Research Articles (Ukwanda Centre for Rural Health)

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Acceptability and feasibility of a school-based contraceptive clinic in a low-income community in South Africa
(Cambridge University Press, 2019) Khoza, Nondumiso; Zulu, Phindile; Shung-King, Maylene
Aim: To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community. Background: Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health workers, long distances to clinics and perceptions of contraceptive side effects may all inhibit contraceptive use by adolescents. Although SBCC has been initiated and investigated in other countries, this approach is inadequately researched in South Africa. Methods: A mixed method study was conducted to assess the attitudes of one community towards establishment of an SBCC in their area. Methods of data collection included: focus group discussions (FGDs) with teenage girls from a local high school; a key informant interview with the school principal; a structured survey, including open-ended questionnaires with randomly selected parents of teenage girls from the same community; and a documentary analysis to explore relevant legal and policy considerations. Findings: Teenage girls, the school principal and parents with teenage daughters largely supported the idea of an SBCC, but with concerns about confidentiality, the possibility of increased promiscuity and contraceptive side effects. While legal statutes and policies in South Africa do not pose any barriers to the establishment of an SBCC, some logistical barriers remain.
The availability, utilisation and relevance of therapeutic apparatuses in South African occupational therapy clinical practice
(The Occupational Therapy Association of South Africa, 2019-12) Duvenage, Catharina Maria Elizabeth; Dube, Kopano Rebaona; Rodrigues, Anne Maria; Swart, Alicia; Slater, Kelly
The World Federation of Occupational Therapists (WFOT) steers the development, use and practice of occupational therapy internationally through numerous operations including policy and research in an effort to homogenise and advance occupational therapy training globally. The Federation has compiled and published the Minimum Standards for the Education of Occupational Therapists that serves as a blueprint to both set the minimum standard for educational programmes in occupational therapy and to foster continuous quality assurance and professional development. In South Africa, the Professional Board for Occupational Therapy, Medical Orthotics and Prosthetics and Arts Therapy has incorporated these standards into the national policies and guidelines for occupational therapy training2,3. Consistent with international standards, one of the key outcomes highlighted in the national policies and guidelines is the graduate’s knowledge of occupation.
The collaborative care project : a practice‑based approach to interprofessional education in a primary healthcare setting in South Africa
(2020-04-18) Muller, Jana
Background: There is global evidence that primary healthcare (PHC) leads to improved health outcomes. In the South Africa PHC model, the PHC team identifies healthcare needs through community visits. For health professional students to learn this PHC model requires an immersed, interprofessional community experience. Context: A select number of final year undergraduate health science students from Stellenbosch University, South Africa spend six weeks to one full year working at a rural clinical school with the focus on contextualised, transformative and interprofessional clinical training. Objective: The collaborative care project is one of the opportunities aimed at exposing students to contextual interprofessional training in a resource constrained community. Students are challenged to collaboratively find potential solutions to problems patients face using local resources, with the aim of improving patient outcomes and transforming students into collaborative change agents. Activities: Students, under the supervision of local community health workers, are tasked with conducting interprofessional home visits for discharged patients or patients identified by community members. Possible environmental, personal and health risk factors are identified and referrals made to existing community or state facilities for further management. Outcome: The collaborative care project has resulted in improved patient identification, accessibility to available resources and referral. Students recognise the value of contextualised collaborative clinical training to shape them as clinicians. Challenges and successes are shared to encourage more practical, community based opportunities for collaborative care. Reciprocal teaching and learning take place and students express a change in self‑perception, team identity and improved role clarification. Conclusion: This project creates an opportunity for students and community to improve their understanding of precipitating factors to illness, which are not often considered as routine health care and to find local solutions to problems identified.
Curriculum and training needs of mid-level health workers in Africa : a situational review from Kenya, Nigeria, South Africa and Uganda
(BioMed Central, 2018-07-16) Couper, Ian; Ray, Sunanda; Blaauw, Duane; Ng’wena, Gideon; Muchiri, Lucy; Oyungu, Eren; Omigbodun, Akinyinka; Morhason-Bello, Imran; Ibingira, Charles; Tumwine, James; Conco, Daphney; Fonn, Sharon
Background: Africa’s health systems rely on services provided by mid-level health workers (MLWs). Investment in their training is worthwhile since they are more likely to be retained in underserved areas, require shorter training courses and are less dependent on technology and investigations in their clinical practice than physicians. Their training programs and curricula need up-dating to be relevant to their practice and to reflect advances in health professional education. This study was conducted to review the training and curricula of MLWs in Kenya, Nigeria, South Africa and Uganda, to ascertain areas for improvement. Methods: Key informants from professional associations, regulatory bodies, training institutions, labour organisations and government ministries were interviewed in each country. Policy documents and training curricula were reviewed for relevant content. Feedback was provided through stakeholder and participant meetings and comments recorded. 421 District managers and 975 MLWs from urban and rural government district health facilities completed self-administered questionnaires regarding MLW training and performance. Results: Qualitative data indicated commonalities in scope of practice and in training programs across the four countries, with a focus on basic diagnosis and medical treatment. Older programs tended to be more didactic in their training approach and were often lacking in resources. Significant concerns regarding skills gaps and quality of training were raised. Nevertheless, quantitative data showed that most MLWs felt their basic training was adequate for the work they do. MLWs and district managers indicated that training methods needed updating with additional skills offered. MLWs wanted their training to include more problem-solving approaches and practical procedures that could be life-saving. Conclusions: MLWs are essential frontline workers in health services, not just a stop-gap. In Kenya, Nigeria and Uganda, their important role is appreciated by health service managers. At the same time, significant deficiencies in training program content and educational methodologies exist in these countries, whereas programs in South Africa appear to have benefited from their more recent origin. Improvements to training and curricula, based on international educational developments as well as the local burden of disease, will enable them to function with greater effectiveness and contribute to better quality care and outcomes.
The demographics and outcomes of burn patients admitted to Worcester Hospital
(Medpharm, 2020-06) Blake, N.; Swart, O.; Duvenage, R. C.
BACKGROUND: Worcester Hospital is a regional healthcare facility in the Western Cape, South Africa, without a dedicated burns unit. Currently there is limited data available of burns patient management outside of academic institutions in South Africa. To describe the incidence and demographics, and to determine the outcomes of burn patients admitted to Worcester Hospital METHODOLOGY: A retrospective descriptive study of burn patients admitted to Worcester Hospital between 1 September 2016 and 31 August 2017 RESULTS: A total of 66 burn patients were included in this study which accounted for 1.6% of the total surgical admissions for this time period. The mean age of the patients was 39 (SD ± 19) years with a male predominance (59%). The mechanism of burn was mostly flame burns (71%); 16 patients (24%) were burned with hot fluids and 3 patients (5%) sustained electrical burns. The median TBSA was 9% (IQR: 5-28). Ten patients (15%) required critical care unit admission. The burn patients' median length of stay was 6 days (IQR: 2-11 days) versus 2 days (IQR: 1-5 days) for non-burn general surgery patients. Fifty burn patients (76%) required surgical intervention comprising of either debridement or skin grafting, or a combination of this. Forty-four patients (67%) underwent skin grafting procedures and the median TBSA grafted was 5% (IQR: 3.5-9.5). The median time from admission to first surgical procedure was 25 hours (IQR: 18.33-51.08). The in-hospital mortality rate was 23% and of the 15 mortalities, 9 patients (60%) had TBSA of 30% or more and therefore classified as a major burn CONCLUSION: Burn injuries treated at Worcester Hospital are often severe and require significant resources. This study supplies critical information regarding the burden of burn related injuries managed at a regional level
The effect of undergraduate students on district health services delivery in the Western Cape Province, South Africa
(Health and Medical Publishing Group, 2018) Reid, S.; Conradie, H.; Daniels-Felix, D.
Background. The quality of care, attitudes of staff and long-term recruitment of practitioners have been shown internationally to improve health services as a result of a health facility accepting students for teaching. This study aimed to develop further insight regarding the impact of undergraduate student involvement on district health services in South Africa to understand the issues in a resource-constrained environment. Objectives. To describe the effect of the placement of undergraduate students on service delivery, and to understand the health service and academic factors that influence this effect. Methods. A descriptive study, using qualitative methods, was undertaken in two rural sites where undergraduate health science students had been recently introduced. Potential respondents were identified to be interviewed on the basis of their positions in the health services, their degree of involvement with students and their knowledge of the health system. Results. Sixteen participants were interviewed, and described the effect of undergraduate students on service delivery in terms of a balance between the burden and benefit. Three pivotal issues, which could tip the balance in favour of one or the other, included the length of time of student rotations, seniority of the students and number of students allocated to a particular site. Overall, it would appear that the balance was marginally in favour of the benefit of student service delivery. Conclusion. Undergraduate students can add value to service delivery under certain conditions, but further research is needed to quantify this effect.
Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage) : an international phenomenological study
(BMJ Publishing, 2020-08) Konkin, Jill; Grave, Laura; Cockburn, Ella; Couper, Ian; Stewart, Ruth Alison; Campbell, David; Walters, Lucie
Objectives: Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. This study explored the lived experience of rural doctors when they practise outside their usual scope of practice to provide medical care for people who would otherwise not have access to essential clinical services. Design: A hermeneutic phenomenological study. Setting: An international rural medicine conference. Participants: All doctors attending the conference who practised medicine in rural/remote areas in a predominantly English-speaking community were eligible to participate; 27 doctors were recruited. Interventions: Semi-structured interviews were conducted. The transcripts were initially read and analysed by individual researchers before they were read aloud to the group to explore meanings more fully. Two researchers then reviewed the transcripts to develop the results section which was then rechecked by the broader group. Primary outcome measure: An understanding of the lived experiences of clinical courage. Results: Participants provided in-depth descriptions of experiences we have termed clinical courage. This phenomenon included the following features: Standing up to serve anybody and everybody in the community; Accepting uncertainty and persistently seeking to prepare; Deliberately understanding and marshalling resources in the context; Humbly seeking to know one’s own limits; Clearing the cognitive hurdle when something needs to be done for your patient; Collegial support to stand up again. Conclusion: This study elucidated six features of the phenomenon of clinical courage through the narratives of the lived experience of rural generalist doctors.
Factors influencing choice of site for rural clinical placements by final year medical students in a South African university
(AOSIS publishing, 2017-04) Mapukata, Nontsikelelo O.; Dube, Rainy; Couper, Ian; Mlambo, Motlatso G.
Background: Most of South Africa’s citizens who live in rural or underserved communities rely on the public health care sector to access quality health care. The value of rural exposure through clinical placements is well documented. Medical schools in South Africa have a responsibility to provide solutions that address the prevailing human resources challenges. Despite this commitment, medical students do not necessarily appreciate their role in resolving South Africa’s human resources challenges. This study aimed to assess the factors that influenced the choice of clinical learning sites in a self-selection process undertaken by Wits final year medical students for the compulsory 6-week integrated primary care block rotation. Methods: Qualitative data related to reasons for choice of service learning site were gathered from 524 pre-placement questionnaires completed by final year medical students entering the rotation over a 3-year period (2012–2014). Thematic analysis was performed using the MAXQDA software. Results: Eight themes emerged from the study indicating that the majority of participants were in favour of local urban underserved placement. Contextual factors, such as work commitments or family responsibilities, being compromised socially and losing academic standing were the main reasons for seeking urban placement. Good supervision, opportunistic learning, skills development and moral support were reasons for seeking rural placements. Previous voluntary exposure to rural practice or being of rural origin was a strong indicator for uptake of rural placement. Conclusion: This study has demonstrated the challenges faced by coordinators in balancing personal and institutional needs with country needs and the contextual factors that must be considered when implementing medical education programmes that respond to social challenges.
Health Research Ethics Committees in South Africa 12 years into democracy
(BioMed Central, 2007-01) Moodley, Keymanthri; Myer, Landon
Background: Despite the growth of biomedical research in South Africa, there are few insights into the operation of Research Ethics Committees (RECs) in this setting. We investigated the composition, operations and training needs of health RECs in South Africa against the backdrop of national and international guidelines. Methods: The 12 major health RECs in South Africa were surveyed using semi-structured questionnaires that investigated the composition and functions of each REC as well as the operational issues facing committees. Results: Health RECs in SA have an average of 16 members and REC members are predominantly male and white. Overall, there was a large discrepancy in findings between under-resourced RECs and well resourced RECs. The majority of members (56%) are scientists or clinicians who are typically affiliated to the same institution as the health REC. Community representatives account for only 8% of membership. Training needs for health REC members varied widely. Conclusion: Most major health RECs in South Africa are well organized given the resource constraints that exist in relation to research ethics in developing countries. However, the gender, racial and occupational diversity of most of these RECs is suboptimal, and most RECs are not constituted in accordance with South African guidelines. Variability in the operations and training needs of RECs is a reflection of apartheid-entrenched influences in tertiary education in SA. While legislation now exists to enforce standardization of research ethics review systems, no provision has been made for resources or capacity development, especially to support historically-disadvantaged institutions. Perpetuation of this legacy of apartheid represents a violation of the principles of justice and equity.
Health sciences students’ contribution to human resources for health strategy : a rural health careers day for grade 12 learners in the North West Province of South Africa
(Health and Medical Publishing Group, 2017) Mapukata, N. O.; Couper, I. D.; Dreyer, A. R.; Mlambo, M.
No abstract
Hospital volunteerism as human resource solution : motivation for both volunteers and the public health sector
(AOSIS Publishing, 2017) Lourens, Guinevere M.; Daniels-Felix, Danielle K.
Background: A volunteer programme with 50 registered volunteers was established in 2007 at a secondary-level public, semi-rural regional hospital in the Cape Winelands, South Africa. This was a rapid response to the extensive renovations and system changes brought about by the hospital revitalisation initiated in 2006 and the resultant expanded services, which required additional human resources. This study describes the hospital volunteer programme and provides hospital administrators with practical planning guidance for hospital volunteer programme implementation. Purpose: The purpose of this study is to (1) describe the outcomes of the hospital volunteer programme implementation intervention and (2) to make sound recommendations for volunteer programme implementation. Methodology and approach: A qualitative case-study methodology was employed using purposive sampling as a technique. Participants were recruited from a public hospital in the Western Cape. A case-study design was applied to explore the hospital volunteer programme implementation. In-depth interviews and a focus group discussion with thematic content analysis of transcripts as well as document reviews were conducted to conclude the study during 2015. The key participants were individually interviewed and included two members of the hospital management, two volunteers and one volunteer coordinator. A focus group discussion consisting of three volunteers was also conducted. Findings: The findings of this study indicate that a volunteer programme can meet needs and be a motivational force for both the individual volunteer and the organisation. However, it requires co-ordination and some secure funding to remain sustainable. Such a programme holds huge benefits in terms of human resource supplementation, organisational development, as well as the possibility of gainful employment for the previously unemployed. Practical implications: In practice, a health service contemplating a volunteer programme should develop criteria for recruitment and selection of volunteers, accompanied by the necessary documentation for applications. A coordinator of the volunteer service needs to be identified. Volunteers will need to be orientated, given access to in-service training and supervised. Consideration needs to be given to risk management of vicarious liability by developing a code of conduct, clear roles and responsibilities, managing staff and volunteer relationships and providing emergency care for injuries while on duty as a volunteer.
Microbicide research in developing countries : have we given the ethical concerns due consideration?
(BioMed Central, 2007-09) Moodley, Keymanthri
Background: HIV prevention research has been fraught with ethical concerns since its inception. These concerns were highlighted during HIV vaccine research and have been elaborated in microbicide research. A host of unique ethical concerns pervade the microbicide research process from trial design to post-trial microbicide availability. Given the urgency of research and development in the face of the devastating HIV pandemic, these ethical concerns represent an enormous challenge for investigators, sponsors and Research Ethics Committees (RECs) both locally and internationally. Discussion: Ethical concerns relating to safety in microbicide research are a major international concern. However, in the urgency to develop a medically efficacious microbicide, some of these concerns may not have been anticipated. In the risk-benefit assessment of research protocols, both medical and psycho-social risk must be considered. In this paper four main areas that have a potential for medical and/or psycho-social harm are examined. Male partner involvement is controversial in the setting of covert use of microbicides. However, given the long-term exposure of men to experimental products, this may be methodologically, ethically and legally important. Covert use of microbicides may impact negatively on relationship dynamics leading to psychosocial harm to varying extents. The unexpectedly high rates of pregnancy during clinical trials raise important methodological and ethical concerns. Enrollment of adolescents without parental consent generates ethical and legal concerns that must be carefully considered by RECs and trial sites. Finally, paradoxical outcomes in recent trials internationally have advanced the debate on the nature of informed consent and responsibility of researchers to participants who become HIV positive during or after trials. Summary: Phase 3 microbicide trials are an undisputed research and ethical priority in developing countries. However, such trials must be conducted with attention to both methodological and ethical detail. It is imperative that guidelines are formulated to ensure that high ethical standards are maintained despite the scientific urgency of microbicide development. Given the controversy raised by emergent ethical issues during the course of microbicide development, it is important that international consensus is reached amongst the various ethics and regulatory agencies in developing and developed countries alike.
A peer evaluation of the community-based education programme for medical students at the University of Zimbabwe College of Health Sciences: a southern African Medical Education Partnership Initiative (MEPI) collaboration
(Health and Medical Publishing Group, 2017) Michaels, D.; Couper, I.; Mogodi, M. S.; Hakim, J. G.; Talib, Z.; Mipando, M. H.; Chidzonga, M. M.; Matsika, A.; Simuyemba, M.
Background. The University of Zimbabwe College of Health Sciences (UZCHS), Harare, which has a long tradition of community-based education (CBE), has not been evaluated since 1991. An innovative approach was used to evaluate the programme during 2015. Objectives. To evaluate the CBE programme, using a peer-review model of evaluation and simultaneously introducing and orientating participating colleagues from other medical schools in southern Africa to this review process. Methods. An international team of medical educators, convened through the Medical Education Partnership Initiative, worked collaboratively to modify an existing peer-review assessment method. Data collection took the form of pre-visit surveys, on-site and field-visit interviews with key informants, a review of supporting documentation and a post-review visit. Results. All 5 years of the medical education curriculum at UZCHS included some form of CBE that ranged from community exposure in the 1st year to district hospital-based clinical rotations during the clinical years. Several strengths, including the diversity of community-based activities and the availability of a large teaching platform, were identified. However, despite the expression of satisfaction with the programme, the majority of students indicated that they do not plan to work in rural areas in Zimbabwe. Several key recommendations were offered, central to which was strengthening the academic co-ordination of the programme and curriculum renewal in the context of the overall MB ChB curriculum. Conclusion. This evaluation demonstrated the value of peer review to bring a multidimensional, objective assessment to a CBE programme.
Post-exposure prophylaxis for rape survivors
(Health & Medical Publishing Group, 2007) Pluddemann, Andreas; Reuter, Helmuth; Johnson, Carol
[No abstract available]
Preparing graduates for interprofessional practice in South Africa : the dissonance between learning and practice
(Frontiers Media, 2021) Muller, Jana; Couper, Ian
With South Africa's tumultuous history and resulting burden of disease and disability persisting post-democracy in 1994, a proposed decentralization of heath care with an urgent focus on disease prevention strategies ensued in 2010. Subsequently a nationwide call by students to adapt teaching and learning to an African context spoke to the need for responsive health professions training. Institutions of higher education are therefore encouraged to commit to person-centered comprehensive primary health care (PHC) education which equates to distributed training along the continuum of care. To cope with the complexity of patient care and health care systems, interprofessional education and collaborative practice has been recommended in undergraduate clinical training. Stellenbosch University, South Africa, introduced interprofessional home visits as part of the students' contextual PHC exposure in a rural community in 2012. This interprofessional approach to patient assessment and management in an under-resourced setting challenges students to collaboratively find local solutions to the complex problems identified. This paper reports on an explorative pilot study investigating students' and graduates' perceived value of their interprofessional home visit exposure in preparing them for working in South Africa. Qualitative semi-structured individual and focus group interviews with students and graduates from five different health sciences programmes were conducted. Primary and secondary data sources were analyzed using an inductive approach. Thematic analysis was conducted independently by two researchers and revealed insights into effective patient management requiring an interprofessional team approach. Understanding social determinants of health, other professions' roles, as well as scope and limitations of practice in a resource constrained environment can act as a precursor for collaborative patient care. The continuity of an interprofessional approach to patient care after graduation was perceived to be largely dependent on relationships and professional hierarchy in the workplace. Issues of hierarchy, which are often systemic, affect a sense of professional value, efficacy in patient management and job satisfaction. Limitations to using secondary data for analysis are discussed, noting the need for a larger more comprehensive study. Recommendations for rural training pathways include interprofessional teamwork and health care worker advocacy to facilitate collaborative care in practice.
Sexual history taking : perspectives on doctor-patient interactions during routine consultations in rural primary care in South Africa
(Oxford University Press, 2021-07) Pretorius, Deidre; Couper, Ian; Mlambo, Motlatso
Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa. Methods: This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors. Main Outcome Measure: Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns. Results: Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history. Conclusion: Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients’ quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting.
South-South Cooperation in health professional education : a literature review
(Health and Medical Publishing Group, 2017) Du Toit, L.; Couper, I.; Peersman, W.; De Maeseneer, J.
In the literature on the evolution of funding approaches there is criticism of traditional funding strategies and the promotion of inclusive models, such as South-South Cooperation (SSC) and triangular models. The latter are felt to have a number of advantages. This article has four broad objectives: (i) to present a literature review on the evolution of Southern approaches to development co-operation; (ii) to indicate examples of current co-operative programmes in health and health professional education in Africa; (iii) to assess the advantages and disadvantages of these models; and (iv) to mention some emerging issues in monitoring and evaluation. The Boolean logic approach was used to search for applicable literature within three topic layers. Searches were conducted using PubMed, PLoS and other accessible databases. An initial draft of the article was presented to a group of academics and researchers at the Flemish Inter-University Council (VLIR-UOS)-Primafamed annual workshop held in August 2010 in Swaziland. Comments and suggestions from the group were included in later versions of the article. It is important to note that the existence of various funding models implemented by a variety of actors makes it difficult to measure their effects. In health and health professional education, however, SSC and triangular models of aid provide conditions for more effective programming through their focus on participation and long-term involvement. With an eye towards evaluating programmes, a number of salient issues are emerging. The importance of context is highlighted.
Support nurses and midwives to strengthen healthcare systems
(James Cook University, 2020-06-13) Fields, Bronwyn; Sibanda, Bongi; Couper, Ian
Nurses and midwives make up more than half of the global health workforce1. WHO has designated 2020 as the Year of the Nurse and Midwife2 to recognize their contribution, and to highlight the challenges they face in meeting the needs of the communities they serve. Both the International Council of Nurses’ International Nurses Day3 and the first State of the World’s Nursing report4, recently launched by the International Council of Nurses and WHO respectively, highlight the crucial role played by nurses and midwives in health promotion, disease prevention and treatment. Their role is even more important in Africa, and in low- and middle-income countries (LMICs) in other regions, where nurses are often the only health professionals accessible to rural and remote communities.
Training for transformation : opportunities and challenges for health workforce sustainability in developing a remote clinical training platform
(Frontiers, 2021-04) Muller, Jana; Reardon, Cameron; Hanekom, Susan; Bester, Juanita; Coetzee, Francois; Dube, Kopano; Du Plessis, Elmarize; Couper, Ian
Background: In 2018, Stellenbosch University’s Ukwanda Centre for Rural Health led a faculty initiative to expand undergraduate health professions training to a new site, 9 hours drive from the health sciences campus in the sparsely populated Northern Cape Province of South Africa in the town of Upington. This is part of a faculty strategy to extend undergraduate health sciences training into an under-resourced part of the country, where there is no medical school. During 2019, the first year of implementation, four final year medical students undertook a longitudinal integrated clerkship at this site, while final year students from other programmes undertook short 5-week rotations, with plans for extending rotations and including more disciplines in 2020. The aim of this study was to understand stakeholder perceptions regarding the development of Upington as a rural clinical training site and how this influenced existing services, workforce sustainability and health professions education. Methods: An iterative thematic analysis of qualitative data collected from 55 participants between January and November 2019 was conducted as part of the case study. A constructivist approach to data collection was utilized to explore participants’ perceptions, experiences and understanding of the new training site. Triangulation of data collection and reflexive thematic analysis contributed to the trustworthiness of the data and credibility of the findings. Findings: The perceptions of three key groups of stakeholders are reported: (1) Dr. Harry Surtie Hospital and Academic Programme Managers; (2) Supervising and non-supervising clinical staff and (3) Students from three undergraduate programs of the Faculty. Five themes emerged regarding the development of the site. The themes include the process of development; the influence on the health service; workforce sustainability; a change in perspective and equipping a future workforce. Discussion: This case study provides data to support the value of establishing a rural clinical training platform in a resource constrained environment. The influence of the expansion initiative on the current workforce speaks to the potential for improved capacity and competence in patient management with an impact on encouraging a rural oriented workforce. Using this case study to explore how the establishment of a new rural clinical training site is perceived to influence rural workforce sustainability and pathways, may have relevance to other institutions in similar settings. The degree of sustainability of the clinical training initiative is explored.
Transformation of medical education through decentralised training platforms : a scoping review
(James Cook University, 2018) Mlambo, Motlatso; Dreyer, Abigail; Dube, Rainy; Mapukata, Nontsikelelo; Couper, Ian; Cooke, Richard
Introduction: Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralized training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact. Methods: This scoping review followed Arksey and O’Malley’s framework outlining five stages: (i) identification of a research question, (ii) identification of relevant studies, (iii) study selection criteria, (iv) data charting, and (v) collating, summarizing and reporting results. The literature for the scoping review was found using online databases, reference lists and hand searched journals. Data were charted and sorted inductively according to key themes. Results: A final review included 59 articles ranging over the years 1987–2015 with the largest group of studies falling in the period 2011–2015 (47.5%). Studies mostly employed quantitative (32.2%), qualitative (20.3%), systematic/literature review (18.6%) and mixed methods research approaches (11.9%). The scoping review highlighted a range of DTP strategies for transforming medical education. These include training for rural workforce, addressing context specific competencies to promote social accountability, promoting community engagement, and medical education partnerships. Viable models of DTP include community based education, distributed community engaged learning, discipline based clinical rotations, longitudinal clerkships and dedicated tracks focusing on rural issues. Shorter rural placements and supplemental rural tracks are also described. Conclusions: This scoping review showed a considerable amount of literature on decentralized training platforms that highlight the necessary adaptations needed for transforming medical education. The rural context is critical for many of these. Further studies are required to address the impact of DTPs on health service outcomes and human resource outcomes.

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