Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers’ use of information in decision-making: experience from Cape Town, South Africa

BackgroundEfficient methods of assessing older persons’ healthcare needs are required in busy public sector primary healthcare clinics in South Africa. These clinics are the main points of entry into the healthcare system. This study was part of a larger study to test the local applicability and adaptability of the World Health Organization's (WHO) Age Friendly Primary Care Toolkit for assessing and managing chronic diseases and common geriatric syndromes.AimTo assess how older persons experience healthcare delivery at two primary healthcare clinics, and identify perceived gaps in health care to older people.Design & settingA qualitative study at two primary healthcare sites in the suburbs of Cape Town, South Africa.MethodFocus group discussions (two at each facility) using an interview guide.ResultsAnalysed data were categorised into five themes: ‘despite the challenges, there is overall good care’; ‘communication gaps and the frustration of feeling unheard’; ‘the health service is experienced as being unreliable, stretched, and is difficult to access’; ‘there is a perception of pervasive structural ageism in the clinics’; and ‘there is a perception that the quality of care received is related to the profession of the healthcare provider’.ConclusionChallenges of access and care for older clients at primary care clinics are linked to their age-specific holistic needs, which are not fully met by the current age-friendly arrangements. Measures should be taken at the clinics to complement the perceived good clinical care received, by improving access to care, making care appropriate to the need, reducing waiting times, and creating opportunities for older persons to feel respected and heard.

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Attitudes towards a proposed GPS-based, location-tracking smartphone application for improving engagement in HIV care among pregnant and postpartum women in South Africa (Preprint)

10.2196/preprints.19243 ◽

2020 ◽

Author(s):

Kate Clouse ◽

Tamsin K. Phillips ◽

Phepo Mogoba ◽

Linda Ndlovu ◽

Jean Bassett ◽

...

Keyword(s):

South Africa ◽

Critical Evaluation ◽

Cape Town ◽

Informed Choice ◽

Healthcare Facility ◽

Smartphone Application ◽

Hiv Care ◽

Mobile Phone Use ◽

Early Results ◽

Engagement In Hiv Care

BACKGROUND Peripartum women living with HIV (WLWH) in South Africa are at high risk of dropping out of care, and also are a particularly mobile population, which may impact engagement in HIV care. With the rise of mobile phone use globally, there is an opportunity to use smartphones and global positioning system (GPS) location software to characterize mobility in real time. OBJECTIVE To develop a smartphone application (app) that could collect individual GPS locations to improve engagement in HIV care, we assessed attitudes towards this proposed app. METHODS We conducted 50 in-depth interviews (IDIs) with pregnant WLWH in Cape Town and Johannesburg, South Africa, and six focus group discussions (FGDs) with 27 postpartum WLWH in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotes. For FGD data, we grouped text into themes, then analyzed for patterns, concepts and associations and selected illustrative quotes. RESULTS In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments related to the convenience of facilitated continued care (“So the clinic will know if you are in another province”), a sense of helpfulness on the part of the researchers and/or facility (“It would show me that I am cared for”), and the difficulties of trying to maintain care while traveling (“People sometimes travel unexpectedly and have not come to the clinic to get medication”). Of the four (8%) participants who responded negatively, comments primarily related to the individual’s responsibility for their own healthcare. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. CONCLUSIONS WLWH participants were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in the researchers and healthcare facility. Within the context of a rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. CLINICALTRIAL

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

BMC Health Services Research ◽

10.1186/s12913-019-4583-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 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.

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Integration of TB and ART services fails to improve TB treatment outcomes: Comparison of ART/TB primary healthcare services in Cape Town, South Africa

South African Medical Journal ◽

10.7196/samj.7696 ◽

2014 ◽

Vol 104 (3) ◽

pp. 204 ◽

Cited By ~ 12

Author(s):

R Kaplan ◽

J Caldwell ◽

L-G Bekker ◽

K Jennings ◽

C Lombard ◽

...

Keyword(s):

South Africa ◽

Treatment Outcomes ◽

Primary Healthcare ◽

Cape Town ◽

Healthcare Services ◽

Tb Treatment

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Evaluating Bloemfontein’s image as a tourist destination: A tour operator’s perspective

South African Journal of Economic and Management Sciences ◽

10.4102/sajems.v9i2.1145 ◽

2014 ◽

Vol 9 (2) ◽

pp. 187-195 ◽

Cited By ~ 2

Author(s):

AJ Strydom ◽

RG Nel

Keyword(s):

South Africa ◽

Decision Making ◽

Information Sources ◽

Cape Town ◽

Tourist Destination ◽

Decision Making Processes ◽

The City ◽

Central South

Tour operators have been identified as vital information sources influencing the images and decision-making processes of tourists. Bloemfontein is situated in Central South Africa. Tourism marketers believe that the city is an ideal stopover destination for national tour operators en route to other destinations. Research was conducted among national tour operators in Johannesburg, Durban and Cape Town to determine their perceptions of Bloemfontein and whether they regard the city as a tourist or stopover destination. The research indicates that the city is not regarded as a tourist destination, but is seen as an ideal stopover destination which could be included in future tour itineraries. It is currently excluded because operators are unfamiliar with the tourism offering(s) of Bloemfontein due to insufficient marketing by the tourism officials of the city.

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Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

Social Science & Medicine ◽

10.1016/j.socscimed.2020.113407 ◽

2020 ◽

Vol 266 ◽

pp. 113407

Author(s):

Lucy Gilson ◽

Soraya Ellokor ◽

Uta Lehmann ◽

Leanne Brady

Keyword(s):

South Africa ◽

Organizational Change ◽

Health System ◽

Cape Town ◽

System Resilience

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Institutional inertia in a changing climate

International Journal of Climate Change Strategies and Management ◽

10.1108/ijccsm-03-2014-0033 ◽

2016 ◽

Vol 8 (2) ◽

pp. 194-211 ◽

Cited By ~ 12

Author(s):

Anna Taylor

Keyword(s):

South Africa ◽

Decision Making ◽

Climate Adaptation ◽

Municipal Government ◽

Cape Town ◽

Adaptation Planning ◽

Content Type ◽

Climate Risks ◽

The Government ◽

Climate Adaptation Planning

Purpose – This paper aims to present an investigation of the climate adaptation planning and implementation process undertaken by the municipal government of Cape Town, South Africa, situating the findings within the broader literature on governance-related barriers to adaptation. Design/methodology/approach – By developing an in-depth case study using methods of organizational ethnography, the research traces phases of climate adaptation planning and implementation in Cape Town. Applied thematic analysis surfaces issues of coordination, decision-making, resource constraints and tracking progress as key constraints to urban climate adaptation. Findings – While considerable progress has been made on developing a citywide climate adaptation plan for Cape Town, implementation is constrained by poor monitoring and feedback within and between departments and a lack of oversight and impetus from central authorities within the government hierarchy. Research limitations/implications – Further research is needed on the interface between technical and political decision-making, governance arrangements that facilitate coordination and iterative adjustment and the organizational uptake of externally commissioned work on climate adaptation. Practical implications – The paper points to the need for a climate adaptation coordination function situated higher up in the municipal government structure than the environment department to implement, monitor, evaluate and revise measures to reduce climate risks and vulnerabilities citywide. Originality/value – The paper is of value to those seeking to understand local government decision-making, as it pertains to climate adaptation and those looking for means to address climate risks and vulnerabilities in cities, especially in South Africa.

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