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Simple Summary: It is known that the death rate amongst giraffes during immobilisation, capture and transportation is high. However, during this study period (2011 to 2021), 75 giraffes were captured for the collection of various samples and purposes and none of these individuals died. General experiences and lessons learned during these captures are described. Data on the knockdown times on 43 occasions of giraffe immobilisation were recorded and analysed. We hope that this shared information could help in shaping future standard operating procedures to increase the success of handling giraffes and ultimately contribute to the conservation of the species. One of the highest occurrences of mortalities among giraffes (Giraffa camelopardalis) takes place during immobilisations, captures and translocations. Common mistakes, human error, unforeseen risks, the awkward anatomy and the sheer size of the animal are leading factors for giraffes' mortalities during these operations. Many risks can be circumvented but some risks are unpreventable, often due to terrain characteristics (rivers, deep ditches, holes and rocky terrain). From 2011 to 2021, seventy-five giraffes were successfully immobilised and captured to collect biological and physiological data from eight different study areas across South Africa. A 0% mortality and injury rate was achieved and, therefore, the techniques described in this paper are testimony to the advances and improvements of capture techniques and drugs. Biological information and capture experiences were noted for 75 immobilised giraffes, of which, knockdown time data were recorded for 43 individuals. Effective and safe immobilisation requires a competent team, proper planning, skill and knowledge. In this manuscript, we address procedures, techniques, ethical compliance, welfare and safety of the study animals. General experiences and lessons learned are also shared and should benefit future captures and immobilisations by limiting the risks involved. The sharing of experiences and information could influence and improve critical assessments of different capture techniques and can likely contribute to the success rate of immobilisation and translocation success for giraffes in the future. [ABSTRACT FROM AUTHOR]

Background: Recent studies in the Sub-Saharan countries in Africa have indicated gaps and challenges for voluntary medical male circumcision (VMMC) quality of service. Less has focused on the changes in quality of service after implementation of continuous quality improvement (CQI) action plans. This study aimed to evaluate the impact of coaching, provision of standard operating procedures (SOPS) and guidelines, mentoring and on-site in-service training in improving quality of VMMC services across four Right to Care (RTC) supported provinces in South Africa. Method: This was a pre- and post-interventional study on RTC supported VMMC sites from July 2018 to October 2019. All RTC-supported sites that were assessed at baseline and post-intervention were included in the study. Data for baseline CQI assessment and re-assessments was collected using a standardized National Department of Health (NDoH) CQI assessment tool for VMMC services from routine RTC facility level VMMC programme data. Quality improvement support was provided through a combination of coaching, provision of standard operating procedures and guidelines, mentoring and on-site in-service training on quality improvement planning and implementation. The main outcome measure was quality of service. A paired sample t-test was used to compare the difference in mean quality of service scores before and after CQI implementation by quality standard. Results: A total of 40 health facilities were assessed at both baseline and after CQI support visits. Results showed significant increases for the overall changes in quality of service after CQI support intervention of 12% for infection prevention (95%CI: 7–17; p<0.001) and 8% for male circumcision surgical procedure, (95%CI: 3–13; p<0.01). Similarly, individual counselling, and HIV testing increased by 14%, (95%CI: 7–20; p<0.001), group counselling, registration and communication by 8%, (95%CI: 3–14; p<0.001), and 35% for monitoring and evaluation, (95%CI: 28–42; p<0.001). In addition, there were significant increases for management systems of 29%, (95%CI: 22–35; p<0.001), leadership and planning 23%, (95%CI: 13–34; p<0.001%) and supplies, equipment, environment and emergency 5%, (95%CI: 1–9; p<0.01). The overall quality of service performance across provinces increased by 18% (95%CI: 14–21; p<0.001). Conclusion: The overall quality of service performance across provinces was significantly improved after implementation of CQI support intervention program. Regular visits and intensive CQI support are required for sites that will be performing below quality standards. [ABSTRACT FROM AUTHOR]

Background. All health researchers in South Africa (SA) are explicitly encouraged by the ethicolegal framework to engage stakeholders meaningfully in their research. Research ethics committees (RECs) have a role to play in shaping researchers' practices in this regard, but very little research has explored how RECs might best achieve this. Objectives. To explore whether SA REC documents are prompting researchers to plan sound stakeholder engagement in health research. Methods. We reviewed publicly available documents of RECs registered with the SA National Health Research Ethics Council. Of the 46 registered RECs as of November 2019, the documents of 37 were publicly accessible. These comprised 72 documents (e.g. standard operating procedures and application forms). We coded these according to ethical reasons mentioned for engagement, stakeholders and strategies highlighted for engagement. We used semantic coding, staying close to the actual wording of REC documents. We utilised thematic analysis to identify key themes. Results. We found that many REC documents encouraged researchers to plan engagement in a way that resonates with ethics guidance (theme 1: 'encouraging sound engagement'). However, we found many wasted opportunities in this regard (theme 2: 'missing opportunities'). For some RECs, there was little harmonisation across their key documents regarding this important issue (theme 3: 'moving towards harmonisation'). Conclusion. In the short term, we recommend that RECs should amend their application forms in particular to better 'trigger' researchers to thoughtfully plan sound stakeholder engagement. In the longer term, we recommend that RECs' documents be better harmonised internally regarding their stance on stakeholder engagement. [ABSTRACT FROM AUTHOR]

• Good governance enables governments to formulate and implement effective policies. • NITAGs recommendations are designed to foster evidence-informed policies. • NITAGs contributions to governance may lead to policy success. • Enhancement of key governance attributes may benefit NITAGs practices. • Assessment of NITAGs may further promote good governance. Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. In 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making. [ABSTRACT FROM AUTHOR]

Background: Teleradiology was implemented across South Africa, to provide reporting services to rural healthcare institutes without a radiologist. This is guided by standard operating procedure manuals (SOP) which standardise the quality of services provided. From observation, end users, namely, the radiographer and referring clinician, experience challenges in fulfilling the roles extending beyond the SOP. Aim: To explore the end users' experiences within this context and the impact it has on service delivery. Setting: A rural district in North West province, South Africa. Method: This was a qualitative, exploratory, descriptive study. Focus group discussions were held with radiographers and referring clinicians from the teleradiology site in the North West province. A one-on-one interview was conducted with a private radiologist at the reporting site in Gauteng. An interview guide was used to ask open-ended questions to address the aim of the study. Results: At the teleradiology site, radiographers and referring clinicians are performing extended roles, not described in the teleradiology service-level agreement (SLA) and felt poorly equipped to fulfil these roles. They also felt that the private radiologists needed training on interprofessional collaboration to understand the challenges facing health professionals at these rural sites. Conclusion: SLA's should align with the clinical needs and practices of the district. This should guide the specific training needs of the end users practicing in rural areas, to support their extended roles in the teleradiology setting. Training should be in-house, ongoing and consistent to cater for the influx of health professionals entering the rural setting using teleradiology systems. [ABSTRACT FROM AUTHOR]

Objective To assess prescriber adherence to standard anti-hypertensive treatment guidelines in South Africa, determine if supply data are useful indicators of drug use, and assess the cost implications of not complying with the guidelines. Methods We undertook two studies: an analysis of records of the anti-hypertensive drugs supplied to all 54 public-sector hospitals with a hypertension clinic in KwaZulu-Natal, and a direct-observation survey of anti-hypertensive drug prescriptions presented to pharmacies in a subset of 16 of the 54 hospitals. We calculated the relative use of each anti-hypertensive drug group as a proportion of all anti-hypertensive drugs supplied or prescribed. We ranked drug groups in order of use for comparison with recommended South African standard treatment guidelines, and we compared the proportions derived from supply data with those derived from the prescription survey. Findings Supply data showed that, in line with treatment guidelines, diuretics and angiotensin-converting enzyme inhibitors were the most frequently supplied medicines (42% and 27%, respectively). However, methyldopa -- not included in the treatment guidelines -- represented 10% of all anti-hypertensives supplied, but the proportion varied widely between hospitals (0--37%). Reserpine, second choice in the treatment guidelines, was used in high amounts by only two hospitals. Calcium channel blockers and beta blockers represented a small proportion of the anti-hypertensive drugs supplied: 6% each. Results from the prescription survey were in concordance with supply data for the most frequently prescribed drugs but gave slightly different estimates of the use of others. Conclusion Supply data, the most available source of information about drug use in developing countries, are (with some provisos) a reliable data source for the evaluation of adherence to treatment guidelines. Our results showed substantial non-adherence to standard treatment guidelines. [ABSTRACT FROM AUTHOR]

The article reports on the liability and supervision of Responsible Pharmacists (RP) in the South African Pharmacy Council (SAPC). It mentions their authority in fulfilling effectively their roles and the need for assurance in monitoring pharmacies along with the establishment of policies. An overview of their updated Standard Operating Procedure (SOP) is also presented.

The article presents information on the standard operating procedure regarding complaints against a pharmacist has been submitted to the South African Pharmacy Council (SAPC). It discusses the law regarding enquiry by the SAPC, contents of letters being sent by the SAPC to pharmacists regarding complaints, and factors to be considered by the Committee of Preliminary Investigation when taking actions on complaints.