Primary health care represents a change from curative approach to preventive approach to rendering health care services. The study analyses the problems encountered in the administration of primary health care in South Africa with specific reference to the Emfuleni Local Authority. The study describes the role of international institutions in the administration of primary health care in South Africa. Furthermore, the historical development, the role of the National Department of Health in the administration of primary health care services is outlined. The study also investigates the role of the Gauteng Provincial Department of Health regarding the implementation of district health system, health promotion, the involvement of the private sector and NGO's in primary health care. Problems encountered by the Emfuleni Local Authority such as lack finance, personnel shartages, security, urbanisation, non-involvement of traditional healers and citizen apathy are investigated. Lastly, governmental relations for primary health care are described.

The purpose of this study was to show how information from the District Health Information System can be used to empower managers to make evidence-based decisions that will strengthen the health care system to reduce the under-five mortality rate. A quantitative, contextual, exploratory evaluative and descriptive approach was followed and a data extraction framework, based on systems theory, was developed to guide the process of extracting existing routine data. A results-based approach was used to measure under-five mortality related health care in terms of impact, outcomes, outputs, processes and inputs. The study has highlighted that proxy indicators obtained this way places health care managers in the position to monitor progress towards achieving the Millennium Development Goal for child mortality in the interim periods between large population surveys. The findings displayed in the diagnostic performance profile revealed that drastic interventions are required to reduce the under-five mortality rate. / Health Studies / M.A. (Health Studies)

Thesis (MBA.) --University of Limpopo, 2016 / The Ward Based Outreach Teams (WBOT) Programme is established in South Africa as part of a series of strategies to strengthen Primary Health Care (PHC) and to improve service delivery in the country. The purpose of the study was to gain an understanding of the experiences of Community Health Workers (CHW) in the implementation of the WBOT programme. The objectives of the study were to evaluate the experiences of CHWs in the WBOT, to evaluate factors that facilitate the implementation and to make recommendations and strategies on what can be done to improve the WBOT programme. A quantitative research design was used where self-administered questionnaires were provided to respondents for data collection. Respondents were asked to complete the questionnaires; completed questionnaires were returned by only 12 of the 27 respondents, resulting in a 44% response rate. The study’s findings indicate that the Community Health Workers (CHWs) regarded the WBOT as helping the community in many ways such reducing the long queues at the clinic and providing the care of the patients in their own homes, although concerns about poor participation by the community structures and nurses in the health facilities were expressed. CHWs expressed experiences that were positive and negative when conducting their work in the community. The results from the study have shown that there are successes, challenges and lesson learned. The results of the study further indicated that the programme is being implemented well even though it is still in a pilot phase in the sub-district. The programme has managed to improve and save many lives in the communities of Kgetleng Sub-district. Despite the level of depth in this study, there is a crucial need for more for more in-depth research regarding the experiences of users of the WBOT services and to conduct similar studies looking into urban areas and to compare and contrast the rural and urban findings.

The purpose of this study was to show how information from the District Health Information System can be used to empower managers to make evidence-based decisions that will strengthen the health care system to reduce the under-five mortality rate. A quantitative, contextual, exploratory evaluative and descriptive approach was followed and a data extraction framework, based on systems theory, was developed to guide the process of extracting existing routine data. A results-based approach was used to measure under-five mortality related health care in terms of impact, outcomes, outputs, processes and inputs. The study has highlighted that proxy indicators obtained this way places health care managers in the position to monitor progress towards achieving the Millennium Development Goal for child mortality in the interim periods between large population surveys. The findings displayed in the diagnostic performance profile revealed that drastic interventions are required to reduce the under-five mortality rate. / Health Studies / M.A. (Health Studies)

The purpose of the study was to explore and describe the professional nurse's perception of working in remote rural clinics in Limpopo Province. The research design was qualitative, exploratory, descriptive and contextual. The research population was the professional nurses working in remote rural clinics in Limpopo Province. Purposive sampling was used and data collected by means of tape-recorded in-depth semi-structured individual interviews. The study revealed that the professional nurses perceived working in the remote rural clinics both positively and negatively and had concerns. / Health Studies / M.A. (Health Studies)

The purpose of the study was to explore and describe the professional nurse's perception of working in remote rural clinics in Limpopo Province. The research design was qualitative, exploratory, descriptive and contextual. The research population was the professional nurses working in remote rural clinics in Limpopo Province. Purposive sampling was used and data collected by means of tape-recorded in-depth semi-structured individual interviews. The study revealed that the professional nurses perceived working in the remote rural clinics both positively and negatively and had concerns. / Health Studies / M.A. (Health Studies)

Philosophiae Doctor - PhD / This thesis presents research on the emergence of sub-structure and sub-district pharmacists in Cape Town by considering their roles and related competencies, and the support required to establish them in these new positions. The research was carried out in partnership with Metro District Health Services (MDHS) and City Health. Both organisations provide services across the whole of the Cape Metro. The research took place as MDHS was dividing the Cape Town Metro District into four sub-structures, and the research is embedded in these unfolding developments. The four sub-structures were created to be closer in size to WHO health districts than the unmanageably large Metro District. Consequently, sub-structures and sub-structure pharmacists in this study should be considered equivalent to districts and district pharmacists in other settings. I used a participatory action research (PAR) approach to partner with pharmacists and managers in both organisations between 2008 and 2011. The partnership benefitted from the contextual and practice experiences of the health services stakeholders and my evolving research expertise. Including a broad stakeholder group was considered important for developing the shared learning and understanding that would translate into action and changen in the organisations. The flexible and emergent approach of PAR was considered suited to a complex health system in the midst of change. After an initiation stage, the research evolved into a series of five iterative cycles of action and reflection, each providing increasing understanding of the roles and related competencies of sub-structure and sub-district pharmacists, and their experiences as they transitioned into these new management positions in the two organisations. The research centered around two series of three interactive workshops I facilitated, attended by both pharmacists and managers, in which I contributed information from published literature and documentary reviews to the collaborative processes. Semi-structured interviews and focus groups were conducted at various stages during the research, to inform conceptualization and supplement workshops, and later on, during years three and four, to reflect on the experiences of substructure and sub-district pharmacists. The research identified five main roles each for sub-structure and sub-district pharmacists. Four of these roles are the same for each: Sub-structure (sub-district) management Planning, co-ordination and monitoring of pharmaceuticals, human resources, budget, infrastructure Information and advice Quality assurance and clinical governance But their fifth roles are different: Research, for sub-structure pharmacists. Dispensing at clinics for sub-district pharmacists. But although they look similar, there were substantial differences between sub-structure and sub-district pharmacist roles in the two organisations. Their roles were shaped by the differences in leadership and governance, as well as by the services provided by the two organisations. Sub-structure pharmacists were generally involved in strategic level management functions whilst sub-district pharmacists combined sub-district management activities with dispensing in clinics. Essentially the two cadres were working at different management and leadership levels, with sub-structure pharmacists working at middle management level and sub-district pharmacists straddling first level and middle management levels. Five competency clusters were identified for both cadres, each with several competencies. Professional pharmacy practice Health system/public health Management Leadership Personal, interpersonal and cognitive Whilst professional pharmacy practice competencies were particularly valued by substructure and sub-district managers, overall, sub-structure and sub-district pharmacists required generic management and leadership competencies. Along with the more technical management and leadership competencies, both organisations recognised the importance of viii „softer‟ competencies for pharmacists moving into these management positions. Again, although the competencies appear similar, there were differences between the roles, so that the different cadres required different competencies within these competency clusters. Transitioning into these new management positions was an emergent process, which entailed pharmacists changing form performing technical and clinical functions associated with professional pharmacy practice to co-ordinating pharmaceutical services across the substructure or sub-district. They moved from working in a pharmacy to being a member of a multi-professional team in a sub-structure or sub-district. Adjusting to these new management positions took time and was facilitated by several personal and organisational factors which varied in the two organisations. Managers and pharmacists mentioned the positive contribution of the PAR in assisting with this transition through the development of shared understanding of the DHS and the roles and functions of pharmacists working in these management positions. The research assisted with practical aspects including the development of new job descriptions. Several implications for developing competencies in sub-structure and sub-district pharmacists emerged during the research. Firstly, although competency frameworks for substructure and sub-district pharmacists are useful for selecting new staff, conducting performance appraisals and identifying learning needs, they need to be tailored for each setting. Secondly, a mixture of traditional training options, including academic qualifications and short courses, as well as innovative on-the-job support such as mentoring and coaching are required to support sub-structure and sub-district pharmacists, and other similar cadres in these positions.

Magister Public Health - MPH / BACKGROUND: Namibia has generalised Human Immunodeficiency Virus (HIV) and tuberculosis (TB) epidemics. In response to the TB/HIV co-epidemics in Namibia, the Ministry of Health and Social Services approved a policy of TB/HIV collaborative activities at national level and the integration of TB/HIV services at the point of service delivery. The present study explored barriers and facilitators of integration of TB and HIV service delivery in Tsandi District Hospital, which lies in rural northern Namibia. It focused on understanding the perspectives of healthcare workers and service users on integration of TB and HIV services at the health facility. AIMS & OBJECTIVES: The study aimed to describe the barriers, facilitators, and opportunities of integrated TB/HIV service delivery in Tsandi District Hospital. The specific objectives were: to describe the staffing and support systems in place for the integration of TB/HIV care; to describe the perceptions and experiences of integrated TB/HIV care by the health care workers, management and co-infected clients; and to describe the factors that facilitate or hinder the integration of TB/HIV services in the district from the point of view of district hospital managers, health care workers and co-infected clients. METHODS: The study used a descriptive qualitative study design with semistructured key-informant interviews conducted with five healthcare managers and senior clinicians and focus group discussions with 14 healthcare workers and five TB/HIV co-infected patients, supplemented by non-participant observation in Tsandi district hospital over two weeks between May – June 2011. Sessions were audiorecorded, transcribed, and thematically analysed. RESULTS: Several factors influenced whether and to what degree Tsandi district hospital was able to achieve integration of TB and HIV services. These are: (1) model of care and nature of referral links; (2) the availability and use of human resources and workspace; (3) the system of rotating staff among departments in the hospital; (4) the supply and mode of providing medicines to patients; (5) information systems, recording and reporting arrangements; (6) and the amount of follow-up and supervision of the integrated services. The main suggested barrier factors are: (1) poor communication and weak referrals links between services; (2) inadequate infrastructure to encourage and deliver TB and HIV care; (3) staff shortages and high workload; (4) lack of training and skills among healthcare workers; (5) financial constraints and other socioeconomic challenges; and (6) fragmented recording and reporting systems with limited data use to improve service delivery. The four main facilitating factors are: (1) positive staff attitudes towards TB/HIV integration; (2) common pool of staff managing different programmes; (3) joint planning and review of TB and HIV activities at the ARV Committee; and (4) informal task sharing to alleviate healthcare worker shortages. CONCLUSIONS: This study recommends that the district build on the current facilitators of integration, while the inhibitors should be worked on in order to improve the delivery of TB/HIV services in the district. Simple and practical recommendations have been made to address the some of the barriers at district level. It is hoped that these will inform future planning and review of the current model of care by the District nagement Team.

Magister Public Health - MPH / Periodic high doses of vitamin A supplementation has been demonstrated to have a dramatic impact on vitamin A status and general health of children, significantly improving child survival. The Eastern Cape Department of Health has therefore adopted a provincial policy on vitamin A supplementation to improve the high child mortality and vitamin A deficiency rates experienced in the province. This study outlines a participatory approach to designing, developing and evaluating the implementation of a management information system (MIS) that will support district level Maternal, Women and Child Health programme managers in problem identification, planning and decision-making when implementing the Eastern Cape policy on vitamin A supplementation. It is an iterative process that: • Begins with a situational analysis • Uses this situational analysis for the conceptualisation of the MIS • Develops this MIS as a part of the vitamin A supplementation programme, embedding the MIS in the management structure and operational systems and • Evaluates the implementation of this MIS The study introduces the concept of trace tables, an integral part of the MIS. It is a unique tool that the researcher has developed to assist programme managers to monitor the implementation of the various elements of a primary health care programme like vitamin A supplementation. The researcher discusses the key findings of the study, the participatory nature of this action research, and elements unique to this study in terms of the vitamin A supplementation programme, the development of a MIS, an action research approach and the context within which the development of the MIS occurred. The study is concluded with key lessons to be learnt from this research and the postulation of a model on a participatory approach to the development of a MIS for Primary Health Care programmes.

Philosophiae Doctor - PhD / A review of the literature has shown that there is a lack of mental health information on which to base planning of mental health services and decisions concerning programme development for mental health services. Several studies have indicated that the use of an evidence-based health information system (HIS) reduces inappropriate clinical practices and promotes the quality of health care services. This study was aimed at developing a framework for a district-based mental health information management system, utilising the experiences of health care providers and caregivers about a district mental health information system (DMHIS). Activity Theory was used as the philosophical foundation of the information system for the study. A qualitative approach was employed using semi-structured individual interviews, Focus Group Discussions (FGDs), systematic review and document analysis. The intervention research design and development model of Rothman and Thomas (1994) was used to guide the study, which was conducted in the Cape Town Metropole area of the Western Cape. A purposive, convenient sampling method was employed to select study participants. Ethical clearance for the study was obtained from the University of the Western Cape, and permission to use the health facilities from the Department of Health. The data collection process involved 62 individual interview participants, from mental health nurses to district health managers, health information clerks, and patient caregivers/families and persons with stable mental conditions. Thirteen caregivers took part in the FGDs. Document review was conducted at three community mental health centres. The data were analysed manually using content analysis. Core findings of the interviews were lack of standardized information collection tools and contents for mental health, information infrastructure, capacity building, and resources. Information processing in terms of collection, compiling, analysing, feedback, access and sharing information were the major problems. Results from document analysis identified inconsistencies and inaccuracies of information recording and processing, which in turn affected the quality of information for decision making. Results from the systematic review identified five functional elements: organizational structure; information infrastructure; capacity building; inputs, process, output and feedback; and community and stakeholders’ participation in the design and implementation of a mental health information system (MHIS). The study has contributed a framework for a DMHIS based on the findings of the empirical and systematic review. It is recommended that there is a need to establish a HIS committee at district health facility level for effective implementation of the framework and quality information processing. There is a need to ensure that staffs have adequate knowledge and skills required for effective implementation of an information system. It is recommended that higher education institutions include a course on HISs in their curriculum. It is suggested that the South African Mental Health Policy be reviewed to include an MHIS and ensure involvement of the community and stakeholders in this system as well as adequate budget allocation.