Irwin Friedman - Academia.edu (original) (raw)

Papers by Irwin Friedman

There is a strong rationale to involve men in supportive roles in issues that impact on sexual an... more There is a strong rationale to involve men in supportive roles in issues that impact on sexual and reproductive health. There is also an urgent need for men to use sexual and reproductive health services in a much more active manner than has traditionally been the case. Current data on the impact of disease on morbidity and mortality points to the devastating effect that HIV is having, particularly on young women and children. Similarly sexual violence and coercion are having a profound impact. Men have an obvious responsibility to improve the situation, but it is noted that they are not escaping the impact of the epidemic. Men may suffer less from HIV than women in their corresponding age cohorts, but they inevitably pay for this in the long run. When other causes of death, particularly violence and traffic accidents are taken in account, men have a shorter life expectancy than women. Current research has emphasised the value of several new areas of innovation, which include partic...

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1994

South Africa today is at the start of a new era. Much hard work and sustained effort are needed t... more South Africa today is at the start of a new era. Much hard work and sustained effort are needed to repair the damage to her social fabric sustained during the dark decades of apartheid. However a unique window of opportunity has been created to develop a ...

South African Medical Journal, 2014

High-quality research is essential for identifying the health needs and improving the health outc... more High-quality research is essential for identifying the health needs and improving the health outcomes of a population. [1] Health research drives development, as it generates the knowledge needed to improve health systems performance and, ultimately, health and health equity. [2] Remarkable medical advances have taken place in South Africa (SA), such as the invention of computed tomography [3] and the first human heart transplant, [4] through investment in health research by government and industry. There has, however, been a perceived reduction in state expenditure on health research in real terms from the beginning of the 1980s, [5] characterised by a redistribution of state expenditure in the healthcare system towards primary healthcare and an apparent stagnation in real terms in the level of government-funded health research expenditure between 1996 and 2006. [6] The Consensus Report on Revitalising Clinical Research in South Africa of the Academy of Science of South Africa (ASSAf) [5] has identified the low level of investment in clinical research as a major factor in SA's declining clinical research performance. This report recommended inter alia that developing countries should invest at least 2% of their gross domestic product (GDP) in research and development (R&D), and that 20% of gross expenditure on R&D (GERD) (i.e. 0.4% of the GDP) should be allocated to health research. [5] Against this background, the SA Ministry of Health, the Department of Health (DoH) and the National Health Research Committee (NHRC) have made a series of commitments to increase investment in health research through the country budget and the national health budget. For example, the National Health Research Policy of 2001 [7] proposed that the country budget for health research should be raised to at least 2% of total public sector health expenditure. Subsequently, the Ministry of Health committed itself through the Mexico, Bamako and Algiers declarations to allocate at least 2% of the national health budget to research. [8-10] In addition, the 2011 National Health Research Summit report [11] recommended that the national DoH increase its funding for health research to achieve the 2% target of the national health budget. This multiplicity of commitments, compounded by the lack of a detailed information system, renders interpretation of these commitments a complex process. The NHRC, which is a statutory body tasked with setting priorities for health research in SA, has therefore conducted an audit to determine the proportion of gross expenditure on R&D that has been spent on health research (as a proxy for the proportion of country budget spent on health research) in the past decade, as well as the proportion of the budget of the DoH that was spent on research in the period 2009/10-2012/13. We have compared these data with internationally accepted benchmarks as a

Abstract: There is a strong rationale to involve men in supportive roles in issues that impact on... more Abstract: There is a strong rationale to involve men in supportive roles in issues that impact on sexual and reproductive health. There is also an urgent need for men to use sexual and reproductive health services in a much more active manner than has traditionally been the ...

Abstract: A review of health research conducted in South Africa between 1994 and 2007 will be pre... more Abstract: A review of health research conducted in South Africa between 1994 and 2007 will be presented in this chapter. The purpose of this review was to assess the extent to which health systems research has reflected the country's emphasis on Primary Health Care, ...

Abstract: This chapter examines the use of various categories of Community Based Health Workers a... more Abstract: This chapter examines the use of various categories of Community Based Health Workers as first line health workers in dealing with important health and social issues, for example with Tuberculosis and HIV/AIDS. It attempts to answer certain key issues: Are ...

Base de datos : BVSDE.BIBLIOGRAFICA. Búsqueda : bvsde.lilacs.192108 [Identificador único]. Refere... more Base de datos : BVSDE.BIBLIOGRAFICA. Búsqueda : bvsde.lilacs.192108 [Identificador único]. Referencias encontradas : 1. Mostrando: 1 .. 1 en el formato [Largo]. pagina 1 de 1, 1 / 1, bvsde.bibliografica, seleccionar. imprimir. ...

Trials, 2013

Background: Poverty undermines adherence to tuberculosis treatment. Economic support may both enc... more Background: Poverty undermines adherence to tuberculosis treatment. Economic support may both encourage and enable patients to complete treatment. In South Africa, which carries a high burden of tuberculosis, such support may improve the currently poor outcomes of patients on tuberculosis treatment. The aim of this study was to test the feasibility and effectiveness of delivering economic support to patients with pulmonary tuberculosis in a high-burden province of South Africa. Methods: This was a pragmatic, unblinded, two-arm cluster-randomized controlled trial, where 20 public sector clinics acted as clusters. Patients with pulmonary tuberculosis in intervention clinics (n = 2,107) were offered a monthly voucher of ZAR120.00 (approximately US$15) until the completion of their treatment. Vouchers were redeemed at local shops for foodstuffs. Patients in control clinics (n = 1,984) received usual tuberculosis care. Results: Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics (intervention 76.2%; control 70.7%; risk difference 5.6% (95% confidence interval:-1.2%, 12.3%), P = 0.107). Low fidelity to the intervention meant that 36.2% of eligible patients did not receive a voucher at all, 32.3% received a voucher for between one and three months and 31.5% received a voucher for four to eight months of treatment. There was a strong dose-response relationship between frequency of receipt of the voucher and treatment success (P <0.001). Conclusions: Our pragmatic trial has shown that, in the real world setting of public sector clinics in South Africa, economic support to patients with tuberculosis does not significantly improve outcomes on treatment. However, the low fidelity to the delivery of our voucher meant that a third of eligible patients did not receive it. Among patients in intervention clinics who received the voucher at least once, treatment success rates were significantly improved. Further operational research is needed to explore how best to ensure the consistent and appropriate delivery of such support to those eligible to receive it.

AIDS Care, 2011

Abstract Home and community-based care (HCBC) has emerged as a way to provide cost-effective and ... more Abstract Home and community-based care (HCBC) has emerged as a way to provide cost-effective and compassionate care to people living with HIV (PLHIV) and those affected by the epidemic. HCBC organisations provide integrated services which address the basic needs of those infected and affected such as food, shelter, healthcare, protection from abuse and malnutrition. The main objective of the study was to conduct an audit of HCBC organisations in South Africa in order to provide the Government with empirical information on their existence, distribution, services and challenges. The primary approach to this task was to conduct a telephonic audit of organisations rendering HCBC services. Of the 2001 HCBC organisations that participated in the audit, the majority were situated in Limpopo and KwaZulu-Natal Provinces. More than half of all the organisations were located in the rural areas. The audited HCBC organisations targeted orphans and vulnerable children, PLHIV and vulnerable households and provided services such as conducting home visits, providing material and psychosocial support and running support groups. Most of the organisations were, however, faced with challenges such as lack of access to water, electricity and computer equipment and a formal office space. In addition, some organisations were in need of funds for stipends for their community caregivers. Non-availability of funds for stipends and necessary assets might affect the quality of HCBC services rendered. The findings of the study therefore suggest the need for more financial assistance from the Government and other stakeholders for organisations rendering HCBC services, in order for them to afford necessary assets and provide sustainable, high-quality services that can help in reducing HIV impacts in South Africa.

Oxford Textbook of Global Public Health, 2015

In the current international context of economic globalization, discussions have not only highlig... more In the current international context of economic globalization, discussions have not only highlighted inequalities within individual countries, but also inequalities between countries. Inequalities between countries are related to the differences in economic and social development achieved by different countries, which are generated by the position that these countries have occupied during different phases of history within the global production system. The latter reflect historical aspects, and the international economic and political environments in relation to each country’s share of global resources and development opportunities. Policies for fighting poverty and inequality require local, national, and global approaches, but funding issues often hamper their feasibility.

Learning from Existing Community Health/Care Worker Programmes. Durban:

Health Systems Trust, …, 2007

Do oc cu um me en nt ti in ng g & & L Le ea ar rn ni in ng g f fr ro om m B Be es st t P Pr ra ac... more Do oc cu um me en nt ti in ng g & & L Le ea ar rn ni in ng g f fr ro om m B Be es st t P Pr ra ac ct ti ic ce e C CH HW W P Pr ro og gr ra am mm me es s 1 1

BMC Medical Informatics and Decision Making, 2014

Background: In an attempt to address a complex disease burden, including improving progress towar... more Background: In an attempt to address a complex disease burden, including improving progress towards MDGs 4 and 5, South Africa recently introduced a re-engineered Primary Health Care (PHC) strategy, which has led to the development of a national community health worker (CHW) programme. The present study explored the development of a cell phone-based and paper-based monitoring and evaluation (M&E) system to support the work of the CHWs. Methods: One sub-district in the North West province was identified for the evaluation. One outreach team comprising ten CHWs maintained both the paper forms and mHealth system to record household data on community-based services. A comparative analysis was done to calculate the correspondence between the paper and phone records. A focus group discussion was conducted with the CHWs. Clinical referrals, data accuracy and supervised visits were compared and analysed for the paper and phone systems. Results: Compared to the mHealth system where data accuracy was assured, 40% of the CHWs showed a consistently high level (>90% correspondence) of data transfer accuracy on paper. Overall, there was an improvement over time, and by the fifth month, all CHWs achieved a correspondence of 90% or above between phone and paper data. The most common error that occurred was summing the total number of visits and/or activities across the five household activity indicators. Few supervised home visits were recorded in either system and there was no evidence of the team leader following up on the automatic notifications received on their cell phones. Conclusions: The evaluation emphasizes the need for regular supervision for both systems and rigorous and ongoing assessments of data quality for the paper system. Formalization of a mHealth M&E system for PHC outreach teams delivering community based services could offer greater accuracy of M&E and enhance supervision systems for CHWs.