Dr. Vera Scott (School of Public Health)
http://hdl.handle.net/10566/2245
2024-03-29T13:01:59ZExploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decisionmaking: experience from Cape Town, South Africa
http://hdl.handle.net/10566/3201
Exploring how different modes of governance act across health system levels to influence primary healthcare facility managers' use of information in decisionmaking: experience from Cape Town, South Africa
Scott, Vera; Gilson, Lucy
BACKGROUND: Governance, which includes decision-making at all levels of the health system, and information have
been identified as key, interacting levers of health system strengthening. However there is an extensive literature
detailing the challenges of supporting health managers to use formal information from health information systems
(HISs) in their decision-making. While health information needs differ across levels of the health system there has
been surprisingly little empirical work considering what information is actually used by primary healthcare facility
managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines
experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers’ use of
information for decision-making influenced by governance across levels of the health system? The research is novel
in that it both explores what information these facility managers actually use in decision-making, and considers
how wider governance processes influence this information use.
METHODS: An academic researcher and four facility managers worked as co-researchers in a multi-case study in which
three areas of management were served as the cases. There were iterative cycles of data collection and collaborative
analysis with individual and peer reflective learning over a period of three years.
RESULTS: Central governance shaped what information and knowledge was valued – and, therefore, generated
and used at lower system levels. The central level valued formal health information generated in the district-based HIS
which therefore attracted management attention across the levels of the health system in terms of design, funding
and implementation. This information was useful in the top-down practices of planning and management of the
public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local,
disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to
perform the people management tasks required. Despite central level influences, modes of governance operating at
the subdistrict level had influence over what information was valued, generated and used locally.
CONCLUSIONS: Strengthening local level managers’ ability to create enabling environments is an important leverage
point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including
equity goals, into appropriate service delivery practices.
2017-01-01T00:00:00ZCritiquing the response to the Ebola epidemic through a primary health care approach
http://hdl.handle.net/10566/2243
Critiquing the response to the Ebola epidemic through a primary health care approach
Scott, Vera; Sarah, Crawford-Browne; David, Sanders
BACKGROUND: The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection. First, it must consider the part it played in relation to an important public health question: why did this epidemic take hold and spread in this unprecedented manner? Second, it must use the lessons learnt to answer the subsequent question: what can be done now to prevent further such
outbreaks in the future? These questions remain relevant, even as scientists announce that the Guinea Phase III efficacy vaccine trial shows that rVSV-EBOV (Merck, Sharp & Dohme) is highly efficacious in individuals. This is a major breakthrough in the fight against Ebola virus disease (EVD). It does not replace but may be a powerful adjunct to current strategies of EVD management and control.
DISCUSSION: We contribute to the current self-reflection by presenting an analysis using a Primary Health Care (PHC) approach. This approach is appropriate as African countries in the region affected by EVD have recommitted themselves to PHC as a framework for organising health systems and the delivery of health services. The approach suggests that, in an epidemic made complex by weak pre-existing health systems, lack of trust in authorities and mobile populations, a broader approach is required to engage affected communities. In the medium-term health system development with attention to primary level services and community-based programmes to address the major disease burden of malaria, diarrhoeal disease, meningitis, tuberculosis and malnutrition is needed. This requires the development of local management and an investment in human resources for health. Crucially this has to be developed ahead of, and not in parallel with, future outbreaks. In the longer-term a commitment is required to address the underlying social determinants which make these countries so vulnerable, and limit their capacity to respond effectively to, epidemics such as EVD. CONCLUSION: The PHC approach offers an insightful critique of the global and regional factors which have compromised the response of health systems in Guinea, Liberia and Sierra Leone as well as suggesting what a strengthened EVD response might involve in the short, medium and long-term.
2016-01-01T00:00:00ZEvaluation of how integrated HIV and TB programs are implemented in South Africa and the implications for rural-urban equity
http://hdl.handle.net/10566/1111
Evaluation of how integrated HIV and TB programs are implemented in South Africa and the implications for rural-urban equity
Scott, Vera; Sanders, David
Introduction: In countries such as South Africa with a high prevalence of HIV and TB policy directives support program integration. Operational research suggests this is desirable, at least for increasing coverage of HIV and TB services, but warns that implementation models must take local health service infrastructure into account.
Methods: A program evaluation of HIV and TB prevention and therapeutic services was performed at facility level in two purposefully selected districts in South Africa – one deep rural and an urban district – in order to describe integration and how it is implemented. Twenty-six rural and 146 urban public primary-care facilities were evaluated using secondary data generated from two large evaluations of HIV/TB/Sexually Transmitted Infections (STI) programs conducted in December 2008 and May 2009. The data collection tools consisted of a review of data in the routine health information system, a facility manager interview, a checklist for equipment and supplies, register reviews and a series of patient folder (health record) reviews. Data were collected on extent to which clients receive integrated services, as well as the quality of care, and the availability of key resources and system capacity to support quality care. Data were entered into MS Excel spreadsheets and proportions calculated for all indicators, and confidence intervals for proportions. Results: Evidence of integration was found across two dimensions - disease programs and the prevention–therapeutic axis. Integration was enabled in both the rural and urban districts because HIV and TB services were co-located in the extensive network of general primary-care services. Smaller rural facilities did not always have staff trained in all the required services, nurses worked without the support of a doctor and supervision was weaker, threatening quality of care. In the rural district there were instances of clients receiving more integrated services. The quality of care in the TB program was high in both districts. Conclusions: In both the districts evaluated, integration across programs and the prevention-care-rehabilitation axis of services was achieved through co-location at primary-care level. Coupled with health system strengthening, this has the potential to improve access across the HIV/TB/STI cluster of services. The benefit is likely to be greater in rural areas. Quality of care was maintained in the long established TB programs in both settings.
2013-01-01T00:00:00ZAssessing and improving care for patients with TB/HIV/STIs in a rural district in KwaZulu-Natal South Africa
http://hdl.handle.net/10566/1040
Assessing and improving care for patients with TB/HIV/STIs in a rural district in KwaZulu-Natal South Africa
Loveday, Marion; Scott, Vera; McLaughlin, Jennifer; Amien, Feroza; Virgina, Zweigenthal
Setting: Despite the prioritisation of TB, HIV and STI programmes
in South Africa, service targets are not achieved, have had little
effect, and the magnitude of the epidemics continues to escalate.
Objective. To report on a participatory quality improvement
intervention designed to evaluate these priority programmes in
primary health care (PHC) clinics in a rural district in KwaZulu-Natal.
Methods: A participatory quality improvement intervention with
district health managers, PHC supervisors and researchers was
used to modify a TB/HIV/STI audit tool for use in a rural area,
conduct a district-wide clinic audit, assess performance, set targets
and develop plans to address the problems identified.
Results: We highlight weaknesses in training and support of
staff at PHC clinics, pharmaceutical and laboratory failures, and
inadequate monitoring of patients as contributing to poor TB,
HIV and STI service implementation. In the 25 facilities audited,
71% of the clinical staff had received no training in TB diagnosis
and management, and 46% of the facilities were visited monthly
by a PHC supervisor. Eighty per cent of the facilities experienced
non-availability of essential drugs and supplies; polymerase chain
reaction (PCR) results were not documented for 54% of specimens
assessed, and the mean length of time between eligibility for ART
and starting treatment was 47 days.
Conclusion: Through a participatory approach, a TB/HIV/STI
audit tool was successfully adapted and implemented in a rural
district. It yielded information enabling managers to identify
obstacles to TB, HIV and STI service implementation and develop
plans to address these. The audit can be used by the district to
monitor priority services at a primary level.
2011-01-01T00:00:00Z