Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
SACDIR Indian Institute of Public Health Hyderabad, Public Health Foundation of India, New Delhi, India
BMJ Open. 2021 Nov 25;11(11):e049988. doi: 10.1136/bmjopen-2021-049988.
To explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).
SA.
Scoping review.
We conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results.
Fifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available.
This review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.
探索南非（SA）实现全民健康覆盖（UHC）以惠及脑卒中患者（PWS）的卫生系统机遇与挑战。
SA。
范围综述。
我们对 SA 实现 PWS 的 UHC 机会和挑战进行了范围综述。2020 年 7 月，检索了全球和非洲特定数据库及灰色文献。纳入了描述 PWS 医疗保健系统的所有设计的研究。使用卫生系统动力学框架和世卫组织框架两个框架来映射关于治理和监管、资源、服务提供、背景、护理重新定位和社区参与的数据。采用叙述方法综合结果。
综述纳入了 59 篇文章。其中一半以上（n=31，52.5%）来自西开普省，大多数（n=41，69.4%）来自城市地区。研究评估了各种卫生系统类别和各种结果。报告最多的常见组件是服务提供（n=46，77.9%），仅有 4 项研究（6.7%）评估了治理和监管。脑卒中护理服务提供的因素常被报道为较差，并受到与背景相关的限制因素的影响。脑卒中护理治理和监管在政府支持、政策投资、治疗指南、资源分配和对循证解决方案的承诺方面受到限制。有一些有希望的支持因素，包括设备齐全、人员配备充足的城市三级设施、卫生专业人员的及时评估、积极的员工态度和护理、两个临床护理指南以及现有的教育和信息资源。
本综述填补了文献空白，提供了南非实现全民健康覆盖 PWS 的一系列机遇与挑战。它强调了一些显示出改善服务提供的综合、质量和护理认知等可喜趋势的卫生系统领域。
