Effective district management, particularly leadership is considered to be crucial element of the district health system. Internationally, the debate around developing leadership competencies such as motivation or empowerment of staff, managing relationships, being solution driven as well as fostering teamwork are argued to be possible through formal and informal training. This paper reports findings on the significance of informal learning and its practical value in developing leadership competencies. A qualitative case study was conducted in one district in the Gauteng province, South Africa. Purposive and snowballing techniques yielded a sample of 18 participants, primarily based at a district level. Primary data collected through in-depth interviews and observations (participant and non-participant) were analysed using thematic analysis. Results indicate the sorts of complexities, particularly financial management challenges which staff face and draws attention to the use of two informal learning strategies—learning from others (how to communicate, delegate) and fostering team-based learning. Such strategies played a role in developing a cadre of leaders at a district level who displayed essential competencies such as motivating staff, and problem solving. It is crucial for health systems, especially those in financially constrained settings to find cost-effective ways to develop leadership competencies such as being solution driven or motivating and empowering staff. The authors note that the study illustrates that it is possible to develop such competencies through creating and nurturing a learning environment (on-the-job training) which could be incorporated into everyday practice.
Governance and participation in health
In 2015 Good Governance Africa (GGA), in conjunction with specialist researchers MarkData, conducted a survey to test public attitudes towards key aspects of governance in South Africa. In 2016 GGA commissioned MarkData to conduct a Voter Sentiment Survey. Respondents were selected using a random multistage sampling process. The survey findings are to some extent in line with the 2011 South African Reconciliation Barometer. The survey showed that in cases relating to government performance, the widely held view was that all areas (administration, economic development and service delivery) required attention and improvement. Participants suggested that service delivery is the priority, followed by economic development and then administration. It was also found that more voters are deploying their vote strategically in relation to their perceptions of governance, despite feeling that they have little say in how they are governed. The authors argue that this reinforces the need for further research and for greater engagement with the voters on the ground, particularly in areas where poor local government performance has been detected.
The prevalence of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa. At the same time, the use of mobile phones is rising, expanding the opportunities for the implementation of mobile phone-based health (mHealth) interventions. This review aims to understand how, why, for whom, and in what circumstances mHealth interventions against NCDs improve treatment and care in sub-Saharan Africa. Four main databases and references of included articles were searched for studies up to March 2015 reporting effects of mHealth interventions on patients with NCDs in sub-Saharan Africa. All studies published up until May 2015 were included in the review. Following a realist review approach, middle-range theories were identified and integrated into a 'Framework for Understanding the Contribution of mHealth Interventions to Improved Access to Care for patients with NCDs in sub-Saharan Africa'. The main indicators of the framework consist of predisposing characteristics, needs, enabling resources, perceived usefulness, and perceived ease of use. Studies were analysed in depth to populate the framework. The search identified 6137 titles for screening, of which 20 were retained for the realist synthesis. The contribution of mHealth interventions to improved treatment and care is that they facilitate (remote) access to previously unavailable (specialised) services. Three contextual factors (predisposing characteristics, needs, and enabling resources) influence if patients and providers believe that mHealth interventions are useful and easy to use. Only if they believe mHealth to be useful and easy to use, will mHealth ultimately contribute to improved access to care. The analysis of included studies showed that the most important predisposing characteristics are a positive attitude and a common language of communication. The most relevant needs are a high burden of disease and a lack of capacity of first-contact providers. Essential enabling resources are the availability of a stable communications network, accessible maintenance services, and regulatory policies. Policy makers and program managers should consider predisposing characteristics and needs of patients and providers as well as the necessary enabling resources prior to the introduction of an mHealth intervention. The authors argue that researchers would benefit from placing greater attention on the context in which mHealth interventions are being implemented instead of focusing (too strongly) on the technical aspects of these interventions.
The new chairperson of the African Union (AU) Commission Moussa Faki Mahamat formally took office in Addis Ababa in March, outlining his top priorities for his four-year tenure. Mahamat said he would focus on implementing structural and financial reforms at the AU, place women and youth at the centre of Africa’s development agenda, accelerate intra-African trade and free movement of people, goods and services in the continent, silence the guns by 2020 and strengthen Africa’s voice in the global arena. However, it is the financing plan that is likely to get the most attention in the short term. It was unveiled at the 2015 AU summit in Kigali by Donald Kaberuka, former president of the African Development Bank (AfDB). As of 2015, more than half of the African Union’s budget is funded by outside funders, compromising the independence of the organisation. The Kaberuka plan is intended to change that, and would see member states finance 100% of the AU’s operating budget, three-quarters of the programmes budget and a quarter of the peace and security budget, starting from January 2016 and phased in incrementally over five years.
The disease burden in urban sub-Saharan Africa is changing rapidly. Mortality and morbidity from chronic physical disease (heart, disease, stroke and cancer) is rising rapidly and believed to equal that from infections. Other increasing disease burdens in sub Saharan Africa include mental illness, substance abuse and accidents, especially road traffic collisions (RTC). Newspaper readership is rising in Uganda. This study used content analysis to examine health-related coverage in one major Ugandan newspaper (New Vision). Twenty-nine consecutive paper copies from September/October 2013 were examined independently by two researchers. Health-related articles were identified, counted and coded according to clinical content. Clinical and healthcare-related coverage was present in every edition and represented approximate proportions of 2.6% and 0.4% respectively of total newspaper content. Of 214 news articles identified, these covered the following clinical themes: general well-being (15.4%), healthcare services (14.5%), HIV (12.1%), violence/accidents (11.2%), chronic physical disease (11.2%), sexual, maternal and reproductive health (SMRH) (10.8%), non-HIV infective diseases (10.8), malnutrition (7.9%), substance misuse (3.3%) and mental health (2.8%). Coverage of RTCs, alcohol, smoking, and cancers other than of the breast and cervix was minimal. Health-related content was dominated by infections, healthcare quality, general wellbeing, SMRH and malnutrition. This does not represent the changing burden of disease in Uganda. There may be scope for targeted interventions with editors to promote coverage of growing challenges, including lifestyle advice to prevent chronic diseases.
Ghana’s president Nana Akufo-Addo came under fire for naming what has been described as an ‘elephant’ cabinet – with 31 cabinet portfolios, several ministries have two or more deputies, bringing the total size of cabinet to 110 ministers and perhaps more. Such a large team may have significant financial implications, in a country where the debt-to-GDP ratio is about 74%, with a $1 billion bailout from the International Monetary Fund (IMF) in 2015. Looking at Africa more broadly, the median size of cabinets is 30 (excluding deputies). The largest such cabinet is in Cameroon with 63 ministers. Uganda’s cabinet has 31 full cabinet ministers and 49 ministers of state, bringing the total number to 80. In Africa, larger cabinets are more common in post-conflict countries that are trying to build a broader national consensus, especially in countries with high political or ethnic fragmentation, as ministerial appointments are an easy way to build loyalty to the regime of the day. The author indicates that they are also common in resource-rich countries, and in those that have had long-serving heads of state, which tend to have heavy patronage networks. In that way, they serve an important political, if not economic or technocratic function – they create compromise and cohesion within the political class.
In recent years there has been a movement to promote patients as partners in their care. However, in the case of critically ill patients, who are often sedated and mechanically ventilated, family members may be more involved in the care of the patient. To date, this type of care has been represented by three dominant theoretical conceptualisations and frameworks one of which is family centred care. There is, however, a lack of consensus on the definition of family centred care. This study explored the meaning of family care within a South African context. This study adopted a qualitative approach and a grounded theory research design by Strauss and Corbin (1990). Participants from two hospitals: one private and one public were selected to participate in the study. There was a total of 31 participants (family members, intensive care nurses and doctors) who volunteered to participate in the study. Data collection included in-depth individual interviews. The findings of this study revealed that family care is conceptualised as togetherness, partnership, respect and dignity. During a critical illness, patients' families fulfil an additional essential role for patients who may be unconscious or unable to communicate or make decisions. Family members not only provide vital support to their loved one, but also become the "voice" of the patient.
UN-Habitat believes that ICT can be a catalyst to improve governance in towns and cities and help increase levels of participation, efficiency and accountability in public urban policies, provided that the tools are appropriately used, accessible, inclusive and affordable. Research shows that ICT use by youth can have a direct impact on increasing civic engagement, giving them new avenues through which to become informed, shape opinions, get organised, collaborate and take action. Youth are at the centre of the ICT revolution, both as drivers and consumers of technological innovation. They are almost twice as networked as the global population as a whole, with the ICT age gap more pronounced in least developed countries where young people are up to three times more likely to be online than the general population. This video shows UN-Habitat’s approach to using Minecraft to encourage youth participation in urban design and governance, to design and present their vision for public spaces in the city, as an input to planning. UN-Habitat’s experiences of using the video game Minecraft as a community participation tool for public space design is reported to show that providing youth with ICT tools can promote improved civic engagement.
This study aims to identify key context features and underlying mechanisms through which community health committees build community capacity within the field of maternal and child health. Since such groups typically operate within or as components of complex health interventions, they require a systems thinking approach and design, and thus so too does their evaluation. Using a mixed methods realist evaluation with intraprogramme case studies, this protocol details a proposed study on community health committees in rural Tanzania and Uganda to better understand underlying mechanisms through which these groups work (or do not) to build community capacity for maternal and child health. It follows the realist evaluation methodology of eliciting initial programme theories to inform the field study design.
The concept of social cohesion is increasingly being used in local and international policy discourse and scholarship. The idea of collective efficacy, defined as ‘social cohesion among neighbours combined with their willingness to intervene on behalf of the common good’, has been posited as having an important protective effect against violence. This article investigates the relevance of international framings of social cohesion and collective efficacy, - largely conceptualised and tested in the global North - to the conditions of social life and violence prevention in a city in the global South. These circumstances are interrogated through an ethnographic study conducted in Khayelitsha township in the Western Cape, where a major internationally funded and conceptualised violence prevention intervention, Violence Prevention through Urban Upgrading (VPUU), has been implemented. The ethnographic material contests some of the key assumptions in international discourses on social cohesion and the manner in which social cohesion has been interpreted and effected in the violence prevention initiatives of the VPUU. Khayelitsha communitarian world views support forms of mutual sociality that are underpinned by a philosophy of ubuntu in which personhood is achieved through social relations rather than through individual empowerment. However, these communitarian networks and ‘ways of life’ are argued to be under social and structural strain and can be conduits not only for reciprocity, but also for violence.