This thesis provides a historical account of the emergence of the pharmacy education system in South Africa, and an analysis of the influence of competing interest groups over the pharmacy education curriculum. It provides a critical evaluation of structural-consensus and micro-interpretive approaches to medical and pharmacy education, and sets out a macrointerpretive account of pharmacy education in South Africa. Following Margaret Archer (1979) it analyzes three forms of negotiation between competing interest groups in their efforts to change the pharmacy curriculum; these are political manipulation, external transaction and internal initiation. The thesis argues that whilst the private sector interest group (comprising of retail, wholesale and manufacturing pharmacy) dominated the pharmacy education system until 1994, since then a newly emerged government interest group has begun to compete for educational control. The priorities pursued by this interest group have consistently reflected the objectives set out in the ANC National Health Plan of 1994. The thesis maintains that given its frustration over the non-implementation of the ANC’s health policy objectives, the government interest group is likely to resort to direct political manipulation by passing legislation to alter the content of the current pharmacy curriculum. Such changes would seek to ensure that the syllabus more accurately reflects the ANC Plan’s community health and primary health care objectives. The thesis asserts that such an outcome (of direct political manipulation of the curriculum) is not inevitable, and can be avoided through a process of internally initiated change. It presents the findings of an interpretive case study into how the Rhodes University Community Experience Programme (CEP) influenced final year pharmacy students’ perceptions of the role of the pharmacist. The students’ comments were collected by means of focus group interviews, participant observation and documentary analysis. Whilst the CEP did not successfully transform their concept of the pharmacist’s role, it did succeed in influencing students’ understanding of the notions of community pharmacy and primary health care in line with the government interest group’s health objectives. This thesis concludes that internally initiated change within the pharmacy education system, would be preferable to that imposed through external political manipulation, as such change would be more likely to preserve the independent professional interests of pharmacy academics.

The nursing student who has undergone the four year diploma or degree training as a nurse also has to undergo compulsory community service as a requirement before she/he can be registered as a qualified professional nurse. While it has been compulsory for other health professionals such as doctors, dieticians or dentists to place students in compulsory community service, it has only been compulsory for nursing students since 2008. This means that the practice is relatively new in nursing and it is not clear how the newly qualified professional nurse experiences compulsory community service (CCS). The overall goal of this study is to determine the experiences of professional nurses placed at the state hospitals in Nelson Mandela Bay regarding compulsory community service clinical placement exposure and to use these descriptions to develop guidelines. The study followed a qualitative, exploratory, descriptive, contextual design. Literature was reviewed in order to identify research that was done previously regarding compulsory community service amongst health care professionals. The research population included professional nurses who underwent compulsory community service in the three state hospitals in the Nelson Mandela Bay. Purposive sampling was utilised to identify the participants. Semi-structured interviews were conducted to collect information and field notes were kept. The interviews were transcribed and Tech’s (1990) in Creswell, 2009:186) eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness which consists of the following four constructs, namely credibility, transferability, dependability and conformability (Lincoln & Guba, 1999, as cited in Schurink, Fouche & de Vos, 2011:419- 421). Three themes and sub themes were identified. Literature control was done to compare the findings with existing research results. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as beneficence, justice and fidelity. All the participants in the study felt that the clinical placement exposure was a worthwhile experience. The participants expressed a feeling of gratitude that they were afforded this opportunity of practicing under the guidance of experienced professional nurses. To them it was an opportunity to master whatever they were taught as student nurses so that by the time they practice as independent practitioners they would be confident and knowledgeable. The CCS nurses indicated that orientation and mentorship were not always of good quality and professional nurses were not always available as in some units professional nurses were not readily accessible. The CCS nurses were left alone and isolated with no one to consult. If proper orientation and mentorship had been in place the CCS nurses would have enjoyed the community service year more and they felt that they would have benefited more. Had there been a mentoring system in place it could have gone a long way to ascertain that the participants gained confidence and were able to perform tasks independently and confidently. The participants overwhelmingly indicated that unit management should have been included in their CCS year placement. During the CCS year the CCS nurses were not exposed to unit management. This was seen by CCS nurses as a missed opportunity. Had they been afforded the opportunity to practice unit management under the supervision of unit nursing managers, professional growth and development in unit management could have been facilitated. That they were not afforded that opportunity deprived them of a valuable skill as well as personal and professional growth. In conclusion guidelines for placement of CCS nurses in the Nelson Mandela State hospitals have been formulated for implementation. Recommendations were made to enhance nursing practice, nursing education and nursing research.

Primary health care has been the cornerstone of South Africa's health policies since its transition to democracy in 1994. In order to optimise the effectiveness of primary health care, the South African government introduced community health committees hich were intended to facilitate primary health care at the grassroots level through community participation. As statutory bodies outlined in the National Health Act, 61 of 2003, and in provincial legislation, Community Health Committees were to be the liaison between communities and government and assist government in improving health services in communities. Since being re-established in 2010, Community Health Committees in the Nelson Mandela Bay Health District, Eastern Cape Province, South Africa have sought to fulfil this role and have remained sustainable. This research was aimed at investigating the strategies and approaches which sustain Community Health Committees in Nelson Mandela Bay Health District. It focused on eliciting information regarding the factors that sustain Community Health Committees, factors that threaten their sustainability and factors that motivate continued membership in Community Health Committees. Qualitative research methods of key informant interviews, observations and focus groups were used and analysed to identify these factors. The findings indicated that Community Health Committees struggle to remain sustainable because of various threats to their functioning. The major threat identified was the disengagement of the Department of Health in the operations of the Community Health Committees. The Department of Health was not visible; rather it was passive and unresponsive to the reports submitted by Community Health Committees on behalf of their communities and provided no re-imbursement for administration costs. Despite threats to sustainability, these Community Health Committees had commitment, passion and drive to assist with the health improvement of their communities in partnership with health facilities in their communities. Good interpersonal relationships in the Community Health Committees, good professional relationships with the health facility staff and the liaising role played by health facility management are some of the factors that contributed to sustainability. Recommendations were made at the end of the study that may assist the Nelson Mandela Bay Health District and the Department of Health to create a working environment that will be conducive to the sustainability of Community health Committees.

The purpose of this study was to explore the lived experiences of the newly qualified professional nurses in midwifery section doing community service. A qualitative descriptive, interpretative phenomenological research was conducted to determine the experiences. The sample included newly qualified professional nurses doing community service. Data collection was conducted by means of unstructured interviews from ten (n=10) informants. Each interview was approximately 45 minutes. Ethical issues were considered. Hussel and Heidergadian’s data analysis steps were followed. Four (4) themes and eleven (11) sub-themes emerged from the data collected. The findings revealed that the newly qualified professional nurses were in a state of reality shock, demonstrated by challenges such as shortage of human and material resources; overcrowding; lack of support; and the placement of Midwifery Nursing Science in the curriculum has impacted negatively on midwives’ registration as professional nurses. Based on the current practical nursing education environment and further research, this study concludes by presenting its recommendations and limitations. / Health Studies / M. A. (Health Studies)

This dissertation reports on an evaluation of the home visiting programme of the SACLA Rehabilitation Worker project against the background of the socio-economic context of the community and the history of the project. The evaluation had two aims. Firstly, it aimed to highlight the programme's strengths and weaknesses so that the work could become both more efficient and more effective. Secondly, it aimed to establish whether the SACLA rehabilitation project is an effective model of a community based rehabilitation project on which other local projects could be based. Quantitative data was collected by interviewing the caregivers of disabled children who were involved in the project. In-depth interviews with the rehabilitation workers provided qualitative data which was used to confirm the validity of some of the quantitative data. The foremost findings were that the mothers were very positive about the support received from the RWs. The majority of the caregivers remembered the activities that they had been taught by the RWs and performed them well. Poor communication with the caregivers and a lack of skills on the part of the RWs gave rise to a number of problems. A number of changes highlighted by the evaluation were suggested. In conclusion, the project was found to be an effective model of local community based rehabilitation on which other projects could be based.

The research study focuses on transformation management in a welfare organisation and is aimed at developing a framework for a prospective model for management of a transformation process in a welfare organisation. The research was directed by two components, the nature, and the management of transformation, and was initiated with a literature study on these two concepts. The research study is limited to the Gauteng area, and only child and family welfare organisations which were already active participants of a transformation process were targeted. Data collection process was initiated by means of a structured interview schedule, completed by managers/senior social workers/ Board chairpersons (the target group). Results of the study indicate that a majority of the twenty targeted organisations had undergone an unstructured transformation process. A structured, well formulated, and planned transformation management process was required as a guideline, with a view to developing a prospective model for the management of a transformation process in a welfare organisation. Results and conclusions drawn from this study can be generalised in the broader spectrum of welfare organisations for the management of a transformation process. Further research is needed to develop the required model. / Social Work / M. Diac. (Social Work)

Text in Afrikaans / Die probleem wat in die studie ondersoek word is: wat die aard van die behoefte aan gemeenskapgesondheidsinligtingdienste (GGID) in Suid-Afrika, met besondere verwysing na Bloemfontein en Mangaung, is. Daar word van 'n verkennende studie gebruik gemaak om die navorsingsdoelstellings te bereik. Die metodes wat gebruik is, is literatuurstudie, gevallestudie en opname. Die tegnieke wat gebruik is, is vraelys, skedule en onderhoud. 'n Oorsig oor gesondheidsorg, met die klem op primere gesondheidsorg as agtergrond vir gesondheidsopvoeding en -inligting, word gegee. Daar word verwys na die rol van verskillende biblioteektipes en die bibliotekaris. Redes vir die ontstaan van gemeenskapgesondheidsinligting, die verspreiding van GGID in die buiteland en die fvksionering daarvan word beskryf. 'n Ondersoek is in Mangaung en Bloemfontein gedoen om die behoefte aan GGID en die aard van gesondheidsinligting te probeer bepaal. 'n Model word saamgestel uit die behoeftebepaling en die literatuurstudie / The subject investigated by this study is: the nature of the need for community health information services (CHIS) in South Africa, with special reference to Bloemfontein and Mangaung. An exploratory study has been used to achieve the research objectives. The methods used are review of the literature, case study and a survey. The techniques used are a questionnaire, schedule and interview. A review of health care, emphasizing primary health care as a backgound to health education and information, is given. The role of different types of libraries and the librarian is discussed. Reasons for the development of community health information, the distribution of CHIS overseas and their functioning are described. An investigation was done in Bloemfontein and Mangaung to gauge the need for CHIS and the nature of health information. A model has been formulated, based on this survey and the literature review / Information Science / M. Bibl. (Inligtingkunde)

The research study focuses on transformation management in a welfare organisation and is aimed at developing a framework for a prospective model for management of a transformation process in a welfare organisation. The research was directed by two components, the nature, and the management of transformation, and was initiated with a literature study on these two concepts. The research study is limited to the Gauteng area, and only child and family welfare organisations which were already active participants of a transformation process were targeted. Data collection process was initiated by means of a structured interview schedule, completed by managers/senior social workers/ Board chairpersons (the target group) . Results of the study indicate that a majority of the twenty targeted organisations had undergone an unstructured transformation process. A structured, well formulated, and planned transformation management process was required as a guideline, with a view to developing a prospective model for the management of a transformation process in a welfare organisation. Results and conclusions drawn from this study can be generalised in the broader spectrum of welfare organisations for the management of a transformation process. Further research is needed to develop the required model. / Social Work / M.Diac. (Social Work)

Thesis (MComm)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: Historically health care in South Africa has been an area of great inequity. Health care was inequitable, inadequate and racially based. In order to redress the gap in the delivery of health care services, created by the previous dispensation of separate development, the National Department of Health has adopted a Primary Health Care (PHC) approach as the guiding principle for the reconstruction of the health system in South Africa. One of the pillars of this approach is the empowerment of communities to participate, thus moving from facility based- to community based health care. The aim of the National Health System (NRS) is to promote health and health knowledge, to provide an equitable, accessible, and appropriate health service, and to empower people to take greater responsibility for their own health. It is constructed around the belief that health for all cannot be achieved simply by improving the formal health system, but that a holistic and multi-sectoral approach is required. This thesis explores the community health worker (CRW) as a possible cost-effective and efficient supplementary service, to the current formal health system, to bridge the gap in the formal health system through the provision of PHC services in a rural setting. This was done through the economic evaluation of a CHW programme operating in the Winelands are of the Western Cape. The aim of this study was to evaluate and analyse the nature, performance, and costs of the programme and place it in context by comparison to other similar programmes. This comparison focused on physical characteristics, goals, and cost structures. It also aims to measure the direct and indirect impact of this type of intervention on the agribusiness sector as well as the local health authorities. The evaluation proceeded from the premise that the CHW programme, if implemented correctly with proper and appropriate training, and adequate post training support, will be a cost-effective and efficient model for the provision ofPHC services in this rural/farming area. The economic evaluation of this CHW programme required it to be viewed from two perspectives. The first component viewed the implementation of the programme from the perspective of the agribusiness sector. This aspect of the study included both a qualitative as well as a quantitative VIew of the costs, benefits (perceived or otherwise), and perceptions of the CHW intervention. The second component assessed the CHW programme within the context of a resource constrained public sector health budget. Since the implementation of this programme implies certain expenditures on the part of the local health authorities, these cost had to be identified and quantified to gauge the effectiveness of that expenditure. / AFRIKAANSE OPSOMMING: Geskikte en doeltreffende gesondheidsdienste in Suid-Afrika se onlangse geskiedenis was nog gereserveer vir 'n uitgesoekte groep mense. Die gesondheidstelsel was ontoereikend, onvoldoende en gebaseer op ras. Daar het 'n gaping ontstaan tussen die dienste wat gelewer is en die werklike behoeftes van die mense wat dit moes gebruik. Ten einde hierdie gaping aan te spreek het die Nasionale Departement van Gesondheid besluit om 'n Primêre Gesondheidsorg (PRe) benadering te volg wat klem plaas op die bemagtiging van plaaslike gemeenskappe deur deelname. Dit was 'n duidelike skuifvanaffasiliteit- na gemeenskap gebaseerde gesondheidsdienste. Die oorkoepelende doel van hierdie verskuiwing in fokus was om voorheen benadeelde gemeenskappe voldoende toegang te gee tot gesondheidsdienste en ook om hierdie dienste aan te pas by die behoeftes van sodanige gemeenskappe. Hierdie tesis ondersoek die Wynland distriksraad se Gemeenskap Gesondheidswerker Program as 'n moontlike koste-effektiewe stelsel vir die lewering van toepaslike primêre gesondheidsdienste in landelike areas. Die doel van die studie was die sistematiese ontleding van die werking en omvang van, en die kostes verbonde aan die implementering en onderhoud van hierdie program. Die studie poog om die impak van hierdie program op die formele landbou sektor asook die plaaslike gesondheidsowerhede te identifiseer en, waar moontlik en prakties wenslik, te kwantifiseer. Die ondersoek sluit in die stelselmatige ontleding van kostes en voordele vir die formele landbou sektor sowel as die plaaslike gesondheidsowerhede. Die kostes asook die kliniese uitkomste geassosieer met die implementasie van die Gesondheidswerker program sal dan in konteks geplaas word deur dit te vergelyk met ander soortgelyke programme wat in die verlede aangepak is. Die vergelyking sal fokus op die fisiese eienskappe, koste struktuur, bronne van ondersteuning en die primêre doel van die intervensie.

The research study focuses on transformation management in a welfare organisation and is aimed at developing a framework for a prospective model for management of a transformation process in a welfare organisation. The research was directed by two components, the nature, and the management of transformation, and was initiated with a literature study on these two concepts. The research study is limited to the Gauteng area, and only child and family welfare organisations which were already active participants of a transformation process were targeted. Data collection process was initiated by means of a structured interview schedule, completed by managers/senior social workers/ Board chairpersons (the target group). Results of the study indicate that a majority of the twenty targeted organisations had undergone an unstructured transformation process. A structured, well formulated, and planned transformation management process was required as a guideline, with a view to developing a prospective model for the management of a transformation process in a welfare organisation. Results and conclusions drawn from this study can be generalised in the broader spectrum of welfare organisations for the management of a transformation process. Further research is needed to develop the required model. / Social Work / M. Diac. (Social Work)