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BACKGROUND: As part of health system strengthening in South Africa (2012-2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system. METHODS: We conducted a realist evaluation, adopting the case study design, over a two-year period (2013-2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs. RESULTS: The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting. CONCLUSION: District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant 'bottom-up' capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.
Subject(s)
Leadership , Motivation , Government Programs , Humans , Qualitative Research , South AfricaABSTRACT
BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. PARTNERSHIP: The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders. CONCLUSION: We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups.
Subject(s)
Diet , Global Health , Noncommunicable Diseases/epidemiology , Adolescent , Africa South of the Sahara , Caribbean Region , Developing Countries , Health Policy , Humans , Income , International Cooperation , Public Health , Research , Risk FactorsABSTRACT
BACKGROUND: In South Africa (SA), clinics and community health centres are the predominant primary level health care facilities in the public health sector. As part of legislated health governance requirements, clinic committees (referring to those for clinics and community health centres) were established to provide management oversight and bring to bear the perspectives and participation of communities at Primary Health Care (PHC) facilities. Clinic committees need training in order to better understand their roles. Facilitators in a district of SA were trained through a designated programme, called the 'PHC Facility Governance Structures Trainer-of-Facilitator (ToF) Learning Programme', in preparation for the training of clinic committees. This paper explores how the programme had evolved and was experienced by the trained facilitators, in a district in SA. METHODS: We employed a retrospective qualitative case study design, guided by the Illuminative Evaluation Framework, with the training programme in the selected district as the case. The study assessed whether the intended aims of the training programme were clearly conveyed by the trainers, and how participants understood and subsequently conveyed the training programme intentions to the clinic committees. Key informant interviews and focus group discussions were conducted with trainers and managers, complemented by a review of relevant policy and legislative documents, and published literature. Study participants were purposively selected based on their involvement in the development, facilitation or training of the programme. Thirteen individuals participated in the study, and 23 (national, provincial and partner) documents were reviewed. RESULTS: Despite the different perceptions and understandings of the ToF Learning Programme, its overall aims were achieved. Trainers' capacity was strengthened and clinic committees were trained accordingly. The training programme holds promise for possible national scale-up. The high quality of the interactive posters can be considered equally valuable as a training tool as the training manuals. CONCLUSIONS: Trainers' capacity was strengthened and clinic committees were trained accordingly, despite deviations in implementation of the original training approach and plan.
Subject(s)
Community Health Centers , Teacher Training , Community Health Centers/legislation & jurisprudence , Focus Groups , Humans , Organizational Policy , Qualitative Research , Retrospective Studies , South Africa , Teacher Training/legislation & jurisprudence , Teacher Training/standards , Teacher Training/statistics & numerical dataABSTRACT
BACKGROUND: This study sought to identify, as far as possible, the extent of the specialist children's nursing workforce in five selected African countries. Strengthening children's nursing training has been recommended as a primary strategy to reduce the under-five mortality rate in African nations. However, information about the extent of the specialist children's nursing workforce in this region is not routinely available. Developing an accurate depiction of the specialist children's nursing workforce is a necessary step towards optimising children's health service delivery. METHODS: This study used a convergent parallel mixed methods design, incorporating quantitative (surveys) and qualitative (questionnaire and interview) components, to generate data addressing three related questions: how many children's nurses are believed to be in practice nationally, how many such nurses are recorded on the national nursing register and how many children's nurses are being produced through training annually. RESULTS: Data provide insights into reported children's nursing workforce capacity, training activity and national training output in the five countries. Findings suggest there are approximately 3728 children's nurses across the five countries in this study, with the majority in South Africa. A total of 16 educational programmes leading to a qualification in paediatric nursing or child health nursing are offered by 10 institutions across the countries in this study, with Kenya, Malawi and Zambia having one institution each and South Africa hosting seven. Data suggest that existing human resources for health information systems do not currently produce adequate information regarding the children's nursing workforce. Analysis of qualitative data elicited two themes: the role of children's nurses and their position within health systems, and the capacity of HRH information systems to accurately reflect the specialist children's nursing workforce. CONCLUSION: The data generated provide an initial indication of the size of the children's nursing workforce in these five countries, as well as an overview of associated training activity. We hope that they can start to inform discussion about what would represent a viable and sustainable regional children's nursing workforce for the future.
Subject(s)
Pediatric Nursing/statistics & numerical data , Health Workforce/statistics & numerical data , Humans , Kenya , Malawi , Pediatric Nursing/organization & administration , South Africa , Uganda , ZambiaABSTRACT
BACKGROUND: The importance of strong and transformative leadership is recognised as essential to the building of resilient and responsive health systems. In this regard, Sustainable Development Goals (SDG) 5 prioritises a current gap, by calling for women's full and effective participation and equal opportunities for leadership, including in the health system. In South Africa, pre-democracy repressive race-based policies, coupled with strong patriarchy, led to women and especially black women, being 'left behind' in terms of career development and progression into senior health leadership positions. METHODS: Given limited prior inquiry into this subject, we conducted a qualitative exploratory study employing case study design, with the individual managers as the cases, to examine the influence of gender on career progression and leadership perceptions and experiences of senior managers in South Africa in five geographical districts, located in two provinces. We explored this through in-depth interviews, including life histories, career pathway mapping and critical incident analysis. The study sample selection was purposive and included 14 female and 5 male senior-managers in district and provincial health departments. RESULTS: Our findings suggest that women considerably lag behind their male counterparts in advancing into management- and senior positions. We also found that race strongly intersected with gender in the lived experiences and career pathways of black female managers and in part for some black male managers. Professional hierarchy further compounded the influence of gender and race for black women managers, as doctors, who were frequently male, advanced more rapidly into management and senior management positions, than their female counterparts. Although not widespread, other minority groups, such as male managers in predominantly female departments, also experienced prejudice and marginalisation. Affirmative employment policies, introduced in the new democratic dispensation, addressed this discriminatory legacy and contributed to a number of women being the 'first' to occupy senior management positions. In one of the provinces, these pioneering female managers assumed role-modelling and mentoring roles and built strong networks of support for emerging managers. This was aided by an enabling, value-based, organisational culture. CONCLUSION: This study has implications for institutionalising personal and organisational development that recognise and appropriately advances women managers, paying attention to the intersections of gender, race and professional hierarchy. It is important in the context of national and global goals, in particular SDG 5, that women and in particular black women, are prioritised for training and capacity development and ensuring that transformative health system policies and practices recognise and adapt, supporting the multiple social and work roles that managers, in particular women, play.
Subject(s)
Administrative Personnel , Career Mobility , Gender Identity , Leadership , Sexism , Adult , Attitude of Health Personnel , Black People , Female , Humans , Male , Middle Aged , Organizational Culture , Power, Psychological , Prejudice , Qualitative Research , Racial Groups , South Africa , Surveys and QuestionnairesABSTRACT
Background: Maternal and child health is a priority for most governments, especially those in low and middle-income countries (LMICs), due to high mortality rates. The combination of individual and social actions designed to gain political commitment, policy support and social acceptance for health goals are influenced by the interplay between the advocates and the strategies they deploy in planning and advocating for maternal and child health issue. This study aims to deepen our understanding of how advocacy has influenced maternal and child health priority setting in Nigeria. Methods: This is a mixed method study that involved 24 key informant interviews, document review, policy tracking and mapping of advocacy events that contributed to the repositioning of maternal and child health on the political agenda was done. Respondents were deliberately selected according to their roles and positions. Analysis was based on Shiffman and Smith's policy analysis framework of agenda setting. Results: Our findings suggest that use of various strategies for advocacy such as influencers, media, generated different outcomes and the use of a combination of strategies was found to be more effective. The role of advocacy in issue emergence was prominent and the presence of powerful actors, favorable policy window helped achieve desired outcomes. The power of the advocates and the strength of the individuals involved played a key role. Conclusion: This study finds it possible to understand the role of advocacy in policy agenda setting through the application of agenda setting framework. To achieve the health SDG goals, advocacy barriers need to be addressed at multiple levels.
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The social determinants of health (SDH), such as access to income, education, housing and healthcare, strongly shape the occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) at the household, community and national levels. The SDH are systemic factors that privilege some more than others and result in poverty and inequitable access to resources to support health and well-being. Primordial prevention is the modification of SDH to improve health and reduce the risk of disease acquisition and the subsequent progression to RHD. Modifying these determinants using primordial prevention strategies can reduce the risk of exposure to Group A Streptococcus, a causative agent of throat and skin infections, thereby lowering the risk of initiating ARF and its subsequent progression to RHD.This report summarises the findings of the Primordial Prevention Working Group-SDH, which was convened in November 2021 by the National Heart, Lung, and Blood Institute to assess how SDH influence the risk of developing RHD. Working group members identified a series of knowledge gaps and proposed research priorities, while recognising that community engagement and partnerships with those with lived experience will be integral to the success of these activities. Specifically, members emphasised the need for: (1) global analysis of disease incidence, prevalence and SDH characteristics concurrently to inform policy and interventions, (2) global assessment of legacy primordial prevention programmes to help inform the co-design of interventions alongside affected communities, (3) research to develop, implement and evaluate scalable primordial prevention interventions in diverse settings and (4) research to improve access to and equity of services across the RHD continuum. Addressing SDH, through the implementation of primordial prevention strategies, could have broader implications, not only improving RHD-related health outcomes but also impacting other neglected diseases in low-resource settings.
Subject(s)
Rheumatic Fever , Rheumatic Heart Disease , Humans , Rheumatic Fever/epidemiology , Rheumatic Fever/prevention & control , Rheumatic Fever/complications , Rheumatic Heart Disease/epidemiology , Rheumatic Heart Disease/prevention & control , Rheumatic Heart Disease/etiology , Social Determinants of Health , Research , Primary PreventionABSTRACT
High sugar intake contributes to diet-related excess weight and obesity and is a key determinant for noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs). The World Health Organization (WHO) gives specific advice on limiting sugar intake in adults and children. Yet, to what extent have policy ideas on sugar intake reduction originating at the global level found expression at lower levels of policymaking? A systematic policy document analysis identified policies issued at the African regional, South African national and Western Cape provincial levels between 2000 and 2020 using search terms related to sugar, sugar-sweetened beverages (SSBs), and NCDs. Forty-eight policy documents were included in the review, most were global and national policies and thus the focus of analysis. A policy transfer conceptual framework was applied. Global recommendations for effectively tackling unhealthy diets and NCDs advise implementing a mix of cost-effective policy options that employ a multisectoral approach. South African country-level policy action has followed the explicit global guidance, and ideas on reducing sugar intake have found expression in sectors outside of health, to a limited extent. As proposed in this paper, with the adoption of the SSB health tax and other policy measures, South Africa's experience offers several learnings for other LMICs.
Subject(s)
Noncommunicable Diseases , Adult , Beverages , Child , Diet , Humans , Noncommunicable Diseases/prevention & control , Policy , Policy Making , South Africa , Sugars , TaxesABSTRACT
Non-communicable diseases (NCDs) contribute significantly to global mortality and are of particular concern in growing urban populations of low- and-middle income countries (LMICs). Physical inactivity is a key NCD determinant and requires urgent addressing. Laudable global and regional efforts to promote physical activity are being made, but the links between physical activity (PA), NCD reduction, and integrated intersectoral approaches to reducing obesogenic environments are not consistently made. This study applied a document analysis approach to global PA and NCD policies to better understand the current global policy environment and how this may facilitate integrated PA promotion. A total of 34 global policies related to PA, from different sectors, were analyzed. PA policy in mitigation of NCDs has evolved exponentially, with a progression towards addressing structural determinants alongside individual behavior change. The global PA agenda is primarily driven by the World Health Organization. Intersectoral collaboration is importantly regarded, but the contributions of other sectors, outside of health, education, transport, and urban planning, are less clear. Improving PA among key sub-populations-women, girls, and adolescents-requires greater policy consideration. It is imperative for PA-relevant sectors at all levels to recognize the links with NCDs and work towards integrated policy and practice in mitigation of the rising NCD pandemic.
Subject(s)
Noncommunicable Diseases , Adolescent , Exercise , Female , Health Policy , Humans , Noncommunicable Diseases/prevention & control , Policy Making , World Health OrganizationABSTRACT
Rates of obesity and related non-communicable diseases are on the rise in sub-Saharan Africa, associated with sub-optimal diet and physical inactivity. Implementing evidence-based interventions targeting determinants of unhealthy eating and physical inactivity in children and adolescents' immediate environments is critical to the fight against obesity and related non-communicable diseases. Setting priorities requires a wide range of stakeholders, methods, and context-specific data. This paper reports on a novel participatory study design to identify and address contextual drivers of unhealthy eating and physical inactivity of children and adolescents in school and in their home neighborhood food and built environments. We developed a three-phase mixed-method study in Cameroon (Yaoundé) and South Africa (Johannesburg and Cape Town) from 2020-2021. Phase one focused on identifying contextual drivers of unhealthy eating and physical inactivity in children and adolescents in each setting using secondary analysis of qualitative data. Phase two matched identified drivers to evidence-based interventions. In phase three, we worked with stakeholders using the Delphi technique to prioritize interventions based on perceived importance and feasibility. This study design provides a rigorous method to identify and prioritize interventions that are tailored to local contexts, incorporating expertise of diverse local stakeholders.
Subject(s)
Diet, Healthy , Noncommunicable Diseases , Adolescent , Built Environment , Cameroon , Child , Humans , Obesity , South AfricaABSTRACT
This special issue presents a set of seven Health Policy Analysis (HPA) papers that offer new perspectives on health policy decision-making and implementation. They present primary empirical work from four countries in Asia and Africa, as well as reviews of literature about a wider range of low- and middle-income country (LMIC) experience.
Subject(s)
Developing Countries , Fellowships and Scholarships , Health Policy , Humans , Policy Making , PoliticsABSTRACT
Introduction: Document analysis is commonly used in health policy analysis (HPA) studies, but the purpose and rigour of application is unclear. This review explored the application and utility of document analysis in HPA studies conducted in low-and-middle income countries (LMICs), intending to derive lessons for strengthening this methodology. Methods: Employing a qualitative systematic review approach, nine electronic databases were searched for LMIC HPA articles that employed document analysis. Articles were subjected to systematic retrieval, storage and quality-assessment. Thematic analysis was used in coding, extraction and analysis of data. Results: Only 28 studies had sufficiently detailed document analyses and met the inclusion criteria. Document analyses were mainly complimentary to primary data collection forms. The majority, barring four studies, lacked clear purpose and utility in answering the research questions, and rigour in methodology and the reporting thereof. The approach to document analyses bore no relationship to the policy phase investigated. Challenges in accessing documents contributed to methodological difficulties. Conclusion: Well-executed document analysis has potential to strengthen HPA studies. Health Policy researcher skill in applying this methodology needs strengthening and could be improved by: purposive alignment of the method to research questions; rigorously applying and reporting on search strategy with rigour; source, organize and store documents systematically; apply robust data coding and analysis; and clearly linking document contribution to study findings and conclusions.
ABSTRACT
BACKGROUND: The persistence of high maternal mortality and consistent failure in low- and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, interventional and health systems perspectives. The role of policy elites and their interests remains inadequately explored in this debate. This study examined elites and how their interests drove maternal health policies and actions in ways that could explain policy failure for MDG 5 in Uganda. METHODS: We conducted a retrospective qualitative study of Uganda's maternal health policies from 2000 to 2015 (MDG period). Thirty key informant interviews and 2 focus group discussions (FGDs) were conducted with national policy-makers, who directly participated in the formulation of Uganda's maternal health policies during the MDG period. We reviewed 9 National Maternal Health Policy documents. Data were analysed inductively using elite theory. RESULTS: Maternal health policies were mainly driven by a small elite group comprised of Senior Ministry of Health (MoH) officials, some members of cabinet and health development partners (HDPs) who wielded more power than other actors. The resulting policies often appeared to be skewed towards elites' personal political and economic interests, rather than maternal mortality reduction. For a few, however, interests aligned with reducing maternal mortality. Since complying with the government policy-making processes would have exposed elites' personal interests, they mainly drafted policies as service standards and programme documents to bypass the formal policy process. CONCLUSION: Uganda's maternal health policies were mainly influenced by the elites' personal interests rather than by the goal of reducing maternal mortality. This was enabled by the formal guidance for policy-making which gives elites control over the policy process. Accelerating maternal mortality reduction will require re-engineering the policy process to prevent public officials from infusing policies with their interests, and enable percolation of ideas from the public and frontline.
Subject(s)
Health Policy , Maternal Health , Female , Humans , Policy Making , Retrospective Studies , UgandaABSTRACT
Non-communicable diseases (NCDs) are the leading cause of death globally. Despite significant global policy development for addressing NCDs, the extent to which global policies find expression in low-and-middle income countries' (LMIC) policies, designed to mitigate against NCDs, is unclear. This protocol is part of a portfolio of projects within the Global Diet and Activity Research (GDAR) Network, which aims to support the prevention of NCDs in LMICs, with a specific focus on Kenya, Cameroon, South Africa and Jamaica. This paper outlines the protocol for a study that seeks to explore the current policy environment in relation to the reduction of key factors influencing the growing epidemic of NCDs. The study proposes to examine policies at the global, regional and country level, related to the reduction of sugar and salt intake, and the promotion of physical activity (as one dimension of healthy placemaking). The overall study will comprise several sub-studies conducted at a global, regional and country level in Cameroon, Kenya and South Africa. In combination with evidence generated from other GDAR workstreams, results from the policy analyses will contribute to identifying opportunities for action in the reduction of NCDs in LMICs.
Subject(s)
Noncommunicable Diseases , Caribbean Region , Developing Countries , Diet , Exercise , Health Policy , Humans , Kenya/epidemiology , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/prevention & control , Policy MakingABSTRACT
Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet-a prominent risk factor-is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents can reveal how amenable the policy landscape is for supporting intersectoral action for health in low-income to middle-income countries. This study applied a document analysis approach to undertake policy analysis on global and African regional policies related to noncommunicable disease and diet. A total of 62 global and 29 African regional policy documents were analysed. Three problem frames relating to noncommunicable disease and diet were identified at the global and regional level, namely evidence-based, development, and socioeconomic frames. Health promotion, intersectoral and multisectoral action, and evidence-based monitoring and assessment underpinned proposed interventions to improve education and awareness, support structural changes, and improve disease surveillance and monitoring. African policies insufficiently considered associations between food security and noncommunicable disease. In order to effectively address the noncommunicable disease burden, a paradigm shift from 'health for development' to 'development for health' is required across non-health sectors. Noncommunicable disease considerations should be included within African food security agendas, using malnutrition as a possible intermediary concept to motivate intersectoral action to improve access to nutritious food in African low-income to middle-income countries.
Subject(s)
Noncommunicable Diseases , Diet , Health Policy , Health Promotion , Humans , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/prevention & control , Policy MakingABSTRACT
Physical inactivity is increasing in low- and middle-income countries (LMICs), where noncommunicable diseases (NCDs), urbanisation and sedentary living are rapidly growing in tandem. Increasing active living requires the participation of multiple sectors, yet it is unclear whether physical activity (PA)-relevant sectors in LMICs are prioritising PA. We investigated to what extent sectors that influence PA explicitly integrate it in their policies in an LMIC such as Cameroon. We systematically identified policy documents relevant to PA and NCD prevention in Cameroon; and using the Walt and Gilson policy triangle we described, analysed, and interpreted the policy contexts, contents, processes, and actors. We found 17 PA and NCD policy documents spanning from 1974 to 2019 across seven ministries. Thirteen (13/17) policies targeted infrastructure improvement, and four (4/17) targeted communication for behaviour change, all aiming to enhance leisure domain PA. Only the health sector explicitly acknowledged the role of PA in NCD prevention. Notably, no policy from the transport sector mentioned PA. Our findings highlight the need for intersectoral action to integrate PA into policies in all relevant sectors. These actions will need to encompass the breadth of PA domains, including transport, while emphasising the multiple health benefits of PA for the population.
Subject(s)
Noncommunicable Diseases , Cameroon , Exercise , Health Policy , Humans , Noncommunicable Diseases/prevention & control , Policy MakingABSTRACT
At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have been shown to have some effects in slowing down the progress of the pandemic, effectively buying time to prepare the healthcare system. However, there has been less of a focus on the indirect impacts of these measures on health behaviours and the consequent health risks, particularly in the most vulnerable. In this current debate piece, focusing on two of the four risk factors that contribute to >80% of the NCD burden, we consider the possible ways that the restrictions put in place to control the pandemic, have the potential to impact on dietary and physical activity behaviours and their determinants. By considering mitigation responses implemented by governments in several LMIC cities, we identify key lessons that highlight the potential of economic, political, food and built environment sectors, mobilised during the pandemic, to retain health as a priority beyond the context of pandemic response. Such whole-of society approaches are feasible and necessary to support equitable healthy eating and active living required to address other epidemics and to lower the baseline need for healthcare in the long term.
Subject(s)
Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Diet , Exercise , Pneumonia, Viral/epidemiology , Urban Population , Urbanization , Betacoronavirus , Built Environment , COVID-19 , Food Supply , Health Behavior , Humans , Pandemics , Risk Factors , SARS-CoV-2ABSTRACT
AIM: To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community. BACKGROUND: Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health workers, long distances to clinics and perceptions of contraceptive side effects may all inhibit contraceptive use by adolescents. Although SBCC has been initiated and investigated in other countries, this approach is inadequately researched in South Africa. METHODS: A mixed method study was conducted to assess the attitudes of one community towards establishment of an SBCC in their area. Methods of data collection included: focus group discussions (FGDs) with teenage girls from a local high school; a key informant interview with the school principal; a structured survey, including open-ended questionnaires with randomly selected parents of teenage girls from the same community; and a documentary analysis to explore relevant legal and policy considerations. FINDINGS: Teenage girls, the school principal and parents with teenage daughters largely supported the idea of an SBCC, but with concerns about confidentiality, the possibility of increased promiscuity and contraceptive side effects. While legal statutes and policies in South Africa do not pose any barriers to the establishment of an SBCC, some logistical barriers remain.
Subject(s)
Contraception , School Health Services , Schools , Adolescent , Feasibility Studies , Female , Focus Groups , Humans , Male , Poverty Areas , South Africa , Surveys and Questionnaires , Young AdultABSTRACT
The Oliver Tambo Fellowship Programme is convened by the School of Public Health and Family Medicine, University of Cape Town, South Africa. It is a health leadership training programme with a post-graduate Diploma at its core, supplemented by management seminars, mentorship and alumni networking. An external evaluation was conducted in 2015 for the period since 2008. This rapid, descriptive study made use of mixed methods-including a document review of existing Programme material (management reports, anonymized alumni's implementation project reports, exit interviews, field interviews and e-mailed questionnaires), a brief e-mailed questionnaire, and 18 semi-structured telephonic interviews conducted by the evaluator with Programme alumni, convenors and senior government line managers. Data were analysed according to indicators and associated criteria developed by the evaluator on the basis of the Programme's objectives, international experience, the nature of the South African health system and the particular philosophy of the Programme. The evaluation found that the Diploma offered a unique contribution. This is because it sought less to convey new technical knowledge, than to empower and galvanize students to become change agents in the complex settings of their workplaces. Reflective practice was an important part of this process. Alumni were able to point to a number of positive changes in their management practice and motivation, translating these into improved performance by their teams and more effective health services. Alumni also helped to build the capacity of their own and other staff, sharing the knowledge and skills they had gained through the Programme, and leading by example. However, the Programme found it difficult to arrange adequate mentorship or peer support for alumni once they returned to their workplaces, pointing to the need for human resource development units in government to become more active in supporting alumni and holding them accountable for improving practice.