Health Systems and Public Health

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This division was formerly known as Community Health (prior to March 2017).

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Browsing Health Systems and Public Health by browse.metadata.advisor "Begg, Kerrin"

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    Factors influencing job satisfaction and intention-to-leave among nurses at Mbabane public hospital, Swaziland
    (Stellenbosch : Stellenbosch University, 2018-03) Mafara, Emma; Begg, Kerrin; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: There is sufficient empirical evidence to show that job satisfaction of nurses tends to affect organizational and health outcomes. However, a clear understanding of workplace variables that influence retention of nurses at an organization is required. Several studies on overall job satisfaction among health care workers have been conducted globally and in sub-Saharan Africa, however, no studies have been conducted in Swaziland on overall job satisfaction and retention of the nurse cadre, in a context where HIV has increased the workload on existing health facilities and consequently on staff. This study was conducted to assess factors influencing overall job satisfaction and intention-to-leave among nurses at Mbabane government hospital in Swaziland. Methods: A cross sectional study was carried out on 147 nurses using both quantitative and qualitative data collection methods from October 1st, 2016 to March 21st, 2017. Participants were nurse assistants, staff nurses, and nursing sisters working full time in the hospital during the study period1. Questionnaire data was analyzed using Stata, version 14.0. Univariate and Multivariate analyses between dependent variables (time pressure, opportunity- to- develop, quality of care, staff relations and work environment) and independent variables (overall job satisfaction and intention- to- leave) were performed using logistic regression. Qualitative data was analyzed using NVivo software. Results: Response rate was 97%, with 147 of 151 nurses participating. Of 147 participants 78 (54.9%) indicated overall satisfaction with their job while 98 (67.1%) indicated that they intended to leave their current position. Opportunity to develop (AOR: 4.11 [95% CI: 1.41-11.10] and Staff relations (AOR: 4.91 [95% CI: 1.75-13.77] were the final significant predictors of overall job satisfaction. After controlling for other factors, the adjusted odds ratio for association between opportunity -to -develop and intention- to- leave increased (0.23 [95% CI: 0.06-0.86]. While adjusted odds ratio for staff relations and intention- to- leave increased (0.22 [95% CI: 0.08-0.61]. Conclusion: The evidence shows that the greatest impact in retention of nurses in organizations will come from improved staff relations and enhanced opportunity-to-develop.
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    Financing of medical products in South Africa
    (Stellenbosch : Stellenbosch University, 2019-12) Mamdoo, Punithasvaree; Begg, Kerrin; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
    ENGLISH SUMMARY : Background: Medical products (encompassing medicines and medical devices) are critical health system building blocks; access to medical products (ATM) impact clinical outcomes. However, cost and operational inefficiencies in the health system limits ATM. Funding strategies and policy reforms are key instruments in managing the supply and demand side determinants of ATM. Objectives: This study aimed to 1) analyse the South African(SA) regulatory framework for medical products; 2) review expenditure on medical products at Private, Public and Household levels; and 3) describe ATM using the WHO Building Blocks framework and 4) gauge the status of supply and demand side determinants of ATM. Methodology: A mixed methods study design was used to represent ATM complexity in the health system. USAID’s Health System Assessment Approach was used to analyse the enabling legislative and regulatory landscape for ATM in SA. Unpublished National Treasury, provincial Departments of Health and Council for Medical Schemes Annual Reports were sources for the descriptive trend analysis of public and private sector medical products expenditure. Household out-of-pocket expenditure was analysed from Statistics SA national household survey data. With data from key informant interviews, a systems diagram was constructed. District Health information system and national survey data was used to present current system performance using supply and demand side indictors of ATM. Results: Medical products expenditure is a major cost driver in the private sector. Households with medical aid, spent more OOP on medical products than the uninsured; province, household size and income sources were not significant factors in estimating medical products expenditure. In the public sector, trends demonstrate increasing investment in medical products, however indicators of supply side ATM determinants show poor performance. In 2014, health contributed 0.9 %( R935) of total household expenditure; which does not constitute catastrophic expenditure levels. A larger proportion of total health spending is on medical products (0.7%) than outpatient medical services (0.6%) in average SA households; pharmaceutical expenditure dominates (90%) compared to therapeutic appliances and other medical products combined (10%). In uninsured households NC and LP provinces and Indian and White population groups were the only statistically significant variables in estimating expenditure. Male headed households spend more actual Rands on medical products than female headed households. A R31.00 decrease in expenditure for rural insured households was calculated for each increase in expenditure by urban insured households. Households in FS, NW, EC and NC had the highest OOP expenditures on medical products. Households in LP had the lowest OOP expenditure on medical products in the survey period. Conclusions and Recommendations: There are opportunities in the scale up to UHC to implement policy options to increase ATM. Capacity building is needed to ensure equitable fiscal allocations, ability to absorb resources and optimise service delivery within government. Need for improved monitoring and data analytics of cost, access and utilisation of medical products at public health facilities; OOP spending on medical products in private sector in terms of outpatient and hospitalisation and survey data at household level spending. Managed care Organisations can contribute to ATM through quality and clinical governance in the private sector.
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    Hospital cleaners’ knowledge, attitude and practices and the influence of training regarding cleaning roles in two government hospitals in the Erongo Region, Namibia
    (Stellenbosch : Stellenbosch University, 2022-12) Geurtze, Etheline Olivia; Begg, Kerrin; English, Rene; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    Introduction: Healthcare associated infections may arise following transfer of microorganisms from the hospital environment to patients. Effective cleaning and disinfection of hospital surfaces reduces the risk of pathogen transmission. This study explored the knowledge, attitudes and practises concerning their cleaning role and training influences of hospital cleaners at two governmental hospitals in the Erongo region, Namibia. Methods: A cross-sectional, mixed-methods design was used. Data were collected using a structured interviewer-administered questionnaire. Participants’ hospital cleaning knowledge, attitudes and practices were evaluated using quantitative analysis Open-ended questions explored their training experiences and thematic analysis was conducted. Results: Sixty-one hospital cleaners were interviewed. Eight participants (13,1%) received formal training. In terms of knowledge 68,9% knew they could carry germs without getting sick, and 55,7% reported that wearing gloves could sufficiently protect against germs. Sixty-five percent felt that they were not supported by other staff. In terms of practices, most of the reported challenges related to absence of necessary resources. Regarding the association between current knowledge, attitudes and practices and training, significant associations were shown for most measures. With regards to whether cleaners can protect themselves against germs without getting sick, and whether they can infect others with germs that they carry, knowledge levels were lowest for those with informal training (59,7%) and job-shadowing (60,1%) (p=0,01). Conclusion: This research study highlights limited formal training for hospital cleaners at two large Namibian hospitals, and demonstrates the need for formal training and better resource allocation of hospital cleaners who play a vital role in IPC and patient and healthcare worker safety.
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    Knowledge, attitudes and practice of healthcare workers on the use of health information technology : a mixed method descriptive survey among healthcare workers in Princess Marina Hospital, Gaborone, Botswana
    (Stellenbosch : Stellenbosch University, 2019-04) Ngcobo, Keamogetse; Begg, Kerrin; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.
    ENGLISH SUMMARY : Background: To date, studies of Health Information Technology (HIT) in Botswana have focused on the evaluation of development, implementation and utilisation of the District Health Information System (DHIS). However, health professionals are facing many challenges regarding the transition from paper to electronic-based system, as throughout the development and implementation of an integrated HIS at district and national levels. This study aims to assess the knowledge, attitude and practice of HIT among healthcare workers from Princess Marina Hospital in Botswana. Methods: A descriptive survey was carried out on 107 randomly selected healthcare workers using both quantitative and qualitative methods for data collection from November 2017 to March 2018. A piloted self-administered questionnaire was used to assess knowledge, attitudes and practices of healthcare workers regarding health information technology. Quantitative data was analysed and reported using descriptive analysis using the Statistical Package for Social Scientists (SPSS) version 24. Qualitative data was analysed using Nvivo software. Results: Overall, 107/110(97.3% response rate) healthcare workers agreed to participate. 67(62.6%) were doctors, 30(28%) pharmacy staff, 8(7.5%) nurses and 2(1.9%) medical records staff. The majority 81(75.7%) reported not receiving any computer training, 43(40.2%) reported a moderate level of proficiency. The majority did not carry out electronic patient documentation, 48(44.9%) or performed the task manually. With regard to attitude, 65(60.8%) were eager to learn. Conclusion: In general, the staff presented a lower level of knowledge and practice of HIT even though they showed positive attitudes. Provision of in-service training is needed in order to up-skill the health professionals regarding the use of HIT for patient care and management.