Exploring adolescents and young people’s candidacy for utilising health services in a rural district, South Africa

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Abstract

Background

We use the ‘candidacy framework’ to describe adolescents’ and young people’s (AYP) experiences of health services in a rural KwaZulu-Natal district, South Africa.

Methods

A qualitative approach was used including group discussions, in-depth and key informant interviews with a purposive sample of AYP ( n = 70), community leaders ( n = 15), school health teams ( n = 10), and health service providers ( n = 6).

Results

Findings indicate tacit understanding among AYP that they are candidates for general health services. However, HIV stigma, apprehensions and misconceptions about sexual and reproductive health, and socio-cultural views which disapprove of AYP pre-marital sex undermine their candidacy for sexual and reproductive services.

Conclusion

Consideration and understanding of the vulnerabilities and reasons AYP exclude themselves will inform interventions to address their health needs. AYP’s participation in the design of health services will increase their acceptability and encourage uptake of services.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-3960-1) contains supplementary material, which is available to authorized users.

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Most cited references 22

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Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review

Helen L. Watson, Soo Downe, Maria Kett (2017)

Background Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. Objective To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Search strategy A systematic search of eight electronic databases was undertaken in 2015 using the terms “Roma” and “maternity care”. A broad search for grey literature included the websites of relevant agencies. Data extraction and synthesis Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Results Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0263-4) contains supplementary material, which is available to authorized users.

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'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa.

Lucy Gilson, Liz Walker (2004)

This study investigates how a group of nurses based in busy urban primary care health clinics experienced the implementation of the free care (the removal of fees) and other South African national health policies introduced after 1996. The study aimed to capture the perceptions and perspectives of front-line providers (street-level bureaucrats) concerning the process of policy implementation. Using qualitative and quantitative research methods, the study paid particular attention to the personal and professional consequences of the free care policy; the factors which influence nurses' responses to policy changes such as free care; and what they perceive to be barriers to effective policy implementation. The research reveals firstly that nurses' views and values inform their implementation of health policy; secondly that nurses feel excluded from the process of policy change; and finally that social, financial and human resources are insufficiently incorporated into the policy implementation process. The study recommends that the practice of policy change be viewed through the lens of the 'street-level bureaucrat' and highlights three sets of related managerial actions. Copyright 2003 Elseiver Ltd.

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Providing comprehensive health services for young key populations: needs, barriers and gaps

Sinead Delany-Moretlwe, Frances M. Cowan, Joanna Busza … (2015)

Introduction Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. Discussion We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. Results YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. Discussion YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.

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Author and article information

Contributors

Busisiwe Nkosi:

ORCID: http://orcid.org/0000-0002-7084-3252

bnkosi@ahri.org

Janet Seeley:

ORCID: http://orcid.org/0000-0002-0583-5272

Janet.Seeley@LSHTM.ac.uk

Nothando Ngwenya:

ORCID: http://orcid.org/0000-0002-5630-6389

NNgwenya@ahri.org

S. Lerato Mchunu:

ORCID: http://orcid.org/0000-0002-3293-4882

LSMchunu@ahri.org

Dumile Gumede:

ORCID: http://orcid.org/0000-0002-8628-5726

DGumede@ahri.org

Jane Ferguson:

ORCID: http://orcid.org/0000-0002-3736-0603

bjaneferguson@gmail.com

Aoife M. Doyle:

ORCID: http://orcid.org/0000-0002-3305-7738

Aoife.Doyle@lshtm.ac.uk

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 28 March 2019

Publication date PMC-release: 28 March 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 195

Affiliations

[1 ]ISNI 0000 0001 0723 4123, GRID grid.16463.36, Africa Health Research Institute, , Nelson R. Mandela School of Medicine, ; 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal 4001 South Africa

[2 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, London School of Hygiene & Tropical Medicine, ; Keppel Street, London, WC1E 7HT UK

Author information

Busisiwe Nkosi http://orcid.org/0000-0002-7084-3252

Janet Seeley http://orcid.org/0000-0002-0583-5272

Nothando Ngwenya http://orcid.org/0000-0002-5630-6389

S. Lerato Mchunu http://orcid.org/0000-0002-3293-4882

Dumile Gumede http://orcid.org/0000-0002-8628-5726

Jane Ferguson http://orcid.org/0000-0002-3736-0603

Aoife M. Doyle http://orcid.org/0000-0002-3305-7738

Article

Publisher ID: 3960

DOI: 10.1186/s12913-019-3960-1

PMC ID: 6438017

PubMed ID: 30922372

SO-VID: 1c8fe9a7-0230-4dd6-9616-932a11c779b9

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 November 2018

Date accepted : 19 February 2019

Funding

Funded by: ViiV Healthcare's Positive Action for Adolescents Programme

Award ID: ITCRZF51

Award Recipient : Janet Seeley

Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;

Award ID: 082384/Z/07/Z

Award Recipient : Busisiwe Nkosi

Funded by: FundRef http://dx.doi.org/10.13039/501100009187, Medical Research Foundation;

Award ID: MR/K012126/1

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: candidacy,health service utilisation,south africa,vulnerability,young people

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: candidacy, health service utilisation, south africa, vulnerability, young people

Exploring adolescents and young people’s candidacy for utilising health services in a rural district, South Africa

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Abstract

Background

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Most cited references 22

Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review

'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa.

Providing comprehensive health services for young key populations: needs, barriers and gaps

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