The National Health Insurance, the decentralised clinical training platform, and specialist outreach

The dynamic transitions in healthcare systems globally necessitate the training of healthcare professionals who are responsive to the needs of the community that they serve to ensure quality and relevance of care. [1] Undergraduate clinical education is therefore critical for the development of socially competent graduates who are equipped with technical skills and insight to function purposefully within these changing social and health contexts. [2] Students' clinical competence, proficiency and aptitude are core to their clinical education and training, which should be rooted in a competency-based undergraduate programme. [3-5] In South Africa (SA), the gaping disparity in health provision between the over-accessed public health facilities and well-resourced private healthcare settings prompted government to introduce the National Health Insurance (NHI), with the incorporation of the primary healthcare (PHC) approach. [6,7] NHI is a government funding model that ensures disenfranchised communities access to quality healthcare. Through NHI, PHC has proposed re-engineering focused on prevention of diseases, promotion of health and ensuring availability of rehabilitative services at community level. PHC is a strategy to ensure that healthcare services are available in resource-scarce communities, but the uptake in healthcare systems nationally remains poor. [8] Innovative approaches of actualising the implementation of the ideal PHC model are necessary to influence the disparity in public v. private healthcare in SA. [8] Perpetuating the vision for NHI, the University of KwaZulu-Natal (UKZN) College of Health Sciences (CHS), in collaboration with the KwaZulu-Natal (KZN) Department of Health (DoH), embarked on the roll-out of community-based training within a PHC (CBTPHC) approach. [9] UKZN adopted this approach to equip health science students with the necessary skills to serve communities in dire need of healthcare. For the purpose of this article, we refer to this method of training as decentralised clinical training (DCT). This study focused on the discipline of physiotherapy within the CHS at UKZN, which offers a 4-year undergraduate degree programme with a professional qualification (Bachelor degree). There is a greater theoretical bias in years 1 and 2, with a deliberate shift to clinical training and competency development in years 3 and 4 of study. Intake varies between 50 students in year 1 and up to 55 students in the final year, depending on the throughput of students during the programme. For 2017, final-year students were introduced to the DCT framework in which they were placed at urban, rural and peri-urban sites in KZN Province, where they were predominantly under the care and supervision of physiotherapy clinicians at the respective settings. The facilities provided them with clinical exposure to neurological, cardiopulmonary and neuromusculoskeletal conditions and communitybased rehabilitation. Each physiotherapy student spent 5 weeks at 4 of the clinical sites, 2 of 6 newly introduced settings t...

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“…Moreover, there is the notion that students who train at rural sites are more likely to accept employment at such sites. [9,27]…”

Section: Researchmentioning

confidence: 99%

Physiotherapists’ perception of a community-based primary healthcare clinical education approach to undergraduate learning

Blose

Chemane

Chetty

et al. 2019

AJHPE

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“…Therefore, health sciences training in South Africa is seeing a shift towards a more primary health care-centred approach in line with global calls for universal health coverage and equity of access. 12 Such models, known elsewhere as distributed training, have been adopted by other institutions in South Africa and across health science professions, including medicine, physiotherapy, occupational therapy and speech language pathology among others. 13,14 Optometry training in KZN has historically been engaged in community-based service learning activities.…”

Section: Introductionmentioning

confidence: 99%

Public sector optometrists’ perspectives on a decentralised model of clinical training for optometry in KwaZulu-Natal, South Africa

Ebrahim

Karim

Gasa

et al. 2019

African Vision and Eye Health

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This study involves optometrists employed within public health facilities in KwaZulu-Natal. Methods:The research followed a qualitative design. Sampling was purposive, with the sample population including all public sector-employed optometrists within the KwaZulu-Natal Department of Health. Questionnaires were used to collect data, which were thematically analysed to gain insight into participants' perspectives relating to the decentralised clinical training (DCT) in optometry.Results: In KwaZulu-Natal, DCT in optometry as a revised clinical training strategy is generally supported by public sector optometrists. It presents opportunities for expanded access to eye care for public sector patients and a mutual learning opportunity between students and practitioners. However, resources required for comprehensive optometric assessments are significantly lacking within the public health sector. Training for public sector optometrists who would be expected to serve as clinical educators was also an identified need. Conclusion:While there are various challenges facing optometry practice within the public health sector in KwaZulu-Natal, decentralised clinical training holds promise for the improved eye care service capacity in KwaZulu-Natal.

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“…For example, in a capacity-building approach 23 , GC specialists from the quaternary hospital can provide yearly training courses at lower level facitilites in severely impacted regions on how to manage complex GC cases at these facilities. Another approach is for a GC specialist from the quaternary hospital to visit these lower level facilities on a monthly basis and directly assist with the management of complex GC cases 24 . Nurse-led outpatient clinics have also shown to be succesful in addressing aspects of GC in overseas settings 25,26 , and this is another approach which should be considered in SA settings.…”

Section: Discussionmentioning

confidence: 99%

Out-patient visits for gastrointestinal cancer at a quaternary South African hospital–trends and geospatial distribution

Moodley

Madiba

2020

Afr H. Sci.

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Background: This study sought to determine trends in out-patient visits for gastrointestinal cancer (GC) at a quaternary hospi- tal in KwaZulu-Natal (KZN), South Africa; and identify geographical regions which contribute most to GC-related out-patient clinic utilization at this hospital. Method: Data for GC-related outpatient visits over an 11-year period was obtained from the hospital’s administrative database. Trends were analyzed using simple regression and trend line analyses. Patient residential postal codes from the administrative database were used to determine the geospatial distribution of complex GC in KZN. Results: Strong increasing trends in GC-related out-patient visits were noted for age >65 years old (R2=0.8014), male (R2=0.7020), female (R2=0.7292), lower GC (R2=0.7094), and rural residence (R2=0.7008). Moderate increasing trends in GC-related out-pa- tient visits were noted for age ≤65 years old (R2=0.6556), upper GC (R2=0.6498), and urban residence (R2=0.6988). The mag- nitude at which the number of out-patient visits increased was greater for urban residence when compared with rural residence (p=0.006). Urban centers and some regions along the North and South coast of KZN contributed the most toward GC-related out-patient visits. Conclusion: Out-patient visits for complex GC in KZN are increasing. Several regions have been identified for anti-cancer interventions and decentralized out-patient services. Keywords: Gastrointestinal cancer; out-patient visits; quaternary hospital; South Africa.

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The National Health Insurance, the decentralised clinical training platform, and specialist outreach

Cited by 10 publications

References 7 publications

Physiotherapists’ perception of a community-based primary healthcare clinical education approach to undergraduate learning

Physiotherapists’ perception of a community-based primary healthcare clinical education approach to undergraduate learning

Public sector optometrists’ perspectives on a decentralised model of clinical training for optometry in KwaZulu-Natal, South Africa

Out-patient visits for gastrointestinal cancer at a quaternary South African hospital–trends and geospatial distribution

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