Health Services In South Africa Research Articles

Experiences of oral pre-exposure prophylaxis use among heterosexual men accessing sexual and reproductive health services in South Africa: a qualitative study.

South African men face a substantial burden of HIV and are less likely to test for HIV and initiate antiretroviral therapy if tested positive and more likely to die from AIDS-related causes than women. In addition to condoms and circumcision, guidelines provide for the use of daily oral pre-exposure prophylaxis (PrEP) as an HIV prevention intervention for any men who recognize their need and request PrEP. However, heterosexual men have not been a focus of PrEP programmes, and since its introduction, there is limited literature on PrEP use among men in South Africa. This study explores the experiences, motivators and barriers to oral PrEP use among heterosexual men accessing primary healthcare services in South Africa. This study forms part of a mixed-methods implementation science study aimed at generating evidence for oral PrEP introduction and conducted in primary healthcare clinics in South Africa since 2018. Men aged ≥15 years who initiated oral PrEP and enrolled in a parent cohort study were purposefully invited to participate in an in-depth interview (IDI). Between March 2020 and May 2022, 30 men participated in IDIs exploring their motivators for PrEP use, and experiences with accessing health services. Interviews were audio recorded, transcribed and analysed thematically. The final analysis included 28 heterosexual men (18-56 years old). Motivations to initiate PrEP included fear of acquiring HIV, self-perceived vulnerability to HIV and mistrust in relationships; health systems factors which motivated PrEP use included the influence of healthcare providers, educational materials and mobile services. Perceived reduction in HIV vulnerability and changing proximity to partners were reasons for PrEP discontinuation. Side effects, daily-pill burden and stigma were noted as challenges to PrEP use. Health system barriers to PrEP use included limited PrEP availability, school and work demands, and inconsistent mobile clinic schedules. Our study reports on the experiences of heterosexual men accessing oral PrEP in real-world settings and contributes to the limited literature among this population. We highlight multiple levels which could be strengthened to improve men's PrEP use, including individual support, education among partners and communities, and addressing health system barriers to access.

Patterns of HIV Pre-exposure Prophylaxis use Among Adolescent Girls and Young Women Accessing Routine Sexual and Reproductive Health services in South Africa

PurposeThis study describes the patterns of pre-exposure prophylaxis (PrEP) use among adolescent girls and young women (AGYW) initiated on daily oral PrEP for the prevention of HIV, within routine sexual and reproductive health services in South Africa. MethodsWe analysed clinical and survey data from a nested cohort of 967 AGYW initiated on oral PrEP between January 2019 and December 2021 in four geographical clusters in South Africa. We describe the periods of PrEP use, and the proportion who discontinued and subsequently restarted PrEP. Logistic regression analyses were conducted to determine factors associated with early PrEP discontinuation, PrEP use for ≥4 months and PrEP restart. ResultsPrEP use for ≤1 month was high (68.6%), although 27% returned and restarted PrEP; and 9% restarted more than once. Initiating PrEP at a mobile clinic (AOR 2.10, 95% CI 1.51 – 2.93) and having a partner known to be HIV negative or whose HIV status was unknown (AOR 7.11, 95% CI 1.45 – 34.23; AOR 6.90, 95% CI 1.44 – 33.09) were associated with PrEP use for ≤1 month. AGYW receiving injectable contraceptives were more likely to restart PrEP (AOR 1.61, 95% CI 1.10 – 2.35). Compared to those aged 15–17 years, participants 18 – 20 and 21 – 24 years were less likely to restart PrEP (AOR 0.51, 95% CI 0.35 – 0.74; AOR 0.60, 95%, CI 0.41 – 0.87), as were those initiating PrEP at a mobile clinic compared to a fixed facility (AOR 0.66, 95% CI 0.47 – 0.92). DiscussionAlthough early PrEP discontinuation was high, it appears that PrEP use is frequently cyclical in nature. Further research is needed to determine if these cycles of PrEP correlate to periods of perceived or actual vulnerability to HIV, which may also be cyclical. PrEP delivery presents a unique opportunity to address multiple unmet health needs of young people.

Eita! Reaching Communities and Young People to Drive Demand for Oral Pre-Exposure Prophylaxis in South Africa

PurposeThis paper describes a holistic but flexible demand creation strategy for pre-exposure prophylaxis (PrEP) in national public health-care settings in low-income to middle-income countries. MethodsWe describe the development and implementation of a model to drive demand for oral PrEP uptake and use as part of comprehensive sexual and reproductive health services in South Africa: The Eita! model. The project adapted two existing response hierarchy models (marketing models used to describe the stages individuals move through from being unaware to using a product), to formulate the Eita! model. Using the RE-AIM framework, we report on the reach, effectiveness, adoption, implementation, and maintenance of the Eita! model. ResultsMore than 34 million connections were made from December 2018 to 2021 through a variety of channels: social media and websites, at events and mobile clinic outreach, and radio and community dialogs. There were 42,447 adolescent girls and young women reached in-person during this time, 16,823 adolescent girls and young women presented for sexual and reproductive health services, and of those 14,637 (87%) initiated on PrEP. The model was implemented in eight health-care facilities and four mobile clinics in three provinces in South Africa. A total of 26 trainings were delivered to project staff implementing the strategy. Various demand creation resources, such as materials and online platforms, have since been adopted by the National Department of Health as national tools. DiscussionThe Eita! model was successfully implemented to support the uptake of HIV prevention services and rollout of biomedical prevention products, and can be adapted by other low-income to middle-income countries.

The Use of HIV Pre-exposure Prophylaxis Among Men Accessing Routine Sexual and Reproductive Health Services in South Africa

PurposeThis study describes a cohort of men seeking oral pre-exposure prophylaxis (PrEP) services and explores their patterns of PrEP use within an implementation project seeking to integrate PrEP provision within sexual and reproductive health services in public health clinics in South Africa. MethodsRoutine program and survey data from 364 males initiated on oral PrEP between July 2020 and May 2022 were analyzed. PrEP use was examined, including time to first discontinuation and restart patterns. Factors associated with early PrEP discontinuation and PrEP restart were analyzed. ResultsDespite primarily focusing on access for adolescent girls and young women, PrEP services reached males with HIV prevention needs. PrEP use for ≤1 month (early discontinuation) was high at 58%; however, 18% restarted on PrEP, with 4% restarting repeatedly. Having depression symptoms was associated with early PrEP discontinuation (adjusted odds ratio [AOR]: 1.71, 95% CI [confidence interval]: 1.06–2.78). Those ≥25 years were less likely to discontinue early, as were those with a partner treated for a sexually transmitted infection in the preceding three months (AOR: 0.33, 95% CI: 0.13–0.84) and those who had been circumcised (AOR: 0.59, 95% CI: 0.36–0.96). Those 18–20 years old were less likely to restart PrEP than those ≥25 years (AOR: 0.43, 95% CI: 0.19–0.97), as were those whose partner's HIV status was unknown (AOR: 0.33, 95% CI: 0.12–0.88). DiscussionThis study identified interest and uptake of oral PrEP among an underrepresented population of predominantly heterosexual males seeking sexual and reproductive health services. It found high rates of early PrEP discontinuation, with a subset returning to restart PrEP. Further research is needed to determine whether these periods of PrEP use are associated with periods of HIV risk.

The economic burden of chronic diseases with co-occurring depression and alcohol use disorder for people in the Western Cape, South Africa

There is limited evidence on the economic burden of chronic diseases with co-occurring depression and alcohol use disorder (AUD) for people in low-and middle-income countries. We describe patient costs related to the utilisation of services and identify factors associated with the economic burden of co-occurring depression and AUD for people with HIV and/or diabetes using government health services in South Africa. We used baseline data from participants enrolled in a cluster randomised controlled trial (RCT). The sample (N = 1340) comprised participants classified as having risk of depression but not AUD (n = 689), risk of AUD but not of depression (n = 221); or risk of depression and AUD (n = 430). We measured total patient costs (direct patient costs (out-of-pocket payments (OOPP) plus indirect patient costs), and catastrophic costs. We applied a conceptual framework to guide multiple linear and logistic regression analyses examining factors associated with economic burden. Mean monthly total costs per patient and the percentage of these total costs attributable to OOPP were (US$9.78 [56.13%]; US$5.98 [24.58%]; US$7.16 [34.07%]) for the depression, AUD, and AUD and depression groups respectively. The depression group reported significantly more visits to private healthcare providers, higher OOPP and higher prevalence of catastrophe than other groups. OOPP were positively associated with urban location and higher educational attainment. Total patient costs were positively associated with urban location, HIV and diabetes comorbidity, and being employed. Higher utilisation was associated with greater odds of income loss. Results indicate a concerning economic burden in people with a chronic disease and co-occurring depression or AUD and suggest that cost and time may present barriers to accessing care. Given that psychological treatments for mental health conditions are largely unavailable in government health services, improving access to care for the most vulnerable may require coordination of financial risk protection mechanisms alongside scale-up of effective first-line psychological treatments.

Access to Public Health Services in South Africa’s Rural Eastern Cape Province

Access to Public Health Services in South Africa’s Rural Eastern Cape Province

Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021

In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemic and extent of recovery. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached - suggesting a slow recovery and continuing impact of the pandemic. The COVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets.

"We Were Afraid": Mental Health Effects of the COVID-19 Pandemic in Two South African Districts.

The impacts of pandemics are recognized to go beyond infection, physical suffering, and socio-economic disruptions. Other consequences include psychological responses. Using a mental wellbeing lens, we analyzed COVID-19-related stressors in healthcare workers (HCWs) and community members who provided and regularly accessed health services in South Africa, respectively. From February to September 2021, during the second COVID-19 wave we conducted a qualitative study in one urban and one rural district. In-depth interviews and focus group discussions were used to collect data among 43 HCWs and 51 community members purposely and conveniently selected. Most participants experienced mental health challenges regarding multiple aspects of the COVID-19 pandemic and its resulting lockdown, with a few reporting positive adjustments to change. COVID-19 impacts on mental health were consistent among both HCWs and community members in urban and rural alike. Participants’ COVID-19-induced psychological responses included anxiety and fear of the unknown, perceived risk of infection, fear of hospitalization, and fear of dying. Physical effects of the pandemic on participants included COVID-19 infection and associated symptoms, possibilities of severe illness and discomfort of using personal protective equipment. These distresses were exacerbated by social repercussions related to concerns for family wellbeing and infection stigma. Lockdown regulations also intensified anxieties about financial insecurities and social isolation. At times when common coping mechanisms such as family support were inaccessible, cultural consequences related to lack of spiritual gatherings and limited funeral rites posed additional stress on participants. In preparation for future public health emergencies, recognition needs to be given to mental health support and treatment.

Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana.

Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development. We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within under-resourced public sector health services in South Africa, Bolivia, Malawi, and Ghana. Drawing on implementation reports, qualitative and quantitative data from our research, prospective and retrospective data collection, self-reflection, and our shared experiences, we review our capacity-building approaches for improving quality of care, implementation effectiveness, and lessons learned. These country studies provide important evidence that improved inpatient management of SAM is scalable in routine health services and scalability is achievable within different contexts and health systems. Effectiveness in reducing inpatient SAM deaths appears to be retained at scale.The country studies show evidence of impact on mortality early in the implementation and scaling-up process. However, it took many years to build workforce capacity, establish monitoring and mentoring procedures, and institutionalize the guidelines within health systems. Key features for success included collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. For frontline staff to be confident in their ability to deliver appropriate care competently, an enabling environment and supportive policies and processes are needed at all levels of the health system.

The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians.

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.

The feasibility and ongoing use of electronic decision support to strengthen the implementation of IMCI in KwaZulu-Natal, South Africa

BackgroundContinued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources.MethodsIn a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers.ResultsFrom December 2019 – January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1–46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032).ConclusionThe ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges.

Perceptions Of Frontline Service Providers On The Accreditation Of Occupational Health Services In South Africa

Perceptions Of Frontline Service Providers On The Accreditation Of Occupational Health Services In South Africa

Implementing solution‐focused brief therapy to facilitate hope and subjective well‐being among South African trauma survivors: A case study

AbstractPositive psychology interventions have been shown to improve well‐being in various contexts. However, few studies have explored the use of these approaches in clinical settings. Considering the high prevalence of trauma and the pressure on public mental health services in South Africa, this study implemented and described solution‐focused brief therapy (SFBT) with South African trauma survivors in order to explore their experiences of hope and subjective well‐being (SWB), during and after exposure to SFBT. Using a multiple case study design, qualitative data were collected from therapeutic sessions and semi‐structured individual interviews with seven black female participants. Following thematic analysis, results indicated that SFBT contributed towards participants’ experiences of hope and SWB. In particular, the therapeutic conversation, empathy and acceptance in therapy, visualising a better future and focusing on strengths instead of the trauma facilitated these experiences. SFBT may thus be an appropriate intervention to facilitate hope and SWB among trauma survivors.

Engaging future healthcare professionals for rural health services in South Africa: students, graduates and managers perceptions

BackgroundThe shortage of healthcare professionals (HCP) negatively affects health services in rural areas in many parts of the world, as is the case in South Africa. Innovative programs designed to improve the recruitment strategies for health system in a rural area are essential. They need support with a scholarship and mentorship programme for young people from rural areas to study for health science degrees, with the aim that they would take up a post at the hospital in their community, once qualified.This paper reports the perceptions and experiences of the students and graduates sponsored by the foundation, and those of managers from the facilities where the students were ultimately placed, in order to gauge whether such a programme can make a sustainable contribution to address the shortage of health personnel in rural areas and to what extent this is happening.MethodsThe authors used qualitative methods, combining semi-structured in-depth interviews and focus groups and the data were analyzed thematically.ResultsThe results provide information on students interviewed who appreciated the financial and socio-emotional support that they received. On the other hand, graduates value the availability of jobs in their home community on completion of their studies. The managers reported the success of the programme in increasing the number of healthcare personnel at the hospitals, and the increased range of available medical services. Since the graduates are familiar with the language and culture of their patients the managers considered that they are better able to assist them.ConclusionsThe system was well thought-out and achieved its goal of improving health services in an underdeveloped rural area of South Africa. More could be achieved if other government services in the area were simultaneously improved and if the system were replicated elsewhere. The students and graduates from rural areas are involved on sustaining health services in rural areas while rural managers support the programme and make suggestions for improvement and to promote the program in other regions.

Investigating language barriers in psychiatric care in Ghana

ABSTRACT Background: In psychiatric care, doctors depend on information from interactions with patients to arrive at the right diagnosis and appropriate therapy (Brisset C, Leanza Y, Rosenberg E, Vissandjée B, Kirmayer LJ, Muckle G, et al. language barriers in mental health care: a survey of primary care practitioners. J Immigr Minor Health. 2014;16(6):1238–46). This is a qualitative descriptive study which seeks to investigate language barriers faced by psychiatrists in their interactions with patients and the effectiveness of the strategies which are employed to deal with the barriers. Methods: Research questions are informed by Convergence (Giles H. Communication Accommodation Theory. In: Baxter LA, Braithewaite DO, editors. Engaging theories in interpersonal communication: multiple perspectives. Thousand Oaks ( CA): Sage Publications; 2008. p. 161–73). Using semi-structured interviews, psychiatric doctors from the three state-owned psychiatric hospitals in Ghana report their experiences with convergence strategies they use, and offer suggestions that could inform future studies and policy formulation with regard to psychiatric care in Ghana. A qualitative conventional content analysis was applied whereby coding categories were derived straight from the text data. Results: The literature suggests that the study is novel with reference to Ghana. Similar studies (Lee E. Cross-cultural communication: therapeutic use of interpreters in mental health for professionals and clinicians. In: Lee E, editor. Working with Asian Americans: a guide for clinicians. New York (NY): The Guilford Press; 1997; Swartz L, Drennan G. Beyond Words: notes on the ‘irrelevance’ of language to mental health services in South Africa. Transcult Psychiatry. 2000;37(2):185–201; Jarvis GE, Ahmed R, Ryder A, Kirmayer LJ. Assessing language barriers to mental health services in a multiethnic population: preliminary findings. Presentation at Health care Access for Linguistic Minorities: Breaking the Barriers. Montreal, Quebec, Canada; 2014) corroborate this paper’s findings that language barriers have the potential of causing misdiagnoses if psychiatrists do not employ effective communication strategies. Conclusions: The paper recommends areas for further research and improvement measures which carry policy implications.

Prohibiting alcohol sales during the coronavirus disease 2019 pandemic has positive effects on health services in South Africa.

As the coronavirus disease 2019 (Covid-19) pandemic evolves globally, we are realising its impact on communities from the disease itself and the measures being taken to limit infection spread. In South Africa (SA), 62 300 adults die annually from alcohol-attributable causes. Alcohol-related harm can be reduced by interventions, such as taxation, government monopolising retail sales, outlet density restriction, hours of sales and an advertising ban. To mitigate the impact of the Covid-19 pandemic, SA instituted a lockdown that also prohibited alcohol sales. This led to a sharp reduction in unnatural deaths in the country from 800–1000/week to around 400/week during the lockdown. We reviewed three 2-week periods at a large rural regional hospital: Before Covid-19 (February), during social distancing (March) and during lockdown with alcohol ban (April). A dramatic drop in patient numbers from 145 to 64 (55.8%) because of assault, from 207 to 83 (59.9%) because of accidents, from 463 to 188 (59.4%) because of other injuries and from 12 to 1 (91.6%) because of sexual assaults was observed during the first 2 weeks of lockdown. As healthcare professionals, we need to advocate for the ban to remain until the crisis is over to ensure that health services can concentrate on Covid-19 and other patients. We encourage other African states to follow suit and implement alcohol restrictions as a mechanism to free up health services. We see this as an encouragement to lobby for a new normal around alcohol sales after the pandemic. The restrictions should focus on all evidence-based modalities.

Evaluation of the effectiveness of a quality improvement intervention to support integration of maternal, child and HIV care in primary health care facilities in South Africa

BackgroundDespite policies and guidelines recommending integration of health services in South Africa, provision of maternal and child health services remains fragmented. This study evaluated a rapid, scaleable, quality improvement (QI) intervention to improve integration of maternal and child health and HIV services at a primary health level, in KwaZulu-Natal, South Africa.MethodsA three-month intervention comprised of six QI mentoring visits, learning sessions with clinic staff to share learnings, and a self-administered checklist aimed to assist health workers monitor and implement an integrated package of health services for mothers and children. The study evaluated 27 clinics in four sub-districts using a stepped-wedge design. Each sub-district received the intervention sequentially in a randomly selected order. Five waves of data collection were conducted in all participating clinics between December 2016–February 2017. A multi-level, mixed effects logistic regression was used to account for random cluster fixed time and group effects using Stata V13.1.ResultsImprovements in some growth monitoring indicators were achieved in intervention clinics compared to control clinics, including measuring the length of the baby (77% vs 63%; p = 0.001) and health workers asking mothers about the child’s feeding (74% vs 67%; p = 0.003), but the proportion of mothers who received feeding advice remained unchanged (38% vs 35%; p = 0.48). Significantly more mothers in the intervention group were asked about their baby’s health (44% vs 36%; p = 0.001), and completeness of record keeping improved (40% vs 26%; I = < 0.0001). Discussions with the mother about some maternal health services improved: significantly more mothers in the intervention group were asked about HIV (26.5% vs 19.5%; p = 0.009) and family planning (33.5% vs 19.5%; p < 0.001), but this did not result in additional services being provided to mothers at the clinic visit.ConclusionThis robust evaluation shows significant improvements in coverage of some services, but the QI intervention was unable to achieve the substantial changes required to provide a comprehensive package of services to all mothers and children. We suggest the QI process be adapted to complex under-resourced health systems, building on the strengths of this approach, to provide workable health systems strengthening solutions for scalable implementation.Trial registrationClinicalTrials.gov NCT04278612. Date of Registration: February 19, 2020. Retrospectively registered.

Trends in practice intentions and preferences of clinical associate students: Implications for training and health services in South Africa

BackgroundThe University of Pretoria (UP) had its first intake of Bachelor of Clinical Medical Practice (BCMP) students in 2009. The objectives of this study were to examine the trends in geographical practice intentions and preferences of the first nine cohorts of BCMP students. We also assessed sector and level of care preferences of six BCMP cohorts.MethodsCross-sectional studies were conducted 2011, 2014 and 2017. First-, second- and third-year UP BCMP students were invited to complete a electronic questionnaire. Our analyses consisted of calculating proportions for the practice intentions and preferences for each surveys, and performing multiple logistic regression on the aggregated date to determine their associations with sociodemographic and training characteristics.ResultsThe proportion of participants intending to practise as a clinical associate in a rural area in South Africa directly after graduating was 62.5% in the 2014 survey and 69.7% in the 2017 survey, compared to 59.6% in the 2011 survey. The majority in all three surveys (53.4% in 2011, 56.6% in 2014 and 59.8% in 2017) indicated a preference for rural practice. Both rural practice intention and rural practice preference were found to be significantly associated with respondent’s self-description of having lived most of her/his life in a rural area, and rural district hospital exposure during training. In 2014 and 2017, approximately two-thirds of the participants selected a public sector option as their most preferred work setting. District hospitals were the most preferred setting of 30.3% participants in 2014 and 32.0% in 2017.ConclusionMost participants across the three surveys intended to work in rural settings. Considering that this could provide a sustainable solution to the shortage of health care workforce in rural areas, policy makers in both higher education and health need to promote and ensure the viability of the training of this category of health care providers.

The use of appreciative inquiry with mental health service consumers -towards responsive occupational therapy programmes

BACKGROUND: Common ways of planning and evaluating occupational therapy services include the clinical judgement of therapists and cause-effect interpretation of statistics. Patient-informed methods of planning occupational therapy services are yet to be explored within occupational therapy, and more specifically within the provision of in- and out-patient mental health services in South Africa. An Appreciative Inquiry was conducted to explore the views of a group of out-patients on a craft group at a tertiary mental health hospital in the Western Cape, South Africa. OBJECTIVES: To highlight the use of Appreciative Inquiry to explore the perspectives of out-patient mental health consumers. To identify the enabling elements contained in an Occupational Therapy out-patient craft group. METHODOLOGY: A social constructivist paradigm framed the research process. The 4-D model of Appreciative Inquiry was used. Six participants selected via purposive sampling were recruited as co-researchers. Five data collection sessions of 90 minutes each were conducted. Inductive analysis was used. FINDINGS: The research participants come from differing ethnic and social backgrounds which contributed to the richness and transferability of the findings. Participants identified ten elements that enabled them to improve their mental health and enhanced their sense of belonging to the group. These included non-judgement, being able to redo the craft activity at home, no pressure, the stimulating effect of the group, being able to talk to the therapist about anything, feeling like a family, socialising nicely, a calm environment, feeling safe at the group and a quiet environment. It may be unrealistic for an occupational therapist to have the time available to evaluate their clinical services using the Appreciative Inquiry model. However, it may be beneficial for occupational therapists to apply the principles of Appreciative Inquiry in the evaluation of their groups. CONCLUSION: Appreciative Inquiry is a valuable method for exploring patient views of useful aspects of occupational therapy outpatient art groups. Key words: Psychiatry, Craft Groups, Outpatients, Appreciative Inquiry

Using section 27 to open up the accessibility of smoking cessation health services in South Africa

Owing to the addictive nature of tobacco products, an effective smoking cessation strategy is key in curbing the tobacco epidemic and promoting health rights. Unaided attempts to cease tobacco consumption are mostly unsuccessful, giving smoking cessation a central role in the fight against the tobacco epidemic. After examining South Africa (SA)’s tobacco control policy, this article argues that to a large extent, the accessibility of both non-pharmacological and pharmacological interventions to treat tobacco dependence is still limited. The central argument made is that the right to access healthcare services under section 27 of the Constitution can be used to unlock access to smoking cessation services. Smoking cessation services should be prioritised as an important subset of the right to access healthcare services in SA.