Jannie Hugo

Rural-origin health science students at South African universities

BACKGROUND Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-to-population ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. OBJECTIVE To determine the proportion of rural-origin students at all medical schools in South Africa. DESIGN A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%). RESULTS . Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine--27.4%, physiotherapy--22.4%, occupational therapy--26.7%, and dentistry--24.8%. CONCLUSION The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas.

Building consensus on clinical procedural skills for South African family medicine training using the Delphi technique

Abstract Background The development of registrar training as part of the newly created speciality of family medicine in South Africa requires the development of a national consensus on the clinical procedural skills outcomes that should be expected of training programmes. Methods This study utilized a Delphi technique to establish a national consensus between 35 experts from training institutions, those already in family practice and managers who might be employing family physicians in both private and public sector contexts. Results Consensus was reached on 214 core skills at different levels of desired competency and 23 elective skills. The core skills were divided into 58 that should be taught by family physicians, 101 that should be performed independently and 55 that should be performed during training under supervision. The panel were unable to reach consensus on a further 21 skills. Conclusion This is the first study that has proposed a set of essential clinical procedural skills for the training of family physicians in South Africa. The findings will act as a benchmark for programmes in South Africa and through the new initiative of ‘FaMEC in Africa’ may influence curriculum development in other African countries. They may be used as a guide for curriculum planning, as a way of monitoring skills development and as an indication to registrars of the skills they need to achieve for assessment purposes. The findings may also inform the planning of training programmes for the proposed mid-level health worker (clinical associate) in South Africa as their skills will be a sub-set of these skills and will be taught by family physicians within district hospitals. Training programmes for undergraduates and interns in family medicine may also want to position themselves as stepping stones in line with these final outcomes of postgraduate training.

The infant-feeding practices of mothers enrolled in the prevention of mother-to-child transmission of HIV programme at a primary health care clinic in the Mpumalanga province, South Africa

Abstract Purpose: To determine whether mothers attending a primary health care (PHC) clinic in the Mpumalanga province, South Africa for post-delivery prevention of mother-to-child transmission (PMTCT) of the Human Immunodeficiency Virus (HIV) follow-up care were adhering to the recommendation of exclusive infant-feeding practices, and to identify possible areas for improvement of the PMTCT of HIV services at the clinic. Setting: A municipal PHC clinic in White River, a semi-urban town in Mpumalanga, South Africa. Design: A cross-sectional descriptive study using a structured infant-feeding questionnaire. Subjects: All mothers attending the clinic for post-delivery PMTCT of HIV follow-up care during a four-month period from 1 November 2007 to 29 February 2008. Results: A total of 33 mothers with infants attended the clinic during the period. All 33 mothers took part in the questionnaire study. Thirty questionnaires were subsequently found suitable for analysis. The mothers were predominantly rural, with low levels of education and no formal employment. Their ages ranged from 22 to 42 years, with a mean of 30.7 years. Fifteen (50%) of the 30 mothers practised exclusive replacement feeding (ERF), 8 (27%) practised exclusive breast-feeding (EBF), and 7 (23%) practised mixed feeding. Conclusion: More than three-quarters of the mothers practised the recommended exclusive infant-feeding methods for PMTCT of HIV, with ERF as the most popular choice. However, the infant-feeding practices could not be generalised as the attendance of mothers for post-delivery follow-up care at the clinic was very poor during the study period. This poor attendance was attributed to frequent non-availability of free formula milk for the programme. Better quality counselling is needed to further increase the adherence to exclusive infant-feeding practices, and to improve the uptake of post-delivery follow-up care.

Thoughts on the state of family medicine in South Africa

Sometimes it feels to us that, as family physicians in South Africa, we are like the dog that is chasing the bus. Now that we have finally caught it, we aren’t quite sure what to do with it. At times, it feels that it would have been better if we had never caught this bus of family medicine becoming a specialty, and all that this brings with it. This may seem like heresy to many colleagues. However, we have many questions as to the state of things in this country of ours, specifically in terms of family medicine and the future of health care. What is the role that we are going to play? What is the role that we are already playing?

Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa

Abstract Globally, models of extending universal health coverage through primary care are influenced by country-specific systems of health care and disease management. In 2015 a rapid assessment of the ward-based outreach component of primary care reengineering was commissioned to understand implementation and rollout challenges. Aim This article aims to describe middle- and lower-level managers’ understanding of ward-based outreach teams (WBOTs) and the problems of authority, jurisdiction and practical functioning that arise from the way the model is constructed and has been operationalised. Setting Data are drawn from a rapid assessment of National Health Insurance (NHI) pilot sites in seven provinces. Methods The study used a modified version of CASCADE. Peer-review teams of public health researchers and district/sub-district managers collected data in two sites per province between March and July 2015. Results Respondents unequivocally support the strategy to extend primary health care services to people in their homes and communities both because it is responsive to the family context of individual health and because it reaches marginal people. They, however, identify critical issues that arise from basing WBOTs in facilities, including unspecific team leadership, inadequate supervision, poorly constituted teams, limited community reach and serious infrastructural and material under-provision. Conclusion Many of the shortcomings of a facility-based extension model can be addressed by an independently resourced, geographic, community-based model of fully constituted teams that are clinically and organisationally supported in an integrated district health system. However, a community-oriented primary care approach will still have to grapple with overarching framework problems.

“Making a difference” – Medical students’ opportunities for transformational change in health care and learning through quality improvement projects

BackgroundQuality improvement is increasingly becoming an essential aspect of the medical curriculum, with the intention of improving the health care system to provide better health care. The aim of this study was to explore undergraduate medical students’ experiences of their involvement in quality improvement projects during a district health rotation.MethodsStudent group reports from rotations in learning centres of the University of Pretoria in Mpumalanga Province, South Africa were analysed for the period 2012 to 2015. Interviews were conducted with health care providers at four learning centres in 2013.ResultsThree main themes were identified: (1) ‘Situated learning’, describing students’ exposure to the discrepancies between ideal and reality in a real-life situation and how they learned to deal with complex situations, individually and as student group; (2) ‘Facing dilemmas’, describing how students were challenged about the non-ideal reality; (3) ‘Making a difference’, describing the impact of the students’ projects, with greater understanding of themselves and others through working in teams but also making a change in the health care system.ConclusionQuality improvement projects can provide an opportunity for both the transformation of health care and for transformative learning, with individual and ‘collective’ self-authorship.

Experiences of general practitioners in the Ga-Rankuwa and Mabopane areas in dealing with patients who have sexual problems

Abstract Background Sexual problems are common. Many patients with sexual health dysfunction use self-help literature or are often managed in general practice. However, many general practitioners (GPs) find it difficult to discuss sexual health issues because they feel uncomfortable with this and lack training in these matters. These GPs are now referring patients with sexual dysfunction to specialists. Aim We sought to explore how GPs working in the Mabopane and Ga-Rankuwa areas of handle sexual problems of their patients. Setting The setting was the Mabopane and Ga-Rankuwa areas of North-West Tshwane, in Gauteng Province. Methods A qualitative study comprising eight free attitude interviews with purposefully selected four male and four female GPs. All interviews were conducted in English and tape-recorded. Field notes in the form of a detailed diary was kept. The tapes were transcribed verbatim, and the transcriptions were checked against the tapes for omissions and inaccuracies. Results Six themes emerged from the interviews: causes of sexual problems; presentation of sexual problems to the doctor; management of sexual health problems; sex is a taboo topic; societys need for sexual health discussions, and these discussions have already begun; previous limited exposure and training, and a need for more sexual health training. Conclusion This study confirms earlier findings that patients could be either reluctant to discuss their problems or are open about them when presenting to doctors with sexual dysfunction. GPs were not exposed to sexual health training at medical school and, because of this shortcoming, felt that training in sexual medicine should be part of the curriculum.

Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

BackgroundTubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants.MethodsThis qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description.ResultsDiverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains.ConclusionsClients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.

'A shelter is not a home’ : voices of homeless women in the City of Tshwane

ABSTRACT In response to a request from the City of Tshwane that homelessness in the city be explored, a research team was established in 2014. The research was divided into four pillars: conceptual/theoretical perspectives of homelessness; narratives and experiences of homeless and former homeless people, particularly women; documentation of current practices to curb homelessness in the city; and policies that address homelessness in City of Tshwane. This article focuses on the second pillar. Individual interviews and one focus group interview with eight women were conducted. The results revealed four storylines: a shelter was halfway home; shelters had restrictive and protective regulations; reconnection programmes with families were required; and hope – as a matter of survival. Improving people’s economic status (not providing shelters) was the permanent solution to homelessness. Emphasis was on women’s right to equal status in housing issues which are guided by well-founded policies that are women friendly.

Students’ perceptions of the instructional quality of district hospital-based training

Background An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria. Aim To measure the students’ perceptions of the instructional quality of district hospital-based training. Setting Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces. Methods A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results. Results The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year. Conclusion Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement.