Browsing by Author "Myburgh, Neil G."

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    Analysis of district oral health services in KwaZulu-Natal
    (SUN journals, 2017) Dookie, S.; Singh, S.; Myburgh, Neil G.
    There is very little published data on public oral health services in KwaZulu-Natal (KZN). This paper analyzes oral health service delivery within the Department of Health in KZN. METHODS The study used an in-depth, analytical and mixed methods approach with a combination of primary and secondary data. The primary data included telephonic interviews. The secondary data comprised a review of health policy documents and statistical records on oral health services in KwaZulu-Natal. Document review comprised 11 purposively selected national and provincial health and oral health policy documents. Structured telephonic interviews were conducted with purposively selected district oral health managers (n=10). Statistical records for the period 2010 to 2012 were obtained from the KZN District Health Information System. Data analysis included content analysis for the health policy documents and thematic analysis for the interview data. The quantitative data was analyzed using the statistical software package for social sciences SPSS version 23.0. RESULTS Five of the reviewed policy documents made reference to oral health care. The majority of the interview participants indicated that oral health service delivery in KwaZulu-Natal was inadequate. The themes that arose from data analysis included lack of human resources, dental equipment and consumables, and inadequate dental education and promotion programmes. Data on oral health service delivery indicated imbalances in the distribution of dental facilities and oral health workers. Although there was an increase in dental visits for the required period, dental extractions remained the most frequent clinical procedure. CONCLUSION There is an urgent need to re-orient oral health service delivery with a stronger commitment to disease prevention and oral health promotion.
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    Assessment of a framework for the allocation of primary dental services
    (University of the Western Cape, 2017) Antunes, Denise Silveira; Naidoo, Sudeshni; Myburgh, Neil G.; Hilgert, Juliana B.; Hugo, Fernando N.; Fisher, Paul D.
    Background: Standardized and evidence-based resource allocation frameworks for timely provision of primary dental services may support equitable distribution of comprehensive dental care. However, such frameworks, which can be applicable to primary care settings in Brazil, are not available. The purpose of this study was to explore the complex issue of equity allocation of dental staff for primary dental care services, by estimating time to dental disease progression in order to analyze costs when survival targets are set for patients waiting for primary dental care. The inclusion of wait time benchmarks for dental services in the design of the framework was an attempt to increase knowledge on the quality of access experienced by people living within catchment areas of the Family Health Strategy in Brazil. In view of ever scarce resources for public health services, ethical dilemmas arise in resource allocation when allocation choices require priority setting among individuals who face similar health needs. Since equity of access must be assured for all Brazilian citizens, the present study proposed a rational resource allocation model to help decision-makers in reconciling equity access and budgets. Aim: This study aimed to compare equity of access to dental services and costs of dental staff of two models for primary care settings. Additionally, staffing requirements and staff costs were projected over a three-year time period. Both models comprised three inter-related components: (i) universal access to oral health care, (ii) comprehensiveness of primary dental care and (iii) equity of access to primary dental services. Method: The present study was part empirical and part modeling in design. In the empirical phase, a set of maximum wait times for dental care determined by experts (Model 1) vs. wait times derived from survival analysis (Model 2) was compared. A one-year follow-up of a cohort of dental patients assigned to five primary health care clinics was conducted. The event of interest was clinical deterioration in the waiting time for dental visits. At each consultation with a dentist either for routine or emergency reasons, the oral quadrants of the patient were assessed and classified according to their urgency for dental care (from 1, less urgent to 5, more urgent). In the modeling phase, costs of dental staff were estimated on the basis of survival probabilities found in Model 1 and on survival targets simulated in Model 2. The amount of staff required as calculated by combining data on: dental service needs, activity standards for dental services, workload components in dental care, cost per working hour of dental staff, and probabilities of clinical deterioration in the wait for dental visits. Main Findings: In Model 1 (wait times determined by experts), survival probabilities were found to be unevenly distributed between diagnostic categories: category 4= 0.939 (SE 0.019); category 3= 0.829 (SE 0.035); category 2= 0.351 (SE 0.061) and category 1= 0.120 (SE 0.044). The cost of dental staff in Model 1 was estimated to be R$104 110.88 (BRL). In cost simulations of Model 2, where wait times were derived from the survival analysis study, a similar 0.900 survival probability target for all sampled quadrants (n=7 376) was found regardless of their final classification in the study year. The resulting cost of Model 2 was R$99 305.89 (BRL). Conclusions: From an equity-access perspective, the survival analysis concluded that wait times for dental visits determined by the experts may engender inequitable survival probabilities for oral quadrants classified in different diagnostic categories. From a dental-staff costs perspective, one concluded that less resources were required by setting an equitable 90% survival target for all oral quadrants studied.
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    A framework for equity access to primary dental care
    (Associacao Brasileira de Pos-Graduacao em Saude Coletiva, 2020) Naidoo, Sudeshni; Antunes, Denise Silveira; Myburgh, Neil G.
    The objective of this study was to demonstrate face validity with a novel resource allocation framework designed to maximize equity into dental booking systems. The study was carried out in 2014. Eleven experts in primary dental care practice in Southern Brazil participated, using a three-round consensus group technique. First, the experts reached consensus on the items to be included in a 5-level diagnostic scale. They identified 21 clinical conditions and categorized them according to the oral health intervention required. Then, they described workload and activity standards for dental staff to carry out health promotion, oral disease prevention, dental treatment, dental rehabilitation, and urgent dental care. Finally, they agreed upon a set of wait times for primary dental care, establishing maximum waits from 2 to 365 days, according to the diagnostic classification. The framework demonstrated potential ability to promote more equitable access to primary dental services, since equal diagnostic classifications share the same waiting times for the dental care they require
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    Location of community pharmacies and prevalence of oral conditions in the Western Cape Province
    (Elsevier, 2013) Amien, Feroza; Myburgh, Neil G.; Butler, Nadine
    Community pharmacists are approached regularly for oral health advice; most commonly for ulcers which could be indicative of oral cancer, HIV, and various systemic diseases. Community pharmacists should know how to manage these conditions yet they have very limited training to manage these conditions appropriately. The area location and socioeconomic status (SES) of the pharmacy should be considered as it may influence patient management. A study of this nature has not yet been conducted in the Western Cape Province of South Africa. To determine the prevalence and frequency of oral complaints at community pharmacies and if these parameters differ by metropolitan location and SES. A cross-sectional survey of 162 randomlyselected private sector pharmacies was conducted. The sample (n = 121) was stratified by SES and metropolitan location. An open-ended structured questionnaire was faxed to pharmacists. A telephonic interview was conducted a day later. Community pharmacists were asked about the frequency and type of oral health problems they encountered. Most pharmacists (91%) dealt with oral health problems frequently, most commonly for ulcers (55.8%), thrush (49.2%), and toothache (33.3%). The results did not differ by metropolitan location and SES (Chi-squared, Fisher’s Exact, p > 0.05), with the exception of toothache and mouth sores. Community pharmacists are an important part of an interdisciplinary team, and play a definite role in the early detection of oral health conditions, namely, caries, HIV and oral cancer. Training on common oral health conditions should be included in undergraduate pharmacy curricula and continuous professional development courses.
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    Patient satisfaction with health care providers in South Africa: The influences of race and socioeconomic status
    (Oxford University Press, 2005) Myburgh, Neil G.; Solanki, Geetesh C.; Smith, Matthew J.
    The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society.
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    South African healthcare reforms towards universal healthcare – where to next?
    (South African Medical Association, 2024) Myburgh, Neil G.; Solanki, Geetesh; Wilkinson, Thomas
    The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.