Background: Since 1849, Catholic religious have provided health services in
South Africa. They have established hospitals, clinics, and have provided
community-based preventive and curative services throughout the country.
Today faith-based organizations (FBOs) continue to play an important role in
healthcare delivery and are crucial to the goal of providing universal access to
antiretroviral therapy (ART). In order to scale up HIV care and treatment, there
is a need to describe and analyze ART models of care (MOC) that address the
challenges faced by developing countries. The South African Catholic Bishopsâ
Conference (SACBC) manages twenty ART clinics in medically underserved South
African communities, where the need is great, but the resources limited. These
SACBC managed ART clinics operate on different MOC. A study to describe,
analyze and compare the different MOC can inform future directions in
healthcare delivery in resource-constrained settings.
Method: A single case-study design was used to describe, analyze and compare
four different MOC (managed by the SACBC) for ART delivery, as embedded units of
analysis. A mixed method approach was used, incorporating qualitative and
quantitative information. Data were collected using structured interviews
(n=1,006 adult ART patients), file audits (n=1,006 files of the respondents), semistructured
interviews (n=27 healthcare workers) and nominal groups (n=12 groups with Home Based Care-workers). Descriptive and inferential data analyses were
conducted by a biostatistician from the Department of Biostatistics at the
University of the Free State and the researcher.
Findings: In the study, patients accessed care late (CD4=119 cells/mm3).
Decentralized care provided better access. Family members are a potential
source of support because disclosure rates to relatives and others were high
(95.63%). Nurse-driven, doctor supported care was not inferior to doctor-driven
care. Task-shifting to registered nurses and HBC-workers can be implemented
successfully with support. Differences exist between the South African
Government (SAG) -managed model and the FBOâmanaged models. Partnership
between the SAG and FBO strengthened the SAG-managed MOC, while
capitalizing on the sustainability of the government services. Functional
information systems, developed by the FBO, were implemented at all the MOC
in 2009. All the MOC focused on acute care.
Conclusions: Nurse-driven decentralized service can most effectively and
appropriately address the chronic nature of HIV and strengthen the healthcare
system by a paradigm shift to a chronic care model. Based on the findings, a
chronic care model was adapted for South Africa that has seven elements: (1)
an integrated, decentralized chronic care system based within a primary health
setting; (2) partnerships with NGOs; (3) an effective information management
system; (4) patients and their families; (5) self-management support to
patients; (6) provider decision support and (7) delivery system redesign.
Implications for the nursing profession include adaptation of focus and training,
as well as the recognition of the nurse practitioners/specialist role in South
Africa.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ufs/oai:etd.uovs.ac.za:etd-08232012-144606 |
| Date | 23 August 2012 |
| Creators | Wilke, Marisa |
| Contributors | Dr R Stark, Prof HCJ van Rensburg, Prof Y Botma |
| Publisher | University of the Free State |
| Source Sets | South African National ETD Portal |
| Language | en-uk |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.uovs.ac.za//theses/available/etd-08232012-144606/restricted/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University Free State or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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