Eight skills-building workshops preceded the 2010 PHASA conference, of which the key messages are presented here.
Workshop 1: Health system reform in South Africa: How can the right to health be strengthened?
Facilitators: Louis Reynolds, David Sanders and Leslie London, from People’s Health Movement South Africa (PHM-SA)
Background
- South Africa’s poor progress in realising social and economic rights entrenched in the constitution and essential for health.
- Growing health inequalities between rich and poor and urban and rural communities.
- Increasing reliance on global funding and donor driven programmes.
- Weak and fragmented wealth systems where both the public and private sectors are in a crisis.
In response, the National Department of Health proposed the establishment of a National Health Insurance (NHI) as part of a broader 10-point plan to provide an equitable health system for all in South Africa. This plan reinvigorated national debates and campaigns around health and the health system among civil society, business and state actors.
Aim
The workshop was intended for public health professionals, policy makers, community activists, students and health managers.
Its objectives were to look at whether the NHI proposal and the 10-point plan, and the national debate that came in their wake, opened new opportunities to strengthen the Right to Health in South Africa and the region, and what actions needed to be taken by civil society to play a meaningful role in this.
Content
Louis Reynolds gave a presentation on Human Rights and Health in South Africa today in relation to the health sector crisis, the 10-point plan and the NHI proposal. This was followed by a discussion in groups where participants reflected on their own work situations and related issues relevant to health and human rights, and then on the role of civil society in the realisation of the Right to Health. This was followed by a presentation by David Sanders on the activities of civil society, and of PHM in particular and its Right to Health Campaign. The final session was a plenary discussion aimed at developing activities.
Key messages
- There was strong agreement among all participants that civil society has a central role to play in making the Right to Health real in South Africa. Civil society, particularly trade unions, NGOs and community-based organisations, have a better sense of conditions ‘on the ground’ and should provide a bridge between communities (who generally are very aware of their needs) and the world of policy makers and the elite groupings that influence them.
- There was a need to demand openness and transparency from government regarding its plans to transform the health sector.
- Academic bodies and institutions have important roles to play in research, in particular into how community members understood health systems, health system funding, and the current government proposals. This discussion also raised the important question of how public revenues collected for the NHI would be allocated and how priorities would be set. In particular, there was a question of whether priority would be given to well-functioning (‘winner’) facilities, or to lower performing institutions in order to improve them.
Priorities for action
- PHM-SA must improve its visibility and its communication with other members of civil society and interested individuals who would like to collaborate in its activities and campaigns.
- Raise awareness around the NHI and the health system at national, provincial and local levels through civil society workshops.
- Civil society should develop critical awareness of developments relating to the NHI and demand openness and accountability from the state.
Workshop 2: Mental health advocacy and psychosocial rehabilitation
Facilitator: Dick Shingange, from Gauteng Consumer Advocacy Movement (GCAM)
Key messages
The outcome of the workshop allowed us to focus on the needs of people with mental disability e.g. employment, education, housing and awareness among families and public:
- Support the development of consumer movements in the rest of the country to empower the mental health care users to advocate for themselves.
- Create and support alternatives to existing models of care and treatment.
- Lobby for access to improve public mental health services, the most effective treatment and improved continuity of care after hospital discharge. • Identify and address the needs on all basis of life of mental health care users.
- Demand that the rights of persons with mental illness are respected and protected.
Workshop 3: Foetal alcohol syndrome prevention in South Africa: What is the current evidence?
Facilitators: Leslie London, School of Public Health and Family Medicine, UCT and Kirstie Rendall-Mkosi, School of Health Systems and Public Health, UP.
Background
Foetal Alcohol Syndrome (FAS) is the most common preventable congenital defect globally. South Africa, given its particular history of dispossession and exploitative social practices, and extremely high levels of alcohol misuse and dependence in certain populations, has the dubious distinction of reporting the highest rates of FAS in the world. Documentation of rates 100-fold higher than risk populations in developed countries have confirmed a huge public health challenge facing South Africa. Research has now shifted towards identifying interventions to prevent FAS with a number of different groups working in this field over the past decade.
Aim
The workshop aimed to share research experiences of the different efforts aimed at addressing the burden of disease caused by FAS, and to highlight current findings, evidence and gaps. Attended by a range of participants, including FAS researchers, community members affected by alcohol and service managers, the workshop provided an opportunity to reflect on a range of questions. These included: Can GIS methods be used for prevention and advocacy in relation to FAS; what are the best methods for surveillance for FAS; what training interventions work with providers to improve their screening and management skills; what is evidence for Motivational Interviewing interventions to reduce FAS risk; how does one translate evidence of effectiveness into policy adoption; what is the burden of FAS in terms of health care utilisation and cost?
Key messages
The workshop confirmed the need for researchers to collaborate on presenting the best evidence to support prevention and came 
up with a range issues for further action. These included suggestions for making better use of GIS methods (for example, testing out participatory GIS research methods that empower communities to take action and using GIS to take into account qualitative aspects of alcohol supply), examining the gendered nature of FAS risk in more detail, identifying the relative and interactive contribution of knowledge, norms and beliefs in generating risks for FAS, exploring the value of the measurement of Alcohol-Exposed Pregnancy (AEP) prevalence as a useful proxy for FAS rates (in co-researchers’ studies and through use of DHS data), expanding research into assessing the operational implementation of interventions (including sustainability of interventions and the best timing for interventions in relation to women’s life span) and the role of community surveillance.
The workshop confirmed the huge challenge posed by FAS and facing researchers seeking to make a difference, but reinforced a collective resolve to use our research findings to produce evidence for policies and programme that will address a relatively hidden problem in South Africa.
Workshop 4: Alcohol, the media and public health
Facilitators: Joanne Corrigall, Public Health Specialist, Western cape Dept of Health, Research Associate, School of Pubic Health and Family Medicine, UCT, and Richard Matzopoulos, Specialist Scientist and Injury Prevention Expert, Medical Research Council.
Key messages
- Alcohol is the most harmful drug in South African society today and causes significant harm in many other African countries as well.
- Alcohol advertising is exacerbating alcohol abuse in South Africa and needs to be urgently regulated or banned.
- The liquor industry is not taking sufficient responsibility for the harms caused by alcohol
- Alcohol abuse is one of the most important causes of violence in South Africa.
- Restricting the supply of alcohol is the most cost-effective way to reduce alcohol related harm.
Workshop 5: Core competencies in public health for undergraduates in South Africa
Facilitator: Virginia Zweigenthal, University of Cape Town
This workshop brought together specialists from a number of Universities in South and southern Africa (Malawi and Namibia), responsible for undergraduate teaching. The aim of the workshop was to identify core public health knowledge for medical students.
Key messages
- Our teaching should be grounded in the health care services as our curriculum should be to prepare students to work in the South Africa public sector. The curriculum should be based on primary health care and should encourage critical thinking around core and contemporary public health issues.
- A concern across the universities is that public health is often seen as less important to medical students than clinical sciences – not always relevant for them and not an essential skill. Pubic health should ideally be integrated into the clinical disciplines so that students will understand the importance of public health in their future work as clinicians.
- Workshop participants began discussions about core competencies and skills for undergraduates. Participants agreed that measuring health and health needs, epidemiology and biostatistics – are essential skills. Communication, advocacy and working in a team are critical skills.
- A priority must be to develop innovative teaching methods that will engage students. The group will explore funding opportunities to develop innovative and interactive ways of teaching.
Workshop 6: Theory-based public health intervention research
Facilitators: Supa Pengpid and Linda Skaal, School of Public Health, University of Limpopo
Background
The rational of this workshop was that to developed interventions to improve health behaviour with an understanding of relevant theories of behaviour change are essential as well as the ability to use them skilfully. A growing body of evidence suggests that interventions developed with an explicit theoretical foundation or foundations are more effective than those lacking a theoretical base and that some strategies that combine multiple theories and concepts have larger effects. Influential work draws on the theoretical perspectives, research, and practice tools of such diverse social and behavioural science disciplines as psychology, sociology, social psychology, anthropology, communications, nursing, economics, and marketing
Aim
This workshop aimed to introduce and equip participants with concepts of theory and evidence based public health intervention. It 
also aimed to build capacity for public health researchers to conduct intervention-oriented research for solving public health problems. The workshop served as platform for exchange of knowledge and research experiences, with the aim to establish an interest group in theory-based and intervention research.
Key message
We hope that countries on the African continent, especially South Africa, will be increase their application of theory-based research, programme implementation and evaluation to effectively solve public health problems in the near future.
Workshop 7: Situating research in public health training and practice: Current debates and emerging good practice
Facilitators: Christina Zarowsky, Lucy Alexander, Hazel Bradley, from the School of Public Health, University of the Western Cape.
Background
Research and evidence are integral to public health practice, but the competencies required for effective practice range from practical Monitoring & Evaluation to critical appraisal skills to original research within and across a range of disciplines. The tensions between these needs are particularly evident within Masters in Public Health (MPH) programmes, which seek to develop professional, management and research skills. There is a wide variety of practices and understandings in South African schools of public health regarding how to train for research, and what kind of research. The issue of research within MPH programmes is underexplored: a recent PubMed search for “Research + MPH” found zero references. In follow up to discussions in March 2010 at a UWC Symposium on “Public Health in the Age of HIV”, this workshop sought to explore and share experiences and perspectives with research in MPH programmes in South African Schools of Public Health.
The workshop was informed by the “Public Health in the Age of HIV” Symposium report; an electronic survey of pre-registered participants asking what is needed for public health research capacity in Africa, what research competencies are needed for different career paths, and how MPH programmes are doing; and a mapping and analysis of curricula and approaches to research across MPH programmes. The surveys are being continued together with telephonic interviews now by Naeema Hoosain and Christina Zarowsky, involving all workshop participants, nine heads of department or MPH programme coordinators at South African Schools of Public Health, and the 19 participants in the inaugural meeting of the African Association of Schools of Public Health in Nairobi in October 2010. The workshop attracted 37 participants, covering most South African Schools of Public Health, the Research Directorate at the National Department of Health, the Medical Research Council (MRC), managers and practitioners from several provinces, and participants from universities, industry and NGOs in Malawi, Zimbabwe, Botswana, Kenya, Burundi, Rwanda, Nigeria, France, and the United States of America.
Aim
The objectives of the workshop were to:
- Understand public health schools’ approaches to research training and outputs in the MPH
- Debate whether research training and outputs should be tailored for different career paths, especially practice/management and policy vs research
- Recommend next steps re curriculum and research output criteria within and across Schools of Public Health in South Africa
- Explore how Schools of Public Health schools could contribute to building overall public health research capacity in Africa
Content
The morning was dedicated to presentations and plenary debate, while over lunch and in the afternoon participants broke into working groups addressing public health research capacity in Africa; curriculum and teaching research in MPH Programmes; and research outputs from the MPH, before returning to plenary to present and discuss recommendations.
Key messages
- Scope and Mission of the MPH: The MPH must provide grounding in the principles and dimensions of public health as a multidisciplinary and multi-sectoral field to all students, including but not limited to a foundation in research.
- MPH Outputs 1: Research Competencies and Meta-skills. While specific research competencies will vary significantly across career paths and specializations and cannot all be acquired during the MPH, research meta-skills are essential for ALL public health specialists, whether in practice, management, policy, or research. These meta-skills include problem/research question formulation, ability to find and critically appraise existing literature, understanding of scientific and ethical principles of research, and capacity to construct, write and effectively communicate a coherent argument linking the question, literature, aims and objectives to methods, findings, and conclusions.
- MPH Outputs 2: Research project and mini-thesis adapted to professional requirements. A mini-thesis is an appropriate output for most MPH students to demonstrate mastery of core research meta-skills, but its structure and focus can be adapted to align more closely with diverse professional requirements and realities. For example, a substantial self-directed project with few interim deadlines is an important rite of passage for students considering a research career, but a more modular approach may be a better preparation for the tight deadlines and limited reflective space characterizing management or policy careers.
- Implementation: Curriculum, modalities, and mentoring. Curriculum content, teaching modalities and mentoring should be adjusted to decrease the gap between coursework and mini-thesis experienced by most schools and students. Academics who examine theses may benefit from capacity strengthening and peer mentoring in assessing research and mini-theses outside their own disciplinary and professional base.
- The State of Public Health Research: Public health research remains seriously under-resourced in Africa, including in South Africa, relative both to the public health needs of the continent and to biomedical and clinical research.
Workshop 8: Healthy people require appropriate health care decisions: Learn how the Cochrane HIV/AIDS Review Group can help you meet this challenge
Facilitators: Elizabeth Pienaar, Babalwa Zani and Charles Okwundu from the South African Cochrane Centre (SACC)
Background
Millennium Development Goal 6 has as its aim combating HIV/AIDS. Given the serious implications of the unfolding HIV/AIDS pandemic it is essential for healthcare providers to provide care based on the most reliable evidence. To make informed decisions, they need to access, appraise and interpret relevant research evidence. With this in mind the aim of the workshop was to equip participants with the knowledge to:
- Understand differences between traditional narrative and systematic reviews (SR)
- Know where to find SRs of HIV/AIDS interventions
- Interpret results of a SR including meta-analyses
Content
There were lively discussions during all presentations. It is clear that HIV/AIDS and its management remains and important topic for everyone involved in healthcare not only in South Africa but on the African continent as a whole. At the end of the workshop many of the attendees expressed interest in similar workshops for their colleagues who could not be there.
Key messages
- HIV/AIDS remains a very important topic for health care practitioners in South Africa.
- Relevant information based on evidence is needed for health care to work.
- It is important for stake-holders to know where to look in order to obtain the relevant research information.
- Consumers need to be able to read and understand research results in order for them to use it.
- It is important for collaborations to be formed between institutions and consumers, so that the research that is conducted is properly used.
Thanks
There is an increasing appreciation that Foetal Alcohol Spectrum Disorder is a major consumer of social welfare and health services. It is the most diagnosed cause of intellectual impairment in Alberta, where considerable resources are diverted to support education and then to support the lives of these victims who are non-competitive in the employment arena. Without this support it is being realised that many are coerced into livelihoods from crime related activity. An initial assessment at correctional centres is revealing higher than expected numbers of inmates fit the criteria for FASD, provoking the possibility that even more long term post release support will be necessary in addition to correctional centre based rehabilitation designed to prevent re-offending (which appears to be ineffective in short stay re-offenders anyway).