Enabling factors for specialist outreach in western KwaZulu-Natal

Abstract

BackgroundThere exists a major disparity in access to specialist care between patients in urban and rural areas. Specialists are a scarce resource and are concentrated in urban areas. Specialist outreach attempts to fill the gap in service provision for patients situated remotely. While there is international evidence that multifaceted specialist outreach has achieved varying levels of success, factors that influence the effectiveness of outreach have not yet been fully elucidated in South Africa.AimThis study attempts to uncover some of the factors that enable good multifaceted specialist outreach.SettingThe study was conducted in hospitals in western KwaZulu-Natal province. This health area is served by a tertiary hospital and 20 peripheral hospitals; three of these are regional level and the majority are district level hospitals. Specialist outreach emanates from the tertiary hospital.MethodsSpecialists providing outreach services from the tertiary hospital and medical officers at seven receiving hospitals were interviewed to explore perceptions regarding factors that might enable successful specialist outreach. Framework analysis on the transcribed interviews was carried out using NVivo version 11.ResultsA major positive finding concerns the relationships formed between outreach specialists and doctors at the recipient hospitals. The management of the programme with respect to structure, dependability, data management, transport provision, communication technology and public health systems was also seen as beneficial in specialist outreach.ConclusionSpecialist outreach plays an essential role in providing equality in health care. To enable effectiveness, it is important to make full use of the multifaceted nature of this intervention.

Bringing Specialist Paediatric Surgical Care to the Doorstep in Rural Ghana

“…The need of outreach in paediatric surgery is increasingly acknowledged among professionals in LMIC's and optional models are discussed. [ 19 20 21 22 23 24 ] The Gye Nyame Professional Mobile Clinic in paediatric surgery has expanded and shared its knowledge to other regions in the world through GICS, namely, Nigeria, and the Pacific islands and furthermore wish to expand the outreach programme into remote neighbouring areas in Ghana with the aim to reach out to Liberia and Sierra Leone in the near future.…”

Experiences and views of clinical psychologists working in non-urban areas of KwaZulu-Natal, South Africa

“…The South African Air Mercy Services (AMS) in partnership with the Department of Health (DOH) provided ‘flying doctor’ services in KZN until August 2020. AMS either transported patients from outlying communities with inadequate or no specialized health care to tertiary institutions or transported health specialists from urban to non-urban health facilities (Caldwell et al, 2018). Clinical psychologists also joined the AMS to reach non-urban patients needing mental health care services closer to where they live (Pillay et al, 2009).…”

“…According to the World Health Organization (WHO; 2011), mental health is a neglected priority, and the disparity of health resources between low- and high-income countries remains a global concern (Caldwell et al, 2018; Vergunst, 2018). Morales et al (2020) emphasize that service disparities carry the risk of poor mental health outcomes in non-urban communities, which compromises efforts towards optimal mental health coverage (WHO, 2013).…”

An assessment of critically ill children admitted to a general high-care unit in a regional hospital in Western Cape, South Africa

“…[23,42,43] In light of this observation, more regionalised critical care support, such as technology-enabled remote care (telemedicine) from the PICU or specialist outreach programmes, could be considered. [44,45]…”