BackgroundBiobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented.MethodsIn-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors.ResultsResearchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements (MTAs) were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust.ConclusionBuilding trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa.Electronic supplementary materialThe online version ...

Background The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite South Africa’s progress and attempts at implementing primary health care, various factors still limit its success. Discussion Inconsistencies and poor understanding of primary care and primary health care raises unrealistic expectations in service delivery and health outcomes, and blame is apportioned when expectations are not met. It is important for all health practitioners to consider the contextual influences on health and ill-health and to recognise the role of the underlying determinants of ill-health, namely, social, economic and environmental influences. The primary health care approach provides a strong framework for this delivery but it is not widely applied. There is a need for renewed political and policy commitments toward quality primary health care delivery, re-orientation of health care workers, integration of primary health care activities into other community-based development, improved management skills and effective coordination at all levels of the health system. There should also be optimal capacity building, and skills development in problem-solving, communication, networking and community participation. Summary A well-functioning district health system is required for the re-engineering of primary health care. This strategy requires a strong leadership, a strengthening of the current district heath system and a greater emphasis on health promotion, prevention, and community participation and empowerment.

Accessing research participants within some social institutions for research purposes may involve a simple single administrative event. However, accessing some institutions to conduct research on their data, personnel, clients or service users can be quite complex. Research ethics committee chairpersons frequently field questions from researchers wanting to know when and why gatekeeper permission should be sought. This article examines the role and influence of gatekeepers in formal and organisational settings and explores pragmatic methods to improve understanding and facilitation of this process. Conscientious and well-informed negotiations with gatekeepers are required in order to honour the ethical obligations to conduct appropriate stakeholder engagement before and during research, along with respect for the autonomy of institutions and their employees/clients/service recipients. Provision must be made to identify explicit and implicit gatekeepers to initiate and build collaborative networks that could best support the research process. Careful mutually respectful access agreements which consider the needs and vulnerabilities of both the gatekeeper and the researcher can improve the quality of the scientific data collected. Strategic planning in the research process must take these sometimes complex processes of gatekeeper permission into careful account.

This article reports an analysis of oral health promotion in South African health policy. The central aim of this research was to determine the form and coherence of oral health promotion elements within health policies of post-apartheid South Africa. The study set out to test the hypothesis that oral health promotion elements are fully integrated into health policy and programmatic efforts. A conceptual framework was developed to systematically analyse oral health promotion policy and subsequent decision-making across the country at national and provincial levels. The information was drawn from policy documents, protocols and programme plans, complemented by interviews. The results indicate distinct contradictions between the policy formulation process and its impact on health system decision-making. South African health policy was found to be strong on the rhetoric of equity, health promotion, integration and several other features of the Primary Health Care Approach, but showed little evidence of translating this into action. The development and implementation of oral health promotion appears to be dominated by the influence of dental professionals that perpetuate a curative focus on service delivery. There is an urgent need to re-examine the process and content of oral health policy-making in South Africa. The conceptual framework developed for this study could facilitate further research in this area.

BackgroundEchoing the sentiments of the Sixty-seventh World Health Assembly of May 2014, mandating the all-inclusive and synchronized efforts for the management of autism spectrum disorder (ASD), the aim of this current study was to investigate the oral health status of children with ASD aged between 7 to 14 years in KwaZulu-Natal, South Africa.MethodsAn investigative cross-sectional quantitative design employing non-probability purposeful sampling was conducted on 149 children with ASD attending special needs schools in KwaZulu-Natal. An intra-oral examination to investigate decayed, missing and filled teeth (DMFT/dmft), gingival index (GI), and plaque index (PI), attrition and soft tissue trauma using the World Oral Health Survey Form for Children, (2013) was implemented during data collection.ResultsAverage DMFT/dmft scores of 3, 42 and 0, 97 were recorded respectively. Molars dominated the decayed component of the DMFT/dmft with an average caries prevalence of (51, 7% and 40, 8%) respectively. These results displayed zero fillings indicative of unmet treatment needs. The gingival index revealed mild gingival inflammation, (46, 3%) and the plaque index demonstrated visible plaque at (43, 6%).Attrition scores revealed mild loss of dental enamel (47%). The most prevalent soft tissue trauma recorded was lip biting (37, 25%).ConclusionRestorative or preventative treatment measures were not evident in this study. Unmet dental needs are therefore an important concern in this population. Health care planners should develop preventive programs targeted at high risk groups such as this study population.