BACKGROUND: South Africa has one the highest TB and HIV burdens globally. TB preventive therapy (TPT) reduces the risk of TB disease and TB-related mortality in adults and children living with HIV and is indicated for use in TB-exposed HIV-negative individuals and children. TPT implementation in South Africa remains suboptimal.METHODS: We conducted a pragmatic review of TPT implementation using multiple data sources, including informant interviews (n = 134), semi-structured observations (n = 93) and TB patient folder reviews in 31 health facilities purposively selected across three high TB burden provinces. We used case descriptive analysis and thematic coding to identify barriers and facilitators to TPT implementation.RESULTS: TPT programme implementation was suboptimal, with inadequate monitoring even in health districts with well-functioning TB services. Health workers reported scepticism about TPT effectiveness, deprioritised TPT in practice and expressed divergent opinions about the cadres of staff responsible for implementation. Service- and facility-level barriers included ineffective contact tracing, resource shortages, lack of standardised reporting mechanisms and insufficient patient education on TPT. Patient-level barriers included socio-economic factors.CONCLUSIONS: Improving TPT implementation will require radically simplified and more feasible systems and training for all cadres of health workers. Partnership with communities to stimulate demand driven service uptake can potentially facilitate implementation.
Background: Public-private partnership (PPP) for the delivery of health services is known to improve access to healthcare, yet little is known about its utilisation for rehabilitation services, particularly in sub-Saharan Africa (SSA).Objectives: As a first step to generating evidence to develop a PPP model for physiotherapy service delivery in South Africa, our study mapped and described available research evidence on PPP models for rehabilitation services in the global literature.Method: The Arksey and O’Malley framework guided our scoping review. Published research on rehabilitation and PPP was searched in five databases from 2000 to August 2022 using keywords, Medical Subject Headings (MeSH) and Boolean terms. Two reviewers independently completed the titles, abstracts and full-text screening of the articles and data extraction from the included articles. A narrative synthesis was conducted, and summaries of the findings are reported.Results: Nine articles were included from a total of 137 obtained from the evidence searches. Of these, five were from Australia and the others from Hong Kong, Denmark, Bangladesh and the Netherlands. All the included articles showed evidence of PPP models for physiotherapy service delivery.Conclusion: Our study suggests that PPP models for physiotherapy service delivery exist, particularly in high-income countries (HICs). It also highlights limited research in low- and middle-income countries (LMICs).Clinical implications: There is a need for primary studies to generate further evidence and develop innovative PPP models for rehabilitation services for the populations who need them most as part of efforts towards improving access to healthcare in LMICs.
Introduction Access to medical rehabilitation remains poor in Sub-Saharan Africa. This is partly due to inadequate service delivery emanating from ill-defined public health policies. Developed countries have adopted public-private partnership (PPP) agreements between the government and private sectors, thus presenting superior quality and access to rehabilitation services. To help develop a PPP model for physiotherapy service delivery in South Africa, this scoping review will map research linked to PPP for medical rehabilitation services delivery and outcomes in the global context. Methodology The Arksey and O’Malley (2005) framework (identify the research question, identify relevant research, select studies, chart the data, collate, summarize, and report findings) will be used to guide this review. Peer-reviewed literature will be searched in PubMed, EBSCOhost, Cochrane library, SCOPUS, and Google Scholar from 2000-2022 using a combination of keywords, Medical Subject Headings, and Boolean terms. Screening of the articles at all stages will be conducted independently by two reviewers using the eligibility criteria as a guide. The reference lists of retrieved articles will be manually searched for relevant studies. Emerging themes and sub-themes will be collated, summarized, and the results reported in the narrative form. Discussion We anticipate identifying literature gaps for future research to inform policy on PPP for rehabilitation services delivery in Sub-Saharan Africa and actual practice. The results of this review will contribute to building a model that will enable the provision of equitable rehabilitation services at the district health level using PPP.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.