Table 3 Themes 2, 3, & 4 according to VSM levels
Beer’s VSM Levels | Theme 2 Identifying existing barriers to aftercare service provision | Theme 3 Situating systemic enablers to aftercare service provision | Theme 4 Associated aftercare systems recommendations |
|---|---|---|---|
Implementation level | • Internal Motivation of PWSUD • Family denial • Family’s limited knowledge of recovery process • Stigmatization of PWSUD • Poor community participation/partnerships in rehabilitation • Long waiting lists in ITCs • Unavailability of medication for withdrawal • Lack of education and training about SUD for service providers • Limited transport for service providers • Poor inter-sectoral collaboration • Lack of funding for aftercare services | • Team approach at hospitals and clinic level by DoH • High level of motivation of a PWSUD • Strong family support • Telephonic follow-ups from ITCs | Case manager or coordinator is required to coordinate aftercare services Teamwork in proving aftercare services • Teamwork should be facilitated through clinic card and CCG • Community partnerships facilitated through education cognizant of the cultural context. |
Coordination level | Poor communication among stakeholders rendering services within the same community Limited awareness of each stakeholder’s roles, responsibilities and scope of practice. Poor communication between ITC & referring service providers | The necessity of collaborating with community caregivers. | Encouraging inter-sectoral collaboration among various sectors Inter-sectoral collaboration should be facilitated through war-room |
Control level | Evaluation of SUD Services: poorly managed and monitored | Maximizing on war-rooms Considering a Ward-based approach | Strengthen monitoring and evaluative mechanism for aftercare services. |
Intelligence/ development level | Limited accountability and reporting of NGOs to local institutions Absence of aftercare statistics in Provincial reports | Negligible support for SUD programs | Accountability of NGOs should also be at institutional level i.e. DSD facilities or hospital. Encouraging comprehensive details of SUD in reports |
Policy level | SUD programs not prioritized by DoH and DSD NGOs reporting renewal at policy level only Lack of standard of care Lack of policy awareness | Policies in place | Revisiting the accountability of NGOs |