scholarly journals Cost-effectiveness of an atypical conventional antipsychotic in South Africa: An economic evaluation of quetiapine versus haloperidol in the treatment of patients partially responsive to previous antipsychotics

2004 ◽  
Vol 10 (3) ◽  
pp. 7 ◽  
Author(s):  
Robin Emsley ◽  
Frederik Booysen
Keyword(s):  
South Africa ◽  
Health Care ◽  
Public Sector ◽  
South African ◽  
Atypical Antipsychotic ◽  
Direct Cost ◽  
Health Care Service ◽  
Total Direct Cost ◽  
Conventional Antipsychotic ◽  
Private And Public

Background. The introduction of a new generation of atypical antipsychotic agents has raised difficult economic and ethical questions, particularly in lower-income countries. The reported tolerability and efficacy advantages of the atypical antipsy- chotics over their conventional predecessors have to be weighed against their higher acquisition costs. Pharmaco-eco- nomic studies conducted in Western countries consistently report cost advantages or cost neutrality for these new agents. However, considerable differences in health care service pro- vision make it difficult to generalise these findings to South Africa.Method. We compared the direct costs (private and public sector) of treating schizophrenia with an atypical antipsychotic quetiapine, and with a conventional antipsychotic haloperidol, by adapting a decision-analytic pharmaco-economic model for South African circumstances. The sample comprised patients partially responsive to antipsychotics, who had partic- ipated in a multinational randomised controlled trial compar- ing the efficacy and safety of quetiapine versus haloperidol. Results. The estimated total direct cost for the treatment with quetiapine in South Africa was slightly less than for haloperidol for various models in both the private and the public sectors.Conclusions. Significant differences in health care provision make pharmaco-economic studies conducted in other coun- tries invalid for South African circumstances. Previously queti- apine treatment did not result in direct cost savings in South Africa. However, the recently introduced legislation to estab- lish single exit prices for medications has resulted in the cost of quetiapine treatment declining by 36.7% and that of haloperi- dol by 13%. This has translated into an overall direct cost sav- ing for quetiapine in both the private and public sector models. This, together with additional indirect advantages of the atypi- cal antipsychotics such as improved quality of life and better social and vocational functioning, argues strongly from both an economic and ethical perspective for the use of atypical antipsychotics in treating schizophrenia in South Africa.

scholarly journals Ethics, codes of conduct, morals and professionalism as a bulwark against corruption and unethical conduct in the public sector: A case of South Africa

2015 ◽  
Vol 5 (4) ◽  
pp. 207-212
Author(s):  
Melody Brauns ◽  
David Mdlazi
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Service Delivery ◽  
South African ◽  
Codes Of Conduct ◽  
Working Environment ◽  
The South ◽  
Unethical Conduct ◽  
The Public ◽  
Private And Public

This paper endeavours to critically examine ethics in South Africa especially after the first democratic elections and later developments. Such an analysis will inevitably overspill to the quality of service delivery and participation. As such there is a need for ethics to be re-examined and investigate how this may be used to improve efficiency and effectiveness in the South African government service. Much has been written on ethics and their relevance to the public sector organisations. Indeed they are critical for service delivery for both sectors namely, private and public sectors. This paper will trace the origins and development of ethics and their relationship with other associated terms such as morals, codes of conduct and relate same to the guidelines emanating from the South African Constitution Act (Act 108 of 1996). Once this objective has been achieved the position of ethics to our daily lives from individual and citizenship perspective will be explored. By such investigation it is envisaged to reposition ethics to our working environment as a vehicle that supports and fuels accelerated quality decision-making and service delivery. In that way it will be possible to locate the area of responsibility and accountability in the public sector. One will also examine the power-authority-responsibility triangle relative to ethics, ethical conduct, codes of conduct, and professionalism and indicate how these can be effectively applied to address issues of violation of human right through fundamental deprivation of critical services and products.

scholarly journals Spatiotemporal modelling and mapping of cervical cancer incidence among HIV positive women in South Africa: a nationwide study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dhokotera Tafadzwa ◽  
Riou Julien ◽  
Bartels Lina ◽  
Rohner Eliane ◽  
Chammartin Frederique ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Cervical Cancer ◽  
South African ◽  
Access To Health Care ◽  
Health Facilities ◽  
Hiv Positive ◽  
The South ◽  
Hiv Positive Women ◽  
Access To Health

Abstract Background Disparities in invasive cervical cancer (ICC) incidence exist globally, particularly in HIV positive women who are at elevated risk compared to HIV negative women. We aimed to determine the spatial, temporal, and spatiotemporal incidence of ICC and the potential risk factors among HIV positive women in South Africa. Methods We included ICC cases in women diagnosed with HIV from the South African HIV cancer match study during 2004–2014. We used the Thembisa model, a mathematical model of the South African HIV epidemic to estimate women diagnosed with HIV per municipality, age group and calendar year. We fitted Bayesian hierarchical models, using a reparameterization of the Besag-York-Mollié to capture spatial autocorrelation, to estimate the spatiotemporal distribution of ICC incidence among women diagnosed with HIV. We also examined the association of deprivation, access to health (using the number of health facilities per municipality) and urbanicity with ICC incidence. We corrected our estimates to account for ICC case underascertainment, missing data and data errors. Results We included 17,821 ICC cases and demonstrated a decreasing trend in ICC incidence, from 306 to 312 in 2004 and from 160 to 191 in 2014 per 100,000 person-years across all municipalities and corrections. The spatial relative rate (RR) ranged from 0.27 to 4.43 in the model without any covariates. In the model adjusting for covariates, the most affluent municipalities had a RR of 3.18 (95% Credible Interval 1.82, 5.57) compared to the least affluent ones, and municipalities with better access to health care had a RR of 1.52 (1.03, 2.27) compared to municipalities with worse access to health. Conclusions The results show an increased incidence of cervical cancer in affluent municipalities and in those with more health facilities. This is likely driven by better access to health care in more affluent areas. More efforts should be made to ensure equitable access to health services, including mitigating physical barriers, such as transportation to health centres and strengthening of screening programmes.

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.

Risk management factors contributing to transgressions in the procurement practices in South African SOEs

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lindani Myeza ◽  
Naledi Nkhi ◽  
Warren Maroun
Keyword(s):  
South Africa ◽  
Risk Management ◽  
Public Sector ◽  
South African ◽  
Public Procurement ◽  
African State ◽  
Political Influence ◽  
Structured Interviews ◽  
Content Type ◽  
Executive Level

PurposeThe study aims to deepen the understanding of why risk management principles are circumvented, thereby contributing to transgressions in public procurement for South African state-owned enterprises (SOEs). A deeper understanding of why risk management principles are circumvented is especially important in South Africa, given the high social, economic and environmental risks to which national and major SOEs are exposed in the procurement process.Design/methodology/approachThe study uses a qualitative design, based on detailed semi-structured interviews with 19 participants comprising management advisors, forensic investigators and auditors to explore why risk management principles are circumvented by South Africa SOEs.FindingsThe results of the study indicate that the tone that is set at political and executive level plays an important role in determining compliance with risk management principles by lower-level staff. Intense levels of political influence at SOEs are the main reason behind risk management systems being undermined.Originality/valueThe current study is one of the first explorations of why transgressions in public procurement continue to be evident despite risk management reforms being adopted by South Africa public sector. The research responds to the call for more studies on why reforms in South Africa public sector are not reducing transgression in public procurement. The study provides primary evidence on the importance of political and executive leadership in influencing the effectiveness of risk management reforms in the public sector.

scholarly journals Reasons for students’ poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme

2010 ◽  
Vol 15 (1) ◽  
Author(s):  
Nomasonto B. Magobe ◽  
Sonya Beukes ◽  
Ann Müller
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Care Service ◽  
Health Care Service ◽  
Health Staff ◽  
Care Programme ◽  
Clinical Competencies ◽  
Primary Health ◽  
Comprehensive Primary Health Care

‘No member of [health] staff should undertake tasks unless they are competent to do so’ is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001)document. In South Africa, primary clinical nurses (PCNs), traditionally known as primary health care nurses (PHCNs), function as ‘frontline providers’ of clinical primary health care (PHC) services within public PHC facilities, which is their extended role. This extended role of registered nurses(set out in section 38A of the Nursing Act 50 of 1978, as amended) demands high clinical competency training by nursing schools and universities.The objectives of the study were to explore and describe the perceptions of both clinical instructors and students, in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students’ poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University).OpsommingDie primêre kliniese verpleegkundiges, tradisioneel bekend as primêre gesondheidsorg verpleegkundiges, funksioneer in Suid-Afrika as eerste-linie verskaffers van kliniese primêre gesondheidsorg (PGS) dienste binne die publieke PGS fasiliteite. Dit is hulle uitgebreide rol. Hierdie uitgebreide rol van die verpleegkundige (soos deur Wet op Verpleging,No 50 van 1978, artikel 38A voorgeskryf), vereis opleiding in kliniese vaardighede van hoë gehalte deur verpleegskole en universiteite.Die doelwitte van die navorsing was om die persepsies van beide kliniese dosente en leerders,met betrekking tot die redes vir swak kliniese vaardighede, repektiewelik te verken en te beskryf.Twee temas is deur die resultate as uitdagings (hoof redes) vir die swak vaardighede van leerders aangetoon, naamlik uitdagings in die PGS kliniese praktyk en die uitdagings in die leerprogram (universiteit).

scholarly journals Sense (Scents) of South Africa

1999 ◽  
Vol 55 (1) ◽  
pp. 3-5
Author(s):  
Katherine F. Shepard
Keyword(s):  
South Africa ◽  
Health Care ◽  
South African ◽  
Health Care Facilities ◽  
Speech Pathology ◽  
African Society ◽  
South African Society ◽  
Care Facilities ◽  
The University ◽  
Physiotherapy Education

This paper presents a brief description of some of the author’s perceptions of the land, of physiotherapy education and practice and of the struggle of the nation of South Africa acquired during a 4 week visit in late spring 1997. One week was spent in Cape Town participating in several venues at the International Congress of the South African Society of Physiotherapy. Three weeks were spent at the University of the Witswatersrand in Johannesburg presenting a course in qualitative research to health care colleagues representing the disciplines of physical therapy, occupational therapy, speech pathology and occupational health. During the time in Johannesburg several health care facilities were visited including Baragwanath Hospital, Natal Hospital and the Wits Rural Facility and Tinswalo Hospital at Acornhoek.

Public sector entrepreneurship in South Africa

2019 ◽  
Vol 8 (4) ◽  
pp. 500-512
Author(s):  
Boris Urban ◽  
Mmapoulo Lindah Nkhumishe
Keyword(s):  
South Africa ◽  
Public Sector ◽  
South African ◽  
Middle Level ◽  
Primary Data ◽  
Content Type ◽  
The Public ◽  
Provision Of Services ◽  
Efficiency And Effectiveness ◽  
Organisational Factors

Purpose Many unanswered questions remain regarding the authors’ understanding of how entrepreneurship can be fostered in the public sector. To fill this knowledge gap, the purpose of this paper is to conduct an empirical investigation to determine the relationship between different organisational factors and entrepreneurial orientation (EO) in the South African public sector. Design/methodology/approach Primary data are sourced from middle-level managers at municipalities in the three largest provinces across South Africa. Hypotheses are statistically tested using regression analyses. Findings Results reveal that the organisational antecedents of structure and culture explain a significant amount of variation in the EO dimensions of innovativeness, risk taking and proactiveness. Additionally, the findings on organisational rewards converge with an emerging stream of research which highlights that while rewards works well to motivate individuals in the private sector, they are negatively correlated with entrepreneurship in the public sector. Research limitations/implications The study implications relate to the efficiency and effectiveness of service delivery of municipalities in South Africa. Due to increases in community protest actions, it is necessary not only to maximise efficiency in the provision of services, but also to innovate and be proactive in order to achieve more with less resources. Originality/value By investigating previously unrelated factors in the public sector, the authors create closer conceptual and empirical links between the role of organisational factors and each of the EO dimensions. Furthermore, the study takes place in a relatively under-researched entrepreneurship and public sector context.

scholarly journals A comparison of the surgical management and treatment outcome of bile duct injuries in private and public sector patients in South Africa

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S742-S743
Author(s):  
J. Lindemann ◽  
E. Jonas ◽  
U. Kotze ◽  
M. Bernon ◽  
C. Kloppers ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Outcome ◽  
Public Sector ◽  
Bile Duct ◽  
Surgical Management ◽  
Bile Duct Injuries ◽  
Private And Public
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