Dr. Vera Scott (School of Public Health)

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https://hdl.handle.net/10566/2245

Dr. Vera Scott
Position: Senior researcher
Department: School of Public Health
Faculty: Faculty of Community and Health Sciences
Qualifications: MBChB (UCT), DCH (UCT), MPH (UWC)
My publications in this repository
More about me: here , and here.
Tel: + 27 21 959 2872
Email: verascott@mweb.co.za

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Browsing by Author "Sanders, David"

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    Evaluation of how integrated HIV and TB programs are implemented in South Africa and the implications for rural-urban equity
    (James Cook University, 2013) Scott, Vera; Sanders, David
    Introduction: In countries such as South Africa with a high prevalence of HIV and TB policy directives support program integration. Operational research suggests this is desirable, at least for increasing coverage of HIV and TB services, but warns that implementation models must take local health service infrastructure into account. Methods: A program evaluation of HIV and TB prevention and therapeutic services was performed at facility level in two purposefully selected districts in South Africa – one deep rural and an urban district – in order to describe integration and how it is implemented. Twenty-six rural and 146 urban public primary-care facilities were evaluated using secondary data generated from two large evaluations of HIV/TB/Sexually Transmitted Infections (STI) programs conducted in December 2008 and May 2009. The data collection tools consisted of a review of data in the routine health information system, a facility manager interview, a checklist for equipment and supplies, register reviews and a series of patient folder (health record) reviews. Data were collected on extent to which clients receive integrated services, as well as the quality of care, and the availability of key resources and system capacity to support quality care. Data were entered into MS Excel spreadsheets and proportions calculated for all indicators, and confidence intervals for proportions. Results: Evidence of integration was found across two dimensions - disease programs and the prevention–therapeutic axis. Integration was enabled in both the rural and urban districts because HIV and TB services were co-located in the extensive network of general primary-care services. Smaller rural facilities did not always have staff trained in all the required services, nurses worked without the support of a doctor and supervision was weaker, threatening quality of care. In the rural district there were instances of clients receiving more integrated services. The quality of care in the TB program was high in both districts. Conclusions: In both the districts evaluated, integration across programs and the prevention-care-rehabilitation axis of services was achieved through co-location at primary-care level. Coupled with health system strengthening, this has the potential to improve access across the HIV/TB/STI cluster of services. The benefit is likely to be greater in rural areas. Quality of care was maintained in the long established TB programs in both settings.
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    Research to action to address inequities: The experience of the Cape Town Equity Gauge
    (BioMed Central, 2008-01-04) Scott, Vera; Stern, Ruth; Sanders, David; Reagon, Gavin; Mathews, Verona
    BACKGROUND: While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description that follows looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. We give an overview of the first phase of our research in which we did an initial assessment of health status and the socio-economic determinants of health across the subdistrict health structures of Cape Town. We then describe two projects from the second phase of our research in which we move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity: an Equity Measurement Tool which quantifies inequity in health service provision in financial terms, and a Equity Resource Allocation Tool which advocates for and guides action to rectify inequity in health service provision. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town through the establishment of a community forum and a pilot study into the acceptability of dry sanitation toilets. METHODS: A participatory approach was adopted. Both quantitative and qualitative methods were used. The first phase, the collection of measurements across the health subdistricts of Cape Town, used quantitative secondary data to demonstrate the inequities. In the Equity Tools for Managers Project further quantitative work was done, supplemented by qualitative policy analysis to study the constraints to implementing equity. The Water and Sanitation Project was primarily qualitative, using in-depth interviews and focus group discussions. These were used to gain an understanding of the impact of the inequities, in this instance, inadequate sanitation provision. RESULTS: The studies both demonstrate the value of adopting the GEGA approach of research to action, adopting three pillars of assessment and monitoring; advocacy; and community empowerment. In the Equity Tools for Managers Project study, the participation of managers meant that their support for implementation was increased, although the failure to include nurses and communities in the study was noted as a limitation. The development of a community Water and Sanitation Forum to support the Project had some notable successes, but also experienced some difficulties due to lack of capacity in both the community and the municipality. CONCLUSION: The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.