James Irlam, Rico Euripidou, Mafoko Phomane, Azeeza Rangunwala
Background South Africa’s long history of dependence on coal-fired power has had severe impacts on climate, environmental health, and public health. Global pressures and local demands for a planned just transition in South Africa have been growing. People are calling for a transition to clean renewable energy that optimises socio-economic and local ecological benefits. The Just Transition Open Agenda is a contribution to the national debate by the Life After Coal civil society campaign. The Open Agenda proposes radical changes leading to a new health system for all. This is needed, especially to address the differential and continual health impacts of unsafe levels of air pollution especially where most of South Africa’s coal-fired power stations are located. Approach This paper reviews South Africa’s climate change response and the role that the healthcare sector (as a significant source of emissions and environmental pollution) can play in reducing global carbon emissions and helping societies to adapt and become more ‘climate resilient’. The chapter considers some of the recommendations for public health within the just transition movement in South Africa, with a particular focus on the heavily polluted Highveld Priority Area in Mpumalanga, and the implications of these recommendations for the healthcare sector. Conclusions A comprehensive public health plan for the Highveld Priority Area, guided by the principles of communication, collaboration, and active participation, would begin to provide some measure of restorative justice for the communities most affected by coal-related pollution. The plan should include effective health surveillance and air pollution early-warning systems, community outreach programmes, and well-resourced and accessible public health facilities prepared to deal with respiratory emergencies. The Global Green and Healthy Hospitals network agenda’s 10 goals towards ‘climate-smart’ health care, which provide practical guidance for achieving sustainable, low-carbon, and climate-resilient health systems must be urgently pursued as part of global and local efforts towards greater climate justice and health equity.
{"title":"The ‘just transition’ and health in South Africa","authors":"James Irlam, Rico Euripidou, Mafoko Phomane, Azeeza Rangunwala","doi":"10.61473/001c.75137","DOIUrl":"https://doi.org/10.61473/001c.75137","url":null,"abstract":"Background South Africa’s long history of dependence on coal-fired power has had severe impacts on climate, environmental health, and public health. Global pressures and local demands for a planned just transition in South Africa have been growing. People are calling for a transition to clean renewable energy that optimises socio-economic and local ecological benefits. The Just Transition Open Agenda is a contribution to the national debate by the Life After Coal civil society campaign. The Open Agenda proposes radical changes leading to a new health system for all. This is needed, especially to address the differential and continual health impacts of unsafe levels of air pollution especially where most of South Africa’s coal-fired power stations are located. Approach This paper reviews South Africa’s climate change response and the role that the healthcare sector (as a significant source of emissions and environmental pollution) can play in reducing global carbon emissions and helping societies to adapt and become more ‘climate resilient’. The chapter considers some of the recommendations for public health within the just transition movement in South Africa, with a particular focus on the heavily polluted Highveld Priority Area in Mpumalanga, and the implications of these recommendations for the healthcare sector. Conclusions A comprehensive public health plan for the Highveld Priority Area, guided by the principles of communication, collaboration, and active participation, would begin to provide some measure of restorative justice for the communities most affected by coal-related pollution. The plan should include effective health surveillance and air pollution early-warning systems, community outreach programmes, and well-resourced and accessible public health facilities prepared to deal with respiratory emergencies. The Global Green and Healthy Hospitals network agenda’s 10 goals towards ‘climate-smart’ health care, which provide practical guidance for achieving sustainable, low-carbon, and climate-resilient health systems must be urgently pursued as part of global and local efforts towards greater climate justice and health equity.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135471015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
By Ashnie Padarath, Themba L. Moeti. Following the COVID-19 pandemic, it is critical to reflect on lessons learned, apply these insights to strengthen the country's response to public health emergencies, and develop more resilient health systems.
作者:Ashnie Padarath, Themba L. Moeti。在2019冠状病毒病大流行之后，至关重要的是要反思吸取的经验教训，将这些见解应用于加强国家对突发公共卫生事件的应对，并建立更具抵御力的卫生系统。
{"title":"Introduction: Foreword, Contents, Acknowledgements","authors":"Ashnie Padarath, Themba L. Moeti","doi":"10.61473/001c.87499","DOIUrl":"https://doi.org/10.61473/001c.87499","url":null,"abstract":"By Ashnie Padarath, Themba L. Moeti. Following the COVID-19 pandemic, it is critical to reflect on lessons learned, apply these insights to strengthen the country's response to public health emergencies, and develop more resilient health systems.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The COVID-19 pandemic caused great social, political and economic disruption, and imposed unprecedented changes in work, lifestyle, service delivery and social interactions in South Africa and worldwide. Healthcare providers, working in often already overstretched healthcare systems, found themselves at the forefront of global and national efforts to contain the havoc of morbidity and mortality wreaked by SARS-CoV2. This chapter describes efforts by the University of Pretoria’s Department of Family Medicine (UPDFM) to deliver on its mandate of teaching, learning, and research in the face of the disruptions of the COVID-19 pandemic during the March-September 2020 nationwide hard lockdown. Methods A perspective review was undertaken, drawing on reports, meeting minutes, email correspondences and electronic personal communications analysed to describe the activities undertaken by the UPDFM during the study period. Results Nationally, some of the adaptive responses triggered by the COVID-19 lockdown drew from the pre-existing UPDFM repertoire of community-oriented, learner- and patient-centred practices of service delivery. Key among these practices were data collection and management using validated tools; virtual communication and meetings; health promotion and disease prevention through training nurses, community health workers and patients on newly developed Covid-19 prevention strategies; clinical intervention, including screening and diagnosis, treatment and care coordination using telemedicine and full service delivery in homeless shelters; patient referral/mobility by staff using sponsored rental cars and using an application to call an ambulance, and treatment continuation through home delivery of medication. Conclusions COVID-19 restrictions presented the UPDFM with a unique opportunity to draw from its experience and create rapid, impactful interventions. Most lessons learnt by the UPDFM during the crisis proved invaluable for use beyond the acute phase of the pandemic, thereby transforming the health system for better pandemic preparedness.
{"title":"A Family Medicine response to the COVID-19 lockdown: University of Pretoria perspective","authors":"Edith N. Madela-Mntla, Sanele Ngcobo","doi":"10.61473/001c.77880","DOIUrl":"https://doi.org/10.61473/001c.77880","url":null,"abstract":"Background The COVID-19 pandemic caused great social, political and economic disruption, and imposed unprecedented changes in work, lifestyle, service delivery and social interactions in South Africa and worldwide. Healthcare providers, working in often already overstretched healthcare systems, found themselves at the forefront of global and national efforts to contain the havoc of morbidity and mortality wreaked by SARS-CoV2. This chapter describes efforts by the University of Pretoria’s Department of Family Medicine (UPDFM) to deliver on its mandate of teaching, learning, and research in the face of the disruptions of the COVID-19 pandemic during the March-September 2020 nationwide hard lockdown. Methods A perspective review was undertaken, drawing on reports, meeting minutes, email correspondences and electronic personal communications analysed to describe the activities undertaken by the UPDFM during the study period. Results Nationally, some of the adaptive responses triggered by the COVID-19 lockdown drew from the pre-existing UPDFM repertoire of community-oriented, learner- and patient-centred practices of service delivery. Key among these practices were data collection and management using validated tools; virtual communication and meetings; health promotion and disease prevention through training nurses, community health workers and patients on newly developed Covid-19 prevention strategies; clinical intervention, including screening and diagnosis, treatment and care coordination using telemedicine and full service delivery in homeless shelters; patient referral/mobility by staff using sponsored rental cars and using an application to call an ambulance, and treatment continuation through home delivery of medication. Conclusions COVID-19 restrictions presented the UPDFM with a unique opportunity to draw from its experience and create rapid, impactful interventions. Most lessons learnt by the UPDFM during the crisis proved invaluable for use beyond the acute phase of the pandemic, thereby transforming the health system for better pandemic preparedness.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135472755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background This chapter aims to provide a repository of data, focusing on the national and provincial levels, that describes the broad status of the South African health system (socio-demographic indicators and determinants and health status indicators, as well as health service indicators). It examines the available health information data sources in South Africa, with a particular focus on whether they have been strengthened during and after the acute phase of the COVID-19 pandemic. The broader context for this chapter lies in the desire to see the lessons learned from the COVID-19 pandemic translated into systemic changes that advance the reform of South Africa’s fragmented health services and hasten the attainment of effective and sustainable universal health coverage. Methods Data were sourced primarily from national routine data sources, but also captured from major surveys and global reports. Using monthly routine data sources, the difference between expected and actual routine measures were calculated and expected trends were forecast. These graphs enabled the depiction of the changes that occurred pre- and post-COVID in South Africa for key health indicators. Conclusions Progress is discernible, but there is also evidence of back-sliding, of a revision to previous positions, and therefore a need to refocus attention on important lessons, lest they be lost. Recommendations Strong health information systems should be the foundation on which evidence-based decisions can be made to support strong governance and leadership, where human resources for health are also supported and healthcare funding is prioritised.
{"title":"Health and related indicators 2022","authors":"Candy Day, Andy Gray","doi":"10.61473/001c.82026","DOIUrl":"https://doi.org/10.61473/001c.82026","url":null,"abstract":"Background This chapter aims to provide a repository of data, focusing on the national and provincial levels, that describes the broad status of the South African health system (socio-demographic indicators and determinants and health status indicators, as well as health service indicators). It examines the available health information data sources in South Africa, with a particular focus on whether they have been strengthened during and after the acute phase of the COVID-19 pandemic. The broader context for this chapter lies in the desire to see the lessons learned from the COVID-19 pandemic translated into systemic changes that advance the reform of South Africa’s fragmented health services and hasten the attainment of effective and sustainable universal health coverage. Methods Data were sourced primarily from national routine data sources, but also captured from major surveys and global reports. Using monthly routine data sources, the difference between expected and actual routine measures were calculated and expected trends were forecast. These graphs enabled the depiction of the changes that occurred pre- and post-COVID in South Africa for key health indicators. Conclusions Progress is discernible, but there is also evidence of back-sliding, of a revision to previous positions, and therefore a need to refocus attention on important lessons, lest they be lost. Recommendations Strong health information systems should be the foundation on which evidence-based decisions can be made to support strong governance and leadership, where human resources for health are also supported and healthcare funding is prioritised.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134982996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This chapter provides a critical examination of South Africa’s COVID-19 testing and contact tracing response, including emerging successes and weaknesses. Lessons emerging from South Africa’s COVID-19 testing and contact tracing strategy highlight the importance of rapid roll-out of community screening and testing across the country, robust implementation of public health measures, and leveraging existing healthcare services such as the deployment of existing Community Health Workers. The absence of a standardised national information system to support contact tracing efforts, long turnaround times and backlogs in testing, and low uptake of digital solutions such as the COVIDConnect and COVID Alert Apps, were noted as some of the challenges of the process. New considerations to take into account in planning for any future outbreaks include ways to enhance intersectoral approaches and integrate with other community surveillance systems, how to rationalise health workforce redistribution during surge periods by prioritising cases, and the use of technology solutions to manage data.
{"title":"Test-Trace strategy for disease control and management: South Africa’s control measures to contain the spread of COVID-19","authors":"Moeketsi Modisenyane, Shadrack Mngemane, Tebogo Maomela, Takalani Nemungadi, Phyllis Chituku, Elizabeth Leonard, Tumisho Langa, Yogan Pillay","doi":"10.61473/001c.74342","DOIUrl":"https://doi.org/10.61473/001c.74342","url":null,"abstract":"This chapter provides a critical examination of South Africa’s COVID-19 testing and contact tracing response, including emerging successes and weaknesses. Lessons emerging from South Africa’s COVID-19 testing and contact tracing strategy highlight the importance of rapid roll-out of community screening and testing across the country, robust implementation of public health measures, and leveraging existing healthcare services such as the deployment of existing Community Health Workers. The absence of a standardised national information system to support contact tracing efforts, long turnaround times and backlogs in testing, and low uptake of digital solutions such as the COVIDConnect and COVID Alert Apps, were noted as some of the challenges of the process. New considerations to take into account in planning for any future outbreaks include ways to enhance intersectoral approaches and integrate with other community surveillance systems, how to rationalise health workforce redistribution during surge periods by prioritising cases, and the use of technology solutions to manage data.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135414996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trudy D. Leong, Andy L. Gray, Tamara Kredo, Renee de Waal, Karen Cohen, Andy G. Parrish, Halima Dawood
The outbreak of the COVID-19 pandemic posed challenges to the practice of evidence-informed decision-making. Soon after the index case was identified in South Africa, the first local clinical guidelines were developed, reliant on preliminary evidence. Quick decisions were essential to inform practice and procurement at a time of exceptional global demand for medicine supply. This chapter describes how a rapid review mechanism was implemented to enable the development of evidence-informed and context-specific clinical treatment and prevention recommendations for COVID-19 in South Africa. The chapter reflects on the extent to which there is evidence for the implementation of these recommendations in clinical practice, using medicinesutilisation data from the public sector. In order to manage the ‘infodemic’ of research evidence of variable quality, a robust mechanism of rapid evidence review, transparent decision-making, and dissemination of trustworthy, accurate and context-specific recommendations was developed. Rapid evidence syntheses were produced by a sub-committee of the National Essential Medicines List Committee, supported by the South African GRADE Network and SAMRC Cochrane Centre. A generic rapid review protocol was developed, relying on GRADE principles and an evidence-to-decision framework. Consensus recommendations informed the National Department of Health/National Institute for Communicable Diseases clinical guidelines. Reviews were published on the National Department of Health website to advance transparency and were updated as new evidence emerged. Medicinesutilisation data showed increased use of corticosteroids, but there was also evidence of increased use of medicines not recommended. Further investment in technical capacity and support is needed to strengthen implementation, monitoring, and evaluation of clinical guidelines.
{"title":"Managing therapeutic uncertainty in the COVID-19 pandemic: rapid evidence syntheses and transparent decision-making","authors":"Trudy D. Leong, Andy L. Gray, Tamara Kredo, Renee de Waal, Karen Cohen, Andy G. Parrish, Halima Dawood","doi":"10.61473/001c.74343","DOIUrl":"https://doi.org/10.61473/001c.74343","url":null,"abstract":"The outbreak of the COVID-19 pandemic posed challenges to the practice of evidence-informed decision-making. Soon after the index case was identified in South Africa, the first local clinical guidelines were developed, reliant on preliminary evidence. Quick decisions were essential to inform practice and procurement at a time of exceptional global demand for medicine supply. This chapter describes how a rapid review mechanism was implemented to enable the development of evidence-informed and context-specific clinical treatment and prevention recommendations for COVID-19 in South Africa. The chapter reflects on the extent to which there is evidence for the implementation of these recommendations in clinical practice, using medicinesutilisation data from the public sector. In order to manage the ‘infodemic’ of research evidence of variable quality, a robust mechanism of rapid evidence review, transparent decision-making, and dissemination of trustworthy, accurate and context-specific recommendations was developed. Rapid evidence syntheses were produced by a sub-committee of the National Essential Medicines List Committee, supported by the South African GRADE Network and SAMRC Cochrane Centre. A generic rapid review protocol was developed, relying on GRADE principles and an evidence-to-decision framework. Consensus recommendations informed the National Department of Health/National Institute for Communicable Diseases clinical guidelines. Reviews were published on the National Department of Health website to advance transparency and were updated as new evidence emerged. Medicinesutilisation data showed increased use of corticosteroids, but there was also evidence of increased use of medicines not recommended. Further investment in technical capacity and support is needed to strengthen implementation, monitoring, and evaluation of clinical guidelines.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136275947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan J. Dempster, Nimesh Naran, Murray Dryden, Zhixin He, Kathleen J. Kabuya, Khadeejah Sheik, Trisha A. Whitbread, Moushumi A. Mathews, Harsha Somaroo, Vivien Essel
The National Institute for Communicable Diseases − a division of the National Health Laboratory Service − launched a clinician and public hotline, adapted from an existing NICD clinicians’ hotline, to guide healthcare workers and members of the public on COVID-19-related queries. The hotlines received over 150 000 queries within eight months. We describe the queries so as to inform recommendations for tailoring clinician training, improving access to information, and guiding health promotion. A retrospective description of data from the NHLS-NICD clinician and public hotlines from January to August 2020 was performed. Queries were analysed by province, caller type and sector. A thematic analysis with a deductive and semantic approach was used to describe the reason for each query. From January to August 2020, 99.9% (152 766/152 985) of queries attended to on the hotlines were related to COVID-19, with most queries being made in April (n=53 471). The majority of queries were from members of the public (95.0%), and from the public sector (97.0%). Gauteng Province accounted for most queries (42.9%). General information on COVID-19, advice for testing and administrative/systems issues (related to nationwide announcements/events), together accounted for the largest proportion of COVID-19 queries, at 86.0%. The hotline provided general and clinical COVID-19 advice. Data from the hotline mirrored information gaps and distributions of concerns related to COVID-19, and could be used to guide clinician training and public informationsharing. A significant proportion of the queries did not fall within the NHLS-NICD scope of practice, indicating a need for targeted public engagement and education. Future outbreak hotline services could be planned on the basis of this experience to define the objectives of contact centres and establish these in awareness campaigns
{"title":"COVID-19-related queries received by the National Health Laboratory Service and the National Institute for Communicable Diseases in South Africa: January to August 2020","authors":"Megan J. Dempster, Nimesh Naran, Murray Dryden, Zhixin He, Kathleen J. Kabuya, Khadeejah Sheik, Trisha A. Whitbread, Moushumi A. Mathews, Harsha Somaroo, Vivien Essel","doi":"10.61473/001c.74344","DOIUrl":"https://doi.org/10.61473/001c.74344","url":null,"abstract":"The National Institute for Communicable Diseases − a division of the National Health Laboratory Service − launched a clinician and public hotline, adapted from an existing NICD clinicians’ hotline, to guide healthcare workers and members of the public on COVID-19-related queries. The hotlines received over 150 000 queries within eight months. We describe the queries so as to inform recommendations for tailoring clinician training, improving access to information, and guiding health promotion. A retrospective description of data from the NHLS-NICD clinician and public hotlines from January to August 2020 was performed. Queries were analysed by province, caller type and sector. A thematic analysis with a deductive and semantic approach was used to describe the reason for each query. From January to August 2020, 99.9% (152 766/152 985) of queries attended to on the hotlines were related to COVID-19, with most queries being made in April (n=53 471). The majority of queries were from members of the public (95.0%), and from the public sector (97.0%). Gauteng Province accounted for most queries (42.9%). General information on COVID-19, advice for testing and administrative/systems issues (related to nationwide announcements/events), together accounted for the largest proportion of COVID-19 queries, at 86.0%. The hotline provided general and clinical COVID-19 advice. Data from the hotline mirrored information gaps and distributions of concerns related to COVID-19, and could be used to guide clinician training and public informationsharing. A significant proportion of the queries did not fall within the NHLS-NICD scope of practice, indicating a need for targeted public engagement and education. Future outbreak hotline services could be planned on the basis of this experience to define the objectives of contact centres and establish these in awareness campaigns","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136275946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Geetesh Solanki, Gabrielle Kelly, Judith Cornell, Emmanuelle Daviaud, Leon Geffen
With more South Africans living past the age of 60, the country faces a growing chronic disease burden. Further research and action are needed for the health system to address the budgetary and social strains of this phenomenon effectively.
{"title":"Population ageing in South Africa: trends, impact, and challenges for the health sector.","authors":"Geetesh Solanki, Gabrielle Kelly, Judith Cornell, Emmanuelle Daviaud, Leon Geffen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>With more South Africans living past the age of 60, the country faces a growing chronic disease burden. Further research and action are needed for the health system to address the budgetary and social strains of this phenomenon effectively.</p>","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525465/pdf/nihms-1679949.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39560688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ushma Mehta, Emma Kalk, Andrew Boulle, Portia Nkambule, Joey Gouws, Helen Rees, Karen Cohen
South Africa has been engaged in pharmacovigilance (PV) activities to assess the impact of adverse drug reactions on public safety and health for 40 years. Activities have evolved from passive regulatory reporting to encompass active surveillance systems. The HIV and AIDS and TB epidemics stimulated pharmacoepidemiological research into the risks associated with medicines used in the standardised regimens of mass treatment programmes. Specific safety concerns, supported by robust local cohort data, have prompted major changes to national and international treatment policies. This chapter describes the expanding body of local knowledge and the historical and emergent surveillance systems that address the burden of drug-related harms, noting the challenges to health system responsiveness. The South African context presents a unique opportunity to characterise the scale and nature of such harms in mass HIV and AIDS and TB treatment programmes. The use of complex regimens at scale poses new PV challenges. There is an urgent need to develop cohesive, sustainable systems to support evidence-based decisions on appropriate regimen choices, while minimising medicine-associated risks. The increasing use of computerised clinical, laboratory and dispensing records, with unique patient identifiers facilitating data linkage, will increase PV surveillance capacity. A coherent national PV framework is an essential part of medicines policy, encompassing regulatory, programmatic and individual needs. Key pillars of this framework include: (i) consolidation and expansion of active and passive PV surveillance, optimising existing programmes; (ii) prioritising post-marketing monitoring within the new health products regulatory authority; and (iii) instilling a culture of active risk management in clinical practice through the creation of effective channels of communication and feedback into policy and practice.
{"title":"Pharmacovigilance: A public health priority for South Africa.","authors":"Ushma Mehta, Emma Kalk, Andrew Boulle, Portia Nkambule, Joey Gouws, Helen Rees, Karen Cohen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>South Africa has been engaged in pharmacovigilance (PV) activities to assess the impact of adverse drug reactions on public safety and health for 40 years. Activities have evolved from passive regulatory reporting to encompass active surveillance systems. The HIV and AIDS and TB epidemics stimulated pharmacoepidemiological research into the risks associated with medicines used in the standardised regimens of mass treatment programmes. Specific safety concerns, supported by robust local cohort data, have prompted major changes to national and international treatment policies. This chapter describes the expanding body of local knowledge and the historical and emergent surveillance systems that address the burden of drug-related harms, noting the challenges to health system responsiveness. The South African context presents a unique opportunity to characterise the scale and nature of such harms in mass HIV and AIDS and TB treatment programmes. The use of complex regimens at scale poses new PV challenges. There is an urgent need to develop cohesive, sustainable systems to support evidence-based decisions on appropriate regimen choices, while minimising medicine-associated risks. The increasing use of computerised clinical, laboratory and dispensing records, with unique patient identifiers facilitating data linkage, will increase PV surveillance capacity. A coherent national PV framework is an essential part of medicines policy, encompassing regulatory, programmatic and individual needs. Key pillars of this framework include: (i) consolidation and expansion of active and passive PV surveillance, optimising existing programmes; (ii) prioritising post-marketing monitoring within the new health products regulatory authority; and (iii) instilling a culture of active risk management in clinical practice through the creation of effective channels of communication and feedback into policy and practice.</p>","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708547/pdf/nihms894059.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35307359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-25DOI: 10.4102/SAJHIVMED.V1I1.491
H. Schneider
Over the past few years, the previously largely silent epidemic of HIV in South Africa has shifted to a visible epidemic of AIDS. The impact of this on health services, families and communities are emerging at a rapid pace. In an attempt to deal with this impact, it is common practice for health care facilities to ration services to people with HIV, with much of the burden of caring for the ill falling onto households and communities. In South Africa, ""home-based care"" has become a national policy priority. This chapter presents the findings of a review of various NGO, community and religious-based projects which are involved in helping people infected and affected by AIDS. The chapter looks at programmes which provide funding, technical assistance and support to communities, those which are involved in advocacy and community mobilisation, drop-in centres and support groups, home visiting and comprehensive home-based care as well as the care of orphans. The challenges to these programmes are listed and discussed, as are the factors which promote their success.
{"title":"Models of community-based HIV/AIDS care and support : chapter 16","authors":"H. Schneider","doi":"10.4102/SAJHIVMED.V1I1.491","DOIUrl":"https://doi.org/10.4102/SAJHIVMED.V1I1.491","url":null,"abstract":"Over the past few years, the previously largely silent epidemic of HIV in South Africa has shifted to a visible epidemic of AIDS. The impact of this on health services, families and communities are emerging at a rapid pace. In an attempt to deal with this impact, it is common practice for health care facilities to ration services to people with HIV, with much of the burden of caring for the ill falling onto households and communities. In South Africa, \"\"home-based care\"\" has become a national policy priority. This chapter presents the findings of a review of various NGO, community and religious-based projects which are involved in helping people infected and affected by AIDS. The chapter looks at programmes which provide funding, technical assistance and support to communities, those which are involved in advocacy and community mobilisation, drop-in centres and support groups, home visiting and comprehensive home-based care as well as the care of orphans. The challenges to these programmes are listed and discussed, as are the factors which promote their success.","PeriodicalId":21814,"journal":{"name":"South African Health Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80895509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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