scholarly journals A health system framework for perinatal care in South African district hospitals: a Delphi technique

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ntombifikile Maureen Nkwanyana ◽  
Anna Silvia Voce ◽  
Sthandwa Octavia Mnqayi ◽  
Benn Sartorius ◽  
Helen Schneider
Keyword(s):  
Health System ◽  
South African ◽  
Delphi Technique ◽  
Perinatal Care ◽  
System Framework ◽  
District Hospitals ◽  
Health System Framework

scholarly journals Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ntombifikile Maureen Nkwanyana ◽  
Anna Silvia Voce
Keyword(s):  
South Africa ◽  
Decision Making ◽  
Decision Support ◽  
Health System ◽  
District Hospital ◽  
Perinatal Care ◽  
Decision Support Tools ◽  
Hospital Level ◽  
District Hospitals ◽  
Support Tools

Abstract Background South Africa has a high burden of perinatal deaths in spite of the availability of evidence-based interventions. The majority of preventable perinatal deaths occur in district hospitals and are mainly related to the functioning of the health system. Particularly, leadership in district hospitals needs to be strengthened in order to decrease the burden of perinatal mortality. Decision-making is a key function of leaders, however leaders in district hospitals are not supported to make evidence-based decisions. The aim of this research was to identify health system decision support tools that can be applied at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Methods A structured approach, the systematic quantitative literature review method, was conducted to find published articles that reported on decision support tools to strengthen decision-making in a health system for perinatal, maternal, neonatal and child health. Articles published in English between 2003 and 2017 were sought through the following search engines: Google Scholar, EBSCOhost and Science Direct. Furthermore, the electronic databases searched were: Academic Search Complete, Health Source – Consumer Edition, Health Source – Nursing/Academic Edition and MEDLINE. Results The search yielded 6366 articles of which 43 met the inclusion criteria for review. Four decision support tools identified in the articles that met the inclusion criteria were the Lives Saved Tool, Maternal and Neonatal Directed Assessment of Technology model, OneHealth Tool, and Discrete Event Simulation. The analysis reflected that none of the identified decision support tools could be adopted at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Conclusion There is a need to either adapt an existing decision support tool or to develop a tool that will support decision-making at district hospital level towards strengthening the health system for perinatal care in South Africa.

scholarly journals Applying the Age-Friendly Health System Framework to Long Term Care Settings

2020 ◽  
Author(s):  
L. S. Edelman ◽  
J. Drost ◽  
R. P. Moone ◽  
K. Owens ◽  
G. L. Towsley ◽  
...  
Keyword(s):  
Health System ◽  
Long Term Care ◽  
System Framework ◽  
Term Care ◽  
Health System Framework

Time for Order in Chaos! A Health System Framework for Foreign Medical Teams in Earthquakes

2012 ◽  
Vol 27 (1) ◽  
pp. 90-93 ◽  
Author(s):  
Karin Lind ◽  
Martin Gerdin ◽  
Andreas Wladis ◽  
Lina Westman ◽  
Johan von Schreeb
Keyword(s):  
Health System ◽  
Disaster Response ◽  
Personal Experience ◽  
Sudden Onset ◽  
System Framework ◽  
Medical Needs ◽  
Essential Components ◽  
Medical Teams ◽  
Health System Framework ◽  
Care Response

The number of reported natural disasters is increasing, as is the number of foreign medical teams (FMTs) sent to provide relief. Studies show that FMTs are not coordinated, nor are they adapted to the medical needs of victims. Another key challenge to the response has been the lack of common terminologies, definitions, and frameworks for FMTs following disasters.In this report, a conceptual health system framework that captures two essential components of health care response by FMTs after earthquakes is presented. This framework was developed using expert panels and personal experience, as well as an exhaustive literature review.The framework can facilitate decisions for deployment of FMTs, as well as facilitate coordination in disaster-affected countries. It also can be an important tool for registering agencies that send FMTs to sudden onset disasters, and ultimately for improving disaster response.

scholarly journals Investigating competencies needed by European-trained doctors in rural South African hospitals

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
James R. Barnacle ◽  
Oliver Johnson ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
South African ◽  
Online Survey ◽  
Rural District ◽  
Eastern Cape ◽  
Rural Medicine ◽  
Rural South ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

scholarly journals Implementation of the Moyo fetal heart rate monitor in district hospitals in Bihar, India: a feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041071
Author(s):  
Hanna Oommen ◽  
Kunal Ranjan ◽  
Sudha Murugesan ◽  
Aboli Gore ◽  
Sunil Sonthalia ◽  
...  
Keyword(s):  
Heart Rate ◽  
Health System ◽  
Fetal Heart Rate ◽  
Clinical Training ◽  
Fetal Heart ◽  
Barriers And Facilitators ◽  
Fetal Heart Rate Monitoring ◽  
Cultural Challenges ◽  
District Hospitals ◽  
Bihar State

ObjectivesGlobally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.SettingCARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data.MethodologyObservational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.ResultsMain barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.ConclusionHealth system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.

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