Contributing Factors to Implementation Gaps in Rehabilitation Services in South Africa: Perspectives from health facility-level Rehabilitation Clinician-Managers

Mapping Intimacies ◽

10.21203/rs.3.rs-357899/v1 ◽

2021 ◽

Author(s):

Qhayiya Magaqa

Keyword(s):

South Africa ◽

Policy Implementation ◽

Health Facility ◽

Rehabilitation Services ◽

Structured Interviews ◽

Contributing Factors ◽

Systems Software ◽

Facility Level ◽

Health Policy Implementation ◽

Implementation Gaps

Abstract Previous studies have examined health policy implementation globally. However, few studies have examined policy implementation as it relates to rehabilitation services. This study aimed to report on the factors which may be contributing to policy implementation gaps in rehabilitation services in a rural district of South Africa. Qualitative semi-structured interviews were conducted with rehabilitation providers who have both clinical and managerial duties in health facilities. The framework method was used to guide analysis. Findings suggest that gaps between rehabilitation policy and the available services may be attributable to a lack of systems hardware and the presence of maladaptive systems software. Additionally, the limited ability of rehabilitation managers to exercise their power to plan and organise rehabilitation services constrained policy implementation. The implications of this work point to the need to better include rehabilitation managers in priority setting and resource allocation processes at the level of the health facility.

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Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010: A retrospective study

Curationis ◽

10.4102/curationis.v37i1.1169 ◽

2014 ◽

Vol 37 (1) ◽

Cited By ~ 1

Author(s):

Mohammed M. Gafar ◽

Norman Z. Nyazema ◽

Yoswa M. Dambisya

Keyword(s):

South Africa ◽

Treatment Outcomes ◽

Health Facility ◽

Treatment Regimen ◽

Diagnostic Category ◽

Limpopo Province ◽

World Health ◽

Factors Influencing ◽

Health Facility Level ◽

Facility Level

Background: South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrugresistant TB.Objectives: To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province.Method: A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes.Results: Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22–55, and 56–74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II.Conclusion: The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services.

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Application of "Actor Interface Analysis" to Examine Practices of Power in Health Policy Implementation: An Interpretive Synthesis and Guiding Steps

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.191 ◽

2020 ◽

Author(s):

Rakesh Parashar ◽

Nilesh Gawde ◽

Lucy Gilson

Keyword(s):

Health Policy ◽

Policy Implementation ◽

Power Relationships ◽

Interface Analysis ◽

Health Policy Analysis ◽

Values And Beliefs ◽

The Difference ◽

Multiple Interface ◽

Health Policy Implementation ◽

Implementation Gaps

Background: The difference between ‘policy as promised’ and ‘policy as practiced’ can be attributed to implementation gaps. Actor relationships and power struggles are central to these gaps but have been studied using only a handful of theoretical and analytical frameworks. Actor interface analysis provides a methodological entry point to examine policy implementation and practices of power. As this approach has rarely been used in health policy analysis, this article aims, first, to synthesise knowledge about use of actor interface analysis in health policy implementation and, second, to provide guiding steps to conduct actor interface analysis. Methods: We conducted an interpretive synthesis of literature using a set of 6 papers, selected using purposeful searches and focusing on actor dynamics and practices of power in policy experiences. Drawing upon the framework synthesis approach and using a guiding framework, the synthesis focused on 4 questions – the type of actor interfaces formed, the power practices observed, the effect of such power practices on implementation and the underpinning factors for the power practices. Results: Multiple interface encounters and power practices were identified which included domination, control, contestation, collaborations, resistance, and negotiations. The lifeworlds of actors that underpinned the power practices, were rooted in social-organisational power relationships, personal experiences and interests, and social-ideological standpoints like values and beliefs of actors. The power practices influenced implementation both positively and negatively. Conclusion: Based on the learnings from synthesis, this paper provides guiding steps for conducting actor interface analysis. Additionally, it presents 2 useful tools for power analysis: (1) ‘actor lifeworlds,’ to understand underpinning factors for power practices and (2) relationships of lifeworlds, interface encounters and power practices with their effect on policy implementation. We suggest that interface analysis should be applied in more empirical settings and across varied health policy experiences to nuance the method better.

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Perceived barriers and contributors to sense of purpose in life in retirement community residents

Ageing and Society ◽

10.1017/s0144686x20001749 ◽

2020 ◽

pp. 1-17

Author(s):

Nathan A. Lewis ◽

Naomi Reesor ◽

Patrick L. Hill

Keyword(s):

Older Adults ◽

Purpose In Life ◽

Retirement Community ◽

Retirement Communities ◽

Structured Interviews ◽

Contributing Factors ◽

Sense Of Purpose ◽

The Social ◽

Continuing Care Retirement Communities ◽

Retirement Facilities

Abstract Despite the growing use of retirement communities and ageing care facilities, little is known about how residing in retirement residences may impact aspects of older adult wellbeing. Living in these communities may hold particular influence on residents’ sense of purpose, if they feel limited in their opportunities for individual action, or could serve to promote purposefulness depending on the social connections available. The current study sought to explore contributing factors as well as barriers to purpose in older adults living in three continuing care retirement communities. Using brief semi-structured interviews, 18 older adults were asked to describe their purpose in life, community-related activities and any perceived challenges limiting their ability to pursue this purpose. Thematic analysis was used to examine themes common across interviews. Interviews presented a mixed picture of the nature of purposefulness in retirement facilities. Residents espoused several benefits of community living such as social and leisure opportunities, while also noting several obstacles to their purpose, including health concerns and the belief that purpose in life was not relevant for older adults. These findings provide insight into how older adults can derive a sense of purpose from activities within their retirement community and how facilities can better tailor programmes to promote purposefulness and support personally valued roles for residents.

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A systematic review of school health policy measurement tools: implementation determinants and outcomes

Implementation Science Communications ◽

10.1186/s43058-021-00169-y ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Gabriella M. McLoughlin ◽

Peg Allen ◽

Callie Walsh-Bailey ◽

Ross C. Brownson

Keyword(s):

Health Policy ◽

Policy Implementation ◽

School Health ◽

School Policy ◽

Implementation Processes ◽

Implementation Outcomes ◽

Policy Measurement ◽

Measurement Tools ◽

School Health Policy ◽

Health Policy Implementation

Abstract Background Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application. Methods Peer-reviewed journal articles published 1995–2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework. Results Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability. Conclusions Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.

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Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

BMJ Global Health ◽

10.1136/bmjgh-2021-005833 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005833

Author(s):

Leena N Patel ◽

Samantha Kozikott ◽

Rodrigue Ilboudo ◽

Moreen Kamateeka ◽

Mohammed Lamorde ◽

...

Keyword(s):

Health Facility ◽

Healthcare Workers ◽

National Level ◽

Lessons Learned ◽

Health Facilities ◽

Infection Prevention And Control ◽

Health Facility Level ◽

Ensure Patient Safety ◽

Increased Risk ◽

Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

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Drivers of Broad-Spectrum Antibiotic Overuse across Diverse Hospital Contexts—A Qualitative Study of Prescribers in the UK, Sri Lanka and South Africa

Antibiotics ◽

10.3390/antibiotics10010094 ◽

2021 ◽

Vol 10 (1) ◽

pp. 94

Author(s):

Carolyn Tarrant ◽

Andrew M. Colman ◽

David R. Jenkins ◽

Edmund Chattoe-Brown ◽

Nelun Perera ◽

...

Keyword(s):

South Africa ◽

Sri Lanka ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Low Income ◽

System Level ◽

Comparative Approach ◽

Structured Interviews ◽

Public And Private ◽

The Uk

Antimicrobial stewardship programs focus on reducing overuse of broad-spectrum antibiotics (BSAs), primarily through interventions to change prescribing behavior. This study aims to identify multi-level influences on BSA overuse across diverse high and low income, and public and private, healthcare contexts. Semi-structured interviews were conducted with 46 prescribers from hospitals in the UK, Sri Lanka, and South Africa, including public and private providers. Interviews explored decision making about prescribing BSAs, drivers of the use of BSAs, and benefits of BSAs to various stakeholders, and were analyzed using a constant comparative approach. Analysis identified drivers of BSA overuse at the individual, social and structural levels. Structural drivers of overuse varied significantly across contexts and included: system-level factors generating tensions with stewardship goals; limited material resources within hospitals; and patient poverty, lack of infrastructure and resources in local communities. Antimicrobial stewardship needs to encompass efforts to reduce the reliance on BSAs as a solution to context-specific structural conditions.

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Tracking Progress from Policy Development to Implementation: A Case Study on Adoption of Mandatory Regulation for Nutrition Labelling in Malaysia

Nutrients ◽

10.3390/nu13020457 ◽

2021 ◽

Vol 13 (2) ◽

pp. 457

Author(s):

SeeHoe Ng ◽

Bridget Kelly ◽

Heather Yeatman ◽

Boyd Swinburn ◽

Tilakavati Karupaiah

Keyword(s):

Policy Development ◽

Structured Interviews ◽

Political Activities ◽

Nutrition Labelling ◽

Policy Windows ◽

Industry Engagement ◽

Stakeholder Partnerships ◽

Implementation Gaps ◽

Health Experts

Mandatory nutrition labelling, introduced in Malaysia in 2003, received a “medium implementation” rating from public health experts when previously benchmarked against international best practices by our group. The rating prompted this qualitative case study to explore barriers and facilitators during the policy process. Methods incorporated semi-structured interviews supplemented with cited documents and historical mapping of local and international directions up to 2017. Case participants held senior positions in the Federal government (n = 6), food industry (n = 3) and civil society representations (n = 3). Historical mapping revealed that international directions stimulated policy processes in Malaysia but policy inertia caused implementation gaps. Barriers hindering policy processes included lack of resources, governance complexity, lack of monitoring, technical challenges, policy characteristics linked to costing, lack of sustained efforts in policy advocacy, implementer characteristics and/or industry resistance, including corporate political activities (e.g., lobbying, policy substitution). Facilitators to the policy processes were resource maximization, leadership, stakeholder partnerships or support, policy windows and industry engagement or support. Progressing policy implementation required stronger leadership, resources, inter-ministerial coordination, advocacy partnerships and an accountability monitoring system. This study provides insights for national and global policy entrepreneurs when formulating strategies towards fostering healthy food environments.

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Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework

Health Policy and Planning ◽

10.1093/heapol/czaa172 ◽

2020 ◽

Author(s):

Joshua P Murphy ◽

Aneesa Moolla ◽

Sharon Kgowedi ◽

Constance Mongwenyana ◽

Sithabile Mngadi ◽

...

Keyword(s):

South Africa ◽

Qualitative Study ◽

Policy Implementation ◽

Community Health ◽

Resource Constraints ◽

Health Workers ◽

Healthcare Providers ◽

Successful Implementation ◽

Programme Implementation ◽

Healthcare Facilities

Abstract South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.

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The transition to general management in South Africa

SA Journal of Human Resource Management ◽

10.4102/sajhrm.v15i0.846 ◽

2017 ◽

Vol 15 (0) ◽

Author(s):

Stephen J. Mallaby ◽

Gavin Price ◽

Karl Hofmeyr

Keyword(s):

South Africa ◽

South African ◽

Personal Characteristics ◽

Structured Interviews ◽

General Manager ◽

General Management ◽

General Managers ◽

Managerial Implications ◽

Effective Development ◽

The Right

Orientation: Understanding the nature and challenges of making the transition from a functional role to a general management role in South African organisations.Research purpose: The objective of this study was to gain insight into the obstacles that affect the transition from functional to general management and identify steps that may be taken to overcome these challenges.Motivation for the study: One of the most difficult crossroads for a manager is making the shift from being a functional specialist to becoming a general manager. New competencies and behaviours are required, as well as a more strategic mind set. If the transition is not made successfully, the manager and the organisation suffer.Research design, approach and method: A qualitative design was used consisting of in-depth, semi-structured interviews, with 19 senior business leaders who had successfully made the transition. The interviews were used to gather insights into the challenges they faced during their transitions, and how these were overcome.Main findings: To make the transition successfully, functional managers need to gain relevant experience to prepare them for the broader scope of a general management role. They need to develop appropriate skills, attitudes and personal characteristics. Mentoring is an effective development process. Newly appointed general managers need to learn to let go of control while maintaining ownership, build relationships and strike the right balance between strategic thinking and execution. There are unique aspects of being a general manager in South Africa, such as dealing with Black Economic Empowerment and challenges of race and identity, given the country’s history.Practical and managerial implications: Specific interventions are suggested which are directed at both aspiring general managers and organisations seeking to assist middle managers to make the transition to general managers.Contribution: This study contributes to knowledge concerning the skills and attributes required by potential general managers, and the practical steps to be taken by South African organisations to facilitate the development of general managers.

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