upheld. The paper argues that the provisions of section 129 of the Children's Act 38 of 2005 and the Gender Affirming Healthcare Guidelines provide sufficient guidance as to how informed consent for gender-reaffirming treatment for children should be obtained in line with their evolving capacities. [ABSTRACT FROM AUTHOR]

Globally, the healthcare industry is plagued by fragmentation, and this fragmentation of the health system has become one of the major problems facing especially low- and middle-income countries. Likewise, the current health system in South Africa is highly fragmented and segmented, with two-tiered systems characterised by a multiplicity of health information systems. This fragmentation has inhibited the efficient delivery of healthcare services and resulted in limited access to integrated health data across healthcare providers. This paper proposes a Digital Health Ecosystem framework to address fragmentation of the health system in South Africa. A qualitative approach was employed, using desktop-based research. A literature review was conducted to elucidate the need for a framework to address fragmentation of the health system in South Africa. It emerged from the literature that the coexistence of subsystems operating independently contributes to health system fragmentation in South Africa. The proposed framework aims to address the ubiquitous problem of health system fragmentation and to enhance data-sharing capabilities across healthcare facilities. A Digital Health Ecosystem offers capabilities to create a digital environment for cooperation, data sharing and information exchange between a network of healthcare organisations. The technology offers South African healthcare facilities a new way to work seamlessly together to provide multidisciplinary and collaborative healthcare services to patients. Healthcare facilities in South Africa are urged to embrace a Digital Health Ecosystem to improve the safety and quality of healthcare and increase access to and availability of clinical, patient and administrative data. [ABSTRACT FROM AUTHOR]

Background: Implementation frameworks and theories acknowledge the role of power as a factor in the adoption (or not) of interventions in health services. Despite this recognition, there is a paucity of evidence on how interventions at the front line of health systems confront or shape existing power relations. This paper reports on a study of actor power in the implementation of an intervention to improve maternal, neonatal and child health care quality and outcomes in a rural district of South Africa.Methods: A retrospective qualitative case study based on interviews with 34 actors in three 'implementation units' - a district hospital and surrounding primary health care services - of the district, selected as purposefully representing full, moderate and low implementation of the intervention, some three years after it was first introduced. Data are analysed using Veneklasen and Miller's typology of the forms of power - namely 'power over', 'power to', 'power within' and 'power with'.Results: Multiple expressions of actor power were evident during implementation and played a plausible role in shaping variable implementation, while the intervention itself acted to change power relations. As expected, a degree of buy-in of managers (with power over) in implementation units was necessary for the intervention to proceed. Beyond this, the ability to mobilise collective action (power with), combined with support from champions with agency (power within) were key to successful implementation. However, local empowerment may pose a threat to hierarchical power (power over) at higher levels (district and provincial) of the system, potentially affecting sustainability.Conclusions: A systematic approach to the analysis of power in implementation research may provide insights into the fate of interventions. Intervention designs need to consider how they shape power relations, especially where interventions seek to widen participation and responsiveness in local health systems. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. Research Design: Narrative. Study Sample and Data Collection: Not applicable. Results: We discuss the implications of each emerging issue for health systems policy and practice. Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement. [ABSTRACT FROM AUTHOR]

Background: Speech–language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying. Aims: To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury. Methods & Procedures: This article forms part of a larger qualitative study that explored SLT&As' experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying. Outcomes & Results: Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self‐reflection and religious practices, they reported alleviation of moral injury. Conclusions & Implications: In order to mitigate moral injury in South African SLT&As, they require professional education, self‐care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As' biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury. What this paper adds?: What is already known on this subject?: Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs. What this article adds?: This article highlights the complexity of speech–language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury. Clinical implications of this article: This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self‐care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying. [ABSTRACT FROM AUTHOR]

Intergenerational support is a common cultural expectation and obligation in most African families. It is a form of reciprocal solidarity wherein a generation uses its privileges to assist a generation in need. This is typical of care and support relationships between parents and their children. As parents care and provide for their children, the unspoken expectation is that they are investing as their children will be obliged to take care of them in the future. In Zimbabwe, the obligations of this social contract have led many to migrate to other countries in search of economic opportunities. However, with the outbreak of the COVID-19 pandemic and the resultant economic hardships, these reciprocal relationships have been negatively impacted. This paper assesses the impact of COVID-19 and the economic difficulties faced by migrants in South Africa, drawing from the life histories of dyads of five parents and five adult children. It explores how the governance systems implemented during the COVID-19 pandemic and the precarity of transnational migrants in South Africa affected intergenerational material support within transnational families. Findings reveal that the pandemic significantly affected intergenerational support within transnational families. The restrictive measures crafted to curb the spread of the pandemic led to notable adaptations in the provision of parental support by migrant children in South Africa. Parental support went beyond reciprocity and altruism, exhibiting a profound moral value embedded in the moral economy perspective, where children remain committed to providing support to their parents despite the economic struggles presented by the pandemic. [ABSTRACT FROM AUTHOR]

Social workers employed in Child Protection Organisations (CPOs) are frequently confronted with child sexual abuse cases. This paper aims to determine the challenges faced by social workers employed by CPOs when dealing with allegations of child sexual abuse. A qualitative study was done using focus group discussions with 71 social workers as participants. The social developmental welfare approach and legislative mandates were used to analyse the research problem of challenges that social workers experience when dealing with allegations of child sexual abuse allegations. The findings indicate that existing South African policies, conventions and legislation do not always complement each other, but rather create challenges and uncertainties amongst social workers in this field. This, together with insufficient resources for service delivery, often leads to re-victimisation of the child who has been sexually abused. This paper concludes with recommendations based on the social developmental principles that suggest integrated and collaborative partnerships to ensure effective responses to child sexual abuse cases. Secondly, it urges universities to relook their curricula to ensure sufficient training for undergraduate social worker students takes place to deal with sexual abuse allegations. [ABSTRACT FROM PUBLISHER]

Background. Traditional birth attendants have since ancient time provided care to pregnant women. As such, the collaboration between midwives and traditional birth attendant (TBAs) can be an essential effort towards the reduction of the maternal and neonatal mortality and morbidity rate especially in low- and middle-income countries (LMICs). This paper argues that the collaboration between traditional and formal health systems expands the reach and improves outcomes of community health care. The study is aimed at exploring the traditional birth attendant's views on collaboration with midwives for maternal health care services at selected rural communities in South Africa (SA). Methods. The study was conducted in two rural communities in Tshwane and Johannesburg metropolitan districts from 15 June to 31 October 2021. The study followed the qualitative explorative and descriptive research design. The sampling technique was nonprobability purposive, and snowballing technique was also used to sample the key informants who are the traditional birth attendants also known as traditional healers and who provide maternal health care services in the respective communities. The access to these participants was through the gatekeepers, the Traditional Health Organisation Council (THO) council. Data collection was through semistructured in-depth interviews. Data were analysed thematically through the eight steps of Tesch. Results. Five main themes were identified which included the recognition of traditional birth attendants as enablers of collaboration, the envisaged value of the collaboration, processes required to foster collaboration, repositioning for new roles, and barriers to collaboration. Conclusion. The TBAs are ready to collaborate with the formal health care system, and all they require is for their services to maternal health care to be recognised and acknowledged. [ABSTRACT FROM AUTHOR]

Background: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. Methods: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. Findings: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0–100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0–51.0). A majority of participants (78.1%) were females, aged 18–24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8–6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9–91.0); specificity:100% (95% CI, 98.1–100). Interpretation: Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered. [ABSTRACT FROM AUTHOR]

Health insurance is an alternative to direct out-of-pocket (OOP) financing. It aims to improve access to care and reduce direct OOP payments. However, this may not be the case if there is high cost sharing and limited cover. This paper uses the methodology of propensity score matching to investigate the impact of private insurance via membership of a medical scheme in South Africa on health-care utilisation and OOP payments. The paper finds that insurance coverage increases the use of private health services as would be expected but there is no significant effect on the use of public services. Further, such coverage does not result in lower OOP payments for scheme members compared to non-members. This calls for a need to design health insurance, in South Africa, in the form that not only ensures adequate utilisation of health services but also provides financial protection to the insured as reflected in the current commitment for a National Health Insurance. [ABSTRACT FROM AUTHOR]

The author reflects on the paper by doctor Joanna Veary which examines the challenges of migration, urbanization, informal livelihoods and HIV in South Africa. She notes that the research has confirmed the diversity of migration experiences within urbanization and identifies central development challenges that should be addressed by local governments. She adds that the paper suggests the need for reframing and reconnecting urban health research to address the public health challenges.

Climate change is predicted to exert further stress on already exploited ecologies and healthcare systems, added to this, the coronavirus SARS-CoV-2 (COVID-19) has signified a stimulus to revolutionize existing models of sustainable development in broad, and sustainable supply chains in the healthcare sector in particular. The Kruger to Canyons biosphere region in South Africa and the Amazonas state in Brazil serve as geographic case studies for this paper. The impact of economic globalization, natural catastrophes such as droughts, economic and geopolitical stresses, deforestation, economic and healthcare access inequalities in these two biomes converge with issues of climate change, and undercut coping mechanisms that are customarily used to oversee extreme events such as pandemics. The COVID-19 pandemic has deepened many of the economic and social difficulties which South Africa and Brazil are already facing. In comparison to Brazil, South Africa’s overall response to the pandemic can be regarded as a standout. By borrowing from best practices from prior public health responses to heath emergencies in South Africa, such as the tuberculosis and the HIV/AIDS crisis, South Africa has demonstrated its comparatively successful means of dealing with COVID-19. [ABSTRACT FROM AUTHOR]

Clinical informatics has enormous potential to ensure healthcare quality in both developed and developing countries. This paper examines the status and challenges of clinical informatics in the South African health care sector, In a recent survey of major international research databases such as Scopus, it was observed that there is a gap in knowledge on clinical informatics particularly as related to the status and challenges in the country's healthcare facilities . The current status and challenges of clinical informatics in South Africa has not been examined. The present study explores the the current status of clinical informatics in the South African healthcare system as well as the challenges facing the development of clinical informatics in South Africa. Through a literature review, the paper provides a conceptual background of clinical informatics, discusses the status and challenges of clinical informatics in South Africa. The last part of the paper discusses the implications of the reviewed literature through a PEST analysis. The paper provides invaluable information on clinical informatics in South Africa that can be used to inform and support further studies in this growing field. The paper is a contribution to discussions and debates on the development of social informatics. [ABSTRACT FROM AUTHOR]

Background: As the prevalence of paediatric dysphagia increases, the need for long‐term non‐oral feeding has also increased. Despite these developments, little is known about caregiver experiences of transitioning a child onto long‐term non‐oral feeds, and the factors which influence the process of decision‐making and the provision of consent to do so. This paper aims to explore these factors. Methods: Semi‐structured interviews were conducted with nine participants recruited from the multidisciplinary out‐patient non‐oral feeding clinic at a hospital. Interviews explored caregiver experiences of decision‐making and the process of providing consent when transitioning their child to non‐oral feeds, as well as the support structures available to the caregivers. Interviews were audio recorded and transcribed, then analyzed using thematic analysis (Braun & Clarke, 2013) and content analysis (Neuendorf, 2016). Results: Challenges to care and quality of life, access to information and culturally relevant counselling, and the involvement of family members and significant others emerged as prominent themes. Findings suggest that quality of life was the most common motivating factor for transitioning a child to non‐oral feeding methods. Several participants suggested that support and information sharing via digital platforms were both useful and effective. Implications: The findings highlight caregivers' needs for improved access to information and social support. The findings hold implications for training of healthcare providers working in similar contexts and for models of service delivery which ensure that family‐centred intervention can be delivered in culturally and contextually relevant ways. With widespread access to smartphones, counselling should include digital messaging as a way of providing support and information sharing. Future research should focus on the complexities of counselling and the process of informed consent in settings impacted by diverse cultural, contextual and linguistic barriers, as well as the potential value of mobile health (mhealth) in ensuring improved health outcomes. [ABSTRACT FROM AUTHOR]

South Africa needs nurse leaders for the 21st century. Conventional leaders and leadership styles of the past are unable to meet the demands of the 21st century. This paper highlights the leadership qualities needed for preparing the new nurse leader of the 21st century in South Africa and on the continent, taking into consideration the values and norms enshrined in African culture. An extensive literature review on leadership and leadership theories was undertaken. It is from these sources that the paper identifies the qualities that should characterise the new leadership style that will prepare African leaders to move in a whole new direction in this century. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper was to introduce a new registry in a developing country by describing the demographics, management and 30-day outcomes of patients undergoing ventral hernia repair in the public and private healthcare sectors of South Africa. Methods: This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020. Results: 353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54 years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m2. The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%, p = 0.01 and performed more emergency repair cases, 21% vs 8%, p < 0.01. The majority (89%) of hernias were repaired with mesh and one-third were repaired laparoscopically. 30 day follow up was obtained in 30% of cases, the private sector had better follow up rates (42% vs 14%). Conclusion: Participation in the HIG (SA) registry was low with poor follow up over the first year. Ongoing prospective data capture on the HIG (SA) hernia registry will continue to provide further insights into hernia repair practices in South Africa. [ABSTRACT FROM AUTHOR]

Breast cancer remains the most common cancer in many parts of the world, particularly for women. In March 2015, a Breast Oncology clinic for breast cancer patients was established at Mankweng Hospital. Invasive ductal carcinoma is the most common (87 %) tumour found in Limpopo, and occasionally, another rare tumour of the breast is presented in the Breast Oncology clinic. The aim: The main objective is to share the experience of a rare tumour of the breast came across over the past 8 years since the establishment of the Breast Oncology clinic. Material and Method: Series of rare case reports of Breast tumours and literature review from the Mankweng Breast Oncology Clinic. Result: Rare tumour encountered in Breast Oncology clinic: adenomyoepithelioma, micro-papillary carcinoma of the breast, primary malignant melanoma of the breast, primary non-Hodgkin's lymphoma of the bilateral breast, advanced breast cancer in a case of Down's syndrome, primary neuroendocrine invasive breast carcinoma, sarcoma of the breast. Conclusions: Most of these rare cases are presented to the Breast Oncology clinic in the advanced stage. Breast cancer awareness campaign is highly important for women in Limpopo, particularly when attending primary health care for any other conditions. [ABSTRACT FROM AUTHOR]

Background New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC). Using theory about complex adaptive systems and policy implementation, this paper considers how actors' sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC. Methods The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa. Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis. It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC. Results The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it - act as a barrier to centrally-led initiatives to strengthen PHC. Staff often fail to take ownership of such initiatives and experience them as disempowering. Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges. Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning. Conclusions PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and incorporate them into their everyday routines and practices. This requires a leadership of sensemaking that enables front line staff to exercise their collective discretionary power in strengthening PHC. We hope this theoretically-framed analysis of one set of experiences stimulates wider thinking about the leadership needed to sustain primary health care in other settings. [ABSTRACT FROM AUTHOR]

Background: In South Africa, human geographic mobility is high as people engage in both permanent and temporary relocation, predominantly from rural to urban areas. Such mobility can compromise healthcare access and utilisation. The objective of this paper is to explore healthcare utilisation and its determinants in a cohort of internal migrants and permanent residents (non-migrants) originating from the Agincourt sub-district in South Africa's rural northeast.Methods: A 5-year cohort study of 3800 individuals aged 18 to 40 commenced in 2017. Baseline data have been collected from 1764 Agincourt residents and 1334 temporary, mostly urban-based, migrants, and are analysed using bivariate analyses, logistic and multinomial regression models, and propensity score matching analysis.Results: Health service utilisation differs sharply by migrant status and sex. Among those with a chronic condition, migrants had 0.33 times the odds of non-migrants to have consulted a health service in the preceding year, and males had 0.32 times the odds of females of having used health services. Of those who utilised services, migration status was further associated with the type of healthcare utilised, with 97% of non-migrant rural residents having accessed government facilities, while large proportions of migrants (31%) utilised private health services or consulted traditional healers (25%) in migrant destinations. The multinomial logistic regression analysis indicated that, in the presence of controls, migrants had 8.12 the relative risk of non-migrants for utilising private healthcare (versus the government-services-only reference category), and 2.40 the relative risk of non-migrants for using a combination of public and private sector facilities. These findings of differential utilisation hold under statistical adjustment for relevant controls and for underlying propensity to migrate.Conclusions: Migrants and non-migrants in the study population in South Africa were found to utilise health services differently, both in overall use and in the type of healthcare consulted. The study helps improve upon the limited stock of knowledge on how migrants interface with healthcare systems in low and middle-income country settings. Findings can assist in guiding policies and programmes to be directed more effectively to the populations most in need, and to drive locally adapted approaches to universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Young people face many barriers to accessing appropriate health care services including screening for HIV and tuberculosis (TB). The study aimed to identify perceived barriers to the uptake of health services among young adults entering the tertiary education system in South Africa. Methods: We conducted a cross-sectional study among first-year students aged 18–25 years, registered at one of three universities in Johannesburg, South Africa, in 2017. Participants completed a self-administered paper-based questionnaire. We describe perceived barriers to accessing health services, stratified by gender and recent engagement in TB or HIV services, together with sources of information about HIV and TB. Results: Seven hundred and ninety-two (792) students were included in the study of which 54.8% were female. Perceived barriers to accessing services included long waiting time (n = 342,43.2%), attitude of health workers (n = 263,33.2%), lack of sufficient information/poor health literacy (n = 148,18.7%), and inability to leave/stay away from studies (n = 137,17.3%). Among participants who tested for HIV in the past 6 months (n = 400, 50.5%), waiting time and attitude of health care workers were perceived as barriers to accessing services. Compared to males, females were more likely to view attitudes of health workers (40.3% vs. 25.0%; p = 0.001) and inability to leave/stay away from studies (20.5% vs.13.4%; p = 0.025) as potential barriers. While just over half of the students (50.5%; 400/792) in this study had accessed health services in the past 6 months, very few (15.0%) opted to use campus health services, and even less (5%) reported receiving information about HIV and TB from the university itself. Conclusion: Despite perceived barriers to accessing HIV and TB services off campus, fewer than one in five students starting out at university opted to use campus health services. Campus health services could address many of the barriers unique to university students. [ABSTRACT FROM AUTHOR]

This paper explores the African American response to an interracial heart transplant in 1968 through a close reading of the black newspaper press. This methodological approach provides a window into African American perceptions of physiological difference between the races, or lack thereof, as it pertained to both personal identity and race politics. Coverage of the first interracial heart transplant, which occurred in apartheid South Africa, was multifaceted. Newspapers lauded the transplant as evidence of physiological race equality while simultaneously mobilising the language of differing 'black' and 'white' hearts to critique racist politics through the metaphor of a 'change of heart'. While interracial transplant created the opportunity for such political commentary, its material reality--potential exploitation of black bodies for white gain--was increasingly a cause for concern, especially after a contentious heart transplant from a black to a white man in May 1968 in the American South. [ABSTRACT FROM AUTHOR]

Voluntary medical male circumcision is an integral part of the South African government’s response to the HIV and AIDS epidemic. Following circumcision, it is recommended that patients abstain from sexual activity for six weeks, as sex may increase the risk of female-to-male HIV transmission and prolong the healing period. This paper investigates the resumption of sexual activity during the healing period among a cohort of school-going males in the KwaZulu-Natal province of South Africa. The analysis for this paper compares two groups of sexually active school-going males: the first group reported having sex during the healing period (n = 40) and the second group (n = 98) reported no sex during the healing period (mean age: 17.7, SD: 1.7).The results show that 29% (n = 40) of young males (mean age: 17.9, SD: 1.8) who were previously sexually active, resumed sexual activity during the healing period, had on average two partners and used condoms inconsistently. In addition, those males that engage in sexual activity during the healing period were less inclined to practice safe sex in the future (AOR = 0.055, p = 0.002) than the group of males who reported no sex during the healing period. These findings suggest that a significant proportion of young males may currently and in the future, subject themselves to high levels of risk for contracting HIV post circumcision. Education, as part of a VMMC campaign, must emphasize the high risk of HIV transmission for both the males their partners during the healing period. [ABSTRACT FROM AUTHOR]

Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care. [ABSTRACT FROM PUBLISHER]

Rationale: Obstructive sleep apnea (OSA) is a significant health problem among adults and children globally, resulting in decreased quality of life and increased costs of healthcare. For optimal clinical care, primary care physicians should be familiar with OSA and confident in their ability to screen, diagnose, and manage this condition.Objectives: To assess the knowledge, attitudes, and practices of primary care physicians in Kenya, Nigeria, and South Africa regarding OSA in adults and children.Methods: We conducted a multicenter cross-sectional survey in Kenya (Nairobi), Nigeria (Edo State), and South Africa (Cape Town) between April 2016 and July 2017. At least 40 participants were randomly selected from a register of primary care physicians at each site. Potential participants were contacted to receive online/paper-based, validated OSA Knowledge and Attitudes (OSAKA) and OSAKA in Children (OSAKA-KIDS) questionnaires related to adults and children, respectively. The median percentage knowledge scores and proportions of favorable attitude were computed and current diagnostic and referral practices were documented.Results: The median OSAKA knowledge scores were 83.3% (interquartile range [IQR], 77.8-88.9), 66.7% (IQR, 55.6-77.8), and 61.1% (IQR, 55.6-77.8) among South African, Kenyan, and Nigerian physicians, respectively. For OSAKA-KIDS, the median knowledge scores were 61.1% (IQR, 50.0-72.2), 64.2% (IQR, 35.3-93.2), and 58.3% (IQR, 44.4-66.7) among South African, Kenyan, and Nigerian physicians, respectively. Most physicians (90-94%) considered adult and pediatric OSA very/extremely important. Fewer physicians agreed/strongly agreed that they were confident about OSA diagnosis (55%), management (25%), and continuous positive airway pressure (18%) use in adults. Even fewer physicians agreed/strongly agreed that they were confident about pediatric OSA diagnosis (35%), management (21%), and continuous positive airway pressure use (18%). South African physicians mainly prescribed polysomnography (51%) and overnight oximetry (22%), whereas 49% of Nigerian physicians and 65% of Kenyan physicians commonly requested lateral cervical radiography.Conclusions: Primary care physicians in South Africa, Nigeria, and Kenya considered OSA to be important but had modest knowledge about OSA in adults and children, and had a low perceived confidence in adult and pediatric management. Focused educational interventions during undergraduate training and continuing professional development programs may improve primary physicians' knowledge about OSA and its diagnosis and management. [ABSTRACT FROM AUTHOR]

Since the end of apartheid, patterns of migration into South Africa have shifted, and South Africa has become a destination for people from across the African continent and beyond - a small but important number of whom are refugees and asylum seekers. While South Africa has a protective, integrative, urban refugee policy, many of these individuals struggle to access the rights to which they are entitled, including healthcare. In addition, many lower-skilled international migrants are unable to legalise their stay in South Africa. As a result, international migrants often become part of the group of 'urban poor,' falling within the periphery of health and social welfare provision and relying on a survivalist livelihood within the informal economy. The health and wellbeing of an individual impact greatly on their ability to maintain a secure livelihood, and this becomes more difficult in the context of an HIV epidemic. This paper presents findings from a case study situated in the City of Johannesburg. The research made use of 1) 2006 survey data on migrant livelihood strategies in Johannesburg, 2) a study investigating non-citizens' access to antiretroviral treatment (ART) in the inner city, which included 3) a set of interviews conducted with migrant ART clients who were working in the city's informal economy. The findings indicate (a) the importance of the informal economy for migrants to Johannesburg; (b) the challenges that non-citizens face in accessing ART in the public sector in South Africa; and (c) the linkages between urban migrants' access to ART and their ability to maintain a survivalist livelihood. The paper argues that upholding people's right to ART for all who need it within South Africa will enable international migrants (including refugees and asylum seekers) to maintain an otherwise fragile survivalist livelihood, and this in turn will assist their self-reliance and integration into urban life. Recommendations are made to ensure that the right to healthcare is upheld for all in South Africa. [ABSTRACT FROM AUTHOR]

HIV has emerged as a highly stigmatizing disease, with a number of negative social representations associated with it. In South Africa, HIV has been the subject of much politicized debate about racist projections of sexual behaviour, and issues of HIV care. This paper uses psychoanalytic theory, particularly the theory of Klein and the concept of the paranoid-schizoid position, to explore how individuals position themselves in relation to others with regard to HIV. In order to protect against threats to the self, negative notions about ourselves are projected onto others who then become at risk for HIV. This is explored in relation to the South African context and the racial politics of HIV. When an individual becomes HIV positive, these notions have to be reincorporated as the individual socially becomes that 'other'. Once again, an 'othering' process may take place as the HIV-positive individual struggles to incorporate these new aspects into their identity. The paper makes use of research and case material to illustrate these processes. [ABSTRACT FROM AUTHOR]

This brief paper is the introduction to this JEMS special issue on Migration and Health in Southern Africa, drawn from papers presented at a conference organised by the Transnational Communities Programme (University of Oxford), the Southern African Migration Programme (Queen's University, Kingston, Canada) and the Faculty of Humanities, University of Cape Town, on 27–29 January 2003. Cross-border and within-country migration have generated complex and challenging difficulties for healthcare provision; not only do migrant populations often require specialist treatment for unfamiliar conditions, but the numbers involved and the distances travelled often change long-held epidemiological assumptions about the local population. In the contemporary southern African context, the spread of HIV/AIDS has often been associated with increased population mobility. This introductory paper summarises each paper in the special issue in turn, and concludes with some practical suggestions for policy measures. [ABSTRACT FROM AUTHOR]

This paper details the responses of a group of African Primary Health Care Nurses (PHCNs), practising in Soweto clinics, to the issue of abortion. The majority of nurses interviewed — 70 per cent of a sample of 27 — unequivocally and unambiguously rejected abortion. The central concern of this paper is to explore why the responses of this ‘rejecting group’ to women who face the predicament of an unwanted pregnancy were cast in such judgemental terms. I argue that this is best understood by unpacking and exploring their identities as African nurses, mothers and wives. In their discourse, abortion symbolises a denial of women's true calling. To them, when a woman has an abortion she is ending not only her pregnancy but also her opportunity to be a mother and even her womanhood. The issue of abortion also provided the opportunity to explore the complex and contradictory ways in which this group of women understands and responds to patriarchal relationships. [ABSTRACT FROM AUTHOR]

As Fourth Industrial Revolution (4IR) technologies continue to gain attention around the world and more so in South Africa, it is important to explore and determine how new technologies in healthcare can be made available, accessible and affordable to everyone. This is important to improve peoples' health and reduce inequalities in the healthcare system that continue to persist. While there may be concerns about job losses and ensuring adherence to some ethical principles, there is no doubt that there are also benefits to be reaped from these technological advances that can improve the health status of many and improve healthcare if managed well. Policy can be the first step in doing so. Using the policy stages framework and a review of literature on 4IR and health, this article attempts to explore policy making for 4IR in healthcare, and argues for the need to do so, especially amid the COVID-19 pandemic. It draws attention to the fact that the agenda for 4IR in health has already been set and what remains is for policy makers to be deliberate about ensuring that 4IR technological benefits in healthcare are equitably distributed for all, taking into account the inequalities in the healthcare system. [ABSTRACT FROM AUTHOR]