Thesis (MBA)--University of Stellenbosch, 2011. / On 16 January 2004, the Parliament of the Republic of South Africa published the Draft Regulations to the Medicines and Related Substances Act No. 101 of 1965 (Republic of South Africa, 2010a) for comments due by 16 April 2004. These regulations would change the retail pharmacy landscape that generations of pharmacists had become dependent on in supporting themselves and the communities that they served. These regulations proposed a single exit price (SEP) that manufacturers might charge pharmaceutical wholesalers, which included the distribution cost. The wholesaler in turn would sell the pharmaceutical to the pharmaceutical retailer at the listed SEP, thus prohibiting discounts and in the process creating transparency in the pharmaceutical industry. This transparency would ensure that all people would pay the same price for their medication with the aim of making it affordable and available to those in need. Preceding these draft regulations was the amendment to the Pharmacy Act No. 53 of 1974 (Republic of South Africa, 2010c) concerning pharmacy ownership, which allowed non-pharmacist and legal entities to own pharmacies as of 2003. This amendment posed the first external threat to the autonomy of pharmacists regarding independent pharmacy ownership. Pharmacists now had to compete not only amongst themselves but also with large corporate food and health shops with in-house pharmacies. The resources and capabilities inherent to independent community pharmacies given the events of the past few years proved inadequate in competing with the corporate retailers. These two amendments to acts that influenced the existing pharmacy landscape posed a real threat to the sustainability of independent pharmacy business models. This paper investigates the issues that independent community pharmacies in South Africa are facing and their strategic options in the pharmaceutical and services value chain.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work / Master / Master of Social Work

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A descriptive design was used to describe five client outcome scales as potential measures of quality care in home health care: discharge status, client satisfaction, medication adherence, general symptom distress and caregiver strain. The conceptual model used necessitated three separate samples: a discharged sample of 20 clients, an active client sample of 14 subjects and a caregiver sample of three subjects for a total of 37 subjects. Structured interviews and questionnaires were used; descriptive statistics were applied to scores. The most notable indicator of quality of care, the medication adherence scale, showed all clients taking medications as prescribed. The primary reason for discharge showed that the client could manage without further services. Clients reported that they were somewhat satisfied or very satisfied with services. Caregivers reported a low perceived level of stress. The scales measuring discharge status and symptom distress need further investigation to determine if they are true indicators of the concept of quality care.

The purpose of this study was to identify the physical needs of the elderly with regard to physiotherapy services in the Livingstone district in Zambia. The objectives were to determine the knowledge of the elderly on the role of physiotherapy in the care of the elderly / the barriers to utilization of the services / the prevalence of physical problems and it also examined associations between education, knowledge and utilization of physiotherapy services in the district.

Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Homeopathy, Durban University of Technology, Durban, South Africa, 2015. / Introduction In South Africa homoeopathy is relatively unfamiliar, even though it has been in existence with formal qualification from 1989 at the Durban University of Technology, (formerly Durban Institute of Technology and Techikon Natal) as well as the University of Johannesburg formerly Wits Technikon). A large portion of the South African public is unclear with regards to homoeopathic understanding and homoeopathic medicine use. South African studies exploring the perception of homoeopathy have revealed that there is a degree of ignorance or misinterpretation of homeopathy. The objectives of this study were to expand the database of knowledge regarding the patients’ experiences of homoeopathy, by investigating their experiences of homoeopathic care rendered at a PHC facility in the eThekwini district, namely, the Redhill homoeopathic clinic. This study was guided by the following grand tour question: What are the experiences of patients of homoeopathic care rendered at a primary healthcare clinic in the eThekwini District? Aim of the study The aim of this study was to determine the experiences of patients receiving homoeopathic care rendered at a primary healthcare facility in the eThekwini district. Methodology A qualitative, explorative, descriptive and contextual design was employed. Qualitative research in this study was considered the most appropriate method to gain an in-depth understanding of the patients’ experiences of homoeopathic care. Convenience sampling was used to recruit a minimum of 10 potential research participants from patients receiving homoeopathic care at the Redhill homoeopathic clinic, but the sample size was only determined once data saturation was obtained. The study population were patients who were visiting the Redhill homoeopathic clinic for the second time or more and those who had utilized homoeopathic remedies. The data was collected and analysed using Tesch’s eight-step procedure. Results Results from this study showed that the study group had knowledge of homoeopathy and that there is growth in the knowledge of homoeopathy as compared to previous studies. The researcher observed that Indian participants had a better understanding of homoeopathy than African participants. Participants showed great confidence in homoeopathy and most of them revealed a high level of satisfaction with the homoeopathic treatment and were very happy with the service delivery. Results showed that there had been an improvement of the patients’ ailments since the commencement of homoeopathic treatment. / M

Background: The recognition of growing health disparities globally and, in particular Sub-Saharan’s continued poor health outcomes, has been responded to with a call to revitalise primary health care (PHC) 30 years after the Alma-Ata Declaration. Despite some limitations, and although not the only solution, community health workers (CHWs) have been shown to be able to reduce factors that can act as barriers to accessing care. However, CHW programmes (often provided by non-governmental organisations in South Africa) have historically been poorly regulated and fragmented. The South African government has proposed to address the health inequities through a series of health system reforms. One of these has been a current attempt to strengthen PHC through the use CHWs in order to reach underserved communities. The capacity of CHWs to provide effective outreach services remains unclear. This work examined the experiences of CHWs in their efforts to improve access to care through community participation and outreach services that work across sectors. Aim: The study aimed to examine the implementation of community health worker-provided services through the comparison of three case studies in order to identify enabling and constraining factors. Methodology: A case study method was used to compare three CHW programmes. Qualitative methods such as key informant interviews, participant observations, focus group discussions and network maps, were used to collect data. A thematic content analysis was used to identify a priori and emergent themes. Results: CHWs operate in communities with multifaceted needs (food, transport, health and social welfare services) requiring a comprehensive approach. The experiences of households in this thesis illustrate the various barriers to accessing services. The success and sustainability of CHW programmes depends on the ongoing commitment of resources, including investment in quality training, supervision, mentoring and organizational support. Furthermore, government institutional contexts with poor cross-sectoral integration, conflicting departmental mandates and poor accountability constrain the efforts of CHWs at local level. Operating within a community with strong social cohesion and social capital provided an enabling environment for CHWs to mobilise the community and facilitate community participation, which is crucial for implementation of cross-sectoral outreach activities. Conclusion: The study indicates that CHWs provide services in communities that live in poverty which results in multiple problems that contribute to ill health. The study goes further to illustrate that in order to strengthen outreach services across relevant sectors, the role of central government is crucial. These findings indicate a need for greater understanding about how to strengthen institutional contexts both in government and in non-governmental organisations.