South African Medical Journal (SAMJ)
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Emerging technologies and virtual medicine in obesity management
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1. Implementation of strategies in the management of obesity can be delivered through web-based platforms (e.g. online education on medical nutrition therapy and physical activity) or mobile devices (e.g. daily weight reporting through a smartphone phone application) (Level 2a, Grade B).
2. We suggest that healthcare providers incorporate individualised feedback and follow-up (e.g. personalised coaching or feedback via phone or email) into technology-based management strategies to improve weight loss outcomes (Level 4, Grade D).
3. The use of wearable activity-tracking technology should be part of a comprehensive strategy for weight loss (Level 1a, Grade A).
The implementation of community-oriented primary care in the Cape Metro Health District: A programme evaluation
Get PDFBackground. An implementation framework for community-oriented primary care (COPC) was developed in the Cape Metro, Western Cape Province, South Africa. In 2018, four learning sites were identified to experiment with the framework. A study was undertaken to explore the implementation of this framework.
Objectives. To explore the process and progress of implementation, as well as the perceptions of the barriers and enablers of implementation.
Methods. A programmatic process evaluation with a descriptive exploratory qualitative study design was used. A logic model was developed, and defined inputs, outputs and the sources of evidence for the implementation process.
Results. The understanding of COPC and its underlying philosophy contrasted with the traditional model of care, and the paradigm shift was challenging. Strong leadership was identified as a facilitator for change. Community and stakeholder engagement were the most challenging issues. COPC requires a wide range of skills and expertise supported by appropriate training and clear role definition. The use of electronic devices in the community was both an advantage and a barrier.
Conclusion. Implementation of COPC needs to be understood as a reform of the model of care, and not as an additional project or service. The findings can guide policy, further scale-up and implementation of COPC
The role of AI in transforming healthcare in South Africa
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South Africa’s healthcare system struggles with resource constraints, workforce gaps, and rising disease burdens. Artificial intelligence (AI) offers a scalable solution – enhancing diagnostics, drug discovery, and clinical decision-making while optimising hospital efficiency. Success depends on interoperable data, bias-aware AI models trained on local datasets, and robust ethical frameworks. Learning from China’s AI health strategy and leveraging BRICS collaboration, South Africa must prioritise a unified digital health infrastructure to ensure equitable, secure AI adoption. Responsible implementation can augment clinical expertise and improve care standards across public and private sectors
Achieving universal healthcare access in South Africa: A policy analysis of consensus reform proposals
No full textBackground. South Africa’s ongoing efforts to realise universal health coverage (UHC) have produced three discernible policy trajectories: UHC0, the de facto configuration of public and private health systems; UHC1, the incremental reform framework initiated post 1994 and recently revisited by the Universal Healthcare Access Coalition; and UHC2, the centralised National Health Insurance approach formalised in a 2017 White Paper.
Objective. To offer a comparative analysis between the three alternative policy trajectories, to determine which offers the most productive pathway to deepen UHC.
Methods. This analysis uses the organising principle of subsidiarity, which argues that decision-making authority should be handled at the most local level possible, with higher levels stepping in only when needed. A qualitative comparative policy analysis methodology is applied to assess the institutional design, financial sustainability, governance integrity, implementation feasibility and equity outcomes of these approaches.
Results. Drawing from primary policy documents, the study finds that UHC1 provides the most feasible and constitutionally aligned pathway for realising UHC. UHC2, by way of contrast, is least likely to be implemented, with design features that deviate substantially from the principle of subsidiarity. UHC0, the status quo option, also incorporates severe deviations from the principle of subsidiarity and is likely to perpetuate systemic inequity and poor outcomes. Importantly, continued attempts to implement UHC2 effectively converge on UHC0, with the result that UHC0 is likely to continue indefinitely unless revised toward UHC1.
Conclusion. Of the three options, UHC1, as envisaged in the 1990s, remains the most viable approach to deepen UHC, with UHC2 unlikely to achieve any key UHC goals owing to design weaknesses that deviate from the principle of subsidiarity and financial constraints. Attempts to implement UHC2, thereby obstructing the implementation of key aspects of UHC1, defaults the health system to the residual UHC0 approach – which lacks any strategic vision for deepening UHC
Monitoring District Health System performance in South Africa: A proposed dashboard based on key pragmatic indicators
Get PDFEffective monitoring and evaluation (M&E) systems are central to ensuring the performance and accountability of the district health system (DHS). Current systems in South Africa are suboptimal and poorly oriented to the decision-making needs of district managers. Drawing on a WHO measurement framework for the performance of primary healthcare, and as a follow-up to a first article describing the challenges of M&E systems in the DHS, this article proposes a DHS performance monitoring dashboard that is both practical and pragmatic. The dashboard was constructed in an iterative and consultative process, and consists of 20 indicators for quarterly monitoring. A set of general criteria underpinning the choice of indicators is spelled out (e.g. the data are readily available and reliable). Indicators that do not have much variability, or are better suited to annual evaluation (e.g. number of community health workers per 1 000 population) are not included. The dashboard includes the name or description of the indicator, the definition of the indicator, why it is useful, challenges and pitfalls to be considered when analysing the indicator and how it can be used for decision-making. We propose that these indicators be assessed, tracked and monitored on a quarterly basis by relevant managers at the facility subdistrict and district levels. We emphasise that the purpose of this dashboard is not external compliance, but rather to support district managerial decision-making and accountability
High frequency of SARS-CoV-2 infection in children admitted to academic hospitals in central South Africa
Get PDFBackground. During the COVID‐19 pandemic, the Omicron variant was highly infectious in children, and resulted in high hospital admission rates in this population compared with other SARS‐CoV‐2 variants.
Objective. To investigate the prevalence of SARS‐CoV‐2 infection in children during the Omicron variant wave in Free State Province, South Africa (SA).
Methods. This prospective cross‐sectional study was conducted from August 2022 to April 2023 in the Free State, SA. A total of 320 children admitted at Pelonomi Tertiary Hospital and Universitas Academic Hospital between the ages of 0 and 12 years were recruited. All participants were tested for SARS‐CoV‐2 using the nucleocapsid antibody rapid test. Parent and caregiver vaccination history was also collected.
Results. In our study, 46.8% of the children tested positive for SARS‐CoV‐2. The highest (60%) infection rate was observed in neonates. Children were admitted for various reasons, and none were screened for suspected SARS‐CoV‐2 on admission. Of the infected population, 28% were premature, 12.6% had gastrointestinal tract infections, 12% had respiratory conditions and 10% had central nervous system conditions. A total of 43.3% of the infected children were from vaccinated parents or caregivers.
Conclusion. Our study showed that a high number of hospitalised children tested positive for SARS‐CoV‐2 while admitted for conditions unrelated to COVID‐19. Most, if not all, children did not exhibit COVID‐19‐specific symptoms, and this may be due to the Omicron variant, which was highly infectious but less virulent, and was associated with mild disease
