Retention of medical officers in the district health services of the Western Cape, South Africa: An exploratory descriptive qualitative study

Mash, Robert; Viljoen, Werner; Swartz, Steve; Abbas, Mumtaz; Wagner, Leigh; Steyn, Herma; Hendricks, Gavin; Stapar, Dusica; Williams, Andrew; Adeniji, A. A.; Schoevers, Johan; Kapp, Paul

doi:10.4102/safp.v64i1.5467

Cited by 10 publications

(12 citation statements)

References 17 publications

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“…Following this survey, a descriptive exploratory qualitative study attempted to unpack what factors were influencing the rating of the facility. 20 This study suggested that teamwork, support, and supervision were critical. Being part of a cohesive and caring clinical team was important, as well as having access to support and supervision when needed from senior colleagues.…”

Section: Discussionmentioning

confidence: 88%

“…The survey pointed towards useful issues that could be explored further in the qualitative study that came afterwards. 20 …”

Section: Discussionmentioning

confidence: 99%

“…The present survey also pointed towards personal and family issues, and the qualitative study highlighted the importance of being with one’s partner, prioritising parenting and childcare, and being close to social support such as family and friends. 20 Management needed to be flexible and sensitive to contractual and overtime issues that might impact on parenting and childcare needs.…”

Section: Discussionmentioning

confidence: 99%

“…This was a descriptive observational cross-sectional survey by means of a questionnaire. The factors identified in this study will be further explored in a descriptive exploratory qualitative study, 20 not reported here.…”

Section: Methodsmentioning

confidence: 99%

“…In many ways the Western Cape appears to be doing well in creating a solid foundation to retain MOs. It is clear however that the overall rating of the facility is still a key factor that can be influenced by the health services and a number of issues may be important: 23  Being part of a cohesive, supportive and caring clinical team  Having support and supervision, including from a family physician.  Shifting to a more approachable, collaborative and supportive management style  Ensuring a learning environment that enables ongoing development  Keeping the workload manageable  Flexibility in terms of overtime and contracts to allow parenting and childcare These issues are likely to apply across the South African context and be important for both district and facility management teams.…”

Section: Implications For Practicementioning

confidence: 99%

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Retention of medical officers in district health services, South Africa: a descriptive survey

et al. 2022

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BackgroundThe health workforce is critical to strengthening district health services (DHS). In the public sector of South Africa medical officers (MO) are essential. Family physicians, responsible for clinical governance, identified their retention as a key issue.AimTo evaluate factors that influence retention of MOs in public sector DHS.Design & settingA descriptive survey of MOs working in DHS, Western Cape, South Africa.MethodAll 125 MOs working in facilities associated with the Stellenbosch University Family Physician Research Network were included in the survey. A questionnaire measured the prevalence of key factors that might be associated with retention (staying >4 years) and included the Satisfaction of Employees in Health Care tool and Short Warwick-Edinburgh Mental Well-being Scale. Data was collected in REDCap and analysed in the Statistical Package for Social Sciences.ResultsNinety-five MOs completed the survey. The overall rating of the facility (P=0.001), age (P=0.004), seniority (P=0.015), career plans (<0.001) and intention to stay in the public sector (P<0.001) were associated with retention. More personal factors such as social support (P=0.007), educational opportunities for children (P=0.002) and staying with one’s partner (P=0.036) were also associated. Gender, rural vs urban location, district hospital vs primary care facility, overtime, remuneration and additional rural allowance, were not associated.ConclusionsThe overall rating of the facility was important and subsequent qualitative work has explored the underlying issues. These findings can guide strategies in the Western Cape and similar settings to retain MOs in the DHS.

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Section: Discussionmentioning

confidence: 88%

“…The survey pointed towards useful issues that could be explored further in the qualitative study that came afterwards. 20 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Implications For Practicementioning

confidence: 99%

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Retention of medical officers in district health services, South Africa: a descriptive survey

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Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review

Firima

Gonzalez

Ursprung

et al. 2022

Preprint

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Introduction The prevalence of type 2 diabetes mellitus (T2DM) and associated morbidity and mortality are increasing in sub-Saharan Africa (SSA). To facilitate access to quality care and improve treatment outcomes, there is a need for innovative community care models and optimized use of non-physician healthcare workers bringing diagnosis and care closer to patients’ homes. Aim We aimed to describe with a scoping review different models of community-based care for non-pregnant adults with T2DM in SSA, and to synthesize the model outcomes in terms of engagement in care, blood sugar control, acceptability, and end-organ damage. We further aimed to critically appraise the different models of care and compare community-based to facility-based care if data were available. Methods We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We included cohort studies, randomized trials and case-control studies that reported on non-pregnant individuals diagnosed with T2DM in SSA, who received a substantial part of care in the community. Only studies which reported at least one of our outcomes of interest were included. A narrative analysis was conducted, and comparisons made between community-based and facility-based models, where within-study comparison was reported. Results 5,335 unique studies were retrieved, four of which met our inclusion criteria. Most studies were excluded because interventions were facility-based; community care interventions described in the studies were add-on features of a primarily facility-based care; and studies did not report outcomes of interest. The included studies reported on a total of 383 individuals with T2DM. Three different community care models were identified. 1) A community-initiated model where diagnosis, treatment and monitoring occurred primarily in the community. This model reported a higher linkage and engagement in care at 9 months compared to the corresponding facility model, but only slight reductions of average blood glucose levels at six months compared to baseline. 2) A facility-originated community model where after treatment initiation, a substantial part of follow-up was offered at community level. Two studies reported such a model of care, both had as core component home-delivery of medication. Acceptability of this approach was high. But neither study found improved T2DM control when compared to facility care 3) An eHealth model with high acceptability scores for both patients and care providers, and an absolute 1.76% reduction in average HbA1c levels at two months compared to baseline. There were no reported outcomes on end-organ damage. All four studies were rated as being at high risk for bias. Conclusion Evidence on models of care for persons with T2DM in SSA where a substantial part of care is shifted to the community is scant. Whereas available literature indicates high acceptability of community-based care, we found no conclusive data on their effectiveness in controlling blood sugar and preventing complications. Evidence from larger scale studies, ideally randomized trials with clinically relevant endpoints is needed before roll-out of community-based T2DM care can be recommended in SSA.

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Burden, Causation, and Particularities of long-COVID in African populations: A rapid systematic review

Nyasulu

Tamuzi

Erasmus

2023

Preprint

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Background: The global estimated prevalence of long COVID-19 is 43%, and the most common symptoms found globally are fatigue, confusion, or lack of confusion, and dyspnea, with prevalence rates of 23%, 14%, and 13%, respectively. However, long COVID still lacks an overall review in African populations. The aim of this review was to determine the prevalence of long COVID, its most common symptoms, comorbidities, and pathophysiological mechanisms. Methods: A systematic review of long COVID in African populations was conducted. The random effects model was used to calculate the pooled prevalence rates (95% CI). If the results could not be pooled, a narrative synthesis was performed. Results: We included 14 studies from 7 African countries, totaling 6,030 previously SARS-CoV-2 infected participants and 2,954 long COVID patients. Long COVID had a pooled prevalence of 41% [26%-56%]. Fatigue, dyspnea, and confusion or lack of concentration were the most common symptoms, with prevalence rates (95% CI) of 41% [26%-56%], 25% [12%-38%], and 40% [12%-68%], respectively. Long COVID was associated with advanced age, being female, more than three long COVID symptoms in the acute phase, initial fatigue and dyspnea, post-recovery stress, sadness, and sleep disturbances, and loss of appetite at symptoms onset, mild, moderate, and severe, pre-existing obesity, hypertension, diabetes mellitus, and the presence of any chronic illness (P ≤0.05). According to our review, high micro clot and platelet poor plasma (PPP) viscosity explain the pathophysiology of long COVID. Conclusion: Long COVID prevalence in Africa was comparable to the global prevalence. However, the prevalence of the most common symptoms was higher in Africa. Comorbidities associated with long COVID may lead to additional complications in African populations due to hypercoagulation and thrombosis.

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Retention of medical officers in the district health services of the Western Cape, South Africa: An exploratory descriptive qualitative study

Cited by 10 publications

References 17 publications

Retention of medical officers in district health services, South Africa: a descriptive survey

Retention of medical officers in district health services, South Africa: a descriptive survey

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review

Burden, Causation, and Particularities of long-COVID in African populations: A rapid systematic review

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