Understanding healthcare and population mobility in southern Africa: The case of South Africa

Walls, Helen; Vearey, Jo; Modisenyane, Moeketsi; Chetty-Makkan, Candice M.; Charalambous, Salome; Smith, Richard; Hanefeld, Johanna

doi:10.7196/samj.2016.v106i1.10210

Cited by 38 publications

(43 citation statements)

References 8 publications

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“…In spite of the SADC region being associated with a long history of diverse population movements, current public health responses to HIV still fail to adequately engage with migration and the movement of healthcare users – both within and between countries . The result is a range of negative outcomes with serious implications for population health and HIV prevention, including challenges in initiating treatment, ensuring treatment continuity, and the associated risks for defaulting and drug resistance .…”

Section: Discussionmentioning

confidence: 99%

“…In this commentary, I explore the implications of the current global migration policy terrain for the Southern African Development Community (SADC), a regional economic community made up of 15 member states that is associated with high levels of both internal (within country) and cross‐border (between country) migration and a high communicable disease burden, including the largest population of people living with HIV globally . With the aim of offering suggestions for ways to mobilize a regional response to migration and HIV in SADC, I outline the challenges – and strategic opportunities – that result from the current global migration policy terrain.…”

Section: Introductionmentioning

confidence: 99%

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Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority

Vearey

2018

J Intern AIDS Soc

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IntroductionGlobal migration policy discussions are increasingly driven by moral panics – public anxiety about issues thought to threaten the moral standards of society. This includes the development of two Global Compacts – agreed principles to guide an international response – for (1) “Refugees” and (2) “Safe, Regular and Orderly Migration.” While the need to address migration and health is increasingly recognized at the global level, concerns are raised about if this will be reflected in the final Compacts. The Compacts focus on securitization, an approach that aims to restrict the movement of people, presenting potentially negative health consequences for people who move. Globally, concern is raised that migration‐aware public health programming initiatives could be co‐opted through a global health security agenda to further restrict movement across borders. This is particularly worrying in the Southern African Development Community (SADC) – a regional economic community associated with high levels of migration and the largest population of people living with HIV globally; this case is used to explore concerns about the health implications of the Global Compacts.DiscussionCurrent HIV responses in SADC do not adequately engage with the movement of healthcare users within and between countries. This negatively affects existing HIV interventions and has implications for the development of universal HIV testing and treatment (UTT) programmes. Drawing on literature and policy review, and ongoing participant observation in policy processes, I outline how Global Compact processes may undermine HIV prevention efforts in SADC.ConclusionsThe global health imperative of developing migration‐aware and mobility‐competent health responses must not be undermined by moral panics; the resultant international policy processes run the risk of jeopardizing effective action at the local level. Globally, migration is increasingly recognized as a central public health concern, providing strategic opportunities to strengthen public health responses for all. Without mainstreaming migration, however, health responses will struggle. This is particularly concerning in SADC where HIV programmes – including UTT initiatives – will struggle, and key health targets will not be met. Globally, contextually appropriate migration‐aware responses to health are needed, including and a specific focus on HIV programming in SADC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority

Vearey

2018

J Intern AIDS Soc

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“…In South Africa, a key motivating factor in patients’ travel to access health services – including travel across borders – was found to be the patients’ perceptions of the quality of health services 20 . Patients may sometimes believe an ineffective and unsafe treatment to be good, even when they have access to effective and safe treatments.…”

Section: Perceived Qualitymentioning

confidence: 99%

Understanding and measuring quality of care: dealing with complexity

Hanefeld

Powell‐Jackson

Balabanova

2017

Bull. World Health Organ.

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Existing definitions and measurement approaches of quality of health care often fail to address the complexities involved in understanding quality of care. It is perceptions of quality, rather than clinical indicators of quality, that drive service utilization and are essential to increasing demand. Here we reflect on the nature of quality, how perceptions of quality influence health systems and what such perceptions indicate about measurement of quality within health systems. We discuss six specific challenges related to the conceptualization and measurement of the quality of care: perceived quality as a driver of service utilization; quality as a concept shaped over time through experience; responsiveness as a key attribute of quality; the role of management and other so-called upstream factors; quality as a social construct co-produced by families, individuals, networks and providers; and the implications of our observations for measurement. Within the communities and societies where care is provided, quality of care cannot be understood outside social norms, relationships, trust and values. We need to improve not only technical quality but also acceptability, responsiveness and levels of patient–provider trust. Measurement approaches need to be reconsidered. An improved understanding of all the attributes of quality in health systems and their interrelationships could support the expansion of access to essential health interventions.

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“…Migration and mobility may be associated with HIV acquisition and providing HIV care to mobile populations presents particular challenges . In South Africa, movement between rural and urban areas for employment, education, healthcare, cultural and family reasons occurs frequently, involving all demographic groups, including women of reproductive age .…”

Section: Introductionmentioning

confidence: 99%

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

et al. 2018

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IntroductionLinkage to care and mobility postpartum present challenges to long‐term retention after initiating antiretroviral therapy (ART) in pregnancy, but there are few insights from sub‐Saharan Africa. We aimed to describe postpartum linkage to care, mobility, retention and viral suppression after ART initiation in pregnancy.MethodsUsing routine electronic data we assessed HIV‐specific health contacts and clinic movements among women initiating ART in an integrated antenatal care (ANC) and ART clinic in Cape Town, South Africa. The local care model includes mandatory transfer to general ART clinics postpartum. We investigated linkage to care after leaving the integrated clinic and mobility to new clinics until 30 months on ART. We used Poisson regression to explore predictors of linkage, retention (accessing care at least once at both 12 [6 to <18] and 24 [18 to <30] months on ART), and viral suppression (HIV viral load [VL] ≤50 and ≤1000 copies/mL after 12 months on ART).ResultsAmong 617 women, 23% never linked to care; 71% and 65% were retained at 12 and 24 months on ART respectively, with 59% retained in care at both times. Those who linked (n = 485) accessed HIV care at 98 different clinics and 21% attended ≥2 clinics. Women >25 years, married/cohabiting or presenting early for ANC were more likely to link. Younger and unemployed women were more likely to attend ≥2 clinics (adjusted risk ratio [aRR] 1.10 95% confidence interval [CI] 1.02 to 1.18 and aRR 1.06 95% CI 0.99 to 1.12 respectively). Age >25 years (aRR 1.17 95% CI 1.02 to 1.33) and planned pregnancy (aRR 1.20 95% CI 1.09 to 1.33) were associated with being retained. Among 338 retained women with VL available, attending ≥2 clinics reduced the likelihood of viral suppression when defined as ≤50 copies/mL (aRR 0.81 95% CI 0.69 to 0.95). Distance moved was not associated with VL.ConclusionsThese data show that a substantial proportion of women do not link to postpartum ART care in this setting and, among those that do, long‐term retention remains a challenge. Women move to a variety of clinics and young women appear particularly vulnerable to attrition. Interventions promoting linkage and continued retention for women initiating ART during pregnancy warrant urgent consideration.

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Understanding healthcare and population mobility in southern Africa: The case of South Africa

Cited by 38 publications

References 8 publications

Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority

Moving forward: why responding to migration, mobility and HIV in South(ern) Africa is a public health priority

Understanding and measuring quality of care: dealing with complexity

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

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