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Olagoke Akintola - One of the best experts on this subject based on the ideXlab platform.
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health Care waste management in community based Care experiences of community health workers in low resource communities in south africa
BMC Public Health, 2017Co-Authors: Lydia Hangulu, Olagoke AkintolaAbstract:In South Africa, community health workers (CHWs) working in Community-Based Care (CBC) programmes provide Care to patients most of whom are living with HIV/AIDS and tuberculosis (TB). Although studies have shown that the Caregiving activities provided by the CHWs generate health Care waste (HCW), there is limited information about the experiences of CHWs on health Care waste management (HCWM) in CBC. This study explored HCWM in CBC in Durban, South Africa from the perspectives CHWs. We used three ethnographic approaches to collect data: focus group discussions, participant observations and informal discussions. Data was collected from 85 CHWs working in 29 communities in the Durban metropolis, South Africa. Data collection took place from July 2013 to August 2014. CHWs provided nursing Care activities to patients many of whom were incontinent or bedridden. Some the patients were living with HIV/AIDS/TB, stroke, diabetes, asthma, arthritis and high blood pressure. These Caregiving activities generate sharps and infectious waste but CHWs and family members did not segregate HCW according to the risk posed as stipulated by the HCWM policy. In addition, HCW was left with domestic waste. Major barriers to proper HCWM identified by CHWs include, lack of assistance from family members in assisting patients to use the toilet or change diapers and removing HCW from homes, irregular waste collection by waste collectors, inadequate water for practicing hygiene and sanitation, long distance between the house and the toilets and poor conditions of communal toilets and pit latrines. As a result of these barriers, HCW was illegally dumped along roads or in the bush, burnt openly and buried within the yards. Liquid HCW such as vomit, urine and sputum were disposed in open spaces near the homes. Current policies on primary health Care (PHC) and HCWM in South Africa have not paid attention to HCWM. Findings suggest the need for primary health Care reform to develop the competencies of CHWs in HCWM. In addition, PHC and HCWM policies should address the infrastructure deficit in low resource communities. In order for low-and-middle-income-countries (LMICs) to develop effective community health worker programmes, there is a need for synergies in PHC and HCWM policies.
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Perspectives of policy-makers and stakeholders about health Care waste management in Community-Based Care in South Africa: a qualitative study.
BMC Health Services Research, 2017Co-Authors: Lydia Hangulu, Olagoke AkintolaAbstract:In South Africa, a new primary health Care (PHC) re-engineering initiative aims to scale up the provision of Community-Based Care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide Care to the largely poor and marginalised communities across the country. The provision of Care will inevitably lead to an increase in the amount of health Care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is Care of a patient. CBC in South Africa is guided by the home-based Care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health Care waste management (HCWM) in CBC in South Africa from the policy-makers’ and stakeholders’ perspective. Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health Care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.
Kara Woolskaloustian - One of the best experts on this subject based on the ideXlab platform.
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task shifting of antiretroviral delivery from health Care workers to persons living with hiv aids clinical outcomes of a community based program in kenya
Journal of Acquired Immune Deficiency Syndromes, 2010Co-Authors: Henry M Selke, Sylvester Kimaiyo, John E Sidle, Rajesh Vedanthan, William M Tierney, Changyu Shen, Cheryl Denski, Adrian R Katschke, Kara WoolskaloustianAbstract:OBJECTIVES: To assess whether Community-Based Care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV Care. DESIGN: Prospective cluster randomized controlled clinical trial. SETTING: Villages surrounding 1 rural clinic in western Kenya. SUBJECTS: HIV-infected adults clinically stable on antiretroviral therapy (ART). INTERVENTION: The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of Care monthly clinic visits. MAIN OUTCOMES MEASURED: Viral load CD4 count Karnofsky score stability of ART regimen opportunistic infections pregnancies and number of clinic visits. RESULTS: After 1 year there were no significant intervention-control differences with regard to detectable viral load mean CD4 count decline in Karnofsky score change in ART regimen new opportunistic infection or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001). CONCLUSIONS: Community-Based Care by PLWAs resulted in similar clinical outcomes as usual Care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective Community-Based Care to PLWAs expediting ART rollout and increasing access to treatment while expanding the capacity of health Care institutions in resource-constrained environments.
Lydia Hangulu - One of the best experts on this subject based on the ideXlab platform.
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health Care waste management in community based Care experiences of community health workers in low resource communities in south africa
BMC Public Health, 2017Co-Authors: Lydia Hangulu, Olagoke AkintolaAbstract:In South Africa, community health workers (CHWs) working in Community-Based Care (CBC) programmes provide Care to patients most of whom are living with HIV/AIDS and tuberculosis (TB). Although studies have shown that the Caregiving activities provided by the CHWs generate health Care waste (HCW), there is limited information about the experiences of CHWs on health Care waste management (HCWM) in CBC. This study explored HCWM in CBC in Durban, South Africa from the perspectives CHWs. We used three ethnographic approaches to collect data: focus group discussions, participant observations and informal discussions. Data was collected from 85 CHWs working in 29 communities in the Durban metropolis, South Africa. Data collection took place from July 2013 to August 2014. CHWs provided nursing Care activities to patients many of whom were incontinent or bedridden. Some the patients were living with HIV/AIDS/TB, stroke, diabetes, asthma, arthritis and high blood pressure. These Caregiving activities generate sharps and infectious waste but CHWs and family members did not segregate HCW according to the risk posed as stipulated by the HCWM policy. In addition, HCW was left with domestic waste. Major barriers to proper HCWM identified by CHWs include, lack of assistance from family members in assisting patients to use the toilet or change diapers and removing HCW from homes, irregular waste collection by waste collectors, inadequate water for practicing hygiene and sanitation, long distance between the house and the toilets and poor conditions of communal toilets and pit latrines. As a result of these barriers, HCW was illegally dumped along roads or in the bush, burnt openly and buried within the yards. Liquid HCW such as vomit, urine and sputum were disposed in open spaces near the homes. Current policies on primary health Care (PHC) and HCWM in South Africa have not paid attention to HCWM. Findings suggest the need for primary health Care reform to develop the competencies of CHWs in HCWM. In addition, PHC and HCWM policies should address the infrastructure deficit in low resource communities. In order for low-and-middle-income-countries (LMICs) to develop effective community health worker programmes, there is a need for synergies in PHC and HCWM policies.
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Perspectives of policy-makers and stakeholders about health Care waste management in Community-Based Care in South Africa: a qualitative study.
BMC Health Services Research, 2017Co-Authors: Lydia Hangulu, Olagoke AkintolaAbstract:In South Africa, a new primary health Care (PHC) re-engineering initiative aims to scale up the provision of Community-Based Care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide Care to the largely poor and marginalised communities across the country. The provision of Care will inevitably lead to an increase in the amount of health Care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is Care of a patient. CBC in South Africa is guided by the home-based Care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health Care waste management (HCWM) in CBC in South Africa from the policy-makers’ and stakeholders’ perspective. Semi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically. The Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes. HCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health Care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.
Henry M Selke - One of the best experts on this subject based on the ideXlab platform.
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task shifting of antiretroviral delivery from health Care workers to persons living with hiv aids clinical outcomes of a community based program in kenya
Journal of Acquired Immune Deficiency Syndromes, 2010Co-Authors: Henry M Selke, Sylvester Kimaiyo, John E Sidle, Rajesh Vedanthan, William M Tierney, Changyu Shen, Cheryl Denski, Adrian R Katschke, Kara WoolskaloustianAbstract:OBJECTIVES: To assess whether Community-Based Care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV Care. DESIGN: Prospective cluster randomized controlled clinical trial. SETTING: Villages surrounding 1 rural clinic in western Kenya. SUBJECTS: HIV-infected adults clinically stable on antiretroviral therapy (ART). INTERVENTION: The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of Care monthly clinic visits. MAIN OUTCOMES MEASURED: Viral load CD4 count Karnofsky score stability of ART regimen opportunistic infections pregnancies and number of clinic visits. RESULTS: After 1 year there were no significant intervention-control differences with regard to detectable viral load mean CD4 count decline in Karnofsky score change in ART regimen new opportunistic infection or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001). CONCLUSIONS: Community-Based Care by PLWAs resulted in similar clinical outcomes as usual Care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective Community-Based Care to PLWAs expediting ART rollout and increasing access to treatment while expanding the capacity of health Care institutions in resource-constrained environments.
Nancy A. Miller - One of the best experts on this subject based on the ideXlab platform.
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Strengthening Home and Community-Based Care Through Medicaid Waivers
Journal of Aging & Social Policy, 2006Co-Authors: Nancy A. Miller, Andrea Rubin, Keith Elder, Martin James Kitchener, Charlene HarringtonAbstract:Abstract States are increasingly using the Medicaid 1915c waiver program to provide Community-Based long-term Care (LTC). We examined state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals. State level data for the period 1992 to 2001 were used to estimate random effects panel models. States with increased Community-Based Care (e.g., home health agencies) and decreased nursing home bed capacity were positively associated with state per capita rates of use, expenditures, and the share of Medicaid LTC dollars supporting 1915c waivers. States appeared to substitute MediCare for Medicaid services for individuals eligible for both. State per capita income was positively related to each measure. State policies that facilitate decreased institutional and increased Community-Based capacity appear essential to state efforts to expand access to Community-Based services. Federal policies that address state resource issues may also spur growth in community-b...
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Use of Medicaid 1915(c) home- and Community-Based Care waivers to reconfigure state long-term Care systems.
Medical Care Research and Review, 2001Co-Authors: Nancy A. Miller, Sarah Ramsland, Elizabeth Goldstein, Charlene HarringtonAbstract:Since Congressional authorization in 1981, Medicaid 1915(c) home- and Community-Based Care waivers have influenced states’ efforts to transform their long-term Care systems. In 1997, every state participated in the 1915(c) waiver program, while waiver expenditures, at $8.1 billion, represented 59.6 percent of all Medicaid Community-Based Care expenditures. To explore state-level factors that appear related to these expenditures, the authors turn to a body of work on Medicaid resource allocation. They compare the influence of five factors—sociodemographic, supply, economic, programmatic, and political environment—on states’ allocations to long-term Care expenditures and 1915(c) waiver expenditures. The state economic environment was an important influence on total, as well as waiver expenditures. State regulation of long-term Care supply demonstrated the most substantive relationship, increasing the share of dollars supporting 1915(c) waivers from 11.6 to 20.0 over the study period, all else equal.
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Medicaid 2176 Home and Community-Based Care Waivers: The First Ten Years
Health Affairs, 1992Co-Authors: Nancy A. MillerAbstract:Abstract: Budget reconciliation legislation in 1981 created a waiver program whereby states could provide home and Community-Based Care under Medicaid for certain populations. States spent nearly $1.7 billion on services delivered under these waivers, known as 2176 waivers, in 1991, compared with $3.8 million in 1982, when only six states were participating in the program. Although these programs have not been rigorously evaluated for effectiveness, they continue to be a popular approach to delivering Care outside of institutions for various groups. Across all states, states spent 13.4 percent of their Medicaid long-term Care dollars on Care outside of institutions (which includes the 2176 waiver program).