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Safer Conception Services (SCS) refers to the provision of a package of care for individuals of reproductive age who are affected with HIV to have safe and healthy pregnancies. South Africa has one of the highest HIV burdens in the world, yet limited availability of SCS. Therefore, this study investigated healthcare managers' response to an implementation project piloting SCS integration into primary healthcare services in Johannesburg. As part of the implementation study, data was collected from six facility healthcare managers using In-Depth interviews between November 2017 - September 2018. Data were analyzed using thematic analysis. The following four (4) themes emerged: positive response to the implementation of SCS, capacity building, the impact of SCS, and the need to scale up SCS. The results suggested that providers engaged saw value in the implementation of SCS. The results further suggest that there was an openness, willingness, cheerful outlook, and support to make SCS more widely available; however, streamlined processes are important to ensure feasibility. Continuous training is necessary to routinize implementation and ensure adequate coverage of services. Available guidelines should be translated into training programs and more initiative-taking policies to support the scale-up of this essential service. [ABSTRACT FROM AUTHOR]

In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism. However, resource constraints limit access to quality training in evidence-based interventions. Web-based training may help fill this gap. This study examined the feasibility, acceptability and appropriateness of the web-based Autism Navigator® JumpStart to Coaching in Everyday Activities course for 26 non-profit organisation providers (10 specialists and 16 non-specialists) in South Africa. Quantitative and qualitative methods were used including a post-training survey. Sixteen providers (62%) completed the course over an average period of 5.58 months, with many completing the course during lockdown restrictions, suggesting time as a barrier to course completion. No provider characteristics were related to attrition, nor to the time taken to complete the course. Better English proficiency, higher education levels and more positive attitudes to implementing an evidence-based intervention were associated with the number of attempts needed to pass some learner assessments, and to perceptions of course feasibility, acceptability, and appropriateness. Adaptations in the training delivery (using a group format and local group conference calls) and inclusion of South African video clips were identified as potential facilitators to acceptability and appropriateness. In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism, including in Africa. However, non-profit organisation service providers may not have access to quality training in proven intervention methods. Web-based or online courses may help to meet this need. In this study, we invited a group of specialist (10) and non-specialist (16) non-profit organisation providers in South Africa to complete a web-based course, Autism Navigator® JumpStart to Coaching in Everyday Activities, a 20-h self-paced course that provides training in an evidence-based parent coaching intervention called Early Social Interaction. We evaluated acceptability, appropriateness, and feasibility of the training. Of the 26 who enrolled, 16 completed the course (7 specialists and 9 non-specialists). All providers found it difficult to find time to do the course until the lockdown restrictions due to COVID-19, when most completed the course. Those whose first language was not English experienced more difficulties with two of six learner assessments and those who were not clinical specialists had more difficulty with the coaching strategies learner assessment. Most providers rated the course highly feasible, acceptable, and appropriate stating that the course content was very valuable and helpful in equipping them to serve their families. They felt the extensive video clips and regular meetings with a local trainer helped them engage with and understand the material. They suggested that including South African video clips would make the course more relatable. The fact that the course was web-based was identified as a strong benefit, especially during COVID-19 restrictions. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify and assess the barriers to implementing modular construction systems (MCS) in developing country's architecture, engineering and construction (AEC) industry, targeting built environment professionals from Nigeria and South Africa. Design/methodology/approach: The study adopted a quantitative research method, using a structured questionnaire to seek the opinions of the professionals on the identified categories of barriers. Findings: Results indicated that all identified categories of barriers were statistically significant using a one-sample t-test at p = 0.05 significance level which indicates they are critical towards the implementation of MCS in developing countries. Assessment of the opinion of the professionals using the Kruskal–Wallis scale showed that they hold similar views on the barriers to the adoption of MCS. Pearson correlation shows a high correlation coefficient amongst the barrier categories and an acceptable level of significance (p = 0.05). Research limitations/implications: This study is limited to two significant African countries (Nigeria and South Africa) selected based on the gross domestic product (GDP). Further studies can consider developing countries outside Africa and investigate broader respondents. Practical implications: The study provides implications on the barriers affecting MCS in developing countries for the academia, industry and government to have an insight into the barriers and make informed decisions and policies. Originality/value: The research satisfies the need to study the barriers affecting the MCS in developing countries that can mitigate housing deficits. This innovative construction method has been adopted and implemented in developed countries, and the result has been positive. [ABSTRACT FROM AUTHOR]

Preparing subject teachers for understanding and implementation of curriculum and Assessment policy statement in schools has become a concern in nations as a way to strive for excellence. Yet, there is a little known about the understanding of curriculum policy than its effectiveness in the school. This study explored teacher understanding of Curriculum and Assessment Policy Statement (CAPS) document implementation. The study employed a qualitative approach, utilizing a case study research design. The interpretivism paradigm was applied to gain an in-depth understanding secondary of teachers' perspectives on the implementation of the CAPS. The population of the research study consisted of 100 teachers in Capricorn District, and the sample of this study consisted of ten (10) teachers who were selected using a convenient sampling technique. Data was collected using individual, semi-structured interviews and focus group interviews, and was analyzed using thematic data analysis method. The study concluded that internal and external workshops could serve the purpose of implementing the CAPS document in the classroom. In addition, movable resources, for better implementation of the CAPS document in the classroom. Lastly, for researchers, these findings may help with further research on strategies to be implemented in schools to encourage constant use of the CAPS document. The unique contribution of this article to existing research on the classroom implementation of CAPS guidelines is to address the gap identified by ineffectiveness of the subject policy to the secondary teaching. [ABSTRACT FROM AUTHOR]

The paint manufacturing sector has not received sufficient attention, having its unique challenges with employee engagement, despite numerous investigations on employee engagement in several industries. This study seeks to address this deficiency by performing a targeted investigation on the levels of employee involvement within the paint manufacturing sector. This study aims to assess the level of employee involvement in the paint manufacturing industry in South Africa. This study systematically assesses the strategies and practices of employee engagement implemented by paint manufacturing companies operating in the region. This study utilises a mixed methods approach and follows an exploratory research design to accomplish its objectives. This methodology utilises many research techniques to provide a thorough understanding of the complex employee engagement processes in the paint manufacturing industry. The survey instrument, comprising of 320 questionnaires, was distributed to managerial professionals, human resource practitioners, and general employees working at paint production plants in South Africa. In addition to collecting quantitative data, interviews were undertaken to further enrich the depth of insights. The findings reveal a beneficial and interconnected link between the factors studied, suggesting a reciprocal strengthening that enhances employee engagement. Moreover, the study highlights the complex interconnection between the six aspects of employee involvement in the company environment. These characteristics jointly contribute to the fundamental aspects of employee engagement within paint manufacturing firms. Industry stakeholders should work together to develop an organisational culture that is deeply ingrained in the industry's identity and resonates with all personnel. One key remedy suggested is to conduct an employee engagement survey across the entire organisation, which will help gain a thorough understanding of engagement dynamics. This study highlights a strong association between employee engagement, departmental affiliation, racial demographics, and age groups. Therefore, organisations can improve workplace engagement by carefully taking into account the impact of departmental divisions, racial origins, and age cohorts on the overall engagement picture. The study's findings shed light on the significant influence of these factors in determining the dynamics of employee engagement. [ABSTRACT FROM AUTHOR]

Introduction: Health system strengthening efforts also entails streamlining an existing referral system in a particular context to improve quality of health care offered to people. Conceptually, the referral system in South Africa, is seemingly sound. Nevertheless, gaps exist in its implementation. The aim of this study was to explore health care professionals' perceptions of referral system implementation in the Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape Province of South Africa. Methods: This qualitative study included 12 health care professionals as participants. Each participant was interviewed using a semi-structured interview guide; with their consent, the interviews were audio recorded and transcribed verbatim. For data analysis, a thematic content analysis was used. Results: The participants identified many impediments to the effective implementation of the referral system in BCCM. The main obstacles were deteriorating infrastructure, inadequate staffing, lack of transportation, and inadequate medical supplies and medications. Conclusion: In mitigation, the participants proposed suggestions such as increasing the capacity of the health workforce, allocating personnel appropriately, increasing the availability of transportation, and providing essential medications to all levels of care. They also suggested involving all stakeholders in the referral process, providing education and training to health professionals on the referral system, and enhancing communication and feedback between the various levels of care. These challenges emphasised in this study highlight the need for targeted interventions to improve the referral system in this setting. [ABSTRACT FROM AUTHOR]

Background: South Africa maintains an integrated health system where syndromic management of sexually transmitted infections (STI) is the standard of care. An estimated 2 million cases of Neisseria gonorrhoeae (N. gonorrhoeae) occur in South Africa every year. Point-of-care diagnostic tests (POCT) may address existing STI control limitations such as overtreatment and missed cases. Subsequently, a rapid lateral flow assay with fluorescence-based detection (NG-LFA) with a prototype reader was developed for N. gonorrhoeae detection showing excellent performance and high usability; however, a better understanding is needed for device implementation and integration into clinics. Methods: A qualitative, time-series assessment using 66 in-depth interviews was conducted among 25 trained healthcare workers involved in the implementation of the NG-LFA. Findings were informed by the Normalization Process Theory (NPT) as per relevant contextual (strategic intentions, adaptive execution, and negotiation capacity) and procedural constructs (coherence, cognitive participation, collective action, reflexive monitoring) to examine device implementation within primary healthcare levels. Interviews were audio-recorded, transcribed, and then analyzed using a thematic approach guided by NPT to interpret results. Results: Overall, healthcare workers agreed that STI POCT could guide better STI clinical decision-making, with consideration for clinic integration such as space constraints, patient flow, and workload. Perceived NG-LFA benefits included enhanced patient receptivity and STI knowledge. Further, healthcare workers reflected on the suitability of the NG-LFA given current limitations with integrated primary care. Recommendations included sufficient STI education, and appropriate departments for first points of entry for STI screening. Conclusions: The collective action and participation by healthcare workers in the implementation of the NG-LFA revealed adaptive execution within the current facility environment including team compositions, facility-staff receptivity, and STI management experiences. User experiences support future clinic service integration, highlighting the importance of further assessing patient-provider communication for STI care, organizational readiness, and identification of relevant departments for STI screening. [ABSTRACT FROM AUTHOR]

Genetic disorders are significant contributors to infant hospitalization and mortality globally. The early diagnosis of these conditions in infants remains a considerable challenge. Clinical exome sequencing (CES) has shown to be a successful tool for the early diagnosis of genetic conditions, however, its utility in African infant populations has not been investigated. The impact of the under representation of African genomic data, the cost of testing, and genomic workforce shortages, need to be investigated and evidence-based implementation strategies accounting for locally available genetics expertise and diagnostic infrastructure need to be developed. We evaluated the diagnostic utility of singleton CES in a cohort of 32 ill, South African infants from two State hospitals in Johannesburg, South Africa. We analysed the data using a series of filtering approaches, including a curated virtual gene panel consisting of genes implicated in neonatal-and early childhood-onset conditions and genes with known founder and common variants in African populations. We reported a diagnostic yield of 22% and identified seven pathogenic variants in the NPHS1, COL2A1, OCRL, SHOC2, TPRV4, MTM1 and STAC3 genes. This study demonstrates the utility value of CES in the South African State healthcare setting, providing a diagnosis to patients who would otherwise not receive one and allowing for directed management. We anticipate an increase in the diagnostic yield of our workflow with further refinement of the study inclusion criteria. This study highlights important considerations for the implementation of genomic medicine in under-resourced settings and in under-represented African populations where variant interpretation remains a challenge. [ABSTRACT FROM AUTHOR]

The youth (15-24 years old) in South Africa remain at high risk of HIV infection despite varied efforts to control the disease. An understanding of the perspectives of relevant stakeholders of HIV-prevention interventions targeting the youth is important to guide research, policy and practice aimed at improving these interventions. This study explores youth and intervention implementers' perceptions of a resilience-based HIV-prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviours among the youth in South Africa. Semi-structured interviews were conducted with 10 young people who participated in the intervention, and four intervention implementers at a not-for-profit organisation in Maluti-a-Phofung Local Municipality, South Africa. Data were analysed using thematic analysis. Three main themes emerged from the data: (1) Acceptability and impact of the intervention; (2) Factors influencing intervention implementation; and (3) Recommendations to improve intervention implementation. These findings provide insights into the acceptability, impact, barriers and facilitators of resiliencebased HIV-prevention interventions for the youth in South Africa and similar contexts, and how implementation of these interventions could be enhanced. The findings can help researchers, policy makers and health care practitioners in the field of HIV prevention to improve interventions targeting young people. [ABSTRACT FROM AUTHOR]

This study explored the challenges faced by municipalities in South Africa in the implementation of the Municipal Standard Chart of Accounts (mSCOA). The study adopted a qualitative approach, following an interpretive ontology, and a purposive sampling technique was used. The City of Tshwane in Gauteng Province was used as a unit of analysis; primary data was collected using virtual interviews as well as open-ended questionnaires, and secondary data was obtained in various documents on mSCOA implementation. The study revealed that there is a low mSCOA implementation level in the City of Tshwane. Furthermore, the study found that numerous challenges influenced the low implementation level. These challenges include resistance to change, a lack of adequate training on mSCOA implementation, a lack of personnel, a lack of pre-consultations, and poor system vendor skills transfer. The study recommends involving implementers in the concept and inception phases of any new reform. [ABSTRACT FROM AUTHOR]

This study seeks to describe the rollout and current state of South Africa's GeneXpert molecular diagnostic program for tuberculosis (TB). Xpert MTB/RIF was introduced in 2011 with a subsequent expansion to include extra-pulmonary and paediatric testing, followed by Xpert MTB/RIF Ultra in 2017. Through a centralised laboratory information system and the use of a standardised platform for more than a decade, over 23 million tests were analysed, describing the numbers tested, Mycobacterium tuberculosis complex detection, rifampin resistance, and the unsuccessful test rates. The stratification by province, specimen type, age, and sex identified significant heterogeneity across the program and highlighted testing gaps for men, low detection yield for paediatric pulmonary TB, and the effects of inadequate specimen quality on the detection rate. The insights gained from these data can aid in the monitoring of interventions in support of the national TB program beyond laboratory operational aspects. [ABSTRACT FROM AUTHOR]

Technology-based interventions in healthcare are often anticipated to improve the quality of healthcare services. These expectations are based on a perceived belief in the ability of technology to alleviate some of the challenges associated with manual, paper-based healthcare service delivery. As a result, the drive to implement healthcare technology has gained significant traction in recent years. Unfortunately, the implementation efforts of most health-related technologies have been tainted with several challenges such as fragmentation, lack of interoperability, and co-ordination. As a result, data management and health-related information dissemination across various levels of healthcare systems have been jeopardized. The objective of this study is to identify context-based factors that influence healthcare information systems (IS) implementation in resource-constrained public hospitals. The emphasis is on the public healthcare landscape in South Africa. A qualitative methodological approach was employed. Semi-structured interviews with purposively sampled participants in a public healthcare hospital provided primary data. The findings indicate that factors such as implementation of policies, planning and support strategies, and analysis of healthcare IS's fitness for purpose in healthcare workflows processes influence successful healthcare IS implementation. Addressing these factors is critical if public healthcare hospitals are to realise fully the transformative potential of technology-based interventions. The contributions made in this paper may be useful to the relevant government bodies, policymakers and other stakeholders interested in advancing adequate healthcare service delivery using healthcare IS. [ABSTRACT FROM AUTHOR]

Preconception care (PCC) is the provision of biomedical, behavioural, and social health interventions to women and couples before they fall pregnant. The World Health Organization (WHO) developed PCC recommendations in 2013, which were included in the South African maternity care guidelines in 2016. The purpose of PCC is to lessen behaviours and environmental factors leading to maternal ill-health, thus reducing maternal and perinatal mortality rates. Objective: To determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo Province and the associated factors. Methods: A qualitative exploratory design was used. Nonprobability, purposive sampling was used to sample 29 professional nurses (PNs), and 51 women of childbearing age (WCBA) (19–35 years) from clinics and community health centres (CHCs). Data were collected through in-depth interviews with the professional nurses and focus group discussions with the WCBA. Data analysis was performed through open coding. Measures of trustworthiness were adhered to. Permission to conduct the study was obtained from relevant stakeholders, participation was voluntary and participants signed a consent form prior to data collection. Results: The findings of the study revealed that there was partial implementation of the PCC recommendations in the selected districts of Limpopo Province, PCC provision was dependent on clients' initiation, a knowledge gap regarding PCC recommendations was identified from the professional nurses, and a lack of awareness regarding PCC from the WCBA. Conclusion: The preconception period is an important determinant of the pregnancy outcome; therefore, focus should be redirected to the pre-pregnancy period and not only to when the woman is already pregnant. However, to achieve this, professional nurses and WCBA should be empowered regarding PCC and its benefits. [ABSTRACT FROM AUTHOR]

Introduction: despite the efforts of professional nurses, exclusive breastfeeding rate is very low in South Africa. Per statistic South Africa, EBF rate is 32% with Limpopo Province being rated 8% as one of the lowest in South Africa. Implementation of exclusive breastfeeding required professional nurses' efforts, lactating mothers, families, and community need information and support from the health care system. The purpose of this study aimed at exploring professional nurses' challenges regarding implementation of exclusive breastfeeding in Limpopo Province. Methods: qualitative research involving phenomenological design was employed to explore professional nurses' challenges using one on one, unstructured, in-depth interview with 30 professional nurses; 27 females and three males, working in the six birthing facilities of two selected districts; Vhembe and Waterberg, in Limpopo Province. Results: the three higher order themes emerged were challenges experienced by nurses during promotion of exclusive breastfeeding; findings revealed challenges as cultural and religious beliefs, lack of family/community and health professional support, teen and HIV positive mothers, nurses found to have challenges to implement exclusive breastfeeding. Healthcare system and services such as shortage of staff and lack of proper training on lactation management and perceived measures to promote exclusive breastfeeding suggested by health professionals, which include ongoing health education, door to door campaigns, implementation of policy by health care professionals would promote exclusive breastfeeding strategies that are in place and encourage families and community to support lactating mothers to improve their confident on breastfeeding. Conclusion: professional nurses had challenges in promoting exclusive breastfeeding. An intervention is needed to promote exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts. Trial registration Clinicaltrials.gov, NCT03342274. Registered 10 November 2017. [ABSTRACT FROM AUTHOR]

Worldwide, countries were forced to redirect their resources, national efforts, and attention to alleviating the widespread of the coronavirus. Efforts such as national lockdowns, restrictions on certain goods and services, and the prohibition of public or social gatherings have been among the common measures that most governments have implemented in attempts to deal with this novel disease. Actions by the South African government have been no exception to these measures, and to some extent, the implementation of government actions to curb the spread of the coronavirus has been either politically, religiously, or even economically criticised. This is because the COVID-19 pandemic presents policy implementation with several challenges. This is largely because this was associated with a change in the way that government plans, acts, and responds to societal needs. It is for this reason that this study seeks to explore challenges in the implementation of responses aimed at curbing the spread of the COVID-19 pandemic in South Africa. The study adopts a qualitative secondary research approach. The research looks at policies in South Africa for dealing with the COVID-19 epidemic. Data is gathered from literature studies in scholarly publications, the internet and print media, government records, and survey findings from a variety of institutions. A descriptive qualitative analysis technique is adopted for the purposes of analysis. The current article adopts an integrated analytical framework to present and discuss the findings on policy implementation complexities during the COVID-19 pandemic in South Africa. The analytical framework is an integration of the 7-C protocols for policy implementation with the WHO's guidelines for the government to overcome the COVID-19 pandemic crisis. The findings of this study revealed that the government's communication lacked an authoritative voice on the ground; despite the "family meetings" that President Ramaphosa used to address and update the general public on developments about COVID-19. In addition, the study found that the number of measures to prevent the spread of COVID-19 was limited, and to some extent, there has been no clear tool to evaluate their impact. [ABSTRACT FROM AUTHOR]

Background: The treatment gap for mental health services is a growing public health concern. A lay-counselling service located at primary health care (PHC) level could potentially help to close the large treatment gap for common mental disorders in South Africa. The aim of this study was to understand multilevel factors contributing to implementation and potential dissemination of such a service for depression at PHC level. Methods: Process qualitative data of the lay-counselling service for patients with depressive symptoms was collected alongside a pragmatic randomized controlled trial evaluating a collaborative care model that included a lay-counselling service for patients with depressive symptoms. Semi-structured key informant interviews (SSI) were conducted with a purposive sample of PHC providers (lay-counsellors, nurse practitioners, operational managers), lay-counsellor supervisors, district and provincial managers, and patients in receipt of services. A total of 86 interviews were conducted. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection as well as Framework Analysis to determine barriers and facilitators for implementation and dissemination of the lay-counselling service. Results: Facilitators identified include supervision and support available for counsellors; person focused counselling approach; organizational integration of the counsellor within facilities. Barriers included lack of organizational support of the counselling service, including lack of counselling dedicated space; high counsellor turnover, resulting in a counsellor not available all the time; lack of an identified cadre to deliver the intervention in the system; and treatment of mental health conditions including counselling not included within mental health indicators. Conclusions: Several system level issues need to be addressed to promote integration and dissemination of lay-counselling services within PHC facilities in South Africa. Key system requirements are facility organizational readiness for improvement of integration of lay-counselling services; formal recognition of counselling services provided by lay counsellors as well as inclusion of lay counselling as a treatment modality within mental health treatment data element definitions and the need for diversification of the roles of psychologists to include training and supervision of lay counsellors was also emphasized. [ABSTRACT FROM AUTHOR]

Background. Despite the implementation of intervention strategies, incidents in specialised care units remain high and are of serious concern, worldwide. Objective. To assess the healthcare professionals' perception of knowledge and implementation of patient safety incident (PSI) reporting and learning guidelines in specialised care units of three selected public hospitals in KwaZulu-Natal, South Africa. Methods. The study used a descriptive, cross-sectional survey design. A purposive sample targeted 237 healthcare professionals. An online structured questionnaire collected the data. Descriptive and inferential statistics were used to analyse data. Results. A total of 181 questionnaires were returned, yielding a response rate of 76%. Notably, 83% of respondents had high-perceived knowledge of the PSI reporting and learning guidelines, while 98% had low perceptions of their implementation. The current unit (p=0.002) and shift of the day (p=0.008) were factors associated with the perception of good knowledge of PSI reporting and learning guidelines, as indicated by a p-value <0.05. The respondents' age (p=0.05), current unit (p=0.015), and shift of the day (p=0.000) were significantly associated with the perception of poor implementation of the PSI reporting and learning guidelines. Conclusion. The respondents demonstrated a good perception of knowledge of PSI reporting and learning guidelines; however, the perception of the implementation was poor. Therefore, a revised implementation strategy coupled with periodical in-service training for healthcare professionals is recommended, to foster and facilitate effective adherence to PSI reporting and learning guidelines. [ABSTRACT FROM AUTHOR]

Curriculum reform was high on the agenda of South Africa's post-apartheid governments. Yet as time passed, the initial reforms were seen as increasingly problematic, especially when pedagogical realities met policy priorities. There was reluctance on the part of policymakers to give up what was seen as the democratic imperative behind the reforms. Yet as schools struggled, public responses blamed inadequate attention to practical issues as undermining the implementation of the reforms. This perspective on curriculum implementation, blaming teachers for the failure of policy reforms, is not uncommon. This paper argues, however, that such a perspective is very often misinformed because it deflects attention from the specific nature of policies and the role of policymaking in neglecting key issues that might have better facilitated implementation. South Africa's democratic curriculum reforms were essential for dismantling a key aspect of the apartheid state. The paper highlights this point arguing that an understanding of policies rather than a focus on the failure of schools provides a better lens for understanding the trajectory of curriculum reform processes in South Africa. [ABSTRACT FROM AUTHOR]

Background: An Antimicrobial Stewardship Programme (ASP) is one of the strategic objectives of the World Health Organization's (WHO) global action plan to combat antimicrobial resistance. There have been numerous publications on the implementation of ASPs in both private and public sectors globally. However, there are no reviews and interpretive scholarly research publications on successful implementation of ASPs in private healthcare settings in Africa. Aim: The aim of this study was to systematically gather relevant information from published findings and to interpret those findings into a coherent body of lessons learnt from successful ASP implemented in private healthcare settings in Africa. Method: Google Scholar and PubMed, which are online databases, were extensively searched, and studies, which met the inclusion criteria for this review, were retrieved. A data-charting list was developed to extract relevant data. Results: Only six South African studies reported on successful implementation of ASPs in private healthcare settings in Africa. The main focus areas include locally driven prescription audits as well as pharmacist-led interventions. Conclusion: Although private healthcare settings in Africa utilise antibiotic therapy for various infectious diseases, reports on implementation of ASPs in these settings are limited. To win the battle against antimicrobial resistance, private healthcare settings in Africa need to implement evidence-based guidelines and report on the rational use of antibiotics. Contribution: The private healthcare sector in Africa needs to play a more meaningful role in the implementation of ASPs. [ABSTRACT FROM AUTHOR]

Daily oral pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. Adolescent girls and young women (AGYW) have been prioritised for PrEP delivery in South Africa. A combination HIV prevention intervention providing integrated biomedical, behavioural and structural interventions for AGYW aged 15–24 in twelve districts in South Africa characterised by high HIV prevalence, was implemented 2019–2022. We conducted qualitative interviews to explore PrEP implementation experiences with 38 individuals involved in the implementation of the combination HIV prevention programme, including programme managers and project coordinators, health care providers / nurses, social workers, counsellors, peer group trainers and outreach workers. Narratives included various challenges associated with PrEP uptake, adherence and acceptability experienced by implementers. Barriers to PrEP acceptability included AGYW fears of side effects and preference for injectable versus daily oral PrEP; resistance towards PrEP from AGYW, communities and parents due to a lack of accurate information; PrEP stigma linked to associations with antiretrovirals and assumptions of promiscuity; and issues pertaining to parental consent. Additionally, implementers faced logistical challenges related to procurement, stockouts, and supply of PrEP. Findings highlighted the critical role of parental and community acceptability of PrEP for successful implementation. Overall, PrEP was perceived by implementers as a valuable HIV prevention tool. In order to ensure the accessibility of PrEP for AGYW in South Africa, efforts to reduce stigma and foster social support for PrEP use, campaigns to raise awareness, ensure positive framing of PrEP, and build community acceptability of PrEP, are needed. [ABSTRACT FROM AUTHOR]

MomConnect is a mHealth programme in South Africa targeted at improving antenatal and maternal health. This study explored the barriers and facilitators to implementing the MomConnect programme in South Africa and the applicable lessons for scaling mHealth programmes in Africa. We reviewed the published literature and collected data through semi-structured interviews of project partners and leaders who worked on the MomConnect project. We asked study participants to identify any barriers and/or facilitators in the implementation of the MomConnect project and how they would overcome those barriers and strengthen the facilitators. We employed the Consolidated Framework for Implementation Research (CFIR) to inform the identification of a priori codes for the directed content analysis. Based on the analysis, the key components that supported the implementation of the MomConnect project included (1) strategic partnership and coordination across partner levels, (2) cost-effective technology and sustainable funding measures, (3) adequate adaptation of the innovation to local and national settings, and (4) guiding mHealth policy and legislation frameworks. The study's results suggest that strong political will and a robust partnership are essential to lead the strategic implementation process of mHealth projects. Such mHealth projects thrive in a policy framework that can support the planning and implementation process. In addition, understanding the accessibility needs of the project's target population as identified in this study is critical to developing mHealth projects that are sustainable in the long term by adapting to cost-effective technologies. [ABSTRACT FROM AUTHOR]

Tuberculosis, which is an infectious airborne disease remained the main leading cause of death in South Africa for three consecutive years from 2016 to 2018. In 2020 alone, the country had an estimated 328,000 people who suffered from TB, with 61,000 dying from it. Collins Chabane Municipality had 129 and 192 new TB cases recorded in 2017 and 2018, respectively, which is far from reaching the END TB STRATEGY targets. WHO scientific evidence demonstrates that TB control measures are effective in reducing the spread and development of new cases. Though scientific evidence revealed negative attitudes towards the recommended TB control measures in public hospitals of the Vhembe district, a deeper understanding of these attitudes is needed to remedy the situation. This study aimed to describe healthcare workers' perceptions of TB control measures at Collins Chabane Municipality in South Africa. A qualitative, exploratory case study design was adopted. Multi-stage sampling technique was used to select both the healthcare facilities and the participants. Only 24 healthcare workers trained on tuberculosis management were voluntarily recruited. However, data were saturated at the twelfth (12) participant purposively selected from six healthcare facilities of Collins Chabane Municipality. Data collected through unstructured in-depth individual interviews were analyzed thematically. The proposal for this study was ethically cleared by the University of Venda Ethics Committee (SHS/20/PDC/35/1111). Results indicate that TB administrative, environmental and respiratory control measures are well understood by health workers even though there are challenges with implementation concerning some, such as closing windows during winter, UVGI lights that are non-functional and taking too long to be fixed, no specimen collection during weekends and holidays thereby delaying TB diagnosis and lack of skills concerning how to use respirators and cough etiquette. The Vhembe district TB control programme should intensify infection control training and continue monitoring giving the needed support. [ABSTRACT FROM AUTHOR]

The passing of the 2019 National Health Insurance Bill (NHI) has revived debate whether such a policy can be effectively implemented in South Africa. The purpose of this article is to discuss the development process of this bill against the backdrop of the country's political and social context. Furthermore, it will examine the constitutional right of public participation in health policy decision-making and its vital role in understanding the user perspectives to ensure successful implementation of the NHI. Approachable and communicative leaders are required to facilitate public participation and to engage with the public and health workers. Such leaders will need to be innovative and creative in order to overcome current public health shortfalls. [ABSTRACT FROM AUTHOR]

Background:  High systolic blood pressure remains a leading modifiable risk factor for cardiovascular diseases worldwide and in South Africa (SA). Information about the extent of guideline implementation and blood pressure (BP) control is lacking in Matlosana Sub-district, North West province, SA. The study aimed to assess the implementation of the South African Hypertension Practice Guideline (SAHPG) and BP control in adults attending primary care facilities in Matlosana., Methods:  Cross-sectional study was conducted, using 523 randomly sampled medical records. Data collected included demographic information, recorded BP readings, anthropometry, screening for target organ damage (TOD), hypertension complications, comorbidities, lifestyle advice and drug therapy., Results:  According to the reviewed records the mean age of the participants was 56.77 years with a standard deviation of 12.4 years and 376 (71.9%) records belonged to females. Blood pressure control was documented in 229 (43.8%) of the medical records, with better control recorded in a group with comorbid human immunodeficiency virus (HIV) than in groups with other comorbidities., Conclusion:  The study found poor documentation of the SAHPG recommendations among patients with hypertension. According to the patient records BP control was suboptimal, the most common documented comorbid illness was HIV, and screening for TOD was generally poorly documented.Contribution: Programmes that audit and improve the quality of hypertension guideline implementation and BP control in primary care require ongoing support and research.

Background:  The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings., Aim:  The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict., Setting:  Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study., Methods:  Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed., Results:  Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support., Conclusion:  If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients.Contribution: Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Background:  Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings., Aim:  This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP., Setting:  The study focused on the primary health care (PHC) sector in Cape Town, South Africa., Methods:  A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes., Results:  The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations., Conclusion:  There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies.Contribution: The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

Background:  In South Africa, various treatment modalities from abroad have been implemented to treat patients with mood disorders. This article is based on a South African model that has been developed, implemented and evaluated for psychiatric nurses to use in facilitating constructive group therapy for patients with mood disorders., Objectives:  This study aimed to describe psychiatric nurses' experiences in implementation of a model to facilitate constructive group therapy for patients with mood disorders., Method:  A qualitative, exploratory, descriptive and contextual research design was used for this study. Participants were psychiatric nurses working in an inpatient unit for patients with mood disorders in a public psychiatric hospital., Results:  The study revealed that psychiatric nurses experienced the model as a supportive tool to facilitate constructive interaction among patients with mood disorders. The model was beneficial in creating a safe space for patients to share and deal with their challenges, promoting optimal functioning outside the hospital setting. The model's implementation also fostered improvement in psychiatric nurses' personal and professional skills., Conclusion:  The model emphasised psychiatric nurses' importance in treating patients with mood disorders and ensuring positive patient experiences and outcomes.Contribution: This study contributes to the theory of clinical psychiatric nursing practice and the empowerment of psychiatric nurses, creating self-awareness related to working with patients with mood disorders.

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]

Purpose of the study: Green supply chain management (GSCM) has gained worldwide momentum, however, its successful implementation in most manufacturing companies has remained problematic. The cement manufacturer in South Africa is not immune to problems related to GSCM implementation. An understanding of employees' perceptions towards factors affecting GSCM implementation is a profound strategy to ensure a successful GSCM programme. It is not uncommon that most manufacturing firms, including cement producers, ignore the importance of incorporating the views of employees when making GSCM decisions. This study's purpose is twofold, namely (i) to assess employees' perceptions of factors affecting GSCM implementation and (ii) to investigate how these factors influence the implementation of the GSCM system. Design/methodology/approach: A descriptive quantitative case study methodology, through a structured questionnaire, was used to collect data from a sample of 306 employees at the cement manufacturer in the City of Tshwane with a total population of 1500 employees. The Statistical Package for Social Sciences (SPSS) 26 was used to conduct multivariate and descriptive analyses including factor analysis, correlations and regression analyses. Findings: It was found that employees had a negative perception towards all five factors (internal, external, customers, competitors, and suppliers) for GSCM implementation and a positive statistically significant relationship was found existing between four factors (internal, external, customers and suppliers) and implementation of the GSCM system at the cement manufacturer in the City of Tshwane. Recommendations/value: The study suggests that management must ensure commitment to green supply chain practice, and this is achieved by taking leaders and managers in different functional areas for green supply chain management training. Managerial implications: This study implies that the cement manufacturer should provide a supportive organisational structure, source skills, invest in technology, involve suppliers and share knowledge in line with GSCM systems. [ABSTRACT FROM AUTHOR]

Implementing the National Youth Policy 2020-2030 in South Africa, focusing specially on the National Youth Service Programme (NYSP) is crucial in developing young people who are battling with the triple challenges of crime, poverty, and unemployment. For decades, civil society organisations have played a vital role in implementing the National Youth Policy with or without government financial assistance. Implementing the National Youth Policy during COVID-19 has been disrupted in South Africa. Therefore, a post- COVID-19 intervention strategy needs to be implemented to ensure the effective implementation of the National Youth Policy 2030. The study aims to explore challenges that the civil society organisations faced in implementing the National Youth Policy2020-2030 in the context of COVID-19, focusing specially on the NYSP in the Western Cape Province, South Africa. A qualitative research method was used in this study, followed by a purposive sample involving ten youth workers from youth-led NPOs and youth-focused Non-Profit Organisations who were sampled to participate in the study from the Western Cape Province, South Africa. The study findings revealed that youth workers drawn from NPOs in the context of the COVID-19 struggle to obtain financial assistance to implement the NYSP. This study recommends that the National Youth Development Agency (NYDA) establish a fund relief project under the National Youth Service Unit called "You served, and I embrace you". This project will fund social entrepreneurs who want to address the social-economic issues in their communities. [ABSTRACT FROM AUTHOR]

This article is premised on the notion that the success of an education system depends entirely on the strong leadership and synergy at all its levels. The intention with this article was to assess the extent to which the circuit managers' views on quality education is affecting its provision at public schools. A Systems Thinking Approach to Leadership guided the study reported on here in which a qualitative research methodology was used. Data were collected through semi-structured interviews, observation and document analysis to ensure data triangulation and guarantee the trustworthiness and credibility of the study. Ten participants were purposively selected from 5 districts in the Limpopo province. The findings reveal that circuit managers' varied views on quality education negatively influence their curriculum delivery, support, and responsibilities entrusted to them. As there is little improvement in the provisioning of basic quality education, I argue for the strengthening of the circuit offices and suggest ways in which they could be utilised to improve the quality of basic education in public schools. The implications of the findings suggest capacity building of effective supervision and monitoring of the provision of quality support by circuit managers. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends tuberculosis preventive treatment (TPT) in people with HIV (PWH), yet implementation remains poor, especially in rural communities. We examined factors influencing TPT initiation in PWH on antiretroviral therapy (ART) in rural South Africa using the Promoting Action on Research Implementation in Health Services (PARiHS) framework to identify contextual factors and facilitation strategies to successfully implement TPT. Patient and clinical factors were extracted from medical records at two primary healthcare clinics (PHCs). Among 455 TPT eligible indivdiuals, only 263 (57.8%) initiated TPT. Patient-level characteristics (older age and symptoms of fever or weight loss) were significantly associated with TPT initiation in bivariate analysis, but PHC was the only independent correlate of TPT initiation (aOR: 2.24; 95% CI: 1.49–3.38). Clinic-level factors are crucial targets for implementing TPT to reduce the burden of HIV-associated TB. Gaps in knowledge of HCW, staff shortages, and non-integrated HIV/TB services were identified barriers to TPT implementation. Evidence-based strategies for facilitating TPT implementation that might be under-prioritized include ongoing reprioritization, expanding training for primary care providers, and quality improvement strategies (organisational changes, multidisciplinary teams, and monitoring and feedback). Addressing contextual barriers through these facilitation strategies may improve future TPT implementation in this setting. [ABSTRACT FROM AUTHOR]

Considering the global trend towards the dissemination and implementation of trauma-focused treatments in the majority of the world, it is imperative to ascertain the contextual factors which affect the treatment of traumatic stress, especially in low- and middle-income countries characterised by ongoing adversity such as poverty and increased levels of trauma exposure. We explored the experiences of non-specialist health workers whose work involved providing trauma-focused services in low-resource communities in South Africa. Participants (n = 18) worked at four non-governmental organisations in the Eastern Cape and Western Cape of South Africa. Semi-structured individual interviews were conducted and analysed using a phenomenologically informed thematic analysis. Two superordinate themes were identified, namely, adjusting to trauma-focused work and trauma in the social context. Five themes that made up the superordinate themes were Encountering Trauma Narratives, Support and Resilience, Going the Extra Mile, Helplessness, and Social Factors. The findings are not only in keeping with the psychological risks of trauma-focused work (e.g., vicarious traumatisation) but also highlighting the impact of the social context on the provision of trauma-focused work. Participants reported experiencing an added burden of helplessness due to social factors, such as poverty and high levels of trauma exposure, which affect the process of treating traumatic stress in low-resource settings. We discuss how these findings can contribute to efforts to implement trauma-focused services in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Agroforestry‐based sustainable land management (SLM) interventions provide opportunities for tackling land degradation and its associated socio‐economic issues. Agroforestry is not a guaranteed SLM fix as every agroforestry practice is not automatically relevant to each context. It is critical to identify key considerations for ensuring a good fit between agroforestry and the receiving environment. This study identifies and analyses key factors for assessing the context‐specific suitability of an agroforestry practice for SLM using a case‐study of homegarden agroforestry in a degraded catchment. An analysis of biophysical and socio‐economic characteristics of the catchment covering land degradation, SLM aspirations of residents, agriculture and agroforestry activities was conducted through literature review, field observations, GIS and remote sensing, stakeholder engagement and a questionnaire survey. Considerations in agroforestry practice assessment for SLM include agricultural and SLM objectives, which at our study site were increased crop production and arresting soil erosion. Availability of requisite resources, namely land, water and fencing; stakeholder interest in the tree and/or crop planting, species of interest and suitability of the species for the biophysical conditions should also be assessed. We propose a framework for systematically working through the relevant factors and assessing the suitability of an agroforestry practice for SLM intervention in a specific context. Based on the framework, homegarden agroforestry is an appropriate SLM intervention as it could meet stakeholders' SLM and agricultural objectives. Identification and systematic assessment of relevant factors are critical for ensuring the acceptability of agroforestry practice in a locality and the sustainability of associated SLM interventions. [ABSTRACT FROM AUTHOR]

The aim of the study was to describe how healthcare professionals at a neurorehabilitation facility currently use the International Classification of Functioning, Disability and Health (ICF) and to identify further possibilities for its future use. The study followed an interpretive description approach. Data were collected through four focus group discussions with 21 participants, all health care practitioners, at the study facility. Thematic analysis was conducted by coding the transcripts and generating themes. Three themes were generated: (1) Current use and gaps in use of the ICF, (2) a non-conducive environment and (3) using the ICF to facilitate holistic, patient-centred management. Current use of the ICF was limited. Gaps in use of the ICF was especially evident in goal setting practices. Goals were generic in nature and did not address participation and the environment. A lack of knowledge, debilitating interpersonal relationships and an unsupportive organisational culture created an environment non-conducive to the implementation of the ICF. Participants felt that the ICF can assist them to work more patient-centred. Participants perceived that the ICF has the potential to improve service delivery at the facility. The implementation process must be well structured, focus on practical use and be supported through an enabling environment created by management. The ICF is not being optimally used in clinical rehabilitation practice, however healthcare practitioners perceive the ICF to have the potential to improve rehabilitation service delivery. Concerted action is required at institutional, interpersonal and individual level to create a conducive environment that facilitates the use of the ICF during rehabilitation service delivery. The ICF can be used to construct a team assessment document that promotes patient-centred goal setting and improves interdisciplinary communication. [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: Continued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources.Methods: In a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers.Results: From December 2019 - January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1-46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032).Conclusion: The ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges. [ABSTRACT FROM AUTHOR]

In order to respond more effectively to the health of young people in South Africa, in 2017 the National Department of Health of South Africa released the National Adolescent & Youth Health Policy. The Policy focused on a range of health problems and recommended interventions for delivery through multiple settings and government departments. It also included specific recommendations to empower and involve young people in policy and programme implementation. Adaptation of a short course on adolescent health in lowand middle-income countries, organized annually by the London School of Hygiene and Tropical Medicine and the World Health Organization, was piloted in 2017 as one means of contributing to the implementation of the Policy. The Adolescent & Youth Health Policy short course was subsequently offered in 2018 and 2019, attracting 96 participants working on adolescent health in various organizations at national and provincial levels throughout the country. Most participants (75%) successfully completed the course, as assessed by the completion criteria that had been defined. The range of topics for the assignments selected by the participants over the 3 years reflected both the content and intent of the Policy. The evaluations of the short course indicate that it helped to create legitimacy and strengthen the capacity of various constituencies, both of which are important prerequisites for policy implementation. [ABSTRACT FROM AUTHOR]

Continuous Improvement and Innovation (CI&I) is a business management strategy that concentrates thinking and action on the things that makes the real difference. Performance assessment is the most significant step in CI&I, as it analyses and reports on outcomes - it reveals which goals have been achieved and which are still to be achieved. Emerging aquaculture farmers are not searching for handouts; they want to compete on a commercial scale. Aquaculture can only attract investors if it becomes profitable and viable. As part of the research reported here, roleplayers in sharptooth catfish businesses attended focus group discussions, and were equipped to implement actions and assess their own performance. The performance assessment process was followed to monitor the action that had been taken and to report results. Mechanisms such as action monitoring and support; observation; the formulation of questions and ideas; identifying opportunities; performance assessment; and achievement stacker were applied to assess the achieved outcomes. The study led to the identification of markets and potential customers; signed orders; access to processing plants; the printing of business material (e.g., stickers); training; and the completion of new ponds. Questionnaires were sent out and completed. An experiment with earthworms and tilapia fry used as catfish feed was completed successfully. In conclusion, the outcomes of this study have revealed a need for further research that would assist small businesses in the catfish industry in growing and becoming profitable. [ABSTRACT FROM AUTHOR]

Background: The management and funding of research in South Africa are managed at the national level by a dedicated public utility. However, the procurement plan implementation at the utility has been unsatisfactory and is hindered by various factors. The institution requests funding, but by the end of the financial year, not all of the funds would have been used up. Funds not utilised by the end of the financial year are returned to the National Treasury, which reflects poor performance in the Supply chain management unit. Objectives: This study examines the factors hindering the implementation of the procurement plan at the National Research Foundation. This is crucial because National Treasury SCM Instruction 2 of 2016 and 2017 stated that some government institutions sorely undermine and weaken the ethos of the Public Finance Management Act and ultimately waste scarce resources that are intended to improve service delivery. Method: A qualitative approach with interviews being the major data collection technique was applied. Results: The findings revealed that there is a lack of support from SCM managers and that SCM officials lack dedication to their work. In addition, the results also reveal a knowledge barrier between Scientists and SCM practitioners. Conclusion: The study recommends that SCM managers arrange quarterly meetings with project managers to discuss the progress of projects on the procurement plan. The National Research Foundation (NRF) business heads should offer support to SCM officials in an effort to assist them to fulfil their responsibilities. The SCM officials should train Scientists on SCM regulations, which would break the knowledge barriers existing between them. [ABSTRACT FROM AUTHOR]

Background: Despite the long-term consequences of malnutrition in hospitalised patients, nutritional practice guidelines for adults, particularly in the recovery phase are rarely implemented in community based primary health care settings. Aim: This study aimed at assessing the current practice to establish preparedness for effective implementation of the 2016 South African Enteral Nutrition Practice Guidelines for Adults. Setting: This study was conducted in a district hospital in KwaZulu-Natal, a community health centre, two primary health care (PHC) clinics and one household. Methods: Non-participant observations were conducted to observe 10 purposefully selected health care professionals involved in nutritional therapy provision to adults, a patient on home enteral nutrition (HEN) and a family caregiver. Content analysis helped identify predominant themes that emerged in the study. Results: Observation results showed that the national enteral nutritional (EN) therapy practice guidelines were not available in all health care institutions. Health care professionals were not aware of them and the care users confirmed that they attended HEN related follow-up care at institutions that prescribed and inserted their feeding tubes. Two major themes that emerged in this study include positive factors and negative factors that influence implementation of the guideline. Conclusion: The study identified factors that can have significant influence on the implementation of the national enteral nutritional therapy practice guidelines, a necessary step for changing clinical practice and thus clinical outcomes of patients. The EN/HEN training and the provision of necessary resources are needed to improve the situation. More research on the strategies for the dissemination of guidelines is essential to improve awareness and thus adoption and implementation. [ABSTRACT FROM AUTHOR]

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In multilingual or multi-cultural settings, teachers must be sensitive to the diverse intelligence of learners for teaching and learning to have impact and be beneficial to them. Low performance and the resultant academic failure among high school learners specifically in South Africa, and inability to manage diverse learning abilities have necessitated the search for a unique way to accommodate the learning differences found in the classroom. The study focused on learners' differences and supports implementation of differentiated instruction. Fewer studies exist on English Second Language (ESL) rural high school teachers' perceptions of the application of socio-cultural and multiple intelligences, and on the diverse ESL learners taught to ascertain the scope of the need for teacher training in differentiated instruction in rural South Africa. Data were drawn from fifty teachers in grade ten using a questionnaire. The study revealed that it is challenging for teachers to determine learners' intelligences and emotional needs. Sixtysix percent (n=33) of the teachers agreed to accommodate students of different learning abilities, 34% (n=17) considered learners' gender differences, and 62% (n=31) considered learners' cultural backgrounds and adopted group learning. The study mainly recommends training and supervision on the strategies for gender differences and accommodation for diverse learning abilities. [ABSTRACT FROM AUTHOR]

The annual herb, Parthenium hysterophorus L. (Asteraceae: Heliantheae) is a severe terrestrial invader globally. Infestations reduce crop yield, limit available grazing, hinder conservation efforts, and affect human and animal health in Africa, Asia and Australia, and on associated islands. Due to the impact and threat of further invasion of P. hysterophorus, a biological control (biocontrol) programme was initiated in 2003 in South Africa. This review discusses the research and implementation activities undertaken on the insect agents from 2011 to 2020. During this period, the stem-boring weevil Listronotus setosipennis Hustache (Coleoptera: Curculionidae), leaf-feeding beetle Zygogramma bicolorata Pallister (Coleoptera: Chrysomelidae) and seed-feeding weevil Smicronyx lutulentus Dietz (Coleoptera: Curculionidae), were found to be host specific and approved for release. Releases of mass-reared insect agents have been concentrated particularly in north-eastern South Africa, where P. hysterophorus infestations are most prolific. Post-release monitoring studies indicated localised establishment and impact of L. setosipennis and S. lutulentus. Listronotus setosipennis persisted through severe drought conditions, and although it disperses slowly, larval feeding is structurally damaging. Establishment of S. lutulentus is improving, reducing seed production where it is established. Zygogramma bicolorata resulted in defoliation at a few sites, but establishment has been poor and the beetle has been absent since 2019. Although a combination of fungal and insect agents were demonstrated to reduce P. hysterophorus, additional natural enemies could improve control. Consequently, the stem-galling moth Epiblema strenuana Walker (Lepidoptera: Tortricidae) and root-crown boring moth Carmenta sp. nr. ithacae (Beutenmüller) (Lepidoptera: Sesiidae) remain under evaluation. The management of P. hysterophorus in South Africa has been guided by the development of a national strategy, which incorporates multiple management methods, including biocontrol. International collaborations have intensified as a growing number of countries begin to utilize biocontrol to manage P. hysterophorus. Despite the progress towards biocontrol of P. hysterophorus during this period, increased utilisation of approved agents and the introduction of additional agents are necessary to achieve greater control. [ABSTRACT FROM AUTHOR]

Background:  The World Health Organization's (WHO) call to eliminate cervical cancer is essential in improving structures and processes at primary healthcare facilities by galvanising change in providing cervical cancer screening services., Aim:  The main objective of this study was to explore challenges affecting the implementation of cervical cancer screening guidelines in selected districts in Limpopo Province., Setting:  The study was carried out at primary health care services (PHCs) in Vhembe and Mopani districts, Limpopo province., Methods:  Qualitative non-experimental research design of an exploratory, descriptive and contextual nature of a qualitative paradigm to understand cervical cancer screening programme challenges from healthcare professionals' perspectives. The study population comprised two males and 16 female professional registered nurses working in Limpopo province's PHC services. The sample size was 18 professional nurses. A face-to-face interview guided by unstructured questionnaires was undertaken to elicit information regarding the implementation of cervical cancer screening services. Captured data were analysed using Tesch's open-coding method., Results:  The study revealed that the cervical cancer guidelines were not effectively implemented as there were contradictions and gaps when applying the guidelines about the management of HIV and AIDS, age restrictions and gestation. Furthermore, structural factors contributed to the inadequacy rate and failure to reach the set targets., Conclusion:  Primary health care is an essential health care and human right; therefore, the government should ensure that guidelines and policies are supported financially and that professional nurses are capacitated for the efficient implementation of services.Contribution: Addressing the inequalities in the implementation of social policies for the prevention of cervical cancer prevention and improving the nurses' knowledge and practice behaviour regarding cervical cancer prevention are imperative.

Upon assuming political office, the ANC government instituted a land redistribution programme to address the land ownership injustice perpetrated during the apartheid regime whereby the non-white citizens owned only 7% of land in South Africa. However, the programme has not achieved the set target; thus, this study sought to understand the challenges curtailing the successful implementation of the programme. The study used a qualitative research approach. An in-depth interview was conducted with three purposefully selected senior officials from three Departments in Greater Kokstad Municipality involved in the land redistribution programme's implementation. The findings indicate that the major issues curtailing the programme's implementation are land claim disputes and mediation process, reliance on the willing-seller-willing-buyer model, lack of institutional capacity, cumbersome beneficiary selection process, land beneficiary resettlement support, and inadequate programme's monitoring and evaluation. There is an urgent need for the government to institute measures to address the challenges preventing the smooth implementation of the land redistribution programme in South Africa. These challenges prevent the programme's beneficiaries from accessing the land, thus preventing them from experiencing socio-economic emancipation as promised. [ABSTRACT FROM AUTHOR]

Background: There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care. Methods: The case of the FTD initiative was constructed through a triangulated analysis of document reviews (34), in depth interviews (22) and observations. The analysis drew on Hall's 'ideas, interests and institutions' framework to understand the shift from political agendas to the implementation of the FTD. Results: In the Western Cape province, the FTD agenda setting process was catalysed by the increasing global evidence on the life-long impacts of brain development during the early childhood years. This created a window of opportunity for active lobbying by policy entrepreneurs and a favourable provincial context for a holistic focus on children. However, during implementation, the intersectoral goal of the FTD got lost, with limited bureaucratic support from service-delivery actors and minimal cross-sector involvement. Challenges facing the health sector, such as overburdened facilities, competing policies and the limited consideration of implementation realities (such as health providers' capacity), were perceived by implementing actors as the key constraints to intersectoral action. As a result, FTD actors, whose decision-making power largely resided in health services, reformulated FTD as a traditional maternal-child health mandate. Ambiguity and contestation between key actors regarding FTD interventions contributed to this narrowing of focus. Conclusion: This study highlights conditions that should be considered for the effective implementation of intersectoral action - including engaging cross-sector players in agenda setting processes and creating spaces that allow the consideration of actors' interests especially those at service-delivery level. Networks that prioritise relationship building and trust can be valuable in allowing the emergence of common goals that further embrace collective interests. [ABSTRACT FROM AUTHOR]

In many countries, including South Africa, the underperformance of Physical Sciences learner's is a great concern. The purpose of this study was to find out how the academic achievement of science learners can be addressed through implementing a parental involvement policy. The policy on parental involvement can only be successful if there is an effort to ensure effective participation of parents in school activities, which includes helping learners with homework, discussing learners' behaviour with teachers, motivating learners and communicating about and participating in science activities. This was a qualitative research study and the cultural–historical activity theory (CHAT) acted as a lens and offered a broad approach to analysing a parental involvement policy and the contexts of science learning. The research was conducted in rural public secondary schools and data were collected by means of face-to-face interviews. The study recommends that parents need training and development to perform their functions optimally in science activities. Effective communication between parents and the school and providing assistance to child-headed families are imperative. [ABSTRACT FROM AUTHOR]