submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, faculty of Health Sciences, Durban University of Technology, Durban, South Africa, 2016. / Globally antenatal care is advocated as the cornerstone for reducing children’s deaths and improving maternal health. The World Health Organization designed and tested a Focussed Antenatal Care model for the developing countries to improve their quality of antenatal care services. South Africa has not successfully implemented this approach, referred to by South Africa as the Basic Antenatal Care approach. A convergent parallel mixed methods design was used to assess how the Basic Antenatal Care approach was implemented in the eThekwini district. Data were collected from 12 Primary Health Care clinics using observations, retrospective record reviews and semi-structured interviews conducted with pregnant women. The quantitative data was analysed using version 21.0 of the Statistical Package of Social Services and qualitative data was analysed using Tech’s method of data analysis. The Basic Antenatal Care approach was not being successfully implemented in the Primary Health Care clinics. Several aspects of planning, people, processes and performance were not done according to the Basic Antenatal Care Principles of Good Care and Guidelines. Although good communication was observed between the clinic staff members and the referral institutions, communication problems existed between the Primary Health Care clinics and the Emergency Medical Rescue Services and also with the pregnant women. Antenatal care and delivery plans and the midwives’ counter checking of maternity charts were not recorded. Some pregnant women had positive perceptions about the antenatal care services but others had negative perceptions. Recommendations pertaining to institutional management and practice, nursing education and research were made. A tailored practice framework and an implementation guide were developed based on setting and client-specific factors to facilitate the implementation of the Basic Antenatal Care approach. The framework highlights the importance of cooperation between management and administration, in-service education and skills development departments/units and the operational level. Effective implementation of the Basic Antenatal Care approach could help to reduce South Africa’s high maternal and neonatal mortality rates. Thus the tailored practice framework and implementation guide, developed as part of this study, could help to improve maternal and neonatal health-related outcomes in South Africa. / D

Thesis (MPhil) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Legislation encourages local government! municipalitiesl local authorities in South Africa, to fulfil a development role. One of the main objectives of municipalities performing a development role is to empower communities, especially previously disadvantaged communities. This study argues that the services delivered by municipalities are an essential component of a development orientation. In view of this fact, the study proposes an operational framework, whereby community empowerment can be achieved through municipal service delivery. The operational framework suggest that for community empowerment to be achieved through municipal service delivery, requires that the empowerment enabler (municipalities or departments within municipalities) should assure that: disadvantaged communities have access to services, services must be delivered in a non-discriminatory manner, the community should understand the rationale as to why the service is delivered, opportunity should be given for community participation in the delivery process, there should be a constant information channel between the giver (enabler) and receiver of services, and human resources from the local community should be utilised where possible in the delivery process. Lastly, a descriptive evaluation is undertaken of the health department's approach (at the Stellenbosch Municipality) to the delivery of primary healthcare services and service infrastructure. The purpose of the evaluation is to ascertain whether the principles as proposed in the operational framework are present in the health department's approach to service delivery. The evaluation reveals that most of the proposed principles of the operational framework features in the health department's approach to the delivery of primary healthcare services and services infrastructure. Thereby, concluding that the health department follows to a certain extent an approach to service delivery that could ultimately lead to community empowerment. / AFRIKAANSE OPSOMMING: Wetgewing vereis dat plaaslike regering/ plaaslike owerhede/ munisipaliteite in Suid-Afrika, 'n ontwikkelingsrol moet vervul. Een van die doelstellings van 'n ontwikkelingsrol vir munisipaliteite, is om gemeenskappe te bemagtig, spesifiek gemik op agtergeblewe gemeenskappe. Hierdie studie argumenteer dat die dienste gelewer deur munisipaliteite 'n essensiële komponent vorm van 'n ontwikkelings-orientasie. Gevolglik, stel hierdie studie 'n operasionele raamwerk voor, waarvolgens gemeenskapsbemagtiging bewerkstellig kan word deur middel van munisipale dienslewering. Die operasionele raamwerk stel voor dat om gemeenskapsbemagting deur dienslewering te bewerkstellig, vereis dat die bemagtiger (munisipaliteite of departemente binne munisipaliteite) moet toesien dat: agtergeblewe gemeenskappe toegang het tot diente, dienste moet gelewer word op 'n niediskriminerende wyse, die gemeenskap moet verstaan waarom die diens gelewer word, geleentheid moet geskep word vir gemeenskapsdeelname aan die diensleweringsproses, 'n kommunikasie kanaal tussen die ontvanger en leweraar (bemagtiger) van dienste, moet geskep word en laastens moet daar van plaaslike arbeid (waar moontlik), in die diensleweringsproses gebruik word. Laastens word 'n beskrywende evaluering onderneem na die Gesondheidsdepartement (by die Stellenbosch Munisipaliteit) se benadering tot die lewering van primêre gesondheidssorgdienste asook diens infrastruktuur. Die doel van die evaluering is om te bepaal of enige van die faktore, soos beskryf in die operasionele raamwerk, teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Die resultate van die ondersoek toon aan dat die meeste van die faktore, soos voorgestel in die operasionele raamwerk, wel teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Gevolglik kan daar afgelei word dat die gesondheidsdepartement wel tot 'n mate, 'n benadering tot dienslewering volg, wat kan lei tot gemeenskapsbemagtiging.

Thesis (MMed)--Stellenbosch University, 2005. / ENGLISH ABSTRACT:The decentralisation of health care services in the primary health care system poses a challenge to the delivery of care to the communities in Zambia. Little is being done in the Ministry of Health to incorporate community-based rehabilitation (CBR) in the mainstream of primary health care service delivery despite rehabilitation being regarded as the fourth component of primary health care. According to statistics, there are 256 690 (2.7%) persons with disabilities in Zambia, of which 38.8% are persons with physical disabilities. There are various community-based rehabilitation programmes in the country trying to meet the needs of persons with disabilities but these programmes have not been evaluated to determine the impact which CBR has on the lives of persons with disabilities. This study aimed to determine the impact of a community-based rehabilitation intervention strategy on persons with physical disabilities in an urban and rural setting in Zambia. It is hoped that the results of this study can be utilised as a means to lobby the Zambian government to become involved in the rehabilitation process. An experimental study was done using a community-based rehabilitation intervention strategy on 66 persons with physical disabilities, of which 62% were male and 38% female, from Lusaka urban and Chipata rural community-based rehabilitation programmes. The researcher completed a self-compiled questionnaire during a personal interview with the participants/proxy. The questionnaire comprised demographic data and an assessment of the disability status of persons with physical disabilities regarding movement, functional activities and their integration into the community. Perceptions of persons with physical disabilities or their proxy as regards their disability status and experiences were also assessed by means of two open-ended questions in the questionnaire. The community-based rehabilitation intervention strategy was conducted for six (6) months by the community rehabilitation workers who visited participants once a week. Data was analysed both quantitatively and qualitatively to determine the impact of a community-based rehabilitation intervention strategy and to test the null hypothesis. The results of this study showed that in Lusaka on one hand, persons with physical disabilities had improvements in movement, functional activities and integration level. On the other hand, Chipata showed that persons with physical disabilities had improvements only regarding integration into the community. However, combined scores showed that community-based rehabilitation had an impact on persons with physical disabilities regarding movement, functional activities and integration into the community. The study also showed that there was a correlation between integration and movement, and integration and functional activities. There was no correlation between integration and caregiver provision and dependency, whereas there was a negative correlation between perceptions and integration. Based on these findings, it is recommended that the Ministry of Health takes up the responsibility of spearheading and coordinating community-based rehabilitation programmes and incorporating the activities in the existing structures of primary health care. / AFRIKAANSE OPSOMMING:Die desentralisasie van gesondheidsorgdienste in die primere gesondheidstelsel hou 'n uitdaging vir dienslewering aan gemeenskappe in Zambie in. Die Ministerie van Gesondheid doen nie veel om gemeenskapsgebaseerde rehabilitasie (GBR) by die hoofstroom van primere gesondheidsorg dienslewering in te Iyf nie, ten spyte daarvan dat rehabilitasie as die vierde komponent van primere gesondheidsorg beskou word. Daar word beraam dat daar 256 690 (2.7%) mense met gestremdhede in Zambie is, waarvan 38.8% mense met liggaamlike gestremdhede is. Daar is verskeie gemeenskapsgebaseerde rehabilitasieprogramme in die land wat poog om in die behoeftes van mense met gestremdhede te voorsien, maar hierdie programme is nie geevalueer om die impak van GBR op die lewens van mense met gestremdhede te bepaal nie. Hierdie studie het ten doel gehad om die impak van 'n gemeenskapsgebaseerde rehabilitasieintervensiestrategie vir mense met liggaamlike gestremdhede in 'n stedelike en landelike omgewing in Zambie te bepaal. Daar word gehoop dat die resultate van hierdie studie gebruik kan word om druk op die Zambiese regering uit te oefen om by die rehabilitasieproses betrokke te raak. 'n Eksperimentele studie is gedoen deur 'n gemeenskapsgebaseerde rehabilitasie-intervensiestrategie op 66 mense met liggaamlike gestremdhede van die Lusaka stedelike en Chipata landelike gemeenskapsgebaseerde rehabilitasieprogramme toe te pas. Twee en sestig persent (62%) van die respondente was manlik en 38% vroulik. Die navorser het tydens 'n persoonlike onderhoud met deelnemers of hulle gevolmagtigdes 'n selfopgestelde vraelys voltooi. Die vraelys het uit demografiese data en 'n bepaling van die mense se gestremdheidstatus ten opsigte van beweging, funksionele aktiwiteite en hulle integrasie in die gemeenskap bestaan. Persepsies van mense met liggaamlike gestremdhede of hulle gevolmagtigdes rakende hulle gestremdheidstatus en ervarings is ook deur middel van twee oop vrae in die vraelys bepaal.Die gemeenskapsgebaseerde rehabilitasie-intervensiestrategie is vir ses (6) maande toegepas deur gemeenskapsrehabilitasiewerkers wat die deelnemers een maal 'n week besoek het. Data is sowel kwantitatief as kwalitatief ontleed om die impak van 'n gemeenskapsgebaseerde rehabilitasie-intervensiestrategie te bepaal en die nulhipotese te toets. Die resultate van die studie het aangedui dat mense met liggaamlike gestremdhede in Lusaka verbetering ten opsigte van beweging, funksionele aktiwiteite en vlak van integrasie getoon het. Mense met liggaamlike gestremdhede in Chipata, daarteenoor, het slegs ten opsigte van integrasie in die gemeenskap verbetering getoon. Gekombineerde tellings het egter getoon dat gemeenskapsgebaseerde rehabilitasie ten opsigte van beweging, funksionele aktiwiteite en integrasie in die samelewing 'n impak op mense met liggaamlike gestremdhede gehad het. Die studie het ook getoon dat daar 'n korrelasie tussen integrasie en beweging, en integrasie en funksionele aktiwiteite bestaan. Daar was geen korrelasie tussen integrasie en versorgervoorsiening en -afhanklikheid nie, en daar was 'n negatiewe korrelasie tussen persepsies en integrasie. Op grand van hierdie bevindinge word aanbeveel dat die Ministerie van Gesondheid verantwoordelikheid vir die leiding en koordinasie van gemeenskapsgebaseerde rehabilitasieprogramme aanvaar en hierdie aktiwiteite by die aktiwiteite van bestaande primere gesondheidsorgstrukture inlyf.

Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo / assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel &reg / . Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo / suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo / health status and ultimate quality of life.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

Submitted in Fulfillment of the requirements for the Master’s Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The aim of the study was to examine students’ perspectives regarding their learning in a community based undergraduate nursing programme at the Durban University of Technology in South Africa. Methodology A quantitative descriptive design was used to examine student nurses’ perspectives regarding their experiences in community-based education (CBE), with specific reference to perceived academic gains, local and global gains, intrapersonal gains and interpersonal gains. Hours spent by students outside their CBE schedule as well as most preferred clinical practice Participants included 203 undergraduate nursing students drawn from the 2010, 2011 and 2012 cohorts. A stratified random sampling technique was used. A modified 4-point Likert scale version of a questionnaire designed by Ibrahim (2010), which also comprised of open-ended questions for supportive qualitative information, was used to collect data. Analysis was done accomplished using SPSS Version 22 for the quantitative data and identification of themes for the supportive qualitative information. Results The study results revealed that students had benefited from CBE in all the four domains under study. Participants rated the impact of CBE on academic gains lowest ( ̅x = 3.09, SD = .38) with perceived impact of CBE on local and global gains rated highest ( ̅x = 3.33, SD = .38). The personal gains subscale was the second highly rated subscale with a mean of 3.27 (SD = .43), followed by the intrapersonal gains domain ( ̅x = 3.15, SD .48). No significant differences were found between groups on all the variables of interest. Furthermore, the results revealed that participants spent a varying number of hours outside of scheduled CBE placement. The majority of the participants spent 200 hours to 399 hours (n= 119) = 58.6% in the first semester and (n = 120) = 59% in the second semester. The majority (72%) of the participants indicated that their preferred clinical practice environment was Primary Health Care. / M

Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015. / The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics / An electronic copy of the Thesis is currently unavailable.

This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change. Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives. This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers. In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.

Thesis (M.Dev. (Management and Law)) -- University of Limpopo, 2013 / Section 27 of the Constitution of the Republic of South Africa, 1996 provides that everyone has a right to have access to health care. South Africa embraces the concept of universal health care coverage. Access to health care has four dimensions: geographic accessibility, availability, financial accessibility and acceptability. If there were barriers to access to health care, the stake-holders would be duty-bound to design interventions requisite to address those barriers. The aim of the study was to establish whether health care users enjoy the right to have access to health services at Ratshaatsha Community Health Centre (RCHC). The study used a combination of quantitative and qualitative research designs. While a questionnaire was used to collect quantitative data, focused group discussions and participant observations were employed to collect qualitative data. The following are the main findings of the study. Human rights instruments clearly spell out the indivisible and mutually supportive rights that persons have. There are barriers that often affect the rights to have access to health services at RCHC. For instance, the RCHC is not within a 25 km radius of some of the consumers of health care. The roads that link up the health care users and RCHC are in poor condition. The community is generally poverty-stricken. Many cannot afford, among others, the costs of basic needs, transport fares and opportunity costs. Travelling distance and time, scarce skills and lack of medication and equipment rank among demand-side and supply-side barriers to access to health care. Health care users often choose to consult churches and traditional healers. It is recommended that government should, among others, co-ordinate primary health care services in collaboration with churches and traditional healers; commission research into traditional health medicine and healing procedures and protocols of other health care providers; develop policy on cross-referral of patients; improve community participation; set minimum norms and standards for the delivery of alternative health care services; establish health care management guidelines for churches and traditional healers; integrate health care provisioning into IDPs; and provide health care in an integrated intergovernmental manner.