Understanding urban black women's health care practices will enable health promoters to develop interventions that are successful. The problem investigated here was to gain an understanding of the health care practices of urban black women that could influence health promotion activities. The design was qualitative and exploratory. The sampling method was convenient and purposive, and the sample size was determined by saturation of the data. Data was gathered through semi-structured interviews using six specific themes and the analysed using open coding. The results indicated that the social environment created by the registered nurses in the primary health influenced the health care practices of the women negatively. Practices regarding the seriousness of a health problem suggest a possible reason may exist for late admission of a person with a serious health problem.
Equitable health services
This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion. It used qualitative research methods to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Complex patterns of service delivery were prevalent throughout many of the health care facilities and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre- and post-abortion counselling, including contraceptive counselling and provision. To sustain a pool of abortion providers, programmes that both attract prospective abortion providers and retain existing providers, need to be developed and financial compensation for abortion care providers needs to be considered.
The authors of this paper argue that the importance of strong health care systems to fragile nations and the damage done to these systems during conflict receive less attention than they should. They note that the impact of the cycle of violence and poverty on health and health care in fragile states is enormous, to the extent that no low-income fragile or conflict-affected country has yet achieved a single Millennium Development Goal. Although the international community spends billions of dollars each year in aid to these nations, gains have generally been small – without infrastructure and stability, much of this aid is wasted. In conclusion, the authors argue that adequate and equitable provision of quality health care will be met only if health systems and structures are preserved and developed, and if health care personnel have the freedom and safety to provide necessary care to those who need it.
Recent analyses have drawn attention to the weaknesses of health care systems in low- and middle-income countries. In response to such deficiencies in the health care system, a number of countries have been introducing new approaches to financing, organizing, and delivering health care. This article briefly reviews the main weaknesses of health care systems in low- and middle-income countries, lists the most common responses to those weaknesses, and then presents three of the most popular responses for further review. These responses, which have attracted considerable controversy, involve the questions of whether to pay for health care through general taxation or contributory insurance funds to improve financial protection for specific sections of the population, whether to use financial incentives to increase health care utilization and improve health care quality, and whether to make use of private entities to extend the reach of the health care system. This review raises that the specific circumstances of individual countries strongly influence both decisions about which approaches might be relevant and their success, so the author cautions that any generalizations made from health systems research in particular countries must be carefully considered. It is unlikely that there is one single blueprint for an ideal health care system design or a magic bullet that will automatically remedy deficiencies. The strengthening of health care systems in low- and middle-income countries must be seen as a long-term developmental process.
All waste generated at health care facilities in the past was regarded as hazardous and was incinerated before disposal. Today however, waste generated at health facilities is separated out and disposed of according to the risks it poses. The purpose of this study was to investigate health care waste (HCW) management practices used in public health clinics in the iLembe Health District, with a view to developing a HCW management intervention strategy. The management of health care waste is of great concern. There is need to develop a health care waste management intervention strategy to be implemented consistently and universally in the district.
While hospitals and health clinics are not a specific focus of mitigation assessment by the Intergovernmental Panel on Climate Change, this policy brief notes that adoption of safe and sustainable building measures by health facilities will offer more health co-benefits than the same measures applied to other commercial buildings. This is partly due to health facilities’ large demands for reliable energy, clean water and temperature/air flow control in treatment and infection prevention. Significant health gains also can be expected from specific interventions, such as the use of natural ventilation as an effective energy-saving and infection-control measure. Resilience of health care services may be enhanced through use of (clean) onsite energy co-generation that ensures more reliable energy supply in cities where frequent energy outages occur, and particularly in remote, resource-poor settings, where a basic electricity supply will allow life-saving procedures to be performed. Health risks to health workers, patients and communities will be reduced by improved management of health care and waste – and so will the carbon footprint. The health care sector is well-positioned to ‘lead by example’, the World Health Organisation argues, in terms of reducing climate change pollutants and by demonstrating how climate change mitigation can yield tangible, immediate health benefits.
Little is known about the health conditions and support needs of people living with intellectual disability (ID) in the African context. To address this gap, the authors conducted this study in residential facilities in the Western Cape Province, South Africa, for people over the age of 18 years with ID. They conducted in face-to-face interviews with the managers of 37 out of 41 identified facilities, as well as a survey of 2,098 residents (54% of them female), representing less than 2% of the estimated population of persons with ID in the province. The survey suggests that such persons experience a wide range of health conditions (notably mental health and behavioural issues) but have limited access to general healthcare and rehabilitation services. Furthermore, the daily living supports required for an acceptable quality of life are limited. The findings highlight the need for better health and support provision to persons with ID.
The study aimed to evaluate health facility and health worker readiness to deliver new artemetherlumefantrine (AL) treatment policy for uncomplicated malaria in Kenya, using a cross-sectional survey at health facilities in four sentinel districts in Kenya. All government facilities in study districts and all health workers performing outpatient consultations were involved in the study. The availability of any tablets of AL , sulfadoxine-pyrimethamine and amodiaquine was nearly universal on the survey day. However, only 61% of facilities stocked all four weight-specific packs of AL. In the past six months, 67% of facilities had stock-out of at least one AL tablet pack and 15% were out of stock for all four packs at the same time. Duration of stock-out was substantial for all AL packs (median range: 27-39% of time). During the same period, the stock-outs of sulfadoxine-pyrimethamine and amodiaquine were rare. Only 19% of facilities had all AL wall charts displayed, AL in-service training was provided to 47% of health workers and 59% had access to the new guidelines. Health facility and health worker readiness to implement AL policy is not yet optimal. Continuous supply of all four AL pack sizes and removal of not-recommended antimalarials is needed. Further coordinated efforts through the routine programmatic activities are necessary to improve delivery of AL at the point of care.
Haemorrhage is the leading causes of obstetric mortality. Studies show that active management of third stage of labour (AMTSL) reduces post partum haemorrhage. This study describes the practice of AMTSL and barriers to its effective use in Tanzania. Correct practice of AMTSL was observed in only 7% of 251 deliveries. Knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.
Health literacy is a composite term to describe a range of outcomes to health education and communication activities. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. A ‘health outcome model’ is presented, which highlights health literacy as a key outcome from health education.