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Health Journalism is important in Health Systems Science because it is how health related information is shared with the public. In class we learned that there are questions that should be asked when writing an opinion piece, they are the following: Who is my audience? Are they familiar with healthcare terminology, or will I need to be mindful of the terms I use, and the level of explanations that I give? What is the purpose or intention of writing this piece? Do I want only to share information, or will there be an element of persuasion? What should the style of my piece be? Is it formal, informal, or a mix of both? What will my word choice (also known as diction) be? How should I organise my points? What is my main argument, and how will I unpack the information in each of the paragraphs? What specific, concrete examples and details can I use to back up each of my points? With this activity I was tasked with reading an article and applying these questions. I learned to carry on these skills into my term paper four essay writing. I've included this activity to show the beginning of my journey learning a new writing skill.

After completing Activity 7.24.6.1_Opinion Piece - Analysis to practice the opinion writing skills that i had been introduced to in class. In this activity I learned the importance of being able to support your stance with evidence that has been well researched and how to write an introduction that states my stance and evidence that catches the interest of the reader. I've included this activity to be able to track my progress as I work of the skill of becoming a better writer.

The purpose of activity was to analyse writing, with a particular focus on an opinion piece. The activity helped me learn how to write an opinion article that fits the following criteria: Focus tightly on one issue or idea — in your first paragraph. Be brief. Express your opinion, and then base it on factual, researched or first-hand information. Have a clear editorial viewpoint – come down hard on one side of the issue. Don’t equivocate. Near the end, clearly re-state your position and issue a call to action. Don’t philosophise. Have verve, and “fire in the gut” indignation to accompany your logical analysis. Don’t ramble. Use clear, powerful, direct language. Avoid clichés and jargon. Appeal to the average reader. Clarity is paramount.

Week 23 Core Domain: Primary Healthcare What are some of the key philosophical arguments underpinning primary healthcare? The philosophy of primary healthcare rests on its ability to promote health through various methods such as health education and awareness campaigns to encourage health consciousness among communities. Furthermore, primary healthcare also takes into account the social view of health and aims to redress inequalities in healthcare. Moreover, primary healthcare is one of the vehicles with which Universal health Coverage can be achieved. In South Africa, the philosophy of primary healthcare is regarded as the cornerstone to health transformation. Many strides have been made by the post-apartheid government to improve equity in health through various means such as health literacy. How is education used as a tool to achieve primary healthcare? Education is an important component of primary health care, which is a whole-of-society approach to effectively organize and strengthen national health systems to bring services for health and wellbeing closer to communities. Health education can help people understand their health problems and the methods of preventing and controlling them, promote healthy behaviours and lifestyles, and increase their participation in health care decisions. Some examples of health education topics in primary health care are: Nutrition and food safety Maternal and child care, including family planning and immunization Environmental, emotional, and sexual health First aid, safety, and disaster preparedness Health education at the Primary Health Care (PHC) level helps to address issues related to disease prevention, consumer health, environmental, emotional, sexual health, first aid, safety and disaster preparedness, substance abuse prevention, human [2]. The importance of health education impacts many areas of wellness within a community, including chronic disease awareness and prevention, maternal and infant health promotion, tobacco use and substance abuse prevention, injury and violence prevention, mental and behavioural health promotion, nutrition, exercise and obesity prevention and the reduction of risky behaviors [3]. Health education tends to be more effective when it is taught by qualified teachers, connects students to health services, engages parents and community partners, and fosters positive relationships between adolescents and adults who are important to them [4]. https://www.who.int/health-topics/primary-health-care https://www.theyogicjournal.com/pdf/2018/vol3issue1/PartB/3-1-6-383.pdf https://www.publichealth.com.ng/5-major-importance-of-health-education/ https://www.cdc.gov/healthyyouth/health-education/index.htm To achieve the ideals of primary healthcare, what are some of the tensions that exist? Some of the tensions that exist are: The gap between policy and practice in implementing PHC principles [2]. The lack of resources, infrastructure, and human resources to provide PHC services [2][3]. The challenges of integrating PHC with other levels of care and sectors [1][3]. The diversity of needs, preferences, and expectations of different communities and populations [1]. https://www.who.int/health-topics/primary-health-care http://www.scielo.org.za/pdf/phcfm/v6n1/04.pdf https://knowledgehub.health.gov.za/system/files/elibdownloads/2021-02/Primary%20Healthcare%20STGs%20and%20EML%207th%20edition%20-%202020-v2.0.pdf Competency: Communication & Teamwork What do you need to work on as a team in preparation for your final presentation? My team has overcome many challenges throughout the year. We have seen exponential growth in communication skills, time management, allocation of tasks and presentation skills which permit me to be confident in my team for our final presentation. Contextual Content: COPC In what ways does COPC apply the philosophy of PHC? Primary Health Care (PHC) is concerned with engaging communities and allowing people to define their health and social problems to implement effective health promotion and illness prevention strategies. PHC is both a philosophy of health care and a model for providing services that support health. Effective PHC is community-based, promotes healthy lifestyles as a pathway to disease and injury prevention, provides continuing care of chronic conditions and recognises the importance of the broad determinants of health. PHC as a philosophy requires community engagement and participation. COPC is one of several broad strands making up the fabric of PHC – it is a structured way of practicing PHC. What are some of the challenges with implementing COPC? "Factors related to governance, finances, community health workers, primary care facilities, community participation, health information and training that influence the implementation of COPC." https://gh.bmj.com/content/4/Suppl_8/e001489 What can we learn from the history of social medicine that might be relevant for our current NHI context? Social medicine is a scientific field that studies the relationships between society, disease, and medicine. It began in the early 19th century in response to the health problems of industrial workers. It aims to create a new social role for medicine that addresses the social determinants of health. One possible lesson from the history of social medicine that might be relevant for the current NHI context is the importance of interdisciplinary collaboration between medicine and social science to understand and address the complex health issues of different populations. Another possible lesson is the need for social justice and equity in health care delivery and financing. https://en.wikipedia.org/wiki/Social_medicine https://www.brainkart.com/article/Evolution-of-Social-medicine-in-India_23480/ https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030399 https://nhi.healthjusticeinitiative.org.za/wp-content/uploads/2022/06/00105082.pdf Week 24 Core Domain: Primary Health Care What factors should be considered when developing strategies for PHC? Accordingly, the development of strategies and the strategic focus requires interventions that ensure an equitable distribution of health services to all, in a manner that these services can be provided in a cost-effective way so that all countries and citizens can afford them. Strategies should not be formulated in isolation, but should rather encompass inter-sectoral collaboration and coordination. This is an important factor in primary health care, as this approach can help maximise the benefits of the intervention. Accordingly, the complexity of the health intervention determines which sectors, departments, agencies, community individuals and academic disciplines (and other roleplayers) should be involved in the process of strategy development and implementation. Another factor in considering the strategy development for implementing primary health care is the appropriate use of technology. Technology must be adapted to meet local needs, should be easily accessible and affordable to use. What are some of the reasons that good strategies fail at the point of implementation? Community Involvement was not prioritised during the planning and implementation phase. The skills and resources needed are not available. Leadership is incompetent. Changes in the external environment that make the strategy obsolete or irrelevant. How can community engagement promote the effectiveness of PHC? The process of community engagement is a powerful model that can be used to improve population health and also their determinants of health. Stakeholders involved in community engagement can include government agents or departments, experts in the field such as academic researchers, local and international health agencies, individual community members and local leaders. Engaging the community is an important element that is required for primary health care to be implemented successfully. Involving communities can help ensure the provision and access of health care services to poorly resourced settings. Furthermore, it can play a crucial role in reducing the burden and transmission of diseases, and in improving health awareness, in turn improving the health system. The concept of community engagement plays a role in health promotion or preventative care. Engaging communities in health interventions such as community-based participatory research, health promotion, and policy-making has been used as an effective strategy to improve health care delivery. Furthermore, community engagement is an important tool for tackling social health inequalities (Whitehead et al., 2006). Sacks, et al. (2019) provide an expanded framework of the building blocks which focus on promoting community engagements throughout the health system. Whitehead, M., Dahlgren, G., Europe, W.H.O.R.O. for, 2006. Levelling up (part 1): a discussion paper on concepts and principles for tackling social inequities in health. Sacks, E., Morrow, M., Story, W.T., Shelley, K.D., Shanklin, D., Rahimtoola, M., Rosales, A., Ibe, O. and Sarriot, E., 2019. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all. BMJ global health. [online] Available at: https://gh.bmj.com/content/bmjgh/3/Suppl_3/e001384.full.pdfLinks to an external site. [Accessed 30 Oct. 2023]. Competency: Scholarship How can you improve your e-Portfolio of learning? Homepage: Describe how to navigate my site. Create a logical order to my website. General: Well-organised & clearly described work. What is the difference and relationship between hard and soft systems? In Hard Systems Thinking/Methodology, a system is considered to have a clear purpose with well-defined goals, and solutions are designed to achieve these goals (Kirk, 1995). Hard systems are usually described and expressed in quantitative terms which allow for mathematical models to be developed (Hasan, 2011). In Soft Systems Thinking/Methodology, a situation is viewed as complex and messy, and that humans are part of the systems and not merely observers (Burge 2015). Instead of the approach to viewing the world as systematic, that is used in hard systems thinking, soft systems methodology using a systematic process of inquiry to understand the situation (Checkland, 2000). Hasan, R. (2011). Hard and Soft Systems Thinking. Hausarbeit. [online] Available at: https://www.hausarbeiten.de/document/208273Links to an external site. [Accessed 30 Oct. 2023]. Kirk, D. (1995). Hard and soft systems. International Journal of Contemporary Hospitality Management. [online] Available at: https://www.emerald.com/insight/content/doi/10.1108/09596119510090708/full/html Links to an external site.[Accessed 30 Oct. 2023]. Burge, S. (2015). An Overview of the Soft Systems Methodology. [online] Available at: https://www.burgehugheswalsh.co.uk/Uploaded/1/Documents/Soft-Systems-Methodology.pdf Links to an external site.[Accessed 30 Oct. 2023]. Checkland, P. (2000). Soft systems methodology: a thirty-year retrospective. Systems research and behavioral science, 17(S1), S11-S58. [online] Available at: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.395.556&rep=rep1&type=pdf Links to an external site. [Accessed 30 Oct. 2023]. Why is it important to identify the root causes of problems in complex challenges? It is important to identify the root causes of problems in complex challenges because they can help you avoid short-term solutions that may not address the underlying issues. https://www.boldbi.com/blog/unravelling-complexity-tackling-challenges-with-root-cause-analysis Complementary: Rural Health How do we define rurality? There are a variety of definitions on the concept of rurality which reflect the multi-dimensional nature of the concept. Accordingly, there is no single or widely agreed upon definition to describe the concept of rurality. It is thus necessary to select definitions appropriate to the context and intended uses of the term (Cloke, 1977). Cloke, P.J., 1977. An index of rurality for England and Wales. Regional Studies, 11(1), pp.31-46. [online] Available at: https://www.tandfonline.com/doi/abs/10.1080/09595237700185041Links to an external site. [Accessed 30 Oct. 2023]. What is rural proofing all about? “Rural-proofing is an approach to the development and review of government policy and strategic planning that recognises that the needs of rural areas and communities are different to those of their urban counterparts” (RHAP, 2015, p4). Rural-proofing is a crucial element supporting the strategic response to addressing the disparities amongst populations. Rural Health Advocacy Project. (2015). Rural-proofing for health: guidelines - a guide to accounting for rural contexts in health policy, strategic planning and resourcing. [online] Available at: https://www.hst.org.za/publications/NonHST%20Publications/2015-01-13-RHAP-Rural-Proofing-Guideline-A4-Email-1.pdfLinks to an external site. [Accessed 30 Oct. 2023]. Week 25 Core Domain: Hospital Reform How did the structure of the hospital as an institution evolve over time? According to Van Rensburg (2012), in the medieval era, hospitals were regarded as places for hospitality, but later the hospital became a place where people who were sick or injured would go for care. Majorossy and Szende (2008), further suggest that early hospitals were also used as refugee camps for those in need. The concept was used as a framework for Christianity during the 10th and 11th century. Since the hospital was also used as refugee camps for those in need, patients suffering from leprosy in the middle ages found refuge in hospitals when they were kicked out of their homes and segregated from society. Modern hospitals have significantly evolved from those of the medieval times. They have transformed to become healthcare institutions responsible for providing various kinds of care such as rehabilitation, treatment and emergency assistance to both inpatients and ambulatory patients. Compared to clinics, hospitals are more complex and comprise various specialised equipment, better trained and skilled medical specialists in order to address predefined conditions. Hospitals operate 24 hours/day and 7 days a week. They are also a place where research and education or training of students. Modern-day hospitals collaborate with research institutes and academic institutes for their research. Different hospitals are set up differently in terms of their size, objective, care programme, type of patients it attends to, type of illness, social structure (Van Rensburg, 2012). Additionally, the structure of the hospital is also divided into various wards. Van Rensburg, H. (2012).A history of health and health care in South Africa: 1652–1994.Pretoria: Van Schaik Publishers. [Chapter 10, page 535 - 591]. Majorossy, J. and Szende, K. (2008). Hospitals in Medieval and Early Modern Hungary, in: Scheutz, M., Sommerlechner, A., Weigl, H., Weiss, A.S. (Eds.), Europäisches Spitalwesen. Institutionelle Fürsorge in Mittelalter Und Früher Neuzeit. Böhlau Verlag, Wien, pp. 409–454. [online] Available at:https://doi.org/10.7767/boehlau.9783205160885.409Links to an external site.[Accessed 30 Oct. 2023]. In what ways has a hospicentric health system perpetuates inequalities in our current health system? Hospitals in poor settings still remain under-resourced and underfunded; this consequently results in them not being able to properly support comprehensive primary health care services, which are at the cornerstone of providing equity health care. What future trends in hospital reform can support the attainment of social justice? The trend of implementing universal healthcare systems, universal health care systems advocate for health equity which means that the building blocks of health systems will be restructured in a manner that benefits social justice efforts. Cross-cutting: Evaluation What is the difference and relationship between monitoring and evaluation? M&E are at the core of managing any successful programme. The main difference between monitoring and evaluation is that monitoring is an ongoing process, while evaluation takes place at specific stages in any programme. How can you apply the 5 stages of evaluation to improve health systems? Evaluations can be conducted internally (internal or self evaluation) where people within a program fund, conduct and control the evaluation. External evaluations are where someone from beyond the program acts as the evaluator and controls the evaluation. Evaluations can be conducted on various aspects of the health system. These include: Processes, which are the organizational operations of a continuous and supporting nature (e.g. personnel procedures, administrative support for projects, distribution systems, information systems, management operations). Services which are based on a permanent structure, and, have the goal of becoming, national in coverage, e.g. Health services, whereas programmes are usually limited in time or area. Projects which normally consist of a set of activities undertaken to achieve specific objectives within a given budget and time period. Conditions which are particular characteristics or states of being of persons or things (e.g. disease, nutritional status, literacy, income level). Programs which are organized sets of projects or services concerned with a particular sector or geographic region. What are the important characteristics of measurement indicators that ensure an accurate evaluation of a health intervention? Within each of the above five aspects, evaluations can focus on: Inputs, which are there sources provided for an activity, and include cash, supplies, personnel, equipment and training. Processes which transform inputs into outputs. Outputs which are the specific products or services, that an activity is expected to deliver as a result of receiving the inputs. A service is effective if it “works”, i.e. it delivers outputs in accordance with its objectives. A service is efficient or cost-effective if effectiveness is achieved at the lowest practical cost. Outcomes refer to peoples’ responses to a programme and how they are doing things differently as a result of it. They are short-term effects related to objectives of the programme under evaluation. Impacts refer to the effects of the service on the people and their surroundings. These may be economic, social, organizational, health, environmental, or other intended or unintended results of the programme. Impacts are more long-term. This ensures an accurate evaluation of a health intervention. Complementary: Rural Health How would you define the concept of rurality? I would define rurality, according to the leadership that exists in the area, proximity to essential services, living conditions and employment Oppurtunites. Why is it important to rural-proof new policies for rural communities? To guarantee that policies implemented are not causing any unintended harmful effects on the community and to ensure that all obstacles are accounted for ensuring the policies effectiveness when implemented. Week 26 Core Domain: Hospital Reform What are some of the lessons learned from the reforms over the course of history? The importance of health equity over equality. The importance of ensuring health systems building blocks function to benefit good health outcomes. What strategies could be put in place to ensure the sustainability of hospitals? How money is raised, it should be according to how much the person is able to afford and not according to the health needs. Why is it important for policymakers to consider the experiences of health workers in the field? Health workers respond to the needs of patients; therefore, it is important for policymakers to ensure that policies enable healthcare workers to provide the patient with the best care possible in an effective, timely and efficient manner. Competency: Advocacy What role do you see yourself playing as a change agent in the health system? As a Health Systems Sciences student, you will hold a position of influence, accordingly, your words and actions have a direct impact on society. As a health advocate, you responsibly use your expertise and influence to advance the health and well-being of the workforce, individuals, communities and populations. You act as a change agent in advocating for the needs of people within the health system as well as those who use healthcare services. You create a voice for both the needs of the workforce and the patient. You enable change by influencing policies, procedures and decision making. Your voice plays an important role in influencing economic and social inequities to achieve social justice. What barriers are stopping you from bringing about change in health systems? How can these be addressed? I did not think about advocating for anything before i joined HSS i did not recognise that anyone's voice including mine can be beneficial in bringing about change. After HSS, I did't know where to start to become an advocate. Next year i plan to join UNICEF or WHO clubs in wits and hope to be able to contribute positively.

Week 19 Core Domain: Health Systems Sciences How does South Africa's allocation of its GDP to healthcare compare to other countries? According to the World Health Organization, South Africa spent 8.6% of its GDP on healthcare in 2020. This is higher than the average of 8.4% for the OECD countries in 2022. However, some countries spend more than South Africa, such as the United States (15.9%), Switzerland (12.1%) and France (11.3%) in 2022. https://knoema.com/atlas/South-Africa/Health-expenditure-as-a-share-of-GDP https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/ How can the allocation and distribution of resources promote equity in healthcare services? According to one source, efficient and equitable resource allocation means that everyone who has a need gets that need addressed, but this is with as few resources as possible. This requires accurate estimates of the true costs of resources and achieving health goals at minimal costs. Another source suggests that resource allocation through capitation is needed to achieve equity in access to health care or health outcome. Capitation is a payment method where a fixed amount of money is paid per person to a health care provider. A third source argues that paying attention to justice and fairness can promote the realization of equity and the improvement of human health, as well as the sustainable development of health services. https://www.healthequityandpolicylab.com/resource-allocation-2 https://openknowledge.worldbank.org/handle/10986/13619 https://www.frontiersin.org/articles/10.3389/fpubh.2021.768728/full What are the shortfalls of Universal Health Coverage in the South African Context? Universal Health Coverage (UHC) is a goal that South Africa is pursuing through the implementation of National Health Insurance (NHI). NHI aims to provide access to quality health services for all South Africans, based on their health needs and irrespective of their socio-economic status. However, there are some shortfalls of UHC in the South African context, such as: The existing inequality and inefficiency of the two-tiered healthcare system, where the public sector serves 71% of the population and the private sector serves 27%. The lack of social innovations and community participation in addressing the pressing health needs that are not met by government services. The impact of state capture, poor governance and corruption on the health sector and its entities. The misalignment between stakeholders on the NHI Bill and its implications for health financing reform. https://health.gov.za/wp-content/uploads/2020/11/some-key-messages-on-nhi.pdf https://www.gov.za/speeches/policy-dialogue-universal-health-coverage-south-africa-12-dec-2022-0000 https://www.hst.org.za/publications/South%20African%20Health%20Reviews/05%20SAHR_2019_Measuring%20National%20Health%20Insurance.pdf https://www.wits.ac.za/news/latest-news/opinion/2021/2021-07/healthcare-in-south-africa-how-inequity-is-contributing-to-inefficiency.html https://idpjournal.biomedcentral.com/articles/10.1186/s40249-021-00804-9 https://southafrica.fes.de/fileadmin/user_upload/SA_NHI_UHC_report_20200803_final.pdf https://www.polity.org.za/article/universal-health-coverage-pathways-for-south-africa-areas-of-misalignment-between-stakeholders-on-the-nhi-bill-require-further-engagement-2020-08-11 What are the ethical concerns surrounding the administration of Depo-Provera as the contraceptive of choice? Depo-Provera is an injectable contraceptive that has been used in many countries for decades. However, it has also raised some ethical concerns, such as: The potential risk of increasing HIV transmission among women who use it. The lack of informed consent and adequate information about its side effects and alternatives. The possible coercion or discrimination of vulnerable groups, such as sexual offenders, poor women, or minorities, to use it. https://jme.bmj.com/content/10/1/9 https://health-e.org.za/2019/08/29/world-health-organization-guidelines-contraceptives-depo-provera-echo-trial/ https://www.tandfonline.com/doi/pdf/10.1080/17441692.2019.1634118 https://www.tandfonline.com/doi/pdf/10.1080/17441692.2019.1634118 Competency: Scholarship Can you describe a few different ways for collecting data from human participants? Questionnaires and surveys, Interviews, Focus groups, Direct observation, Computer- and internet-based surveys and Social networking sites and mobile devices: From what you have learnt so far about research problems, research designs and sampling, what do you think are important aspects to consider when deciding how to gather data? Research problems. What other practical and logistical aspects do you think play a role in deciding how to collect data? --- Complementary: Debate In the context of resource allocation, and with reference to the STEEEP framework should Depo-Provera be the first line of contraception? Resource allocation is the process of assigning and managing the available resources in an organization or a project in the most efficient and effective way. The STEEEP framework is a variation of the STEEP analysis, which considers socio-cultural, technological, economic, environmental/ecological, political, legal and ethical factors in strategic decision making. Depo-Provera is a contraceptive injection given every three months that was introduced in South Africa in the 1970s and largely given to black women as part of the apartheid government’s population control agenda. It has been linked to increased risk of HIV infection and other health issues. To answer the question, you may need to weigh the benefits and risks of Depo-Provera against other contraceptive options, as well as consider the social, economic and ethical implications of its use in South Africa. https://www.projectmanager.com/blog/resource-allocation https://fourweekmba.com/steep-analysis/ https://bing.com/search?q=Depo-Provera+contraception+South+Africa https://health-e.org.za/2018/02/12/contraception-hiv-control-black-womens-bodies/ Week 20 Core Domain: Health Financing How is the private healthcare sector structured? In South Africa, private healthcare can be divided into two main classifications: Providers refer to those who provide healthcare services, such as hospitals and professional bodies, including: Private health service providers, such as doctors, nurses, midwives; Private health facilities such as hospitals; Laboratories and pathological providers; Pharmaceutical providers; The institutions that represent health professionals; Traditional health practitioners. and Funders refer to the systems and organisations that are responsible for the financing of private healthcare systems, such as; Medical Aid Schemes; Out of Pocket Payments; Life Insurance; Short Term Insurance; Grants or Subsidies. How is the private healthcare sector funded? Private healthcare can be accessed and is funded through: Membership of medical schemes and other forms of health insurance. Out-of-pocket expenditure. Access at their workplace, through workplace programs or medical schemes. Non-profit organisations and NGOs. High costs in accessing private healthcare make it inaccessible for most people, and thus puts further pressure on the public health system. According to the health finance profile published in 2016, approximately 14% of South Africans receive private medical healthcare through medical schemes, whilst 86% of South Africans depend on the public health sector. The financing of the private sector also comes from various sectors such as the pharmaceutical (largest in the African continent) and medical supplies industries, which together with the private healthcare sector, are in a symbiotic relationship where both benefit. The pharmaceutical industry, for example, makes a lot of profit from its relationship with the private sector through procurement. How does a medical aid scheme work? Medical Aid Schemes function by pooling contributions from members and using these pooled funds to pay healthcare providers. They are responsible for conducting all administrative functions and provide the necessary infrastructure for its administration. Medical Aid Scheme charge administration fees and make profits from their services for: Undertaking Risks; Benefit design; Underwriting; Service; Collection of contributions; Processing of claims. They provide cover for medical expenses such as medicine, hospitalisation and treatment (depending on the plan) for the members who pay monthly premiums. There are various types of medical aid plans from which one can choose, and the monthly premium will vary based on the plan that a member chooses. It varies with the different medical aids, for example, a member of the Momentum medical aid scheme does not pay the same rate as a member of the Discovery Health medical aid scheme even though they might have the same plan. There are also closed medical aid schemes, which are provided to staff by their companies, and open medical aid schemes, which are for any public person who can afford them. Competency: Scholarship From what you have learnt so far about research and research methods, what do you think are important aspects to consider when analyzing data? Through the process of data analysis, researchers summarise and make sense of the raw data they have collected in relation to the research question/s, and start the important process of making their findings accessible to others. The data analysis strategies that researchers choose need to address their research question and correspond to the research design and data collection tools used. How do you think quantitative and qualitative data analysis differ in their objectives and output? The first analysis type, quantitative data analysis involves information in the form of numbers. Quantitative data analysis is the organisation, summarisation and interpretation of numerical information, usually through the use of statistics. The second analysis type, qualitative data analysis, involves data where information is in the form of words. Qualitative data analysis is the systematic reading, description, understanding and interpretation of (usually non-numerical) data. Why do you think it is important to plan for your data analysis in your research protocol? Yes Resource Allocation: National Health Insurance What are the ethical arguments surrounding the implementation of NHI? NHI stands for National Health Insurance, which 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. Here are some of the main ones: The argument for NHI: Quality healthcare for all. NHI aims to address the massive inequalities in the current access South Africans have to quality healthcare, where only 16% of the population can afford private medical care and the rest depend on the state’s health services. NHI would create a single pool of healthcare funding for both public and private providers, and ensure the same standard of care for everyone. This argument is based on the principles of justice, solidarity and human rights. The argument against NHI: The state can’t afford it or taxes will need to pay for it. NHI critics question the state’s ability to fund NHI, which will have mammoth costs, and fear that the taxpayers will have to bear the burden of financing it. They also doubt the state’s capacity 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. https://www.citizen.co.za/lifestyle/health/arguments-for-and-against-nhi/ https://www.vocfm.co.za/the-arguments-for-and-against-the-nhi/ https://www.news24.com/News24/the-arguments-for-and-against-the-nhi-20190819 https://www.rcpjournals.org/content/clinmedicine/21/2/147 Do you think that the NHI will be successfully implemented by 2026? NHI stands for National Health Insurance, a health financing system that aims to provide access to quality affordable health services for all South Africans. The NHI Bill was passed by the National Assembly in June 2023 and the implementation is expected to be completed by 2026. However, there are some legal and logistical challenges that could delay the process. https://www.gov.za/about-government/government-programmes/national-health-insurance-0 https://www.sanews.gov.za/features-south-africa/national-health-insurance-all-you-need-know https://www.news24.com/News24/explained-when-will-the-national-health-insurance-be-implemented-20190815 https://www.citizen.co.za/lifestyle/health/explained-when-will-the-nhi-be-implemented/ https://www.polity.org.za/article/nhi-expected-to-face-legal-challenges-says-panado-maker-adcock-ingram-2023-10-23 https://health-e.org.za/2022/12/13/nhi-implementation-headaches-loom-for-health-dept/ https://www.health.gov.za/nhi-faq/ https://www.parliament.gov.za/project-event-details/54 Is the proposed approach to NHI a viable option for South Africa? Achieving universal health coverage is an important goal for South Africa. South Africa is currently transitioning to a Universal Health Coverage (UHC) healthcare system, using the National Health Insurance (NHI) and Primary Healthcare (PHC) as vehicles to achieve UHC. The main aim or expected outcome of this transition is to improve the quality and accessibility of healthcare services for all South Africans. However, there are also many challenges and criticisms regarding the implementation, funding, governance and impact of the NHI. Some of the arguments against the NHI are that it will be costly, inefficient, unaccountable, unsustainable and detrimental to the existing medical schemes and private sector. https://businesstech.co.za/news/government/333817/how-you-will-be-paying-for-the-nhi-and-what-happens-to-your-medical-aid-everything-you-need-to-know/ https://www.news24.com/News24/the-arguments-for-and-against-the-nhi-20190819 https://www.researchgate.net/publication/264821800_The_pros_and_cons_of_National_Health_Insurance_in_South_Africa https://www.citizen.co.za/witness/news/kzn/nhi-bill-the-pros-and-cons/ https://www.insuranceoptions.co.za/blog/advantages-and-disadvantages-of-national-health-insurance/ Week 21 Core Domain: Human Resources in Health What is the local, regional and global picture regarding the distribution of human resources for health? The distribution of human resources for health (HRH) varies widely across countries and regions, depending on factors such as population health needs, health system capacity, health workforce policies and investments, and health labour market dynamics. According to a recent study, the global HRH stock in 2020 was estimated at 59.2 million full-time equivalent (FTE) workers, of which 23.6 million were physicians, 19.3 million were nurses and midwives, 5.9 million were other health professionals, and 10.4 million were health support workers. The study projected that the global HRH stock would increase to 68.5 million FTE workers by 2030, but with significant regional disparities. For example, the study estimated that the African region would have the lowest HRH density in 2030, with only 1.4 FTE workers per 1000 population, compared to 14.8 in the European region and 12.9 in the Americas region. Similarly, another study found that India had a HRH density of only 2.3 FTE workers per 1000 population in 2016, with large variations across states and districts. Some countries have developed national strategies or plans to address the challenges of HRH distribution and development, such as the Philippines, South Africa, and others. At the global level, the World Health Organization has launched the Global Strategy on Human Resources for Health: Workforce 2030, which aims to improve health outcomes, health equity, and health security by ensuring a sufficient, competent, responsive, and well-distributed health workforce. https://gh.bmj.com/content/7/6/e009316 https://bmjopen.bmj.com/content/9/4/e025979 https://hhrdb.doh.gov.ph/nhrhmp/ https://www.samedical.org/file/1604 https://www.gov.za/documents/human-resources-health-south-africa-2030-draft-hr-strategy-health-sector-201212-201617 https://www.who.int/news/item/02-06-2022-global-strategy-on-human-resources-for-health--workforce-2030 What are the different cadres in the delivery of health care services and how is a ‘health worker’ defined? Health Service Providers and Health Management and Suppourt Workers. The health workforce can be defined as “all people engaged in actions whose primary intent is to enhance health. The structure of the health workforce can be classified into two sectors: The Health Sector- which encompasses all those that are involved in the provision of goods and services to treat patients. Other Sectors- are those industries which do not provide goods and services to treat patients. What are the main challenges regarding the production and retention of human resources for health in South Africa? Insufficient stewardship of Human Resources for Health planning across the entire healthcare system; lack of a national integrated HRH information system, and inadequate information on overall HRH supply to address historical inequities between urban and rural areas and the public and private health sectors; gaps, and at times failures, in HRH governance; fragmentation, weak coordination and suboptimal governance of health sciences education; and poor and ineffective operational management across all types of health facilities and provincial health departments. Health Systems Trust. (2018). South African Health Review. [online] Available at: https://www.hst.org.za/publications/South%20African%20Health%20Reviews/SAHR%202018.pdf Competency: Scholarship What do you think is meant by the “quality of research” and what parts of the research process is it applicable to? The quality of research can be defined as the extent to which the research meets the standards of rigor, relevance, and impact [1]. It is applicable to all parts of the research process, from planning and design to data collection and analysis to reporting and dissemination [2][3]. https://academic.oup.com/rev/article/25/1/1/2362728 https://www.cde.state.co.us/sites/default/files/documents/research/download/pdf/highqualityresearch.pdf https://www.editage.com/insights/when-is-research-good How do you think criteria differ between quantitative and qualitative research for establishing research quality? --- You have learnt a lot about ethics - do you know what aspects of research ethics need to be explained in a research protocol/proposal? Informed Consent Have you considered how you would like to disseminate your research? No Complementary: Ethics What circumstances may lead to a healthcare worker choosing to work at more than one place of employment (known as dual practice)? Low income Development of skills and Work experience which is provided by different working environment and patients. Flexibility Training and professional benefits What are the possible benefits of dual practice? Work experience Increased income Improve skills What are the possible drawbacks of dual practice? May create challenges for the public health system such as: General high absenteeism. Abuse of sick leave privileges. High stress levels (headaches, insomnia, fatigue, heart problems and endocrine disorders). Low morale. Fewer services offered and long patient queues. Aggression, resignations, group conflicts and group coalitions. Abuse of medical aid facilities. Abuse of state assets to treat private patients. Affect public service by: patient neglect medical negligence poor quality of services patient experience and patient satisfaction is negatively affected What ethical principles could be helpful in guiding dual practice? The principle of beneficence: the practitioner has a moral obligation to act in the best interest of the patient. Virtue Ethics: Focused on the character of the person, with regards to dual practice it is Professional integrity, Integrity meaning the quality of a person. Week 22 Core Domain: Human Resources in Health What is the reasoning behind the decision for the South African Government in recruiting the Cuban Medical Brigade to support the COVID-19 response? Improving the capacity of the health workforce can play a crucial role in ensuring that each country can respond to emergencies, such as COVID-19. The outbreak of the coronavirus has exposed the gaps in the health systems of many countries and has shown the importance of having a well-established health workforce. Furthermore, it has emphasised the importance of investing in and improving the capacity of the health workforce and its role in building a strong and resilient health system. What strategies can be implemented to improve the production and retention of health workers? Human Resource for Health Strategy South Africa Nursing Strategy Human Resource Strategy How can building the capacity of the health workforce contribute to achieving UHC? By increasing health workers there will be a decrease in shortage in the public health sector and therefore an increase in accessibility of care to some extent. Competency: Scholarship Do you feel more confident in your teamwork for Presentation Report 5 after incorporating the feedback you have received from previous work? Yes. Is your team collaborating successfully to meet deadlines, or do you need to adapt your work strategies to ensure the successful completion of Presentation Report 5? My team is collaborating successfully to meet deadlines. Are you becoming confident in proposing a research project as it would be written up in a research protocol? Yes.

Week 16: Core Domain: Population Health ❏ 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 grounded in the sciences of population health, which is described as the study of the conditions that shape the determinants of health. Additionally, population health also studies the mechanisms in which conditions manifest as the health of individuals. Population health is an “interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally”. Population health is also described as the analysis and design of interventions and management of large groups of citizens focused on improving their health status. Population health is crucial because it provides information about how a health problem came to be. What role does policy play in addressing the needs of a defined population? Population health policy is a form of policy that prioritizes early detection, treatment, and mitigation of, and rehabilitation following, disease among at-risk and symptomatic individuals. Furthermore, a population includes directives, plans, and courses of action that may be required by law or developed in compliance thereto, or proffered voluntarily, documented in written instruments or manifest in norms and behaviours sanctioned through customary practice without objection. Population health policy can also be described as the set of rules that were put in place for people to follow. What are some of the objectives of population health? To determine causes of health outcomes of a population and thus develop intervention and prevention strategies which are targeted at the causes. Competency: Scholarship Why is it important to choose an appropriate research design for your study? Research Design is the overall strategy of how you will conduct your study to answer your research question. It forms the ‘blueprint’ of your study as it determines the methodology that you will use to collect, analyse and interpret data (Brink et al. 2018). The purpose of a research design is to ensure that the results obtained from a research project will effectively enable the researcher to address the research problem by answering the research question logically and unambiguously. What distinguishes quantitative research designs from qualitative research designs? Quantitative research designs are used to collect numerical data objectively (Bezuidenhout et al., 2014), to reduce bias and ensure academic rigour (Brink et al., 2014). Quantitative research designs are usually applied from the perspective of a positivist research paradigm where the reason for doing research is to establish causal relations that can be used to predict and control phenomena (Bezuidenhout et al., 2014). What quantitative research designs are you familiar with? Non-experimental Research Designs Complementary: Research Ethics Why is ethics in research important? Without the principles of ethical research guiding these studies, human subjects were made up of people who were already disempowered, including slaves, prisoners, the poor, and mental-health patients. Many of these studies were very little more than torturous, often under the guise of scientific research. What ethical constraints involving vulnerable participants can you think of? It was only after World War II, when the world learned about Nazi war crimes and experimentation on humans, and the Nuremberg trials unearthed these atrocities, that the Nuremberg Code was established, outlining a set of rules to protect human participants. How did research ethics develop over time? National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was conducted in 1976. From this Commission, the Belmont Report was published in 1979, outlining the principles of Respect for Persons, Beneficence, and Justice. These principles ultimately led to a new approach in bioethics known as Principlism. The Declaration of Helsinki (DoH) is the World Medical Association’s (WMA) best-known policy statement. The first version was adopted in 1964 and has been amended seven times since, most recently at the General Assembly in October 2013. The current (2013) version is the only official one; all previous versions have been replaced. Week 17: Core Domain: Population Health What policies do you know of that aim to improve health and health outcomes? Policy on Quality in Health Care for South Africa, Health Legislation and Policy and the National Health Insurance policy. What factors contribute to the biophysical environment that influences health outcomes? The biophysical factors include climate change, deteriorating and unsafe freshwater resources, soil degradation, pollution, the loss of biodiversity and other factors. Quality of air, water, soil and other factors, which have direct impacts on the status of health and quality of life. What factors contribute to the social environment that influences health outcomes? The Global Context of Health and Socio-economic Development, The Socio-economic Landscape of Health in South Africa, Disparities in Health Indicators,Teenage Pregnancies, Poverty and Development, and Poverty, Mortality and Reproductive Health. What are the disparities that exist between the rich and poor, that affect health outcomes? There are inequities of housing, access to water, sanitation and healthcare are prevalent, as the divide between affluent and poor communities persist. Competency: Scholarship What qualitative research designs are you familiar with? Phenomenology, Ethnography, Grounded Theory and Case Study. From what you learnt last week, what types of research do you think cannot be addressed by quantitative research designs? Qualitative research designs are used to explore the meanings, experiences, and contexts of human phenomena. They are not suitable for studies that require quantitative measurements, statistical analysis, or generalizable results. These topics require numerical data, hypothesis testing, and inferential statistics to answer the research questions. Qualitative research designs cannot provide such information. Why do you think a researcher will choose to do a mixed-methods design instead of only a quantitative or qualitative research design? Mixed-methods research is commonly found in the social, behavioural and health sciences, and has gained popularity. The reason for the popularity of mixed methods research lies in the nature of the research that is conducted. In life, we have multiple ways of seeing, hearing and interpreting information and thus rely on a combination of qualitative and quantitative information to create understanding. Complementary: Research Ethics What makes a compelling introduction in an essay? Introduce your reader to the subject of your essay. Give your reader an overview of what you will be doing (road map). Assume the reader does not know the question – tell them what your essay is about. Summarise and interpret the question, but don’t write it out. Give a breakdown (road map) of the most important sections of your essay. Say what position you will be defending (thesis statement). In what ways can you substantiate the claims made in your essay? Present and explain evidence that is used to justify my claims. How can defining your ethical stance in an essay support your writing? Defining your ethical stance in an essay means explaining your beliefs about right and wrong conduct and how they influence your arguments or evidence [1]. This can support your writing by showing your attitude towards the topic and establishing your credibility as a writer [2]. https://www.collinsdictionary.com/dictionary/english/ethical-stance https://academicmarker.com/essay-writing/introductory-paragraphs/stance/what-is-stance-in-academic-writing/ Week 18: Core Domain: Population Health When addressing the needs of different population groups, what are some of the interrelated elements that should be considered? Improving the health of the population involves individual and collective efforts from public health stakeholders such as nurses, doctors, researchers, health agencies and government departments that collect, analyse and interpret data and then communicate that data, make recommendations which can inform policy-making and improve overall population health outcomes. What strategies can be used to monitor and address the outbreak of disease to protect the health of populations? Surveillance can be used to monitor and address the outbreak of disease to protect the health of populations. Surveillance methods can be either passive or active. Active surveillance refers to the process of actively seeking out health information, is the type of surveillance used in outbreaks. What is the importance of surveillance during an outbreak? The disease can be one that results in hospitalisation of many people, or even death, and can have serious after-effects. Active surveillance, in this case, will play a role in various ways such as limiting the spread of disease through contact tracing and by conducting health promotion campaigns. Furthermore, active surveillance can lead to early detection and treatment, which may lead to further interventions. Competency: Scholarship What characteristics do you think are important to explain when describing a group of people for a particular research study? The population of interest, the sample, and sampling strategy needs to be described in the research protocol and the final research report. When describing the sampling strategy, it is necessary to specify which subtype of random or non-random sampling strategy was used. A justification for the choices made should also be provided. Why do researchers select only some participants from an entire group of people that they wish to study? The sample is a subset of the entire population that is selected by the researcher for a study. Sampling is the process of selecting the sample from a population in a way that will allow researchers to gain information about the phenomenon being researched to address the research problem and questions. In what ways do you think the way you select participants can influence your findings? There are two broad sampling strategies (also called sampling approaches or sampling techniques) that are used to obtain samples: Random (probability) sampling where individual elements from the population are selected at random, ensuring that each individual in that population has an equal chance of being selected. Non-random (non-probability) sampling where individuals from the population do not have equal chances of being selected. Random sampling strategies usually result in representative samples being collected from populations, while non-random sampling often does not. Complementary: Research Ethics Why is informed consent important in research? Informed consent is an essential part of healthcare practice and research. Informed consent is applied under various contexts; for instance, in South Africa, it is required for all medical treatment. In research, informed consent is a legal and ethical process which indicates that a competent participant enrolled in the study voluntarily upon being informed and receiving all the information relating to the research study in which they are enrolled. What are the requirements for informed consent? According to Manti and Licari (2018), informed consent in research is defined as a procedure through which a competent subject voluntarily provides his or her willingness to participate in a clinical trial upon having received and understood all the research-related information. Informed consent in a healthcare setting is described as the process whereby a healthcare provider explains a medical procedure or treatment to the patient before the patient agrees to undergo the procedure or intervention. What are the main differences between informed consent in clinical care and research? The main differences between informed consent in clinical care and research are: The purpose: In clinical care, informed consent is mainly to protect the patient’s autonomy and right to choose the best option for their health. In research, informed consent is also to protect the participant’s welfare and rights, but also to ensure the scientific validity and ethical conduct of the study [1][2]. The content: In clinical care, informed consent usually includes information about the diagnosis, prognosis, treatment options, risks, benefits, alternatives and costs. In research, informed consent usually includes information about the study design, objectives, procedures, risks, benefits, confidentiality, compensation and voluntary nature of participation [1][2][3]. The process: In clinical care, informed consent is usually obtained verbally or in writing before the treatment is initiated. In research, informed consent is usually obtained in writing after the participant has received a detailed consent form and has had enough time to ask questions and consider their decision [1][2]. https://www.webmd.com/a-to-z-guides/what-to-know-informed-consent-clinical-trials https://www.fda.gov/patients/clinical-trials-what-patients-need-know/informed-consent-clinical-trials https://www.samedical.org/images/attachments/guideline-on-informed-consent-jul012.pdf How do ethical and moral theories influence your own perspective? ---

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