scholarly journals The management of diabetic retinopathy in the public sector of eThekwini district of KwaZulu-Natal

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Zaheera Abdool ◽  
Kovin Naidoo ◽  
Linda Visser
Keyword(s):  
South Africa ◽  
Diabetic Retinopathy ◽  
Public Sector ◽  
Fundus Photography ◽  
Screening Methods ◽  
Initial Examination ◽  
District Health ◽  
Ocular Complications ◽  
The Public ◽  
Kwazulu Natal

Background: Estimates from the year 1990–2010 showed an increase in blindness and vision impairment (moderate or severe) because of diabetic retinopathy (DR) in Sub-Saharan Africa’s sub-regions (central, eastern, southern and western Africa).1 The rate of DR in South Africa is expected to increase because of the lack of screening protocols and policies for the management of diabetic eye disease in the district health system of South Africa. Aim: The purpose of this study was to determine the current role of healthcare practitioners (HCPs) towards managing DR in the eThekwini district of KwaZulu-Natal.Method: A cross-sectional study was conducted, and questionnaires were distributed to a total of 104 HCPs in public health institutions situated in the northern eThekwini district of KwaZulu-Natal. Clinics and community health centres (CHCs) were selected based on the assumption that primary healthcare nurses, medical officers (MOs) and ophthalmic nurses and/or optometrists practice at these institutions. The hospitals selected were the referral institutions for the selected clinics and CHCs. The questionnaires distributed included questions relating to diabetic patient registers, referrals to and from other HCPs, management of ocular complications, ocular screening methods, fundus examinations and involvement in screening programmes.Results: Over a third of the ophthalmologists (35.3%) indicated that DR was present at the initial examination in more than 50% of patients, though overall ophthalmologists reported loss of vision in at least one eye in fewer than 5% of patients on presentation. Less than half of the public sector general practitioners or MOs (40.6%) conducted fundus examinations but 90.6% did not dilate pupils, although 71.9% had knowledge on the use of a direct ophthalmoscope. Only 40.6% of the MOs discussed the ocular complications of uncontrolled diabetes mellitus (DM) with patients and 62.5% encouraged regular eye examinations. Less than 50% of the MOs (43.8%) referred patients complaining of visual difficulties to optometrists and 9.4% referred to the ophthalmic nurses. Only 6.25% referred patients with DM needing further evaluation to ophthalmologists. Data from the optometrists were inconclusive because of the poor response rate of 5 (20%). None of the ophthalmic nurses reported doing fundus photography or refractions. Two-thirds of the ophthalmic nurses were interested in training to properly grade DR.Conclusion: The study established that there are key challenges in referral, training and practice in the management of DR. These need to be addressed in order to develop a comprehensive approach for the prevention and management of visual impairment and blindness because of DM.

scholarly journals Recruitment and retention strategies for public sector optometrists in KwaZulu-Natal Province, South Africa

2016 ◽  
Vol 75 (1) ◽  
Author(s):  
Prasidh Ramson ◽  
Pirindha Govender ◽  
Kovin Naidoo
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Financial Incentives ◽  
Online Survey ◽  
Demographic Data ◽  
District Health ◽  
Cross Sectional ◽  
Recruitment And Retention ◽  
The Public ◽  
Kwazulu Natal

Background: In South Africa, there is a paucity of optometrists serving the needs of the larger public sector. KwaZulu-Natal is one of the most densely populated provinces and home to several of the poorest districts. Despite an optometry school in the province, and with a lack of compulsory community service for new graduates, more optometrists are needed to serve the public sector. While studies on the recruitment and retention of medical and allied health professionals have been conducted, limited evidence exists on work trends of public sector optometrists.Methods: A cross-sectional study design using both quantitative and qualitative data collection methods was used. All public sector optometrists and local district health co-ordinators in the province were contacted, with an 80% (41 out of 51) and 75% (9 out of 12) response rate, respectively. Questionnaires containing demographic, recruitment, retention and open-ended questions were distributed by post, fax and email and via an online survey to both groups. Telephonic interviews were also conducted using semi-structured techniques. Frequency distributions, Fisher’s exact test and odds ratios were used to statistically describe the demographic data, while qualitative responses were recorded and analysed for commonly occurring themes.Results: The present public sector optometry workforce comprises mainly young (73%), black (70%), women (66%). They chose to work in the public sector to ‘make a difference’ and were attracted by ‘good working hours’ and ‘job security’. Fifty-three percent of optometrists work in the public sector due to a study bursary, for which there was a statistically significant association for race (p = 0.01), gender (p = 0.05) and background origin (p = 0.05). To aid their retention in public service, improved salaries, career progression, recognition, improved management relations and improved instrumentation were ranked highest by these optometrists.Conclusion: The demographic profile of presently serving public sector optometrists poses many human resource (HR) challenges and opportunities. Universities should pay attention to rural origin of students and provide exposure to rural clinical experiences during study. Departments of Health use study bursary incentives to recruit optometrists, but need to consider financial and non-financial incentives for their retention. At hospital level, a responsive HR management system should be implemented with emphasis on career management, recognition, improving infrastructure and supporting professional development.

scholarly journals Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal?

2018 ◽  
Vol 20 ◽  
Author(s):  
Diane van Staden
Keyword(s):  
Public Health ◽  
South Africa ◽  
Public Sector ◽  
Health Service ◽  
Health Services ◽  
Clinical Training ◽  
Health Service Delivery ◽  
The Public ◽  
Eye Health ◽  
Kwazulu Natal

AbstractBackgroundDecentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN’s College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector.DiscussionDCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce ‘fit-for-purpose’ graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training.ConclusionWhile the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.

scholarly journals The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

2010 ◽  
Vol 2 (1) ◽  
Author(s):  
Panjasaram Naidoo ◽  
Champaklal C. Jinabhai ◽  
Myra Taylor
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Private Sector ◽  
Hiv And Aids ◽  
Metropolitan Region ◽  
P Value ◽  
Binary Logistic Regression Model ◽  
Aids Patients ◽  
The Public ◽  
Kwazulu Natal

Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients.Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may infuence their responses.Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant.Results: Most of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01).Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector.

Leadership of change in South Africa public sector turnarounds

2018 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mampe Kumalo ◽  
Caren Brenda Scheepers
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Current Literature ◽  
Organisational Change ◽  
Director General ◽  
Change Processes ◽  
Structured Interviews ◽  
Content Type ◽  
The Public ◽  
Financial Consequences

PurposeOrganisational decline has far-reaching, negative emotional and financial consequences for staff and customers, generating academic and practitioner interest in turnaround change processes. Despite numerous studies to identify the stages during turnarounds, the findings have been inconclusive. The purpose of this paper is to address the gap by defining these stages, or episodes. The characteristics of leaders affect the outcome of organisational change towards turnarounds. This paper focusses, therefore, on the leadership requirements during specific episodes, from the initial crisis to the full recovery phases.Design/methodology/approachA total of 11 semi-structured interviews were conducted with executives from the public sector in South Africa who went through or were going through turnaround change processes and 3 with experts consulting to these organisations.FindingsContrary to current literature in organisational change, this study found that, in these turnaround situations, leadership in the form of either an individual CEO or director general was preferable to shared leadership or leadership distributed throughout the organisation. This study found four critical episodes that occurred during all the public service turnarounds explored, and established that key leadership requirements differ across these episodes. The study shows how these requirements relate to the current literature on transactional, transformational and authentic leadership.Practical implicationsThe findings on the leadership requirements ultimately inform the selection and development of leaders tasked with high-risk turnaround change processes.Originality/valueFour episodes with corresponding leadership requirements were established in the particular context of public sector turnaround change processes.

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