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Week 1: Core Content: Defining Health Systems Health systems are described in different ways, as ‘particular healthcare system’ or ‘national healthcare systems’ - what aspects should be considered when defining a health system? Service Delivery, Health Workforce, Leadership and Governance, Financing, Infromation Technology, Medical Products, Vaccine and Technology. How would you define and explain the purpose of a health system? A health system is made up of many components that have a common aim to provide preventative and treatment to people inflicted with a disease. Cross-cutting Content: Teamwork What is the difference between a group and a team? A team is a unit of two or more people who regularly interact to accomplish common goals and who hold themselves mutually accountable for meeting performance results. A group of people is not a team. Even though they might have a common goal, they do not interact regularly, and they are not accountable to each other for reaching the goal. How does a group become a team? A team implies a commitment to a shared objective and collective responsibility for achieving it. Therefore, to be a team and not a group there must be a common goal as well as all members invested in working towards achieving this goal with a sense of responsibility and accountability. What are the different roles that people play within teams? According to Belbin's Team Roles they are resource Investigator, Team worker, Co-ordinator, Plant, Monitor Evaluator, Specialist, Shaper, Implementer and Completer Finisher. How can teams acknowledge and draw on the benefits of diversity? Through an understanding of team dynamics which comes from team roles which are assigned based on intersecting personality traits, characteristics and motivations. Complementary Content: History of Medicine What is the difference between information and knowledge? Information is everything that can be known about a topic. Knowledge is what amount an individual knows and can accurately recall. What is the relationship between epistemology and ontology? Epistemology is a field of science that tends to describe the many approaches we can choose to understand our world. It is by definition the science of knowledge, or the study of knowledge or knowing. Ontology is about describing things and their relationships to answer the question "What is it?" while epistemology's personal concern is to investigate the ways that lead you to think that. Ontology is the study of “being.” What is the difference between history and historiography? History is what has happened in the past. Historiography refers to the observation that historical accounts are always subjective and constructed to reflect causal linearity. Week 2: Core Content: Components of Health Systems How does context, culture and environment affect the structure of health systems? There are a number of external determinants that impact health systems. These include sociocultural factors such as the history of a country, its economic and political circumstances, and the legacy that these factors have on the way that health systems function. There are also a number of natural environmental factors such as the size of a country, the typography, climate, and population density, that affect the structure and function of a national healthcare system In addition to the socio-structural and cultural factors that impact a health system, one needs to account for users within a health system - their knowledge, beliefs, attitudes and behaviours. These all affect how care is delivere and how people in the community accept care. Considering a patient-centred approach to healthcare, how can health systems address the diverse social, economic, and familial circumstances of patients? [I am struggling to answer this question] Cross-cutting Content: Working in Teams What common problems do teams encounter? Absence of team identity, Difficulty making decisions, Poor Communication, An inability to resolve conflict, Lack of participation, Lack of Creativity, Groupthink, and Ineffective Leadership. What can teams do to support a productive work culture? Active listening, Communication, Dependability and Creativity. What is problem solving and what steps do you take when solving a problem? Step 1: Identify the problem Step 2: Analyse the cause/s Step 3: Generate potential solutions. Step 4: Select and plan the best solution. Step 5: Implement the solution. Step 6: Evaluate the solution. Complementary Content: History of Medicine What impact has Hippocratic Medicine had on the practice of medicine today? The Hippocratic Oath is the earliest expression of medical ethics in Western medicine and many of the principles remain significant to the practice of medicine today, such as patient confidentiality and non-maleficence. Some of the core aspects of Hippocratic Medicine are maintained within the Oath, such as the commitment to patient-centred care, the promotion of wellness and the prevention of disease, and the recognition that the environments in which we live are integral to our health. What are the similarities and differences between the different health systems frameworks that you have learnt about on this course? Patient-centred care, the promotion of wellness and the prevention of disease, and the recognition that the environments in which we live are integral to our health. Week 3: Core Content: Complex Adaptive Systems What is the difference between complex and complicated systems? A complex system comprises many parts, relationships between the variables that describe the sections that are nonlinear and have feedback but the overall behavior is unpredictable. Complicated systems are made up of many parts that work together to achieve a goal and are predictable. What are the characteristics of a complex system? Complex adaptive systems theory offers a particular description of systems that are or have: Retrospective coherence Non-linear Unpredictable Multi-level and nested Open to the environment; to the past; and to the future Emergent How does ‘order’ manifest in different kinds of systems? Chaotic systems do have order. The qualification is that the order is non-linear and cannot be predicted. Furthermore, it is sometimes necessary to observe the behaviour of the system, over time, to be able to identify its order. What role does complexity and systems thinking play in understanding complex health issues such as the global management of disease outbreaks? [I don't know how to answer this] Cross-Cutting Content: Managing Conflict How can conflict be positive? Conflict often occurs in teams, especially during the storming phase of team development where the team is trying to establish its shared vision and group dynamics. During this time conflicting ideas, values and opinions may arise. What is your approach to dealing with conflict? Compromising, Accommodating, and Collaborating. How would you avoid conflict? By making sure that me and my team members have clear communiation. Complementary Content: History of Medicine What were the differences and the relationship between the medieval physician, surgeon, and apothecary? A medieval physician has a college education, a surgeon amputates parts of people and an apothecary is like a pharmacist. How did institutions such as the hospital and the university impact the practice of western medicine? University have made the focus of medicine to be anatomy and also brought about the need for health professions to go to school before they are allowed to practice. The hospital has made medicine lack the person-centeredness that it used to have when physicians would visit people's homes. Overall Module 1 Reflection:

The importance of Sustainable Development Goal 3 in attaining an equal and quality health system in South Africa, and policies that are relevant to SDG 3. In order to end poverty, decrease unequal opportunities, and create peaceful, thriving communities by the year 2030 the United Nations Member States, which includes South Africa, chose to take on Sustainable Development Goals (SDG) in 2015. (UNICEF, n.d.) There are seventeen sustainable development goals. SDG 3 is related to health, Good Health and Well-being. SDG 3 has goals that are well aligned with the creation of a National Health System (NHI). The NHI removes monetary obstacles which affect accessibility to healthcare by guaranteeing that everyone who resides in South Africa as a citizen or a resident, regardless of their economic status, have access to high-quality healthcare offered through the collaborating of private and public health sectors. (South African Government, 2014) SDG3 has nine targets, which can be used a quality measuring tool with its implementation. The first goal is to reduce the maternal death rate worldwide. Second, to stop new-born and young children under the age of five from dying needlessly. The third is to tackle hepatitis, water-borne illnesses, and other communicable diseases while also putting a stop to the epidemics of AIDS, TB, malaria, and neglected tropical diseases. Fourth, encourage mental health and wellbeing and minimize death from noncommunicable diseases by utilising prevention and treatment methods. The fifth goal is to strengthen efforts to prevent and treat substance misuse, particularly alcohol abuse and narcotic drugs. (United Nations South Africa, 2023) The sixth goal is to reduce by half the annual amount of people killed and injured in traffic accidents worldwide. Seventh, make sure that all people have access to family planning, information, and education, as well as the inclusion of reproductive health in national policies and initiatives. The eighth goal aims to realize universal health coverage, which includes financial risk protection, accessibility to high-quality basic medical services, and universal access to safe, reliable, high-quality, and reasonably priced basic medications and immunizations. Target nine is the reduction of fatalities and diseases caused by toxic substances, as well as pollution and contamination of the environment, including soil, water, and air. (United Nations South Africa, 2023) For SDG 3 to be realised in South Africa hindrances need to be dealt with. Numerous structural and systemic issues, such as ubiquitous inefficiencies, personnel shortages, differences in skill levels across rural and urban areas, and subpar handling of patients are some of the issues that the South African health system faces. Owing to the continuing disparities between public and private healthcare, the public sector is overburdened relative to the private sector. Additionally, due to urban planning practices from the time of apartheid, many South Africans continue to lack convenient access to public institutions, services, and amenities. (de Villiers, 2021) SDG 3, target one to five, aim to improve health access and make use of preventing strategies to reduce the prevalence of communicable diseases. For the goals to be met the South African Health system must address the structural and systematic issues discussed above. The two policies that are relevant for the realisation of SGD 3 are the National Health Act and the National Health Insurance Bill (NHI Bill). The two policies raise the importance of each and every citizen having the right to receive healthcare. This is consistent with SDG 3, which promotes wellbeing for each individual and protects the health of all people. (Mhlanga and Garidzirai, 2020) The National Health Act endeavours to manage national health and establish standardization for medical services throughout the country. In addition to protecting South African's right to obtain health care services, notably reproductive health care, it outlines the rights and obligations of providers of healthcare, workers, institutions, and users. It also promotes the rights of vulnerable groups like women, children, the elderly, and people with disabilities, the people of South Africa to an environment that is not detrimental to their health or well-being, and children to access basic nourishment, and basic health care services. (REPUBLIC OF SOUTH AFRICA, 2004) During the South African apartheid era, race and socioeconomic status (SES) were significant determinants of access to and use of healthcare services. The health sector is one of several areas of the nation where post-apartheid inequality is still severe. As opposed to a person's need for care, SES has a greater impact on access to high-quality services. (Mhlanga and Garidzirai, 2020) The National Health Act addresses SES issues and works to improve the health system which reaches the many of the same goals that are set out in the SDG 3. It embodies goals six to nine of SDG 3 while addressing structural and systematic issues, if implemented it will significantly increase the chance of South Africa having good health and Well-being for all. In accordance with the Constitution, the NHI Bill's goal is to provide all South Africans access to high-quality healthcare. By making sure that no one is denied the right to healthcare according to their socioeconomic status, the NHI Bill aims at accomplishing this. The end goal is to attain Universal Health Coverage (UHC), and to do this, one public health fund is established with sufficient resources to prepare for and successfully satisfy the health requirements of everyone in the nation, not just for a small number of individuals. (Parliament of the Republic of South Africa, 2020) With high-quality healthcare for all being the focus, effective implementation will lead to SDG 3 success in South Africa. Reference list: de Villiers, K. (2021). Bridging the health inequality gap: an examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty, [online] 10(1). doi:https://doi.org/10.1186/s40249-021-00804-9. Goal Tracker South Africa (2017). GOAL 3 GOOD HEALTH AND WELL-BEING. [online] Goaltracker.org. Available at: https://south-africa.goaltracker.org/platform/south-africa/goals/3 [Accessed 7 Jun. 2023]. Mhlanga, D. and Garidzirai, R. (2020). The Influence of Racial Differences in the Demand for Healthcare in South Africa: A Case of Public Healthcare. International Journal of Environmental Research and Public Health, [online] 17(14). doi:https://doi.org/10.3390/ijerph17145043. Parliament of the Republic of South Africa (2020). National Health Insurance (NHI) Bill - Parliament of South Africa. [online] Parliament.gov.za. Available at: https://www.parliament.gov.za/project-event-details/54 [Accessed 8 Jun. 2023]. REPUBLIC OF SOUTH AFRICA (2004). Government Gazette REPUBLIC OF SOUTH AFRICA THE PRESIDENCY. [online] Goal Tracker South Africa, Cape Town , pp.16–18. Available at: https://www.datocms-assets.com/7245/1574922053-national-health-act-no-61-of-2003.pdf [Accessed 7 Jun. 2023]. South African Government (2014). Health | south african government. [online] Www.gov.za. Available at: https://www.gov.za/about-sa/health [Accessed 8 Jun. 2023]. UNICEF (2023). UNICEF and the Sustainable Development Goals | UNICEF. [online] www.unicef.org. Available at: https://www.unicef.org/unicef-and-sustainable-development-goals [Accessed 7 Jun. 2023]. United Nations South Africa (2023). Sustainable Development Goal 6: Clean Water and Sanitation | United Nations in South Africa. [online] southafrica.un.org. Available at: https://southafrica.un.org/en/sdgs/6 [Accessed 7 Jun. 2023].

In week six, we started with Module 3, which focuses on human resources as a building block of a health system. Human resources consist of the human workforce and human resources management. “A well-preforming health workforce works in ways that are responsive, fair, and efficient to achieve the best health outcomes possible, given available resources and circumstances.” The health workforce consists of health service providers (for example doctors and nurses) and health management and support workers (such as accountants who work in hospitals and janitors). Human Resource management is a function within an organisation with aim of helping an organisation reach its strategic objectives. In South Africa, there is a shortage in the health workforce. The reasons for the shortage are, a shortage in the number of health services, health management and support workers that are graduating compared to the demands, low retention of health care professionals (doctors leaving the country and the public sector losing health care professionals to the private sector) and there are not enough posts for health care professionals due to financial reasons. There are four dimensions in understanding workforce performance, availability, competence, responsiveness, and productivity. Availability has to do with the distribution and attendance of existing workers in areas where they are needed. Competence encompasses the combination of technical knowledge, skills and attitudes, and work behaviours. Responsiveness means that people are treated decently, regardless of social, economic, or health status, who they are or whether or not their health improves. Productivity means that producing the maximum effective health services and health outcomes possible given the existing staff; reducing waste of staff time or skills and other complementary resources. This is how each dimension applies in South Africa. Availability, Challenges: There is a lack of health care workers - especially for some disciplines. Health care workers are not always available to deliver services where it is needed. Solutions: Train more mid-level workers, such as Clinical Associates. Improve team-based care with the use of Community Health Workers Within a team-based care approach, encourage task-sharing. Give healthcare professionals positive exposure to rural health training. Competency, Challenges: Health care workers are not always suitably qualified to serve the needs of a population due to a skills gap mismatch of competencies with patient and population needs. Solutions: Train people to address QBD (quadruple burden of disease). Re-orient medical education, research, and service priorities to respond to current and future health needs and challenges in society. Train healthcare professionals in primary healthcare settings. Improve supervision of healthcare workers. Responsiveness: Challenges: Low morale and insufficient supervision. Unsafe conditions in the workplace. High attrition. Solutions: Improve working environments, e.g., through the Ideal Clinic initiative. Improve compensation, e.g., Rural Health Allowance or Occupation Specific Dispensation. Productivity, Challenges: Lack of efficiency, Supervision, Management. Solutions: Improve quality assurance, e.g. through the Office of Health Standards Compliance. Improve guidelines and protocols, by introducing a performance management framework for public sector employees. From this module, I have learned the importance of human resource management, especially after seeing how the challenges in South Africa are solved by HR. Health systems need there to be healthcare professionals and people outside of health care to be able to be successful so it is interesting to release the importance of HR. HR organises Health Systems to reach its strategic objectives. References: Health Professionals Council of South Africa, 2018. Professional Boards. Available at: https://www.hpcsa.co.za/Professionals/ProBoardsLinks to an external site. (Last accessed: 15 September 2022). The Allied Professions Council of South Africa, 2018. AHPCSA. Available at: https://ahpcsa.co.za/Links to an external site. (Last accessed: 15 September 2022). Mohr, J./WHO. 2006. Health Workers: A Global Profile. Available at: https://www.who.int/whr/2006/06_chap1_en.pdfLinks to an external site. (Last accessed: 15 September 2022). Hart, J.T., 1971. The inverse care law. The Lancet, 297(7696), pp. 405-412. Lumen Candela, N.D. The Functions and Goals of HR. (online) Available at: https://courses.lumenlearning.com/boundless-business/chapter/the-functions-and-goals-of-hr/#:~:text=In%20short%2C%20human%20resource%20activities,a%20wide%20variety%20of%20activitiesLinks to an external site. [Accessed 15 September 2022] Lumen Candela, N.D. Human Resource Management. (online) Available at: https://courses.lumenlearning.com/wmopen-introductiontobusiness/chapter/human-resource-management/Links to an external site. [Accessed 15 September 2022] Nina Burokas, 2020. Functions of Human Resources Management. (online) Available at: https://biz.libretexts.org/Courses/Lumen_Learning/Book%3A_Human_Resources_Management_(Lumen)/04%3A_Module_1%3A_The_Role_of_Human_Resources/04.5%3A_Functions_of_Human_Resources_ManagementLinks to an external site. [Accessed 15 September 2022] Smith, A., Unv. ‘Chapter 4: Making the Most of Existing Health Workers’ in The World Health Report, 2006. Available: https://www.who.int/whr/2006/06_chap4_en.pdfLinks to an external site. (Last accessed: 15 September 2022).

This week we began a new module about service delivery. First, we analysed the levels of care which are primary, secondary, and tertiary. The primary level of care is the first point of entry when looking for healthcare services. During a presentation, we learnt that family and friends are part of the primary level of care, at the very bottom of the pyramid. For patients to enter the first level of health care, most consult their families and friends first. This level consists of clinics and community health centres. The secondary level of care includes district hospitals and referral (regional) hospitals. The district hospital can also be part of the primary level of care, any hospital services that are part of primary care are done in a district hospital. The services offered at the secondary level care are specialised, the patient requires the care of a specialist or special technology. The tertiary level of care and an additional level called the quaternary level require very specific technology and human resources. The more specialised the care. The more expansive it is to provide. Patients must be referred up and down the levels of care. The provinces in South Africa are divided into municipal districts, which are boundaries which dictate how services should be provided in that area. Health services are delivered through the district health system. The district health system is an area in which healthcare services are managed and provided to a defined population. The district health system is the main vehicle through which primary healthcare services are delivered to a population. It comprises of district hospitals, primary health care (PHC) clinics, community-based health services and community health centres. A patient would be referred, this is a referral up the district health system, from the community-based health services (for example non-profit organisations and traditional healers) to the clinic then the community health centre (CHC) and lastly the district hospital. Through the different levels of care, the health system can manage patients and ensure that they receive the necessary attention that they need for the kind of illness. The referral system ensures that expensive equipment, treatments, and the services of specialised professionals do not go to waste. We learnt in a previous session that a good health system keeps the cost down as well as provides quality services, the referral system is how a good health system keeps the cost down since smaller issues can be dealt with in clinics and CHCs. The formation of health districts also has advantages such as the management of health services is decentralised so that service delivery is simpler and more responsive. Health services can be tailored to the needs of a defined population, which better meets the immediate health needs of that population. Decisions can be localised around the needs of the population. Health districts facilitate the involvement of communities in their specific needs. Collecting health information and reporting health statistics is easier and simpler. Referral in South Africa needs to be improved for the full benefits to be realised. Firstly, as stated before patients often consult family and friends before they seek help from health institutions. There are some problems in the transition, ordinary people aren’t trained enough to know when to look for health care services, and there could be no money and no transport to the clinic, CHC or non-profit organisation (NPO). Once the patients do have access the staff’s attitudes and long waiting hours could be a barrier to them being referred to the necessary health institutions. Secondly, from the health care providers’ point of view, they could be dismissive of patients’ symptoms, ambulance time of arrival to transport the patient to the hospital that they were referred to, lack of infrastructure, there’s not very good communication between physician’s when a patient needs to be referred. All mentioned above should be improved for the referral system to function better in South Africa. References: Hodkinson P, Argent A, Wallis L, Reid S, Perera R, Harrison S, et al. (2016) Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death. PLoS ONE 11(1): e0145473. Available at:https://doi.org/10.1371/journal.pone.0145473Links to an external site. (Last Accessed: 13 September 2022) Hodkinson, P.; Argent, A.; Wallis, L.; Reid, S.; Perera, R.; Harrison, S.; Thompson, M.; English, M. (2016). Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death (accessed from Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death | PLOS ONE)

In week 4 we focused on how art, and literature can define health. We first revised the WHO definition of health, which is “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (World Health Organization 2022) Then we analysed art and how it can help us define what health means. The first piece of art that we looked at was The Waiting Room by Gerald Sekoto in 1940. The painting shows a woman, her husband, and their child. They are health seekers, but they are far behind. The lady looks hopeful, the baby uncomfortable and the man is slumped over very tired. This painting shows how accessing care is often a prolonged process for people who are caregivers (mostly women), old and poor. It shows their disadvantage, that hope sometimes is not enough to get the level of care that people need because the health system has put them at a disadvantage. Another disadvantaged group, occasionally, is chronically ill patients or people who are likely not to recover. The second painting The Doctor by Luke Fildes in 1891. The painting shows a doctor next to a terminally ill child. The doctor next to them, even though they do not have a cure. The doctor instead offers his presence and acknowledgment of life. This piece of art emphasises the importance of compassion in the health system. The third painting, The Mining Doctor by William Kentridge in 1999, is set in 1886 to 1899. The painting is from the artist’s perspective of the artists trying to understand the illness that the miner is experiencing and the burden of disease on the young ambitious man who was trying to provide for his family or even just climb in social status. The artist used the miner and the mining doctor to interrogate the meaning of health in South Africa. William Kentridge also did paintings of HIV and AIDS and Tuberculosis. This painting places importance on health systems that put preventative measures in place to take care of a community. The last piece of art that we looked at is The Flemish Plague Triptych (the 1700s) and the Keiskamma Triptych. The second painting drew inspiration from the other, both are about the journey of people through their illnesses and teach compassion. Then the focus was on the history of health and human rights in South Africa. health as a right is a 20th-century phenomenon. It began as people tried to answer what it meant to be human through movements such as anticolonialism and defining what it meant to be working class, a peasant, and a serf. Wars and epidemics brought the idea of health rights to be fully realised. The WHO organisation was formed. The right to health is fundamental to the physical and mental well-being of all individuals and is a necessary condition for the exercise of human rights. The right to health is provided is in three sections of South Africa’s constitution. These provide access to healthcare services including reproductive health, emergency medicine, basic healthcare for children, and medical services for detained persons. Now let us reflect on South Africa’s history with health rights. During apartheid, South Africa was not upholding some articles of faith that it had signed with WHO. Money on healthcare was spent differently depending on gender and race. It was applied loosely to white people and even less to people of colour. In the 70s and the 80s, people of colour began to demand healthcare rights. People Health Society was formed with people from civil society and faith-based organisations. Health as a right was incorporated into the struggle for equal rights in South Africa. During apartheid, there were also court cases that were brought against the government for not fulfilling its end of the bargain. References: South African Human Rights Commission. (n.d.). Access to Health Care. [online] Available at:https://www.sahrc.org.za/home/21/files/FINAL%20Access%20to%20Health%20Care%20Educational%20Booklet.pdf [Accessed 16 September 2022] Moyo, K. (2017). Realising the right to health in South Africa. [online] Available at: http://www.fhr-mirror.org.za/files/7215/1247/1732/Health.pdf [Accessed 16 September 2022] Child, C. (2018). Life Esidimeni: Moseneke finds officials behaved unconstitutionally. [online] Available at: https://www.timeslive.co.za/news/south-africa/2018-03-19-officials-in-esidimeni-behaved-unconstitutionally-finds-moseneke/ [Accessed 16 September 2022]

How has my perceptions of equity, equality and access in health changed? How will this influence my future goals for healthcare service delivery? I knew that equality meant equal distribution of resources and that everyone is treated the same. I also knew that equity is the fair of distribution of resources according to an individual’s needs, providing the necessary tools for everyone to succeed. What I leant is how to apply these to health. Health Inequality is the difference in health status (outcomes) or distribution of health resources between different populations and this can happen when vulnerabilities are not considered, so there is inequitable health and distribution of resources. Therefore, it is important to utilise the community diagnosis that we learnt about in Public Health in week 2 session 2. Health equity is the absence of systematic disparities in health or major social determinants of health between groups of various levels of underlying social advantage or disadvantage. Health inequity is systematically putting groups of people who are already socially disadvantaged at a further disadvantage regarding their health. Access to health care is being able to utilise health care services whenever they are needed but if the healthcare centre does not have the necessary resources or the person is a part is part of a socially disadvantaged group that the health system discriminates against, it would be difficult to access the health services need. The health system must be revised to get rid of any health inequity and inequality. I as a future health professional will work to address those parts of the health system that do not serve the people of the community. References: Gulliford, M., Figueroa-Munoz, J., Morgan, M., Hughes, D., Gibson, B., Beech, R. and Hudson, M., 2002. What does ‘access to health care’ mean?. Journal of health services research & policyLinks to an external site., 7(3), pp.186-188. Thiede, Akweongo & McIntyre (2007). Exploring the dimensions of access. In: McIntyre & Mooney (Eds). The economics of health equity. Cambridge University Press, Cambridge.

Activity 1.3.2 - Case Study on Life Esidimeni, a reflection The Life Esidimeni tragedy is about the death of ninety-four (and possibly more) mental health patients that occurred from the 23rd of March 2016 to the 19th of December 2016. The patients were transferred from the Life Esidimeni (LE) Hospital Non-Governmental Organisation (NGO) which were said to specialised in providing mental healthcare. 2000 patients were transferred. “All the 27 NGOs to which patients were transferred operated under invalid licenses” (W Makgoba, 2017) Many patients were transferred out of the LE hospital, that provides quality full time care, to NGO’s that were not fully equipped with staff that had the necessary skills provide care to metal health patients nor did they have the necessary resources. Some patients were moved to NGO’s far away from family members, sometimes being transferred to multiple NGO’s before they could be found. Some families were not notified of their family members being moved out of the LE hospital. The transfer of patients was apparently to move towards deinstitutionalised care for mental heal users however, the throughout the process of doing so there was a lack of organisation which led to disarray irresponsible way of dealing with patients. The Mental Health Care Act, (MHCA), 2002 (Act No. 17 of 2002), was a law used to justify the above actions and how rapidly the process took place, while it is recommended, conversely, that “Deinstitutionalisation of patients must be done systematically and with adequate provision made for community services” (W Makgoba, 2017) The departments decision was protested with the “South African Society of Psychiatrists (SASOP) writing to the MEC Qedani Mahlangu and team warning about the likely consequences of terminating the contract with Life Esidimeni. They warned that the move was "premature" and would result in negative outcomes. Around the same time the South African Depression and Anxiety Group (Sadag) also expressed concern about the termination of contract. They were however lambasted by the MEC.” (City Press, 2017) Human right of the patients were violated according to the “Constitution and contravened, the National Health Act (NHA), (Act No. 61 of 2003) and the Mental Health Care Act (MHC), (Act No. 17 of 2002). Some executions and implementation of the project have shown a total disregard of the rights of the patients and their families, including but not limited to the Right to Human dignity; Right to life; Right to freedom and security of person; Right to privacy, Right to protection from an environment that is not harmful to their health or well-being, Right to access to quality health care services, sufficient food and water and Right to an administrative action that is lawful, reasonable and procedurally fair.” (W Makgoba, 2017) Health inequity is defined as systematically putting people who are already social disadvantaged at a further disadvantage to their health. The Life Esidimeni Tragedy illustrates how health inequity happens to people who can access and afford healthcare. Respect for mental health users has to be taught to communities. In addition to this the people need to be educated on what being mental health patient is so that situations like this do not occur where people think believe it is acceptable to cut costs in providing health care services to mental health users. “This move, she said, was to save the department money” (City Press, 2017) Through this case study I learnt that even with all the health education that a community can be given, the health services, the rights pertaining to health that are put in place and the public health studies that are conducted it is particularly important that leaders who are in charge care about the people that their decisions affect. Their moments of selfishness and greed can devastate the same communities that they claim to care about and lead to so many lives being lost. In my opinion not having a good leader to manage health systems should be considered health inequality. References City Press. (2017, February 7). Timeline: Life Esidimeni tragedy. Retrieved September 8, 2022, from Citypress website: https://www.news24.com/citypress/News/timeline-life-esidimeni-tragedy-20170207 W Makgoba, P. M. (2017). THE REPORT INTO THE “CIRCUMSTANCES SURROUNDING THE DEATHS OF MENTALLY ILL PATIENTS: GAUTENG PROVINCE.” In Life-Esidimeni-FINALREPORT.pdf (pp. 8, 9). HEALTH OMBUD: Republic of South Africa: Office of the Health Ombud. Retrieved from Office of the Health Ombud website: https://section27.org.za/wp-content/uploads/2016/04/Life-Esidimeni-FINALREPORT.pdf

Week 2 Reflection How is my view on health changing? What are the core underlying values for me in terms of receiving healthcare or how healthcare is provided to the population? I’m learning that health includes populations of people and by improving the health of a population you directly improve the health of the individual. This is because you address the determinants of health that affect the majority of people. Then you’re left with only dealing with a few people who require more specialised care. The core values are, the main health problem in the community be addressed and the determinants of health for the community are identified. Another core value for me is intervention. Interventions are implemented to focus on the identified problems and the causes of the problem. “These interventions focus on three key public health services and functions: Promotion, prevention and protection.” “These interventions have proven exceedingly successful in preventing diseases within the 20th century, such as vaccinations, improved sanitation, fewer deaths from heart disease and stroke, healthier mothers and babies, and reduction in tobacco use to name a few.” Public health is important for the well-being of the individual in a community. Since it its interventions focus on the cause of any problem it saves lives as seen in the examples, I quoted in the paragraph above. What did I find most interesting from this session and how did my understanding of the role of public health change? What I found most interesting is how a single narrative can be accepted. It makes me question whether I have chosen to ignore the positives of the public health sector in South Africa. Weekly Reflective Entry 2: Health Systems Science and Public Health An important learning experience for me this week was learning the importance of public health and population health and how it ultimately benefits the individual even when they are not the focus. “Public health is defined as the science and art of promoting health and well-being, preventing ill-health and prolonging life through the organised efforts of society (Sir Donald Acheson, 1988, p. 5). Public health is concerned with improving the health of populations or groups of people, rather than treating individual patients.” The health of a population is assessed through community diagnosis which identifies, firstly, the main health concerns of the community, secondly, the determinants of health for the specific community. After the community diagnosis, an intervention is implemented. The interventions focus on prevention, promotion, and protection. The intervention addresses the most common problems and its cause. Intervention need some enabling functions to work, which are governance (regulations that guide us on what to do e.g., legislation), capacity (e.g. enough medical equipment, beds, etc.), advocacy(speaking up for the most vulnerable to the disease; including who have no choice such as those who use public transport), and information(guides in planning and interventions for example about the disease). After an intervention, we go and evaluate whether the intervention was successful. To evaluate we would look at the following factors incidence, prevalence, and mortality. Population health is measured to: Assess the quality of life of a population/community. Develop a baseline of information against which changes over time can be measured or assessed. Help evaluate the impact of a project or service on people’s lives. Identify aspects of their lives people feel most dissatisfied with and aspects of community health that need tailored intervention. (e.g.: where to find Key/vulnerable/most affected populations). Help raise awareness of the different components of health among a particular population. Components that measure population health is Morbidity (impairment and disability) and mortality (infant mortality rate, child mortality rate, and case-specific mortality) Determinants in health are multiple and varied factors that cause populations to be unhealthy or influence the health of a population. The extent to which individuals show symptoms of a disease is contingent upon additional determinants of health. These determinants include Individual biology (age, immunity, etc.). Behavioural determinants (help-seeking behaviours, harmful alcohol use, unsafe sex, smoking, limited physical activity, etc.). Social determinants (access to sanitation, working and living conditions, level of education, etc.) From this week’s work I have learnt that public health is the best way for organisations or governments to improve the health of communities that they would like to help. Public health already takes into consideration the people who are part of the communities that are being helped for example two of the determinants of health is looking at individual biology and behavioural determinants. Hence, the success of previous interventions that improve the quality of life for the people makes sense, and due to the interventions relying on governance, capacity, advocacy and information public health uplifts the whole health system. This course is about health system sciences, and health system sciences has public health as one of its pillars. Public health is a great way to improve the system because for it to be successful it takes into consideration the people of the community, the government, the capacity of hospitals and clinics in the community, advocacy, and teaching health information. Plus, in addition, public health does community diagnosis and then comes back to check whether the intervention worked. Health system sciences is about understanding how health is delivered to improve the health system so health can improve. Public health goes hand in hand with what health system sciences is about, it contributes a lot to understanding and through its evaluations improves the health system in the community. Reflections: Let’s Learn Public Health, 2017. What is Public Health? Available at: https://www.youtube.com/watch?v=t_eWESXTnic&t=19sLinks to an external site. (Last accessed: 13 September 2022). Kindig, D. and Stoddart, G. 2003. What Is Population Health American Journal of Public Health, 93, 380-383. Acheson, S.D., Office, G.B.H.M.S., 1998. Independent Inquiry Into Inequalities in Health Report. Stationery Office. Marmot, M., 2005. Social determinants of health inequalities. The Lancet, 365(9464), pp.1099-1104. Available at: https://www.sciencedirect.com/science/article/pii/S0140673605711466 (Links to an external site.) (Last accessed: 13 September 2022).

Has my idea of health systems science changed after this session? If so, how? My idea has not changed, but I have learned what health system sciences is. It is made up of three building blocks, health systems science, public health and bioethics, and health law. Health system sciences involve studying components such as the ones listed above to improve the health of the patients and the community at large. Health system sciences is the third pillar of health science education after Basic sciences and Clinical sciences. “Health system sciences compliments and synergizes with basic and clinical sciences by addressing the fact that the quality of healthcare is determined by the health system that supports it. This includes the fundamental building blocks such as Governance, Finance, Service delivery, Human resources, Health Information Systems, and Medicines and Technologies.” Health system sciences building blocks are service delivery, health workforce (such as doctors and nurses), health information systems, access to essential medicines, financing (how much is invested into hospitals and how much are people being paid), Leadership, and Governance. The outcomes of improving these building blocks mean that there will be improved health (level and equity), responsiveness, social and financial risk protection, and improved efficiency. “Ultimately, Health System Sciences is about improving health outcomes for the population by improving the different yet interrelated aspects of the health systems that work together to provide quality health care.” How has my definition of health changed after this session? Yes, I defined health as eating healthy food, exercising, and not staying in a stressful environment. But then I see now that health is subjective and should be adapted to every person. People with chronic illnesses, disabilities, etc...should be accommodated in the definition. Health is something that one works on and improves not a state of being, it is not measurable. How do the initial steps required for academic writing differ from the steps for creative and narrative writing? What are my weaknesses and strengths for this kind of writing? What skills do I still need to work on to become better? in the initial steps, it is important to check that the research that you have found is reliable and that it can be used. A lot of what you state must be factual and backed up by evidence, so you need to plan out your argument. But because you need evidence you also must have the skill of paraphrasing and citing and referencing properly to not plagiarise someone else’s work. What I need to work on is the flow of my essay, but my strength is critical thinking and connecting things as well as evidence to support my point of view. What skill do I need to work on, I would say communication. References: Skochelak, S.E., Hawkins, R.E., Lawson, L.E., Starr, S.R., Borkan, J. and Gonzalo, J.D., 2016. Health Systems Science. Elsevier Health Sciences. Amzat, J. and Razum, O., 2017. Towards a sociology of health discourse in Africa. Springer. Read: pages 1 – 5. Bircher, J., 2005. Towards a dynamic definition of health and disease. Medicine, Health Care and Philosophy, 8, 335–341. Huber, M., Knottnerus, J.A., Green, L., van der Horst, H., Jadad, A.R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M.I., van der Meer, J.W. and Schnabel, P., 2011. How should we define health?. Jadad, A.R. and O'Grady, L., 2008. How should health be defined?. BMJ: British Medical Journal (Online), 337. WHO (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946.

They are not formatted because these are my notes that I used to study and do work.