Are Return of Service Bursaries an Effective Investment to Build Health Workforce Capacity? A Qualitative Study of Key South African Policymakers

2021 ◽  
Author(s):  
Sikhumbuzo A. Mabunda ◽  
Andrea Durbach ◽  
Wezile W. Chitha ◽  
Blake Angell ◽  
Rohina Joshi
Keyword(s):  
South Africa ◽  
South African ◽  
Health Professionals ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Design Decision ◽  
Marginalised Groups ◽  
Virtual Platform ◽  
The Impact ◽  
Skilled Health

Abstract Background: Return-of-service schemes or bursaries are used in South Africa and other nations to publicly fund the training of skilled health professionals in return for the beneficiary agreeing to return to serve in their local provinces on a year-for-year basis. This study aimed to understand how these policies operate across different provinces in South Africa to examine whether they achieved their objectives and identify strengths and areas for improvement in the schemes to inform policymakers in South Africa and internationally. Methods: This research draws on the insights of 15 key South African policymakers from eight of its nine provinces through semi-structured, qualitative interviews. The respondents were interviewed through Microsoft Teams virtual platform, either in pairs (4) or as individuals (7). Data were analysed using inductive, thematic content analysis in NVIVO. Results: Respondents reported that the schemes had resulted in an increase in the number of skilled health professionals and had provided opportunities for study and employment for previously marginalised groups. Formal evaluations of the impact of the schemes were not reported, however, a number of shortcomings with current schemes were identified that were likely limiting their effectiveness. Respondents reported a lack of foresight in the scheme implementation including a bias in the selection of beneficiaries towards medical professionals at the expense of other health workers. Furthermore, failure to plan for practice location when beneficiaries finished training limited the capacity of the schemes to meet the needs of local populations. Monitoring of recipients was limited by loopholes in contract design, decision-making and, poor coordination between departments. Between 5 and 30% of beneficiaries were reported to default their contracts with some not completing their studies, some not returning after completing their internship and others terminating their services before concluding their contracts. Conclusions: Return-of-service schemes have helped in overcoming health professional shortages. However, they haven’t been formally evaluated. Several planning and implementation shortcomings were identified which can be improved to enhance access to healthcare in South Africa.

scholarly journals Effects of Brain Drain on the South African Health Sector; Analysis of the Dynamics of its Push Factors

2017 ◽  
Vol 9 (4(J)) ◽  
pp. 62-72
Author(s):  
Victor H. Mlambo ◽  
Toyin Cotties Adetiba
Keyword(s):  
South Africa ◽  
South African ◽  
Brain Drain ◽  
Health Professionals ◽  
Health Workers ◽  
Health Sector ◽  
The South ◽  
Push Factors ◽  
African Health ◽  
South African Health

While there has been a plethora of studies that addresses migration in Africa, many have yet to successfully unpack the effects of brain drain on the South African health sector. Using textual analysis of the available literature relevant to the topic under consideration; this work seeks to identify the major structural and socio-economic push factors that drive the migration of health professionals in South Africa, relying on Revestain’s laws of migration and Lee’s push/pull theory of migration. The study also looks at explaining other factors that contribute to the migration of health professionals in South Africa. We argue that for South Africa to retain health professionals, the government needs to increase the training of health workers, improve their working conditions and security, upgrade infrastructure and ensure availability of resources as well as develop a more open immigration policy prioritizing skilled immigration.

scholarly journals An examination of the factors fueling migration amongst Community Service practitioners

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Candice Reardon ◽  
Gavin George
Keyword(s):  
South Africa ◽  
Community Service ◽  
Health Professionals ◽  
Health Workers ◽  
The United Kingdom ◽  
Bilateral Agreement ◽  
Qualitative Focus Groups ◽  
The Government ◽  
The Uk ◽  
The Impact

Background: Research is needed in order to understand the potential influence of the Bilateral Agreement between South Africa and the United Kingdom (UK), as well as other more recent international and local policies restricting movement of South African health workers abroad; and to determine what effect they have on the migration intentions and plans of health professionals in South Africa.Aim: The aims were to (1) explore the migration intentions and the factors that influence these intentions amongst Community Service (CS) nurses and doctors; (2) explore their views and opinions about the Bilateral Agreement between the UK and South Africa (SA) and other UK policies around the recruitment and employment of foreign health professionals; and (3) understand the impact of these policies on the migration plans of these CS doctors and nurses.Method: Qualitative focus groups and interviews were conducted with 23 CS doctors and nurses. To supplement this, 6 interviews were conducted with nurses and a doctor who had worked in the UK.Results: A higher disposition toward moving abroad was apparent amongst those who had experienced a challenging and frustrating CS year. Poor working conditions, including long work hours, high patient loads and inadequate resources and equipment, as well as low salaries and the perceived ambivalence of the government to the complaints of health practitioners, were influencing decisions to migrate abroad.Conclusion: The findings suggest that government efforts to better manage, recognise and respect the work and contribution of health professionals to the country would go a long way toward retaining health professionals.

scholarly journals Effects of Brain Drain on the South African Health Sector; Analysis of the Dynamics of its Push Factors

2017 ◽  
Vol 9 (4) ◽  
pp. 62 ◽  
Author(s):  
Victor H. Mlambo ◽  
Toyin Cotties Adetiba
Keyword(s):  
South Africa ◽  
South African ◽  
Brain Drain ◽  
Health Professionals ◽  
Health Workers ◽  
Health Sector ◽  
The South ◽  
Push Factors ◽  
African Health ◽  
South African Health

While there has been a plethora of studies that addresses migration in Africa, many have yet to successfully unpack the effects of brain drain on the South African health sector. Using textual analysis of the available literature relevant to the topic under consideration; this work seeks to identify the major structural and socio-economic push factors that drive the migration of health professionals in South Africa, relying on Revestain’s laws of migration and Lee’s push/pull theory of migration. The study also looks at explaining other factors that contribute to the migration of health professionals in South Africa. We argue that for South Africa to retain health professionals, the government needs to increase the training of health workers, improve their working conditions and security, upgrade infrastructure and ensure availability of resources as well as develop a more open immigration policy prioritizing skilled immigration.

Some Reflections on Reparation in Post-Apartheid South Africa, using a Couple Therapy Intervention as a Microcosm of South African Society

2011 ◽  
Vol 1 (2) ◽  
Author(s):  
Andrea Hill ◽  
Sylvia Poss
Keyword(s):  
South Africa ◽  
South African ◽  
Couple Therapy ◽  
South African Society ◽  
Depressive Position ◽  
Central Hypothesis ◽  
Transference And Countertransference ◽  
Constructive Engagement ◽  
The Impact ◽  
Therapy Intervention

The paper addresses the question of reparation in post-apartheid South Africa. The central hypothesis of the paper is that in South Africa current traumas or losses, such as the 2008 xenophobic attacks, may activate a ‘shared unconscious phantasy’ of irreparable damage inflicted by apartheid on the collective psyche of the South African nation which could block constructive engagement and healing. A brief couple therapy intervention by a white therapist with a black couple is used as a ‘microcosm’ to explore this question. The impact of an extreme current loss, when earlier losses have been sustained, is explored. Additionally, the impact of racial difference on the transference and countertransference between the therapist and the couple is explored to illustrate factors complicating the productive grieving and working through of the depressive position towards reparation.

The impact of climate temperature on counts, recovery, and death rates due to SARS-CoV-2 in South Africa. (Preprint)

2020 ◽  
Author(s):  
Neven Chetty ◽  
Bamise Adeleye ◽  
Abiola Olawale Ilori
Keyword(s):  
South Africa ◽  
South African ◽  
Death Rate ◽  
Western Cape ◽  
Warm Climate ◽  
The South ◽  
Recovery Rates ◽  
Death Rates ◽  
Online Resource ◽  
The Impact

BACKGROUND The impact of climate temperature on the counts (number of positive COVID-19 cases reported), recovery, and death rates of COVID-19 cases in South Africa's nine provinces was investigated. The data for confirmed cases of COVID-19 were collected for March 25 and June 30, 2020 (14 weeks) from South Africa's Government COVID-19 online resource, while the daily provincial climate temperatures were collected from the website of the South African Weather Service. Our result indicates that a higher or lower climate temperature does not prevent or delay the spread and death rates but shows significant positive impacts on the recovery rates of COVID-19 patients. Thus, it indicates that the climate temperature is unlikely to impose a strict limit on the spread of COVID-19. There is no correlation between the cases and death rates, an indicator that no particular temperature range is closely associated with a faster or slower death rate of COVID-19 patients. As evidence from our study, a warm climate temperature can only increase the recovery rate of COVID-19 patients, ultimately impacting the death and active case rates and freeing up resources quicker to enable health facilities to deal with those patients' climbing rates who need treatment. OBJECTIVE This study aims to investigate the impact of climate temperature variation on the counts, recovery, and death rates of COVID-19 cases in all South Africa's provinces. The findings were compared with those of countries with comparable climate temperature values. METHODS The data for confirmed cases of COVID-19 were collected for March 25 and June 30 (14 weeks) for South African provinces, including daily counts, death, and recovery rates. The dates were grouped into two, wherein weeks 1-5 represent the periods of total lockdown to contain the spread of COVID-19 in South Africa. Weeks 6-14 are periods where the lockdown was eased to various levels 4 and 3. The daily information of COVID-19 count, death, and recovery was obtained from South Africa's Government COVID-19 online resource (https://sacoronavirus.co.za). Daily provincial climate temperatures were collected from the website of the South African Weather Service (https://www.weathersa.co.za). The provinces of South Africa are Eastern Cape, Western Cape, Northern Cape, Limpopo, Northwest, Mpumalanga, Free State, KwaZulu-Natal, Western Cape, and Gauteng. Weekly consideration was given to the daily climate temperature (average minimum and maximum). The recorded values were considered, respectively, to be in the ratio of death-to-count (D/C) and recovery-to-count (R/C). Descriptive statistics were performed for all the data collected for this study. The analyses were performed using the Person’s bivariate correlation to analyze the association between climate temperature, death-to-count, and recovery-to-count ratios of COVID-19. RESULTS The results showed that higher climate temperatures aren't essential to avoid the COVID-19 from being spread. The present results conform to the reports that suggested that COVID-19 is unlike the seasonal flu, which does dissipate as the climate temperature rises [17]. Accordingly, the ratio of counts and death-to-count cannot be concluded to be influenced by variations in the climate temperatures within the study areas. CONCLUSIONS The study investigates the impact of climate temperature on the counts, recovery, and death rates of COVID-19 cases in all South Africa's provinces. The findings were compared with those of countries with comparable climate temperatures as South Africa. Our result indicates that a higher or lower climate temperature does not prevent or delay the spread and death rates but shows significant positive impacts on the recovery rates of COVID-19 patients. Warm climate temperatures seem not to restrict the spread of the COVID-19 as the count rate was substantial at every climate temperatures. Thus, it indicates that the climate temperature is unlikely to impose a strict limit on the spread of COVID-19. There is no correlation between the cases and death rates, an indicator that there is no particular temperature range of the climatic conditions closely associated with a faster or slower death rate of COVID-19 patients. However, other shortcomings in this study's process should not be ignored. Some other factors may have contributed to recovery rates, such as the South African government's timely intervention to announce a national lockout at the early stage of the outbreak, the availability of intensive medical care, and social distancing effects. Nevertheless, this study shows that a warm climate temperature can only help COVID-19 patients recover more quickly, thereby having huge impacts on the death and active case rates.

scholarly journals Exploring sustainability potentials in vineyards through LCA? Evidence from farming practices in South Africa

2021 ◽  
Author(s):  
V. Russo ◽  
A. E. Strever ◽  
H. J. Ponstein
Keyword(s):  
South Africa ◽  
Life Cycle Assessment ◽  
Life Cycle ◽  
Human Health ◽  
South African ◽  
Wine Grape ◽  
Impact Categories ◽  
Farming Practices ◽  
Manual Labour ◽  
The Impact

Abstract Purpose Following the urgency to curb environmental impacts across all sectors globally, this is the first life cycle assessment of different wine grape farming practices suitable for commercial conventional production in South Africa, aiming at better understanding the potentials to reduce adverse effects on the environment and on human health. Methods An attributional life cycle assessment was conducted on eight different scenarios that reduce the inputs of herbicides and insecticides compared against a business as usual (BAU) scenario. We assess several impact categories based on ReCiPe, namely global warming potential, terrestrial acidification, freshwater eutrophication, terrestrial toxicity, freshwater toxicity, marine toxicity, human carcinogenic toxicity and human non-carcinogenic toxicity, human health and ecosystems. A water footprint assessment based on the AWARE method accounts for potential impacts within the watershed. Results and discussion Results show that in our impact assessment, more sustainable farming practices do not always outperform the BAU scenario, which relies on synthetic fertiliser and agrochemicals. As a main trend, most of the impact categories were dominated by energy requirements of wine grape production in an irrigated vineyard, namely the usage of electricity for irrigation pumps and diesel for agricultural machinery. The most favourable scenario across the impact categories provided a low diesel usage, strongly reduced herbicides and the absence of insecticides as it applied cover crops and an integrated pest management. Pesticides and heavy metals contained in agrochemicals are the main contributors to emissions to soil that affected the toxicity categories and impose a risk on human health, which is particularly relevant for the manual labour-intensive South African wine sector. However, we suggest that impacts of agrochemicals on human health and the environment are undervalued in the assessment. The 70% reduction of toxic agrochemicals such as Glyphosate and Paraquat and the 100% reduction of Chlorpyriphos in vineyards hardly affected the model results for human and ecotoxicity. Our concerns are magnified by the fact that manual labour plays a substantial role in South African vineyards, increasing the exposure of humans to these toxic chemicals at their workplace. Conclusions A more sustainable wine grape production is possible when shifting to integrated grape production practices that reduce the inputs of agrochemicals. Further, improved water and related electricity management through drip irrigation, deficit irrigation and photovoltaic-powered irrigation is recommendable, relieving stress on local water bodies, enhancing drought-preparedness planning and curbing CO2 emissions embodied in products.

scholarly journals Efficacy of a brief online mindfulness-based intervention on the psychological well-being of health care professionals and trainees during the COVID-19 pandemic: A mixed method design

2021 ◽  
Vol 26 ◽  
Author(s):  
Iram Osman ◽  
Shaista Hamid ◽  
Veena S. Singaram
Keyword(s):  
South Africa ◽  
Health Care ◽  
Mixed Method ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Well Being ◽  
Personal Accomplishment ◽  
Intervention Analysis ◽  
Health Crisis ◽  
The Impact

Background: During the coronavirus disease 2019 (COVID-19) pandemic, health professionals were pushed to the front line of a global health crisis unprepared and resource constrained, which affected their mental well-being.Aim: This study aimed to investigate the effectiveness of a brief online mindfulness-based intervention (MBI) on stress and burnout for health professionals training and working in South Africa during the COVID-19 crisis.Setting: The context of the study is the overburdened, under-resourced health care system in South Africa during a global pandemic.Methods: A mixed method framework was adopted for this study. The quantitative data was analysed using descriptive analysis and the participants’ qualitative experiences were interpreted using interpretative phenomenological analysis.Results: Forty-seven participants took part in this study. The study found a statistically significant (p 0.05) reduction in stress levels and emotional exhaustion as well as an increase in mindful awareness and feelings of personal accomplishment after the intervention. The participants’ shared experiences were analysed in two parts. The pre-intervention analysis presented with central themes of loss of control and a sense of powerlessness because of COVID-19. The post-intervention analysis comprised themes of a sense of acquired control and empowerment through increased mindfulness.Conclusions: The study found that a brief online MBI can be associated with reduced levels of stress and burnout as well as an increased sense of control and empowerment, felt both personally and professionally, during a global crisis.Contribution: The impact of an online MBI for health care professionals amidst a pandemic has not been previously documented.

scholarly journals HIV Risks in Sexual Networks of Heterosexual Men in South Africa

2019 ◽  
Vol 11 (13) ◽  
pp. 146
Author(s):  
Nonzwakazi P Ntombela ◽  
Tivani P Mashamba-Thompson ◽  
Andile N Mtshali ◽  
Desmond Kuupiel ◽  
Ayesha BM Kharsany
Keyword(s):  
South Africa ◽  
Hiv Infection ◽  
South African ◽  
Heterosexual Men ◽  
Sexual Networks ◽  
Design Development ◽  
Sexual Partnerships ◽  
Hiv Risks ◽  
Prevention Interventions ◽  
The Impact

BACKGROUND: The interaction of HIV risks in sexual networks remains unclear in South Africa. We provide an overview of the dynamics of HIV risks in South African men through a systematic scoping review. METHODS & ANALYSIS: Literature searches were conducted on seven online databases. Two reviewers independently screened articles against the inclusion criteria and performed a Kappa coefficient test to evaluate the degree of agreement on article selection. Thematic content analysis and a Mixed Method Appraisal Tool version 2018 were used to present the narrative account of the outcomes and to assess the risk of bias on included studies. RESULTS: Of the 1356 records identified, six studies reported on the dynamics of HIV infection in heterosexual men in sexual networks. All studies that were included were published between 2006 and 2016. The participants were aged 13 years and above and comprised of sero-discordant couples, HIV patients, and male and female in the general population. These studies were conducted in multiple diverse regions including South Africa, Senegal, Uganda, Malawi, Kenya, Tanzania, Botswana and Zambia. Evidence showed that age and sexual partnerships were most commonly identified attributes to either HIV infection and/or transmission risks in men. While other biological and behavioral data were reported, the results were not specific to men. DISCUSSION: The impact of age and sexual partnerships are poorly understood and the data available limit inferences to South African men. Limited empiric evidence of HIV risk among men impacts on the design, development and tailoring of HIV prevention interventions to alter the trajectory.

scholarly journals The impact of the credit legislation on consumers

2016 ◽  
Vol 6 (4) ◽  
pp. 503-509 ◽  
Author(s):  
Hlako Choma ◽  
Thifulufhelwi Cedric Tshidada ◽  
Tshegofatso Kgarabjang
Keyword(s):  
South Africa ◽  
South African ◽  
Consumer Protection ◽  
The Other ◽  
The South ◽  
Other Hand ◽  
Credit Agreement ◽  
Financial Obligation ◽  
The Impact ◽  
National Credit Act

The purpose of this paper is to examine two South Africa legislations dealing with over indebtedness of a consumer. It is clear that in terms of the South African law, section 129 (1) and 130 (3) of the National Credit Act provide that a creditor provider who wishes to enforce a debt under a credit agreement must first issue a section 129 (1) (a) notice to the consumer (the purpose of the notice is to notify the consumer of his/her arrears). On the other hand, the South African National Credit Act encourages the consumers to fulfil the financial obligations for which they are responsible. The second legislation to be examined which serve or appear to serve same purpose as the National Credit Act is the Insolvency Act. It therefore, postulated that the compulsory sequestration of a consumer in terms of the Insolvency Act would stand as an alternative remedy for a credit provider before she/he can have recourse mechanisms, such as debt review that are focused on satisfaction of the consumer’s financial obligation , in terms of the provisions of the National Credit Act. The paper determines to what extend these measures comply with the constitutional consumer protection demands. The legislature had been pertinently cognizant of the Insolvency Act when it lately enacted the National Credit Act. This is much apparent from the express amendment of section 84 of the Insolvency Act to the extent set out in schedule 2 of the National Credit Act

scholarly journals SASS: South African Simulation Survey – a review of simulation-based education

2019 ◽  
pp. 12-20
Author(s):  
R Swart ◽  
R Duys ◽  
ND Hauser
Keyword(s):  
South Africa ◽  
South African ◽  
Undergraduate Students ◽  
Online Survey ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Survey Tool ◽  
South African Society ◽  
Simulation Based ◽  
The Impact

Background: Simulation-based education (SBE) has been shown to be an effective and reproducible learning tool. SBE is used widely internationally. The current state of SBE in South Africa is unknown. To the best of our knowledge this is the first survey that describes the use and attitudes towards SBE within South Africa. Methods: An online survey tool was distributed by email to: i) the South African Society of Anaesthesiologists (SASA) members; and ii) known simulation education providers in South Africa. The respondents were grouped into anaesthesia and non-anaesthesia participants. Descriptive statistics were used to analyse the data. Ethics approval was obtained: HREC REF 157/2017. Results: The majority of the respondents provide SBE and integrate it into formal teaching programmes. There is a will amongst respondents to grow SBE in South Africa, with it being recognised as a valuable educational tool. The user groups mainly targeted by SBE, were undergraduate students, medical interns, registrars and nurses. Learning objectives targeted include practical skills, medical knowledge, critical thinking and integrated management. Amongst anaesthesia respondents: the tool most commonly used to assess the quality of learner performance during SBE, for summative assessment, was ‘expert opinion’ (33%); the most frequent methods of evaluating SBE quality were participant feedback (42%) and peer evaluation (22%); the impact of SBE was most frequently assessed by informal discussion (42%) and learner feedback (39%). In anaesthesia SBE largely takes place within dedicated simulation facilities on site (47%). Most respondents report access to a range of SBE equipment. The main reported barriers to SBE were: finance, lack of trained educators, lack of equipment and lack of protected time. A limited number of respondents report engaging in SBE research. There is a willingness in both anaesthesia and non-anaesthesia groups (96% and 89% respectively) to collaborate with other centres. Conclusion: To the best of our knowledge this publication provides us with the first cross-sectional survey of SBE in anaesthesia and a selection of non-anaesthetic respondents within South Africa. The majority of respondents indicate that SBE is a valuable education tool. A number of barriers have been identified that limit the growth of SBE within South Africa. It is hoped that with a commitment to ongoing SBE research and evaluation, SBE can be grown in South Africa.

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