Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa

Simple item page
dc.contributor.authorMagadzire, Bvudzai Priscilla
dc.contributor.authorBudden, Ashwin
dc.contributor.authorWard, Kim
dc.contributor.authorJeffery, Roger
dc.contributor.authorSanders, David
dc.date.accessioned2019-10-29T12:28:59Z
dc.date.available2019-10-29T12:28:59Z
dc.date.issued2014
dc.description.abstractBackground: Front-line health providers have a unique role as brokers (patient advocates) between the health system and patients in ensuring access to medicines (ATM). ATM is a fundamental component of health systems. This paper examines in a South African context supply- and demand- ATM barriers from the provider perspective using a five dimensional framework: availability (fit between existing resources and clients’ needs); accessibility (fit between physical location of healthcare and location of clients); accommodation (fit between the organisation of services and clients’ practical circumstances); acceptability (fit between clients’ and providers’ mutual expectations and appropriateness of care) and affordability (fit between cost of care and ability to pay). Methods: This cross-sectional, qualitative study uses semi-structured interviews with nurses, pharmacy personnel and doctors. Thirty-six providers were purposively recruited from six public sector Community Health Centres in two districts in the Eastern Cape Province representing both rural and urban settings. Content analysis combined structured coding and grounded theory approaches. Finally, the five dimensional framework was applied to illustrate the interconnected facets of the issue. Results: Factors perceived to affect ATM were identified. Availability of medicines was hampered by logistical bottlenecks in the medicines supply chain; poor public transport networks affected accessibility. Organization of disease programmes meshed poorly with the needs of patients with comorbidities and circular migrants who move between provinces searching for economic opportunities, proximity to services such as social grants and shopping centres influenced where patients obtain medicines. Acceptability was affected by, for example, HIV related stigma leading patients to seek distant services. Travel costs exacerbated by the interplay of several ATM barriers influenced affordability. Providers play a brokerage role by adopting flexible prescribing and dispensing for ‘stable’ patients and aligning clinic and social grant appointments to minimise clients’ routine costs. Occasionally they reported assisting patients with transport money. Conclusion: All five ATM barriers are important and they interact in complex ways. Context-sensitive responses which minimise treatment interruption are needed. While broad-based changes encompassing all disease programmes to improve ATM are needed, a beginning could be to assess the appropriateness, feasibility and sustainability of existing brokerage mechanisms.en_US
dc.identifier.citationMagadzire et al. Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa. BMC Health Services Research 2014, 14:520 http://www.biomedcentral.com/1472-6963/14/520en_US
dc.identifier.issn1472-6963
dc.identifier.urihttps://doi.org/10.1186/s12913-014-0520-6
dc.identifier.urihttp://hdl.handle.net/10566/5073
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.subjectAccess to medicinesen_US
dc.subjectProvider perceptionsen_US
dc.subjectHealth servicesen_US
dc.subjectHIVen_US
dc.subjectDiabetesen_US
dc.subjectEmpathyen_US
dc.titleFrontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africaen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
s12913-014-0520-6.pdf
Size:
321.02 KB
Format:
Adobe Portable Document Format
Description:
magadzire_frontline_health_workers_2014
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

Research Articles (School of Public Health)