Christo Heunis | University of the Free State (original) (raw)

Papers by Christo Heunis

Research Square (Research Square), Aug 5, 2020

Background South Africa faces a chronic shortage of professional health workers. Accordingly, com... more Background South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce de ciencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs' motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). Methods In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. Results Out of 235 participants, 89.2% were female. Participants' median age was 39 (inter-quartile range: 33-45) years. CHW motivation was de ned by 16 items across three dimensions-intrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed

UpSpace Institutional Repository (University of Pretoria), Jan 18, 2017

Objective: To determine the status of early intervention services provided to children who are de... more Objective: To determine the status of early intervention services provided to children who are deaf or hard of hearing and their parents/caregivers from birth to five years of age at two main state hospitals in Riyadh, Saudi Arabia, based on their parents' perceptions. Method: A descriptive quantitative research design was used to determine the status of early intervention services for deaf or hard of hearing children in Saudi Arabia based on their parents' perceptions. Semistructured interviews based on a questionnaire were conducted with 60 research participants from two main state hospitals where early detection and intervention services are provided. A purposive sampling technique was employed. Descriptive and inferential statistical analyses were performed on the data collected. Results: The participants' children were diagnosed at a substantially late age, resulting in delayed ages for initial hearing aid fitting and enrollment in early intervention services. A significant relationship was found between the residential area of the participants and timely access to intervention services. The results indicated that participants residing in Riyadh were fitted with hearing aids and enrolled into EI services earlier than those living outside of Riyadh. The delivery of information also emerged as a weakness in the EI system for the majority of participants.

African Journal of Primary Health Care & Family Medicine, 2020

Background: The human resources for health crisis in rural Eswatini led to a novel community-base... more Background: The human resources for health crisis in rural Eswatini led to a novel community-based multidrug-resistant tuberculosis (MDR-TB) treatment strategy based on task-shifting, that is delegation of directly observed treatment (DOT) and administration of MDR-TB injections, traditionally restricted to professional nurses, to lay community treatment supporters (CTSs).Aim: This study assessed the level of patient satisfaction with receiving community-based MDR-TB care from a CTS.Setting: The study was conducted at three MDR-TB-treating facilities in the mostly rural Shiselweni region.Methods: A cross-sectional survey of a purposive sample of 78 patients receiving DOT and intramuscular MDR-TB injections from CTSs was carried out in 2017. Descriptive statistics and regressions were calculated.Results: A high overall general patient satisfaction score for receiving community-based MDR-TB care from a CTS was observed. Adherence counselling, confidentiality, provider selection and tr...

Acta Academica, 2006

Before the implementation of ART, and again seven months later, interviews were conducted with fa... more Before the implementation of ART, and again seven months later, interviews were conducted with facility managers and nurses leading PHC programmes. Their perceptions of the impact of ART are discussed. A positive finding was that ART assessment site managers had been optimistic about ART from the outset, and by the end of the sevenmonth period even more so. Nurses leading other PHC programmes were initially concerned about overcrowding the facility due to ART, but this problem did not feature prominently during the follow-up survey. ART programme nurses' perceptions of the problems at their facilities mostly related to staff and space. On the whole the data show that pessimism preceding the implementation of ART was in many respects allayed with implementation. Aanvanklike verwagtings en ervarings van antiretrovirale terapie onder bestuurders by ART-assesseringsfasiliteite in die Vrystaat Voor die implementering van ART, en weer sewe maande later, is onderhoude gevoer met fasiliteitsbestuurders en verpleegkundiges wat PGS-programme lei. Hul persepsies van die impak van ART word bespreek. 'n Positiewe bevinding was dat die bestuurders van assesseringsfasiliteite uit die staanspoor optimisties was oor ART, en teen die einde van die sewe maande-periode selfs meer so. Verpleegkundiges wat ander PGS-programme lei, was aanvanklik besorg oor oorlading van die fasiliteit vanweë ART, maar dié probleem was nie prominent tydens die opvolgopname nie. Verpleegkundiges in die ARTprogram se persepsies van die probleme wat in hulle fasiliteite ontstaan het, het meestal met personeel en ruimte verband gehou. In die geheel toon die data dat die pessimisme wat ART voorafgegaan het, in vele opsigte met implementering weerlê is.

BMC Infectious Diseases, Mar 5, 2018

Background: In 2012, the World Health Organization launched guidelines for systematically investi... more Background: In 2012, the World Health Organization launched guidelines for systematically investigating contacts of persons with infectious tuberculosis (TB) in low-and middle-income countries. As such, it is necessary to understand factors that would influence successful scale-up. This study targeted household contacts of newlydiagnosed infectious TB patients in the Mangaung Metropolitan district to explore factors associated with nonattendance of clinical evaluation. Method: In September-October 2016, a pilot study of household contacts was conducted. At each of the 40 primary health care (PHC) facilities in the district, at least one out of four types of TB index cases were purposefully selected. These included children <5 years, smear-positive cases, HIV co-infected cases, and multidrug-resistant TB (MDR-TB) cases. Trained fieldworkers administered questionnaires and screened contacts for TB symptoms. Those with TB symptoms as well as children <5 years were referred for clinical evaluation at the nearest PHC facility. Contacts' socio-demographic and clinical characteristics, TB knowledge and perception about TB-related discrimination are described. Logistic regression analysis was used to investigate factors associated with nonattendance of clinical evaluation. Results: Out of the 259 participants, approximately three in every five (59.5%) were female. The median age was 20 (interquartile range: 8-41) years. While the large majority (87.3%) of adult contacts correctly described TB aetiology, almost three in every five (59.9%) thought that it was hereditary, and almost two-thirds (65.5%) believed that it could be cured by herbal medicine. About one-fifth (22.9%) of contacts believed that TB patients were subjected to discrimination. Two in every five (39.4%) contacts were referred for clinical evaluation of whom more than half (52.9%) did not attend the clinic. Non-attendance was significantly associated with inter alia male gender (AOR: 3.4;

African Journal of Primary Health Care & Family Medicine, Jun 24, 2019

Unremitting health care inequality and inequity contradicts the aim of the National Health Act (6... more Unremitting health care inequality and inequity contradicts the aim of the National Health Act (61 of 2003) 6 to transform the national health system. The Act requires the National Health Council to monitor HRH utilisation across the public and private sectors. It also provides for a district health system (DHS) with municipalities responsible for their own primary health care (PHC) budgets. Primary health care clinics are the entry point for patients in need of preventative care and diagnosis and treatment of minor ailments. Professional nurses (PNs) with additional PHC training usually render these services, with MPs visiting on a rotating basis. Launched in 2012, the National Development Plan (NDP) 7 is the country's blueprint for sustainable growth until 2030. One of the 'critical actions' of the Plan is to phase in national health insurance (NHI). The 2017 National Department of Health's (NDoH) White Paper 8 envisaged that NHI will bridge the gap between the public and private sectors. National health insurance is being phased in over a 14-year period, with the first phase (2012-2017), which focused on public sector strengthening, already in the past. Background: South Africa is implementing national health insurance (NHI) and primary health care (PHC) re-engineering, and has concomitantly introduced the Human Resources for Health (HRH) Strategy. These policies are underpinned by the National Development Plan (NDP), which aims to address widespread inequality and inequity. Aim: The aim of this study was to analyse the alignment of national HRH-related policies to implement NHI and PHC re-engineering and determine knowledge gaps and research needs. Method: A narrative review of the NDP, PHC re-engineering, HRH and NHI strategies was carried out, supplemented by key HRH reports, data and articles. Results: Current policies stress NHI and PHC re-engineering without effectively addressing shortages and maldistribution of HRH across the provincial and public-private divides. In line with PHC re-engineering, the HRH Strategy emphasised strengthening of community health workers (CHWs), professional nurses (PNs), mid-level workers (MLWs), medical practitioners (MPs) and clinical specialists (CSs). Four of these, CHWs, MLWs, MPs and CSs, are varyingly still in absolute shortfall, as well as being inequitably distributed across the provincial and public-private divides. The seeming adequacy in the absolute number of PNs may disguise provincial and public-private sector disparities. Although expedited HRH development and equitable deployment are crucial, it is also vital to resolve extant education and accreditation challenges delaying HRH policy implementation. Conclusion: The current lack of alignment of HRH policies does not portend well for the successful implementation of NHI and PHC re-engineering. Knowledge gaps include the need for further clarification of ideal multidisciplinary team compositions and responsibilities.

BMC Public Health, Jul 1, 2010

Background: Although South Africa has the largest public-sector anti-retroviral treatment (ART) p... more Background: Although South Africa has the largest public-sector anti-retroviral treatment (ART) programme in the world, anti-retroviral coverage in adults was only 40.2% in 2008. However, longitudinal studies of who is accessing the South African public-sector ART programme are scarce. This study therefore had one main research question: who is accessing public-sector ART in the Free State Province, South Africa? The study aimed to extend the current literature by investigating, in a quantitative manner and using a longitudinal study design, the participants enrolled in the public-sector ART programme in the period 2004-2006 in the Free State Province of South Africa. Methods: Differences in the demographic (age, sex, population group and marital status) socioeconomic (education, income, neo-material indicators), geographic (travel costs, relocation for ART), and medical characteristics (CD4, viral load, time since first diagnosis, treatment status) among 912 patients enrolled in the Free State public-sector ART programme between 2004 and 2006 were assessed with one-way analysis of variance, Bonferroni post-hoc analysis, and cross tabulations with the chi square test. Results: The patients accessing treatment tended to be female (71.1%) and unemployed (83.4%). However, although relatively poor, those most likely to access ART services were not the most impoverished patients. The proportion of female patients increased (P < 0.05) and their socioeconomic situation improved between 2004 and 2006 (P < 0.05). The increasing mean transport cost (P < 0.05) to visit the facility is worrying, because this cost is an important barrier to ART uptake and adherence. Encouragingly, the study results revealed that the interval between the first HIV-positive diagnosis and ART initiation decreased steadily over time (P < 0.05). This was also reflected in the increasing baseline CD4 cell count at ART initiation (P < 0.05). Conclusions: Our analysis showed significant changes in the demographic, socioeconomic , geographic, and medical characteristics of the patients during the first three years of the programme. Knowledge of the characteristics of these patients can assist policy makers in developing measures to retain them in care. The information reported here can also be usefully applied to target patient groups that are currently not reached in the implementation of the ART programme.

BMC Public Health, Apr 15, 2009

Background: African and Asian cohort studies have demonstrated the clinical efficacy of antiretro... more Background: African and Asian cohort studies have demonstrated the clinical efficacy of antiretroviral treatment (ART) in resource-limited settings. However, reports of the long-term changes in the physical and emotional quality of life (QoL) of patients on ART in these settings are still scarce. In this study, we assessed the physical and emotional QoL after six and 12 months of ART of a sample of 268 patients enrolled in South Africa's public-sector ART programme. The study also tested the impact of the adverse effects of medication on patients' physical and emotional QoL. Methods: A stratified random sample of 268 patients undergoing ART was interviewed at baseline (< 6 months ART) and follow-up (< 12 months ART). A model of the relationships between the duration of ART, the adverse effects of medication, and physical and emotional QoL (measured using EUROQOL-5D) was tested using structural equation modelling. Results: The improved physical and emotional QoL shown at baseline was sustained over the 12month study period, because treatment duration was not significantly associated with changes in the patients' QoL. Physical QoL significantly and positively influenced the patients' emotional QoL (subjective well-being [SWB]) (β = 0.33, P < 0.01). Longitudinal data showed that patients reported significantly fewer adverse effects at follow-up than at baseline (β =-0.38, P < 0.001) and that these adverse effects negatively influenced physical (β =-0.27, P < 0.01) and emotional QoL (β =-0.15, P < 0.05). Conclusion: This study provides evidence that the South African public-sector ART programme is effective in delivering sustained improvement in patient well-being. However, the results should encourage clinicians and lay health workers to be vigilant regarding the adverse effects of treatment, because they can seriously affect physical and emotional QoL.

Future Virology, Jul 1, 2011

Research Square (Research Square), Apr 14, 2023

Background In an attempt to discern lessons to improve future pandemic responses, this study meas... more Background In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) con rmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. Methods A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon sign ranked tests. A 5% statistical signi cance level was considered Results Over the study period, the median values for the annual number of PHC visits was 1.8, 55.3% for unreferred OPD visits, 69.4% for ART commencement, 95.1% and 18.7% for DS-TB con rmation and treatment commencement respectively, and 93.7% for BCG coverage. While BCG coverage increased by 5.85% (p=0.0101), declines were observed in PHC utilisation (10.53%; p=0.0010), unreferred OPD visits (12.05%; p=0.0006), ART commencement (9.53%; p=0.0174), and DS-TB con rmation (5.24%; p≥0.050) and treatment commencement (3.80%; p≥0.050). Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics-as well as the entire quadruple burden of disease-in South Africa, the nding that the PHC utilisation rate statistically signi cantly decreased in the Free State post-COVID-19 commencement is particularly concerning. Conclusions The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a signi cant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a declines in PHC service utilisation, the decreased numbers of new patients commencing ART and lower con rmed DS-TB case and DS-TB treatment commencement rates, we also learned that EPHS delivery in the province was fragile. Background The COVID-19 virus infected more than 600 million and killed more than 6.5 million people [1]. With the end of the pandemic in sight [2-4], it is prudent to assess its effects on health care systems to identify challenges in order to strike a balance between managing emergencies and maintaining essential public health services (EPHSs) in the future [5-11]. After declaring the COVID-19 outbreak a global pandemic on 11 March 2020, on 1 June 2020 the World Health Organization (WHO) provided operational guidance to avert indirect morbidity and mortality and prevent acute exacerbations of chronic conditions when services are disrupted. Although the WHO [11 p. 6] emphasised certain high-priority health service areas-such as essential prevention and treatment services for communicable diseases, including immunisations-it stressed that countries should identify context-relevant EPHSs to be prioritised for continuation during the acute phase of the COVID-19 pandemic. South Africa embarked on a rapid COVID-19 response, characterised by the temporary suspension of research, diversion of key HIV and TB control resources, and regulation of patient access to health care facilities (12]. Early in the COVID-19 pandemic, an assessment of its impact on access to publicsector health care in South Africa indicated a sharp reduction in primary health care (PHC) utilisation [13]. Based on analysis of routine health care utilisation data from the District Health Information System (DHIS), this study reported that the pandemic had a considerable in uence on healthcare utilisation during April and May 2020 when strict lockdown regulations were in effect. There was dramatic impact on total and under 5 utilisation of PHC, as well as HIV testing. However, early access to antenatal care was only somewhat affected and recovered quite quickly after this period. Based on data routinely collected via the DHIS in 2019 and 2020, Pillay et al. (2021) analysed the impact of the COVID-19 pandemic in South Africa and reported that the severely restrictive lockdowns to reduce transmission and limit the number of patients requiring hospitalisation had mixed consequences for routine health services [14]. The services most seriously affected were early child care, access to contraceptives, and testing for HIV and TB. While a wide variation of measurable effects on EPHSs were observed, this varied by type of service, province and district. The full extent of the impact of the COVID-19 on the EPHS spectrum in South Africa is not yet clear. This study aimed to address the need for evidence on the impact of COVID-19 on EPHSs in the Free State province. In order to learn lessons to mitigate the impact of future pandemics on EPHSs, the objectives were to establish the effects of COVID-19 on EPHSs related to 1) PHC and 2) outpatient department (OPD) utilisation, 3) the antiretroviral treatment (ART) commencement rate, 4) the drug-susceptible tuberculosis (DS-TB) con rmed rate, 5) the DS-TB treatment commencement rate, and 6) Bacillus Calmette-Guérin (BCG) coverage during January 2019 to March 2021. The DS-TB con rmed and treatment commencement and BCG coverage rates respectively relate to the overall global agenda to improve TB diagnosis, care, and prevention [15, 16]. The ART commencement rate relates to one component (care or treatment) of the global agenda to improve HIV diagnosis, care, and treatment [17]. Methods Setting One of the country's nine provinces, the Free State is located in inland South Africa. The province had a population of 2 928 903 million in 2020 [18] and accommodated about 5% of the public health sector dependant population in the country, of whom more than 80% are African [19]. The province is confronted with serious public health systems challenges, including fragmentation of service delivery [20, 21]. The majority of the citizens are historically

This study reviews the origins and spread of tuberculosis in South Africa in the international co... more This study reviews the origins and spread of tuberculosis in South Africa in the international context. It shows that TB is far from being under control, despite the availability of effective technology. Five arguments offer explanations for this failure. First, control strategies fail to eradicate the macro-conditions that create a breeding ground for TB. Secondly, new disease conditions-especially HIV/AIDS and MDRTB-confound efforts at control. Thirdly, the health system and its priorities are insufficiently focused and resourced to cope with TB. Fourthly, healthcare staff responsible for TB care are often weak links in the chain of control. Fifthly, TB patients fail due to ignorance, delay in seeking care, and non-adherence to treatment regimens. TB consequently remains a major public health challenge, today more than ever in its protracted history. Tuberkulosebeheer in Suid-Afrika: redes vir voortdurende mislukkings Hierdie bydrae gee 'n oorsig van die oorsprong en verspreiding van tuberkulose in Suid-Afrika teen die agtergrond van die internasionale gemeenskap. Dit toon dat TB hoegenaamd nie onder beheer is nie ten spyte van die beskikbaarheid van doeltreffende tegnologie. Vyf argumente word vir hierdie mislukking aangevoer. Eerstens faal beheerstrategieë om daardie makro-omstandighede uit te wis wat die teelaarde vir TB daarstel. Tweedens, nuwe siektetoestande-veral MIV/VIGS en MDRTB-bemoeilik kontrolepogings. Derdens, die gesondheidsisteem en-prioriteite is nie genoegsaam gefokus en toegerus om TB suksesvol te hanteer nie. Vierdens, gesondheidspersoneel verantwoordelik vir TB-sorg is dikwels swak skakels in die kontroleketting. Vyfdens, TB-pasiënte faal dikwels deur hul onkunde, uitstel om behandeling te soek, en deur nie behandelingsvoorskrifte te volg nie. Gevolglik bly TB 'n hoof openbare gesondheidsprobleem, vandag meer as ooit tevore in sy uitgerekte geskiedenis.

Public health action, Mar 21, 2015

BMC Health Services Research, Sep 18, 2020

Background: South Africa faces a chronic shortage of professional health workers. Accordingly, co... more Background: South Africa faces a chronic shortage of professional health workers. Accordingly, community health workers (CHWs) are being employed to mitigate the ongoing health workforce deficiencies. As increased access to quality service delivery hinges upon their motivation, this study explored CHWs' motivation to deliver systematic household contact tuberculosis (TB) investigation (SHCI). Methods: In 2017, a cross-sectional survey was conducted among CHWs in the Mangaung Metropolitan District, Free State Province. Exploratory factor analysis was performed on a 30-item scale to determine the dimensions underlying CHW motivation. Items with factor loadings of 0.4 and above were retained. Descriptive and inferential analyses were used to determine CHW motivation levels. Multiple linear regression analysis was used to investigate the determinants of CHW motivation. Results: Out of 235 participants, 89.2% were female. Participants' median age was 39 (inter-quartile range: 33-45) years. CHW motivation was defined by 16 items across three dimensionsintrinsic job satisfaction, burnout and team commitment, together explaining 56.04% of the total variance. The derived scale showed satisfactory internal consistency (Cronbach's alpha: 0.81), with a mean motivation score of 52.26 (standard deviation [sd]: 5.86) out of 64. Statistically significant differences were observed between formal CHWsthose with at least phase 1 standardised accredited training, and informal CHWsthose without such accredited training regarding team commitment scores (17.82 [sd: 2.48] vs. 17.07 [sd: 2.82]; t (233) = 2.157; p = 0.013). CHW age (β = 0.118, p = 0.029), location (β = 1.737, p = 0.041), length of service (β = − 0.495, p < 0.001), attendance of TB SHCI training (β = 1.809, p = 0.036), and TB SHCI competence (β = 0.706, p < 0.001), contributed statistically significantly to CHW motivation. Conclusion: CHW motivation to perform TB SHCI was both intrinsic and extrinsic. The high overall mean score implies that the CHWs were well-motivated to perform TB SHCI. To ensure sustained improved access to quality TB SHCI service provision, programme managers in the Free State and similar settings could potentially use the tool derived from this study to monitor and inform CHW motivation interventions. Interventions should pay close attention to the CHWs' formalisation, competence and training.

African Journal of AIDS Research, Jun 1, 2013

With its emphasis on task shifting and multi-trained and skilled outreach teams the primary healt... more With its emphasis on task shifting and multi-trained and skilled outreach teams the primary healthcare (PHC) re-engineering strategy in South Africa depends on the training, knowledge and attitudes of community health workers (CHWs) to provide a variety of TB/HIV services. The aim of this exploratory research was to assess TB/ HIV-related training, knowledge and attitudes of CHWs. Interviews were conducted with 206 CHWs at 28 clinics in 1 urban and 2 rural sub-districts in the Free State province. Descriptive and bivariate analyses were performed using chi-square, Kruskal-Wallis (H) and Mann-Whitney (U) tests for non-parametric data. More than half (54.9%) had not received basic training in HIV counselling and testing; almost one-third (31.1%) had not received basic training in TB/directly observed treatment (DOT) support. Furthermore, most CHWs had not received any follow-up training in HIV counselling and testing and in TB/DOT support. Significant associations (0.01 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) between the types of CHWs and their sub-district location, and their TB/HIV-related training, knowledge and attitudes were observed. In respect of the TB/HIV knowledge items assessed, a large majority (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;95%) were knowledgeable, with only a few being ignorant about important facts related to TB/HIV. Lay counsellors were significantly more knowledgeable about TB/HIV than TB/DOT supporters and other CHWs were. Most CHWs disagreed with stigmatising statements about people with TB/HIV. The sub-district location of CHWs was significantly associated with their attitudes towards people with TB/HIV. CHWs in the two rural sub-districts were more likely to agree with stigmatising statements. In the context of PHC re-engineering, this exploratory research suggests that CHW TB/HIV training, knowledge and attitudes can and need to be improved if integrated TB/HIV services are to be successfully task-shifted to them in line with policy recommendations.

International Journal of Infectious Diseases, 2017

To determine and describe the factors influencing treatment default of tuberculosis (TB) patients... more To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa Methods: A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05.

Journal of the Association of Nurses in AIDS Care, 2011

Reliable data are a prerequisite for evidence-based decision making in health care policy (AbouZa... more Reliable data are a prerequisite for evidence-based decision making in health care policy (AbouZahr & Boerma, 2005). Accurate measurement is crucial in evaluating epidemic trends, as well as in planning and monitoring disease-specific service provision. On the basis of a systematic review of descriptive and comparative studies and previous reviews of health information technologies, Chaudhry et al. (2006) demonstrated the efficacy of information gathered using health information technologies, such as electronic health records, to improve both quality and efficiency of health care. Sound data are especially vital for the success of large-scale public sector health programs in developing countries where limited human and financial resources require their optimal use (Fraser et al., 2005). Lippeveld (in AbouZahr & Boerma, 2005) defined a health information system (HIS) as an "integrated effort to collect, process, report and use health information and knowledge to influence policy-making, programme action and research" (p. 579). HISs are especially important when responses need to be urgent, as in the case of epidemic diseases such as tuberculosis (TB) and HIV infection. The scale-up of both TB and HIV treatment in resource-limited settingsesuch as South Africaerequires an integrated approach that bundles the respective TB and HIV information systems to combat the co-epidemic.

African Health Sciences

Background: Based on the World Health Organization’s health systems strengthening framework, the ... more Background: Based on the World Health Organization’s health systems strengthening framework, the Health Systems Governance and Accountability (HSGA) intervention to strengthen public health leadership/management, service integration and outcomes was developed in the Free State. Objectives: This study describes the process to implement and measure the effects of the HSGA intervention for system-wide improvement of leadership/management under routine conditions in a resource-constrained setting. Methods: Based on normalisation process theory, participatory discussions were held with health managers, staff and local stakeholders to attain buy-in. Evaluation of the implementation process considered progress in improving leadership/management through application of the Balanced Scorecard (BSC). All provincial reporting units were assessed during 2014/15 and again during 2015/16. Results: The mean scores on three BSC perspectives improved statistically significantly from 2014/15 to 2015/1...

African Health Sciences

Background: A system-wide health system strengthening (HSS) initiative, the Health Systems Govern... more Background: A system-wide health system strengthening (HSS) initiative, the Health Systems Governance and Accountability (HSGA) intervention, was developed, translated to policy, and implemented in the Free State province. This study assessed health managers (HMs) and community representatives’ (CRs) views of the intervention and whether it improved integration and performance. Method: A questionnaire survey among 147 HMs and 78 CRs and 14 focus group discussions (FGDs) with a mean of 10.3 participants and a total of 102 HMs and 42 CRs, were conducted. The questionnaire and FGD data were descriptively and thematically analysed to triangulate findings. Results: Many HMs (44%) mostly positioned at the operational levels indicated that implementation of the HSGA intervention did contribute to integration of health services. Most CRs (54%) believed that communities were actively involved in the intervention. However, both the self-administered questionnaire and the FGD data evidenced la...

International Journal of Environmental Research and Public Health

Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective rol... more Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive–critical vaccine literacy, trust in the government’s ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government’s ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, ...

Additional file 1. Survey questionnaire.

Research Square (Research Square), Aug 5, 2020

UpSpace Institutional Repository (University of Pretoria), Jan 18, 2017

African Journal of Primary Health Care & Family Medicine, 2020

Acta Academica, 2006

BMC Infectious Diseases, Mar 5, 2018

African Journal of Primary Health Care & Family Medicine, Jun 24, 2019

BMC Public Health, Jul 1, 2010

BMC Public Health, Apr 15, 2009

Future Virology, Jul 1, 2011

Research Square (Research Square), Apr 14, 2023

Public health action, Mar 21, 2015

BMC Health Services Research, Sep 18, 2020

African Journal of AIDS Research, Jun 1, 2013

International Journal of Infectious Diseases, 2017

Journal of the Association of Nurses in AIDS Care, 2011

African Health Sciences

International Journal of Environmental Research and Public Health

Additional file 1. Survey questionnaire.