The Department of Health (DH) is responsible for one of the largest estates in Europe. In this capacity, the DH produce and disseminate estates-related Standards & Guidance (S&G) to provide support to the briefing and design processes for new, and refurbishment projects in old healthcare buildings. The estate is made up of a variety of buildings, many ageing and in need of extensive refurbishment or replacement. It is therefore important to the stakeholders in the procurement and provision of healthcare environments that the DH S&G provide them with the information and data they need at the relevant time in the process to enable them to design and construct healthcare facilities that are safe and fit-for-purpose. Policy changes over the past 20 30 years have had a profound effect upon the estate. The estate was seen to be in need of modernisation, but Government lacked the extensive funding necessary to achieve anything like the extent of redevelopment required. The introduction of private sector funding to achieve this resulted in a major shift in the ownership of the estate, and latterly the regulation of the estate, both private sector and National Health Service (NHS). The NHS Constitution, introduced in 2009, was the first Government document explicitly to recognise the estate and the importance of it being fit-for-purpose. This research seeks to establish the importance of the DH S&G, and their benefits and dis-benefits to stakeholders using them, including organisations and individuals from the private and public sectors. The groups have differing roles and priorities and the research seeks to establish how these affect their requirements for S&G, how effectively the S&G meet those requirements and how they contribute to the overall provision of healthcare environments. Moreover, hospital accommodation has been proven to have an effect on the patients and staff, therefore, the provision of useful and helpful S&G could be seen to have an indirect influence on patient outcomes, and also on providing a pleasant and efficient environment for staff. The research has identified three major strands: Policy; the DH S&G themselves; and what is important to users about them and any benefits or dis-benefits incurred. Policy is viewed as the driver for the need for DH S&G. The changing political environment, amongst many other factors, affects how the S&G have been operationalized. This study of the application of DH S&G aims to establish how users view the benefits and dis-benefits and their effects on the healthcare environment. Research in the construction industry sector spans the scientific and social worlds, and the methodology is deductive research orientated, exploiting a range of data. Qualitative and quantitative data have been collected through open interviews with known experts and an on-line survey of the stakeholders using the S&G from private and public sector organisations involved with the provision of healthcare accommodation. Reference to the DH S&G and related unpublished DH documents traces their development and examines their content. The results have been mapped to the stakeholder categories (Designers, Service Users, Estates and Facilities Managers, Contractors and the DH/NHS), thus enabling comparisons to be made between each group, and between the public and private sectors. Analysis of the data identified the characteristics users found to be of importance and of benefit or dis-benefit. On balance, it was clear that the DH S&G are beneficial, but not universally. Of prime importance to its users is the DH endorsement of the S&G and its independence from commercial influences. However, the classification of the DH S&G, defined as best practice is often regarded and applied as mandatory. The content of the S&G varies in its scope, content and characteristics, being perceived as incomplete, inconsistent and out-of-date. Taking all these factors, therefore there is a danger that the DH S&G may contribute to healthcare buildings being unfit-for-purpose or out-of-date.

The goal of the study was to explore the effect of garnishee orders on the personnel of the Department of Health, Rustenburg. The researcher utilised a qualitative research approach to gain deeper understanding of the effects of garnishee orders on the employees. The study used a non-probability sampling technique with volunteer sampling to select the sample of ten participants. Semi-structured interviews conducted with the use of an interview schedule in conjunction with a recording device were used to gather data. A qualitative analysis was used to grasp the richness of themes derived from the narrative of participants. In analysing data the researcher was guided by the analytical spiral of Creswell (1968) as stipulated by De Vos (2005:334) which involves planning and recording of data, data collection and preliminary analyses, managing and organising data, reading and writing memos, generating categories, themes and patterns, coding the data, testing the emergent understanding, searching for alternative explanations and representing and visualising. The empirical findings reveal that employees and management were confronted by the phenomenon of garnishee orders on a daily basis. The majority of participants view external factors to be the cause of their financial difficulties. The participants further revealed that they feel trapped by over-indebtedness resulting in psycho-social and occupational maladjustments. Ironically, some of the participants reported positive effects of garnishee orders. Furthermore, the study revealed that the participants felt that they would benefit from regular guidance and training with regard to personal financial management. / Dissertation (MSocSci)--University of Pretoria, 2013. / Social Work and Criminology / unrestricted

(MBA) North West University, Mafikeng campus, 2005

M. Tech. Business Administration / The subject of absenteeism in human resources management literature has considerably dominated centre stage at a global level. Based on the National Department of Health's 2011 Quarterly Report, absenteeism in the department has for long been claimed to be on the rise. As a result, it has been said to be causing detrimental repercussions on the department's capacity to deliver sufficient health facilities to society as it is constitutionally mandated. It is against the background of these claims that the researcher has been prompted to evaluate the factors causing absenteeism in the National Department of Health and further recommending appropriate remedial measures that can be enforced to minimise and ultimately curb such high rates of absenteeism. The aim of the study is to explore and evaluate the relevant causes of absenteeism in the National Department of Health.

Contemporary English health policy is saturated with claims about what the world is like and how it might be otherwise. These claims span the wide range of subject matters covered by health policy, from hospital waiting times to our preparedness for major disease outbreaks; from structures for the planning and purchasing of healthcare to requirements around the sharing of patient records. Despite this, empirical studies of health policymakers working at the national level in the UK suggest that research evidence plays only a very limited role in policy development (Lavis et al. 2005; Dash 2003; Dash et al. 2003; Innvær et al. 2002; Petticrew et al. 2008). This apparent contradiction was the starting-­‐point for this project. If civil servants are not drawing on research knowledge in their work, how is it that they are able to devise policy about such complex and technical policy issues? Policy-­‐making requires knowing the world in some way in order to act upon it. My research asks, what kinds of knowledge are civil servants in England’s Department of Health using in their work, and what forms does this use take? This thesis is situated in an emerging field of interpretive policy analysis which treats policymaking as realised in the daily work practices of communities of individuals (Wagenaar & Cook 2003; Wagenaar 2004; Colebatch 2006; Colebatch et al. 2010; Freeman et al. 2011). I have adopted an ethnographic approach, conducting 60 hours of original data collection in the form of interviews and meeting observations among mostly mid-­‐ranking civil servants working on various high-­‐profile health policies in 2010-­‐11. By analysing my fieldwork experiences and the resulting data, and by relating these to insights from theoretical resources in sociology, psychology and philosophy, I offer an account of the different forms of knowing and knowledge entailed in the practice of policy-­‐making. I identify three forms of knowledge and knowing that were integral to the work of the civil servants I studied: the ‘practices of knowing’ by which they came to understand the objects of their policies and think through the possibilities for their reform; the ‘pragmatic use of knowledge claims’ in which facts, figures and stories were invoked to generate support for policies and to defend decisions taken; and the ‘know-­‐how of policymaking’, which was the most important form of knowledge for the civil servants’ professional identities. In the conclusion, I reflect on the aspects of knowledge and knowing which are shared by the civil servants’ practices and my own work in producing this thesis.

Objective: To describe a sample that received human rabies postexposure prophylaxis (PEP) in Virginia as a result of animal exposures in 2002 and 2003 and to determine the extent to which PEP decisions were appropriate.Methods: PEP surveillance data were requested from 35 Virginia health districts within 5 regions. Retrospective chart review was used to gather demographic, exposure and source animal data from patient records and animal exposure reports. Descriptive statistics are presented. True exposures and appropriateness of PEP were defined using the 2004 Virginia Rabies Control Guidelines and the Recommendations of the 1999 Advisory Committee on Immunization Practices. The 2003 sample was analyzed for appropriateness of PEP because it was more representative than the 2002 sample. Stepwise syntax was created in SPSS utilizing 3 key decision variables and the 2004 Virginia Rabies Control Guidelines Algorithm for PEP decisions to determine appropriateness of PEP. Results: The 2002 and 2003 sample consisted of 838 PEP records, (73.6%) of 1139 PEP reported to the Division of Zoonotic and Environmental Epidemiology (central office of the Virginia Department of Health). Most PEP patients were young (mean 32.3 years) and had true exposures during spring or summer that resulted from approaching and handling a potentially rabid animal. Over half of the source animals were not captured. For the analysis of appropriateness, 55.2% (270/489) of PEP was appropriate, 22.5% (110/489) was inappropriate and 22.3% (109/489) of PEP had missing data on key decision variables. Inappropriate PEP primarily resulted from not true exposures [79% (87/110)]. Group exposures represented 42% more inappropriate PEP than individual exposures.Conclusion: Much PEP could be avoided in Virginia if more source animals were captured. The majority of inappropriate PEP occurred because PEP was given for exposures that were not true. New educational strategies for health care providers, public health personnel and the public are recommended to reduce the number of inappropriate PEP. Standardization of data collection methods, linking human and source animal data, computerization and formation of a central database are recommended to improve human rabies PEP surveillance in Virginia.

Thesis (M.M. (Public Policy))--University of the Witwatersrand, Faculty of Commerce, Law and Management, Graduate School of Public and Development Management, 2013. / The Auditor General identified some gaps in the quality of performance information that was reported by the Gauteng Department of Health and Social Development (GDHSD) to the public. The information was inaccurate and unreliable (Gauteng Department of Health and Social Development, 2009; 2010; 2011). The National Government passed the Policy Framework on Government-Wide Monitoring and Evaluation System in 2007. Some of the objectives of which were to improve the quality of performance information and service delivery in government. This development required government departments to develop and implement strong and effective M&E systems. The GDHSD formally implemented its M&E system in 2007; one of the objectives of which was to generate good quality performance information. The GDHSD’s M&E system has failed to achieve this objective. The study investigated some aspects of the GDHSD’s M&E system with regard to its poor quality performance information. The study found that some of the problems in the GDHSD’s M&E system, which the study highlighted, were the lack of adequate and appropriate capacity and skills for monitoring and evaluation; the absence of proper structures, processes and systems for monitoring and evaluation; the absence of quality assurance mechanisms for performance data; the selective application of data management rules and regulations; and a low morale amongst some staff members of the GDHSD. One of the notable findings was that there is manipulation of some performance information for political reasons. The study made some recommendations on how to strengthen the GDHSD’s M&E system based on the identified gaps. Some recommendations are that the GDHSD needs to capacitate its M&E directorate; develop proper monitoring, evaluation, reporting and data management processes and systems; address the problem of manipulation of performance information for political reasons; and promote a culture of good work ethics within the staff members of the GDHSD. The implementation of these recommendations may assist to strengthen the GDHSD’s M&E system, thus also helping it to improve the quality of its performance information and service delivery.

As the situation of politics and economy becomes more and more unstable in Taiwan, people have higher criticism and expectation to government efficiency. However, both of Taipei Household Registration Office and Department of Health Kaohsiung City Government have successfully implemented many innovations in organization and started the initial change in less than 3 years. Thus, this research tries to analyze why and how innovations could be diffused efficiently in these two government organizations and started the change. This research collects abundant data and information through studying documents and many deep interviews at first. Then, these data or information are made a static analysis by Everett M. Rogers¡¦ theory of Diffusion of Innovations and Innovation Process in Organizations, and a dynamic analysis by Casual Loop Diagrams of Systmes Thinking. All analyses include the comparison of these two cases. There are 15 findings as followed: 1. Creating can bring better performance than problem-solving. 2. Characteristics of innovations and inertia of organization will affect the speed of innovations diffusion and the acceptability of innovations. 3. Both of innovations and organization will be modified to fit each other. 4. The leader is the most influent point for diffusion of innovations in bureaucracy. 5. The leader sets an example with his/her own conduct and starts change from small things can be helpful to diffusion of innovations. 6. The leader persistence of innovations is helpful to diffusion of innovations. 7. How the leader diffuses innovations is a process of dynamic coordination. 8. The leader is a designer of loops. 9. Different cases have similar key successful loops and key successful factors because they have the same structure of bureaucracy. 10. Structure can help and block leaders to diffuse and implement innovations in bureaucracy. 11. The innovation process in organization should be observed in a larger structure or system. 12. Reports of Media can motivate employees effectively and facilitate the phenomenon of ¡§lock-in¡¨. 13. Examination and evolution have much efficiency in changing employees¡¦ behaviors in bureaucracy. However, what can change employees¡¦ attitude often are others¡¦ appreciation, work results or leader¡¦s moral integrity. 14. Reports of Media, education training and visits can break the closed system of bureaucracy. This is helpful for diffusion of innovations in organization. 15. No matter the focal point of innovations is on easy and small things whose results are obvious, or on fundamental, long-term and more difficult things such as system and value change, ¡Ketc, all can result in profound changes in organizations. Moreover, this research also finds whether ¡§democratization¡¨, ¡§media¡¨, and ¡§bureaucracy¡¨ will bring good or bad contribution, these three things aren¡¦t the point and the most important thing is how we use them. We should take the responsibility by ourselves.

In May 2004 there was a shake-up in the private pharmaceutical industry in South Africa. The National Department of Health (DOH) introduced a form of price control which for the first time attempted to regulate prices at every level of the pharmaceutical distribution chain. The price controls was immediately challenged and was not properly implemented until partially upheld by the Constitutional Court at the end of 2005. Throughout 2006 the DOH (through the Pricing Committee) reconsidered parts of the price controls, dealing with an appropriate dispensing fee for retailers, which were struck down by the Constitutional Court. In late 2006, a new dispensing fee was published and then immediately challenged. The DOH claims they had to do this to make sure that medicines remain affordable, and pharmacists at the end of the day get a reasonable income from each price band. The United South African Pharmacies (USAP) and the Pharmacy Stakeholders1 Forum (PSF) claim that implementation of the price controls would have pharmacies not being able to cover their expenses. The objectives of the study are to ascertain whether the price controls forced upon the healthcare industry by the DOH of South Africa is viable in small retail pharmacies and what the impact will be on small retail pharmacies and their communities. The actual annual income statements for 2006 of three typical pharmacies were obtained. The next step was to determine the effect that the price controls would have had on the total sales and key financial factors in the income statement if the price controls was already in force in 2006. A revised experimental income statement was then created for the pharmacies. The experimental statements were then compared to the actual statements to determine the effects of the price controls. The comparison showed that all the pharmacies were following the same trend and had a decrease in net profit. Two of the pharmacies would have had a net loss for the year while the third will continue to show a net profit although much lower. This net profit decreased from 7% to 3% following a decrease in gross profit (GP) from 33% to 30%. The GP of the front sales shop remained unchanged, while the GP percentage for the dispensary decreased by 5% from 30% to 25%. The DuPont model showed that the Return on Equity (ROE) decreased from 83% to 33%. Drug price regulations could force many pharmacies into bankruptcy and ensure that the distribution of drugs to rural and remote areas will be financially impracticable. Once in place, the drug price regulations are likely to become ever more complex and onerous to comply with. The price regulations may end up reducing price competition among manufacturers, and in the long run, will harm the consumer by fixing prices above what would otherwise have been achieved in an open competitive market. The drug price regulations distort the normal market clearing process and effectively increase demand for medicine without providing the economic incentives that serve to match demand with supply. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2008.

In May 2004 there was a shake-up in the private pharmaceutical industry in South Africa. The National Department of Health (DOH) introduced a form of price control which for the first time attempted to regulate prices at every level of the pharmaceutical distribution chain. The price controls was immediately challenged and was not properly implemented until partially upheld by the Constitutional Court at the end of 2005. Throughout 2006 the DOH (through the Pricing Committee) reconsidered parts of the price controls, dealing with an appropriate dispensing fee for retailers, which were struck down by the Constitutional Court. In late 2006, a new dispensing fee was published and then immediately challenged. The DOH claims they had to do this to make sure that medicines remain affordable, and pharmacists at the end of the day get a reasonable income from each price band. The United South African Pharmacies (USAP) and the Pharmacy Stakeholders1 Forum (PSF) claim that implementation of the price controls would have pharmacies not being able to cover their expenses. The objectives of the study are to ascertain whether the price controls forced upon the healthcare industry by the DOH of South Africa is viable in small retail pharmacies and what the impact will be on small retail pharmacies and their communities. The actual annual income statements for 2006 of three typical pharmacies were obtained. The next step was to determine the effect that the price controls would have had on the total sales and key financial factors in the income statement if the price controls was already in force in 2006. A revised experimental income statement was then created for the pharmacies. The experimental statements were then compared to the actual statements to determine the effects of the price controls. The comparison showed that all the pharmacies were following the same trend and had a decrease in net profit. Two of the pharmacies would have had a net loss for the year while the third will continue to show a net profit although much lower. This net profit decreased from 7% to 3% following a decrease in gross profit (GP) from 33% to 30%. The GP of the front sales shop remained unchanged, while the GP percentage for the dispensary decreased by 5% from 30% to 25%. The DuPont model showed that the Return on Equity (ROE) decreased from 83% to 33%. Drug price regulations could force many pharmacies into bankruptcy and ensure that the distribution of drugs to rural and remote areas will be financially impracticable. Once in place, the drug price regulations are likely to become ever more complex and onerous to comply with. The price regulations may end up reducing price competition among manufacturers, and in the long run, will harm the consumer by fixing prices above what would otherwise have been achieved in an open competitive market. The drug price regulations distort the normal market clearing process and effectively increase demand for medicine without providing the economic incentives that serve to match demand with supply. / Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2008.