e-Portfolio 2nd Submission: Task 2 (part 1)

Module One

Q1.1: How would you define and explain the purpose of a health system?

Healthcare systems are made up of many components that have a common aim to provide preventative approaches to illnesses and treatment to people inflicted with a disease. These components are Service Delivery, Health Workforce, Leadership and Governance, Financing, Information Technology, Medical Products, Vaccine and Technology. A health system can be organized in different ways, depending on the history, culture, politics, and resources of a country or region, however the components listed above are what is commonly found in most health systems. Due to the several components of a health system, it is a complex system. A complex system comprises many parts, relationships between the variables that describe the sections that are nonlinear and have feedback, but the overall behaviour is unpredictable. A health system can be evaluated by how well it achieves its goal of improving health outcomes, as well as how efficiently, equitably, and responsively it operates.

Q1.2: What is the Hippocratic Corpus and why is it important in the practice of medicine today?

The Hippocratic Corpus are bodies of writing, about 60 or so, done by Hippocrates. Most of his writing does not survive whole, which means there are areas where it can be inconsistence or argue for different points of view. These texts attributed to Hippocrates deal with various topics related to health and healing, such as how to examine, treat, and prevent illnesses.

The Hippocratic Oath is the oldest expression of medical ethics in Western medicine and many of its ideas are still important for medical practice today, such as keeping patients’ information private and not harming them. The Hippocratic Oath came from the Hippocratic Corpus and has been changed and improved to match the professional and ethical rules of practice in modern scientific medicine. Some of the basic aspects of Hippocratic Medicine are kept within the Oath, such as the promise to focus on patient’s needs, health promotion and disease prevention, and the recognition that the places where we live are vital to our health. (Bynum, 2008)

Q1.3: What tools or approaches have you applied in dealing with conflict in team settings?

Teams often face conflict, especially when they are in the storming stage of team formation where they are working on creating a common goal and a way of working together. This is when different ideas, beliefs and views may emerge.

My preferred mode of dealing with conflict is accommodating, comprising, and collaborating. Accommodation (Low assertion/High cooperation): People who choose accommodation put others' needs ahead of their own and cooperate with others' desires. They frequently forego all their personal objectives in favour of maintaining a positive relationship with the other person (or people). Collaboration (High assertiveness/High cooperation) - People that have a collaborative mindset seek out a solution that benefits all parties. They meticulously define the problems, analyse the situation, and carry out the decisions made. This tactic promotes group collaboration and teamwork. Working together does not produce winners and losers. It doesn't acquire authority over others. The application of this strategy also generates chances for innovation and experimentation. The Dual Concern/Conflict Grid Model. Compromise: People who prefer to reach a compromise are flexible and willing to give up some of their interests. All parties must agree on a compromise. Each party will have to forfeit something in exchange for receiving something from the other parties

References:

Bynum, W. (2008). The History of Medicine: A very Short Introduction . 191. Oxford: Oxford University Press.

Activity 1.3.2 - Managing & Resolving Conflict

Module 2

Q2.1: With reference to theoretical frameworks, what are the different dimensions of quality in health systems?

Maxwell's dimensions of quality are outlined as: Service Accessibility, Relevance, Effectiveness, Equity, Acceptability, Efficiency and Economy.

Quality is crucial for every aspect of the healthcare system. The quality level in one area affects the quality level in other areas. Quality has costs, but the costs of not meeting quality standards can be much higher. Poor quality care can be costly and harmful for patients, institutions and society. Health institutions may face unnecessary tests, overloaded resources and low staff morale. Patients may not follow treatment if they have poor quality and poor experiences. Poor quality can also cause other problems such as wrong diagnosis, ineffective treatment, repeated visits, longer illness or death.

Maxwell discovered the stated Dimensions of Quality, which then constituted the STEEEP framework. These Quality Dimensions serve as benchmarks against which performance is judged, and they advocate for a patient-centred approach to care delivery. The STEEEP framework strives to offer safe, timely, efficient, effective, equitable, and patient-centred treatment. The Donabedian Model likewise offers a patient-centred approach to evaluating care quality. Structure, Process, and Outcome are the three steps. Structure refers to all of the components that influence the setting in which care is provided, including facilities, Human resources, and equipment. It also covers the infrastructure and facilities that enable health care providers to offer care. This can be used to examine how quality influences health care institutions. Process refers to actions that fall under the purview of health care, such as diagnosis, treatment, preventative care, and patient education. The state of patients after obtaining treatment, the healthcare status, behaviour or knowledge, and patient satisfaction are all examples of outcomes. This can be used to assess how quality impacts patients.

Q2.2: What impact did ‘Hospital Medicine’ have on the ways in which medicine in taught and practiced today?

After the French revolution there was a need for doctors to address the disease and illnesses of the revolutionary governments soldiers and sailors. Antoine Fourcroy was appointed by the revolutionary assembly to come up with a new way of educating and training doctors. He stressed three aspects of medical education. First, that it should consist largely of practical work from day one. Second, that medical education was to be based in hospitals where there are more sick people for students to interact with and opportunities to learn by doing compared to lecture classrooms and outside of hospital settings. Thirdly, medical student will learn both surgery and medicine. Traditionally, before the change, physicians learned about medicine that encompasses the whole body while surgeons learned about abnormalities that needed interventions.

French hospital medicine developed a new perspective on disease based on three elements combined in a new way. The elements were examining the body, linking pathology and clinical signs, and using incident rate to classify diseases and assess treatments. These elements have been essential to medicine ever since, as has the role of the hospital.

Modern Medical schools are designed to train more practically rather than theoretically, and training is done within hospitals. Medical students are trained in both medicine and surgery. Lastly the history of hospital medicine developed the asylum, where mental and psychiatric conditions were relegated to mental hospitals. Making mental and psychiatric conditions not accepted and stigmatised. Psychiatry hospitals are still separate today.

Q2.3: What strategies have you applied in effectively communicating your ideas and providing fair and constructive feedback?

When I communicate my ideas I use a straightforward style of communication. Should a group member disagree with my idea, I actively listen to group members when the respond when, then I paraphrase what they have said so that there is no miscommunication. Then I carefully consider the feedback given and decide to either advocate for my idea or drop my idea.

For constructive feedback towards group members, I use the same style as when I voice my ideas, should it be necessary. However, most of the time I ask questions first to make sure I’m understanding the idea that is being communicated to me. Through this both me and my group members are able to identify and discard ideas that aren’t foolproof.

References:

Bynum, W. (2008). The history of medicine: a very short introduction . 191. Oxford: Oxford University Press. [Chapter 2 page 19 - 42] .

[Module 2 Reflection]

Module 3

Q3.1: What are the dimensions of data quality?

Data is a collection of facts. There are six dimensions of data quality: accuracy, completeness, consistency, timeliness, validity, and uniqueness. (Sarfin, 2022)

“Data values are as close as possible to real values, All required data values are present, Data values within a column comply with a rule, Data represent the reality from a required point in time, Distinct values appear only once, and Data conforms to the format, type, or range of its definition.” (IBM, 2023)

Q3.2: How have pandemics shaped and influenced health systems in South Africa?

The Plague catalysed the development of single, segregated state run locations away from city centres. With segregation there was inequality and inequity in healthcare delivery. The Smallpox pandemic brought about reforms of public health and the significance of biomedicine, the vaccine against smallpox saved many lives. (Phillips, 2012) The Spanish flu caused for the Public Health Act to be put in place which emphasised the importance of sanitation and cleaning Housing. It was the catalyst for the development of a health system focused on Public Health, hospitals infrastructure and an increase in health literacy. (Phillips, 2012) The HIV/AIDS pandemic called for the government to be able to distribute drugs to where they are need in South Africa. This virus also helped to point out weaknesses in the socioeconomic, governmental, and cultural factors that for pandemics to spread. (Phillips, 2012) This pandemic brought to the attention of the government which factors they need to invest in developing to improve health.

Q3.3: With regards to the criteria that are used to rank the evidence of sources, what factors need to be considered when determining the academic rigour of a source?

References:

IBM (2023). Data quality dimensions (Watson Knowledge Catalog). [online] www.ibm.com. Available at: https://www.ibm.com/docs/en/cloud-paks/cp-data/4.7.x?topic=quality-data-dimensions [Accessed 1 Nov. 2023].

Phillips, H. (2012). Plague, Pox and Pandemics: A Jacana Pocket History of Epidemics in South Africa. The South African Medical Journal , 102(10).

Sarfin, R.L. (2022). Data Quality Dimensions: How Do You Measure Up? (+ Free Scorecard). [online] Precisely. Available at: https://www.precisely.com/blog/data-quality/data-quality-dimensions-measure#:~:text=Data%20quality%20meets%20six%20dimensions [Accessed 1 Nov. 2023].

[Activity 3.9.4 Interrogating the Strength of your Sources]

[Activity 3.9.2 What Counts as Evidence?]

Module 4

Q4.1: How would you briefly describe the policy process?

Policies go through processes before implementation to ensure that resources are not wasted and that it will not fail. The first step of the policy process is agenda setting. Agenda setting is when political and social organizations, community members and experts well-versed on the problem meet and discuss possible solutions. The second step is policy formation. Policy Formation is when governments and stakeholders consult with the relevant actors and are knowledgeable of what was discussed in agenda setting. The third step is policy adoption, which is when a policy is drafted and accepted. In this step stakeholders are able to reject, accept, make changes or implement the policy. The fourth step is Policy implementation. The policy is accepted by the government and stakeholders and resources are allocated to implement the policy. The policy is put into action by the healthcare workforce. The final step is policy evaluation. This is to identify where the policy failed to succeed and why. Policies are monitored, evaluated, and reported on a regular basis to ensure that implementation of the policy is worth the resources and is achieving the intended objectives.

Policies are important and history shows the importance of policy analysis. Policy analysis can prevent policies being made that have detrimental effects in the future. Research Conceptualization cross-cutting content links to the researched information that policies require and how much effort is needed to come up with a solution to a problem that a policy addresses. Especially when there are stakeholders and Institutions involved who have independent opinions.

Q4.2: At the start of South Africa’s democracy, many brilliant policies were created. What are the factors that impacted the poor implementation of many of these policies?

The South African government was faced with the HIV/AIDS pandemic, which burdened the already fractured health systems and prevented the full realisation of health policies that were put in place.

Shortage of skilled health professionals in the public healthcare system. The public health sector loses healthcare worker to the private sector, emigration overseas, poor supervision and the abuse of remunerative work outside the public health sector. (Van Rensburg, 2012)

Q4.3: What is the difference between formal research and simply gathering information?

Formal research is to gather information in order to present it or make an argument. Simply gathering information is for knowledge is for discussions and explanatory purposes. Simply gathering information is obtained by studying people, occurrences, and items pique your interest (W. Stacks, 2021). On the contrary, formal research involves numerous individuals, processes, and systems. Most of formal research contributes to shared knowledge and is utilised and applied practically when discovering solutions which can be design and implement solutions. Finding from formal research can be used to draw conclusions and applied to other group unlike Simply gathering information. (Johnson, 2017)

References:

Johnson, R. (2017). Take a closer look at research types and reporting. [online] Two Rivers Marketing. Available at: https://www.tworiversmarketing.com/blog/take-closer-look-research-types-reporting#:~:text=An%20example%20of%20formal%20research [Accessed 1 Nov. 2023].

Van Rensburg, H. (2012).A history of health and health care in South Africa: 1652–1994.Pretoria: Van Schaik Publishers.

W. Stacks, D. (2021). Understanding Research: an Introduction with Public Relations Implications. [online] Guilford.com. Available at: https://www.guilford.com/excerpts/stacks_ch1.pdf [Accessed 1 Nov. 2023].

[Activity 4.14.2 Making sense of policy]

[Module Reflection 4]

Module 5

Q5.1: What are the main differences between public health and population health?

Public health is a collective effort from the various interest groups (e.g., individuals, stakeholders, health agencies, etc.) which aims to create and improve the conditions that can help keep populations healthy. Public health is about disease prevention, health promotion, and ensuring safety and health of communities in the external environment. Public Health focuses on the health outcomes of whole populations and not individuals. Public health designs and implements interventions based on sciences such as epidemiology, biostatistics, clinical microbiology and infectious diseases, occupational health and environmental health (To name a few).

Population health is the foundation upon which Public Health is built, population health is studying the circumstance which cause certain determinants of health to be prevalent in communities. Population Health also observes individuals to understand how conditions affect health. Population health traces negative health outcomes in communities to its exposure in order to understand the exposure pathway.

Q5.2: With reference to the concept of informed consent, what are the key ethical concerns that need to be considered when conducting research on vulnerable populations?

Avoid causing harm to the participant, find a way to maximise benefits while doing this. Ensure that the participant is well-informing of the study and the ability to leave the study at any time. Have procedures in place to protect participants data. Protect the autonomy of the participant. (Quinn, 2015)

All the ethical concerns noted above should be explained to the participant before they are a part of the research population.

Q5.3: What distinguishes quantitative research designs from qualitative research designs?

Quantitative research designs are used to collect object numerical data (Bezuidenhout et al., 2014), to decrease prejudice that the investigator may have and to ensure finding accurately represent the phenomenon that is being studied (Brink et al., 2014). Quantitative research designs are not very objective, where the aim of the research is to establish causal relations that can be used to predict and control phenomena Bezuidenhout et al., 2014). Quantitative research designs measure and test phenomena and then statistically analyse the results. Qualitative research designs observe and interpret phenomena and then analyse data according to the trend of the data.

References:

Quinn, C.R. (2015). General considerations for research with vulnerable populations: ten lessons for success. Health & Justice, 3(1). doi:https://doi.org/10.1186/s40352-014-0013-z.

[Module 5 Reflection]

Module 6

Q6.1: What are some the main challenges regarding the production and retention of human resources for health in South Africa?

Insufficient stewardship for Health planning across the entire healthcare system; There is no HRH information system to allow for HRH to be integrated, and inadequate or failure in HRH governance (Health Systems Trust, 2018). Provincial departments of health lack the efficiency and skills to manage human health resources. (Health Systems Trust, 2018)

Healthcare workers move to private health organisation or to foreign countries where they may find better pay, working conditions and opportunities to develop skills that allow them to advance in their career.

There is a problem in the education that is provide to students in medical school, it is not standardised or coordinated, thus some medical professionals are not able to work in certain settings such as rural areas.

Q6.2: What are the key ethical arguments surrounding the implementation of NHI?

NHI is a proposed system of universal health coverage in South Africa. There are different ethical arguments surrounding the implementation of NHI, depending on one’s perspective and values. Some of the main ones are:

For NHI: All South Africans will have access to quality healthcare services. NHI aims to address the disproportionate inequalities in access to quality healthcare, where only less than twenty percent of the population has access to private healthcare and the rest depend on the public health system (News24 Wire, 2019). NHI would pooling healthcare funding for both public and private providers health system and ensure the same standard of care for everyone (News24 Wire, 2019). This argument argues for solidarity and health equity for all in South Africa.

Against NHI: there are concerns that it is too expensive for South Africa to fund this system and therefore it will have to utilise taxes to subsidise where the funding shortfalls. Which will increase the burden on taxpayers (News24 Wire, 2019) Leadership and governance does not have a good track record and the trust of the people of South Africa. Therefore, many doubt that South Africa’s government ability to manage NHI efficiently and effectively, given the corruption and mismanagement that plague the public health sector. They argue that NHI would undermine the autonomy and choice of individuals, and that it would harm the private health sector and the economy. (News24 Wire, 2019)

Q6.3: What do you think is meant by the “quality of research” and what parts of the

research process is it applicable to?

Quality of research is determined by the following characteristics:

• it utilises a methodical and acceptable research methodology,

• employs relevant, empirical data and adequate data analysis methods,

• recognizes its limitations and makes recommendations for future study,

• and is ethical. (Bouchrika, 2022)

This research process is used during data collection and data analysis.

References:

Bouchrika, I. (2022). Top 10 qualities of good academic research. [online] Research.com. Available at: https://research.com/research/top-10-qualities-of-good-academic-research [Accessed 1 Nov. 2023].

Health Systems Trust. (2018). South African Health Review. [online] Available at: https://www.hst.org.za/publications/South%20African%20Health%20Reviews/SAHR%202018.pdf

[Module 6 Reflection]

News24 Wire (2019). Arguments for and against NHI. [online] The Citizen. Available at: https://www.citizen.co.za/lifestyle/health/arguments-for-and-against-nhi/ [Accessed 29 Oct. 2023].

Module 7

Q7.1: What distinguishes the primary healthcare approach from primary care?

Healthcare services provided by general medical physician and nurses is referred to as Primary Care. Primary care is the care provided when a patient first enters the health system. This care serves to diagnose and treat in its early stages and refer to patient to higher levels of the healthcare system should their health continue to deteriorate. Primary Care is concerned with the prevention of illness and is focused on treating individual patient or families. (Dookie and Singh, 2012)

Primary Health Care (PHC) is a public health care approach that originated from social medicine and aims to address health inequalities. It is a philosophy which promotes health consciousness and through this aims to improve health by meeting the basic needs of individuals. The way primary health care manifest in communities is different, it is all dependent on socioeconomic determinants that are found in said community. PHC is not only concerned with the health of individuals and families but also populations, it is able to do this because communities are the target group for interventions. PHC incorporates social and economic systems into health and healthcare along with principles of equity. (Dookie and Singh, 2012)

Q7.3: How would you describe the COPC process?

COPC is an on-going process that includes the following steps:

1. Explaining and characterising the community.

2. Carry out a community diagnosis to recognize health problems that are prevalent in the community. Seld-directed by community members.

3. Developing and implementing an intervention - based on community diagnosis by the community members.

4. Observing & evaluating how impactful the intervention was.

5. Make certain that community members are involved in steps one to four.

Q7.4: What is the difference between health advocacy and activism?

Health Activism is when action is taken to bring about positive change in the healthcare system. The action tends to be outside the standards of what would be considered normal in society. The health activists will challenge existing institutions and structures in order to achieve social justice and equality. (Laverack, 2013)

Health advocacy involves activities done to prevail over stumbling blocks which prevent the effective delivery of primary healthcare and ensuring public health. (World Health Organisation, 2003)

References:

Dookie, S. and Singh, S. (2012). Primary health services at district level in South Africa: a critique of the primary health care approach. BMC Family Practice, [online] 13(1). doi:https://doi.org/10.1186/1471-2296-13-67.

Laverack, G. (2013). Health activism: the way forward to improve health in difficult times. Global Health Promotion, [online] 20(3), pp.49–52. doi:https://doi.org/10.1177/1757975913499038.

World Health Organisation. (2003). Workplace health promotion Geneva. [online] Available at: https://www.who.int/occupational_health/topics/workplace/en/index2.htmlLinks to an external site. [Accessed 2 Nov. 2023].