The juxtaposition of doing ‘more with less’, and ‘being privileged to be a community welfare worker’ gives some indication of the anomalies present in how community welfare work is conceived and manifested. The original contribution of this thesis is to provide further knowledge and understanding of the nature, level and extent of paucity management models to inform the way that community welfare services are delivered in rural communities. Paucity management relates to the way that managers identify and utilise strategies to counter the anomaly of possessing a deep philosophical underpinning in the value of community work, with the lack of means to meet all the needs and expectations of community members. Fifteen managers from the Central West Region of New South Wales in Australia were asked to share work narratives about the way their activities contributed to sustaining their communities. The research confirms yet again that community services are delivered strategically in spite of, or because of, a resource poor environment that is mainly punctuated by the non-availability of ever-decreasing funds. New ways of seeking resources has resulted in managers and workers navigating competing priorities at ground level, with trying to balance the tensions implicit in a directive provider-purchaser work dynamic that has seen the evolvement of the hybrid government organisation. This qualitative research used a phenomenographic approach to collect the managers’ stories. Data collection methods included individual interviews, focus group discussions, as well as further consultative communication. A complex theoretical framework, incorporating ideas from paucity management, aspects of structuration, and chaos/ complexity, was used to analyse the data through a structure of awareness of variation in the managers’ experiences. The findings show that community welfare managers do work in a resource poor environment, do acknowledge the presence of paucity management, and do address the limit-situations of service delivery through different, but complimentary, paucity management models that are creative, pragmatic, communicatively competent, and ‘auto-managed’. Their combined narrative gives a clearer understanding of the style of management that the managers used, as well as some of the strategies that contributed to ‘chameleon qualities’ of management. / Doctor of Philosophy (PhD)

Thesis (Ph.D.)--McMaster University, 2006. / Supervisor: Wayne Warry. Includes bibliographical references (p. 154-164).

Thesis (M. Ed.(Educational psychology))-University of Pretoria, 2005. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Thesis (M.P.A.)--Kutztown University, 1996. / Source: Masters Abstracts International, Volume: 45-06, page: 2937. Abstract precedes thesis as [3] preliminary leaves. Typescript. Includes bibliographical references (leaves [3]).

Not available / text

HIV/AIDS is a significant social problem impacting on families, communities, the public health sector and greater society. This qualitative study looked at the experiences of social support among volunteer caregivers of people living with AIDS and relationships of trust and solidarity between caregivers and members of the community. KwaZulu-Natal has the highest HIV infection rate in South Africa. This further compounds the burden of care and stigma surrounding caring for people living with HIV/AIDS .This study draws on aspects of social support theory, social capital framework and the theoretical resources of socio-ecological theory more broadly. Methodologically, in-depth interviews were conducted with 10 female volunteer caregivers with a minimum of three months care work experience and Ulin’s thematic analysis was utilized to highlight the salient themes around their experiences of social support. The findings of this study revealed that the burden of care, stigma experienced by the volunteer caregivers and the relationships between the volunteers and community members as well as social networks all played a significant role in the need for the provision of social support to the volunteers. Furthermore, the findings of the study highlighted the social consequences of care work and the need for support in this ambit. The study concluded that social support for the volunteers is severely lacking for the following reasons; there was a complete breakdown of social cohesion between the volunteers and their community; the relationships between the volunteer and surrounding social networks were under strain and as a result had a negative impact on the accessing of social support. Factors such as social trust, social bonding, social bridging and social linking were lacking between the volunteers and the community therefore accessing social support becomes problematic. Poverty is a factor that had a ripple effect on the volunteer and resulted in the urgent need for support in the form of tangible and emotional resources. Volunteerism is an undeniable necessity in the treatment or care of HIV/AIDS patients. The issues around social trust and social networks played a key role in the accessing of social support which ultimately impacted on the efficacy of care provided by the volunteer. The findings highlighted that there was a dire need to mobilize social capital within the KwaNgcolosi community in order to create relationships that would facilitate the social support needed by the volunteer. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2009.

Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

A contemporary view of health and health care has arisen, out of the broadened social understandings of the later half of this century, which recognizes the individual as a whole person (rather than a clinical object), and which recognizes the local community as the preferable locus of care. The community health center model has emerged as a response to this contemporary view. It is a community-specific model of health care delivery, health promotion, and community action. Its services cover a full range of primary health care needs (from social work to urgent care), utilizing a multi-disciplinary team approach. While the response of facility planning and programming to the contemporary view of health and health care has been explored to great depth over the past twenty five years, the response of architecture has not. The intent of this thesis was, therefore, to create an architectural design that may serve as a model of the multiservice community health center, and as a source of architectural ideas which respond to the contemporary view of health and health care. A rural site was selected as the most appropriate setting for a new purpose-built facility. The design solution specifically sought to countermand the alienation, stress, loss of sense of personal control, unfamiliarity, sterility, and institutional qualities of the common medical environment - particularly, from the experiential viewpoint of the client. The design also sought to stand on its own as a legitimate work of architecture. Towards these ends, the building was bound to the community via prominence, accessibility and familiarity in the activities of daily life. A concept of democratic space sought to extend the public realm and a sense of public ownership into the facility. A marketplace vocabulary and communitycontrolled space contributed towards this end. The building was bound to place via architectural expression and explorations of processional qualities; responding to the nature of its island place, to the forest environment, and to local vernacular architecture. The design sought to establish a relationship with nature, or natural order, via an interstitial relationship with the forest, the use of natural materials, a truthful structural expression, a presence of natural light, and, at the conceptual level, an interplay between order and aggregation. As a representation of health care architecture, the design sought to express the notion of a community of services, rather than that of an untouchable institution. It also sought to achieve all of this in accord with efficient functioning and way-finding, and to achieve it at costs comparable to existing facilities (if not less expensive), via strategic choices regarding systems and construction.

In Nunavik, the question of self-determination in health care is becoming increasingly embedded in the community health discourse, which is used by both health planners and Inuit alike to negotiate diverging positions. While health planners envision northern health care as a subset of the Quebec system, Inuit perceive it as a vehicle to ends that transcend conventional health issues. This thesis will provide an overview of the development of Nunavik health services since the James Bay agreement, focusing on how the use of the community health discourse serves to promote, but also shapes and limits regional and community self-determination.

Community healing is an issue of great importance today in many Native communities across Canada, and yet the concept goes largely undiscussed by medical anthropologists who have instead traditionally focused on the 'ethnomedicine' and poor health conditions of these communities. For Innu of Sheshatshit, Labrador, community healing involves much more than mending physical aliments. Healing signifies a move towards new social meaning and coherence and is a forum for negotiating Innu identity. This thesis attempts to redress this gap in the literature by describing the deeply nuanced meanings community healing takes on in community discourse and its implications for contemporary Innu identity. Additionally, this account explores the significance of nostalgia for the past and of country space in community discourse as it relates to community healing.