Delivery of pharmaceutical services and care at three primary healthcare clinics with different dispensing models in the Nelson Mandela Bay Health District
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
- Authors: Bobbins, Amy Claire
- Date: 2018
- Subjects: National health insurance -- South Africa , Community health services -- South Africa Pharmaceutical services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/23580 , vital:30583
- Description: As South Africa moves into an era of National Health Insurance (NHI), the idea of primary health care (PHC) re-engineering is placed at the forefront; however, the role of the pharmacist in this process remains vague. Task-shifting of the dispensing process to pharmacist’s assistants and nurses in PHC clinics is a common phenomenon, but the implications of this on the provision of pharmaceutical services and care to patients is largely unstudied. Thus, this study aims to explore these pharmacist-based, pharmacist’s assistant-based and nurse-based dispensing models present in PHC clinics. A two-phase, mixed methods approach was utilised, comprising of a pharmaceutical services audit and semi-structured interviews. The interviews provided insight into the lived experiences of personnel and patients of pharmaceutical care provision. Results revealed that although basic pharmaceutical services may be available at clinics with each of the three dispensing models, the quality is of a varying standard due to challenges in infrastructure and maintenance and poor personnel support. Furthermore, the provision of quality pharmaceutical care is minimal with all three dispensing models, resulting in a missed opportunity to optimise patient health outcomes in patient-centred PHC.
- Full Text:
- Date Issued: 2018
Future role of community pharmacy in the national health insurance
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
- Authors: Aluko, Olubusola Aderonke
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Community health services -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21472 , vital:29525
- Description: Governments all over the world have shown interest in the healthcare system and various policies and measures have been adopted to ensure optimum health of the people. Inequity in health provision in South Africa is a great challenge. In South Africa, the healthcare system is currently characterised by distinctly different public and private sectors. The public sector serves approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to, and quality of, health services. In particular, relative to the population it serves and the disease burden that it carries, the public sector is under-resourced. In order to address the inequities characteristic of the current two-tiered system, the South African Government is in the process of implementing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization within the public sector. Funding contributions will be linked to the ability of an individual to pay and benefits will be determined by an individual’s need for care. A core principle of NHI is to provide access to quality care. It has been suggested that within a NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies specifying the roles and functions of pharmacists in the NHI or in a re-engineered Primary Health Care system, although it has been suggested that for South Africa to have a successful healthcare system it requires the support and assistance of pharmacists. Research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study describes the perceptions and attitudes of community pharmacists and the lay public in Nelson Mandela Bay Metropole toward NHI and the potential role of community pharmacists within the NHI. A qualitative approach was used to provide an in-depth exploration of the attitudes and perceptions of community pharmacists and the lay public in Nelson Mandela Bay Metropole (NMBM). It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI. Semi-structured, in-depth interviews were conducted with both community pharmacists and with members of the public. The interviews were digitally recorded and then transcribed. The transcriptions were coded and analysed thematically. The analysis of the themes identified revealed that while community pharmacists and the public are aware of NHI they are uncertain as to how it is being implemented. However, both community pharmacists and patients see NHI as an advantage and display a positive attitude towards NHI.
- Full Text:
- Date Issued: 2018
Semi-rural community pharmacists’ perceptions of their future role in the national health insurance
- Authors: Pambuka, Simbongile Patrick
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Pharmacy -- Practice -- South Africa Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/23027 , vital:30396
- Description: The healthcare system in South Africa is currently characterised by distinctly different public and private sectors. The public sector services approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to and quality of health services. In particular, the public sector is very under-resourced relative to the population and disease burden that it serves. In order to address the inequities inherent in the current two-tiered system, the South African government is in the process of introducing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization of the public sector. Funding contributions will be linked to an individual’s ability-to-pay and benefits will be determined by an individual’s need for care. It has been suggested that within an NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies that have been developed specifying the roles and functions of pharmacists in the NHI, and in a re-engineered Primary Health Care system. Furthermore, research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study used a qualitative approach in order to provide a comprehensive exploration of the attitudes and perceptions of community pharmacists in the semirural Eastern Cape towards the NHI as well as their future role and function within it. In this explorative and descriptive study, semi-structured in-depth interviews were conducted with community pharmacists within a 60km radius of Queenstown in the Eastern Cape. The interviews were digitally recorded and then transcribed. The transcriptions were coded and thematically analysed using computer assisted qualitative data analysis software - Atlas.ti®. It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI.
- Full Text:
- Date Issued: 2018
- Authors: Pambuka, Simbongile Patrick
- Date: 2018
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa Pharmacy -- Practice -- South Africa Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/23027 , vital:30396
- Description: The healthcare system in South Africa is currently characterised by distinctly different public and private sectors. The public sector services approximately 84% of the population while the private sector services the smaller portion, 16% of the population. However, the expenditure in both the private and public sectors is almost the same, with approximately five times more being spent per capita in the private sector than in the public sector. The South African health care system is therefore unbalanced with respect to expenditure per capita resulting in inequitable access to and quality of health services. In particular, the public sector is very under-resourced relative to the population and disease burden that it serves. In order to address the inequities inherent in the current two-tiered system, the South African government is in the process of introducing a National Health Insurance (NHI). The NHI will provide a means of pooling all healthcare funding, thereby providing a means of cross subsidization of the public sector. Funding contributions will be linked to an individual’s ability-to-pay and benefits will be determined by an individual’s need for care. It has been suggested that within an NHI system private pharmacies may be contracted through service agreements to provide both chronic and acute medicines. However, there are currently no policies that have been developed specifying the roles and functions of pharmacists in the NHI, and in a re-engineered Primary Health Care system. Furthermore, research suggests that the majority of pharmacists do not believe that the NHI is a suitable means to address South Africa’s healthcare problems and many do not agree with the principles behind it. This study used a qualitative approach in order to provide a comprehensive exploration of the attitudes and perceptions of community pharmacists in the semirural Eastern Cape towards the NHI as well as their future role and function within it. In this explorative and descriptive study, semi-structured in-depth interviews were conducted with community pharmacists within a 60km radius of Queenstown in the Eastern Cape. The interviews were digitally recorded and then transcribed. The transcriptions were coded and thematically analysed using computer assisted qualitative data analysis software - Atlas.ti®. It is envisaged that this understanding will provide a basis for addressing pharmacists’ concerns and may contribute towards the further development of the role and the scope of practice of community pharmacists in the NHI.
- Full Text:
- Date Issued: 2018
Implementation of National Health Insurance in South Africa: views of healthcare managers in a private healthcare institution
- Authors: Grewar, David Alan
- Date: 2017
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa , Medical personnel -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/7503 , vital:21789
- Description: South Africa is in the process of reforming its healthcare system by implementing universal health coverage for its citizens. Universal health coverage is defined as the access of all people to comprehensive health services at an affordable cost with protection against catastrophic health expenditures leading to financial hardship. The system being implemented in South Africa is known as National Health Insurance (NHI) and is seen by the South African government as the key to addressing the shortcomings and disparities in the current public and private healthcare sectors. Healthcare managers have a crucial role to play in health reform yet are often overlooked in debate over health reform. The primary aim of this study was to better understand the views of healthcare managers, working in a private healthcare institution in South Africa, towards the implementation of the NHI. The purpose of this was to make recommendations that would assist the private healthcare institution under investigation to optimise the implementation of the NHI. A quantitative research design was used to explore and describe the views of healthcare managers. Firstly, a literature review was conducted to gain international as well as local perspectives of healthcare practitioners on universal health coverage. Secondly, a census survey in the form of an online questionnaire was developed and distributed to 193 healthcare managers representing different managerial and medical disciplines in a private healthcare institution with facilities nation-wide. A total of 63 questionnaires were returned for analysis. Quantitative data were analysed using Microsoft Excel, Statistica and SPSS Statistics. Qualitative data in the form of written comments by the participants were analysed using interpretive analysis that involved sequential steps of familiarisation and immersion, development of themes, coding, elaboration and interpretation and checking. The qualitative element of the study was limited in nature and was used merely to enrich the quantitative findings. The study found that there was a lack of knowledge amongst private healthcare managers concerning the NHI, poor communication from the government regarding the proposed NHI and high levels of negativity towards the ability of the government to successfully implement the NHI. However it was found that despite concerns regarding the NHI, the private healthcare managers surveyed showed a willingness to actively participate in its implementation. Recommendations regarding policy and practise were made for private healthcare institutions as well as for the South African government in order to assist with the implementation of the NHI.
- Full Text:
- Date Issued: 2017
- Authors: Grewar, David Alan
- Date: 2017
- Subjects: National health insurance -- South Africa , Health care reform -- South Africa , Medical personnel -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/7503 , vital:21789
- Description: South Africa is in the process of reforming its healthcare system by implementing universal health coverage for its citizens. Universal health coverage is defined as the access of all people to comprehensive health services at an affordable cost with protection against catastrophic health expenditures leading to financial hardship. The system being implemented in South Africa is known as National Health Insurance (NHI) and is seen by the South African government as the key to addressing the shortcomings and disparities in the current public and private healthcare sectors. Healthcare managers have a crucial role to play in health reform yet are often overlooked in debate over health reform. The primary aim of this study was to better understand the views of healthcare managers, working in a private healthcare institution in South Africa, towards the implementation of the NHI. The purpose of this was to make recommendations that would assist the private healthcare institution under investigation to optimise the implementation of the NHI. A quantitative research design was used to explore and describe the views of healthcare managers. Firstly, a literature review was conducted to gain international as well as local perspectives of healthcare practitioners on universal health coverage. Secondly, a census survey in the form of an online questionnaire was developed and distributed to 193 healthcare managers representing different managerial and medical disciplines in a private healthcare institution with facilities nation-wide. A total of 63 questionnaires were returned for analysis. Quantitative data were analysed using Microsoft Excel, Statistica and SPSS Statistics. Qualitative data in the form of written comments by the participants were analysed using interpretive analysis that involved sequential steps of familiarisation and immersion, development of themes, coding, elaboration and interpretation and checking. The qualitative element of the study was limited in nature and was used merely to enrich the quantitative findings. The study found that there was a lack of knowledge amongst private healthcare managers concerning the NHI, poor communication from the government regarding the proposed NHI and high levels of negativity towards the ability of the government to successfully implement the NHI. However it was found that despite concerns regarding the NHI, the private healthcare managers surveyed showed a willingness to actively participate in its implementation. Recommendations regarding policy and practise were made for private healthcare institutions as well as for the South African government in order to assist with the implementation of the NHI.
- Full Text:
- Date Issued: 2017
The medical profession and the universalisation of South African Health Care: analysing the response of Eastern Cape general practitioners to the National Health Insurance proposals
- Authors: Hannah, Bridget
- Date: 2017
- Subjects: Health insurance -- South Africa , Health insurance -- Government policy -- South Africa , Medical care, Cost of -- South Africa , National health insurance -- South Africa , Medical policy -- South Africa , Physicians -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/6075 , vital:21029
- Description: In 2011, the Green Paper on National Health Insurance (NHI) in South Africa was released, committing the South African government to a 14-year plan to radically transform the currently inequitable health system towards providing comprehensive quality health care free at point of access to all citizens. The pursuit of universal health coverage (UHC) in South Africa forms part of a global aspiration to achieve more equitable healthcare delivery. One of the critical issues emerging from the Green Paper was how the NHI would be staffed. The NHI is unlikely to be adequately staffed without GPs but evidence suggests that private sector doctors have always been resistant to nationalisation or socialisation as a threat to their occupational power and professional status. The core work of this thesis is a study undertaken of 78 doctors in the Eastern Cape, focusing on private sector general practitioners (GPs), as the largest constituency of medical professionals in the country. The interview schedule was designed to gauge doctors' responses to the NHI, encourage discussion on their reactions to the reforms, and its implications in their view for private medical practice. The responses of the doctors are analysed through application of two theoretical themes, namely: (i) actor-centred policy creation, discussed through application of Walt and Gilson's (1994) shared focus on content, context, process and actors in the policy process, and (ii) the debate on medical professionalism, espoused by Freidson (1973, 1994) and argued against by Haug and Sussman (1969), and McKinlay (1972, 1993). Thus, if the process of policy making must take into account key actors in order to deliver a successful policy transition, what are the implications if these actors are actively excluded, or do not willingly cooperate? Does this indicate anything telling about the private sector's role to play in the pursuit of universal healthcare?
- Full Text:
- Date Issued: 2017
- Authors: Hannah, Bridget
- Date: 2017
- Subjects: Health insurance -- South Africa , Health insurance -- Government policy -- South Africa , Medical care, Cost of -- South Africa , National health insurance -- South Africa , Medical policy -- South Africa , Physicians -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/6075 , vital:21029
- Description: In 2011, the Green Paper on National Health Insurance (NHI) in South Africa was released, committing the South African government to a 14-year plan to radically transform the currently inequitable health system towards providing comprehensive quality health care free at point of access to all citizens. The pursuit of universal health coverage (UHC) in South Africa forms part of a global aspiration to achieve more equitable healthcare delivery. One of the critical issues emerging from the Green Paper was how the NHI would be staffed. The NHI is unlikely to be adequately staffed without GPs but evidence suggests that private sector doctors have always been resistant to nationalisation or socialisation as a threat to their occupational power and professional status. The core work of this thesis is a study undertaken of 78 doctors in the Eastern Cape, focusing on private sector general practitioners (GPs), as the largest constituency of medical professionals in the country. The interview schedule was designed to gauge doctors' responses to the NHI, encourage discussion on their reactions to the reforms, and its implications in their view for private medical practice. The responses of the doctors are analysed through application of two theoretical themes, namely: (i) actor-centred policy creation, discussed through application of Walt and Gilson's (1994) shared focus on content, context, process and actors in the policy process, and (ii) the debate on medical professionalism, espoused by Freidson (1973, 1994) and argued against by Haug and Sussman (1969), and McKinlay (1972, 1993). Thus, if the process of policy making must take into account key actors in order to deliver a successful policy transition, what are the implications if these actors are actively excluded, or do not willingly cooperate? Does this indicate anything telling about the private sector's role to play in the pursuit of universal healthcare?
- Full Text:
- Date Issued: 2017
An examination of health care financing models : lessons for South Africa
- Authors: Vambe, Adelaide Kudakwashe
- Date: 2012
- Subjects: National health insurance -- South Africa , Medical care -- South Africa , Public health administration -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:9032 , http://hdl.handle.net/10948/d1021110
- Description: South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.
- Full Text:
- Date Issued: 2012
- Authors: Vambe, Adelaide Kudakwashe
- Date: 2012
- Subjects: National health insurance -- South Africa , Medical care -- South Africa , Public health administration -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:9032 , http://hdl.handle.net/10948/d1021110
- Description: South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.
- Full Text:
- Date Issued: 2012
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