Browsing by Author "Christian, Carmen"

Now showing 1 - 8 of 8
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    Access to health care in post-apartheid South Africa: availability, affordability, acceptability
    (Cambridge University Press, 2018) Burger, Ronelle; Christian, Carmen
    We use a reliable, intuitive and simple set of indicators to capture three dimensions of access – availability, affordability and acceptability. Data are from South Africa’s 2009 and 2010 General Household Surveys (n=190,164). Affordability constraints were faced by 23% and are more concentrated amongst the poorest. However, 73% of affordability constraints are due to travel costs which are aligned with findings of the availability constraints dimension. Availability constraints, involving distances and transport costs, particularly in underdeveloped rural areas, and inconvenient opening times, were faced by 27%. Acceptability constraints were noted by only 10%. We approximate acceptability with an indicator measuring the share of community members bypassing the closest health care facility, as we argue that reported health care provider choice is more reliable than stated preferences. However, the indicator assumes a choice of available and affordable providers, which may often not be an accurate assumption in rural areas. We recommend further work on the measurement of acceptability in household surveys, especially considering this dimension’s importance for health reform.
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    Alternative mechanisms for delivery of medication in South Africa: A scoping review
    (AOSIS, 2021) Mash, Robert; Christian, Carmen; Chigwanda, Ruvimbo V
    Background: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa. Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively. Results: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication. Conclusion: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.
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    Investigating the economic relationship between buy-back centres and plastic waste recycling entrepreneurs
    (University of the Western Cape, 2022) Kamanzi, Mwajuma; Christian, Carmen
    Persistently high unemployment level and rate remains as one of South Africa‟s most serious social and economic problems. Over the years, entrepreneurship has been identified as one of the main vehicles to create jobs and alleviate poverty. South Africa is one of the finest plastic recyclers in the world with almost 50% of plastics used as inputs come from recycled plastics (Plastics SA, 2019). This presents an opportunity: Buy-back centres (BBCs) in the waste management industry have proven to be economically feasible with many of these centres employing people and profiting from selling recyclable materials to recyclers. Focusing on the Western Cape, in 2019, the province generated about 150 000 tonnes of plastics with the market value estimated at between R474 and R632 million per year.
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    Patient perceptions of the quality of health services in South Africa quality management conference (in association with COHSASA)
    (2018) Christian, Carmen
    Patient perceptions of quality drives acceptability of health services (Penchansky and Thomas, 1981). ▪ Services not acceptable less likely to return for follow-up, less likely to seek healthcare, more likely to access private sector. ▪ Bypassing of closest clinics (Burger & Christian, 2018; Rao & Sheffel, 2018). ▪ Patients with low-quality perceptions of public healthcare services prefer to utilise private healthcare facilities (Burger et al., 2010; Van der Berg et al., 2010). ▪ Understanding quality of health services – from a user’s perspective – is essential for health outcome improvements.
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    Patient perceptions of the quality of public healthcare in South Africa
    (University of the Western Cape, 2019) Ntunta, Asanda; Christian, Carmen
    The South African democratic government is mandated by the constitution to provide quality healthcare services to the citizens of the country. Therefore, healthcare in South Africa is considered as a basic human right. The existing healthcare system exhibits extreme inequality, which translates into inequity in health outcomes across different demographic factors. Even though quality healthcare is a basic human right, problems related to the quality of healthcare remain, which poses a major challenge for the South African government. This dissertation investigates patient perceptions of the quality of public healthcare in South Africa, using General Household Survey data (2009-2016), with the objective of determining the level and trends of patient satisfaction and complaints reported when accessing public healthcare services in South Africa and identifying the correlates of these perception. This study found that patient satisfaction with public healthcare services in South Africa has increased over time while complaints have decreased over time. This study refrains from drawing conclusion on these findings at face value, since they may be other factors that explain the observed trends. The most common complaint was long waiting time at public healthcare facilities. On average, White individuals, male household heads, individuals residing in rural areas and individuals from smaller household were more likely to report to being satisfied with healthcare services received at public healthcare facilities in South Africa. Therefore, patient satisfaction survey approach should be used in conjunction with other healthcare quality measures such as direct observation, vignettes and standardised or mystery patient.
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    Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities: The case of the Western Cape, South Africa
    (Springer Nature, 2019) Christian, Carmen; Burger, Cobus; Claassens, Mareli
    This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population.The study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors.
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    Predictors of mask-wearing during the advent of the COVID-19 pandemic: Evidence from South Africa
    (Oxford University Press, 2022) Burger, Ronelle; English, Rene; Maughan-Brown, Brendan; Christian, Carmen
    Background: In the absence of a vaccine, the global spread of COVID-19 during 2020 has necessitated non-pharmaceutical interventions to curb the rise of cases. Purpose: The article uses the health belief model and a novel rapid mobile survey to examine correlates of reported mask-wearing as a nonpharmaceutical intervention in South Africa between May and August 2020. Methods: Two-way tabulations and multivariable analysis via logistic regression modeling describe correlations between reported mask-wearing and factors of interest among a sample of 7074 adults in a two-period national longitudinal survey, the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM). Results: In line with the health belief model, results showed that self-efficacy, the prevalence of others’ mask-wearing in the same district, and affluence were positively associated with reported mask-wearing. Those who reported staying at home were significantly less likely to report wearing a mask. There was little evidence that the expected severity of the disease if contracted, affects these decisions. Hypertension, obesity, or being overweight (measured three years earlier) did not have a significant association with maskwearing. The prevalence of mask-wearing increased significantly from May to August 2020 as COVID-19 cases increased and lockdown restrictions were eased. Contrary to the health belief model, we found that despite having a higher mortality risk, the elderly had significantly lower odds of mask-wearing. Conclusion: In South Africa, the mask-wearing adherence has increased rapidly. It is concerning that the elderly had lower odds of mask-wearing. This should be examined further in future research.
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    Protecting the standardised patient in TB scenarios: The South African study
    (2019) Christian, Carmen; Gerdtham, Ulf; Hompash, Dumisani
    SPs used in TB scenarios experience repeated exposure to TB in high risk settings. Exposure for each TB standardised patient.an average of 2.5 hours per facility - at least 19 times - over a five-week period.Public healthcare facilities in South Africa (SA)