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In South Africa there is an abundance of research studies available for policy development but few of the results have contributed to policy development, despite a seemingly-receptive new political environment. This highlights the need for a health research framework at local level, in order to guide the link between research and policies or programmes. Although a number of studies have been undertaken, the eThekwini Municipality does not seem to have a framework to facilitate a link between research studies, the policy - development process and implementation (service delivery). This results in policies or health programmes that are not informed by research, and as such, are often a waste of the resources of the above municipality. There is no evidence to indicate that research results have influenced the health policy, implementation or intervention process. The absence of an explicit health research agenda at eThekwini Municipality has meant that health research has not addressed health priorities or needs, nor have the available resources been channelled towards them. The study comes at an ideal time as the municipality is currently reviewing its approach to service delivery as well as finalising the planning process through integrated development planning (IDP), a legislative requirement in terms of the Municipal Systems Act. This study will help to create awareness in stakeholders regarding the lack of a link between research and policy processes. The arguments made in the study are that at the local sphere of government (the unit of analysis being eThekwini Municipality) there is no Health Research Policy Framework. This lack of a framework leads to ad hoc health research and the research results not being used. In addition, the health policies and programmes are not being informed by local research. The main argument is that there is an urgent need for the local sphere of government within the health sector to now develop and adopt a Health Research Policy Framework for linking research policy and implementation. The purpose of the study is to develop a Research Policy Framework for linking research, policy and implementation for the eThekwini Municipality. The objectives of the study are to analyse the existing health research policy framework, identify stakeholders in the health research policy processes, determine their role in the health research policy process, determine the conditions necessary for facilitating the linking of research to policy and to propose a research policy framework for the eThekwini Municipality. In order to attain the above-mentioned objectives of the study, a literature review, document review, a consultative workshop and semi-structured interviews were undertaken. After the data analysis was completed the following conclusions were drawn: there is a need for a health research policy framework, the knowledge base of some stakeholders is lacking, there is a lack of participation by key stakeholders in the health research policy processes, there is a lack of communication among key stakeholders and there is also a lack of use of health research results. A proposed health research policy framework is provided as part of the recommendations, as well as the processes to be followed in implementing the proposed framework. / Thesis (PhD.)-University of KwaZulu-Natal, Westville, 2006.

Despite legal and technological advances, women still face barriers to abortion care in legally restricted or low-resource settings. The advent of medication abortion using misoprostol with or without mifepristone, has enabled women to self-manage their abortions outside of the formal healthcare system. Self-managed abortions are often assisted by telemedicine services, which provide women with evidence-based guidance on managing the abortion process on their own. This thesis explores two separate abortion telemedicine services operating in legally restricted and/or low resource settings – a global online telemedicine service and an abortion support hotline in Venezuela – and evaluates the outcomes associated with each. By interviewing counsellors at a Venezuelan abortion support hotline and the women who used the service, we gained a stronger understanding of the hotline’s successes, barriers, and areas for improvement. We conclude that abortion telemedicine services provide effective and acceptable care, in general, and we recommend greater access to misoprostol in Venezuela.

Yes / Background Recently, primary care in the United Kingdom has undergone substantial changes in skill mix. Non-medical prescribing was introduced to improve patient access to medicines, make better use of different health practitioners’ skills and increase patient choice. There is little evidence about value-based patient preferences for ‘prescribing nurse’ in a general practice setting. Objective To quantify value-based patient preferences for the profession of prescriber and other factors that influence choice of consultation for managing a minor illness. Design Discrete choice experiment patient survey. Setting and participants Five general practices in England with non-medical prescribing services, questionnaires completed by 451 patients. Main outcome measure Stated choice of consultation. Main results There was a strong general preference for consulting ‘own doctor’ for minor illness. However, a consultation with a nurse prescriber with positive patient-focused attributes can be more acceptable to patients than a consultation provided by a doctor. Attributes ‘professional’s attention to patients’ views’ and extent of ‘help offered’ were pivotal. Past experience influenced preference. Discussion and conclusion Respondents demonstrated valid preferences. Preferences for consulting a doctor remained strong, but many were happy to consult with a nurse if other aspects of the consultation were improved. Findings show who to consult is not the only valued factor in choice of consultation for minor illness. The ‘prescribing nurse’ role has potential to offer consultation styles that patients value. Within the study’s limitations, these findings can inform delivery of primary care to enhance patient experience and substitute appropriate nurse prescribing consultations for medical prescribing consultations. / Department of Health, Project 016/0108. NIHR, CDF/01/2008/009.

BACKGROUND: Quality improvement (QI) efforts in which providers from various health facilities, with support from coaches, work together to implement innovations for improving health care are rapidly spreading from high-income settings to resource-poor settings. However, limited research exists regarding the factors which drive teams to succeed or fail, spread, and sustain best practices. The purpose of this study was to understand the factors facilitating or inhibiting the performance of QI teams of maternal and child health (MCH) service delivery in resource-poor settings. METHODS: A qualitative multi-site case study was conducted in northern Ghana to determine the views and beliefs of QI teams, coaches, and beneficiaries of Project Fives Alive (PFA) about the application of QI to MCH service delivery. Using key informant interviews, document review, and group interviews, the study elicited information about: 1) the factors that affect QI team success and failure when implementing QI methods designed to improve MCH service delivery; 2) the interplay of factors that facilitate or inhibit the spread of best practices among QI teams in northern Ghana; and 3) steps being taken by stakeholders to sustain these best practices. Grounded theory processes were used to identify themes from the data. RESULTS: Testing of changes using Plan-Do-Study-Act (PDSA) cycles and adoption of a client-centered model to the delivery of services has helped teams to identify the felt needs of clients, resulting in perceived increased uptake of MCH services. Key contributory factors to successes were: availability and accessibility of midwives, training of QI teams, incentive packages for providers and clients, community support groups, and PFA partners. Key challenges inhibiting success were: staff turnover, inadequate supervision, cultural practices, and inadequate infrastructure. Some of the key factors that shaped successes have dissipated, threatening sustainability of QI efforts two years after PFA ended. CONCLUSION: The presence of a midwife, providing leadership for organizing team members and implementing PDSA cycles, can facilitate success. Project staff support is important, but teams and coaches need space and time to drive the QI process independently and practice QI methods in ways that foster continuity beyond donor support.

The purpose of this study was to investigate the health service delivery by private health sector and develop guidelines to enhance provision of health service so as to increase their contribution in the country’s health system. Interviews with 1112 participants were conducted in phase I. Descriptive statistics, chi square tests and logistic regression analysis were used for analysis. Private health facilities (30.5%) were providing healthcare services in their own buildings that were constructed for that purpose while others work in a rented houses built for residence or others. Some facilities (11.7%) received loan services from financial institutions in the region. A significant association was found between obtaining loan and owning building for healthcare services delivery (x2=13.99, p<0.001). Private health facilities were mainly engaged in profit driven and curative services while their participation in the promotive and preventive services like FP, ANC HIV test, TB and malaria prevention and control was not minimal. Majority, 247 (96.5%) provide services for extended hours out of normal working time such as evening, weekends and holidays. Physicians, more than other professionals were found practicing part time work (dual practice). Service consumers of the private health sector were urban dwellers 417 (71.6%) and 165 (28.4%) rural residents. Nearly three-fourth (73.0%) of study participants had a history of multiple visits to both public and private health facilities for current medical condition. Median payment of patients in a single visit including diagnosis and medicine was 860 birr ($30.85) (IQR = 993 ($35.62). Only 2.1% have paid through insurance services while others through out of pocket payments. Price of services delivered in private health facilities were set mainly by owners’ will (91.4%) while others with established team. Satisfaction on the fairness of prices to services obtained from each facility were reported by 63.1% service consumers. Those patients without any companion (AOR=1.83, 95% CI=1.16-2.91) and no history of visit to other facilities (AOR=1.97, 95% CI=1.24-3.12) were more likely to be satisfied than those coming with companions and those with history of visit. In addition, as age of consumers increase, satisfaction to services prices tend to decline (AOR=0.97, 95% CI=0.96-0.99). Uncomplimentary regulatory system to private health facilities, lack of training and continuing education for health professionals, unavailability of enough health workforce in the market and shortage of supplies to private facilities were among main gaps disclosed. Based on findings, five guidelines were developed to enhance health services delivery in the private health sector, namely, increase facilitation for financial access to actors in the sector, increase facilitation to access regular updating trainings and continuing education for healthcare workers, enhance and scale up the capability of existing association in the private health sector, strengthen and support working for extended hours to promote user friendly services and accessibility of healthcare services for the poor through community based health insurance and exemption. Therefore, these recommendations to help enhance the private health sector for better performance and contribution. / Health Studies / D.Lit.Phil (Health Studies

This thesis examines the law relating health care in South Africa rather than medical law which is a subset of this field. It attempts to synthesise five major traditional areas of law, namely international, constitutional, and administrative law, the law of contract and the law of delict, into a legal conceptual framework relating specifically to health care in South Africa. Systemic inconsistencies with regard to the central issue of health care across these five traditional fields are highlighted. The alignment of the various pre-existing areas of statutory and common law with the Constitution is an ongoing preoccupation of the executive, the judiciary, the legislature and academia. In the health care context, the thesis critically examines the extent to which such alignment has taken place and identifies areas in which further development is still necessary. It concludes that the correct approach to the constitutional right of access to health care services is to regard it as a unitary concept supported by each of the five traditional areas of law. The traditional division of law into categories of public and private and their further subdivision into, for instance, the law of delict and the law of contract is criticized. It promotes a fragmented approach to a central constitutional construct resulting in legal incongruencies. This is anathema to a constitutionally based legal system. There is no golden thread of commonality discernible within the various public international law instruments that contain references to rights relating to health and it is of limited practical use in South African health law. The rights in the Bill of Rights are interdependent and interconnected. The approach of the courts to the right of access to health care needs to be considerably broader than it is at present in order to fully embrace the idea of rights as a composite concept. Administrative law, especially in the public health sector, offers an alternative basis to pure contract for the provider-patient relationship. It is preferable to a contractual relationship because of the many inbuilt protections and legal requirements for administrative action. Contracts can be unfair but courts refuse to strike them down purely on this basis. Administrative action is much more likely to be struck down on grounds of unfairness: The law of contract as a legal vehicle for health service delivery is not ideal. This is due to the antiquated approach of South African courts to this area of law. There is still an almost complete failure to incorporate constitutional principles and values into the law of contract. The law of delict in relation to health care services has its blind spots. Although it seeks to place the claimant in the position in which he or she found himself prior to the unlawful act whereas the law of contract seeks to place him in the position he would have occupied had the contract been fulfilled, in the context of health care this is a notional distinction since contracts for health services seldom guarantee a specific outcome. / Thesis (LLD)--University of Pretoria, 2004. / Public Law / unrestricted

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The basis of my study is the belief that governance of the local delivery of health could usefully include full and wide community representation and participation by the stakeholders and the larger community. The study was initially carried out in 2003 and now the same clinic has been targeted to carry out an update to see whether the perceptions have changed; if so why and if not what the status is. This study investigates the proposition that if communities do not participate in policy formulation processes, implementation is crippled. The case study is of free health-care policy in a small area of Pietermaritzburg, the Mpumuza area. This area is chosen because it has a local clinic that is being used by the local people to get free primary health care services, covered by the national policy. My interest in the study is influenced by the role I played as a public servant within the district Department of Health one and a half years ago. I dealt, on a daily basis, with service delivery (with a focus on facilitation of the process of service delivery). My interest is to know how the processes of policy development unfold in practice. The study will be examining what the different writers allude to in relation to policy formulation and implementation, the legislative framework pertaining to health policy, the actual case study and finally the conclusions drawn and recommendations, which are open for further exploration in other studies. The study looks at the impact of lack of involvement of the community members (who are at the receiving end) and the role of service providers (who for the purposes of this study will be confined to the nurses that offer the health services at the specific local clinic). Basically the study found that the subject of involving communities in policy formulation is a crucial one if the policy is to be successfully implemented and these are detailed later in the document. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.