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The evaluation of public psychiatric services in three provinces of South Africa
Abstract
Objectives. To describe the quality of care in communityand hospital-based care in three provinces in terms of 13 standards of care and the criteria associated with each; and to explore the similarities and differences between provinces.
Design. A descriptive study in the form of a survey using interviews, observation and questionnaires.
Setting. Three provinces of South Africa, namely Gauteng, KwaZulu-Natal and the Eastern Cape. In each of the provinces hospitals and clinics were the focus of the study.
Subjects. The person heading the mental health service in each province completed a questionnaire about the services in the province. Consumers (both direct consumers and family) received questionnaires or were interviewed if illiterate. In each province a sample of hospital units and clinics was visited and interview and observation schedules were completed.
Outcome measures. Thirteen previously tested standards of care were addressed covering a comprehensive array of indicators of care. Management, research and development, structural and process standards were included.
Results. All three provinces fared wen for three standards (staff attitudes, process of hospital admission and availability of forensic care). On another three all the provinces fared poorly (management, regular review and/or evaluation of services, and research activity). In terms of clinic services all three provinces scored low for the availability of weekend and emergency services and psychosocial rehabilitation. In terms of hospital care the criteria referring to human rights of patients produced the lowest scores.
Conclusions. The paucity of management information on some aspe<;ts makes planning and evaluation difficult. However, the report does indicate specific areas that need improvement in each province.
