The proposed study intends to establish how procedural the reward systems are being implemented in the Limpopo Department of Health and whether claims of biases are founded. The study is aimed to determine the system’s influence on the organisation’s ability to track poor performance and to manage it. It also provides a refreshed view of the current pitfalls in the implementation of the programme, and subsequently provides indications of remedial action to recover the purpose of the performance management and development system. The study furthermore assesses the impact of performance management practices and explored the best implementable practices for effective performance management systems and best service delivery by the Limpopo Department of Health. A qualitative research approach that included interviews with HR and line managers was utilised and a quantitative research approach that included questionnaires from ordinary employees was followed. The findings are that the system cannot be linked to employee output, but an obvious benefit is employee rewards. The literature review shows that there is a general poor understanding of performance management and development system in the public service. It (Literature review. Chapter 2) further establishes that there are several challenges that hinder the effective implementation of performance management and development system in the public service. Other findings of the study include that there is a challenge of biased ratings (subjective assessment), and a setting of unrealistic performance targets which are unrealisable by employees. The main finding of the study is that lack of training poses a serious challenge in implementing performance management and development systems. Many respondents indicated that employees need to be brought to awareness about the implementation of the model so that both management and employees can work towards the Department’s vision. Some suggested that management should realise our needs and arrange training for capacity building. Another employee agitated that “I am not involved in any performance management because this is used for financial gains. This is another corrupt activity?” The above-mentioned statements clearly show concerns of employees in their overall performance. / Public Administration / M.P.A.

In a landmark report, the Secretary of Health and Human Services once characterized the legacy of disparities in healthcare and health outcomes in the United States as “an affront to our ideals and the ongoing genius of American medicine.” Since then, a vast amount of scientific evidence regarding health equity has been generated and important interventions developed. Yet despite substantial concerted efforts, health inequity remains a persistent and pervasive public health concern. A significant challenge is the lack of scalable resources to organize, synthesize, and integrate knowledge gleaned from available scientific evidence and real-world observational data in a comprehensive, systematic fashion. Recognizing this, the National Institute on Minority Health and Health Disparities recently embarked on a science visioning process and enumerated a set of strategic goals to foster a new generation of research capable of making major strides. Among the strategies proposed, the institute promotes development of new methods and measurements that enable 1) evaluation of health equity research and ensuring its relevance to a diversity of populations, 2) better leveraging and fostering linkage between existing and emerging data sources to enhance analytic capacity, and 3) analysis of health determinants contributing to health disparities among subpopulations and small groups. In alignment with this vision, the studies presented in this thesis seek to advance health equity science by developing, applying, and evaluating informatics-based approaches to support evidence synthesis, monitoring, and precision. In particular, systematic, scalable, and sustainable (i.e., reproducible) approaches are emphasized. This dissertation employs robust methods for big data collection, integration, and analysis while drawing from a rich set of existing and emerging data sources including a large corpus of biomedical literature, electronic health records from the largest public health information exchange in the United States, open datasets provided by public agencies, proprietary national insurance claims datasets, and public health reporting data. The dissertation first aims to facilitate large-scale evidence synthesis to identify major areas of focus in health equity research and elucidate potentially less well studied populations, conditions, and topics. In order to accomplish these tasks, it draws from the informatics toolbox by leveraging machine learning, natural language processing, and symbolic reasoning to assess a vast portfolio of research and compare it to real-world data on condition prevalence. In doing so, it spotlights potential paths for additional scientific inquiry and attention in public health practice. Ultimately, we find that there are indeed potential disparities in disparities research and elucidate less well studied areas of interest. Building on these insights, this thesis then leverages underutilized real-world data sources (e.g., health information exchanges) and a common data model to buttress the highly fragmented and outdated public health data infrastructure currently used to monitor conditions of interest and elucidate potential disparities among populations. By intention, the illustrative example presented operates at a scale commensurate with current regional public health reporting, increases the number and types of data elements available for analysis, and improves turnaround time for surveillance report generation. We found a substantial lack of alignment between testing practices and population- and neighborhood-level trends in cases of sexually transmitted infections, signaling potential disparities and inefficient resource allocation. Thus, our work meets several hallmarks of infectious disease surveillance in the era of big data including volume, variety, velocity, and value, respectively. Importantly, these findings were not otherwise or less likely detectable given existing public health reporting practices. Finally, as existing health equity literature and public health surveillance practices do not often incorporate intersectionality as an integral lens for drawing comparisons, in large part due to the technical intractability of examining all possible demographic intersections, we demonstrate a novel subgroup discovery approach tailored to elucidating intersectional disparities in health outcomes. In doing so, it aims to better inform efforts to recognize and engage subgroups who might benefit from greater attention and more closely tailored interventions. To our knowledge, this new approach is the first to leverage supervised clustering to operationalize intersectionality for health disparities research. To ground this work, clinical examples focus especially on demonstrating application of each new approach to generalizable use cases involving HIV and other sexually transmitted infections – highly stigmatized conditions for which there is a long history of inequity.

The study comprehensively analysed the impact of primary prevention services for reproductive health in the environment within which the adolescents grow towards life skills ecquisition and positive behavior patterning. The availability, accessibility and the effectiveness of adolescents' accompaniment in Soshanguve Township by certain caregivers were assessed. Unstructured observations, review of documents, questionnaire and semi-structured interviews were used for data collection. The results revealed the least support by parents and churches to accompany the adolescents and the inaccessibility of specialised center to the disadvantaged. The continued lack of knowledge and life-skills perpetuated the onset of reproductive problems. The lack of programmes to equip care providers on how to improve communication during care provision was a major setback. There is a great need for the erection of special care centers for adolescents. / Health Studies / M.A. (Nursing Science)

The purpose of this research is to explore students’ on-line interactivity in an Open Distance Learning institution with other students, educators, study materials and Unisa as the sampled prototypical research subject. A mixed-method of research encompassing both explorative and descriptive aspects was used. Data was collected through myUnisa discussion forum, focus group interviews and an on-line questionnaire from second and third year Health Services Management students at the University of South Africa (Unisa). Although the findings indicated that 84.9% of students owned computers, and 100% owned cellular phones, only 3.8% participated in the discussion forum. On-line discussion forum are critical in Open Distance Learning (ODL) because it allows people who cannot physically attend the educational institution to interact with each other. Almost 40% of these sampled students agreed that the discussion forum allowed them to study with their peers. However, only 53 of the 1,379 students registered for both second and third year studies during the first semester participated in the discussion forum. This indicates that very few students benefit from on-line interaction. Most of the students who are enrolled in Health Services Management course are from 21 to above 50 years of age. This age factor can have an impact on computer literacy. Some of them indicated that they struggled with the utilisation of technology. The majority of these students do not utilise the prescribed on-line interactive tools effectively. Students’ need support cognitively, academically, administratively, institutionally and affectively. The findings suggest that although students are aware of the benefits of using online technologies, they do not have the support from the institution to enable them to better their skills in using these technologies. The other challenge that they have raised is that educators also interact minimally on-line. Therefore, they do not receive the necessary feedback they require. The university systems are sometimes offline, which becomes worse during registration and submission of assignments. The recommendations emanating from the study warrants various interventions of multiple stakeholders to resolve the students’ challenges. / Health Studies / D.Litt, et Phil. (Health Studies)

This quantitative study was aimed at determining the value of the psychosocial services rendered by the staff members of the Godisanang OVC programme to OVC in Rustenburg in order to make recommendations on how these services could be improved. Fifteen caregivers, who were employed by the Godisanang OVC programme, were interviewed in October 2013. Data was presented in the form of statistics, tables and numbers. This study revealed that the psychosocial services that are rendered by the Godisanang OVC programme to OVC are of value. Therefore, it is recommended that the psychosocial services be extended to other regions of Rustenburg. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

OBJECTIVE/ METHOD The study examined implementation challenges faced by primary health care workers within the Ekurhuleni Metropolitan Municipality in Gauteng South Africa. Data collection was based on semi-structured interviews carried out on a purposive sample (n=19) of frontline clinicians working within the district as primary health care practitioners. RESULTS Participants confirmed that work within the primary health care service disproportionately focussed on curative and rehabilitative functions of their roles with little prioritisation of preventive and promotive interventions. Primary identified reasons included, institutional culture that prioritised short-term curative approaches. Clinicians also cited a range of other organisational barriers, such as – poor strategic planning, and a lack of understanding of health promotion and illness prevention. CONCLUSIONS Although the challenges that exist in implementing primary health care are clearly understood, clinicians perceive the solutions for these as being within the control of policy makers and those with power within the organisation. / Health Studies / M.A. (Public Health)

【研究緣起與問題】2003年春季，SARS在全球造成一陣轟動，同時也重創全球的經濟，如今SARS會不會再來？政府如何因應？政府如何監測疫情？如何防治疫情？如果SARS等新興及再浮現感染症 （Emerging and Re-emerging Infectious Diseases）出現時，負責全國傳染病防治任務的行政院衛生署疾病管制局是如何作好全國傳染病防治工作呢？中央及地方主管機關之溝通，如何共同消除指責與誤會，發揮團隊精神，如何共同作好全國傳染病防疫任務，爭取公眾對政府之瞭解並加以支持，同時防止任何可能之攻擊，才是全民之福祉。故以「全國傳染病通報系統」的績效，其所仰賴之溝通通路之問題研究，是本研究的動機。了解「傳染病通報管理系統(WEB版)」最大的問題及新興傳染病（如SARS）防治通報的問題及「傳染病通報管理系統」最需要改進之的地方，是本研究的目的。 【研究方法與資料】本研究採取量化與質化並重的方法，以網路問卷方式的進行問卷調查，問卷對象為全國使用傳染病通報管理系統之相關人員，問卷問題內容的設計主要的型式含有開放式問卷（Open –Ended Question）、封閉式問卷（Close-Ended Question）及混合型問卷（Mixed Question）三種。同時以九十二年針對新興傳染病SARS期間為例，深度訪談當時任職於中央與地方負責傳染病防治權責具代表性者五位主管進行訪談，瞭解受訪者對新興傳染病如SARS防治的問題及「傳染病通報管理系統」最需要改進之的地方，以彌補問卷調查法無法深入瞭解到問題之缺點。 【研究結論與建議】 一、根據筆者初步研究經問卷的實證調查之後，從問卷分析資料顯示，使用者使用電腦的時間愈久，對以新版為溝通工具滿意度愈低；而愈瞭解通報系統的使用者，其以新版為溝通工具滿意度愈高，愈滿意新版改進之電腦網路溝通效果。顯示新版的通報系統在設計的操作介面與程序上，沒有人性化，作業內容繁多、需輸入的項目、資料太繁瑣、版面太繁瑣等，反而徒增使用者的困擾；而愈瞭解通報系統的使用者，其對新版的滿意度越高，表示對於使用者在操作上的教育訓練仍須加強，才能發揮新版通報系統的成效。 二、從敘述統計分析中發現： 受訪者對「訊息異動通知作業流程滿意」的使用滿意度的平均數最高，平均數為2.8095表示：較為滿意。「通報作業流程滿意嗎」的使用滿意度的平均數最低，平均數為2.3934，受訪者表示：較為滿意。以新版為溝通工具整體溝通滿意情形，平均數為2.558滿意。 三、開放式問卷分析資料顯示，花太多時間、速度太慢、網路的頻寬過窄又不穩定或無法登錄、作業內容繁多、作業流程問題、資訊管理問題及功能增添與建議等部分。 四、根據筆者初步研究深度訪談之後，彙整中央主管機關及地方主管機關的訪談核心二部分的問題與建議。 五、研究建議： 綜合問卷調查及深度訪談結果，提出政策層面、組織溝通層面、管理層面、實務操作層面等之建議。 【關鍵字】傳染病通報系統、嚴重急性呼吸道症候群(severe acute respiratory syndrome, SARS)、組織溝通、溝通通路、行政院衛生署疾病管制局 / 【Background and Issues】 In the spring of 2003, SARS outbreaks devastated the whole world; they also heavily damaged the world economy. Will SARS come back? How can governments manage it? How can government monitor the epidemics? How can we control the infection? When emerging and re-emerging infectious diseases such as SARS appear, how can the Center for Disease Control of the Department of Health, an organization in charge of national disease control, plan and execute measures for the control of communicable diseases? Effective communication between the central and the local competent authorities to remove together blames and misunderstanding, to develop team spirit, to attain jointly the goal of disease control, to solicit understanding and support of the public to the government, and to prevent any likely attack are some of the considerations in improving the welfare of the public. The reason of the present study was to understand, through the achievements thus far of the National Communicable Disease Reporting System, issues involved in the communication channels. The purposes of the study were to understand the major problems of the Communicable Disease Reporting and Management System (the Web version), issues involved in the reporting of emerging infectious diseases, and areas of the Communicable Disease Reporting and Management System where improvement was most urgently needed. 【Method and Materials】 Both the quantitative and qualitative methods were used. Questionnaire interview was conducted through the web to persons using the Communicable Disease Reporting and Management System throughout the country. The questionnaire contained open-end questions, closed-end questions and questions of mixed types. At the same time, to understand in depth areas not properly covered by the questionnaire interview, five key persons responsible for disease control at the time of the SARS outbreaks in 2003 at the central and the local levels were interviewed to understand their attitudes toward the control of emerging infectious diseases such as SARS, and the improvement most urgently needed for the Communicable Disease Reporting and Management System. 【Results and Recommendations】 1. Preliminary findings from analysis of the questionnaire interview showed that users became less satisfied with the new version communication means the longer they were in use of computers. Users who knew more about the use of the reporting system were more satisfied with the new communication means, were at the same time, more satisfied with the communication effects of the improved version. These facts suggested that the new reporting system was less user-friendly in the designing of interface and procedures. The system required more work, more detailed inputs, and thus added additional burdens on the part of the users. The more the users understood the reporting system, their satisfaction was higher, indicating that, for the new version reporting system to function in full, training of the users in the use of the system should be strengthened. 2. From the descriptive analysis, it was found that the average score of user satisfaction on the “information change reporting procedures” was as high as 2.8095, suggesting that the users were fairly satisfied. The satisfaction score on “reporting procedures” was the lowest at 2.3934. The overall satisfaction score on the use of the new version as a communication means was 2.558. 3. Findings from the open-end questions gave the following recommendations: taking too much time, too slow, frequency of the web too narrow, unstable, and unable to load, too detailed, issues related to operational procedures, issues related to information management and additional functions, etc. 4. By analysis of the in-depth interview, some issues were raised and recommendations made to the central and the local competent authorities. 5. Through questionnaire survey and in-depth interview, some recommendations concerning policies, organizational communication, management and practical operation were made. 【Key Words】 Communicable Disease Reporting System, SARS (Severe Acute Respiratory Syndrome), organizational communication, communication channels, Center for Disease Control, the Department of Health

This quantitative study was aimed at determining the value of the psychosocial services rendered by the staff members of the Godisanang OVC programme to OVC in Rustenburg in order to make recommendations on how these services could be improved. Fifteen caregivers, who were employed by the Godisanang OVC programme, were interviewed in October 2013. Data was presented in the form of statistics, tables and numbers. This study revealed that the psychosocial services that are rendered by the Godisanang OVC programme to OVC are of value. Therefore, it is recommended that the psychosocial services be extended to other regions of Rustenburg. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

The study comprehensively analysed the impact of primary prevention services for reproductive health in the environment within which the adolescents grow towards life skills ecquisition and positive behavior patterning. The availability, accessibility and the effectiveness of adolescents' accompaniment in Soshanguve Township by certain caregivers were assessed. Unstructured observations, review of documents, questionnaire and semi-structured interviews were used for data collection. The results revealed the least support by parents and churches to accompany the adolescents and the inaccessibility of specialised center to the disadvantaged. The continued lack of knowledge and life-skills perpetuated the onset of reproductive problems. The lack of programmes to equip care providers on how to improve communication during care provision was a major setback. There is a great need for the erection of special care centers for adolescents. / Health Studies / M.A. (Nursing Science)

OBJECTIVE/ METHOD The study examined implementation challenges faced by primary health care workers within the Ekurhuleni Metropolitan Municipality in Gauteng South Africa. Data collection was based on semi-structured interviews carried out on a purposive sample (n=19) of frontline clinicians working within the district as primary health care practitioners. RESULTS Participants confirmed that work within the primary health care service disproportionately focussed on curative and rehabilitative functions of their roles with little prioritisation of preventive and promotive interventions. Primary identified reasons included, institutional culture that prioritised short-term curative approaches. Clinicians also cited a range of other organisational barriers, such as – poor strategic planning, and a lack of understanding of health promotion and illness prevention. CONCLUSIONS Although the challenges that exist in implementing primary health care are clearly understood, clinicians perceive the solutions for these as being within the control of policy makers and those with power within the organisation. / Health Studies / M.A. (Public Health)