Addressing NCDs in Africa: Promoting Health Through Hospitals

Global Health Promotion, 2010

A district hospital in a rural area of the Limpopo Province in South Africa has recently been launched as a 'Health Promoting Hospital', based on the principles of the Ottawa Charter and according to standards developed by WHO-Europe. The initiative was conceived as a project in partnership with stakeholders from the local community and is considered a pilot by Provincial health authorities, representing an advance in health promotion practice in the region. The project was designed as a research intervention, guided by the principles of critical action research integrated with the Precede-Proceed model for the systematic evaluation of health promotion and education. This commentary reports on the process undertaken in successfully transforming this community-based hospital into a Health Promoting Hospital by integrating the concept, values and standards of health promotion into its structure and culture, thereby creating a healthy setting and promoting the health and wellbeing of the hospital's staff, its patients, and their relatives. (Global Health Promotion, 2010; Supp (2): pp. 33-36)

Global Health Promotion, 2011

This project aimed at transforming a rural District Hospital in the Limpopo Province of South Africa into a Health Promoting Hospital according to standards developed by WHO-Europe. The intervention used a diagnostic approach and baseline needs assessment of hospital staff, patients, and their relatives to identify health education and promotion needs. Activities included empowerment training and skills development, implementation of health education and promotion activities, and the integration of health-promoting standards and values in the hospital structure and culture. The project indicated applicability of the model in a resource-limited setting, based on staff empowerment, local leadership, and stakeholder engagement.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2013

Journal of Public Health Research

Background: Chronic non-communicable diseases (CNCDs) are increasing with grave consequences to countries’ development. The purpose of this study was three-fold: (1) to determine challenges PURE study participants faced regarding CNCD interventions and what they required from a CNCD intervention programme, and (2) to explore courses of action Department of Health (DoH) officials thought would perform best, as well as (3) to determine what DoH officials perceive to be obstacles in addressing the CNCD epidemic. Design and methods: A subsample of 300 participants from the Prospective Urban and Rural Epidemiological study’s Western Cape urban cohort and six key officers from the DoH were recruited to participate in this cross-sectional study. Questionnaires were used in face-to-face interviews with the PURE study participants and DoH officials, together with the multi-criteria mapper (MCM) interviewing method with the latter. Results: Most PURE participants were overweight/obese, but no...

Development Southern Africa, 2018

Systems' thinking places high value on understanding the context. This study focused on the collection of disaggregated data in order to understand the context, to facilitate improvement of health outcomes. The aim of this article was to assess the implementation of municipal ward-based health data collection (disaggregated data) and health care workers' perceptions of this data collection process. This cross-sectional study used mixed methods in Amajuba district. The participants were professional nurses at the Primary Health Care level. Of the 131 respondents, 123 (93.9%) collected municipal ward-based health data, and found it useful. Opportunities for improving data collection were identified. Disaggregation of the data at ward level contributes to a better understanding of the target population's health, assists planning for health needs and enables provision of targeted interventions in order to improve health outcomes, to prevent financial regression and waste of health resources.

BMC Health Services Research, 2018

BackgroundChronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. The aim of this study was to develop interventions to improve management of chronic diseases in the form of an integrated, evidence-based chronic disease management model in Dikgale, a rural area of Limpopo Province in South Africa.MethodsA multifaceted intervention, called ‘quality circles’ (QCs) was developed to improve the quality and the management of chronic diseases in the Dikgale Health and Demographic Surveillance System (HDSS). These QCs used the findings from previous studies which formed part of the larger project in the study area, namely, the quantitative study using STEPwise survey and qualitative studies using focus group discussions and semi-structured interviews.ResultsThe findings from previous studies in Dikgale HDSS revealed that an epidemiological transition is occurring. Again, the most widely reported barriers from previous studies in this rural area were: lack of knowledge of NCDs; shortages of medication and shortages of nurses in the clinics, which results in patients having long waiting-time at clinics. Lack of training of health care providers on the management of chronic diseases and the lack of supervision by the district and provincial health managers, together with poor dissemination of guidelines, were contributing factors to the lack of knowledge of non-communicable diseases (NCDs) management among nurses and community health care workers (CHWs). Consideration of all of these findings led to the development of model which focuses on integrating nursing services, CHWs and traditional health practitioners (THPs), including a well-established clinical information system for health care providers. A novel aspect of the model is the inclusion of community ambassadors who are on treatment for NCDs and are, thus, repositories of knowledge who can serve as a bridge between health care workers and community members.ConclusionThe model developed highlights the need for health interventions that aim to control risk factors at the population level, the need for availability of NCD-trained nurses, functional equipment and medication and a need to improve the link with traditional healers.

South African Family Practice

Background: Measuring indicators for health promotion (HP) practice among healthcare workers is essential if health goals and objectives must be achieved. Such indicators provide connections between health policies and health outcomes; and ultimately add value to healthcare. This study identi ed indicators of health promotion among healthcare workers and compared them across levels of healthcare facilities in Nelson Mandela Bay Municipality, South Africa. Method: A cross sectional study involving 495 healthcare workers randomly sampled from 23 hospitals including primary, secondary, and tertiary level hospitals was conducted. Questionnaires were distributed to medical doctors, nurses, and allied health workers (AHW) such as social workers, physiotherapists, occupational therapists, and speech therapist. Questions (hereto referred to as dimensions) in the questionnaires were categorized to address Facility Related Indicators (FRI), Health worker related indicators (HRI) and Outcome related indicators (ORI). Descriptive and bivariate analysis were used to identify the indicators of HP among the three HCW groups from the three levels of health care. Indicators observed to be signi cant in the bivariate analysis were subjected to a multivariate analysis using the multinomial regression model. (p-value < 0.05). Results: Emerging Indicators were grouped into three categories: facility related indicators (FRI), healthcare workers' related indicators (HRI), and outcome related indicators (ORI). Four FRI dimensions were observed to be predictors of HP among doctors. Two dimensions were positively associated with HP practices while two others were negatively associated with HP practices among medical doctors and AHWs. On the other hand, seven HRI dimensions were signi cantly associated with HP among medical doctors and AHW. Furthermore, 5 outcome related indicator (ORI) dimensions were signi cant predictors of HP among medical doctors while only two dimensions were predictors of HP among AHW. The generalized Hosmer-Lemeshow Chi-square test showed that the models for the different HP indicators t the data. Conclusions: We identi ed indicators for measuring HP that can be applied at primary, secondary and tertiary hospitals in Nelson Mandela Bay Municipality, South Africa. These indicators which healthcare workers and health systems' managers in the study area should be aware of may be adapted for use in other areas. Background Worldwide, performance measurement of health promotion (HP) practice among healthcare workers (HCWs) is a contemporary theme in health systems (1, 2). However, there is no consensus on the approach for measuring HP practice among healthcare workers. For instance, existing HP indicators focus on speci c HP programmes and not on overall HP practices of healthcare workers (3, 4). Developing such indicators will provide the health system tools for assessing the effectiveness and quality of HP services by the HCWs. This will improve the performance of HCW to discharge HP services and ultimately reduce pressure at healthcare facilities as patients and the general community become empowered. Clearly de ned indicators are critical as instruments for methodical execution of HP practices. This enhances practice objectivity, improves understanding, decision making, ensures feedback on the way things are progressing and provide for prompt warning signs to authorities (5). Healthcare delivery faces signi cant challenges (6, 7) ranging from costs associated with healthcare to basic healthcare infrastructures. Globally, serious shortcomings have been documented across several domains in healthcare (8) and this may have long term effects on human health. Many low and middle income countries (LMIC) suffer from poor quality of care described by the World Health Organization (WHO) as worrisome particularly for Africa (9). In an analysis of healthcare services assessed against health outcomes, Africa scored an overall index of 0.48 (9) indicating that the continent utilizes only 48% of imaginable health services required for the health and well-being of its population. For instance, in Malawi, the healthcare delivery system is saddled with poor distribution of resources, disintegration of services and staff shortage (10). Similarly in Nigeria, the healthcare system is laden with poor service delivery and infrastructure (11). In South Africa, there is a strong commitment by the state to improve the healthcare delivery system evident from supportive policies and programmes implemented; and the funding invested (12-14). Despite these efforts, health outcomes remain polarised, unequal and unfair (12). Currently the country has a two-tiered system (15) that provides services to the population-the public and the private healthcare sectors. The public health care provides free health services and is fully funded by the state hence strongly overstretched. The private healthcare sector mainly provides services to wealthier and employed classes who subscribe to private health insurance schemes (16,17). This healthcare system has been described as one under increased strain as a result of overstretch of her HCWs capacity and operational resources (18). The success of any healthcare system is largely dependent on performance of HCWs, and worldwide, millions of patients visit the healthcare facilities daily to meet the HCWs for various health needs. Establishing a set of indicators for measuring HP practices among HCWs will enhance HP awareness and practice among the HCWs. Such HP indicators will provide HCWs with vital tools for systematically conducting follow-up and have an effective HP practices (3). These tools will assist in unravelling areas for improvement and intervention. Good sets of indicators will assist policy makers and stakeholders to monitor and evaluate HP practices of HCWs. Metrics for such measurement will require clear HP indicators and a framework that integrates relationships across the different elements of HP practices. This study identi ed selected measures or attributes for assessing HCWs HP practices and compared them across the various levels of healthcare in the Nelson Mandela Bay Municipality, South Africa. Method Study area The Nelson Mandela Bay Municipality (NMBM), is one of eight category A or metropolitan municipalities (19) in South Africa. NMBM is the largest of two Category A Metropolitan Municipalities in the Southern coast of the Eastern Cape Province (20).

A number of challenges remain, not the least of which is the prevailing perspective of the citizen as an object of health care or object of research, rather than the required perspective of citizen as participant and knower. So, this perspective needs to change. In research and training, this change of perspective can help to promote health literacy, greater intentionality and a better understanding of local-central power relations, which will inform crossdisciplinary designs for future research.

2017

The national strategic plan for non-communicable diseases emphasises the need for community-based strategies for prevention, control and management to complement facility-based health services. S outh Africa is experiencing an increase in the prevalence of non-communicable diseases (NCDs), which imposes a heavy burden on healthcare services. The South African government has made great strides towards management and control of NCDs, including the development of management guidelines, healthpromotion and prevention policies intended to assist healthcare workers, facilities and communities in NCD care. However, it appears that the facility-based component of NCD management and control efforts has received more attention than the community-level components.

Global Health Promotion, 2010

Background. This paper describes a project to strengthen the capacity for health promotion in two Provinces in South Africa. The project draws on the key health promotion capacity dimensions of partnership and networking, infrastructure, problem-solving capacity, and knowledge transfer. The project was carried out in a partnership between the Provinces, the Ministry of Health of South Africa, the government of Flanders, Belgium, and the World Health Organization (WHO). Objectives. The project aimed to: (i) integrate health promotion into national, Provincial and district level health policy plans (ii) strengthen the health promotion capacity in the two Provinces; and (iii) support the development of tools to monitor and evaluate health promotion interventions. Method. Starting from a situation analysis and identification of priority health issues and existing actions in each Province, capacity-building workshops were organized for senior participants from various sectors. Community-based health promotion interventions were then planned and implemented in both Provinces. Outcomes. A systematic evaluation of the project involving an internal audit of project activities and results based on document analysis, site visits, focus groups and interviews with key persons demonstrated that stakeholders in both Provinces saw an increase of capacity in terms of networking, knowledge transfer, problem solving, and to a lesser extent infrastructure. Health promotion had been well integrated in the Provincial health plans, and roll-out processes with local stakeholders had started after the conclusion of the project. The development of tools for monitoring and evaluation of health promotion was less well achieved. Lessons learnt. The project illustrates how capacities to deliver health promotion interventions in a developing country can be enhanced through international collaboration. The conceptual model of capacity building that served as a basis for the project provided a useful framework to plan, identify and assess the key components of health promotion capacity in an African context. (Global Health Promotion, 2010; Supp (2): pp. 06-16).