Master of Science / Department of Industrial & Manufacturing Systems Engineering / Jessica L. Heier Stamm / The main goal of public health emergency preparedness efforts is to mitigate the impact of events on the health of the population. However, decision-makers must also remain conscientious of the costs associated with these efforts. Planning is further complicated by uncertainty about the location and volume of demand that will need to be met in an emergency, the speed with which demand must be met, and the potential scarcity of needed items once an emergency occurs. To address these challenges, public health emergency planners often keep inventory stockpiles that are distributed when an event happens. Managing these stockpiles is a difficult task, and inefficient stockpile location and equipment distribution strategies can be costly both in terms of cost and public health impact. This research is motivated by challenges faced by state public health departments in creating stockpile location and equipment distribution strategies. The primary emphasis is on facemasks and respirators used by health workers during an influenza pandemic, but the approach is generalizable to other scenarios. The model proposed here uses a two-stage approach to generate a holistic solution to the problem. The first stage uses a pull distribution strategy to make stockpile location decisions. Additionally, it determines how counties should be assigned to stockpiles to minimize both storage and distribution costs. The second stage adopts a push distribution strategy to determine optimal delivery routes based on the county assignments made in stage one. This stage offers guidance for public health planners who have made location-allocation decisions but who then face a different distribution scenario than what was anticipated in the original planning phase. Recourse methods for managing demand uncertainty are also proposed. A case study of the state of Kansas is conducted using the methods introduced in the thesis. The computational results yield several significant insights into the tradeoffs and costs of various facility location-allocation and vehicle routing decisions: • For the tested range of storage and distribution cost parameters, multiple stockpile locations are preferred over a single location. • In a pull distribution system, storage costs play a greater role in location-allocation decisions than distribution costs. • In the push distribution system, finding an optimal vehicle routing plan is computationally intensive for stockpiles with a large number of assigned counties. • Efficient heuristics perform well to design recourse routing plans when realized demand is greater than expected. • In the event that planners wish to specify routes well in advance, the results of this research suggest adopting a robust routing plan based on higher-than-expected demand levels. This thesis makes three important contributions. The first is an optimization approach that considers multiple distribution strategies. This is especially relevant when stockpiling for an influenza pandemic where stockpiles need to be located significantly before the material is needed, during which time the distribution strategy may change. Second, the case study demonstrates that the proposed methods are applicable to a large-scale problem arising in practice. Finally, this research illustrates for decision-makers the tradeoffs between different stockpile management strategies and between optimal and heuristic methods.

The research is a quantitative descriptive survey. The sample is a stratified random sampling of the workforce (n=4,010) of the four hospitals in Gauteng that fall under the jurisdiction of Tshwane, Ekurhuleni and Johannesburg Metropolitan Councils. The research examines the extent of the impact of age, gender, occupation, salary level, tenure and race on workplace absenteeism. The data were collected in three phases involving auditing of hard copy files, structured interviews and information technology system. The findings of the research reflect high workplace absenteeism in females by 83.2%, age group between 45 to 49 years by 22.35%, salary range of 2 to 3 by 35.3%, African race group by 96.3%, tenure of 11 to 20 years by 44.3%, nurses by 20.8% and administration support by 35.4%. The research found that the mature employee in age and of higher year of tenure presented comparatively with lower rate of absenteeism. / Public Administration / M.A. (Public Administration)

M. Tech. Language practice / At the centre of the messages and information disseminated to the public, there is language. This study investigated the role played by language when health awareness campaigns are planned by the Department of Health (DoH) in South Africa. The background and rationale of the project is discussed, with special reference to the language speakers in Pretoria, since the study was undertaken in this area. Pretoria is a city occupied by residents that are representative of all South African language groups; namely, English, Afrikaans, Sotho, Nguni, Venda, and Tsonga. This coming together of all languages in one small area of the country has indirectly led to the evolution of a language that has never stopped to grow over the years. This language that has evolved in Pretoria is unofficially called Sepitori (Pretoria Sotho); it has become a language of pride, and the communities in and around Pretoria see it as a compromise between Sepedi and Setswana. Since Sotho is widely spoken in Pretoria, the communities have become so attached to this language that anyone who speaks English around them is seen as snobbish, or an elite who normally doesn't get a warm welcome by the average Pretoria township resident, and they are often labeled 'coconuts'. In the health centres of the city and surrounding townships, health information is conveyed mostly in the English language. Through observation, one may say that important information might be ignored by the people visiting public clinics and hospitals, or they might have little or no interest in reading it. This might be because of various reasons which the study will try to find out, as guided by the language policy of South Africa in the DoH. The concern in this study is the language used for the displayed information. The study attempts to assess whether consideration is given to the language(s) of the locals when health awareness campaigns are prepared.

<p>The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use / the documentation of the practice of primary health care in the Khayelitsha Community Health Centre / an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service / and finally to draw conclusions and make recommendations.</p>

<p>The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use / the documentation of the practice of primary health care in the Khayelitsha Community Health Centre / an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service / and finally to draw conclusions and make recommendations.</p>

This study used a quantitative approach to evaluate the application of the performance management and development system in the Eastern Cape Department of Health, from the perspective of employees. The evaluation report has three sections that are designed as interrelated but stand-alone documents. Section One is written as a report directed to the Eastern Cape Department of Health. Section Two is a review of the relevant literature that was conducted to review the existing literature related to the application of performance management and development systems, and underpinned the construction of the questionnaire. Section Three provides a description and justification of the design of the research, as well as describing the research procedure followed. Pertinent components of Sections Two and Three are extracted from these sections and included in the report in Section One. The literature review focused on the following areas: the purpose of performance management, components of the performance management process, challenges/ criticism of performance management systems, integration of performance management with other systems and the effectiveness of performance management system. The results revealed that about 74% of employees disagree that management is committed towards the successful application of the performance management system. This finding concurs with the literature. For example, De Waal and Counet (2009:367) argue that one of the problems in the application of performance management system is that the management lacks commitment to the implementation of a performance management system. Systematic sampling (Leedy and Ormrod, 2010) was used to select 120 participants in three Departmental programmes or clusters from grade levels six to 15. The researcher distributed the questionnaires to every fifth person of the population electronically using SurveyBob, which is an on line survey tool. The collected data was then analyzed using Excel software. The findings indicated that although overall employees are not satisfied with the application of the PMDS system in the Eastern Cape Department of Health, there were some successes. Nevertheless, the challenges outweighed successes of the system. The challenges that resulted in the failure of the system include poor communication, a lack of understanding of the system by the employees and a lack of knowledge with regards to the integration of PMDS with other initiatives and plans already in place. Page 4 There were positive views with enabling factors and these were work plans that are mutually agreed upon between the employee and their supervisors and are aligned to departmental strategic priorities. Constraining factors included the low levels of commitment of the management to the application of the PMDS processes, review meetings not being undertaken on a quarterly basis, and a lack of written outcome reviews. The majority of the study participants believe that the PMDS lacks fairness in its implementation. Recommendations were made on the basis of the gaps that were identified so as to improve the application of the performance management system in the Eastern Cape Department of Health. It is therefore recommended that the Department should ensure that training and development of employees on the PMDS takes place to enhance manager’s understanding of the policy. This will enable managers to understand the important role played by performance management in their day to day activities. A performance management and development system needs to be integrated with all other processes to be effective. On-going communication of the PMDS policy should be considered. Accountability of managers to the Accounting Officer and submission of quarterly reports are imperative to ensure their compliance. In conclusion, dissatisfaction outweighs satisfaction of the employees with regards to the implementation of the PMDS system.

Health Professionals are critical in the provision of health services, more especially when it comes to nurses who are next to the patient most of the time. It is critically important for the Eastern Cape Department of Health to ensure that skilled health professionals such as doctors, pharmacists, nurses and the like are retained and the staff turnover regarding this category of staff is appropriately managed. The difficulty to attract and retain health professionals is negatively affecting service delivery in the Eastern Cape department of Health and leaves the department with an unacceptably high vacancy rate. This often put more of a burden on to the health professionals who remain within the organization. Some of them will end up leaving the organization. There is a great shortage of health professionals in South Africa and it becomes easier for the health professionals to get employment elsewhere, particularly in the private sector which appears to have a competitive advantage as compared to the public sector. In this study, both quantitative and qualitative methods were used to gather information through the utilization of a questionnaire and interviews were conducted mainly to confirm the results obtained. The results of the study have assisted to reflect factors that could be influencing the health professionals to leave health facilities of the Eastern Cape Department of Health. The respondents were drawn from the two areas within the Health Department, and these are, Mthatha and Port Elizabeth areas. One hundred (100) questionnaires were issued to the health professionals and sixty three responded. Documents that were received from the department were helpful in determining the turnover rate. The study has revealed that the Eastern Cape Department of Health may succeed in retaining the health professionals if they can be made to feel that their job is important. It appears that health professionals would like to be given enough opportunity to perform their functions and participate in the decision making processes of the department. Some factors may be contributing to the staff turnover and these are, lack of career opportunities to develop, challenges in the workplace, conflict with the management and colleagues. It is always important for the organizations to recognize its employees by giving them space to practice their profession and create a comfortable workplace that could have an impact in influencing the employee to remain within the organization. Employee turnover can be minimized, if employees can be exposed to a healthy workplace environment that will assist if fostering happiness, and in the process, enhance their motivation. It is imperative for the Eastern Cape Department of Health to focus on the training and development of its employees in order to increase the efficiency and competitiveness. As the employees gain the necessary skills to perform their job, productivity may improve. The performance of the employees should be properly managed, and the resultant incentives and rewards must be fairly distributed. This could promote harmony in the workplace and that could help in building relationships among employees. If employees are satisfied, there is an increased chance that they will stay within the organization and it becomes difficult for other competitors to attract them. Employees must be given adequate space to participate in the decision making processes of the organization, and by doing so, their loyalty to the organization could be increased.

This research was instigated by testimony of the failure and the subsequent crisis in the South African public healthcare system. Official investigations had brought to light alarming operational deficiencies in institutions under the aegis of the Gauteng Department of Health. The South African public sector and government departments, in general, are currently challenged by a complex transformation process which has a prime objective to ameliorate public accountability, service delivery and budgetary control. They are likewise faced with the equally labyrinthine and demanding task of establishing a public-sector organisation with meaningful and effective operational processes that are, in addition, expected to synchronise with the modern economy. The researcher is unequivocal: the success of the GDH in responding to the challenges of improving organisational performance and healthcare service delivery depends essentially on their knowledge management strategy. Knowledge, across public-sector organisations, is increasingly being acknowledged, not only as a strategic resource but also as a valuable organisational asset. In the context of this research, knowledge is defined as the experience that resides in the minds of people; termed tacit knowledge (as opposed to formal, codified or explicit knowledge). In an analogous manner, research studies abound with evidence that has identified knowledge management as having an influence on operational performance for healthcare service delivery. Yet, a brief inquest indicated that our overall understanding of the existence of the relationship between knowledge management and operational performance for healthcare service delivery in the South African public sector is, at best, exiguous. With these appraisals in mind, the researcher developed a theoretical model that revealed factors that could influence organisational performance and healthcare service delivery. The model focused on knowledge management capabilities and organisational performance. The prime objective was to operationalise the theoretically derived knowledge management capabilities constructs, identify statistically the enhancing or impeding factors that impact on organisational performance and develop a structural equation model to verify this theoretical paradigm. The ambition of this study was similarly to investigate the use of knowledge management by the Gauteng Department of Health for its transformation to achieve improved organisational performance and healthcare service delivery. This study in essence addressed four research questions: Firstly, what was the level of understanding of knowledge management in the Gauteng Department of Health and related healthcare facilities? Secondly, how were knowledge management strategies and practices aligned with the Gauteng Department of Health strategies and operational objectives? Thirdly, how was knowledge management used by the employees in the Gauteng Department of Health? and fourthly, how could the results of the literature review and the empirical data be used to create a knowledge-management culture and a collaborative working environment for the Gauteng Department of Health? The elemental, hypothesised pursuit governing the study was to determine the existence of a relationship between the use of knowledge management and an improvement in organisational performance and healthcare service delivery. Collaterally, what enabling environment would be instituted by the gatekeepers of the institutional praxes to capacitate other staff members specifically so as to include the succession planning conundrum? To accomplish this and after reviewing the literature, the effective factors in knowledge management were identified, namely, knowledge infrastructure proficiencies and knowledge process capabilities. The research followed the parallel mixed-methods approach in gathering and analysing research data. Data was collected using questionnaires with 496 respondents and interviews with 35 interviewees. The sample used in this study comprised employees of the Gauteng Department of Health and its regional healthcare centres. The survey respondents and interview participants were the general staff and executive/senior managers of the Gauteng Department of Health. These individuals were considered to possess the most comprehensive knowledge about their organisation’s characteristics and strategy, which included knowledge management adoption. In order to identify the relationships between the model elements, appropriate tests were initiated using the Statistical Package for Social Sciences. Exploratory and confirmatory factor analyses and structural equation modelling were utilised and the proposed model was then extracted and content analysis was applied in evaluating the resulting qualitative data. The findings of this study furthermore indicated that knowledge management concepts were not universally understood in the Gauteng Department of Health. A structural equation model development strategy, postulated in the factor analysis, also produced a new best-fitting knowledge management capability model based on the new constructs. The structural equation model suggested that significant factors influencing the improvement of the organisational performance and healthcare service delivery are those of knowledge management capability. The regression analysis showed that most of the inter-correlations were significant, thus confirming the theory that knowledge management capabilities have a direct influence on organisational performance and healthcare service delivery. The research contributed theoretically to a comprehensive understanding of the relationship between knowledge management principles and factors that influence organisational performance and healthcare service delivery. Practically, the research contributed to confirming the use of knowledge management by the Gauteng Department of Health could to the improvement of its overall organisational performance and healthcare service delivery. The study further demonstrated the impact of knowledge management activities as a driving force for organisational change and the effect of knowledge management on the improvement of workforce productivity and organisational effectiveness. The new knowledge management capability model could additionally assist the Gauteng Department of Health determining the extent to which knowledge management is used and where to focus in developing and implementing knowledge management strategy. The study encourages practitioners to take cognisance of the fact that organisations are unique and that the factors which enhance or impede knowledge management are to be thoroughly examined. This case study was endorsed for its significant contribution to regional healthcare system, as well as the broader national healthcare structure. / School of computing / Ph. D. (Information Systems)

Magister Administrationis - MAdmin / The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use; the documentation of the practice of primary health care in the Khayelitsha Community Health Centre; an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service; and finally to draw conclusions and make recommendations. / South Africa

The purpose of this study was to compare the nutritional status of a rural population of Mossi people in Burkina Faso during the pre- and post-harvest seasons. Comparisons were made between the sample population and the American population, between the pre- and post-harvest seasons, between males and females in the sample population and between the various age groups in the sample population. This nutritional assessment consisted of collecting demographical information, anthropometrical measurements such as weight and height, a clinical assessment to evaluate physiological signs of nutritional deficiencies and a food frequency questionnaire to describe the dietary practices of the population. Due to the potential risks of handling human blood, urine and feces, biochemical analyses were not performed in this study. Special attention was given to the nutritional problems most common in Africa: protein energy malnutrition, vitamin A deficiency, iron deficiency and goiter. Adults in this study had an average body mass index of 19.1, classifying the adult population as "underweight". The population of American adults, however, has a tendency toward a body mass index in the slightly overweight category. The BMI range of adults in the study population was 12.9 to 27.8. A total of 36.9% of the adult population presented with some level of protein energy malnutrition while only 2.7% were slightly obese. Seventy percent of children were below the 50th percentile on the 2000 Centers for Disease Control weight-for-height growth chart. A third of all children were below the 3rd percentile of weight-for-height. The vast majority of children in this study had a weight-for-height below the median, or "average", American child. The mean percent of median body weight-for-height for the child population in the lean season was 85.2% indicating that the median child in this sample population was mildly wasted. The mean percent of median weight-for-height rose to 94.6% in the post-harvest season indicating that the median child of the sample population was "normal" concerning wasting status. The results of this study indicate that this rural population of Mossi people was less well-nourished than their American counterpart and that their nutritional status differed based on season (F=[4,177] 4.77, p=.03 for adults and F=[4,51] 8.56, p=.005 for children) but not gender (F=[ 4,177] .04, p=.83 for adults and chi square= 4.37, p=.22, df=3 for children) or age group for adults (r=.l 0, p=.29). In children, nutritional status was based on age group (but contrary to the expected outcome) with prepubescent children having lower weight-for-height percentiles than the under-five population (chi square = 40.34, p=.02, df=24). Nutritional status improved as predicted during the postharvest, or plentiful, season. Due to the lack of biochemical analyses, the potential vitamin and mineral deficiencies indicated in the brief physical examination were not confirmed. Vitamin A deficiency was the most likely nutrient deficiency; symptoms occurred in 51% of the population, primarily in adults and older children. PEM, although indicated by the anthropometric measures to affect 37.1% of the adult population and 55.4% of the child population, did not greatly manifest itself in clinical symptoms. The incidence of iron deficiency anemia was also relatively low with only 7% of the population presenting with pale conjunctivae, a potential, but non-specific sign of iron deficiency anemia. The goiter rate was also very low with only two cases occurring during the post-harvest season.