Background to the Study
Setting and Context
Problem Statement
In South Africa, mental health and substance abuse problems constitute a large disease burden among disadvantaged communities (Havenaar, Geerlings, Vivian, Collinson, & Robertson, 2008). Most research on substance abuse conducted in South Africa has focused on service users with less or no focus on service providers.
Research Questions
Aim and Objectives
Study Outline
The study explored the experiences of substance abuse service providers in providing services in UMkhanyakude District. There are still limited studies on the experiences of substance abuse service providers in South Africa.
LITERATURE REVIEW 9
Substance Abuse in KwaZulu Natal
Alcohol and cannabis use remains high in KwaZulu Natal and the outpatient treatment pattern has been steadily increasing over time, reaching 65% in 2006 and 82% in 2009 (SACENDU, 2010). For example, the rural areas of UMkhanyakude are serviced by SANCA in Nongoma (Zululand District) with a satellite office in Jozini, which is an outpatient program and is far from other areas.
Substance Abuse at UMkhanyakude District
Therefore, a number of well-known drugs may not be accessible in this district, such as cocaine, due to financial constraints.
Substance Abuse in rural areas
In response to objective A (perceptions and experiences) and B (barriers and benefits), theme one, poor regulation of substances represents the shared views (perceptions) and experiences of all service providers in relation to substance misuse. Mental health and substance abuse are poorly integrated into the day-to-day operations of healthcare facilities.
Collaboratiom/inter-sectoral approach to Substance Abuse
Monitoring and evaluation of Service Delivery
This is a gap identified by the NDMP, and in response this study explores the experiences and perceptions of rural substance abuse providers to inform policies and guidelines for service delivery. Rural areas have been characterized by a lack of resources, scarcity of service providers (Eager et al., 2013).
Conclusion
RESEARCH METHODOLOGY 21
Research Design
Location of the Study
UMkhanyakude District Municipality consists of District Management Areas known as DMAs and five local municipalities (see annex 1 for more details of UMkhanyakude District and its five local municipalities). Furthermore, the socio-economic quintile of UMkhanyakude district is rated as poor according to the deprivation index of the District Health Barometer 2007.
Study Population
Selection/Selection and Recruitment of Participants
Data Collection Strategies
The focus group was used exclusively with substance abuse providers in the field, while interviews were conducted with both field workers and substance abuse service managers. Twelve semi-structured interviews (9 individual and 3 dyad interviews) were conducted with participants who were not part of the focus group.
Data Management
Data Analysis
Data reduction: The researcher delved into the data by reading and re-reading the transcripts and identifying initial codes. Drawing and checking conclusions: Themes were then presented in the discussion as topics for discussion in relation to the literature where necessary.
Trustworthiness of the Study
The researcher worked at the study location for four years, therefore this strategy was applied throughout the study (proposal, data collection, data analysis and report writing) as recommended by Groenewald (2004). The researcher had regular meetings with the research supervisor and interacted via email to ensure an external review of the research process.
Ethical Considerations
In this way, the rigor of the research and the credibility of research findings were improved, resulting in the credibility of the study. A research proposal was sent to the Human and Social Science Research Committee of the University of KwaZulu Natal (HSSREC). In accordance with Department of Social Development procedure, a research proposal, preliminary ethical approval and a letter requesting permission was sent to the Research Director and Population Studies in KwaZulu Natal.
A letter requesting permission to conduct the study was sent to the Director of Ophondweni Youth Development Initiative with the attachment of the preliminary ethical approval. The letter granting permission has been received (see appendix 2). Regarding the study participant's autonomy, the researcher also informed them about their right to decide whether they want to participate in the study or not.
Summary
RESULTS 45
Theme 1: Easy access and poor regulation of substances
Theme 2: Impact of Poverty on substance
Theme 3: Lack of Resources is a barrier to
Theme 6: Enablers or strengths of Substance abuse services
Summary
Service providers have found that substance abuse in this county is leading to family breakdowns. Substance abuse service providers felt that mental health was not being focused on or considered as an important program. This research gap and its inequitable focus present a challenge to rural substance abuse service providers.
The experience of service providers was that civil society supports drug addiction services in UMkhanyakude district. An epidemiological study is required to understand the prevalence of drug abuse in rural South Africa. Monitoring and evaluation of substance abuse services in South Africa: Implications for policy and practice.
What is your experience as a substance abuse service provider working in rural areas of UMkhanyakude district.
DISCUSSION 85
Easy access and poor regulation of substances within the district
Impact of poverty on substance abuse service delivery
Lack of resources is a barrier to substance abuse service delivery
The perceptions of service providers were that there is poor monitoring and evaluation of substance abuse services at UMkhanyakude District, this is a weakness/disadvantage to their service provision. The findings indicate that challenges have been experienced in overall drug abuse service delivery in the rural areas of UMkhanyakude district. A study is required to investigate the impact of Culture (ancestor worship and amarula festival) in the spread of Substance Abuse at UMkhanyakude district.
This study has answered its research question regarding the experiences and perceptions of substance abuse service providers working in a rural area of KZN, South Africa. A study to explore the experiences and perceptions of service providers in the provision of substance abuse services to rural South Africa.
No prioritization of Mental Health and substance abuse in the district
Prohibiting factors to effective substance abuse services in the district
Enablers or strengths of the substance abuse services in the district…
The relationship between stakeholders was perceived by service providers as good and strong between different parties/sectors, although some are not yet on board. There were two enablers identified by service providers that catalyze the strong relationship, namely, the National Drug Master Plan (NDMP) through the Local Drug Action Committee (LDAC) and Operational Sukuma Sakhe (OSS) through the war rooms. LDAC, is a committee endorsed by South Africa's National Drug Master Plan, which is a constitutional document on substance abuse by the Central Drugs Authority (CDA).
In addition, the NGO heads the Local Drug Action Committee, on behalf of the local municipality. While this is against NMDP guidelines, it appears to be a positive.
Summary
Although there are weaknesses or barriers, there were also strengths or enablers/benefits of substance abuse services in UMkhanyakude District. Above all, the resilience and innovation of a number of substance abuse providers could not be missed or ignored. Despite these limitations, the study findings will help to provide foundational evidence on the experiences and delivery of substance abuse in a South African context.
In addition, the development of a substance abuse service standard is needed to improve and move toward quality substance abuse services. What is your experience of working with other actors in substance abuse service delivery?
CONCLUSION AND RECOMMENDATIONS 106
Dissemination of Findings
The findings of the study will be published in the form of an article in an accredited journal to maximize benefit to society. A thesis will be submitted to meet the requirements for a Masters in Occupational Therapy, after the examination process the thesis will be submitted to the UKZN Library, it will be available online and in hard copy. The completed research report will be made available through presentation in the Local Drug Committee and district forum of UMkhanyakude District and the KZN Substance Abuse Forum.
In addition, a written short version report and a publication will be sent by e-mail to the study participants and all sectors responsible for substance abuse in private sectors and all levels of management, i.e. Apart from these future plans, the researcher presented the preliminary findings of the study. in the Rural Health Annual Conference in Cape Town, September 2014.
Significance of the Study
Recommendations
The traditional leadership should strengthen their support for substance abuse, as there appeared to be poor support in some areas. The Department of Arts and Culture should look at the culture of UMkhanyakude and the impact it has on drug addiction and then help educate, especially during the amarula festival where their support is appreciated by the community. This can help prevent the spread of abuse among young people through constructive activities.
DSD should allocate more resources to NGOs (SANCA and OYDI and all other substance abuse services) and strengthen its human resources with trained substance abuse service providers. In addition, the Rural Advocacy Project (RAPH), which focuses on advocacy, should be more supportive of mental health and substance abuse.
Conclusion
A policy study is required which will focus in more detail on the implementation of the National Drug Master Plan of South Africa in rural areas. Mokallik M., (2013) Mental Illnesses Neglected by Government, Retrieved 03 December 2014 from http://www.enca.com/south-africa/mental-illnesses- neglected-government. National Liquor Authority on 03 December 2014 from http://www.thedti.gov.za/business_regulation/nla_act.jsp.
National Drug Master Plan 1999 Central Drug Authority and Department of Social Development South Africa 03 June 2013 from www.dsd.gvo.za 26. South African Community Epidemiology Network on Drug Use (SACENDU) Monitoring of Alcohol and Drug Abuse Treatment admission in South Africa June 2010 Update Medical Research Council Alcohol and Drug Abuse Research Group, South Africa, Cape Town.
Maps (Pictures) of UMkhanyakude District
Gatekeeper Permission Letters
Ethical Clearance Certificates
Information Document and Consent Forms
In this study you will participate in a focus group and/or individual interview where you will be asked to answer questions in relation to your experience and perception of substance abuse services in rural areas. The information gathered from this process will be transcribed through verbatim procedure and then analyzed for the completion of this study. A publication will then be made which will be communicated back to you and published for community benefit and improved service delivery.
Through your participation in this study, the existing knowledge and insight into the experiences of service providers working in rural areas will be better understood, resulting in improved service delivery of rural substance abuse services. In addition, the information will be stored in a lockable vault accessible to the researcher and supervisor.
Questions for Interview and Focus Group
Mercury Newspaper Covering the Study
