Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2012. / Background : The current alarming growth of diseases and complications, especially in Africa, makes the integration of traditional and conventional health practices a priority in medical training, research and planning, and the funding of health services. Unplanned and/or unintended treatment non-compliance and unnecessary deaths from diseases like tuberculosis and Human Immunodeficiency Virus are escalating in spite of health information and/or education, support groups and awareness events. The World Health Organisation recommends Directly Observed Treatment Strategy for illnesses like tuberculosis, and suggests the inclusion of traditional health practitioners in the strategy because they are constantly in contact with the community and could therefore be utilized as reminders, support system, doctors and care givers. Therefore it is a high priority that traditional health practitioners be integrated into partnership with conventional medicine practitioners, as they are considered the entry point to primary health care programmes in South Africa. Aim of the study The aim of this study was to explore the nature of the partnership between the African traditional and conventional health care in the eThekwini District. Methodolody : A qualitative, multiple case study design was used to explore the partnership between African traditional and conventional health care within the South African health care system in the eThekwini district of KwaZulu-Natal Province. In attempting to explore and understand the extent to which both these health care systems work together, a qualitative research method was used. All ethical issues were considered after which individual interviews were conducted using an interview guide and a tape recorder. A cross-case synthesis was used to analyse data. Results : Results from the study suggest that a partnership is far from being implemented by both the Traditional Health Practitioners and Conventional Health Care Practitioners. It is apparent that they both do not share a common vision. The government has some responsibility and a major role to play in guiding such a partnership and making sure that the South African community is provided with best practices governed by policies and legislation that are transparent, fair and legally binding to everybody involved.

M.Ed. ( Educational Psychology) / This research study shows that young HIV sufferers undergo disturbances involving the mind, body and spirit causing a variety of future adjustment difficulties, problems and coping abilities. This is attributed to fear, loss, grief, guilt, denial, anger, anxiety, depression, stress, physiological changes, pain and hypochondria. This study indicates that they are particularly fearful about being isolated and rejected. They are overwhelmed by thoughts of loss of everything, accompanied by profound feelings of grief. Guilt and self-reproach affect their health further, having an effect on them both physically and mentally. The uncertainty of their future having contracted HIV intensifies anger with themselves as well as others. This also brings about anxiety due to lack of information and appropriate support systems in Soweto...

A research report submitted to the Faculty of Humanities University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Migration and Displacement Studies), March 2017 / Background: Policy responses to communicable diseases and other noncommunicable ones in South (ern) Africa have not adequately engaged with mobility. While Southern African Development Community member states have all adopted clear policies and programmes to deal with communicable diseases for their population in South Africa and elsewhere, deliberately, these do not extend to non nationals. In South Africa, there is a perception that many health care workers are not aware of national health policies and legislation that affect their practice, which leads to poor outcomes. But, in reality, a number of polices and guidelines are incomplete or inapplicable to non nationals, making frontline discretion unavoidable. Objectives: This study mainly sought to understand the practices that frontline health care workers adopt to navigate a space of blurred policy and the “grey areas inbetween” (McConnel, 2010), in relation to migration and antiretroviral treatment, using bottom-up policy analysis, namely “street-level bureaucracy” (Lipsky, 2010) as an analytical tool. Methods: Qualitative methods were used including policy review, literature review, in-depth interviews with frontline health care workers and participant observation. Findings: Empirical research in Vhembe district and Johannesburg found that in spite of several institutional challenges, health care workers were providing health care services and antiretroviral treatment to various categories of non-nationals reliant on public health care, albeit sometimes with some difficulties. But, the difficulties they faced in providing antiretroviral treatment were policy and systems related, in that, those that had a hard time accessing treatment did so because they were not in possession of identity documents, required referral letters or spoke non-native languages in the absence of translation services. This thesis illustrates the various innovations frontline health care workers employed to address these challenges. It demonstrates that health care workers discretion plays a crucial role in health care delivery, and there is need to recognise the importance of informal elements such as human relationships, communication networks, leadership and motivation towards the policy function of the country’s health system. It concludes that the informal practices of frontline health care workers ought not only to be recognised but also strengthened where possible. / XL2018

The development of health systems in sub-Saharan Africa has been seriously challenged in the last two decades by the rise of HIV/AIDS. In this thesis I argue that the interface between health policy and HIV/AIDS in South Africa is poorly understood and that this has been to the detriment of fairly radical health care reforms as well as more general health systems development. The research problem outlined above is two-fold, requiring different types of enquiry and analysis. Firstly, there is a gap in our understanding of the impact of HIV/AIDS on health systems. Empirical evidence is presented from research on health facilities and health management structures in Ugu district, KwaZulu-Natal to address this concern. Secondly, it is asserted that our limited understanding of the impact of HIV/AIDS and the nature of the epidemic have prevented a true appreciation of its significance for health policy. This dimension of the problem is addressed through an analysis of South African health policy from 1994 through to the present, as well as a more theoretical look at the potential future influence of the antiretroviral therapy programme on the health system. Both quantitative and qualitative methodologies are employed in this research to acquire empirical insights. Health service utilisation trends are assessed retrospectively by quantitative analysis of key indicators from district and provincial information systems. Meanwhile, the prospective component of the quantitative research can best be described as repeat cross-sectional surveys of a selection of health facilities in Ugu district. These surveys capture data on the profile of patients seeking care and the resource requirements for managing these patients. Qualitative methodologies (predominantly semi-structured interviews) are used at facility level to gain insight into human resource issues and at the management level to better understand health system functioning in relation to HIV/AIDS. One would expect the increasing HIV prevalence and burden of AIDS illness in South Africa to translate into a higher demand for health care. However, this has not occurred in Ugu district, largely because of difficulties with access to care. Despite this, at lower level health services, namely clinics and district hospitals, HIV-related service provision has outpaced an increase in resources. Specifically, the introduction of the antiretroviral therapy programme and the decentralisation of a range of HIV/AIDS services are causing new strains on the system. In essence, the epidemic has created a need to address barriers to accessing care and to expand support for district health services. HIV/AIDS not only increases the demand for health care, but on the supply side erodes the capacity of the health system to deliver care. My research demonstrates that health care workers in KwaZulu-Natal are being severely impacted by the epidemic, with the nature of their work contributing to both their susceptibly and vulnerability. Not only is HIV/AIDS increasing absenteeism and attrition through escalating morbidity and mortality, but it is also working in more subtle ways to contribute to a range of 'push' factors driving health workers from the public health sector. None of these issues have been addressed because of the narrow definition of 'human resource management', despite the obviously heightened need to monitor attrition trends and develop creative retention strategies. My research looks not only at the impact of HIV/AIDS impact on health services in Ugu district, but also at the impact of the epidemic on higher levels of the health system which constitute management structures. At these levels, the health system is challenged by an urgency to deliver HIV/AIDS services, as well as an increasing involvement of donors and partners such as civil society organisations or faith based organisations. This has resulted in trends towards more centralised control of planning and management and, in some instances, a deflection of resources towards HIV/AIDS issues and programmes. This context has called for a strong focus on capacity development and means to ensure the integration of health programmes. Many of the trends in Ugu district demonstrate the insidious nature of HIV/AIDS impact and give some insight into why these trends have not been adequately addressed by South African health policies. My analysis suggests that despite the appropriateness of the overarching direction of health reforms, some concerns arising from the HIV/AIDS epidemic have received little attention. These include a need to: 1) manage human resource impacts, 2) develop home community based care and establish a continuum of care, and 3) lead and direct the involvement of donors and partners in the health sector. On the other hand, there have been some beneficial policy developments, such as the elimination of user fees for certain services and the attention paid to the way in which a focus on HIV/AIDS care can potentially weaken the health system. Unfortunately, in many instances HIV/AIDS has also widened the gap between policy and implementation and opportunities have been missed to develop the health system in an appropriate manner. The South African antiretroviral therapy programme, launched in 2003, is a source of uncertainty regarding the future development of health policy in the country. My analysis makes use of scenarios to explore the potential future impact of the programme. I consider the ways in which the programme is steering us away from our post-apartheid vision of an equitable and well functioning national health system and towards 'AIDS exceptionalism'. I look to Botswana, the first country in southern Africa to provide antiretroviral therapy in the public health sector, for early lessons as to what we might expect. My case study of this programme suggests that HIV/AIDS care can be integrated with time, so limiting damage to the development of fragile health systems. Only through ongoing reassessment of the South African situation will it become apparent whether such lessons are transferable. Nonetheless, forward thinking should allow us to move from a crisis-orientated response to one that is more strategic. This thesis concludes with four key messages (or recommendations) emerging from both the empirical research and the health policy analysis. Firstly, there is a clear need to establish systems that can provide comprehensive and timely information concerning the impact of HIV/AIDS on public health services. Secondly, trusting relationships have to be built between academics/researchers and health policy makers so that research informs policy. Thirdly, there is a need to (re)establish a shared vision of the national health system and maintain a focus on achieving this vision. Finally, priority programmes and resources allocated to these must be used to strengthen our national health system in creative ways. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: A national roll-out of antiretroviral therapy in the public sector was started in 2004, and Paarl was one of the first sites to start these services in the Western Cape. Operational research is required to guide the continuous improvement of such services. This research aimed to describe the characteristics of the treatment cohort started at TC Newman CDC’s ARV clinic in Paarl, to determine the retention in treatment rate and to assess the clinical and virological outcomes. Methods: A retrospective descriptive and observational study was done at the TC Newman ARV clinic in Paarl. All adult HIV positive patients that were started on antiretroviral therapy in the given time period were included. Patient and treatment data had been collected in an electronic database (e-register) and were extracted and analysed. Results: Starters: Out of the 2469 patients that were enrolled for ARV treatment between February 2004 and December 2010, 2254 started locally (the rest transferred in). 64% of them were female (decreasing rate over the years). Strugglers: By June 2011 51.5% of patients were still on ARVs, 6.9% patients had died, 16.7% had been ‘transferred out’and 24.7% were reported as ‘Lost to Follow-up’. 40% of the attrition of the cohort occurred in the first 6 months, 70% in the first 18 months. Stayers: Of the 1172 patients retained after start at TC Newman CDC, 1023 (87.3%) were still on Regime 1 and 149 (12.7%) on Regime 2. Conclusions: The results of this treatment cohort (mortality, treatment retention and regimen durability) equal those in other published treatment cohorts, although very limited comparable data are available. However, the high ‘lost to follow-up’ rate is of concern and needs further investigation. Changes in the programme structure and environment tend to have an immediate effect on initiation numbers of new patients.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: NACOSA had an eventful history spanning 22 years. The first phase between 1992 and 2001 is labeled Great Expectations as the composite multi-sectoral structure started a groundbreaking initiative on HIV and AIDS in South Africa and believed that the first AIDS plan drafted by them would be implemented as planned. Expectations came to nothing as government struggled to find its feet through a decade of blunders leading to the demise of the structure by end 2001. The next phase between 2001 and 2010 is labeled Starting Over as the Western Cape branch of NACOSA reinvented itself as a community mobilisation network for the province. Within a period of ten years Western Cape NACOSA developed into a successful national network with a large membership fully involved through its networking, capacity building and promoting dialogue functions. The third phase between 2010 and 2015 is labeled Rapid Growth as NACOSA developed into a large training and grant management agency with strong systems providing funding to its members through sub-granting. Networking continued at a slower pace but is still highly important for the organisation. The network contributes to localised social capital through shared learning and collaboration. NACOSA‟s sustainability has been developed through the ability to raise long-term funds for network activities, capacity building of members and coordinated service delivery on the ground. NACOSA also has a culture of identifying and acting fast on opportunities and adapting to change when it is needed. Strategic factors attributing to the success of NACOSA are a sector based approach promoting diversity in its membership; a consistently focused and shared purpose throughout the years; a community agent approach believing in and advocating for community systems strengthening; obtaining a mandate from network members for main strategy changes; strategic partnerships; a strong capacity building approach focussing on organisational and programmatic competencies; not competing with network members but acting as main weaver; creating specialist networks for specific HIV-related causes; a committed representative executive committee and skilled staff; bringing groups together on a regular basis for discussions and strategising; a variety of social media; and a network mindset intent on a culture of learning and building trust between member organisations. / AFRIKAANSE OPSOMMING: NACOSA het 'n gebeurtenisvolle geskiedenis wat strek oor 'n periode van 22 jaar. Die eerste fase tussen 1992 en 2001 word genoem Groot Verwagtinge, verwysende na die saamgevoegde multi-sektorale struktuur wat ontstaan het as die eerste groot MIV en VIGS inisiatief in Suid-Afrika. Hulle het verwag dat hul eerste VIGS-plan geïmplementeer sou word soos wat hulle dit beplan het. Hul verwagtinge het egter skipbreuk gely as gevolg van die regering wat oor die dekade heen hul voete gesleep en foute gemaak het wat uiteindelik gelei het tot die struktuur se ondergang in 2001. Die volgende fase tussen 2001 en 2010 word genoem Oorbegin verwysende na die Wes-Kaap tak van NACOSA wat hulself herskep het as „n gemeenskapsmobiliseringsnetwerk. Wes-Kaap NACOSA het binne tien jaar weer ontwikkel in 'n suksesvolle nasionale netwerk met 'n groot ledetal wat volledig ingeskakel is by die organisasie se netwerk, kapasiteitsbou en bevordering van dialoogaktiwiteite. Die derde fase tussen 2010 en 2015 word genoem Snelle Groei verwysende na NACOSA se ontwikkeling in 'n groot opleidings- en fondsbestuursagentskap met sterk stelsels wat befondsing aan hul lede verskaf. Netwerkskakeling het voortgeduur teen 'n stadiger pas maar is steeds baie belangrik vir die organisasie. Die netwerk dra by tot die bou van plaaslike sosiale kapitaal deur middel van samewerking en saam leer. NACOSA se volhoubaarheid het ontwikkel deur hul vaardigheid om langtermynfondse in te samel vir netwerkaktiwiteite, kapasiteitsbou en gekoördineerde dienslewering op grondvlak. NACOSA het ook 'n kultuur om geleenthede vinnig te identifiseer en daarop te reageer, asook om aan te pas by veranderinge wanneer nodig. Strategiese faktore wat bygedra het tot NACOSA se sukses sluit in 'n wye sektorbenadering met diverse lidmaatskap; 'n konsekwente gedeelde doelwit oor die jare; die bevordering van sterk gemeenskapstelsels; die verkryging van 'n mandaat by netwerklede vir strategie-veranderinge; strategiese vennootskappe; 'n sterk kapasiteitsboubenadering wat fokus op organisatoriese en programmatiese vaardighede; geen kompetisie met lede-organisasies maar eerder die rol van “hoofwewer”; skep van spesialisnetwerke vir spesifieke MIV-verwante kwessies; 'n toegewyde raad en vaardige personeel; gereelde bymekaarbring van groepe vir dialoog en strategie bou; 'n verskeidenheid van sosiale media; en 'n netwerk denkpatroon gefokus op 'n leerkultuur en die bou van vertroue tussen lede.

Submitted in fulfilment of the requirements for the Degree of Doctor in Public Management, Durban Universit of Technology, 2017. / HIV-AIDS has infected more than 37 million individuals globally and has resulted in approximately 35 million HIV-AIDS related deaths globally since its discovery 35 years ago. HIV-AIDS remains a global and local health crisis as, despite innovative and accessible HIV-AIDS prevention efforts, the disease continues to spread. UNAIDS estimated over 2 milliion new HIV-AIDS infections with 700 000 of these infections occurring in young African women in 2015, revealing that the burden of HIV-AIDS is far from over (UNAIDS, 2016). As more individuals become infected with HIV-AIDS, more infected individuals are living longer, productive lives due to the international rollout and scale-up of life-saving antiretroviral (ARV) therapy aimed at halting disease progression. In 16 years, the world has initiated over 16 million HIV-infected individuals onto ARV programmes across the world aimed at preserving first line drug effectiveness of treatment, less resistance and lower mortality and morbidity rates( UNAIDS, 2016). This number is set to double as countries across the globe take bold steps to provide ARV treatment for all, based on latest WHO guideline changes. The initiative of ARV roll out for all HIV-positive individuals globally, brings with it the challenges and complexities of infrastructure support, resource allocation, uninterrupted drug supply, global access and clinical training requirements for HIV-AIDS programmes across the globe. Quality management systems with monitoring and evaluation frameworks in particular play a pivotal role in planning, allocating and utilising resources for optimal health benefits.This research study reviews available data on the prevalence of quality management systems in HIV-AIDS healthcare and identifies gaps and smart practises towards recommendations for comprehensive global HIV-AIDS standards development. This research study aims to propose a conceptual monitoring and evaluation framework derived from quality management systems for management of HIV-AIDS private sector programmes that can be used in both public and private healthcare sectors through analysis of current conceptual frameworks in the HIV-AIDS healthcare and the HIV-AIDS programmes within the South African context of HIV-AIDS healthcare provision. / D

South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.

Currently South Africa has the highest number of persons living with HIV-AIDS (PLWAs) in the world. Focus-group discussions conducted by Moon (2005:3) in the Eastern Cape indicated that people may not want to get tested for HIV or to access antiretroviral therapy (ART) for fear of disclosure of their HIV-positive status and of stigmatization. These findings prompted the researcher to conduct a study in this field. The objectives of this study are to explore and describe the experiences of PLWAs with regard to the comprehensive ART management received from registered nurses at selected public primary healthcare clinics in Nelson Mandela Bay; and to develop guidelines for registered nurses that could facilitate them in rendering appropriate comprehensive ART management. The research study is based on a qualitative, explorative, descriptive, phenomenological and contextual research design. The research population comprised of HIV-positive patients who received treatment at the selected public primary healthcare clinics. Criterion-based, purposive sampling was used to select participants for the interviews. Ten in-depth unstructured interviews were conducted. Data was then transcribed and coded. One central theme identified the fact that PLWAs experienced both positive and negative experiences at the clinics. The main findings of this research included evidence of various forms of stigma experienced by the PLWAs; distrust of the lay health counselors; but also that PLWAs were generally well-treated and satisfied with the service they had received. Broad guidelines for registered nurses was formulated that could facilitate them in rendering appropriate comprehensive ART management. The study concludes with recommendations made with regards to the areas of nursing practice, education and research. Throughout the study the researcher abided by the ethical considerations. The aspects of trustworthiness implemented in this study, included dependability, credibility, transferability and confirmability (Holloway & Wheeler, 2002:354).

The aim of the study was to examine the procedures followed by traditional healers treating people living with HIV and AIDS in the Instika Municipality and the challenges faced by them in this endeavour. Using the qualitative research method, in-depth interviews and focus group discussions were conducted with twenty traditional healers. Among the significant findings of this study were the hardships encountered by traditional healers in terms of finance, the transport needed to collect medicinal plants, the shortage of medicinal plants, the lack of co-operation from the formal health care sector and the discrimination and abuse suffered at the hands of members of the community, with Christians and members of the SAPS being among the chief antagonists. It is also acknowledged in this study that traditional healers have been trained by the Department of Health concerning issues of hygiene and that traditional healers have knowledge of the symptoms of HIV and AIDS. It can therefore be concluded that traditional healers have a significant role to play in preventing the spread of HIV and AIDS if they employ preventative measures such as the use of protective gloves and limiting the use of a blade to one patient only. However, traditional healers are not supplied with safety kits or condoms to distribute to patients who consult them for treatment of STIs.