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Health information plays a vital role in the larger health system. Over the last twenty-five years, South Africa has developed several health information systems (HISs) that aim to collect high-quality health information to be used to inform clinical decision-making, shape new policies and programmes and strengthen other components of the health system. To date, most research in this area has focused on the production of health information and the technical challenges that appear when developing and implementing HISs. Much less is known about how health information is used in practice. This research explores how both community actors and health systems stakeholders at different levels of the health system gain access to, use and exchange health information, both for their own decisionmaking and practice, but also to address persistent health challenges. This research adopted an ethnographic approach, whereby I conducted extensive qualitative research for a period of 18 months in Gugulethu, an underprivileged peri-urban neighbourhood in Cape Town. Three case studies emerged from this research that provide a lens to analysing the role of health information in South Africa. The use and exchange of health information in the larger health system is inherently complex. Key findings from this research project show that firstly, there is a wide interest among a diverse group of stakeholders, including community representatives and NGOs, to use health information. Secondly, despite the interest for using health information, this data is not always available for a variety of reasons, which encourages stakeholders to develop creative strategies to collect new forms of evidence or to gain access to existing forms of data. Thirdly, adopting new strategies, health actors use a combination of routinely collected, semi-formal, and informal data, often concurrently. Lastly, this research demonstrates that health information is never neutral or value-free, but is produced, used and exchanged within a larger social, cultural and religious context, and is thus shaped by these contexts. This research challenges several assumptions about how health information is used in South Africa, and who can, or should, have access to this information. To answer these questions, it is important to open the health information system (HIS) to a more a diverse group of people actively in order to make available a variety of information that informs health stakeholders' daily work, influences health programmes and provides new perspectives on current health issues. Lastly, to further stimulate the use and exchange of health information for health system strengthening purposes, there is a need to provide a dedicated third space, where establishing new relationships and strengthening existing ones among actors at different levels of the health system is actively encouraged as a way to stimulate further use and sharing of health information.

Includes bibliographical references. / Diabetes is the most common non-communicable disease worldwide and contributes to substantial morbidity and mortality. The prevalence of diabetes is increasing and reaching epidemic proportions, with the largest increase being seen in developing countries, including South Africa. Among the many complications of diabetes, lower extremity amputations are common, with a leg being lost to diabetes somewhere in the world every thirty seconds. The vast majority of these amputations is preventable and is a reflection of inadequate care of diabetic patients. Studies done in South Africa have shown that the care of diabetes in the public sector is suboptimal. A study in the private sector in South Africa showed that by ensuring optimal care of diabetic patients, long term glycaemic control and a decrease in complications and hospital admissions can be achieved. Lower extremity amputations can be the result of complications due to poor glycaemic control. There are, however, few studies that have been done in South Africa assessing the contribution that diabetes makes to the performance of lower extremity amputations. This study will attempt to begin to fill in this gap in South African data and the results will be compared to a previous unpublished South African study in the Cape Town Metropole from 1999.

Includes abstract. / Includes bibliographical references. / Type 1 diabetes is an important chronic endocrine illness of adolescence. It presents a range of unique and difficult to manage problems by virtue of the developmental challenges that face adolescents. Medical services are often ill equipped to deal with this patient group while the complicated management regimes necessary for glycaemic control has far ranging and potentially adverse psychosocial effects on the adolescent and their family. These challenges are experienced directly by the family, arguably the most important proximate influence in the adolescents’ life. Psychosocial factors are pivotal in not only managing metabolic control but also in determining healthy family function and quality of life. This compels health workers who treat diabetic adolescents to comprehensively understand the families they work with. While there has been much research into the psychosocial aspects of adolescents with Type 1 diabetes, there is far less on the way that families and specifically parents experience this chronic illness in family life. Mothers are usually the most important caregivers within this context, taking the lead in co-ordinating and managing the health care needs of their families. The aim of this study is to gain further understanding of how families, specifically mothers make sense and incorporate their experiences into their broader comprehension of how Type I diabetes has affected themselves and their families.

Prayer and spirituality are aspects of patient care that are not often addressed in modem medical practice. Controversy surrounds the family practitioner's role regarding prayer. The patient's belief system and religion are neglected psychosocial variables. Prayer is accepted as an integral aspect of therapeutic counselling, by pastoral counsellors. This is a qualitative study of a purposeful sample of 10 adult patients, selected by the author and three other family practitioners of different religious persuasions. All the participating doctors practise in the "township" areas of the Cape Peninsula. The intention is to gauge the patients' opinion on the family doctors' role regarding prayer and to determine whether differences in religion between the doctor and patient affects the patients' choice of doctor or their religious enquiry or discussion. The individual semi structured interviews are summarised in Venn diagrams. Results, after analysis, are presented collectively. The results confirm other studies and literature, viz. that there is a lack of religious inquiry, initiated by doctors. All respondents had, however, indicated that they would attend doctors of different religious persuasions. Most respondents felt that they would not discuss religious or spiritual issues and would only attend those practitioners for biomedical needs. The positive reinforcement of the doctor patient relationship, for respondents who shared spirituality or prayer with their practitioners, is a significant finding. A sample spiritual inquiry and respondents' suggestions to facilitate the introduction of spirituality into the family practice consultation are presented.

Introduction: In 1994 the Bonteheuwel and Valhalla Park clinics in Cape Town started a pilot project for the care of patients with chronic disorders. Patients in Bonteheuwel and Valhalla Park with chronic disorders who were previously under the care of Day Hospital or Hospitals in other suburbs, can now receive treatment and follow-up at the local authority clinic. There are currently nearly two thousand patients under Bonteheuwel clinic and nearly two hundred patients under Valhalla Park Clinic. Aim: To see if decentralising the care of patients with chronic medical conditions to local clinic level results in altered patient satisfaction. Objective: To look at patient satisfaction with clinic care compared to satisfaction with care at the previous place of service through administration of a comparative questionnaire. Methods: Data was collected by administering a questionnaire to a systematic sample of patients. The questionnaire was administered to 271 clients at Bonteheuwel and 43 clients at Valhalla Park clinics whilst they were waiting to see the doctor or to collect medication. The questionnaire asked patients to assess the clinic service in comparison to their previous place of service by asking whether various aspects of the service are better at the clinic, were better at their previous place or service or are much the same. Patients were also asked what they like best and least about the clinic's service and that of their previous place of service. Results: Results showed a high level of satisfaction with the clinic service compared to the previous place of service, especially in terms of access, cost, surroundings and waiting times. 95% of patients at Bonteheuwel and 98% of patients at Valhalla Park preferred being under the care of the clinic rather than under the care of their previous place of service. Patients felt there was not much difference in the doctor's technical or communication skills at the clinic compared to their previous place of service. Some patients at Bonteheuwel Clinic voiced concerns about the lack of facilities available at the clinic and felt that the clinic needed to be expanded to become a day hospital. Conclusions: Decentralising the care of patients with chronic medical conditions to local clinic level has resulted in increased satisfaction of patients. With the restructuring of health services in the Western Cape at present, decentralising the care of patients with chronic medical conditions to local clinic level may be an option for some communities.

Includes abstract. / Includes bibliographical references. / The general aim of this thesis is therefore to analyse alcohol consumption variables and possible confounding risk factors associated with risky sexual behaviour amongst women in the urban city of Tshwane in Gauteng and the rural Western Cape sites, respectively.