South Africa

This review of the South African Health Information System (HIS) maps essential health-related information, discusses the District Health Information System, details the current status of the HIS and the challenges the HIS faces.

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

This study investigates the experiences of informal caregivers of people living with HIV in two semi-rural communities in South Africa. It is argued that a thorough understanding of how home-based care undermines the physical health and psychological wellbeing of already vulnerable women is crucial for informing policies on home-based care. Thus, there is a need to incorporate gender perspectives when planning and implementing home-based care programs. [from abstract]

The Gender Policy Guidelines have been established in order to support the Department of Health in meeting not only its constitutional commitment to promoting gender equity and equality, but also its own commitments to equity, meeting the needs of those who have been previously marginalized and improving its productivity and quality of care within the health services.

There is no doubt that one of the most effective ways of improving quality of health care at district level, is by means of clinic supervision. To that end, the Clinic Supervisor’s Manual is being used to implement supervision throughout health districts in South Africa. This booklet is a simple tool which guides the effective use of the Clinic Supervisor’s Manual in addition to guiding the day to day activities involved in supervision towards successful and improved outcomes.

This resolution, enacted by the Department of Health in South Africa, details the management and conditions of an allowance designed to attract and retain health workers in rural areas.

The aim of this interventional study was to assess, document and improve the Patient-held Record System in the Emtshezi Subdistrict. The study began in 1998 and was conducted using a Quality Assurance Cycle, which focuses on systems and processes and encourages a team approach to problem solving and quality improvement. [from abstract]

In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. [publisher’s description]

This issue of the HST Update contains articles on: overview of nursing in South Africa, transforming nursing education towards primary health care, problems in nursing today, nursing summit charters a way forward, placement of nurses, nurse training in Mount Frere health district, and the quest for rational drug use.

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

The primary objective of the study was to identify organisations/institutions that provide HIV and AIDS services at the sub-district level, the range of services they provide and their funding sources. This in turn will inform sub-district and district management teams of the progress and impact of services provided and furnish them with tools to monitor the performance and activities on NGOs in their sub-districts and districts. It is hoped that the report will serve as a baseline for ongoing monitoring of the country’s response to the epidemic. Data was collected through self-administered questionnaires, staff interviews and record reviews.

The maintenance of competence by rural district hospital medical practitioners is a challenge faced by all countries and, most acutely, by resource-poor nations. It is a vital element in addressing the disparity between rural and urban health care in South Africa. The aim of this study was to define expert consensus on the content and methods most suitable for the maintenance of competence by rural district hospital practitioners in the Western Cape province of South Africa. [author’s description]

Historically, the doctor-nurse relationship is an unequal one characterised by the dominance of the doctor, with nurses assuming a position of lower status and dependence on physicians. Both professions have however demonstrated a willingness to promote teamwork in hospitals. This was a descriptive qualitative study in which the experiences of Kwa-Nobuhle general practitioners and professional nurses were explored. [from author’s description]

A successful leprosy care and control program within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of, and practical training on, leprosy. This study describes PHC workers’ knowledge of leprosy, and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province, South Africa, where leprosy still occurs. [author’s description]

Health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis, while the results of the district hospital performance data and in-depth interviews are reported elsewhere.

This policy brief discusses the efforts of the South African government to create legislation for the country’s traditional medicine, and provides a synopsis of national initiatives that are transforming the field of traditional knowledge. It also examines what these changes mean for the users of traditional medicines. [author’s description]

The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement. [abstract]

This report presents a review of issues in the regional policy context that are of relevance to the retention of human resources for the health sector (HRH) within the region, based on a rapid appraisal in selected countries and at regional level. This work specifically focussed on the actions needed to stem the flow of international migration by encouraging the retention of health staff within countries. A particular concern raised across countries is staff retention in the public and rural services that preferentially serve the poorest populations. Importantly, policy documents and national

The Department of Health in South Africa has attempted to address the shortage of rural doctors by introducing various interventions, including an increase in salaries, introduction of scarce skills and rural allowances, the deployment of foreign doctors, and upgrading of clinics and hospitals. Despite these, the maldistribution of doctors working in South Africa has not improved significantly. The main objectives of this study were to identify interventions as proposed by doctors in the rural Limpopo province of South Africa and to develop recommendations based on these. [from introduction]

This study aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. We have used the term nursing staffing dynamics to encompass a range of human resource processes including staff turnover, absenteeism, average length of stay in a facility, vacancy rates and workload. The study was carried out in Limpopo, KwaZulu-Natal and Mpumalanga provinces in South Africa. [author’s description]

This study provides evidence on the cost of providing HAART to health care workers and suggests that this strategy could reduce absenteeism and alleviate future staff shortages at moderate cost to hospitals. This is crucial, given the impending human resources crisis in health care in South Africa and the growing burden of HIV/AIDS. These cost estimates should be good indicators of the costs of extending antiretroviral therapy to health care workers in public-sector hospitals in KwaZulu-Natal. [author’s description]

This study aims to examine the range of impacts the [HIV/AIDS] pandemic has had on selected NGO partners of Oxfam operating in South Africa, Zambia, and Zimbabwe, and to make recommendations useful to NGOs, including Oxfam, donors, and policy-makers based on its results. [author’s description]

This paper evaluates structural quality of hospital care in the context of an evaluation of contracting out district hospital services in South Africa. Three contractor hospitals, run by a private company and paid by public purchasers to provide district hospital care to a rural catchment population, were matched with three adjacent public hospitals and three private hospitals serving largely insured patients. A structured instrument was used to provide a quantitative measure of structural quality. Private hospitals scored highest overall, followed by public and then contractor hospitals.

The International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched in 2000 a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector.

The National Human Resource Plan is a national guideline for all stakeholders. It outlines broad issues whilst taking the lead in some areas in order to facilitate the resolution of some of the chronic systemic challenges facing the health system. In implementing this plan, all stakeholders will be required to adapt to the guidelines expressed here. It is envisaged that there will be a measure of variation between the provinces, because each province must take into consideration the prevailing conditions and demands on its human resource capacity to plan objectively.

Public-Private health sector Interactions (PPI) are on the increase in South Africa. However, there are few mechanisms for the two sectors to routinely engage with each other. Such mechanisms are necessary to allow all stakeholders to understand better the motivations of, and the challenges that face, each sector and are a key part of the process of building trust between the sectors. The overall purpose of PPIs, and therefore of engagement between the public and private sectors, is to strengthen the overall health system for the benefit of all South Africans. [author’s description]

This brief report describes four different accreditation programs in South Africa: one is nationwide and addresses hospitals; the second accredits privately financed healthcare programs; the third is a provincial program accrediting all public healthcare facilities, and the fourth assesses clinics providing adolescent reproductive health. This operations research study interviewed stakeholders of the South Africa healthcare system to elicit their views of the best possible options for South Africa and of the strengths and weaknesses of the four existing programs. [author’s description]

Recruitment and retention of medical staff are important issues in rural health. The aim of this study was to describe and understand the perceptions of women doctors working in rural hospitals in South Africa about their work. [from abstract]

This study explored the factors that motivate lay volunteers to join tuberculosis (TB) control programmes in high burden but resource-limited settings. [adapted from abstract]