Browsing by Author "Reagon, Gavin"

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    Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa
    (PAGEPress, 2017) Daniels, Johann; Zweigenthal, Virginia; Reagon, Gavin
    A waiting time survey (WTS) conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT). A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77- 30.23), a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40) more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28- 4.19) more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.
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    Assessment of the quality of HIV data in an electronic system in a health sub-district in the Eastern Cape
    (University of Western Cape, 2020) Makazha, Timothy; Reagon, Gavin
    In South Africa, public health facilities provide free antiretroviral treatment (ART) mainly via primary healthcare (PHC) nurses. To streamline data collection an electronic HIV information system (TIER.Net), was introduced in 2010. Data originates in paper-based records completed by clinicians with the data from these paper systems then being captured into TIER.Net by clerical data capturers. TIER.Net is designed to effectively monitor outcomes of the ART programme and generate information for planning, management and decision making. For Enock Mgijima subdistrict to attain these functions, it is imperative that data collected at the 21 PHC facilities in the sub-district be of good quality. There has been uncertainty around the quality levels of the data collected through the paper records and TIER.Net, and it was unclear which factors promote or inhibit improved data quality.
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    Exploration of the underlying causes of high waiting times at a community health centre in Cape Town, South Africa
    (The University of the Western Cape, 2017) Piquer, Russel; Reagon, Gavin
    At public sector health facilities in Cape Town, South Africa, patients experience very high waiting times, with a medium waiting time of 3 hours which prevailed at the study facility being common. So the question arose as to why waiting times are so very high and what could be done to reduce them? While for the facility under investigation the immediate causes of the high waiting times were known, the underlying causes were quite opaque. A concern expressed therefore, was that if the underlying causes were not uncovered then efforts to reduce waiting times might not be successful, as they would just address the immediate causes. The legitimacy of the concern derives from the view that if underlying causes are not addressed, then they will continue to exert an influence on the immediate causes, and therefore perpetuate the environment which creates fertile ground for immediate causes to arise and persist, with resultant persistence of high waiting times. Hence, my interest to undertake research to explore the underlying causes of high waiting times.
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    Measuring the underlying causes of long waiting times and the barriers to implementing recommendations to reduce waiting times, at a public sector primary health care facility in Cape Town
    (University of the Western Cape, 2017) Caesar, Warren; Reagon, Gavin
    Long waiting times before receiving a health service, give rise to long queues and congested health facilities, both of which are unnecessary and avoidable. Since patients in part judge the quality of the service by the length of time they spent waiting for it, it is imperative to measure waiting times, and determine and mitigate the immediate and underlying causes of lengthy waits. The facility under investigation was known to have excessively long waiting times. Since the immediate causes of long waiting times were known, it was thus required to research and understand the underlying causes of long waiting times and consequently whether there were any barriers to implementing recommendations to reduce waiting times at this primary health care facility. AIM: The aim of the study was to determine the underlying causes of long waiting times and the barriers to implementing recommendations to reduce waiting times. METHODS: A quantitative cross-sectional analytical study with a small qualitative component was undertaken. The qualitative study took a workshop format by piggy-backing onto feedback sessions held to present the results of the previously conducted waiting time survey to staff. Staff commentary at the workshops on possible underlying causes and barriers to recommendations to reduce them, were then used to develop a questionnaire for the quantitative portion of the study. The population and sample for the qualitative part of the study were all staff working at the facility who attended the feedback sessions. The cross-sectional descriptive quantitative study intended to uncover what underlying causes affected long waiting times, what recommendations could be explored to mitigate long waiting times and improve the patient experience, and if there were any barriers to these recommendations. The quantitative study population and sample were all staff who worked at the facility for more than six months and all patients who had utilised the services at the facility for three or more times. Data was collected using structured questionnaires, which were different for staff and patients. A detailed descriptive analysis was conducted.
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    Measuring the underlying causes of long waiting times and the barriers to implementing recommendations to reduce waiting times, at a public sector primary health care facility in Cape Town
    (University of the Western Cape, 2017) Caesar, Warren; Reagon, Gavin
    Long waiting times before receiving a health service, give rise to long queues and congested health facilities, both of which are unnecessary and avoidable. Since patients in part judge the quality of the service by the length of time they spent waiting for it, it is imperative to measure waiting times, and determine and mitigate the immediate and underlying causes of lengthy waits. The facility under investigation was known to have excessively long waiting times. Since the immediate causes of long waiting times were known, it was thus required to research and understand the underlying causes of long waiting times and consequently whether there were any barriers to implementing recommendations to reduce waiting times at this primary health care facility. Aim: The aim of the study was to determine the underlying causes of long waiting times and the barriers to implementing recommendations to reduce waiting times. Methods: A quantitative cross-sectional analytical study with a small qualitative component was undertaken. The qualitative study took a workshop format by piggy-backing onto feedback sessions held to present the results of the previously conducted waiting time survey to staff. Staff commentary at the workshops on possible underlying causes and barriers to recommendations to reduce them, were then used to develop a questionnaire for the quantitative portion of the study. The population and sample for the qualitative part of the study were all staff working at the facility who attended the feedback sessions. The cross-sectional descriptive quantitative study intended to uncover what underlying causes affected long waiting times, what recommendations could be explored to mitigate long waiting times and improve the patient experience, and if there were any barriers to these recommendations. The quantitative study population and sample were all staff who worked at the facility for more than six months and all patients who had utilised the services at the facility for three or more times. Data was collected using structured questionnaires, which were different for staff and patients. A detailed descriptive analysis was conducted. Results: The study found a number of potential underlying causes for each immediate cause of long waiting times at the facility. For early morning batching the underlying causes found were: 45% of patients were given early appointments which caused clients to arrive early; 100% of patients with appointments after 10H00 arrived before 10H00; and 43% of the patients stated that they arrived early because they feared being turned away.
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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.