Publications by authors named "Charles Hongoro"

38 Publications

How has sustainable development goals declaration influenced health financing reforms for universal health coverage at the country level? A scoping review of literature.

Global Health 2021 Apr 23;17(1):50. Epub 2021 Apr 23.

School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Gauteng Province, 0028, South Africa.

Background: Achieving universal health coverage (UHC) requires health financing reforms (HFR) in many of the countries. HFR are inherently political. The sustainable development goals (SDG) declaration provides a global political commitment context that can influence HFR for UHC at national level. However, how the declaration has influenced HFR discourse at the national level and how ministries of health and other stakeholders are using the declaration to influence reforms towards UHC have not been explored. This review was conducted to provide information and lessons on how SDG declaration can influence health financing reforms for UHC based on countries experiences.

Methods: We conducted a rapid review of literature and followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline. We conducted a comprehensive electronic search on Ovid Medline, PubMed, EBSCO, Scopus, Web of Science. In searching the electronic databases, we combined various conceptual terms for "sustainable development goals" and "health financing" using Boolean operators. In addition, we conducted manual searched using google scholar.

Results: Twelve articles satisfied our eligibility criteria. The included articles were analyzed thematically, and the results presented narratively. The SDG declaration has provided an enabling environment for putting in place necessary legislations, reforming health financing organization, and revisions of national health polices to align to the country's commitment on UHC. However, there is limited information on the process; how health ministries and other stakeholders have used SDG declaration to advocate, lobby, and engage various constituencies to support HFR for UHC.

Conclusion: The SDG declaration can be a catalyst for health financing reform, providing reference for necessary legislations and policies for financing UHC. However, to facilitate better cross-country learning on how SDG declaration catalyzes HFR for UHC there, is need to examine the processes of how stakeholders have used the declaration as window of opportunity to accelerate reforms.
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http://dx.doi.org/10.1186/s12992-021-00703-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066969PMC
April 2021

Senior Managers' Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya.

Healthcare (Basel) 2021 Mar 18;9(3). Epub 2021 Mar 18.

School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa.

Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers' experiences with health status, happiness, and motivation in hospitals and the perceived impact on the health system in Kenya. This qualitative study applied a phenomenological research design. Senior managers within the hospital management teams were selected using purposive sampling. Semi-structured interviews were carried out among senior managers across eleven hospitals in Meru County, Kenya. Among the eleven participants 63.6% were female and 36.4%, were male and the mean age was 44.5 years. The audio-taped data were transcribed and analyzed using Colaizzi's phenomenological approach. The five themes revealed were: (1) Happiness in the health system; (2) Health status in the health system; (3) Motivation in the health system; (4) Challenges in the health system; (5) Possible solutions to the challenges in the health system. This study revealed the positive and negative impact of the three domains, challenges, and solutions, from the senior managers' perspective. Healthy, happy, and motivated senior managers and healthcare workers are more responsive and perform better. Policy interventions and programs promoting happiness, health status, and motivation are necessary for strengthening the health workforce and health system.
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http://dx.doi.org/10.3390/healthcare9030350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003158PMC
March 2021

Predictors of Health-Related Quality of Life among Healthcare Workers in the Context of Health System Strengthening in Kenya.

Healthcare (Basel) 2020 Dec 25;9(1). Epub 2020 Dec 25.

School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, Gauteng Province, South Africa.

Kenya is among the countries with an acute shortage of skilled health workers. There have been recurrent health worker strikes in Kenya due to several issues, some of which directly or indirectly affect their health. The purpose of this study was to investigate the predictors of health-related quality of life (HRQOL) among healthcare workers in public and mission hospitals in Meru County, Kenya. A cross-sectional study design was undertaken among 553 healthcare workers across 24 hospitals in Meru County. The participants completed the EuroQol-five dimension-five level (EQ-5D-5L) instrument, which measures health status across five dimensions and the overall self-assessment of health status on a visual analogue scale (EQ-VAS). Approximately 66.55% of the healthcare workers reported no problems (i.e., 11,111) across the five dimensions. The six predictors of HRQOL among the healthcare workers were hospital ownership ( < 0.05), age ( < 0.05), income ( < 0.01), availability of water for handwashing ( < 0.05), presence of risk in using a toilet facility ( < 0.05), and overall safety of hospital work environment ( < 0.05). Personal, job-related attributes and work environment characteristics are significant predictors of healthcare workers HRQOL. Thus, these factors ought to be considered by health policymakers and managers when developing and implementing policies and programs aimed at promoting HRQOL among healthcare workers.
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http://dx.doi.org/10.3390/healthcare9010018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824200PMC
December 2020

An Investigation of Healthcare Professionals' Motivation in Public and Mission Hospitals in Meru County, Kenya.

Healthcare (Basel) 2020 Dec 2;8(4). Epub 2020 Dec 2.

School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa.

Strengthening health systems in developing countries such as Kenya is required to achieve the third United Nations' Sustainable Development Goal of health for all, at all ages. However, Kenya is experiencing a "brain drain" and a critical shortage of healthcare professionals. There is a need to identify the factors that motivate healthcare workers to work in the health sector in rural and marginalized areas. This cross-sectional study aims to investigate the factors associated with the level and types of motivation among healthcare professionals in public and mission hospitals in Meru county, Kenya. Data were collected from 24 public and mission hospitals using a self-administered structured questionnaire. A total of 553 healthcare professionals participated in this study; 78.48% from public hospitals and 21.52% from mission hospitals. Hospital ownership was statistically nonsignificant in healthcare professionals' overall motivation ( > 0.05). The results showed that sociodemographic and work-environment factors explained 29.95% of the variation in overall motivation scores among participants. Findings indicate there are more similarities than disparities among healthcare professionals' motivation factors, regardless of hospital ownership; therefore, motivation strategies should be developed and applied in both public and private not-for-profit hospitals to ensure an effective healthcare workforce and strengthen healthcare systems in Kenya.
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http://dx.doi.org/10.3390/healthcare8040530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761626PMC
December 2020

Access to and Satisfaction with Basic Services in Informal Settlements: Results from a Baseline Assessment Survey.

Int J Environ Res Public Health 2020 06 19;17(12). Epub 2020 Jun 19.

Developmental, Capable and Ethical State, Human Sciences Research Council, Pretoria 0001, South Africa.

Subjective responses of satisfaction with basic services delivery is an indicator of service delivery performance. This study provides an overview of the status of basic service delivery and determines the factors associated with service delivery satisfaction within informal settlements targeted for upgrading in South Africa. A multinomial logistic regression was used to analyze the relationship between satisfaction with basic services of water, sanitation, refuse and electricity with several predictors including individual factors, household factors, community factors and service-related factors. The most common source of drinking water, toilet facility and refuse disposal method were communal tap (55%) pit latrine (53%) and local authorities (34%), respectively. Approximately 52% of the respondents in the study reported not having access to electricity. Results also show that satisfaction in basic services delivery varies and is influenced by service-related factors. Interventions targeted at improving the quality of basic service provided are essential to meet the targets set out in the sustainable development goals.
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http://dx.doi.org/10.3390/ijerph17124400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345018PMC
June 2020

Determinants of Motivation among Healthcare Workers in the East African Community between 2009-2019: A Systematic Review.

Healthcare (Basel) 2020 Jun 10;8(2). Epub 2020 Jun 10.

School of Health Systems and Public Health (SHSPH), Faculty of Health Sciences, University of Pretoria, Pretoria 0028, Gauteng Province, South Africa.

Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and sub-optimally functioning health systems. As countries globally aim to attain Universal Health Coverage and the Sustainable Development Goal 3, it is crucial that the significant role of the health workforce in this achievement is recognized. In this systematic review, we aimed to synthesise the determinants of motivation as reported by healthcare workers in the EAC between 2009 and 2019. A systematic search was performed using four databases, namely Cochrane library, EBSCOhost, ProQuest and PubMed. The eligible articles were selected and reviewed based on the authors' selection criteria. A total of 30 studies were eligible for review. All six countries that are part of the EAC were represented in this systematic review. Determinants as reported by healthcare workers in six countries were synthesised. Individual-level-, organizational/structural- and societal-level determinants were reported, thus revealing the roles of the healthcare worker, health facilities and the government in terms of health systems and the community or society at large in promoting healthcare workers' motivation. Monetary and non-monetary determinants of healthcare workers' motivation reported are crucial for informing healthcare worker motivation policy and health workforce strengthening in East Africa.
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http://dx.doi.org/10.3390/healthcare8020164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349547PMC
June 2020

Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa.

BMC Endocr Disord 2020 Jan 28;20(1):15. Epub 2020 Jan 28.

Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands.

Background: Self- management is vital to the control of diabetes. This study aims to assess the diabetes self-care behaviours of patients attending two tertiary hospitals in Gauteng, South Africa. The study also seeks to estimate the inequalities in adherence to diabetes self-care practices and associated factors.

Methods: A unique health-facilities based cross-sectional survey was conducted amongst diabetes patients in 2017. Our study sample included 396 people living with diabetes. Face-to-face interviews were conducted using a structured questionnaire. Diabetes self-management practices considered in this study are dietary diversity, medication adherence, physical activity, self-monitoring of blood-glucose, avoiding smoking and limited alcohol consumption. Concentration indices (CIs) were used to estimate inequalities in adherence to diabetes self-care practices. Multiple logistic regressions were fitted to determine factors associated with diabetes self-care practices.

Results: Approximately 99% of the sample did not consume alcohol or consumed alcohol moderately, 92% adhered to self-monitoring of blood-glucose, 85% did not smoke tobacco, 67% adhered to their medication, 62% had a diverse diet and 9% adhered to physical activity. Self-care practices of dietary diversity (CI = 0.1512) and exercise (CI = 0.1067) were all concentrated amongst patients with higher socio-economic status as indicated by the positive CIs, whilst not smoking (CI = - 0.0994) was concentrated amongst those of lower socio-economic status as indicated by the negative CI. Dietary diversity was associated with being female, being retired and higher wealth index. Medication adherence was found to be associated with older age groups. Physical activity was found to be associated with tertiary education, being a student and those within higher wealth index. Self-monitoring of blood glucose was associated with being married. Not smoking was associated with being female and being retired.

Conclusion: Adherence to exercising, dietary diversity and medication was found to be sub-optimal. Dietary diversity and exercise were more prevalent among patients with higher socio-economic status. Our findings suggest that efforts to improve self- management should focus on addressing socio-economic inequalities. It is critical to develop strategies that help those within low-socio-economic groups to adopt healthier diabetes self-care practices.
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http://dx.doi.org/10.1186/s12902-020-0492-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986066PMC
January 2020

Incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment for diabetes care in South Africa: a study at two public hospitals in Tshwane.

Int J Equity Health 2019 05 22;18(1):73. Epub 2019 May 22.

Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Background: Direct out of pocket (OOP) payments for healthcare may cause financial hardship. For diabetic patients who require frequent visits to health centres, this is of concern as OOP payments may limit access to healthcare. This study assesses the incidence, socio-economic inequalities and determinants of catastrophic health expenditure and impoverishment amongst diabetic patients in South Africa.

Methods: Data were taken from a cross-sectional survey conducted in 2017 at two public hospitals in Tshwane, South Africa (N = 396). Healthcare costs and transport costs related to diabetes care were classified as catastrophic if they exceeded the 10% threshold of household's capacity to pay (WHO standard method) or if they exceeded a variable threshold of total household expenditure (Ataguba method). Erreygers concentration indices (CIs) were used to assess socio-economic inequalities. A multivariate logistic regression was applied to identify the determinants of catastrophic health expenditure and impoverishment.

Results: Transport costs contributed to over 50% of total healthcare costs. The incidence of catastrophic health expenditure was 25% when measured at a 10% threshold of capacity to pay and 13% when measured at a variable threshold of total household expenditure. Depending on the method used, the incidence of impoverishment varied from 2 to 4% and the concentration index for catastrophic health expenditure varied from - 0.2299 to - 0.1026. When measured at a 10% threshold of capacity to pay factors associated with catastrophic health expenditure were being female (Odds Ratio 1.73; Standard Error 0.51), being within the 3rd (0.49; 0.20), 4th (0.31; 0.15) and 5th wealth quintile (0.30; 0.17). When measured using a variable threshold of total household expenditure factors associated with catastrophic health expenditure were not having children (3.35; 1.82) and the 4th wealth quintile (0.32; 0.21).

Conclusion: Financial protection of diabetic patients in public hospitals is limited. This observation suggests that health financing interventions amongst diabetic patients should target the poor and poor women in particular. There is also a need for targeted interventions to improve access to healthcare facilities for diabetic patients and to reduce the financial impact of transport costs when seeking healthcare. This is particularly important for the achievement of universal health coverage in South Africa.
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http://dx.doi.org/10.1186/s12939-019-0977-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530010PMC
May 2019

Challenges to the implementation of malaria policies in Malawi.

BMC Health Serv Res 2019 Mar 27;19(1):194. Epub 2019 Mar 27.

University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001, South Africa.

Background: Despite malaria prevention initiatives, malaria remains a major health problem in Malawi, especially for pregnant mothers and children under the age of five. To reduce the malaria burden, Malawi established its first National Malaria Control Programme in 1984. Implementation of evidence-based policies contributed to malaria prevalence dropping from 43% in 2010 to 22% in 2017. In this study, we explored challenges to implementing malaria policies in Malawi from the perspective of key stakeholders in the country.

Methods: In this qualitative study, we conducted in-depth interviews with 27 key informants from April to July 2015. We stopped sampling new participants when themes became saturated. Purposive and snowballing sampling techniques were used to identify key informants including malaria researchers that were policy advisors, policy makers, programme managers, and other key stakeholders. Interviews were conducted in English, recorded and transcribed, and imported into QSR Nvivo 11 for coding and analysis. Data were analysed using the qualitative content analysis approach.

Results: Participants identified three main categories of challenges to the implementation of malaria policies. First structural challenges include inadequate resources, unavailability of trained staff, poor supervision and mentorship of staff, and personnel turnover in government. The second challenge is unilateral implementation of policies. The third category is the inadequately informed policy development and includes lack of platforms to engage with communities, top-down approach in policy formulation and lack of understanding of socio-cultural factors affecting policy uptake by communities.

Conclusions: Policy makers should recognize that inadequate support of policy objectives leads to an implementation gap. Therefore, policy development and implementation should not be viewed as distinct, but rather as interactive processes shaping each other. Support for health policy and systems research should be mobilized to strengthen the health system. Detailed assessment of implementation challenges to specific malaria policies should also be conducted to address these challenges and support the shift from the paradigm of malaria prevention and control to elimination in Malawi.
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http://dx.doi.org/10.1186/s12913-019-4032-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437884PMC
March 2019

A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service.

J Occup Med Toxicol 2019 21;14. Epub 2019 Jan 21.

Research Use and Impact Assessment, Human Sciences Research Council Building, 134 Pretorius Street, Pretoria, 0083 South Africa.

Background: Occupational hazards, injuries and diseases are a major concern among police officers, including in Sub-Saharan Africa. However, there is limited locally relevant literature for guiding policy for the South African Police Service (SAPS). The purpose of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark policy implications for the SAPS.

Methods: We conducted a systematic review of studies using Google Scholar, PubMed and Scopus.

Results: A total of 36 studies were included in this review. Six revealed that police officers' exposure to accident hazards may lead to acute or chronic injuries such as sprains, fractures or even fatalities. These hazards may occur during driving, patrol or riot control. There were two studies, which confirmed physical hazards such as noise induced hearing loss (NIHL), due to exposure to high levels of noise. Three studies on chemical hazards revealed that exposure to high concentrations of carbon dioxide and general air pollution was associated with cancer, while physical exposure to other chemical substances was linked to dermatitis. Four studies on biological hazards demonstrated potential exposure to blood borne diseases from needle stick injuries (NSIs) or cuts from contaminated objects. One study on ergonomic hazards showed that musculoskeletal disorders can result from driving long distances and lifting heavy objects. There were 15 studies that indicated psychological hazards such as post-traumatic stress disorder (PTSD) as well as stress. Moreover, four studies were conducted on organizational hazards including burnout, negative workplace exposure and other factors.

Conclusions: This review outlined the global impact of occupational hazards, injuries and diseases in the police force. It served as a benchmark for understanding the policy implications for South Africa, where there is paucity of studies on occupational health and safety.
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http://dx.doi.org/10.1186/s12995-018-0221-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341669PMC
January 2019

Perceptions of and support for national health insurance in South Africa's public and private healthcare sectors.

Pan Afr Med J 2018 16;30:277. Epub 2018 Aug 16.

Population Health, Health Systems and Innovation (PHHSI) Research Programme, Human Sciences Research Council (HSRC), Pretoria, South Africa.

Introduction: For the purpose of effective implementation of a National Health Insurance (NHI) policy it is necessary to have an understanding of the awareness and perceptions of and support for such policy among clients using the healthcare system.

Methods: The South African National Health and Nutrition Examination Survey asked household heads a series of questions on healthcare utilisation and access and collected information on knowledge and perceptions of and support for national health insurance. Comparisons are drawn between private sector healthcare users with medical aid and public sector healthcare users without medical aid, using descriptive and regression analysis.

Results: Inequalities in access to quality healthcare remain stark. Only 8.5% of private users had postponed seeking healthcare compared to 23.9% of public users (p < 0.001). Only 11.9% of public users were very satisfied with the quality of healthcare services compared to 50.2% of private users (p < 0.001). More than eighty percent of healthcare users however were of the opinion that NHI is a top priority. However, for healthcare users to sacrifice choice required a national health insurance that provides better quality healthcare, increasing the probability of support for an NHI with lower cost and full coverage by 10.1%.

Conclusion: It is imperative to provide better quality healthcare services in the public sector for private sector users to be supportive of national health insurance. Concerted efforts are also required to develop a proper communication strategy to disseminate information on and garner support for national health insurance, both in the public and private healthcare sectors.
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http://dx.doi.org/10.11604/pamj.2018.30.277.14147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317390PMC
January 2019

"You Travel Faster Alone, but Further Together": Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant.

Int J Health Policy Manag 2018 11 1;7(11):977-981. Epub 2018 Nov 1.

Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, UK.

Providing universal health coverage (UHC) through better maternal, neonatal, child and adolescent health (MNCAH) can benefit both parties through North-South research collaborations. This paper describes lessons learned from bringing together early career researchers, tutors, consultants and mentors from the United Kingdom, Kenya, and South Africa to work in multi-disciplinary teams in a capacity-building workshop in Johannesburg, co-ordinated by senior researchers from the three partner countries. We recruited early career researchers and research users from a range of sectors and institutions in the participating countries and offered networking sessions, plenary lectures, group activities and discussions. To encourage bonding and accommodate cross-cultural and cross-disciplinary partners, we asked participants to respond to questions relating to research priorities and interventions in order to allocate them into multidisciplinary and cross-country teams. A follow up meeting took place in London six months later. Over the five day initial workshop, discussions informed the development of four draft research proposals. Intellectual collaboration, friendship and respect were engendered to sustain future collaborations, and we were able to identify factors which might assist capacity-building funders and organizers in future. This was a modestly funded brief intervention, with a follow-up made possible through the careful stewardship of resources and volunteerism. Having low and middle-income countries in the driving seat was a major benefit but not without logistic and financial challenges. Lessons learned and follow-up are described along with recommendations for future funding of partnerships schemes.
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http://dx.doi.org/10.15171/ijhpm.2018.73DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326641PMC
November 2018

Assessment of the multi-sectoral approach to tobacco control policies in South Africa and Togo.

BMC Public Health 2018 Aug 15;18(Suppl 1):962. Epub 2018 Aug 15.

City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA.

Background: Tobacco use is the world's leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health Organization's "best-buys" interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo.

Methods: This two-country case study consisted of a document review of tobacco control policies and of key informant interviews (N = 56) about the content, context, stakeholders, and strategies employed throughout policy formulation and implementation in South Africa and Togo. To guide our analysis, we used the Comprehensive Framework for Multi-Sectoral Approach to Health Policy, which is built around four major constructs of context, content, stakeholders and strategies.

Results: The findings show that the formulation of tobacco control policies in both countries was driven locally by the political, historical, social and economic contexts, and globally by the adoption WHO Framework Convention on Tobacco Control (FCTC). In both countries, the health department led policy formulation and implementation. The stakeholders involved in South Africa were more diverse, proactive and dynamic than those in Togo, whereas the strategies employed were more straightforward in Togo than in South Africa. The extent of understanding and use of MSA in both countries consisted of an inter-sectoral action for health, whereby the health department strove to collaborate with other sectors within and outside the government. Consequently, information sharing was identified as the main outcome of the interactions between institutions and interest groups within and across three critical sectors of the state, namely the public (government), the private and the civil society.

Conclusion: Tobacco control policies in South Africa and Togo were formulated and implemented from an inter-sectoral approach perspective, which relied heavily on information transfer between stakeholders and less on collaborative problem-solving approach. Incorporation of multiple stakeholders allowed both countries to formulate policies to meet FCTC goals for tobacco control and NCD reduction.
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http://dx.doi.org/10.1186/s12889-018-5829-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117630PMC
August 2018

Multi-Sectoral Approach to Noncommunicable Disease Prevention Policy in Sub-Saharan Africa: A Conceptual Framework for Analysis.

Int J Health Serv 2019 04 10;49(2):371-392. Epub 2018 May 10.

1 School of Health Systems and Public Health, Faculty of Heath Sciences, University of Pretoria, Pretoria, South Africa.

Conceptual frameworks for health policy analysis guide investigations into interactions between institutions, interests, and ideas to identify how to improve policy decisions and outcomes. This review assessed constructs from current frameworks and theories of health policy analysis to (1) develop a preliminary synthesis of findings from selected frameworks and theories; (2) analyze relationships between elements of those frameworks and theories to construct an overarching framework for health policy analysis; and then, (3) apply that overarching framework to analyze tobacco control policies in Togo and in South Africa. This Comprehensive Framework for Multi-Sectoral Approach to Health Policy Analysis has 4 main constructs: context, content, stakeholders, and strategies. When applied to analyze tobacco control policy processes in Togo and in South Africa, it identified a shared goal in both countries to have a policy content that is compliant with the provisions of international tobacco treaties and differences in strategic interactions between institutions (e.g., tobacco industry, government structures) and in the political context of tobacco control policy process. These findings highlight the need for context-specific political mapping identifying the interests of all stakeholders and strategies for interaction between health and other sectors when planning policy formulation or implementation.
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http://dx.doi.org/10.1177/0020731418774203DOI Listing
April 2019

Analysis of selected policies towards universal health coverage in Uganda: the policy implementation barometer protocol.

Arch Public Health 2018 15;76:12. Epub 2018 Feb 15.

3Makerere University School of Public Health, Kampala, Uganda.

Background: Policy implementation remains an under researched area in most low and middle income countries and it is not surprising that several policies are implemented without a systematic follow up of why and how they are working or failing. This study is part of a larger project called Supporting Policy Engagement for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda. It seeks to support policymakers monitor the implementation of vital programmes for the realisation of policy goals for Universal Health Coverage. A Policy Implementation Barometer (PIB) is proposed as a mechanism to provide feedback to the decision makers about the implementation of a selected set of policy programmes at various implementation levels (macro, meso and micro level). The main objective is to establish the extent of implementation of malaria, family planning and emergency obstetric care policies in Uganda and use these results to support stakeholder engagements for corrective action. This is the first PIB survey of the three planned surveys and its specific objectives include: assessment of the perceived appropriateness of implementation programmes to the identified policy problems; determination of enablers and constraints to implementation of the policies; comparison of on-line and face-to-face administration of the PIB questionnaire among target respondents; and documentation of stakeholder responses to PIB findings with regard to corrective actions for implementation.

Methods/design: The PIB will be a descriptive and analytical study employing mixed methods in which both quantitative and qualitative data will be systematically collected and analysed. The first wave will focus on 10 districts and primary data will be collected through interviews. The study seeks to interview 570 respondents of which 120 will be selected at national level with 40 based on each of the three policy domains, 200 from 10 randomly selected districts, and 250 from 50 facilities. Half of the respondents at each level will be randomly assigned to either face-to-face or on-line interviews. An integrated questionnaire for these interviews will collect both quantitative data through Likert scale-type questions, and qualitative data through open-ended questions. And finally focused dialogues will be conducted with selected stakeholders for feedback on the PIB findings. Secondary data will be collected using data extraction tools for performance statistics.

Discussion: It is anticipated that the PIB findings and more importantly, the focused dialogues with relevant stakeholders, that will be convened to discuss the findings and establish corrective actions, will enhance uptake of results and effective health policy implementation towards universal health coverage in Uganda.
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http://dx.doi.org/10.1186/s13690-018-0258-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813378PMC
February 2018

Cost of diabetes mellitus in Africa: a systematic review of existing literature.

Global Health 2018 01 16;14(1). Epub 2018 Jan 16.

Department of Health Services Research; CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.

Background: There is an increasing recognition that non communicable diseases impose large economic costs on households, societies and nations. However, not much is known about the magnitude of diabetes expenditure in African countries and to the best of our knowledge no systematic assessment of the literature on diabetes costs in Africa has been conducted. The aim of this paper is to capture the evidence on the cost of diabetes in Africa, review the methods used to calculate costs and identify areas for future research.

Methods: A desk search was conducted in Pubmed, Medline, Embase, and Science direct as well as through other databases, namely Google Scholar. The following eligibility criteria were used: peer reviewed English articles published between 2006 and 2016, articles that reported original research findings on the cost of illness in diabetes, and studies that covered at least one African country. Information was extracted using two data extraction sheets and results organized in tables. Costs presented in the studies under review are converted to 2015 international dollars prices (I$).

Results: Twenty six articles are included in this review. Annual national direct costs of diabetes differed between countries and ranged from I$3.5 billion to I$4.5 billion per annum. Indirect costs per patient were generally higher than the direct costs per patient of diabetes. Outpatient costs varied by study design, data source, perspective and healthcare cost categories included in the total costs calculation. The most commonly included healthcare items were drug costs, followed by diagnostic costs, medical supply or disposable costs and consultation costs. In studies that reported both drug costs and total costs, drug costs took a significant portion of the total costs per patient. The highest burden due to the costs associated with diabetes was reported in individuals within the low income group.

Conclusion: Estimation of the costs associated with diabetes is crucial to make progress towards meeting the targets laid out in Sustainable Development Goal 3 set for 2030. The studies included in this review show that the presence of diabetes leads to elevated costs of treatment which further increase in the presence of complications. The cost of drugs generally contributed the most to total direct costs of treatment. Various methods are used in the estimation of diabetes healthcare costs and the costs estimated between countries differ significantly. There is room to improve transparency and make the methodologies used standard in order to allow for cost comparisons across studies.
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http://dx.doi.org/10.1186/s12992-017-0318-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771003PMC
January 2018

Development of a framework to improve the utilisation of malaria research for policy development in Malawi.

Health Res Policy Syst 2017 Nov 21;15(1):97. Epub 2017 Nov 21.

University of Pretoria Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X363, Pretoria, 0001, South Africa.

Background: The existing gap between research evidence and public health practice has attributed to the unmet Millennium Development Goals in Africa and consequently, has stimulated the development of frameworks to enhance knowledge translation. These efforts aim at maximising health research utilisation in policy and practice to address the world's disease burdens, including malaria. This study aimed at developing a contextual framework to improve the utilisation of malaria research for policy development in Malawi.

Methods: The study used two approaches including: two case studies of policy analysis exploring the policy-making process in Malawi, utilisation of local malaria research, and the role of key stakeholders in policy formulation process; and the assessment of facilitating factors and barriers to malaria research utilisation for policy-making in Malawi.

Results: From the case studies' lessons and elements identified during the assessment of facilitating factors and barriers, a framework is developed to promote an integrated approach to knowledge translation. In this framework the Ministry of Health is considered as the main user of knowledge from research through the demand created by the research directorate and the National Malaria Control Programme. Key documents identified as being particularly relevant to the Ministry of Health for purposes of knowledge translation include the National Health Research Agenda, Guidelines for Policy Development and Analysis, and Guidelines for Evidence Use in Policy-making. Institutions conducting academic and policy-relevant malaria research in Malawi are identified and a consolidation of their linkages with the users of research is established through the Knowledge Translation Unit, the Evidence Informed decision-making Centre, and the African Institute for Development Policy. Equally, key players in this framework are the funding partners for both research and programmes that need to see accountability and impact of their support. Independent advisors, partners, and consultants also have their vital role in the process.

Conclusion: The framework offers a practical basis for the factors identified and their linkages to promote a co-ordinated approach to malaria research utilisation in policy-making. Its applicability and success hinges on its wider dissemination and ownership by the government through the National Malaria Control Programme.
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http://dx.doi.org/10.1186/s12961-017-0264-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697395PMC
November 2017

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012.

PLoS One 2017 2;12(10):e0184264. Epub 2017 Oct 2.

Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United Stated of America.

South Africa faces an epidemic of chronic non-communicable diseases (NCDs), yet national surveillance is limited due to the lack of recent data. We used data from the first comprehensive national survey on NCDs-the South African National Health and Nutrition Examination Survey (SANHANES-1 (2011-2012))-to evaluate the prevalence of and health system response to diabetes through a diabetes care cascade. We defined diabetes as a Hemoglobin A1c equal to or above 6.5% or currently on treatment for diabetes. We constructed a diabetes care cascade by categorizing the population with diabetes into those who were unscreened, screened but undiagnosed, diagnosed but untreated, treated but uncontrolled, and treated and controlled. We then used multivariable logistic regression models to explore factors associated with diagnosed and undiagnosed diabetes. The age-standardized prevalence of diabetes in South Africans aged 15+ was 10.1%. Prevalence rates were higher among the non-white population and among women. Among individuals with diabetes, a total of 45.4% were unscreened, 14.7% were screened but undiagnosed, 2.3% were diagnosed but untreated, 18.1% were treated but uncontrolled, and 19.4% were treated and controlled, suggesting that 80.6% of the diabetic population had unmet need for care. The diabetes care cascade revealed significant losses from lack of screening, between screening and diagnosis, and between treatment and control. These results point to significant unmet need for diabetes care in South Africa. Additionally, this analysis provides a benchmark for evaluating efforts to manage the rising burden of diabetes in South Africa.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184264PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624573PMC
October 2017

The extent and determinants of diabetes and cardiovascular disease comorbidity in South Africa - results from the South African National Health and Nutrition Examination Survey (SANHANES-1).

BMC Public Health 2017 09 26;17(1):745. Epub 2017 Sep 26.

Population Health, Health Systems and Innovation, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, Pretoria, 0002, South Africa.

Background: Diabetes is a major health problem and cause of death worldwide. It is predicted that the prevalence of diabetes will increase from 415 million in 2015 to 642 million in 2040. However, the burden of diabetes in low- and middle-income countries is not clearly understood, particularly its interaction with other chronic illnesses. This study investigates the self-reported prevalence of and factors associated with diabetes and cardiovascular comorbidity in South Africa.

Methods: Data used in this study are from the 2012 South African National Health and Nutrition Examination Survey; a nationally representative cross-sectional household survey (N = 25,532). Diabetes and cardiovascular disease comorbidity was defined as the coexistence of diabetes plus one or more cardiovascular diseases reported at the time of the survey. This study makes use of multinomial logistic regression models to analyse the relationship between diabetes - cardiovascular disease comorbidity and several predictors including race, income, socio-economic status and obesity.

Results: According to the survey data we analysed, 5% of South Africans aged 15 and above had self-reported diabetes in 2011-2012. Among those with self-reported diabetes, 73% had at least one additional cardiovascular chronic illness. Diabetes and its cardiovascular disease comorbidity was more prevalent in Africans (66%), females (66%), those who lived in urban areas (75%), had secondary education (44%) and were unemployed (62%). Factors strongly associated with diabetes - cardiovascular disease comorbidity were older age (Odds ratio [OR] 1.09; 95% Confidence Interval [CI] 1.06-1.12), high household income (0.27; 0.10-0.76) versus low income, moderate (0.33; 0.11-0.96) and good self-rated health (0.24; 0.08-0.68) versus bad self-rated health, occasional (0.29; 0.10-0.88) and regular smokers (0.25; 0.12-0.53) versus non-smokers and physical activity (0.15; 0.03-0.68) versus no physical activity.

Conclusion: The study provides insight into the factors associated with cardiovascular disease comorbidity in diabetic individuals. The findings indicate that there are differences in the factors associated with diabetes and those associated with diabetes - cardiovascular disease comorbidity. This provides information, which can be used to design programmes that encourage healthy lifestyles in people living with diabetes.
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http://dx.doi.org/10.1186/s12889-017-4792-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615430PMC
September 2017

Malaria research in Malawi from 1984 to 2016: a literature review and bibliometric analysis.

Malar J 2017 06 12;16(1):246. Epub 2017 Jun 12.

School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.

Background: Malaria research can play a vital role in addressing the malaria burden in Malawi. An organized approach in addressing malaria in Malawi started in 1984 by the establishment of the first National Malaria Control Programme and research was recognized to be significant. This study aimed to assess the type and amount of malaria research conducted in Malawi from 1984 to 2016 and its related source of funding.

Methods: A systematic literature search was conducted in the Medline/PubMed database for Malawian publications and approved malaria studies from two Ethical Committees were examined. Bibliometric analysis was utilized to capture the affiliations of first and senior/last authors, funding acknowledgements, while titles, abstracts and accessed full text were examined for research type.

Results: A total of 483 publications and 165 approved studies were analysed. Clinical and basic research in the fields of malaria in pregnancy 105 (21.5%), severe malaria 97 (20.1%) and vector and/or agent dynamics 69 (14.3%) dominated in the publications while morbidity 33 (20%), severe malaria 28 (17%) and Health Policy and Systems Research 24 (14.5%) dominated in the approved studies. In the publications, 146 (30%) first authors and 100 (21%) senior authors, and 88 (53.3%) principal investigators in approved studies were affiliated to Malawian-based institutions. Most researchers were affiliated to the Malawi-Liverpool Wellcome Trust, College of Medicine, Blantyre Malaria Project, Ministry of Health, and Malaria Alert Centre. The major malaria research funders were the National Institute for Health/USA, Wellcome Trust and the US Agency for International Development. Only three (2.5%) out of 118 journals publishing research on malaria in Malawi were from Africa and the Malaria Journal, with 76 (15.7%) publications, published most of the research from Malawi, followed by the American Journal of Tropical Medicine and Hygiene with 57 (11.8%) in comparison to only 13 (2.7%) published in the local Malawi Medical Journal.

Conclusions: Clinical and basic research, which is mostly funded externally, in the fields of malaria in pregnancy, severe malaria and vector and/or agent dynamics dominated, while health policy and system research was least supported. The quantity may reflect scientific research activity but the initial primary impact is contribution to policy development.
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http://dx.doi.org/10.1186/s12936-017-1895-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5469173PMC
June 2017

Changing the policy for intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy in Malawi.

Malar J 2017 02 20;16(1):84. Epub 2017 Feb 20.

School of Health Systems and Public Health, Institute for Sustainable Malaria Control (UP ISMC), University of Pretoria, Private Bag X363, Pretoria, 0001, South Africa.

Background: The growing resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) treatment for uncomplicated malaria led to a recommendation by the World Health Organization for the use of artemisinin-based combination therapy. Inevitably, concerns were also raised surrounding the use of SP for intermittent prevention treatment of malaria during pregnancy (IPTp) amidst the lack of alternative drugs. Malawi was the first country to adopt intermittent prevention treatment with SP in 1993, and updated in 2013. This case study examines the policy updating process and the contribution of research and key stakeholders to this process. The findings support the development of a malaria research-to-policy framework in Malawi.

Methods: Documents and evidence published from 1993 to 2012 were systematically reviewed in addition to key informant interviews.

Results: The online search identified 170 potential publications, of which eight from Malawi met the inclusion criteria. Two published studies from Malawi were instrumental in the WHO policy recommendation which in turn led to the updating of national policies. The updated policy indicates that more than two SP doses, as informed by research, overcome the challenges of the first policy of two SP doses only because of ineffectiveness by P. falciparum resistance and the global lack of replacement drugs to SP for IPTp.

Conclusion: International WHO recommendations facilitated a smooth policy change driven by motivated local leadership with technical and financial support from development partners. Policy development and implementation should include key stakeholders and use local malaria research in a research-to-policy framework.
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http://dx.doi.org/10.1186/s12936-017-1736-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319082PMC
February 2017

Self-reported diabetes during pregnancy in the South African National Health and Nutrition Examination Survey: extent and social determinants.

BMC Pregnancy Childbirth 2017 01 10;17(1):20. Epub 2017 Jan 10.

Population Health, Health Systems and Innovation, Human Sciences Research Council, HSRC Building, 134 Pretorius Street, Pretoria, 0002, South Africa.

Background: Diabetes is a serious and growing public health concern in South Africa, but its prevalence and distribution in pregnant women is not well known. Women diagnosed with diabetes during pregnancy have a substantially greater risk of adverse health outcomes for both mother and child. This study aims to determine the prevalence and social determinants of diabetes during pregnancy in South Africa.

Methods: Data used in this study were from the 2012 South African National Nutrition and Health Examination Survey; a nationally representative cross-sectional household survey. The analysis was restricted to girls and women between the ages of 15 to 49 years who self-reported ever being pregnant (n = 4261) Logistic regression models were constructed to analyse the relationship between diabetes during pregnancy and several indicators including race, family history of diabetes, household income, area of residence and obesity.

Results: The prevalence of diabetes during pregnancy in South Africa was 3% (144 women) of all women who reported ever being pregnant. The majority of the women who had ever had diabetes were African (70%), 51% were unemployed and 76% lived in rural areas. Factors strongly associated with diabetes during pregnancy were age (1.04 [Odds Ratio], 0.01 [Standard Error]), family history of diabetes (3.04; 0.8) and race (1.91; 0.53).

Conclusion: The analysis will contribute to an understanding of the prevalence of diabetes during pregnancy and its social determinants. This will help in the development of effective interventions targeted at improving maternal and child health for mothers at high risk.
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http://dx.doi.org/10.1186/s12884-016-1218-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223373PMC
January 2017

Prioritizing health system and disease burden factors: an evaluation of the net benefit of transferring health technology interventions to different districts in Zimbabwe.

Clinicoecon Outcomes Res 2016 24;8:695-705. Epub 2016 Nov 24.

Human Sciences Research Council of South Africa.

Introduction: Health-care technologies (HCTs) play an important role in any country's health-care system. Zimbabwe's health-care system uses a lot of HCTs developed in other countries. However, a number of local factors have affected the absorption and use of these technologies. We therefore set out to test the hypothesis that the net benefit regression framework (NBRF) could be a helpful benefit testing model that enables assessment of intra-national variables in HCT transfer.

Method: We used an NBRF model to assess the benefits of transferring cost-effective technologies to different jurisdictions. We used the country's 57 administrative districts to proxy different jurisdictions. For the dependent variable, we combined the cost and effectiveness ratios with the districts' per capita health expenditure. The cost and effectiveness ratios were obtained from HIV/AIDS and malaria randomized controlled trials, which did either a prospective or retrospective cost-effectiveness analysis. The independent variables were district demographic and socioeconomic determinants of health.

Results: The study showed that intra-national variation resulted in different net benefits of the same health technology intervention if implemented in different districts in Zimbabwe. The study showed that population data, health data, infrastructure, demographic and health-seeking behavior had significant effects on the net margin benefit for the different districts. The net benefits also differed in terms of magnitude as a result of the local factors.

Conclusion: Net benefit testing using local data is a very useful tool for assessing the transferability and further adoption of HCTs developed elsewhere. However, adopting interventions with a positive net benefit should also not be an end in itself. Information on positive or negative net benefit could also be used to ascertain either the level of future savings that a technology can realize or the level of investment needed for the particular technology to become beneficial.
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http://dx.doi.org/10.2147/CEOR.S95037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125992PMC
November 2016

Facilitating factors and barriers to malaria research utilization for policy development in Malawi.

Malar J 2016 Oct 19;15(1):512. Epub 2016 Oct 19.

Institute for Sustainable Malaria Control (UP ISMC), School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.

Background: Research on various determinants of health is key in providing evidence for policy development, thereby leading to successful interventions. Utilization of research is an intricate process requiring an understanding of contextual factors. The study was conducted to assess enhancing factors and barriers of research utilization for malaria policy development in Malawi.

Methods: Qualitative research approach was used through in-depth interviews with 39 key informants that included malaria researchers, policy makers, programme managers, and key stakeholders. Purposive sampling and snowballing techniques were used in identifying key informants. Interview transcripts were entered in QSR Nvivo 11 software for coding and analysis.

Results: Respondents identified global efforts as key in advancing knowledge translation, while local political will has been conducive for research utilization. Other factors were availability of research, availability of diverse local researchers and stakeholders supporting knowledge translation. While barriers included: lack of platforms for researcher-public engagement, politics, researchers' lack of communication skills, lack of research collaborations, funder driven research, unknown World Health Organization policy position, and the lack of a malaria research repository.

Conclusion: Overall, the study identified facilitating factors to malaria research utilization for policy development in Malawi. These factors need to be systematically coordinated to address the identified barriers and improve on malaria research utilization in policy development. Malaria research can be key in the implementation of evidence-based interventions to reduce the malaria burden and assist in the paradigm shift from malaria control to elimination in Malawi.
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http://dx.doi.org/10.1186/s12936-016-1547-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070004PMC
October 2016

Malaria research and its influence on anti-malarial drug policy in Malawi: a case study.

Health Res Policy Syst 2016 Jun 1;14(1):41. Epub 2016 Jun 1.

University of Pretoria Centre for Sustainable Malaria Control (UP CSMC), School of Health Systems and Public Health (SHSPH), University of Pretoria, Private Bag X363, Pretoria, 0001, South Africa.

Background: In 1993, Malawi changed its first-line anti-malarial treatment for uncomplicated malaria from chloroquine to sulfadoxine-pyrimethamine (SP), and in 2007, it changed from SP to lumefantrine-artemether. The change in 1993 raised concerns about whether it had occurred timely and whether it had potentially led to early development of Plasmodium falciparum resistance to SP. This case study examined evidence from Malawi in order to assess if the policy changes were justifiable and supported by evidence.

Methods: A systematic review of documents and published evidence between 1984 and 1993, when chloroquine was the first-line drug, and 1994 and 2007, when SP was the first-line drug, was conducted herein. The review was accompanied with key informant interviews.

Results: A total of 1287 publications related to malaria drug policy changes in sub-Saharan Africa were identified. Using the inclusion criteria, four articles from 1984 to 1993 and eight articles from 1994 to 2007 were reviewed. Between 1984 and 1993, three studies reported on chloroquine poor efficacy prompting policy change according to WHO's recommendation. From 1994 to 2007, four studies conducted in the early years of policy change reported a high SP efficacy of above 80%, retaining it as a first-line drug. Unpublished sentinel site studies between 2005 and 2007 showed a reduced efficacy of SP, influencing policy change to lumefantrine-artemether. The views of key informants indicate that the switch from chloroquine to SP was justified based on local evidence despite unavailability of WHO's policy recommendations, while the switch to lumefantrine-artemether was uncomplicated as the country was following the recommendations from WHO.

Conclusion: Ample evidence from Malawi influenced and justified the policy changes. Therefore, locally generated evidence is vital for decision making during policy change.
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http://dx.doi.org/10.1186/s12961-016-0108-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888534PMC
June 2016

The Consideration of Socioeconomic Determinants in Prevention of Traditional Male Circumcision Deaths and Complications.

Am J Mens Health 2018 05 18;12(3):597-607. Epub 2016 Mar 18.

1 Human Sciences Research Council, Pretoria, South Africa.

The responsiveness to socioeconomic determinants is perceived as highly crucial in preventing the high mortality and morbidity rates of traditional male circumcision initiates in the Eastern Cape, a province in South Africa. The study sought to describe social determinants and explore economic determinants related to traditional circumcision of boys from 12 to 18 years of age in Libode rural communities in Eastern Cape Province. From the results of a descriptive cross-sectional survey ( n = 1,036), 956 (92.2%) boys preferred traditional male circumcision because of associated social determinants which included the variables for the attainment of social manhood values and benefits; 403 (38.9%) wanted to attain community respect; 347 (33.5%) wanted the accepted traditional male circumcision for hygienic purposes. The findings from the exploratory focus group discussions were revolving around variables associated with poverty, unemployment, and illegal actions to gain money. The three negative economic determinants were yielded as themes: (a) commercialization and profitmaking, (b) poverty and unemployment, (c) taking health risk for cheaper practices, and the last theme was the (d) actions suggested to prevent the problem. The study concluded with discussion and recommendations based on a developed strategic circumcision health promotion program which is considerate of socioeconomic determinants.
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http://dx.doi.org/10.1177/1557988316638157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987959PMC
May 2018

An Assessment of Private General Practitioners Contracting for Public Health Services Delivery in O.R. Tambo District, South Africa.

J Public Health Afr 2015 Aug 17;6(2):525. Epub 2015 Aug 17.

Albertina Sisulu Centre for Global Health and Research, Faculty of Health Sciences, Walter Sisulu University , Mthatha, South Africa.

Low- and middle-income countries are striving towards universal health coverage in a variety of ways. Achieving this goal requires the participation of both public and the private sector providers. The study sought to assess existing capacity for independent general practitioner contracting in primary care, the reasons for the low uptake of government national contract and the expectations of general practitioners of such contractual arrangements. This was a case study conducted in a rural district of South Africa. The study employed both quantitative and qualitative data collection methods. Data were collected using a general practitioner and practice profiling tool, and a structured questionnaire. A total of 42 general practitioners were interviewed and their practices profiled. Contrary to observed low uptake of the national general practitioner contract, 90% of private doctors who had not yet subscribed to it were actually interested in it. Substantial evidence indicated that private doctors had the capacity to deliver quality care to public patients. However, low uptake of national contarct related mostly to lack of effective communication and consultation between them and national government which created mistrust and apprehension amongst local private doctors. Paradoxically, these general practitioners expressed satisfaction with other existing state contracts. An analysis of the national contract showed that there were likely to benefit more from it given the relatively higher payment rates and the guaranteed nature of this income. Proposed key requisites to enhanced uptake of the national contract related to the type of the contract, payment arrangements and flexibility of the work regime, and prospects for continuous training and clinical improvements. Low uptake of the national General Practitioner contract was due to variety of factors related to lack of understanding of contract details. Such misunderstandings between potential contracting parties created mistrust and apprehension, which are fundamental antitheses of any effective contractual arrangement. The idea of a contract was probably inappropriate.
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http://dx.doi.org/10.4081/jphia.2015.525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349272PMC
August 2015

A Cost-Effectiveness Analysis of a Home-Based HIV Counselling and Testing Intervention versus the Standard (Facility Based) HIV Testing Strategy in Rural South Africa.

PLoS One 2015 14;10(8):e0135048. Epub 2015 Aug 14.

Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

Introduction: There is growing evidence concerning the acceptability and feasibility of home-based HIV testing. However, less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing. This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa.

Methods: Two alternatives: clinic and home-based HIV counselling and testing were compared. Costs were analysed from a provider's perspective for the period of January to December 2010. The outcome, HIV counselling and testing (HCT) uptake was obtained from the Good Start home-based HIV counselling and testing (HBHCT) cluster randomised control trial undertaken in KwaZulu-Natal province. Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively. Average costs were calculated as the cost per client tested, while cost-effectiveness was calculated as the cost per additional client tested through HBHCT.

Results: Based on effectiveness of 37% in the intervention (HBHCT) arm compared to 16% in control arm, home based testing costs US$29 compared to US$38 per person for clinic HCT. The incremental cost effectiveness per client tested using HBHCT was $19.

Conclusions: HBHCT was less costly and more effective. Home-based HCT could present a cost-effective alternative for rural 'hard to reach' populations depending on affordability by the health system, and should be considered as part of community outreach programs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0135048PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537202PMC
May 2016

Association between the use of biomass fuels on respiratory health of workers in food catering enterprises in Nairobi Kenya.

Pan Afr Med J 2013 6;15:12. Epub 2013 May 6.

Department of Public Health, Kenyatta University, Kenya.

Introduction: Indoor air pollution from biomass fuel use has been found to be responsible for more than 1.6 million annual deaths and 2.7% of the global burden of disease. This makes it the second biggest environmental contributor to ill health, behind unsafe water and sanitation.

Methods: The main objective of this study was to investigate if there was any association between use of bio-fuels in food catering enterprises and respiratory health of the workers. A cross-sectional design was employed, and data collected using Qualitative and quantitative techniques.

Results: The study found significantly higher prevalence of respiratory health outcomes among respondents in enterprises using biomass fuels compared to those using processed fuels. Biomass fuels are thus a major public health threat to workers in this sub-sector, and urgent intervention is required.

Conclusion: The study recommends a switch from biomass fuels to processed fuels to protect the health of the workers.
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http://dx.doi.org/10.11604/pamj.2013.15.12.1831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725321PMC
February 2014