Adverse or acceptable: Negotiating access to a post-apartheid health care contract

  • Globalization and Health, Volume 10, No. 1, Year 2014

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Study Justification:
This study examines access barriers to quality health services in South Africa, a country that has transitioned from authoritarianism to democracy. Despite constitutional guarantees, access to healthcare remains inequitable and contested. The study aims to explore how a post-apartheid health care contract is narrated, practiced, and negotiated by patients and providers. By understanding these dynamics, the study seeks to contribute to the conceptualization and promotion of more inclusive and equitable health services in a post-conflict setting.
Highlights:
– The study conducted in-depth interviews with 45 patients and 67 providers, and observed health facilities in rural and urban areas.
– Access to health care in South Africa is not automatically or unconditionally inclusive, despite constitutional guarantees.
– Access barriers include poverty, an under-resourced hierarchical health system, the nature of illness and treatment, and negative attitudes and actions.
– Differences in patient and provider expectations of the health care contract can lead to conflicting identities of inclusion and exclusion.
– Caring communication, acts of kindness, institutional flexibility, and leadership can mitigate access barriers and foster positive forms of inclusion.
– Negotiating a new social contract is necessary for building health in fragile and post-conflict societies.
– The health system can play a crucial role in highlighting and addressing the political economy, institutions, and social relationships that contribute to exclusion and inclusion.
Recommendations:
– Surface and engage with differences in patient and provider expectations of the health care contract to promote more acceptable and accessible health care services.
– (Re)politicize suffering by highlighting the political and social factors that contribute to exclusion and inclusion in health care.
– Coordinate and lead intersectoral action to overcome affordability and availability barriers to inclusive and equitable health care services.
Key Role Players:
– Policy makers and government officials responsible for health care planning and implementation.
– Health care providers, including doctors, nurses, and other medical professionals.
– Patient advocacy groups and civil society organizations.
– Researchers and academics specializing in health policy and post-conflict settings.
Cost Items for Planning Recommendations:
– Funding for research and data collection.
– Resources for training and capacity building of health care providers.
– Investments in infrastructure and equipment to improve the quality and accessibility of health care services.
– Budget allocation for intersectoral collaboration and coordination efforts.
– Support for patient advocacy and community engagement initiatives.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study conducted in-depth interviews with a significant number of patients and providers, and also included field observations from multiple health facilities. However, the abstract does not provide specific details about the methodology used, such as sampling techniques or data analysis methods. To improve the strength of the evidence, the authors could provide more information about the study design and methodology, as well as the specific findings and conclusions drawn from the data.

Background: As in many fragile and post-conflict countries, South Africa’s social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting.Methods: Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering – negotiating – maternal health, tuberculosis and antiretroviral services in South Africa.Results: Although South Africa’s right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care.Conclusions: Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion – (re)politicise suffering – and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services. © 2014 Harris et al.; licensee BioMed Central Ltd.

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Based on the information provided, it is difficult to identify specific innovations for improving access to maternal health. However, some potential recommendations could include:

1. Strengthening healthcare infrastructure: Investing in the development and improvement of healthcare facilities, particularly in rural areas, can help ensure that maternal health services are more accessible to all women.

2. Increasing healthcare resources: Allocating more resources, such as medical equipment, supplies, and healthcare professionals, to maternal health services can help improve the quality and availability of care.

3. Enhancing community engagement: Implementing community-based programs and initiatives that raise awareness about maternal health and provide education and support to pregnant women can help increase access to care.

4. Addressing socio-economic barriers: Implementing policies and programs that address socio-economic factors, such as poverty and inequality, can help reduce barriers to accessing maternal health services.

5. Improving transportation options: Providing reliable and affordable transportation options for pregnant women, particularly in remote areas, can help ensure that they can access healthcare facilities when needed.

6. Promoting cultural sensitivity: Training healthcare providers to be culturally sensitive and respectful of diverse beliefs and practices can help improve access to maternal health services for marginalized communities.

7. Utilizing technology: Exploring the use of telemedicine and mobile health applications can help overcome geographical barriers and improve access to maternal health services, particularly in remote areas.

It is important to note that these recommendations are general and may need to be tailored to the specific context and challenges faced in South Africa.
AI Innovations Description
Based on the provided description, it is difficult to determine a specific recommendation for improving access to maternal health. However, the study suggests that addressing access barriers, such as poverty, under-resourced health systems, negative attitudes, and differences in expectations between patients and providers, can contribute to more inclusive and equitable health care services.

To develop this into an innovation, one recommendation could be to implement community-based interventions that focus on addressing these access barriers. This could involve initiatives such as:

1. Strengthening community health systems: Investing in training and equipping community health workers to provide maternal health services in underserved areas. This can help bridge the gap between communities and formal health care facilities.

2. Improving transportation services: Enhancing transportation options for pregnant women in remote areas to ensure they can access prenatal care and delivery services in a timely manner.

3. Promoting health education and awareness: Conducting community outreach programs to educate women and their families about the importance of maternal health care, including prenatal care, safe delivery practices, and postnatal care.

4. Addressing cultural and social barriers: Collaborating with community leaders, traditional birth attendants, and local organizations to address cultural beliefs and practices that may hinder access to maternal health services.

5. Enhancing communication and collaboration between patients and providers: Implementing strategies to improve communication and understanding between patients and health care providers, such as patient-centered care approaches and cultural competency training for health care professionals.

These recommendations can be further developed and tailored to the specific context and needs of the community, with the aim of improving access to maternal health services and reducing disparities in care.
AI Innovations Methodology
Based on the provided description, it seems that the focus is on improving access to maternal health care in South Africa. Here are two potential innovations that could be recommended to improve access to maternal health:

1. Mobile Clinics: Implementing mobile clinics that travel to rural and remote areas can help overcome geographical barriers and provide essential maternal health services to underserved populations. These clinics can offer prenatal care, antenatal check-ups, vaccinations, and education on maternal health. By bringing healthcare services directly to the communities, it can increase access and reduce the need for long-distance travel.

2. Telemedicine: Utilizing telemedicine technology can improve access to maternal health services, especially in areas with limited healthcare infrastructure. Through video consultations, pregnant women can receive medical advice, guidance, and support from healthcare professionals remotely. This can be particularly beneficial for routine check-ups, monitoring high-risk pregnancies, and providing postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group that will benefit from the innovations, such as pregnant women in rural areas or areas with limited healthcare facilities.

2. Collect baseline data: Gather data on the current state of access to maternal health services in the target population. This can include information on the number of healthcare facilities, distance to the nearest facility, availability of services, and any existing barriers.

3. Simulate the implementation of the innovations: Use modeling techniques to simulate the introduction of mobile clinics and telemedicine in the target population. This can involve estimating the number of clinics needed, their locations, and the coverage they can provide. For telemedicine, simulate the availability of technology, connectivity, and the number of healthcare professionals providing remote consultations.

4. Assess the impact: Evaluate the impact of the innovations on improving access to maternal health services. This can be done by comparing the simulated scenario with the baseline data. Key indicators to consider may include the number of women accessing prenatal care, the reduction in travel distance to healthcare facilities, and the overall improvement in maternal health outcomes.

5. Refine and iterate: Based on the simulation results, refine the implementation strategy and iterate the simulation to further optimize the impact. This can involve adjusting the number and locations of mobile clinics, improving telemedicine infrastructure, or addressing any identified barriers that may still exist.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of these innovations on improving access to maternal health and make informed decisions on their implementation.


Statistics:
Citations: 12
Identifiers:
DOI: 10.1186/1744-8603-10-35
Research Areas:
Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
South Africa
Study Approach:
Qualitative
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