In urban South Africa there has been increasing child morbidity and mortality as a result of HIV/AIDS; a paucity of data on health-seeking behaviour for childhood illnesses; high reported use of traditional medicine and general patient dissatisfaction with free public health services. This study therefore aims to investigate the main factors influencing choice of health care provider for Black children under 6 years of age in Johannesburg and Soweto, using both qualitative and quantitative methods. In-depth interviews with caregivers (n = 5), providers of traditional (n = 6) and Western (n=6) health care, as well as 5 focus groups with caregivers, provide insight into different health care beliefs and practices. An utilisation-based survey was conducted with 206 Black caregivers of children under 6 years of age from 1 public clinic in Soweto (n = 50), 2 private clinics (50 caregivers in total) in Johannesburg, 2 public hospitals (53 caregivers in total) from Johannesburg and Soweto and 2 traditional healers (53 caregivers in total) from Johannesburg and Orange Farm, an informal settlement on the outskirts of Johannesburg. The facilities where interviews took place in this study were purposively selected. Caregiver beliefs were found to be at the heart of the decision-making process. These beliefs are shaped by the caregiver's world-view, religion, family (particularly grandmothers of the child and caregiver), social networks and previous experiences. Beliefs were also found to affect the caregiver's perceptions of the child and the illness. Findings suggest that the caregiver will be limited in her decision-making by her age and accumulated knowledge, her socio-economic status as well as the availability of support and social networks. These in turn affect the degree to which distance and cost are barriers to health care-seeking. Characteristics of the provider, experiences in the past, as well as the outcome of the treatment, were all found to interact with the afore-mentioned factors to shape current patterns of resort, as well as future decisions made. When a child was unwell, caregivers usually gave home treatments first, particularly for diarrhoea, vomiting, fever, constipation and crying. Although the use of over-the-counter (OTC) medicines in this study varied according to the illness being treated, overall the higher socio-economic status (SES) respondents were more likely to use OTC medicines and less likely than other groups to use home treatments. Home treatments as well as OTC medicines were not always used appropriately. Nearly three-quarters of caregivers had given or would give traditional medicine to their child if the need arose, although this varied by education levels and SES. The most wellknown African childhood illnesses were inyoni and ibala, which in the South African world-view Western medicine is not able to treat. In general, private sector care (primary and higher) was perceived to be better than public sector care because of more thorough examinations, stronger medicines, enough medicines and generous prescriptions, no queues, friendly staff who listen and are attentive, the availability of a doctor, high-tech equipment, cleanliness and the food provided. Although the public hospitals suffer from similar problems to those found at PHC clinics, compared with the primary health care facilities they were generally thought to be better-stocked with medicines and more accessible in terms of opening hours, performing better physical examinations, having more doctors and high-tech equipment, and staff were believed to be more attentive than their PHC counterparts. Results from this study highlight the need for community and household integrated management of childhood illnesses {IMCI) which has remained underdeveloped in South Africa. In particular, this should involve understanding the symptoms that mothers themselves recognise as significant and incorporating these into health education messages, as well as educating caregivers (mothers, grandmothers and relatives) about the safe, timely and appropriate use of enemas, home treatments, over-the-counter medicines and traditional medicines. Furthermore, these results underline the need to improve patient and provider communication as well as patient care in public services, the need to include traditional healers in the community component of IMCI, as well as training Western health care providers about health-seeking behaviour in the context of the local belief system. In order to improve the future health and well-being of millions of children in South Africa, understanding the determinants of health-seeking behaviour is essential for ensuring that effective strategies are put in place and that changes are implemented where they are needed most.

Thesis (MPH) --University of Limpopo, 2011 / Since 1994, the post apartheid government and the Department of Health have developed and implemented a number of policies and pieces of legislation that impacted directly and indirectly on the delivery of health services such as the general public health, health personnel, financial matters, transportation of medicines and foodstuffs. These policies were timeously received by the hospitals from National Office, Provincial Departments and Local Government, but were not implemented due to numerous challenges. This study explores the health policy implementation challenges facing implementers in the public health sector in the Capricorn district in Limpopo that constrain them from rendering their managerial functions effectively and thus, impact negatively on policy implementation and service delivery. The objective of the study is to explore the challenges with a view of describing the nature and causes of the challenges, explore and document them, develop suggestions for minimizing these challenges and subsequently suggesting possible solutions. The study focused on the Capricorn district in Limpopo Province. The district is the biggest among the five districts and has eight functional hospitals which are under the leadership of Chief Executive Officers (CEO). The researcher used both qualitative and quantitative (mixed) research methods. The methodology entailed the distribution of self-administered questionnaires containing closed and open ended questions to the management of Capricorn district hospitals. The results obtained in this study revealed that there are numerous challenges that constrain policy implementers from implementing health policies effectively and efficiently in their work environments. These challenges range between poor incentives, lack of equipment, lack of office space, lack of dedicated transport for outreach, budget constraints, shortage of resources – human and physical, lack of career mobility, poor working conditions, communication problems and poor supervision style. These challenges impact negatively on policy implementation.It is therefore recommended that the comprehensive strategy to maximize the health workers’ motivation in the health sector has to involve a mix of financial and non-financial incentives, the provincial department of health and Social Development should open some communication lines with the service providers at grass root level in order to address some of the issues before they become chronic challenges, there should also be regular meetings where feedback about provincial and national issues are addressed to the service providers. The current system of dissemination of information from the province and national government to the hospitals is apparently not clear.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Climate change, a reality, a myth, a conspiracy, remains a point of research and concern, specifically with regards to the impact it has on human health. Reports concerning climate change are accepted by many but are also rejected by prominent figures of society and powerful enterprises flourishing in the race for economic development. Yet all living organisms on Earth are dependent on its natural resources and delicate balance of co-existence. A disruption of ecological balance will bring about changes to biomes and niches. These changes will affect disease patterns and well-being for all. Vulnerable groups will be most affected. If these changes have occurred and continue to occur what provision should be made to reduce population vulnerability? What investment should be made to public healthcare to assist vulnerable population groups and improve adaptability? This study was conducted with the aide of the South African Red Cross Society in three large South African provinces, Limpopo, Mpumalanga and Kwa-Zulu Natal, each known for its rich diverse ecologies and tropical to sub-tropical climates. The study aimed to determine the level of awareness amongst the healthcare workers with emphasis on education. The participants were counsellors working closely with the National Department of Health and local clinics. A total of 101 participants completed a close-ended questionnaire. The results indicated a strong workforce of young people with post-matric qualifications and strong views. Qualitative research was used with descriptive statistics to analyse and describe the data collected. It was, therefore, recommended that investment be made into this growing workforce in healthcare, as well as healthcare as a whole, since climate change, as documented, will threaten food security and water availability, see altered diseases patterns including emerging and re-emergence of infectious diseases and cardiovascular concerns brought on by heat stress. Funding must support education and training to strengthen awareness and preparedness so as to empower this workforce so that they may assist local populations to better adapt to the changes, become more resilient and, thereby, reduce their vulnerability and risk / Health Studies / M.Sc. (Life Sciences)

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Climate change, a reality, a myth, a conspiracy, remains a point of research and concern, specifically with regards to the impact it has on human health. Reports concerning climate change are accepted by many but are also rejected by prominent figures of society and powerful enterprises flourishing in the race for economic development. Yet all living organisms on Earth are dependent on its natural resources and delicate balance of co-existence. A disruption of ecological balance will bring about changes to biomes and niches. These changes will affect disease patterns and well-being for all. Vulnerable groups will be most affected. If these changes have occurred and continue to occur what provision should be made to reduce population vulnerability? What investment should be made to public healthcare to assist vulnerable population groups and improve adaptability? This study was conducted with the aide of the South African Red Cross Society in three large South African provinces, Limpopo, Mpumalanga and Kwa-Zulu Natal, each known for its rich diverse ecologies and tropical to sub-tropical climates. The study aimed to determine the level of awareness amongst the healthcare workers with emphasis on education. The participants were counsellors working closely with the National Department of Health and local clinics. A total of 101 participants completed a close-ended questionnaire. The results indicated a strong workforce of young people with post-matric qualifications and strong views. Qualitative research was used with descriptive statistics to analyse and describe the data collected. It was, therefore, recommended that investment be made into this growing workforce in healthcare, as well as healthcare as a whole, since climate change, as documented, will threaten food security and water availability, see altered diseases patterns including emerging and re-emergence of infectious diseases and cardiovascular concerns brought on by heat stress. Funding must support education and training to strengthen awareness and preparedness so as to empower this workforce so that they may assist local populations to better adapt to the changes, become more resilient and, thereby, reduce their vulnerability and risk / Health Studies / M.Sc. (Life Sciences)

This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)

In contemporary multicultural societies, health is emerging as a fundamental right alongside education and welfare: a frame of reference endorsed by the Government of National Unity in South Africa. Health workers are confronting issues far beyond the more traditional modes of health education. The initial thrust of this research was to investigate the most relevant social, health and education knowledge bases and issues relative to health education in cross cultural encounters in order to formulate universal guidelines applicable to the national situation. Differences inherent in allopathic and traditional health systems are explored in historical time, in conjunction with concepts of social change, communality in diversity and the co-existence of multiple realities. An understanding of common denominators across all human and group experience emerges and, with it, insight into problems that occur when universalistic conceptions of human behaviour are linked to communicocentric hegemony. The parameters within which cross cultural health education are viewed are extended through an analytical, empirical evaluation of the andragogic consequences of a broader conceptualisation of culture and the patterned relationships existing between elements within society. The ontic fact that similar variables may have widely different meanings and be differently construed by people whose life experiences differ is affirmed. Culture shock becomes a potential personal reality for all engaged in cross cultural encounters. Radical reflection on human nature and the eidos of man constitutes the foundation upon which the aims and various theories of health education are systematically and progressively evaluated. Evidence surfaces that the original intent of the research was rooted in the Western medical tendency towards standardisation, specialisation and the creation of scientifically validated routines for professional practice and that gaps exist between the theory and practice of health education and the everyday experiences of people. On the basis of scientifically based insights, guidelines have been formulated to narrow the divide between the factual, linearly based procedural aspects of health education and the human experience of learning. The guidelines embody the notion that the health educator's role in cross cultural encounters is one of facilitating meaningful, appropriate and informed choices on the part of adult learners. / Educational Studies / D.Ed. (Philosophy of Education)

Risk management strategy is a broad discipline aimed at identifying, evaluating and handling risks by both physical and financial means. The medical aid industry in South Africa has experienced a disproportionate increase in expenditure relative to the overall economic growth. These cost pressures have placed restraints on their ability to obtain new members, which is vital when subsidizing higher risks with younger healthier members, and has resulted in losses for many schemes. Compounding the problem has been political and regulatory health care reforms as well as technological advances, which have initiated a complete restructure of the industry. This dissertation reviews the risk management strategies implemented by medical insurers in South Africa. An analysis of alternate risk management strategies is taken with the view of recommending a tentative means of making medical aids more efficient in an increasingly difficult market. / Business Management / M. Comm. (Business Management)

This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)