South African Health Review最新文献

{"title":"The Western Cape Surgical Recovery Project: experience at Groote Schuur Hospital","authors":"Shrikant M. Peters, Daniel Nel, Lydia Cairncross, Ross Hofmeyr, Pierre Arends, Farai Chigumadzi, Janine Watson, Deidre Anthony, Melinda Davids, Zainap Ganief, Eugenio Panieri, Bhavna Patel, Bernadette Eick, Belinda Jacobs, Kristy Evans, Grant Strathie, Dominique Van Dyk, Marcin Bartosz Nejthardt, Richard Llewellyn, Bruce M. Biccard","doi":"10.61473/001c.81642","DOIUrl":"https://doi.org/10.61473/001c.81642","url":null,"abstract":"Background Data from six Western Cape secondary-level hospitals have shown that during the first wave of the COVID-19 pandemic (which lasted from May to July of 2020), total surgeries decreased by 44%, and elective surgeries by 74%, due to secondment of nursing, anaesthetic and surgical staff to COVID high-care and intensive-care services. At Groote Schuur Hospital, the loss of surgical output over the two years of the pandemic-related surgical service de-escalation (2020-2021) was estimated at 10 000 cases, with 6 000 patients with progressive disease waiting for elective surgical care. Methods In early May 2022, a Surgical Recovery Project was initiated; funding from the Western Cape Department of Health, and donations from the Gift of the Givers Foundation, private individuals, businesses, and other non-governmental organisations were used to build, staff, and equip a Day-Case Surgery Suite. Results By the Project midway point (end October 2022), a total of 800 extra cases had been completed, and the Project is currently on track to exceed the target of 1 500 cases in a calendar year by at least 10%. The largest number of procedures done were eye cases (n = 191), followed by cases involving surgery to the integumentary system (n = 141), and musculoskeletal system cases (n = 123). There were a total of 30 patient cancellations. While the Project expectedly had poorer on-time-start statistics in the first quarter of operation (range 0.0 - 6.9%), the percentage of on-time-start statistics improved markedly over the second quarter (range 43.3 - 56.5%). World Health Organization checklists were completed for 85.1% of operations performed at the Day-Case Surgery Suite, and no adverse incidents or mortalities were recorded at the Unit. Conclusions This project demonstrates that the volume of services provided in the public sector can be escalated with the use of external funding of capital for human resources, equipment and consumables. However, these services become truly effective when there is sufficient multi-disciplinary planning, alignment and support, at operational, strategic and executive levels of healthcare facilities.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-border collaboration and capacity-building for improved health emergency response planning in Southern Africa","authors":"Joslyn Walker, Marieta Liebenberg, James Michael Burnett, Tonicah Maphanga, Judith King","doi":"10.61473/001c.81023","DOIUrl":"https://doi.org/10.61473/001c.81023","url":null,"abstract":"Background Many countries were ill prepared for the COVID-19 pandemic and the sudden border closures introduced to stem contagion. To address this planning and response gap, Health Systems Trust and the US Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine jointly implemented a capacity-building project among eight Southern African countries during 2022. The intention was to strengthen collaboration among the countries in implementing public health emergency response strategies. Shared analysis of cross-border movement patterns, and building neighbouring countries’ capacity to identify priority areas for such response planning, strengthened relationships for communicating health risks and events. Approach This chapter presents findings from project participants’ perspectives on whether and how the project supported improved regional collaboration for emergency responses to public health events, and their perceptions of how the project strengthened their border health systems. Country delegates were convened in multi-sectoral regional and sub-regional meetings and workshops to facilitate cross-border public health information-sharing and co-ordination, and to align surveillance for emergency preparedness and response. They drafted procedures to: strengthen cross-border and multi-sectoral communication; prioritise points of entry for cross-border co-ordination; map population movement patterns; and identify national and regional border health priorities. Training focused on points of entry to enhance planning for future disease outbreaks by introducing the Population Connectivity Across Borders Toolkit for analysing population movement data to guide the design of public health interventions. Conclusions Collaboration with global and regional institutions strengthened the countries’ ability to comply with International Health Regulations in responding to communicable disease outbreaks. The outcomes indicate that sustained engagement, refinement of standard operating procedures, and multilateral agreements that ensure balancing of country priorities with global health requirements, can be achieved. Continued analysis of and reflection on country work plans are needed to assess similarities and differences in priority identification, which will guide future training and development of regional strategies to build stronger border health systems.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Following the science’: the role of an independent advisory structure in the COVID-19 pandemic response and beyond","authors":"Andrew Gray, Jacqui Miot, Mathildah Mokgatle, Helen Rees","doi":"10.61473/001c.74968","DOIUrl":"https://doi.org/10.61473/001c.74968","url":null,"abstract":"Background As the COVID-19 pandemic spread in 2020, many governments across the globe put structures in place to access rapid independent scientific evidence. The South African Minister of Health established an advisory committee in March 2020 to provide high-level strategic advice. This technical guidance, developed as topic-specific ‘advisories’, was expected to be context-specific and based on the best available evidence, locally and internationally. The authors developing the advisories could draw on systems-wide, multidisciplinary experience. Approach This chapter provides a reflective experience of the process of preparing advisories, the development of rapid evidence syntheses and their use in decision-making, the outputs and the lessons learned from that process, and the structural and operational changes over the course of the pandemic. As South Africa has moved out of the acute phase of the pandemic, the lessons learned must be embraced and best practices adopted to inform future pandemic preparedness. Advisories needed to use the best available evidence rather than wait for the best possible evidence. Some advisories were therefore revised multiple times, as new evidence emerged. Advisories were submitted to the Minister of Health for consideration prior to public release. However, in some cases, delays in such release led to confusion as to the scientific basis of policy decisions. The confidentiality of the committee debates also needed to be balanced against the need for engagement with the public. In order to promote accountability and build public trust, from March 2022 all advisories were published on a dedicated website within seven days of receipt by the Minister. The public were thus informed of the scientific basis of the advice, providing important context for subsequent executive decisions. Consistent feedback to the committee from decision-makers was also important, as their advice was only one of many inputs considered by a complex array of government bodies, across different departments. Conclusions The world faces a significant risk of further pandemics and other public health emergencies and is engaged in high-level negotiations on strengthening global capacity to respond. Whether that involves a global pandemic accord, strengthened International Health Regulations, or a strengthened global approach to medical countermeasures, rapid, credible, independent and country-specific scientific advice will remain essential. The lessons learned during COVID-19 should not be lost. Submitted on behalf of the Ministerial Advisory Committee on COVID-19.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the COVID-19 pandemic on women’s, maternal and child health services in Tshwane District, South Africa","authors":"Annelet Kruger, Manei Letebele-Hartell, Mphailele Tshukudu, Mpho Moshime-Shabangu, Tabea Manyane, Maria Van der Westhuizen, Mary Mlangeni, Setlola Phoshoko, Rebecca Makau, Vivian Mfolo, Maureen Masha, Vundli Ramokolo, Tanita Botha, Ute Feucht","doi":"10.61473/001c.77852","DOIUrl":"https://doi.org/10.61473/001c.77852","url":null,"abstract":"Background The COVID-19 pandemic severely impacted healthcare service delivery globally. The aim of this study was to assess effects of the COVID-19 pandemic on the uptake of routine healthcare services related to maternal, newborn, child, and women’s health (MNCWH) in Tshwane District, an urban locality in Gauteng Province, South Africa. Methods As part of the observational Tshwane Maternal-Child COVID-19 study, routine data sources, including the District Health Information System and other district-based datasets, were studied from April 2019 to March 2022, to describe the impact of the first four COVID-19 waves in Tshwane District. The year pre-pandemic was used as a baseline. Data included MNCWH data elements/indicators, child health data elements/indicators, and COVID-19 surveillance data. Data analysis included descriptive statistics, together with visual analysis of trends over time. Statistical investigation included testing of differences between data from the pre-pandemic year (as baseline) and data from the following two pandemic years (2020/2021 and 2021/2022), as per the National Department of Health’s financial years (from April to March of the following year). Results Multiple MNCWH health elements/indicators showed major decreases during the COVID-19 pandemic period, with preventive services rendered at primary healthcare and community level more severely affected than facility-based clinical services. The most significant decreases were recorded during the first pandemic year, most notably during the first strict lockdown period, with partial or complete recovery in the second pandemic year, while selected indicators saw large impacts during the actual COVID-19 waves. Conclusions The COVID-19 pandemic severely impacted the ability of women and children to access healthcare services in this large urban district in South Africa. Health system strengthening measures and adequate planning for future emergency situations are crucial to mitigate the negative impact on maternal and child health, as South Africa strives to move towards reaching its Sustainable Development Goals.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South African Health Review 2022: health systems recovery after COVID-19","authors":"Ashnie Padarath, Themba L. Moeti","doi":"10.61473/001c.87567","DOIUrl":"https://doi.org/10.61473/001c.87567","url":null,"abstract":"By Ashnie Padarath, Themba L. Moeti. Following the COVID-19 pandemic, it is critical to reflect on lessons learned, apply these insights to strengthen the country's response to public health emergencies, and develop more resilient health systems.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health committee participation in South Africa during the COVID-19 pandemic: a shifting picture","authors":"Natasha Kannemeyer, Christopher J. Colvin, Hanne Haricharan","doi":"10.61473/001c.75320","DOIUrl":"https://doi.org/10.61473/001c.75320","url":null,"abstract":"Background Community participation is an important component in disease outbreak management during times of systemic disruption. However, community participation was lacking in South Africa during the COVID-19 pandemic. It is known that participation at community level faces numerous barriers locally and globally, with efforts towards meaningful participation often being inadequate. The spaces (referring to invented, invited and closed spaces for participation) where participation takes place impact the level and quality of participation. Methods The aim of this chapter is to explore how participation in health committee spaces was affected during the pandemic, and how the relationship between the state (the Western Cape Department of Health (WCDoH)) and health committees evolved during this period. Health committees are linked to primary care facilities and include community representatives, facility managers, and municipal political representatives (ward councillors), functioning as a bridge between community and health facilities. This qualitative study was conducted in three phases. In phases one and three, focus group discussions were held with health committees in two economically marginalised areas in Cape Town, South Africa. Phase two involved a three-month observation of committee activities. Both inductive and deductive content analysis were used to analyse the findings. In the deductive analysis, two conceptual frameworks – Arnstein’s Ladder of Citizen Participation and Gaventa’s notion of invited and invented spaces – were used to interpret the findings. Results During the COVID-19 pandemic, health committees responded to community needs and carried out tasks that the WCDoH failed to do. The Department recognised the limits of its pandemic response and the need for collaboration with community actors. This recognition led to an opening up of previously closed spaces to include health committees in more meaningful forms of participation. While there was an opening up, barriers in these spaces hindered participation. Health committees accordingly expanded their roles and empowered members to include themselves in WCDoH spaces and invent their own spaces for participation. Conclusions The COVID-19 pandemic illustrated the critical role health committees can play in disease outbreak management. The interplay between invited and invented spaces is highlighted as an important consideration for meaningful participation. Health committees should be actively involved in decision making and implementation processes for participation in invited spaces to be meaningful.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender differences in mental health outcomes during the first COVID-19 pandemic lockdown in South Africa","authors":"Atholl Kleinhans, Antonio Lentoor, Mokoena Maepa","doi":"10.61473/001c.81256","DOIUrl":"https://doi.org/10.61473/001c.81256","url":null,"abstract":"Background While the COVID-19 pandemic affected everyone in society, it was women who bore the brunt during the first hard lockdown in South Africa. This study examined the gender differences in mental health outcomes during the first COVID-19 pandemic lockdown in the country. Methods A cross-sectional, survey-based study was done, with a total of 327 participants recruited in South Africa via convenience sampling using online platforms such as Facebook, Twitter, university websites, WhatsApp, forums, and emails. The participants completed socio-demographic and COVID-19 threat- and stress-related questions. The Patient Health Questionnaire (PHQ-9) was completed as a measure of depression. The chi-squared test and Analysis of Variance (ANOVA) were applied during analysis. All analyses were conducted using IBM SPSS Statistics version 20 (IBM Corporation, Armonk, NY, USA), with a level of significance set at 0.05, two-tailed. Results The study found that fear of COVID-19 disease impacted stress and depression levels in both genders, with a significantly greater impact among women. A higher proportion of women than men reported stress related to the lockdown (62.9% versus 23%, p = 0.01). Subjective risk at work, work stress, and being required to continue work during lockdown were significantly associated with depression among women. Conclusions The study highlights the differential effect of stress, fear, and worry during the pandemic lockdown on vulnerability to depression, by gender. This has major implications for mental health interventions post-pandemic. It brings an opportunity to reduce gender difference in mental health through providing tailored care services, especially to working women during times of high stress.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining healthcare worker willingness to promote COVID-19 vaccines in South Africa: the importance of a clear evidence base","authors":"Gavin George, Phiwe B. Nota, Michael Strauss, Emma Lansdell, Remco P.H. Peters, Petra Brysiewicz, Nisha Nadesan-Reddy, Douglas Wassenaar","doi":"10.61473/001c.75321","DOIUrl":"https://doi.org/10.61473/001c.75321","url":null,"abstract":"Background Studies have shown that healthcare workers (HCWs) are considered trusted sources of coronavirus disease 2019 (COVID-19) information in their communities, ideally placing them as effective vaccine advocates. However, limited data exist on the role of HCWs in the promotion of vaccines, and whether they feel adequately equipped to fulfil this role. This study therefore aimed to determine the willingness of HCWs in promoting COVID-19 vaccines, how this correlated with their own vaccination behaviour and attitudes to alternative therapies, and whether they felt they had adequate knowledge and skills to communicate effectively with patients. Methods A mixed-methods design was adopted, involving an online web-based survey and in-depth interviews (IDIs). HCWs were recruited for the online survey from an integrated health system database in South Africa using voluntary response sampling, with follow-up qualitative interviews conducted with HCWs who indicated interest in participating in an interview. Univariate and multivariate logistical regression models were used to understand how demographic characteristics, HCW roles, vaccination status, attitudes and practices around alternative medications, and information on COVID-19 vaccines were related to the willingness of HCWs to recommend vaccination to their patients. Results Most of the survey sample were vaccinated (90.7%) and indicated that they would recommend vaccination (81.7%). However, a significant proportion of the sample (58.6%) felt that they did not have enough information on COVID-19 vaccines, while 59.8% felt that they required additional guidance on how to educate their patients on COVID-19 vaccines. Vaccinated HCWs were more likely to recommend vaccination (OR=10.63 [95% CI: 6.53-17.31]) than their unvaccinated counterparts. The qualitative results provide further insights into why HCWs were willing or unwilling to administer and promote vaccines, with three themes emerging: (i) HCWs’ belief in the value of vaccines and their promotion strategies; (ii) challenges facing HCWs in fulfilling their mandate of administering and promoting COVID-19 vaccination; and (iii) the rationale for HCWs discouraging vaccination and promoting alternative medicines for COVID-19 prevention and treatment. Conclusions This study posits that if HCWs are key to the success of national vaccination programmes, then they will need to be provided with clear, contextual, up-to-date information in order to enhance patient communication and vaccine uptake.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning from COVID and climatic events to build a resilient health system: Western Cape Department of Health","authors":"Amanda Quintana, Laura Angeletti-du Toit, Lucy Gilson, Wayne Smith, Krishna Vallabhjee","doi":"10.61473/001c.74966","DOIUrl":"https://doi.org/10.61473/001c.74966","url":null,"abstract":"Background The devastating KwaZulu-Natal floods in early 2022 were a reminder of the extensive damage to property and loss of life that climate change will exacerbate in South Africa. Extreme weather events are projected to increase in frequency and intensity in the southern African region. In recent years, the Western Cape has experienced fires, floods, drought, load-shedding, and COVID-19. Approach This chapter reflects on the experience of the Western Cape Department of Health around a series of adverse events in the province. The main lessons are identified, and a framework is suggested to strengthen the health sector’s response to climate change. The Department has been on an intentional learning journey to strengthen the health system, build health-system resilience, and to learn from these events. In addition to the need to adapt to external events, the health system itself contributes to greenhouse gas emissions. As such, the Department has discussed the mitigation activities it is engaged in to reduce its contribution to climate change. Building on the lessons learned from adverse events, the Department has identified five focus areas to strengthen the health sector’s ability to respond to climate change: (i) structural and relational aspects of governance; (ii) stewardship, leadership, and management; (iii) partnerships and intersectoral collaboration; (iv) system capacities; and (v) learning oriented culture. Conclusions As the impacts of climate change are increasingly felt, there is an urgent need to share lessons from the health sector’s response to adverse events. This learning can assist in implementing adaptive actions that strengthen health-system functions and that mitigate the health sector’s greenhouse gas emissions. Health-sector leadership in South Africa needs to participate actively in climate action through the Presidential Climate Commission and other fora. The chapter concludes with recommendations that speak to the focus areas and shared learnings that can be helpful in other settings where health systems face climate risks.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SAHR 2022: Editorial","authors":"Ashnie Padarath, Themba L. Moeti","doi":"10.61473/001c.84923","DOIUrl":"https://doi.org/10.61473/001c.84923","url":null,"abstract":"By Ashnie Padarath, Themba L. Moeti. The 2022 SAHR offers promising examples of COVID-19 response, mitigation, and recovery strategies. Emerging lessons may be used to enhance health system resilience and better prepare for future pandemics.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}