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Valuing water gains in the Eastern Cape's Working for Water Programme
SG Hosking, M Du Preez
Water SA , 2002,
Abstract: Water is one of the most important measured benefits of the Working for Water Programme (WWP). This programme entails the removal of high water-consuming alien vegetation and the restoration of low water-consuming indigenous vegetation. For this reason it is crucial that the pricing of this water be an accurate reflection of its relative scarcity. This paper sheds more light on this aspect. A procedure for pricing water is described and applied in six WWP projects in the Eastern Cape province: Tsitsikamma, Kouga, Port Elizabeth Driftsands, Albany, Balfour and Pott River. It is shown that the procedure yields very different prices at the different sites, and higher prices for projects that increase river flows feeding metropolitan demand. WaterSA Vol.28(1) 2002: 23-28
Programme costs in the economic evaluation of health interventions
Benjamin Johns, Rob Baltussen, Raymond Hutubessy
Cost Effectiveness and Resource Allocation , 2003, DOI: 10.1186/1478-7547-1-1
Abstract: Programme costs, defined as costs incurred at the administrative levels outside the point of delivery of health care to beneficiaries, may comprise an important component of total costs. Cost-effectiveness analysis has sometimes omitted them if the main focus has been on personal curative interventions or on the costs of making small changes within the existing administrative set-up. However, this is not appropriate for non-personal interventions where programme costs are likely to comprise a substantial proportion of total costs, or for sectoral analysis where questions of how best to reallocate all existing health resources, including administrative resources, are being considered.This paper presents a first effort to systematically estimate programme costs for many health interventions in different regions of the world. The approach includes the quantification of resource inputs, choice of resource prices, and accounts for different levels of population coverage. By using an ingredients approach, and making tools available on the World Wide Web, analysts can adapt the programme costs reported here to their local settings. We report results for a selected number of health interventions and show that programme costs vary considerably across interventions and across regions, and that they can contribute substantially to the overall costs of interventions.Estimating the costs of health interventions is important to policy-makers for a number of reasons including the fact that the results can be used as a component in the assessment and improvement of the performance of their health systems. As part of its WHO-CHOICE cost-effectiveness work programme (go to http://www.who.int/evidence/cea webcite for more details), WHO has undertaken an effort to assess the overall costs and effects of a wide variety of health interventions [1]. Single global estimates of intervention costs are not relevant to individual countries. On the other hand, very few countries are able to est
HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings
Catherine E Draper, Anniza de Villiers, Estelle V Lambert, Jean Fourie, Jillian Hill, Lucinda Dalais, Zulfa Abrahams, Nelia P Steyn
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-398
Abstract: This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.Non-communicable diseases (NCDs), including type 2 diabetes, have become an increasing global concern. The burden of these diseases is growing in Sout
Who is the nutrition workforce in the Western Cape?
H Goeiman, D Labadarios, NP Steyn
South African Journal of Clinical Nutrition , 2011,
Abstract: Objectives: The aim of the present study was to determine the current nutrition staffing profile of the Integrated Nutrition Programme (INP) in Department of Health in the Western Cape, and establish whether it is adequate to meet the objectives of the INP. Method: Self-administered questionnaires compiled in English were used as the main data collection instrument for nutrition staff in districts and at hospitals (n = 647). Eight individual questionnaires, one per staff category, were developed and utilised in the study. Results: Foodservice workers were the largest group of nutrition personnel (n = 509; 79%), followed by dietitians (n = 64; 10%), managers (n = 31; 5%), auxiliary workers (n = 28; 4%), and administrative workers (n = 15; 2%). Sixty-two per cent of the nutrition workforce was located in urban areas and 38% in rural districts. Hospital and district dietitians experienced common problems, as well as specific differences. Regarding problems, both categories referred to limited resources, inadequate number of available posts, and lack of acknowledgement and support from administrative and supply chain management. District dietitians were also hampered by lack of space for consultations, poor referrals from doctors, insufficient posts for nutrition advisers, and difficulty in communicating with Xhosa-speaking patients. Hospital dietitians were hampered by insufficient interaction with district dietitians and lack of dietitians for specialised units. They also mentioned that poor salaries were affecting morale. Conclusion: Recommendations such as additional posts for dietitians, improved conditions of service and salaries, increased advocacy for nutrition, and a number of human resources recommendations were made, and should be considered if the INP objectives are to be met.
Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions  [PDF]
Allanise Cloete,Anna Strebel,Leickness Simbayi,Brian van Wyk,Nomvo Henda,Ayanda Nqeketo
AIDS Research and Treatment , 2010, DOI: 10.1155/2010/420270
Abstract: This paper presents the findings of an exploratory study to investigate the challenges faced by people living with HIV/AIDS (PLWHA) in communities in Cape Town, South Africa. The primary goal of the study was to gather data to inform the adaptation of a group risk reduction intervention to the South African context. Qualitative methods were used to examine the experiences of PLWHA. Eight focus group discussions (FGDs) were conducted with 83 HIV-positive participants and 14 key informants (KIs) involved in work with PLWHA were interviewed. Findings revealed that AIDS-related stigma was still pervasive in local communities. This was associated with the difficulty of disclosure of their status for fear of rejection. Also notable was the role of risky behaviours such as lack of condom use and that PLWHA considered their HIV/AIDS status as secondary to daily life stressors like poverty, unemployment, and gender-based violence. These findings have implications for the adaptation or development of behavioural risk reduction interventions for PLWHA. 1. Introduction As people living with HIV/AIDS (PLWHA) now live longer and healthier lives due to the greater availability of antiretroviral (ARV) treatment, the urgency of including behaviour change strategies for PLWHA into the public health system becomes an imperative to curb the further spread of the disease and also to prevent reinfection [1]. Moreover, where ARV treatment is readily available decreasing HIV/AIDS morbidity has been paralleled by increasing HIV/AIDS infection rates suggesting that prevention programmes targeting only HIV-negative persons may be inadequate to curb the HIV epidemics [2]. Behaviour change strategies tailored to the specific needs of PLWHA are termed positive prevention. In the United States of America (USA), positive prevention is now the standard for HIV prevention and many of the intervention models that have shown efficacy in reducing unsafe behaviour are being replicated in South Africa [3]. South Africa is currently estimated to have amongst the most PLWHA globally [4]. Addressing the HIV/AIDS prevention needs of PLWHA becomes even more of a priority in the light of studies illustrating that a significant minority of PLWHA in South Africa are still engaging in risky behaviour [5–8]. Hence, a public health imperative is created to address the HIV risk reduction needs of PLWHA. Risk reduction interventions designed to reduce HIV transmission risk behaviours in people who know they are HIV-positive have demonstrated risk reduction benefits in several studies conducted in the USA
A cross-sectional survey to compare the competence of learners registered for the Baccalaureus Curationis programme using different learning approaches at the University of the Western Cape  [cached]
Loretta Z. le Roux,Thembisile D. Khanyile
Curationis , 2011, DOI: 10.4102/curationis.v34i1.53
Abstract: The purpose of the study was to compare the extent to which the different teaching approaches applied in the Baccalaureus Curationis programme adequately prepare graduating learners for professional competence. The research methodology was a quantitative approach, based on descriptive research, with a clinical competence development model to guide the data collection procedure. The target population of the study included a sample of 250 learners in the four-year B.Cur programme, that extended from first-to-fourth-year. Stratified random sampling was applied to select the sample learners for this research and data were collected by means of a five-point Likert scale questionnaire. Data were organised and managed using the SAS statistical software package. Descriptive statistics were gathered with measures of central tendency and dispersion included, and their findings were illustrated on descriptive tables. A correlation technique was applied to determine the effects of the independent variable on the dependent variable. The results of the study indicated that progression in competence did not occur as learners progressed through higher levels of their training, except during the third-year of study. However, the study’s results confirmed the strengths of the Case-based clinical reasoning approach to teaching and learning. This approach is able to combine the strengths of the traditional methods, which dealt with large class sizes and that had a focus on learner centred learning, with a focus on clinical practice. This approach provides realistic opportunities for learners to experiment with solutions to dilemmas encountered in real life situations, from the protected and safe environment of the classroom. The first-year learners who were observed in this study, who although novices, were exposed to Case-based teaching approaches and showed more self-perceived competence than learners in later years. This occurred in spite of the limited exposure of the first-year learners to real life clinical situations. The outcome of this study recommends that more studies are conducted, in the School of Nursing at the University of the Western Cape (UWC), to explore teaching and learning approaches that fully maximise the clinical and theoretical competencies of the learners. The outcome further recommends that learner-centred teaching approaches, such as Case-based method, are applied to all year levels of study in the B.Cur programme, due to its proven value when it was applied to first-year learners. The Case-based clinical reasoning approach to learning, that ha
Quantitative Literacy Interventions at University of Cape Town: Effects of Separation from Academic Disciplines
Vera Frith
Numeracy , 2012,
Abstract: The aim of the Numeracy Centre at the University of Cape Town is to develop students’ quantitative literacy (QL) in a manner consistent with their programmes of study and intended roles in the community. Our theoretical perspective on the nature of QL is in line with that of the New Literacies Studies and sees academic QL as practices in different academic disciplinary contexts. This means that for us the ideal curriculum structure for developing QL would fully integrate it into the teaching of the disciplines. This is in practice not achievable in most cases, especially since many students do not have the necessary foundations of mathematical and statistical knowledge and skills. The unavoidable deviation from the ideal curriculum structure presents challenges to the design of QL interventions. Two illustrative examples which display different degrees of separation from the disciplinary teaching are described and discussed. This discussion is based on lecturers’ reflections on the teaching experience and on student evaluations. The ‘stand-alone’ QL course for Humanities and Law students, which uses a context-based approach, is the least integrated with the disciplinary curriculum, and presents challenges in terms of tensions in the classroom between the contexts and the mathematical and statistical content, as well as challenges in terms of student motivation. The QL intervention for medical students is more closely integrated into the medical curriculum and presents fewer challenges. Both interventions are intended to provide ‘foundations’ in terms of QL and suffer from difficulties in providing students with authentic motivation.
Delivery of the Nutrition Supplementation Programme in the Cape Town metropolitan area from the perspective of mothers of under-5s: A qualitative study
EC Andresen, M Wandel, WB Eide, M Herselman, PO Iversen
South African Journal of Child Health , 2009,
Abstract: Background. Child malnutrition is a major problem in South Africa despite implementation of various policies and programmes. Ideally these programmes should be delivered within a human rights paradigm, i.e. parents are responsible for their children’s health, while the State authority is obliged to help parents meet their responsibility. The Nutrition Supplementation Programme (NSP) aims to help underweight children gain weight and empower parents to tackle malnutrition. Objective. To study mothers’ experience with the NSP, and assess this in relation to South Africa’s emphasis on human rights. Subjects and methods. Seven focus group discussions were conducted with a total of 28 mothers of under-5s included in the NSP. The methodology used is particularly suitable for disclosing unexplored and unexpected issues. Results. Most mothers expressed satisfaction with receiving the supplements, which they perceived to be nutritious. However, they had received little or no education and lacked knowledge and skills regarding how to help their children gain weight. In addition, many mothers had experienced poor communication with staff members as well as unfavourable comments and lack of respect. These experiences and perceptions were real for mothers and indicate that the way the NSP was delivered resulted in inadequate compliance with certain principles of human rights, especially respect for human dignity, client participation and empowerment. Conclusions. Even though small studies are relatively prone to bias, this qualitative study is informative. More focus on the education part of the NSP would enable mothers to manage their children’s nutrition better. Measures to improve health workers’ knowledge of how to work within a human rights paradigm are necessary in order to strengthen accountability of the health authorities and improve children’s health.
Feasibility and Acceptability of Screening and Brief Interventions to Address Alcohol and Other Drug Use among Patients Presenting for Emergency Services in Cape Town, South Africa  [PDF]
Bronwyn Myers,Dan J. Stein,Bulelwa Mtukushe,Katherine Sorsdahl
Advances in Preventive Medicine , 2012, DOI: 10.1155/2012/569153
Abstract: Despite evidence from high income countries, it is not known whether screening and brief interventions (SBI) for alcohol and other drug (AOD) use are feasible to implement in low and middle income countries. This paper describes the feasibility and acceptability of a peer-led SBI for AOD-using patients presenting with injuries at emergency services in Cape Town, South Africa. Data were extracted from program records on the number of eligible patients screened and the number of program refusals. A questionnaire examined preliminary responses to the intervention for 30 patients who had completed the program and 10 emergency personnel. Peer counselors were also interviewed to identify barriers to implementation. Of the 1458 patients screened, 21% (305) met inclusion criteria, of which 74% (225) were enrolled in the intervention. Of the 30 patients interviewed, most (83%) found the program useful. Emergency personnel were supportive of the program but felt that visibility and reach could improve. Peer counselors identified the need for better integration of the program into emergency services and for additional training and support. In conclusion, with limited additional resources, peer-led SBIs for AOD use are feasible to conduct in South African emergency services and are acceptable to patients and emergency personnel. 1. Introduction South Africa has high rates of alcohol and other drug (AOD)-related problems, with these problems being particularly prevalent in the Western Cape Province of the country. For example, findings from a recent nationally representative survey indicate that the lifetime prevalence for any AOD use disorder (defined by DSM-IV criteria for abuse or dependence) was 20.3% in this province, which far exceeds the national average of 13.3% [1]. Furthermore, according to several nationally representative surveys, the Western Cape has one of the highest prevalence rates of hazardous and harmful alcohol use in the country [2, 3]. These high levels of problematic AOD use are a major concern for public health in the province, especially given evidence that AOD use is strongly associated with interpersonal violence and injury [4–8], which is the second leading cause of life years lost in the province after HIV/AIDS [9]. Evidence from earlier studies suggests that AOD use is associated with interpersonal violence and injury in several ways. First, AOD use leads to disinhibition which can trigger aggressive behavior and violence [10–12]. Second, people who are intoxicated are more likely to become victims of violence; mainly because AOD use
Evaluation of community-based growth monitoring in rural districts of the Eastern Cape and KwaZulu-Natal provinces of South Africa
M Faber, S Schoeman, C.M Smuts, V Adams, T Ngomane
South African Journal of Clinical Nutrition , 2009,
Abstract: Background: The Health Systems Trust implemented a community-based growth monitoring intervention project that fits into the Integrated Nutrition Programme focus areas and commissioned an evaluation of this project. Objective: To assess project volunteers’ knowledge on infant and young child nutrition and growth monitoring, and evaluate communitybased growth monitoring activities. Design: Five randomly selected growth monitoring sites per sub-district were evaluated. Project volunteers (n = 45) and caregivers (n = 186) attending the growth monitoring sites were interviewed by means of a questionnaire. Growth monitoring and nutrition education activities were observed at the growth monitoring sites. Setting: Two rural districts in KwaZulu-Natal (Umkhanyakude: sub-district Jozini; and Zululand: sub-district Phongola), and one rural district in the Eastern Cape (OR Tambo), South Africa. Results: Project volunteers were mostly women (87%), 38 ± 10 years old, and 27% had matric/Grade 12. There was a high turnover of project volunteers. Their nutrition knowledge varied. Forty-six per cent of the project volunteers and 39% of the caregivers could correctly identify the growth curve of a healthy growing child. Seven of the 13 sites that were visited were at a crèche. There was a referral system between the growth monitoring site and the local clinic, and links with the Department of Agriculture and, to a lesser extent, the Department of Social Welfare. Weighing methods were inconsistent and the steps of growth monitoring were not followed through. Nutrition education to the caregivers was lacking at several of the sites. Conclusion: The study highlighted both strengths and limitations of the project. Areas that need improvement include the selection, training and supervision of project volunteers performing community-based growth monitoring.
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