scholarly journals Effective and meaningful participation or limited participation? A study of South African health committee legislation

2021 ◽  
Vol 22 ◽  
Author(s):  
Hanne Jensen Haricharan ◽  
Maria Stuttaford ◽  
Leslie London
Keyword(s):  
Health Care ◽  
Human Rights ◽  
Primary Health Care ◽  
Health Facility ◽  
National Policy ◽  
Health Care Facilities ◽  
Western Cape ◽  
Meaningful Participation ◽  
Primary Health ◽  
Health Committee

Abstract Background: Health committees are participatory structures providing community input in health systems. Community participation is a critical tenant in the Alma-Ata Declaration and the Right to Health. In South Africa, national and provincial legislation provides for health committees to be established at all primary health care facilities. Aims: This paper aims to analyze whether the Western Cape Health Facility Boards and Committees Act (2016) is likely to result in effective and meaningful participation consistent with a Primary Health Care (PHC) and human rights approach to participation. The paper also explores whether the provincial Act addresses challenges identified in practice. Methods: The methods consist of an analysis of the Western Cape Health Facility Boards and Committees Act, which is then compared to the international PHC and human rights approach to participation. Findings from an explorative mixed-methods study with health committees in Cape Town are used to discuss whether the Act addresses shortcomings identified in practised participation. Findings and analysis: The paper found that the current legislation is unlikely to lead to effective and meaningful participation. First, the roles prescribed in the Act are narrowly defined. They resemble roles practised and are inconsistent with right-based and PHC frameworks. Second, though the Act provides support, which the empirical research demonstrates is necessary, the support is insufficient, and often contingent. Third, the Act conceptualizes health committees as structures appointed by the Provincial Minister of Health; a formation process likely to lead to structures that do not adequately represent community interests. Conclusions: The paper argues that the Western Cape legislation is unlikely to lead to effective and meaningful participation. It suggests using international PHC and human rights frameworks and national policy documents to restructure health committee participation in the Act and the National Health Insurance Bill.

scholarly journals Burnout among rural hospital doctors in the Western Cape: Comparison with previous South African studies

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrew R. Liebenberg ◽  
Johan F. Coetzee ◽  
Hofmeyr H. Conradie ◽  
Johan F. Coetzee
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
South African ◽  
Health Care Facilities ◽  
Western Cape ◽  
District Health ◽  
District Health System ◽  
Primary Health ◽  
Care Facilities ◽  
Primary Health Care Facilities

Background: Burnout among doctors negatively affects health systems and, ultimately,patient care.Aim: To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies.Setting: Rural district hospitals.Methods: During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands.Results: Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants.Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey;however, the score for personal accomplishment (PA) was greater. EE and PA scores weresimilar to that of a study of junior doctors working in the Red Cross Children’s Hospital;however, EE was smaller.Conclusion: This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.

scholarly journals The role of community participation in primary health care: practices of South African health committees

2021 ◽  
Vol 22 ◽  
Author(s):  
Hanne Jensen Haricharan ◽  
Maria Stuttaford ◽  
Leslie London
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Human Rights ◽  
Primary Health Care ◽  
Community Participation ◽  
Policy Development ◽  
Primary Role ◽  
Cross Sectional Survey ◽  
Primary Health ◽  
Health Committee

Abstract Background: Community participation is an essential component in a primary health care (PHC) and a human rights approach to health. In South Africa, community participation in PHC is organised through health committees linked to all clinics. Aims: This paper analyses health committees’ roles, their degree of influence in decision-making and factors impacting their participation. Methods: Data were collected through a mixed-methods study consisting of a cross-sectional survey, focus groups, interviews and observations. The findings from the survey were analysed using simple descriptive statistics. The qualitative data were analysed using thematic content analysis. Data on health committees’ roles were analysed according to a conceptual framework adapted from the Arnstein ladder of participation to measure the degree of participation. Findings: The study found that 55 per cent of clinics in Cape Town were linked to a health committee. The existing health committees faced sustainability and functionality challenges and primarily practised a form of limited participation. Their decision-making influence was curtailed, and they mainly functioned as a voluntary workforce assisting clinics with health promotion talks and day-to-day operational tasks. Several factors impacted health committee participation, including lack of clarity on health committees’ roles, health committee members’ skills, attitudes of facility managers and ward councillors, limited resources and support and lack of recognition. Conclusions: To create meaningful participation, health committee roles should be defined in accordance with a PHC and human rights framework. Their primary role should be to function as health governance structures at facility level, but they should also have access to influence policy development. Consideration should be given to their potential involvement in addressing social determinants of health. Effective participation requires an enabling environment, including support, financial resources and training.

scholarly journals Community participation in the collaborative governance of primary health care facilities, Uasin Gishu County, Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248914
Author(s):  
Jackline Sitienei ◽  
Lenore Manderson ◽  
Mabel Nangami
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Participation ◽  
Health Facility ◽  
Service Providers ◽  
Collaborative Governance ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Primary Health Care Facilities

Introduction Community participation in the governance of health services is an important component in engaging stakeholders (patients, public and partners) in decision-making and related activities in health care. Community participation is assumed to contribute to quality improvement and goal attainment but remains elusive. We examined the implementation of community participation, through collaborative governance in primary health care facilities in Uasin Gishu County, Western Kenya, under the policy of devolved governance of 2013. Methods Utilizing a multiple case study methodology, five primary health care facilities were purposively selected. Study participants were individuals involved in the collaborative governance of primary health care facilities (from health service providers and community members), including in decision-making, management, oversight, service provision and problem solving. Data were collected through document review, key informant interviews and observations undertaken from 2017 to 2018. Audio recording, notetaking and a reflective journal aided data collection. Data were transcribed, cleaned, coded and analysed iteratively into emerging themes using a governance attributes framework. Findings A total of 60 participants representing individual service providers and community members participated in interviews and observations. The minutes of all meetings of five primary health care facilities were reviewed for three years (2014–2016) and eight health facility committee meetings were observed. Findings indicate that in some cases, structures for collaborative community engagement exist but functioning is ineffective for a number of reasons. Health facility committee meetings were most frequent when there were project funds, with discussions focusing mainly on construction projects as opposed to the day-to-day functioning of the facility. Committee members with the strongest influence and power had political connections or were retired government workers. There were no formal mechanisms for stakeholder forums and how these worked were unclear. Drug stock outs, funding delays and unclear operational guidelines affected collaborative governance performance. Conclusion Implementing collaborative governance effectively requires that the scope of focus for collaboration include both specific projects and the routine functioning of the primary health care facility by the health facility committee. In the study area, structures are required to manage effective stakeholder engagement.

scholarly journals A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

2015 ◽  
Vol 31 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Mary-Anne Ahiabu ◽  
Britt P Tersbøl ◽  
Richard Biritwum ◽  
Ib C Bygbjerg ◽  
Pascal Magnussen
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Facilities ◽  
Eastern Region ◽  
Primary Health ◽  
Retrospective Audit ◽  
Care Facilities ◽  
Primary Health Care Facilities

scholarly journals Factors affecting health care users’ first contact with primary health care facilities in north eastern China, 2008–2018

2021 ◽  
Vol 6 (2) ◽  
pp. e003907
Author(s):  
Ran Liao ◽  
Yaqian Liu ◽  
Shunzhuang Peng ◽  
Xing Lin Feng
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Eastern China ◽  
Medical System ◽  
Health Care Facilities ◽  
Factors Affecting ◽  
Primary Health ◽  
North Eastern ◽  
First Contact ◽  
Hierarchical Medical System

BackgroundChina set out the vision to establishing a hierarchical medical system, with primary health care (PHC) facilities serving health care users’ first contact. Common ailments were listed, supported by a series of auxiliary policy measures. We aim to assess whether these policies were effective to prompt users’ preference to PHCs within these contexts.MethodsUsing data from three waves of National Health Service Survey, we examined trends in care users’ first contact with PHC facilities in Jilin, a north eastern province, during 2008–2018. We analysed trends and factors affecting care users’ choices, stratified by type of diseases and urban–rural settings.ResultsFrom 38 823 respondents, the survey identified 3302 health care users who sought outpatient care. 54.92% and 82.49% with diseases recommended to PHC, in urban and rural Jilin, respectively, contacted PHC facilities first. While 33.51% and 61.19% with diseases not recommended to PHC did so. Care users’ first contact with PHC facilities followed an inverse U shape during 2008–2018. Such trends were more profound among care users with hypertension and/or diabetes. Neither social health insurance coverage nor contracting with family doctors was associated with care users’ first contacts. Only 1.25% care users had referral experiences. Low perceived quality was the main barrier to choose PHC facilities.ConclusionHealth care users sought PHC in a chaotic manner in Jilin. None of the recent efforts seemed effective in prompting their preference to PHC facilities. Without levering quality of PHC, an effective hierarchical medical system could be hardly forged in China.

scholarly journals Perceptions of Ghanaian traditional health practitioners, primary health care workers, service users and caregivers regarding collaboration for mental health care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Solomon Nyame ◽  
Edward Adiibokah ◽  
Yasmin Mohammed ◽  
Victor C. Doku ◽  
Caleb Othieno ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Human Rights ◽  
Primary Health Care ◽  
Service Users ◽  
Traditional Health ◽  
Healthcare Needs ◽  
Primary Health ◽  
Traditional Health Practitioners ◽  
Health Practitioners

Abstract Background In low- and middle-income countries, the paucity of conventional health services means that many people with mental health problems rely on traditional health practitioners (THPs). This paper examines the possibility of forging partnerships at the Primary Health Care (PHC) level in two geopolitical regions of Ghana, to maximize the benefits to both health systems. Methods The study was a qualitative cross-sectional survey. Eight (8) focus group discussions (FGDs) were conducted between February and April 2014. The views of THPs, PHC providers, service users (i.e. patients) and their caregivers, on the perceived benefits, barriers and facilitators of forging partnerships were examined. A thematic framework approach was employed for analysis. Results The study revealed that underlying the widespread approval of forging partnerships, there were mutual undertones of suspicion. While PHC providers were mainly concerned that THPs may incur harms to service users (e.g., through delays in care pathways and human rights abuses), service users and their caregivers highlighted the failure of conventional medical care to meet their healthcare needs. There are practical challenges to these collaborations, including the lack of options to adequately deal with human rights issues such as some patients being chained and exposed to the vagaries of the weather at THPs. There is also the issue of the frequent shortage of psychotropic medication at PHCs. Conclusion Addressing these barriers could enhance partnerships. There is also a need to educate all providers, which should include sessions clarifying the potential value of such partnerships.

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