scholarly journals Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sonja Klingberg ◽  
Esther M. F. van Sluijs ◽  
Stephanie T. Jong ◽  
Catherine E. Draper
Keyword(s):  
South Africa ◽  
Health Care ◽  
Public Sector ◽  
Health Workers ◽  
Care Facility ◽  
Health Care Facility ◽  
Preschool Age ◽  
Primary Health Care Facility ◽  
Community Based ◽  
Primary Health

Abstract Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.

scholarly journals Linkage to TB care: A qualitative study to understand linkage from the patients’ perspective in the Western Cape Province, South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260200
Author(s):  
Nosivuyile Vanqa ◽  
Graeme Hoddinott ◽  
Baxolele Mbenyana ◽  
Muhammad Osman ◽  
Sue-Ann Meehan
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Easy Access ◽  
Primary Health Care Facility ◽  
Western Cape ◽  
Tb Treatment ◽  
Primary Health

Background Delayed linkage to tuberculosis (TB) treatment leads to poor patient outcomes and increased onward transmission. Between 12% and 25% of people diagnosed with TB are never linked to a primary health care facility for continued care. The TB health program is for creating processes that promote and facilitates easy access to care. We explored how TB patients experience TB services and how this influenced their choices around linkage to TB care and treatment. Methods We enrolled 20 participants routinely diagnosed with TB in hospital or at primary health care facilities (PHC) in a high TB/HIV burdened peri-urban community in South Africa. Using the Western Cape Provincial Health Data centre (PHDC) which consolidates person-level clinical data, we used dates of diagnosis and treatment initiation to select participants who had been linked (immediately, after a delay, or never). Between June 2019 and January 2020, we facilitated in-depth discussions to explore both the participants’ experience of their TB diagnosis and their journey around linking to TB care at a primary health care facility. We analysed the data using case descriptions. Results Twelve of twenty (12/20) participants interviewed who experienced a delay linking were diagnosed at the hospital. Participants who experienced delays in linking or never linked explained this as a result of lack of information and support from health care providers. Unpleasant previous TB treatment episodes made it difficult to ‘face’ TB again and being uncertain of their TB diagnosis. In contrast, participants said the main motivator for linking was a personal will to get better. Conclusion The health care system, especially in hospitals, should focus on strengthening patient-centred care. Communication and clear messaging on TB processes is key, to prepare patients in transitioning from a hospital setting to PHC facilities for continuation of care. This should not just include a thorough explanation of their TB diagnosis but ensure that patients understand treatment processes. Former TB patients may require additional counselling and support to re-engage in care.

scholarly journals Facility Managers’ Perceptions of Support and Supervision of Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in KwaZulu-Natal, South Africa. A Qualitative Study

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1718
Author(s):  
Euphemia Mbali Mhlongo ◽  
Elizabeth Lutge
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Care Facility ◽  
Health Care Facility ◽  
Primary Health Care Facility ◽  
Primary Health ◽  
Kwazulu Natal

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.

scholarly journals Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s National Antiretroviral Therapy Programme between 2012 and 2015

2019 ◽  
Author(s):  
Richard Makurumidze ◽  
Tsitsi Mutasa-Apollo ◽  
Tom Decroo ◽  
Regis C. Choto ◽  
Kudakwashe C. Takarinda ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antiretroviral Therapy ◽  
Cox Regression ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Primary Health Care Facility ◽  
Primary Health

AbstractBackgroundThe last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) through the Zimbabwe public sector was conducted in 2011, covering the 2007-2010 cohorts. The reported retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. We report findings of a follow up evaluation for the 2012-2015 cohorts to assess the implementation & impact of recommendations from this prior evaluation.MethodsA nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling was used to select health facilities and study participants records. The data extracted from patient manual records included demographic, baseline clinical characteristics and patient outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up (LFTU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention was estimated using survival analysis. The predictors associated with attrition were determined using a multivariate Cox regression model.ResultsA total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 28-42). Overall, retention increased to 92.4%, 86.5%, 79.2% and 74.4% at 6, 12, 24 and 36 months respectively. LFTU accounted for 98% of attrition. Being an adolescent or a young adult (aHR 1.41; 95%CI:1.14-1.74), receiving care at primary health care facility (aHR 1.23; 95%CI:1.01-1.49), having initiated ART between 2014-2015 (aHR 1.45; 95%CI:1.24-1.69), having WHO Stage 4 (aHR 2.06; 95%CI:1.51-2.81) and impaired functional status (aHR 1.24; 95%CI:1.04-1.49) predicted attrition.ConclusionThe overall retention was higher in comparison to the previous 2007–-2010 evaluation. Further studies to understand why attrition was found to be higher at primary health care facilities are warranted. Implementation of strategies for managing patients with advanced HIV disease, differentiated care for adolescents and young adults and tracking of LFTU should be prioritised to further improve retention.

Respiratory Viruses in a Primary Health Care Facility in Amsterdam, the Netherlands

2018 ◽  
Vol 26 (4) ◽  
pp. 211-215 ◽  
Author(s):  
Andrea H.L. Bruning ◽  
Wilhelmina B. de Kruijf ◽  
Henk C.P.M. van Weert ◽  
Anja Vrakking ◽  
Menno D. de Jong ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
The Netherlands ◽  
Care Facility ◽  
Health Care Facility ◽  
Respiratory Viruses ◽  
Primary Health Care Facility ◽  
Primary Health
Sign in / Sign up

Export Citation Format

Share Document