Master of Public Health - MPH / Tuberculosis (TB) continues to be a major cause of ill health and the leading cause of death from a single infectious agent worldwide. Furthermore, young children, especially those under five years old and infants, are at risk of developing more severe forms of TB. TB cases continue to cluster among disadvantaged groups such as the poor whose lives are characterised by adverse living conditions. Defaulting from treatment poses a severe threat to children’s health because untreated TB or breaks in treatment could lead to a child developing more severe forms of TB, or worse, could result in mortality. Currently, long-term hospitalisation has the most successful TB treatment outcomes. Therefore, to ensure compliance, children are taken out of their social environment and admitted to hospital. However, being separated from one’s family, especially at a crucial stage of development, could have long-terms effects on the child’s development. The study explored, factors influencing access to care that caregivers of children; who are five years and younger, who received prolonged treatment at a specialised TB hospital in the Western Cape, South Africa experienced. A qualitative approach allowed the researcher to use personal interactions as a focus for studies and was suitable when aiming to understand health behaviour in its everyday context as experienced by the participant. The study results indicated the factors that enable caregiver visitation, is largely dependent on availability of finances. Furthermore, the hospital itself was identified as being accommodating with regards to visiting hours, telephonic calls and served as important mediator between health service provider, the children, their caregivers and the rest of the staff. Visitation depended on availability of finances, and this was the main barrier that was identified by caregivers. The challenges that hampered visitation were unemployment, lack of access to private and public transport and challenges related to farm-workers. A large number of caregivers work on farms in the Cape Winelands and many of them are dependent on seasonal work which results in inconsistent income. This limited availability of finances for visitation. Furthermore, the working conditions, long shifts and lack of employment benefits which were associated with farming, prevented caregivers from visiting. This study revealed that there are a series of factors which influence access to care of caregivers; this is especially the case in children hospitalised for TB. These factors need to be considered by policy makers as well as the Specialised Tuberculosis facility when dealing with children under five as the best way to ensure that treatment is completed through hospitalisation. Therefore, the strategies to assist families of children with TB need to be explored to assist in the continuity of care as well as the child’s development.

Magister Artium (Development Studies) - MA(DVS) / This research study explores seasonal farm working womens’ food insecurity and dietary diversity in Cape Winelands District (CWD). It describes the food difficulties seasonal farm working women are facing that prevents them from acquiring a healthy diverse diet; specify their diet choices as well as portray the current assistance they are receiving from government. The research study found that seasonal farm working women in CWD do experience food insecurity and lack dietary diversity mainly during certain months of the year when they are unemployed or underemployed due to various barriers they experience.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Employees, whether in the public or private sector, are the most valuable asset of an organisation. The human resource component of the organisation contributes toward the creation of a positive advantage for that organisation. Any organisation with high performance goals will treat people as their most valuable asset and the top priority within the organisation. Too many organisations still do not invest in the human side of the equation, but emphasise the technical efficiency which reaps financial investment. Organisations that want to remain competitive and at the leading edge must invest more in the human side of the equation. Today more and more organisations are aware of their social responsibility towards their employees. Employees experience a multitude of personal and work-related problems such as marital, family and financial difficulties, substance abuse, the impact of HIV/AIDS, job stress, job burnout and other. These problems influence work performance detrimentally, which in turn causes financial losses to the organisation. Further pressure is placed on the work community with government legislation on employment equity and affirmative action, which also leads to diversity problems within the workplace. In this milieu, work organisations are challenged to take up their social responsibility towards their employees and take better care of them. One way in which organisations can take care of their employees is through an Employee Assistance Programme (EAP). An EAP is a service provided by organisations to their employees to deal with health, personal, marital and substance abuse problems and other. It is a short-term, confidential counselling service for employees who are experiencing personal problems that affect their work performance and which can therefore improve the employees‟ general wellness. Cape Winelands District Municipality (CWDM) does not have a formal structure such as an EAP to render support to a troubled employee. This research focused on the question: “Is there a need for an EAP at CWDM?” The data gathered in this study reveal that there is a great need for an EAP. On the basis of the outcome of the study, ten practical guidelines for implementation of an EAP are provided to the organisation. / AFRIKAANSE OPSOMMING: Werkernemers, hetsy in die privaat of publieke sektor, is die waardevolste bate van die organisasie. Die menslike hulpbron komponent dra by tot die skepping van ʼn positiewe voorsprong vir daardie organisasie. Enige organisasie met hoë prestasiedoelwitte sal hul werknemers as hul waardevolste bate en die hoogste prioriteit behandel. Te veel organisasies belê steeds nie in die menslike sy van die organisasie nie, maar eerder in die tegniese sy wat meer finansiële beleggings oplewer. „n Organisasie wat kompeterend en toonaangewend wil bly, moet meer belê in die menslike sy. Deesdae besef al hoe meer organisasies dat hulle ʼn sosiale verantwoordelikheid teenoor hul werknemers het. Werkrnemers ervaar ʼn magdom persoonlike en werkverwante probleme soos byvoorbeeld huweliks-, gesins- en finansiële probleme, middelmisbruik sowel as die impak van HIV/VIGS, werkstres, uitbranding en ander. Hierdie probleme beiinvloed werksproduktiwiteit aansienlik, wat direk lei tot finansiële verliese vir die organisasie. Voorts word verdere druk op die werksgemeenskap geplaas deur regeringsbeleid te wete werksgelykheid en regstellende aksie wat ook aanleiding gee tot diversiteitsprobleme binne die werksplek. Teen hierdie agtergrond word werksorganisasies uitgedaag om sosiale verantwoordelikheid vir sy werknemers te aanvaar en om beter sorg te dra vir sy werknemers. Een manier waarop organisasies na hul werknemers kan omsien, is deur „n werknemerhulpprogram. ʼn Werknemerhulpprogram is ʼn diens wat verskaf word deur werkgewers aan werknemers wat probleme ondervind met byvoorbeeld gesondheid, huwelik, gesin, middelmisbruik en ander.. Dit is ʼn korttermyn, konfidensiële beradingsdiens vir werknemers wie se werkvermoë negatief beïnvloed word. ʼn Werknemerhulpprogram het ten doel om ʼn werknemer se totale welstand te verbeter. Kaapse Wynland Distriksmunisipaliteit (KWDM) het tans, nie ʼn formele struktuur soos „n werrknemerhulpprogram wat bystand aan die geaffekteerde werker kan bied nie. Hierdie navorsingstudie fokus op die vraag:”Is daar ʼn behoefte aan ʼn werknemerhulpprogram by KWDM”? Die data wat tydens die studie ingesamel is, toon dat daar wel ʼn behoefte aan ʼn Werknemerhulpprogram is. Gegrond op die uitkoms van die studie, word tien praktiese riglyne vir die implementering van 'n Werknemerhulpprogram aan die organisasie voorgestel.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The Local Government Municipal Finance Management Act (MFMA, Act 56 of 2003) is the final piece of legislation to completely overhaul local government budgeting and financial management in South Africa. The MFMA recognises that previous budgeting and financial management practices of municipalities suffered from a number of weaknesses that hampered transformation and service delivery in communities. This research project evaluates the local government budget process and implementation within the Cape Winelands District Municipality (CWDM) by focusing on the framework within the MFMA and providing a budget process guideline for the annual budgets of municipalities. Specifically, the roles and responsibilities of various role-players within the budget process are clarified. Key characteristics of the budget process are also evaluated as well as key challenges and constraints within local government. The elements crucial to a good budget process includes: establishing broad goals to guide local government decision-making; developing approaches to achieve goals; developing a budget consistent with these approaches to achieve goals and evaluation of performance and making adjustments. Furthermore the various outcomes and opportunities within the budget process, particularly at the Cape Winelands District Municipality are identified. A simplified guide to the budget process and essential recommendations were made. Recent local community issues and public debate on local government finances – pertaining to corruption, mismanagement and lack of service delivery – can adversely affect the community’s confidence in municipalities to deliver services. As the last sphere of government to undergo transformation, municipalities find it difficult and more challenging to effectively address the multiplicity of issues and needs within the community. The transformation in public financial management, particularly, public budgeting, is crucial in ensuring a smooth transition to a better life for all. For the budget process to be successful, all role-players must recognise that with the implementation of the MFMA, a re-engineering of the budget process needs to take place. The organisational structure and financial budgeting framework must change from one of control to one of management. Role-players, individuals and departments within municipalities – that have for years ‘jealously guarded their turf’ must work together to improve public budgeting, implementation, transparency and delivery – a difficult challenge that is not easily tackled. / AFRIKAANSE OPSOMMING: Die Wet op Plaaslike Regering: Munisipale Finansiële Bestuur, 2003 (WMFB,Wet 56 van 2003) is van die wetgewing wat ingestel is op plaaslike regeringsvlak om veranderinge in veral munisipale begrotings en finansiële bestuur in Suid Afrika te weeg te bring. Die WMFB erken en stel dit duidelik dat vorige praktyke in begroting en finansiële bestuur van munisipaliteite, veranderinge, transformasie en dienslewering in gemeenskappe verhinder het. Hierdie navorsingsprojek evalueer die begrotingsproses en implementering in die Kaapse Wynland Distriksmunisipaliteit met die fokus op die raamwerk binne die WMFB. Duidelike riglyne word voorgestel wat die jaarlikse begrotingsproses van munisipaliteite uiteensit. Meer spesifiek word daar ook gekyk na die rolle en verantwoordelikhede van die verskeie rolspelers in die begrotingsproses. Die kritieke eienskappe van die begrotingsproses word ook ge-evalueer sowel as die uitdagings en tekortkominge binne plaaslike owerhede. Die belangrike eienskappe van ’n goeie begrotingsproses sluit in: die vestiging van breë doelwitte om sodoende leiding te verskaf vir besluite wat deur die Plaaslike Regering gemaak word; die ontwikkeling van verskeie benaderinge om doelwitte te bereik en die evaluering van prestasie sowel as veranderinge wat aangebring word. Verder word daar ook gekyk na die verskeie resultate en geleenthede binne die begrotingsproses soos identifiseer by die Kaapse Wynland Distriksmunisipaliteit. Onlangse gemeenskapsprobleme en debatte oor munisipale dienslewering en veral finansiële bestuur – soos korrupsie, wanbestuur en geen dienslewering – kan ‘n negatiewe invloed hê op gemeenskappe se vertroue in munisipaliteite om wèl noodsaaklike dienste aan die gemeenskap te lewer. As die laaste regeringsvlak om transformasie te ondergaan, vind munisipaliteite dit al moeiliker en meer uitdagend om aan die gemeenskap se wye spektrum van behoeftes te voorsien. Die huidige veranderinge en transformasie in openbare finansiële bestuur, veral die begrotingsproses, is belangrik sodat tranformasie gouer kan plaasvind vir ‘n beter lewe vir almal. Vir die begrotingsproses om suksesvol te wees, sal alle rolspelers moet erken dat met die implementering van die WMFB, ‘n herstruktuering van die begrotingsproses noodsaaklik is. Die strukture binne organisasies sowel as die finansiële begrotingsraamwerke, moet verander vanaf ‘n situasie van kontrole tot hedendaagse bestuursmeganismes. Rolspelers, individue en departemente binne munisipaliteite wat oor jare hul ‘eie stukkie grond’ jaloers beskerm en verdedig het, sal moet saamwerk om die openbare begrotingsproses, implementering, deursigtigheid en dienslewering in die gemeenskap te verbeter. ‘n Moeilike en uitdagende taak wat nie maklik aangepak kan word nie.

<p> <p>&nbsp / </p> </p> <p align="left">In this thesis I argue that by taking account of economic disparities and backlogs in intergovernmental infrastructure grants to municipalities in South Africa, government will effectively meet its constitutional obligation to equitably allocate infrastructure grants to local government according to the principles of parity, proportionality and priority (Young, 1994). Municipalities will thus be able to provide basic services to households in keeping with the Bill of Rights of the Constitution of South Africa (1996). Adapting the Petchey et al (2004) provincial capital expenditure grant model to the provision of municipal services using secondary data and information from local municipalities in the Cape Winelands District, I evaluate whether government&rsquo / s existing municipal grants are allocated equitably and, whether they account for disparities that differentiate municipalities from each other. The findings from my analysis show that the current approach to financing municipal infrastructure does not sufficiently account for disparities and thus, undermines the requirement for equitability, adequacy and efficiency of intergovernmental allocations. Consequently, the right of citizens to basic municipal services is compromised and the macroeconomic structure is weakened. Furthermore the institutional arrangements for local government autonomy is undermined because municipalities cannot ensure stability, predictability, flexibility and economic efficiency of infrastructure budgets. As municipalities receive part of their finance from national government through infrastructure grants, I used data from five local municipalities to examine the extent to which there is equitability and efficiency in the way this finance is allocated. To this end I constructed and applied a composite disparity index for each municipality to my adapted municipal infrastructure grant model to analyze and observe the impact of economic disparities in grant allocations. The findings show that a grant model that accounts for economic disparities satisfies the constitutional, economic and institutional considerations that should inform municipal grant allocation decisions. I conclude the thesis by highlighting the limitations and possibilities of using a municipal infrastructure grant model that accounts for economic disparities and, I propose some recommendations for applying such a model in South Africa.</p>

<p> <p>&nbsp / </p> </p> <p align="left">In this thesis I argue that by taking account of economic disparities and backlogs in intergovernmental infrastructure grants to municipalities in South Africa, government will effectively meet its constitutional obligation to equitably allocate infrastructure grants to local government according to the principles of parity, proportionality and priority (Young, 1994). Municipalities will thus be able to provide basic services to households in keeping with the Bill of Rights of the Constitution of South Africa (1996). Adapting the Petchey et al (2004) provincial capital expenditure grant model to the provision of municipal services using secondary data and information from local municipalities in the Cape Winelands District, I evaluate whether government&rsquo / s existing municipal grants are allocated equitably and, whether they account for disparities that differentiate municipalities from each other. The findings from my analysis show that the current approach to financing municipal infrastructure does not sufficiently account for disparities and thus, undermines the requirement for equitability, adequacy and efficiency of intergovernmental allocations. Consequently, the right of citizens to basic municipal services is compromised and the macroeconomic structure is weakened. Furthermore the institutional arrangements for local government autonomy is undermined because municipalities cannot ensure stability, predictability, flexibility and economic efficiency of infrastructure budgets. As municipalities receive part of their finance from national government through infrastructure grants, I used data from five local municipalities to examine the extent to which there is equitability and efficiency in the way this finance is allocated. To this end I constructed and applied a composite disparity index for each municipality to my adapted municipal infrastructure grant model to analyze and observe the impact of economic disparities in grant allocations. The findings show that a grant model that accounts for economic disparities satisfies the constitutional, economic and institutional considerations that should inform municipal grant allocation decisions. I conclude the thesis by highlighting the limitations and possibilities of using a municipal infrastructure grant model that accounts for economic disparities and, I propose some recommendations for applying such a model in South Africa.</p>

Philosophiae Doctor - PhD / In this thesis I argue that by taking account of economic disparities and backlogs in intergovernmental infrastructure grants to municipalities in South Africa, government will effectively meet its constitutional obligation to equitably allocate infrastructure grants to local government according to the principles of parity, proportionality and priority (Young, 1994). Municipalities will thus be able to provide basic services to households in keeping with the Bill of Rights of the Constitution of South Africa (1996). Adapting the Petchey et al (2004) provincial capital expenditure grant model to the provision of municipal services using secondary data and information from local municipalities in the Cape Winelands District, I evaluate whether government’s existing municipal grants are allocated equitably and, whether they account for disparities that differentiate municipalities from each other. The findings from my analysis show that the current approach to financing municipal infrastructure does not sufficiently account for disparities and thus, undermines the requirement for equitability, adequacy and efficiency of intergovernmental allocations. Consequently, the right of citizens to basic municipal services is compromised and the macroeconomic structure is weakened. Furthermore the institutional arrangements for local government autonomy is undermined because municipalities cannot ensure stability, predictability, flexibility and economic efficiency of infrastructure budgets. As municipalities receive part of their finance from national government through infrastructure grants, I used data from five local municipalities to examine the extent to which there is equitability and efficiency in the way this finance is allocated. To this end I constructed and applied a composite disparity index for each municipality to my adapted municipal infrastructure grant model to analyze and observe the impact of economic disparities in grant allocations. The findings show that a grant model that accounts for economic disparities satisfies the constitutional, economic and institutional considerations that should inform municipal grant allocation decisions. I conclude the thesis by highlighting the limitations and possibilities of using a municipal infrastructure grant model that accounts for economic disparities and, I propose some recommendations for applying such a model in South Africa.

Stellenbosch University. Faculty of Medicine and Health Sciences. Interdisciplinary Health Sciences. Family Medicine and Primary Care. / Thesis (MFamMed) -- Stellenbosch University, 2010. / Bibliography / ENGLISH ABSTRACT: Introduction: This thesis summarises the findings of a medical audit on the management of Cryptococcal Meningitis (CM). The study population of HIV positive adults (N = twenty five) were admitted during November 2009 – June 2010 to five hospitals of the Cape Winelands (East) District, Western Cape, South Africa. In the context of the HIV pandemic, CM has become the most common cause of community-acquired meningitis, and has poor outcomes if left untreated. The South African HIV Clinician Society has published treatment guidelines in 2007. These guidelines have been used by the audit team to compile a list of measurable criteria (with set targets) to evaluate the structure, process and outcome of CM management. A pilot audit (2008) at the regional hospital has demonstrated that certain target standards were not met. Aims and Objectives: The aim was to improve the quality of the clinical care of HIV-patients diagnosed with CM in the Cape Winelands (East) district. The objectives included the review of the audit criteria and target standards, demonstrating improvement in quality of CM care at the Level 1 and 2 hospitals, identifying new interventions based on the findings and providing recommendations to the health facilities. Methods In 2009, the researcher formed a new audit team, reviewed the audit criteria and held teaching interventions based on the national treatment guidelines. An intervention, based on the findings of the pilot audit, aimed at improving the clinical team’s adherence to the treatment guidelines. Results The audit identified the following areas that did not meet the target standards: the availability of Amphotericin B (Ampho B) and spinal manometers; the use of manometry in all initial lumbar punctures (LPs); completing fourteen days of the required Ampho B treatment; renal monitoring in patients on Ampho B; commencement of antiretroviral treatment (ART) by week four; and, the two-month survival figures post-diagnosis. The re-audit at the Level 2 hospital highlighted the need for improved medical record keeping to aid the audit process. Arrangement of inpatient ART counselling happened more consistently at the Level 1 hospitals. Adherence to the ART target and measures to prevent Ampho B related morbidity is comparable to that of the Level 2 hospital. The audit has also provided insight to the researcher and audit team on the practical challenges of conducting a prospective data collection technique across different care settings. Recommendations Level 1 hospitals should continue to manage CM patients. The availability of spinal manometers and closer adherence to renal monitoring require attention. Formal feedback to the audit team and clinical teams is planned. A multimodal interdisciplinary Quality Improvement approach (such as an integrated care pathway) is recommended and a future re-audit is encouraged to assess improved adherence to the CM management guidelines. The buy-in of stakeholders (management, health care workers and patients), the ongoing support of an audit team and a committed Quality Improvement environment will allow the medical audit process to become ingrained in the South African public healthcare setting. / AFRIKAANSE OPSOMMING: Inleiding Hierdie tesis bied ‘n opsomming van die sleutelbevindinge van ‘n mediese oudit van Cryptokokkale Menigitis (CM) sorg. Die studie groep van MIV-positiewe volwassenes (N = vyf-en-twintig) het binne-pasiënt behandeling ontvang gedurende November 2009 tot Junie 2010 in vyf hospitale van die Kaapse Wynland (Oos) distrik. In die konteks van die MIV pandemie het CM die mees algemene oorsaak van gemeenskapsverworwe meningitis geword, en het swak uitkomste indien onbehandeld. Die Suid-Afrikaanse HIV Clinici Vereniging het in 2007 behandelingsriglyne gepubliseer. Hierdie riglyne het die oudit span gebruik om ‘n lys van meetbare kriteria (met teiken standaarde) saam te stel om die struktuur, proses en uitkoms fasette van CM sorg te evalueer. ‘n Proef oudit (2008) by die streekshospitaal het getoon dat sekere teiken standaarde nie behaal was nie. Doelstelling Die doelstelling was om die kwaliteit van kliniese sorg van MIV-pasiënte met CM (in die Kaapse Wynland (Oos) distrik) te verbeter. Die doelstelling sluit in die hersiening van die oudit kriteria, die bevesting van verbetering in kwaliteit CM sorg by vlak 1 en 2 hospitale, identifisering van nuwe ingreep-moontlikhede gebaseer op die bevindinge en die verskaffing van toepaslike aanbevelings aan die gesondheidsorg fasiliteite. Metodes Die navorser het in 2009 ‘n nuwe oudit span gevorm, die oudit kriteria hersien en opleidingsingrepe geskoei op die nasionale riglyne gefasiliteer. Opleidingsingrepe, gebaseer op bevindinge van die proef oudit, het ten doel gehad dat die kliniese span die nasionale riglyne nakom. Resultate Die oudit het die volgende areas uitgelig waar daar nie aan die teikenstandaarde voldoen was nie: the beskikbaarheid van Amphotericin B (Ampho B) en spinale manometers; die gebruik van manometrie in alle aanvanklike lumbaal punksies (LPs); voltooi van die veertien dae Ampho B behandelingsteiken; nierfunksie monitoring van pasiënte op Ampho B; aanvang van anti-retovirale behandeling teen week vier; en, die twee maande oorlewing post-diagnose syfers. Die opvolg oudit by die vlak 2 hospitaal bevestig die belang van verbeterde kliniese notas om die oudit proses te vergemaklik. Die reël van binne-pasiënt ART berading gebeur meer bestendig in Vlak 1 hospitale. Bereiking van die ART teiken en maatreëls om Ampho B verwante morbiditeit te voorkom, is vergelykbaar met die bevindinge by die vlak 2 hospitaal. Die oudit het die navorser en die oudit span ingelig rakende die praktiese uitdagings om ‘n prospektiewe data insamelingsmetode te poog in verskillende kliniese kontekste. Aanbevelings Vlak 1 hospitale kan steeds CM pasiënte versorg. Die beskikbaarheid van spinale manometers en deeglike nierfunksie monitering sal die behaling van teiken standaarde vergemaklik. Formele terugvoer aan die oudit span en kliniese span word beoog. ‘n Multimodale interdissiplinêre Kwaliteitsverbeterings benadering (soos ‘n geïntegreerde sorgplan) word aanbeveel en ‘n toekomstige oudit word aangemoedig om verbetering in toepassing van die CM riglyne te evalueer. Dit is belangrik om die sleutelspelers (bestuur, gesondheidswerkers en pasiënte) te betrek. Verder word voortgesette ondersteuning van die oudit span en ‘n toegewyde omgewing van kwaliteitsverbetering aanbeveel. Sodoende sal die oudit proses in Suid-Afrikaanse publieke sorg geintegreer word.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Global economic conditions are forcing donor and development agencies to reduce aid to developing countries and communities. This reduction is resulting in less developmental programmes for disadvantaged communities. To ensure that developmental programmes are implemented successfully and cost effectively, implementing agents will have to ensure that they improve their developmental communication. It is also becoming important that those who are to benefit from developmental programmes convey or identify exactly what their needs are. There should be very little speculation from development agencies about what the needs of the disadvantaged are. It is becoming necessary to review current developmental tools, methods and systems, and also to explore what other measures can be applied to ensure that speculation or time and money wasting exercises are eliminated. This study attempts to look at two things that will influence effective development communication. The first is to examine if community radio is still as an efficient developmental communication tool as perhaps two decades ago. Secondly, it looks at the possibility to tailor-make information for those who need develop, especially in the context of evolving technology.

The study aims to evaluate the Entrepreneurial Seed Fund Programme (ESFP) of the Cape Winelands District Municipality (CWDM). This Programme aims to provide seed funding to emerging and established businesses in order to start and/or grow their businesses. The Programme provides funding through a grant-in-kind by procuring the goods and equipment that the business needs. The businesses qualifying for the funding are not solely focusing on profit-making; they are addressing social issues through business activities in their communities. The population of the study includes five successful and unsuccessful beneficiaries and a questionnaire was designed in order to determine the contributing factors to the success or failure of the business and if the objectives of the Programme was realised. In conclusion, the ESFP can be regarded as a sustainable programme which contributed to job creation and social upliftment. The ESFP should be strengthened with a small business incubation programme in order to enhance its sustainability. / Public Administration & Management / M. Tech. (Public Management)