Submitted in fulfillment of the Masters degree in Technology: Community Health Nursing, Durban University of Technology, 2013. / Background One of the major challenges for the Department of Health in South Africa today is inequity and the need to provide quality integrated health care for all its citizens. Primary Health Care (PHC) has been declared as the way to achieve this goal, through the District Health System. Standard Treatment Guidelines (STGs) and the Essential Medicines List (EML) have been developed and are used at PHC clinics and hospitals. This study explored the use of STGs and the EML by professional nurses at PHC clinics in the UMgungundlovu District, KwaZulu-Natal, South Africa. Methods A quantitative descriptive research design was used. Questionnaires were used to collect data from respondents at the PHC clinics. A retrospective review of facility registers kept by the respondents on the rational use of drugs was also carried out by the researcher. Results The findings of the study revealed that the respondents had a good understanding of the use of the STGs and the EML. There was no evidence of polypharmacy, and medications were prescribed according to guidelines. Areas that were suboptimal were related to prescription writing in writing of schedules and routes of medication as indicated in facility records. The results further showed that training on the use of the STGs and EML were inadequate, which implies the need for strengthening of training programmes.

Introduction This research was a descriptive study into the cold chain management of childhood vaccines by nurses in Primary Health Care Clinics in the uMgungundlovu District. It is imperative for health professionals to follow the procedures and policies set out by the immunisation and health manuals by of the World Health Organization. The success of any childhood vaccination programme depends on how well nurses and health professionals are able to adhere to the laws, regulations and procedures. There is also a need for clinics and health institutions to be flexible enough to deal with certain constraints so that the vaccination programmes are not interrupted for extended periods of time but rather run efficiently and benefit the intended population. As a result pandemics are easily avoided and a healthy generation of children will bring about a better society. Methodology The study was carried out in two phases i.e. an observational study and a self-administered questionnaire. In the first phase, the observational study was carried out at 14 different clinics in the uMgungundlovu District. In the second phase, the cold chain management of vaccines by nurses was explored by means of a self-administered questionnaire. Results The key findings of the observational study include that on most occasions policy was not being implemented. Furthermore there were no contingency plans to deal with equipment and electricity issues, no monitoring and evaluation systems, poor recording keeping, poor management of the cold box, access to stock and the actual management of the cold chain for vaccines. The self-administered questionnaire was completed by 276 nurses via a simple random sample from the different clinics. The most salient aspects of the research in this phase of the study revealed that education and experience of the nurses are crucial to the sustainability of the childhood immunisation programme. Not surprisingly, some of the findings were similar to that of the observational study. Issues surrounding equipment and electricity, monitoring and evaluation systems, poor recording keeping, poor access to stock and ordering of stock were prevalent in this phase of the research as well. Conclusion Recommendations have been made for ongoing communication between the Department of Health, the District Office of Health and clinics so that the short and long term problems identified are solved.