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Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

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      Abstract

      Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

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      Most cited references 52

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        Point-of-care diagnostics for global health.

        Biomedical engineers have traditionally developed technologies in response to the needs of the developed world's medical community. As a result, the diagnostic systems on which they have worked have met the requirements of well-funded laboratories in highly regulated and quality-assessed environments. However, such approaches do not address the needs of the majority of the world's people afflicted with infectious diseases, who have, at best, access to poorly resourced health care facilities with almost no supporting clinical laboratory infrastructure. A major challenge for the biomedical engineering community is to develop diagnostic tests to meet the needs of these people, the majority of whom are in the developing world. We here review the context in which the diagnostics must operate, some of the appropriate diagnostic technologies already in distribution, and some emerging technologies that promise to address this challenge. However, there is much room for innovation, adaptation, and cost reduction before these technologies can impact health care in the developing world.
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          Is there a bias against telephone interviews in qualitative research?

           Gina Novick (2008)
          Telephone interviews are largely neglected in the qualitative research literature and, when discussed, they are often depicted as a less attractive alternative to face-to-face interviewing. The absence of visual cues via telephone is thought to result in loss of contextual and nonverbal data and to compromise rapport, probing, and interpretation of responses. Yet, telephones may allow respondents to feel relaxed and able to disclose sensitive information, and evidence is lacking that they produce lower quality data. This apparent bias against telephone interviews contrasts with a growing interest in electronic qualitative interviews. Research is needed comparing these modalities, and examining their impact on data quality and their use for studying varying topics and populations. Such studies could contribute evidence-based guidelines for optimizing interview data. 2008 Wiley Periodicals, Inc
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            Author and article information

            Affiliations
            [1 ]Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa; Sartorius@ 123456ukzn.ac.za
            [2 ]Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa; Jaman@ 123456ukzn.ac.za
            [3 ]International Clinical Research Center, Department of Global Health, University of Washington, Seattle, WA 98105, USA; pkdrain@ 123456uw.edu
            [4 ]Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98105, USA
            [5 ]Department of Epidemiology, University of Washington, Seattle, WA 98105, USA
            [6 ]Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
            [7 ]Department of Maths, Science and Technology, Embury Institute, Durban, 4001, South Africa; rowant@ 123456eite.ac.za
            Author notes
            [* ]Correspondence: Mashamba-Thompson@ 123456ukzn.ac.za ; Tel.: +27-031-260-2530
            Contributors
            Role: Academic Editor
            Journal
            Diagnostics (Basel)
            Diagnostics (Basel)
            diagnostics
            Diagnostics
            MDPI
            2075-4418
            08 January 2017
            March 2017
            : 7
            : 1
            28075337
            5373012
            10.3390/diagnostics7010003
            diagnostics-07-00003
            (Academic Editor)
            © 2017 by the authors.

            Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

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