Background: South Africa, similar to most developing countries is faced with ever increasing demands for health care emanating from various reasons, which include a quadruple burden of disease. More appropriate health policies have been developed since the new government dispensation post-1994. Most of these have been implemented. These include, inter alia, the District Health System (DHS) as a vehicle to deliver Primary Health Care services. The decentralization principle was key to the implementation of the DHS and was intended to shift decision making to the periphery to improve overall responsiveness to local health needs. Study Aim: The study aimed at exploring the management roles and functions of the Registered Nurse-In-Charge of Primary Health Care clinics in eThekwini District, both from a policy and operational perspective. It is envisaged that this body of knowledge will contribute to policy development for effective, efficient and economical management of PHC service delivery at clinic level. Methodology: The study was conducted in eThekwini District and adopted a qualitative design. The target population was the Registered Nurses-In-Charge of clinics. The sampling method employed was purposive, a priori heterogeneous sampling. Data collection methods used included in-depth interviews with key informants and focus group discussions. Eight indepth interviews were conducted on key informants. Two were from a municipal clinic, two were from a provincial clinic and two were from a state subsidized clinic. One was conducted on the District Programme Manager and one on the District Primary Health Care Coordinator. Three focus group discussions were conducted: one with clinic nurses, one with Registered Nurses-In-Charge, and one with Primary Health Care Clinic Supervisors. Data analysis was undertaken using the deductive content analysis which was done according to the predetermined categories guided by the objectives. Within these broad groupings of responses, themes, sub-themes and patterns were established, noting particular similarities and differences between respondents. The patterns were aligned to the study objectives in order to keep focus on the research question Findings: The study revealed that although the Registered Nurses-ln-Charge of clinics possessed certain particular theoretical knowledge on the management roles and functions required of them at clinic level, most of these functions were not being performed. The policy documents, including the Registered Nurses-In-Charge's job descriptions, indicated gaps in relation to the management roles and functions required of Registered Nurses-In- Charge. In certain instances the policy omitted functions that were in the job descriptions and vice versa. This showed that the policy documents were not considered in the development of job descriptions. Major gaps were in leadership and planning, human resource management, financial management and information management. The gaps in the policy documents and job descriptions were attributed to the narrow decision space transferred to the clinics. Most management functions of clinics are still held at support institutions be it at a hospital or community health centre. Some of the reasons reported by the Registered Nurses-In-Charge themselves, as limiting the fulfillment of management roles and functions, were lack of orientation and training on management, lack of dedicated clinic managers, staff shortage and lack of support from clinic supervisors and the support institution. Conclusion: The recommendations include building management capacity, and reviewing the degree of decision space transferred to clinics if they are to succeed in fulfilling the function of being the first entry point into the health system. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

The purpose of the study was to develop best practice guidelines to prevent permanent hearing loss associated with the management of multi-drug resistant tuberculosis (MDR-TB) through raised awareness and monitoring. The Human Immunodeficiency Virus (HIV) and MDR-TB are global public health problems requiring urgent scale-up of treatment services. Irreversible sensorineural hearing loss (SNHL) is one of the adverse drug reactions of the current World Health Organization (WHO) recommended MDR-TB chemotherapy fuelling another public health problem, that disabling hearing loss, which is the second highest contributor of Years Lived with Disability (YLD) according to the World Health Report (2003). Expansion of MDR-TB treatment threatens to increase incidence of SNHL unless there is urgent implementation of intervention towards preservation of hearing for patients on treatment. This empirical study determined and documented the incidence of SNHL in HIV positive and HIV negative patients on MDR-TB treatment, the risk factors for SNHL, from the time treatment initiation to SNHL. Based on the findings, developed and improved the understanding of best practice guidelines for monitoring and prevention of MDR-TB treatment-related SNHL. The empirical study recruited a cohort of 173 patients with normal hearing status, after diagnosis with MDR-TB and enrolled on MDR-TB therapy over thirteen month period. Patients in the cohort received monthly hearing sensitivity testing during the intensive MDR-TB therapy when injectable aminoglycoside antibiotics are part of the treatment regimen. The three study endpoints included completion of the eight-month intensive treatment phase without developing hearing loss, development incident hearing loss or loss to follow up. Data was analysed using STATA statistical software and summarised using frequencies, means, proportions, and rates. The study documented incidence of SNHL, time to hearing loss and risk factors for hearing loss. Recommendations to prevent and monitor hearing loss are made based on the the study findings. / Health Studies / D. Litt. et Phil. (Health Studies)