We found no statistically significant differences in most education, health and labour outcomes between orphans and the non-orphans with whom they live. Paternal orphans are more likely to be behind in school, and recent mobility has a positive effect on schooling outcomes.

The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professional graduates who choose to practise in rural and under-served areas in South Africa. It consists of an academic from each of nine universities in South Africa with a health science faculty, who is involved in communitybased education, service-learning or rural health, or similar activities that prepare students for rural and under-served areas. Literature reviews, 1,2 a qualitative study 3 and a case-control quantitative study 4 have been completed, around the same research question. An integral component has been peer reviews at each university in the collaboration, to identify in more detail how each faculty is preparing its students for service in rural or under-served areas. All nine participating institutions have held a review to date, and this article reports on the outcomes. Each university has a different approach and operates in a unique context. The reviews therefore amount to a series of case studies, each complete in itself. We report the insights, learning and recommendations arising from each peer review around common themes and assess these in terms of proposed best practices for South Africa. MethodologyA case study approach was used, with each peer review constituting a study in its own right. A standard protocol including tools was developed through the first two pilot project reviews. This protocol was drawn up using the literature, principally the 1987 World Health Organization (WHO) Report. 5 It was approved by each host university's ethics committee. The sample included all nine participating universities, but the host institution purposively selected the educational programmes to be reviewed according to their own priorities. Within each review, a further level of purposive sampling involved questionnaires and interviews with faculty or school leaders, key informants, relevant faculty staff, and final-year students in each programme who had completed at least one community-based module. Each research team comprised at least three reviewers, each from different universities excluding the university or faculty programme under review. Each review was conducted over at least three days on site. Document reviews, semi-structured interviews, focus group discussions, questionnaires and observations during site visits were used to collect data.A letter detailing the project, a questionnaire and a curriculum framework spreadsheet were sent to the participants before the visit. The questionnaire quantified issues that were subsequently qualified and finalised in the interviews. The sampling process determined the specific questionnaire respondents, drawn from faculty staff who chaired committees such as the faculty curriculum committee and curriculum implementation committee, and who were involved in community-based education and curriculum development or related fields. The interviews aimed to assist the research team in making a...

No abstract

BackgroundMedical and Health Sciences students in South Africa undertake community-based education (CBE). Health professionals based at host sites are jointly responsible for training of these students in conjunction with university staff. This study explored the communities’ views, attitudes and recommendations regarding CBE undertaken by these students, in order to improve the quality of community support for these programmes.MethodA qualitative descriptive study was conducted at CBE placement sites of students from the Faculties of Health Sciences of the University of Limpopo (UL), University of KwaZulu-Natal (UKZN) and University of the Western Cape (UWC) during 2010 and 2011. Focus group discussions were held with site facilitators, community leaders and patients, and interviews were audio recorded, transcribed and translated into English where necessary. Data were analysed using NVivo (version 9).FindingsCBE was seen to benefit communities, students and host institutions as there was perceived improvement of service delivery, better referral to hospitals and reduction of workloads on site staff. CBE was also seen as having potential for recruiting professionals who have better orientation to the area, and for motivating school pupils for a career in health sciences. Students acquired practical skills and gained confidence and experience. Challenges included poor communication between universities and host sites, burden of student teaching on site facilitators, cultural and religious sensitivity of students and language barriers.ConclusionThe study revealed that communities have an important role to play in the CBE of future health care professionals. CBE activities could be better organised and managed through formalised partnerships.

To assess differences in psychosocial wellbeing between recent orphans and non-orphans, we followed a cohort of 157 school-going orphans and 480 non-orphans ages 9-15 in a context of high HIV/AIDS mortality in South Africa from 2004 to 2007. Several findings were contrary to published evidence to date, as we found no difference between orphans and non-orphans in anxiety/depression symptoms, oppositional behavior, self-esteem, or resilience. Female gender, self-reported poor health, and food insecurity were the most important predictors of children’s psychosocial wellbeing. Notably, girls had greater odds of reporting anxiety/depression symptoms than boys, and scored lower on self-esteem and resilience scales. Food insecurity predicted greater anxiety/depression symptoms and lower resilience. Perceived social support was a protective factor, as it was associated with lower odds of anxiety/depression symptoms, lower oppositional scores, and greater self-esteem and resilience. Our findings suggest a need to identify and strengthen psychosocial supports for girls, and for all children in contexts of AIDS-affected and economic adversity.

No abstract

We compared demographics, socioeconomic status, and food insecurity between households with and without recent orphans in a region of high HIV/AIDS mortality in South Africa. We recruited a cohort of 197 recent orphans and 528 non-orphans ages 9–15 and their households using stratified cluster sampling. Households were classified into three groups: orphan-only (N=50); non-orphan-only (N=377); and mixed (N=210). Between September 2004 and May 2007, households were interviewed three times regarding demographics, income and assets, and food insecurity. Baseline bivariate associations were assessed using chi-square- and t-tests. Longitudinal bivariate associations and multivariate models were tested using generalized estimating equations. At baseline, mixed households generally exhibited greater characteristics of vulnerability than orphan and non-orphan households. They were larger, had older, less educated household heads, and reported a much smaller annual per capita income. Orphan households were more likely to report a death in the previous year, and less likely to have an adult employed. These differences persisted over the study. Even non-orphan households exhibited characteristics of vulnerability, with 14% reporting a death one year before baseline, 45% of whom were prime-age adults. At baseline, a much smaller proportion of orphan households reported receiving the child support grant than the other household types, but notably, there were no differences among households in receipt of the grant by Round 3. Household food insecurity was highly prevalent: more than one in five orphan-only and mixed households reported being food insecure in the previous month. These findings suggest that the effects of HIV/AIDS only exacerbate existing high levels of poverty in the district, as virtually all households are vulnerable regardless of orphan status. Community-level programs must help families address a spectrum of needs, including food security, caregiving, and financial support, as well as better target social welfare grants and make them more accessible to vulnerable households.

The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework.