The purpose of the study was to investigate the knowledge of TB patients receiving TB treatment at a clinic in Tshwane regarding the condition and their treatment. A descriptive cross-sectional survey was conducted. Data was collected using a self-designed structured questionnaire administered by the researcher and nurses. The population consisted of diagnosed TB patients. The total sample consisted of 74 respondents. The respondents were described in terms of inter alia their demographics, aspects of their health and TB and aspects related to clinic visits. For the knowledge about TB a competency indicator was set at 70% which means that those that achieved this were regarded as knowledgeable. Those that were found to be not knowledgeable were 41.9% of the sample. The mean score achieved by the group was 61% with a standard deviation of 25. Recommendations were made to amend knowledge deficits of TB patients and for further research / Health Studies / M.A. (Public Health)

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background South Africa is burdened by consistently high maternal and perinatal mortality rates. In a move to alleviate this burden the South African National Department of Health (DoH) instructed the adoption of the Basic Antenatal Care (BANC) approach in all antenatal care (ANC) facilities. Whereas many facilities have begun the implementation of the BANC approach, in the eThekwini district, not all of the facilities have been successful in doing so. The study was conducted in those eThekwini Municipality Primary Health Care (PHC) facilities that have been successful in order to identify the factors influencing their success in implementing BANC. Methods The facilities that had been successful in implementing BANC were identified, followed by a review of the past records of the patients who had completed their ANC and had given birth. This was done in order to establish whether the facilities that were said to be implementing BANC, were in fact, following BANC guidelines. The factors that influenced successful implementation of BANC were identified based on information obtained from the midwives who were working in the ANC facilities that were successfully implementing BANC. The sample size was comprised of 18 PHC facilities that were successfully implementing BANC from which a total of 59 midwives were used as the study participants. Results Several positive factors that influenced successful implementation of BANC were identified. These factors included; availability and accessibility of BANC services: Policies, Guidelines and Protocol; various means of communication; a comprehensive iii package of services and the integration of services; training and in-service education; human and material resources and the support and supervision offered to the midwives by the PHC supervisors. Other factors included BANC programme supervisors’ understanding of the programme and the levels of experience of midwives involved in implementation of BANC. There were, however, certain challenges and negative factors that were identified and these included: shortage of staff; lack of cooperation from referral hospitals; lack of in-service training; problems in transporting specimens to the laboratory; lack of material resources; lack of management support and the unavailability of BANC guidelines.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introduction Access to effective health care is at the heart of the discourse on how to achieve the health related Millennium Development Goals. Lesbian and gay persons are affected by a range of social and structural factors in their environment, and as a result have unique health needs that might not be met by existing health care services. Sexual stigma remains a barrier to seeking appropriate health care. Lesbians and gays might delay seeking health care when needed or avoid it all together, because of past discrimination or perceived homophobia within the health care system. Aim of the study The aim of the study was explore and describe the accessibility of primary health care services to lesbians and gays in Umlazi in the province of KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Aday and Andersons’ theoretical framework of access was chosen to guide this study. Semi-structured interviews were conducted with 12 lesbian and gay participants. The findings of this study were analysed using content analysis. Results Four major themes that emerged from the data analysis were discrimination of homosexual men and women by health care providers and community members in PHC facilities; attitudes of homosexual men and women towards health care providers; homophobic behaviour and equality of PHC services. Few participants were satisfied with the primary health care services they received. Intervention by the Department of Health, Department of Education, curriculum planners and Health Professionals Councils is recommended wherein homosexuality education should be addressed during pre-service and in-service education sessions so as to familiarise health care providers with such clients’ health care needs and to decreased homophobic attitudes.

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.

Submitted in fulfillment of the requirements for the degree of Doctor in Public Management, School of Public Management and Economics, Durban University of Technology, Durban, South Africa, 2016. / The shortage of staff in hospitals resulted in the overcrowding of outpatients departments (OPDs) and long waiting times. The problems of the current health care system include the lack of access to transportation and high transport fees which cause delays in health seeking behaviours by patients or them resorting to traditional medicine in their neighbourhood. To alleviate the above issues, the new Primary Health Care (PHC) approach provides health care at a ward based and household level through community care giver (CCGs) and outreach teams. The study evaluated the management of rural ward-based primary health care in the UThukela District Municipality (UDM). The study intended to evaluate current performance systems in order to provide effective and efficient PHC; identify the role of the operational manager (OM) in the provision of PHC; and identify the factors affecting the performance of CCGs. A mixed methods approach was used amongst 368 CCGs and 17 OMs. Data was collected from CCGs using questionnaires while an interview schedule was used to collect data from OMs. The study showed that the performance management systems currently being used were not providing the desired performance management outputs. There were no performance bonuses to recognise best performing staff and therefore no increase in performance. The study also showed a significant relationship between the management of referrals and participation in the activities of PHC outreach teams. The clinic was not regularly giving feedback to the respondents and also not consistently conducting performance reviews. The findings indicated that OMs were playing various roles in the provision of PHC, namely policy and strategy implementation; leadership and governance; clinical care; allocation of resources; clinic budget management; supply chain management; and writing clinic reports. The extent of the allocation of resources to the wards varied from 43% for medicines and equipment to 31% for financial resources and only 18% for human resources. More than 95% of the CCGs viewed the availability of transport, resources, training and the provision of a stipend to be strong enabling factors for them to perform their work. Respondents indicated that monitoring and evaluation was done through reporting, performance reviews, feedback and supervision. The findings indicated that ward-based outreach teams are crucial in the delivery of PHC services in rural municipal wards within the Operation Sukuma Sakhe programme. Lack of management and supervisory support contribute to high rates of dissatisfaction amongst CCGs, as well as poor quality of work for community caregivers. There is a need for the Department of Health (DoH) to invest in the ward-based outreach teams (WBOTs) and allocate CCG budgets within the ward-based outreach teams. The study recommended that a review of monitoring and evaluation policy is required to clearly state the tools, activities and benefits of the implementation of the M & E performance management systems. The use of point-of-care technology by the WBOTs should be strengthened especially in deep rural wards. Therefore, biomedical technology will enhance point-of-care diagnosis, for instance, rapid home test kits for HIV diagnosis and pregnancy tests. The KwaZulu-Natal DoH should fast-track development of the sub-districts in order strengthen service delivery at a local level with top management ensuring development of OMs and PHC Supervisors in order to increase the level of competence and thereby improve service delivery at the PHC facilities. Another recommendation was to strengthen implementation of Operation Sukuma Sakhe (OSS) where the war room and the ward committee increase commitment to designing community-specific interventions with the engagement of community structures and government departments and local municipality through social planning, social action and locality development. Therefore, the results of the study should also influence the formulation of policies, programmes, methods and interventions which will enable UThukela District Municipality to improve health outcomes. / D

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: An exploration of the integrated nature of sustainable development planning and health care was done in the context of people living and working in the town of Grabouw in the Western Cape. The problem that was investigated was that people working within local government and community health networks treated sustainable development planning and health care as separate issues. The notion of wellness, as different from health, was used as a central theme in the study. It allowed for an acknowledgement of the multidimensionality and contextual nature of human well-being. The notion of sustainable community wellness was used to guide the research, and was viewed as a complex phenomenon. The meanings of sustainable community wellness to people who work and live within local government and community health networks in Grabouw were observed and documented. Complexity theory was then used to discuss the observed perspectives on sustainable community wellness. Two factors informed the selection of Grabouw as a research site: Firstly, a comprehensive sustainable development programme was being carried out in the town of Grabouw during the research. Secondly, a few community health care initiatives were also being implemented at the time. Community care workers who worked in one of the community health organisations participated as primary research participants. The research combined conceptual and empirical research. The conceptual research consisted of a literature review of perspectives on wellness in Grabouw. The empirical research methods that were used combined ethnography in the form of participant observation, and participatory action research in the form of participatory photography. The researcher accompanied community care workers on their daily visits to patients. The care workers took photographs of aspects of their surroundings that represented sustainable community wellness, or the lack thereof, to them. Photographs were analysed through focus group discussions and pertinent themes were subsequently identified. Three meanings of sustainable community wellness were discovered. The first was the structural, governmental meaning that gave importance to health and socio-economic statistics, based on the mortality profile of the area. Wellness was seen from this perspective as a challenge that could be met with strategic planning. The second meaning was the community-based experience of environmental factors in Grabouw that had an impact on wellness, such as water, community forums and living spaces. In this case, wellness was experienced as a rich and diverse set of factors, both social and environmental. The third meaning was observed as instances where the apparent separate entities of local government, the community, and the physical environment were seen as one socio-ecological system, of which sustainable community wellness was an emergent property. These instances demonstrated the importance of managing the quality of relationships within the system, the need to enhance the autonomy of people working in the system and the potential of community care workers to be agents of sustainable community wellness. / AFRIKAANSE OPSOMMING: Ondersoek is gedoen na die geïntegreerde aard van volhoubare ontwikkelingsbeplanning en gesondheidsorg in die konteks van mense wat in die dorp Grabouw in die Wes-Kaap woon en werk. Die probleem wat ondersoek is, is dat mense wat in plaaslike regerings- en gemeenskapsgesondsheidnetwerke werk, volhoubare ontwikkelingsbeplanning en gesondheidsorg as afsonderlike sake beskou. Die begrip ‘welstand’, wat in betekenis van ‘gesondheid’ verskil, is as 'n sentrale tema in die studie gebruik, en is soortgelyk aan die begrip ‘welwees’. Dit het erkenning verleen aan die meerdimensionele en kontekstuele aard van menslike welwees. Die begrip volhoubare gemeenskapswelstand wat as 'n komplekse verskynsel beskou is, het die ondersoek gerig. Die betekenis van volhoubare gemeenskaps-welstand vir mense wat in plaaslike regerings- en gemeenskapsgesondheidnetwerke in Grabouw woon en werk, is waargeneem en gedokumenteer. Kompleksiteitsteorie is voorts gebruik om die waargenome perspektiewe op die volhoubare gemeenskaps-welstand te bespreek. Twee faktore het die besluit om Grabouw as 'n navorsingsgebied te gebruik, beïnvloed: Eerstens was daar tydens die navorsingstydperk reeds 'n omvattende volhoubare ontwikkeling program in Grabouw aan die gang. Tweedens was 'n paar gemeenskapsgesondheidsorg-inisiatiewe ook in dié tydperk aktief. Gemeenskapgesondheidswerkers wat in een van die gemeenskapsgesondheidsorganisasies gewerk het, was primêre deelnemers aan die navorsing. In hierdie ondersoek is konseptuele en empiriese navorsing gekombineer. Die konseptuele navorsing het uit 'n literatuuroorsig van perspektiewe op welwees in Grabouw bestaan. Die empiriese navorsingsmetodes wat gebruik is, het etnografie in die vorm van deelnemende waarneming, asook deelnemende-aksie-navorsing in die vorm van deelnemende fotografie, behels. Die navorser het gemeenskapsgesondheidswerkers op hul daaglikse besoeke aan pasiënte vergesel. Hierdie werkers het foto's geneem van die aspekte van hul omgewing wat na hulle mening die volhoubare gemeenskaps-welstand, of die gebrek daaraan, verteenwoordig. Foto's is tydens fokusgroepbesprekings ontleed en relevante temas is daardeur geïdentifiseer. Drie betekenisse van die volhoubare gemeenskaps-welstand het tydens die ondersoek na vore gekom. Die eerste is die strukturele, regeringsverwante betekenis wat bestaan het uit gesondheidsen sosio-ekonomiese statistiek, gebaseer op die sterftesyferprofiel van die gebied. Welstand is vanuit hierdie perspektief gesien as 'n uitdaging wat deur middel van strategiese beplanning aangepak kon word. Die tweede betekenis is die gemeenskapsgebaseerde ervaring van omgewingsfaktore wat 'n uitwerking op welstand het, soos water, gemeenskapsforums en leefareas in Grabouw. Welstand is in hierdie geval ervaar as bestaande uit 'n reeks ryke en diverse faktore wat beide sosiaal en omgewingsverwant is. Die derde betekenis is waargeneem deur die identifisering van die gevalle wat die kompleksiteit van die stelsel wat bestudeer is, verteenwoordig het. In hierdie gevalle is die oënskynlike aparte entiteite van plaaslike regering, die gemeenskap, en die fisiese omgewing gesien as 'n sosio-ekologiese sisteem waarvan volhoubare gemeenskaps-welstand 'n ontluikende element is. Deur hierdie gevalle is daar aangetoon dat dit belangrik is om die gehalte van die verhoudings binne die stelsel te bestuur en om die outonomie van die mense wat binne die stelsel werk te ondersteun. Ten slotte is die potensiaal van gemeenskapsgesondheidswerkers om as agente van die volhoubare gemeenskaps-welstand op te tree, uitgelig.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The accessibility of anti-retroviral drugs to patients and families affected by HIV and AIDS, and the affordability of these drugs, have been challenges to the Du Noon community in the Cape Peninsula. The aim of the study was to assess the effectiveness of primary health care services in addressing HIV/AIDS in the light of these challenges. The focus was on patients registered on the ARV programme and who were receiving treatment at Du Noon Clinic. Interviews were conducted with 15 groups of 10 patients each using a patient questionnaire. During these interviews qualitative and quantitative data were gathered and secondary data was used for quantitative analysis. The results that the data analysis yielded are in keeping with the hypothesis that the HIV/AIDS programme is effective in meeting the needs of the HIV/AIDS patients of Du Noon. After content analysis of qualitative data, two themes related to patient satisfaction emerged: positive and negative feelings that were categorised as satisfied and not satisfied with the service. Most often noted was the feeling of satisfaction with the services rendered at the clinic and that the staff were helpful. The staff rendering the service were also satisfied with the kind of service offered to the patients, but were dissatisfied with the allocation of resources. An increase in enrolment figures of patients was noted in the statistical analysis for the period 2004-2008 with 1,018 patients registered. The statistics illustrate the linear tendency in the enrolment of patients, which indicated the accessibility and affordability of the service. / AFRIKAANSE OPSOMMING: Geredelike toegang tot en die bekostigbaarheid van anti-retrivorale middels (ARM’s) vir pasiënte en families wat deur MIV en VIGS aangetas is, is ‘n uitdaging vir die Du Noon-gemeenskap in die Kaapse Skiereiland. Die doel van die studie was om die doeltreffendheid van primêre gesondheidsorgdienste te bepaal wanneer MIV/VIGS aangespreek word. Die fokus is op geregistreerde pasiënte wat die ARM-program volg en behandeling by die Du Noon Kliniek ontvang. Met behulp van ‘n pasiëntevraelys was onderhoude met 15 groepe van 10 pasiënte elk gevoer. Tydens hierdie onderhoude is kwalitatiewe data versamel en vir kwantitatiewe analise was sekondêre data aangewend. Die resultate wat uit die data analise verkry was, strook met die hipotese dat die MIV/VIGS-program doeltreffend is om die behoeftes van die pasiënte en die gemeenskap van Du Noon aan te spreek. Nadat ‘n inhoudsanalise van die kwalitatiewe data onderneem was, het twee temas rakende positiewe en negatiewe gevoelens – gekategoriseer as tevrede en nie tevrede nie – ten opsigte van die gelewerde diens na vore getree. Veral die gevoel van tevredenheid teenoor die diens gelewer by die kliniek en die personeel as behulpsaam, is opgemerk. Die personeel wat die diens lewer, was ook tevrede met die diens wat aan die pasiënte gelewer word, maar was ontevrede oor die toekenning van hulpbronne. By die statistiese analise is ‘n toename in die inskrywingsgetalle deur pasiënte waargeneem. Toename in inskrywingsgetalle deur pasiënte is gemerk in statistiese analise van 2004 - 2008, met 1,018 pasiënte geregistreer. Die statistiek het die lineêre tendens toegelig ten aansien van die inskrywing van pasiënte wat die toeganklikheid en bekostigbaarheid van die diens uitbeeld.

This research investigated the availability and nature of the rehabilitation service at primary health care level rendered by rehabilitation staff in the Metropole district health services. The aim of the study was to determine the extent to which selected elements of the rehabilitation components of the primary health care service package are currently being implemented. In doing so, the study aimed to identify obstacles within the district management as perceived by rehabilitation therapists that hinder the implementation of the rehabilitation programme, so as to make recommendations for future planning.

The purpose of this study was to explore and describe staff experiences in managing data and/or information when utilising the District Health Information System (DHIS) as a support mechanism for data quality improvement, including the strengths and weaknesses of current data management processes. It was also aimed to identify key barriers and to make recommendations on how data management can be strengthened. Key informants included in this study were those based at the district office (health programme managers and information officers) and at the primary health care (PHC) facilities (facility managers, clinical nurse practitioners and data capturers). An exploratory, descriptive and generic qualitative study was conducted. Consent was requested from each participant. Data were collected through semi-structured interviews. The study findings highlighted strengths, weaknesses and key barriers as experienced by the staff. Strengths, such as having data capturers and DHIS software at most if not all facilities, were highlighted. The weaknesses and key barriers highlighted were staff shortages of both clinical and health management information staff (HMIS), shortage of resources such as computers and Internet access, poor feedback, training needs and data quality issues. Most of the weaknesses and key barriers called for further and proper implementation of the District Health Management Information Systems (DHMIS) policy, the standard operating procedures (SOP), the eHealth strategy and training of the staff, due to the reported gaps between the policy and the reality and/or practice at the facility / Health Studies / M. A. (Public Health with specialisation in Medical Informatics)

OBJETIVO: Verificar se a adoção da estratégia Saúde da Família (ESF; antigo Programa Saúde da Família, PSF) está ou não associada a menores taxas, chances ou risco de internação por condições sensíveis à atenção primária (CSAP), quando comparada à atenção básica tradicional. MATERIAIS E MÉTODOS: Estudo de revisão sistemática da literatura científica, usando os termos \'saúde da família\' e (\'programa\' ou \'estratégia\') e (\'internações sensíveis\' ou \'condições sensíveis\'), bem como seus correspondentes em inglês. A busca não foi limitada por ano de publicação, mas abrangeu apenas pesquisas originais que tenham testado a associação entre o modelo de atenção básica e as internações por CSAP na população geral. As fontes de dados utilizadas foram os índices MEDLINE, LILACS e IBECS, através da Biblioteca Virtual em Saúde (BVS) e do PubMed. A qualidade metodológica não foi usada como critério de exclusão, mas sim para explorar as eventuais divergências dos resultados. O instrumento de avaliação foi uma lista com 10 itens a serem verificados, proposta por Downs & Black e adaptada por Nedel et al. RESULTADOS: Foram localizadas 82 citações únicas, das quais apenas 4 atenderam aos critérios de inclusão. Os estudos tinham variadas abordagens metodológicas, mas todos encontraram alguma associação inversa entre a ESF e as internações por CSAP. Essa associação variou de acordo com a faixa etária, o sexo, o grupo de CSAP, e o tamanho do município. DISCUSSÃO: A Saúde da Família se mostrou associada a um menor número de internações por CSAP, especialmente no sexo feminino, nos idosos, e para as condições cardiovasculares, as condições respiratórias e o diabetes mellitus. Sugere-se a necessidade de que as análises sejam conduzidas separadamente para cada combinação de sexo, faixa etária e CSAP, e que o controle ou não da análise por aspectos de qualidade da atenção básica seja explicitamente decidido com base num marco conceitual. / OBJECTIVE: To verify if the adoption of the Family Health strategy (ESF; formerly named Family Health Program, PSF) is associated with lower rates, odds or risk of hospitalization by ambulatory care sensitive conditions (ACSC), compared to the traditional Brazilian primary health care (PHC) model. MATERIALS & METHODS: A systematic review of the scientific literature using the terms (\'family health program\' or \'familial health strategy\') and (\'sensitive conditions\' or \'sensitive hospitalizations\'), as well as the corresponding terms in Portuguese. The was no publication date limit, but the search was restricted to original research testing whether if there\'s an association between the PHC model and hospitalizations by ACSC in the general population. The data sources included MEDLINE, LILACS and IBECS, through PubMed and Biblioteca Virtual em Saúde (BVS). The methodological quality was not used as an exclusion criterion, but to explore eventual divergences in the results. The assessment instrument was a checklist with 10 items, proposed by Downs & Black and adapted by Nedel et al. RESULTS: 82 unique citations were found, but only 4 of them matched the inclusion criteria. The studies have variable methodological approaches, but all of them found some association between ESF and hospitalizations by ACSC. This association changed with age, sex, ACSC group, and municipality size. DISCUSSION: Family Health was associated with less hospitalizations by ACSC, specially in the female sex, in the elderly, and for cardiovascular conditions, respiratory conditions and diabetes mellitus. It may be necessary to run the analysis separately for each combination of age group, sex and ACSC group. Controlling or not the analysis for PHC quality should be explicitly decided on basis of a conceptual framework.