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  1. Article: Harnessing the law to advance equitable cancer care in South Africa: exploring the feasibility, desirability and added value of a dedicated national cancer act.

    Meyer, Salomé / Harries, Jane / Torode, Julie / Baldwin-Ragaven, Laurel

    Ecancermedicalscience

    2024  Volume 18, Page(s) 1658

    Abstract: Background: The 2017 World Health Assembly resolution on integrated cancer prevention and control provided clear guidance on creating an enabling environment for cancer care. Through a variety of mechanisms, including civil society advocacy, some ... ...

    Abstract Background: The 2017 World Health Assembly resolution on integrated cancer prevention and control provided clear guidance on creating an enabling environment for cancer care. Through a variety of mechanisms, including civil society advocacy, some countries have secured overarching legislation in the form of national cancer acts to promote equitable access and outcomes for cancer patients. In South Africa, cancer incidence is set to double by 2030; and, while existing legislative and policy frameworks do address cancer prevention and control, these are fragmented, poorly implemented and have had limited success.
    Methods: This study assessed the feasibility and potential impact of promulgating a dedicated national cancer act in South Africa through exploratory in-depth interviews with 25 purposively selected key informants from various stakeholder groups, including cancer survivors; legal scholars; human rights advocates; health care providers; public health specialists and academicians.
    Findings: Following thematic analysis, three key themes were identified: the content of a dedicated national cancer act, the socio-political leveragability of an act and accountability mechanisms that would support such an act.
    Conclusion: While most respondents had not considered the possibility of a dedicated national cancer act, they were open to the concept for South Africa. Concerns about widening inequities, duplication, funding and accountability would need to be addressed against the current backdrop of health inequities and limited human rights leveraging for health.
    Language English
    Publishing date 2024-01-24
    Publishing country England
    Document type Journal Article
    ISSN 1754-6605
    ISSN 1754-6605
    DOI 10.3332/ecancer.2024.1658
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  3. Article ; Online: Exploring barriers to switching "on time" to second-line antiretroviral therapy among nurses in primary health care facilities, Ekurhuleni Health District, South Africa.

    Tenza, Immaculate Sabelile / Njuguna, Christine / Sodo, Pumla Pamella / Ruch, Aviva / Francis, Joel Msafiri / Omole, Olufemi Babatunde / Cooke, Richard / Agbo, Samuel / Baldwin-Ragaven, Laurel

    PloS one

    2023  Volume 18, Issue 4, Page(s) e0284996

    Abstract: Background: Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate ... ...

    Abstract Background: Ensuring that all HIV-infected people receive antiretroviral therapy (ART) and achieve viral suppression are key South African strategies to end the AIDS epidemic in the country. National HIV treatment guidelines recommend an immediate switch to second-line ART following virological failure with first-line ART. Nurses based in district health facilities are at the forefront of implementing this recommendation. While there are often delays in switching and in some instances no switch, the reasons for and barriers to delayed switching are not well understood at the primary care level.
    Aim: To explore the views of frontline nursing staff about factors contributing to delayed switching of patients who have failed first-line ART regimen in Ekurhuleni district, South Africa.
    Methods: A qualitative study was conducted among 21 purposively sampled nurses who provide HIV treatment and care to patients in 12 primary health care (PHC) facilities in Ekurhuleni Health District, Gauteng Province, South Africa. Individual in-depth interviews explored nurses' experiences regarding their recognition of virological failure and understanding of "on time" switching to second-line ART. Interviews probed the circumstances contributing to delays in switching. After digital audio recording and transcription, manual inductive thematic analysis was used to analyse the data.
    Findings: Multiple barriers were identified: 1) Healthcare provider factors included a lack of knowledge and confidence coupled with demotivation in the workplace; 2) Patient issues similarly comprised a lack of knowledge as well as resistance to being switched to another drug regimen and loss to follow up; 3) Systems factors were poor facility leadership, shortages of medication, staffing constraints, and the inability to trace laboratory results, especially for migrant patients.
    Conclusion: Reasons for delayed switching of patients to second-line ART are multifactorial and require integrated interventions at health provider, patient and health system levels.
    MeSH term(s) Humans ; South Africa/epidemiology ; Anti-HIV Agents/therapeutic use ; Anti-Retroviral Agents/therapeutic use ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Viral Load ; Primary Health Care
    Chemical Substances Anti-HIV Agents ; Anti-Retroviral Agents
    Language English
    Publishing date 2023-04-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0284996
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  4. Article: Intimate partner violence: are we ready for action?

    Baldwin-Ragaven, Laurel

    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

    2010  Volume 100, Issue 9, Page(s) 577–578

    MeSH term(s) Female ; Firearms/legislation & jurisprudence ; Humans ; Nurse-Patient Relations ; Physician-Patient Relations ; Public Policy/legislation & jurisprudence ; South Africa ; Spouse Abuse/legislation & jurisprudence ; Spouse Abuse/prevention & control
    Language English
    Publishing date 2010-09-07
    Publishing country South Africa
    Document type Comment ; Editorial
    ZDB-ID 390968-2
    ISSN 2078-5135 ; 0256-9574 ; 0038-2469
    ISSN (online) 2078-5135
    ISSN 0256-9574 ; 0038-2469
    DOI 10.7196/samj.4475
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  5. Article ; Online: The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study.

    von Pressentin, Klaus B / Mash, Robert J / Baldwin-Ragaven, Laurel / Botha, Roelf Petrus Gerhardus / Govender, Indiran / Steinberg, Wilhelm Johannes / Esterhuizen, Tonya M

    Annals of family medicine

    2018  Volume 16, Issue 1, Page(s) 28–36

    Abstract: Purpose: Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income ... ...

    Abstract Purpose: Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system.
    Methods: We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size.
    Results: Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7,
    Conclusions: In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.
    MeSH term(s) Community Health Centers ; Cross-Sectional Studies ; Hospitals ; Humans ; Physicians, Family/statistics & numerical data ; Quality Assurance, Health Care/statistics & numerical data ; Quality Indicators, Health Care ; Regression Analysis ; South Africa ; Workforce
    Language English
    Publishing date 2018-02-23
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171425-3
    ISSN 1544-1717 ; 1544-1709
    ISSN (online) 1544-1717
    ISSN 1544-1709
    DOI 10.1370/afm.2133
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  6. Article ; Online: The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey.

    von Pressentin, Klaus B / Mash, Robert J / Baldwin-Ragaven, Laurel / Botha, Roelf Petrus Gerhardus / Govender, Indiran / Steinberg, Wilhelm Johannes / Esterhuizen, Tonya M

    BMC family practice

    2018  Volume 19, Issue 1, Page(s) 24

    Abstract: Background: Evidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also ... ...

    Abstract Background: Evidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also contextually defined. The South African family medicine discipline has agreed on six roles. These roles were incorporated into a family physician impact assessment tool, previously validated in the Western Cape Province.
    Methods: A cross-sectional study design was used to assess the perceived impact of family physicians across seven South African provinces. All FPs working in the district health system (DHS) of these seven provinces were invited to participate. Sixteen respondents (including the FP) per enrolled FP were asked to complete the validated 360-degree assessment tool.
    Results: A total number of 52 FPs enrolled for the survey (a response rate of 56.5%) with a total number of 542 respondents. The mean number of respondents per FP was 10.4 (SD = 3.9). The perceived impact made by FPs was high for five of the six roles. Co-workers rated their FP's impact across all six roles as higher, compared to the other doctors at the same facility. The perceived beneficial impact was experienced equally across the whole study setting, with no significant differences when comparing location (rural vs. metropolitan), facility type or training model (graduation before and ≥ 2011).
    Conclusions: The findings support the need to increase the deployment of family physicians in the DHS and to increase the number being trained as per the national position paper.
    MeSH term(s) Community Health Services ; Cross-Sectional Studies ; Health Care Surveys ; Health Workforce ; Humans ; Physicians, Family/supply & distribution ; South Africa
    Language English
    Publishing date 2018-02-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041495-X
    ISSN 1471-2296 ; 1471-2296
    ISSN (online) 1471-2296
    ISSN 1471-2296
    DOI 10.1186/s12875-018-0710-0
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  7. Article ; Online: Training trainers in health and human rights: implementing curriculum change in South African health sciences institutions.

    Ewert, Elena G / Baldwin-Ragaven, Laurel / London, Leslie

    BMC medical education

    2011  Volume 11, Page(s) 47

    Abstract: Background: The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South ...

    Abstract Background: The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning.
    Methods: A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication.
    Results: Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were still employed in academic settings (67%). Twenty-two respondents (48%) implemented a total of 33 formal human rights courses into the curricula at their institutions. Respondents were nine times more likely (relative risk 9.26; 95% CI 5.14-16.66) to implement human rights education after completing the training. Seventy-two extracurricular activities were offered by 21 respondents, many of whom had successfully implemented formal curricula. Enabling factors for implementation included: prior teaching experience in human rights, general institutional support and the presence of allies - most commonly coworkers as well as deans. Frequently cited barriers to implementation included: budget restrictions, time constraints and perceived apathy of colleagues or students. Overall, respondents noted personal enrichment and optimism in teaching human rights.
    Conclusion: This Train-the-Trainer course provides the historical context, educational tools, and collective motivation to incorporate human rights educational initiatives at health sciences institutions. Increased implementation of human rights instruction, both formally and extracurricularly, has demonstrated the training's significance not only within academic institutions but more broadly across the health sector. Coworkers are vital allies in teaching human rights to health sciences students, helping to alleviate institutional barriers. Training fellow staff members and those in key leadership roles is noted as vital to the sustainability of human rights education.
    MeSH term(s) Biological Science Disciplines/education ; Curriculum ; Data Collection ; Health Knowledge, Attitudes, Practice ; Health Personnel/education ; Human Rights/education ; Humans ; Program Development ; South Africa ; Teaching
    Language English
    Publishing date 2011-07-25
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/1472-6920-11-47
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  8. Article ; Online: When doctors go to war.

    London, Leslie / Baldwin-Ragaven, Laurel

    The New England journal of medicine

    2005  Volume 352, Issue 14, Page(s) 1497–9; author reply 1497–9

    MeSH term(s) Ethics, Medical ; Ethics, Professional ; Guidelines as Topic ; Human Rights ; Humans ; Military Medicine/ethics ; Torture/ethics ; United States
    Language English
    Publishing date 2005-04-07
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
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  9. Article ; Online: Training Trainers in health and human rights

    Baldwin-Ragaven Laurel / Ewert Elena G / London Leslie

    BMC Medical Education, Vol 11, Iss 1, p

    Implementing curriculum change in South African health sciences institutions

    2011  Volume 47

    Abstract: Abstract Background The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals ... ...

    Abstract Abstract Background The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning. Methods A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication. Results Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were still employed in academic settings (67%). Twenty-two respondents (48%) implemented a total of 33 formal human rights courses into the curricula at their institutions. Respondents were nine times more likely (relative risk 9.26; 95% CI 5.14-16.66) to implement human rights education after completing the training. Seventy-two extracurricular activities were offered by 21 respondents, many of whom had successfully implemented formal curricula. Enabling factors for implementation included: prior teaching experience in human rights, general institutional support and the presence of allies - most commonly coworkers as well as deans. Frequently cited barriers to implementation included: budget restrictions, time constraints and perceived apathy of colleagues or students. Overall, respondents noted personal enrichment and optimism in teaching human rights. Conclusion This Train-the-Trainer course provides the historical context, educational tools, and collective motivation to incorporate human rights educational initiatives at health ...
    Keywords Special aspects of education ; LC8-6691 ; Medicine ; R
    Subject code 170 ; 306
    Language English
    Publishing date 2011-07-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article ; Online: Israel-Gaza conflict.

    London, Leslie / Sanders, David / Klugman, Barbara / Usdin, Shereen / Baldwin-Ragaven, Laurel / Fonn, Sharon / Goldstein, Sue

    Lancet (London, England)

    2014  Volume 384, Issue 9945, Page(s) e34

    MeSH term(s) Humans ; Warfare
    Language English
    Publishing date 2014-08-30
    Publishing country England
    Document type Comment ; Letter
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(14)61443-4
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