Access to substance abuse treatment in the Cape Town metropole ...

More documents

Recommendations

Info

This lack of leadership entrenches community resistance to governmentinterventions by perpetuating community beliefs that the state is not heldaccountable for service delivery outcomes:“The lack of (government) leadership and the inability to implement effectiveinterventions in communities has actually made the community quite resistant.It's made them resistant and very angry. It's made them resistant to effectivetreatment, because it's coming from outside the community.” [LDAC]“At the end of the day, what is really needed is a person or a single person ordepartment, where the buck stops. Yes, somebody needs to be accountable,because it is public money; it is funding that is involved.” [TSP]5.1.1.5. Ideologies & political agendas at the cost of community needsGovernment’s responses to substance-related issues are also hampered bypolitical agendas; which sometimes take precedence over community needs.This is reflected in government’s tendency to seek “quick fixes” rather than“sustainable solutions” to substance abuse problems in HDCs:“Peoples frustration is just, if you look at the past 2 years, the amount of moneythat went from the various departments to training people without any properfollow up plan, or to make things sustainable…. And sometimes, I feel thedepartment is very short sighted and they try and look at quick fixes and there isno way you can do that in this field.” [TSP]“If you think in terms of community development, in one area that was identified,they want us to change the community within 6 months and we said no… it isnothing to have all those projects in place and it can be completed within 6months, but there is no sustainability. So they don't have a sustainable plan inplace and that is why the impact is lacking.” [TSP]These political agendas are also reflected in (i) reports that the governmentplaces more importance on “being seen to be acting in communities’ bestinterests” instead of service outcomes and (ii) claims that the government onlytakes swift action when it is politically opportune to do so. These politicalpositions tend to increase community resistance to external interventions:81
“Part of the government's agenda is definitely to make an impact in communities.But part of the agenda is also to be seen to be making an impact, and there'sless of an emphasis on the impact being made as opposed to being seen.” [TSP]“I think a lot of the time there's a bit of an Elastoplast attitude where you just wantto cover it up or you just want to be seen to be doing something. And a lot ofmoney goes down the drain that way. That you don't tender properly for it, thenthe tender goes to the cheapest person without evaluating the actual quality ofthe training and what approach people are taking to the training. And sometimesits pure political being seen to be doing something about substance abusebecause it's a major community thing and it's had lots of publicity.” [TSP]There also appears to be a relationship between government’s responses tosubstance abuse and their allocation of resources to substance abuse treatment.5.1.2. Allocation of resources to the social welfare and health sectorsGovernment’s allocation of financial and personnel resources for substanceabuse intervention seems to hinder treatment utilization by limiting (i) serviceproviders’ capacity to provide substance abuse-related services; (ii) theavailability of affordable, publicly-funded substance abuse treatment; and (iii) theavailability of ancillary health services.5.1.2.1. Allocation of personnel resourcesLack of personnel within district social service offices limits state social workers’capacity to provide substance-related services by restricting the number ofpeople that can be served, service coverage, and service quality:“Understand that really there is a shortage of staff and this area we findourselves in is overpopulated, there is a lot of people here… I don't know howmany social workers; there is one social worker for whatever. But you will findthat ….the population of community Z is increasing… So it becomes really verydifficult. At times you can see our waiting room here is full, full and these peoplethey need to be served by today and they must be at home by the time we knockoff. So do you think really that we are producing quality service, I doubt it.” [SAC]82
Page 1 and 2:
Access to substance abuse treatment
Page 3 and 4:
CONTENTSINTRODUCTION ..............
Page 5 and 6:
5.4. SUMMARY.......................
Page 7 and 8:
al., 2004; Reddy et al., 2003; Shis
Page 9 and 10:
1.3. IS ACCESS TO SUBSTANCE ABUSE T
Page 11 and 12:
1.4.2. Racial disparities in the ne
Page 13 and 14:
illegally and are unregulated by th
Page 15 and 16:
CONCEPTUAL MODELThis study’s conc
Page 17 and 18:
presenting problems and ability to
Page 19 and 20:
need for services is the most immed
Page 21 and 22:
This study focuses specifically on
Page 23 and 24:
METHOD3.1. STUDY AIMS & OBJECTIVESA
Page 25 and 26:
the researcher to explore possible
Page 27 and 28:
esidential areas from each of the s
Page 29 and 30:
3.3.2.4. Data collection: controlsF
Page 31 and 32: o Problem recognition, Desire for h
Page 33 and 34: Table 1.Domains and measures compri
Page 35 and 36: The 19-item MOS-SSS measures functi
Page 37 and 38: information on the accessibility of
Page 39 and 40: RESULTS: PHASE ONE4.1. VARIABLES AS
Page 41 and 42: efficacy to stop using drugs for mo
Page 43 and 44: (Table 6). Effect sizes were large
Page 45 and 46: were 2.4 times more likely to not a
Page 47 and 48: esteem scales (Table 9). Stigma als
Page 49 and 50: Table 10.Logistic regression coeffi
Page 51 and 52: 4.2.2. Model 2: Predisposing variab
Page 53 and 54: poverty scale, and the variable “
Page 55 and 56: of the model increased significantl
Page 57 and 58: controls had greater self-efficacy
Page 59 and 60: and R1000 per month than their fema
Page 61 and 62: subjects earning less than R500 per
Page 63 and 64: and race (Table 16). This indicates
Page 65 and 66: were 3 times more likely to earn le
Page 67 and 68: (which are higher for Black/African
Page 69 and 70: substance use or remain abstinent d
Page 71 and 72: monetary needs rise, subjects repor
Page 73 and 74: with improved awareness of services
Page 75 and 76: 4.4.4.4. Predictors of “community
Page 77 and 78: • In historically disadvantaged c
Page 79 and 80: RESULTS: PHASE TWODuring qualitativ
Page 81: 5.1.1.3. Government’s responses t
Page 85 and 86: putting extra strain and pressure o
Page 87 and 88: The impact of availability and affo
Page 89 and 90: availability of affordable services
Page 91 and 92: completed a hospital-based detoxifi
Page 93 and 94: “I have thirty beds that are unus
Page 95 and 96: “I don't see it amongst the bona
Page 97 and 98: going to be a good day. So, yes it
Page 99 and 100: in the fourth week they relapse, it
Page 101 and 102: esponses to treatment, in part, are
Page 103 and 104: • Awareness of appropriate treatm
Page 105 and 106: This perception is prevalent in Col
Page 107 and 108: substance abuse problem - without a
Page 109 and 110: o These community influences are lo
Page 111 and 112: 6.2.1. Awareness of substance abuse
Page 113 and 114: informational support can improve a
Page 115 and 116: salient for low-income groups who h
Page 117 and 118: diminishing self-efficacy and motiv
Page 119 and 120: self-efficacy and negative percepti
Page 121 and 122: 6.3. TREATMENT SYSTEM FACTORS ASSOC
Page 123 and 124: This study found that limited resou
Page 125 and 126: 6.4. RECOMMENDATIONSBased on study
Page 127 and 128: • As findings suggest that female
Page 129 and 130: • While the affordability of trea
Page 131 and 132: To address these barriers, we argue
Page 133 and 134:
o To ensure objectivity, this needs
Page 135 and 136:
egistration process should gather i
Page 137 and 138:
REFERENCESAday, L.A., & Awe, W.C. (
Page 139 and 140:
First, MB; Spitzer, RL; Gibbon, M;
Page 141 and 142:
Myers, B., & Parry, C.D.H. (2005).
Page 143 and 144:
Ross, M.W., Williams, M.L., Timpson
show all

Access to substance abuse treatment in the Cape Town metropole ...

Create successful ePaper yourself

Delete template?

Save as template?