M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2008. / Disasters are events that cause death, injury or disease, damage to property, damage to the environment and disrupt the life of the community. The majority of South Africa’s population lives in fragile and vulnerable conditions due to high levels of poverty, low standards of living and lack of access to resources. The risk of further disaster occurrences is increased by population growth outstripping available residential, agricultural, commercial and industrial development leading to occupation of “at risk” areas such as flood plains. Furthermore South Africa’s extensive coastline and proximity to shipping routes present various meteorological and marine threats. The Disaster Management Act, 2002 (No. 57 of 2002) was promulgated in January 2003 and seeks to focus on disaster risk reduction and prevention. Among other things, the Act requires every sphere of government to develop disaster management plans. It is not clear how much progress has been made by local government in Gauteng province in this regard. A cross-sectional descriptive survey was conducted to evaluate the disaster management function of municipalities in Gauteng province as at February 2008. The study aim was broken down into three study objectives; a) to determine the availability of disaster management plans; b) to determine the degree of compliance of each disaster management plan to the standard required by the Act and c) to determine the disaster management capacity of each municipality. A questionnaire was forwarded at least two weeks before Key informant interviews with designated disaster managers were conducted. Following each interview a physical site inspection of each Disaster Management Centre was carried out and assessed against a uniform check list. All six metropolitan and district municipalities were evaluated with no abstention. The key findings of the study were that; • 66.7% (four out of six municipalities) had approved disaster management plans. The remaining two had draft plans. All the plans were level 1 disaster management plans. • In terms of compliance of the disaster management plans, the municipalities scored between 65.6% - 84.4% with an overall average score for Gauteng province at 75%. • In terms of capacity to carry out their disaster management function; the municipalities ranged from 35.5% - 78% with the overall average for Gauteng province at 65.6%. Significantly Metsweding district municipality was the only municipality in Gauteng province without a Disaster Management Centre. The study made the following recommendations; • The National Disaster Management Centre and subsequently the Provincial Disaster Management Centre need to develop a Remedial plan of action with new time frames for the development of level 3 disaster management plans that are realistic. The Remedial plan of action should prioritize which objectives and Key Performance Indicators in the Disaster Risk Management Framework are deliverable in the immediate term, the medium term and over the long term. • The establishment of a Disaster Management Centre for Metsweding district municipality. This will require that the municipality engages with the Provincial and National Disaster management Centres about the allocation of a conditional grant to fund start up costs as provided for in the Disaster Risk Management Framework (Enabler 3 – funding arrangements). • The National and Provincial Disaster Management Centres need to provide guidelines on the standards/norms for the staffing requirements of a Disaster Management Centre as well as the physical infrastructure requirements of a Municipal Disaster Management Centre.

In November 2003, the Department of Health launched the Operational Plan for Comprehensive Care, Management and Treatment (CCMT) for South Africa. This policy has as its central goal universal access to antiretroviral therapy to 1 million people living with HIV by the end of 2007. National implementation of the operational plan began in April 2004 and as at the end of October 2006, South Africa had initiated 213 828 people onto ART through the Plan, making it the biggest programme in the world. Of these, 55 580 people had been placed on treatment in Gauteng Province. Despite these early achievements, there are concerns as to whether the South African public health sector can rise to the challenge of universal access while achieving good clinical outcomes and programme performance. As Venter (2006: 298) states, “the health sector is buckling under the current load, and currently does not have the capacity to do anymore than dent the numbers needed to treat, unless a radical restructuring of health services occurs.” A crucial factor in providing a comprehensive approach to HIV/AIDS is the reorientation of service delivery from acute to chronic disease care. In addition to the shift in focus to chronic disease management of HIV/AIDS, health system constraints need to be addressed. These include inadequate health system infrastructure and human resources. This study aimed to comprehensively assess organisational capacity to provide antiretroviral therapy (ART) in two public sector CCMT sites in Gauteng Province and the influence of these organisational factors on follow-up and adherence to ART, with the view to understanding whether public sector CCMT sites are able to deal with new challenges posed by the Plan. The objectives were to assess: (1) levels of follow-up and adherence in patients registered at the CCMT site, (2) dimensions of organisational capacity, drawing on internationally recognised chronic disease care frameworks, namely the Wagner Chronic Care Model (CCM) and Innovative Care for Chronic Conditions (ICCC). These dimensions were: presence of motivated and adequately staffed teams; delivery systems design; the quality of support systems; and facility information systems. 3) the similarities and differences between the two sites with respect to organisational capacity, follow-up and adherence. The two sites were selected through a stratified (CHC and hospital) random sample of CCMT sites in Region A of the province, excluding the long–standing and well-established academic hospital CCMT sites in the sampling frame. The two sites, located in a District Hospital in the West Rand and a Community Health Centre (CHC) in Central Witwatersrand, were visited between May and July 2006. They had initiated 540 and 1001 patients on ART respectively since October 2004. A multi-method health service evaluation of capacity in the HIV related services (ART/Wellness, VCT, PMTCT, and TB) was conducted. This consisted of 11 semi-structured interviews with facility and programme managers; review of registers and routine facility data; an observation checklist and mapping to assess the physical infrastructure of the facility, presence of management and health information systems; 35 self administered questionnaires to assess the levels of motivation of nursing staff at each site. Data on self-reported adherence and viral loads were obtained from a separate study involving exit interviews with 356 patients who had been attending the services for at least four months in the two sites.1 Of the 540 and 1001 patients enrolled in the two services, 69.8% and 69.3% were still in the service after 18 months at the hospital and CHC, respectively. The monthly drop-out rate at the hospital had risen fairly sharply towards the end of the 18 month period, attributed by the staff to growing difficulties in access to the site by new enrolments. Nevertheless, based on self-reports (3- day recall period), viral load measures, and loss to follow-up, adherence levels at both sites appeared to be in line with national and international best practice. The percentage of patients with undetectable virus was 76.2% and 74.4% at the hospital and CHC, respectively. Staffing of the CCMT sites matched the pre-requisites outlined by the National Department of Health for a ‘core’ health care team treating 500 patients. The CHC CCMT site, however, had more than 500 patients on ART and moreover was providing two services within one unit, i.e. ART/Wellness and VCT thus increasing the patient load. Sites were reaching saturation and this was due to the lack of sufficient space coupled with the high volumes of patients, shortage of certain scarce skills (in particular pharmacy staff), and the multiple responsibilities of nursing staff. In general, the staffing situation at the hospital appeared better. More staff had joined than left the hospital over the year prior to March 2006, and clinical workloads both in the ambulatory services and the CCMT site were less than at the CHC. Vacancy rates were low, at 13.8% and 4.8% for the hospital and CHC, respectively. Strong leadership of CCMT sites by motivated ART programme managers was displayed; site managers were highly respected and revered by staff. Based on ratings in a self-administered questionnaire, overall levels of motivation and organisational commitment at both sites appeared good, although, worryingly, a sizeable proportion of respondents in both sites agreed with statement “I intend to leave this hospital/clinic.” Lack of external support (from the HIV/AIDS, STI, TB Programme) and debriefing systems for programme managers and nursing staff was identified as weaknesses. With some exceptions, both sites showed evidence of strong ‘horizontal’ mechanisms of referral and coordination between HIV and AIDS related services within sites; however the PMTCT programme at the hospital was less co-ordinated and networked with other services. In addition, ART and PMTCT programme managers at the hospital indicated that the relationship between hospital services and surrounding clinics was poor. Apart from the lack of space at the CHC CCMT site, support systems were adequate. There were no reported drug stock outs and supply of drugs and general supplies was good at both sites. Both sites were able to offer a range of routine and HIV specific tests. A combination of paper and electronic based information systems were used at both sites, however, the hospital CCMT site used a mixture of standard and locally designed data collection forms compared to the CHC which mainly used standard Department of Health forms. The information systems were adequate in monitoring and evaluating patients and programme performance; however, the study highlighted the absence of a clear patient register for individual and programme monitoring and only cross sectional patient data was reported. There was also considerable duplication at the hospital in collecting and compiling patient information. The findings of the study suggest that the two sites, located in the ‘routine’ public sector environment of Gauteng Province have demonstrated ability to build organisational capacity for ART provision, through a degree of systems integration and design, decision support systems, generation and local use of information and motivated local champions. Through these elements of organisational capacity, both sites have achieved good adherence rates. The key factors to achieving this good programme performance were motivated local champions who drove programmes forward and good working relationships between the CCMT and other players. In light of the weaknesses identified, the following key recommendations are proposed: Review sites to identify the reasons for the high-drop out rate and address these issues Due to evidence of early saturation at the CHC, it is suggested that additional roll-out sites be established, or alternatively increase staffing and space at the CHC to meet the needs of the high patient load. In addition, well patients should be decanted to lower level services e.g. community based care organisations, thus reducing the burden on the site Pay attention to the physical infrastructure needs of clinic based sites, especially as they become saturated Foremost, the current Employee Assistance Programme (EAP) implemented in Gauteng Province should be strengthened and marketed so that staff members are more aware of the service and make use of it accordingly. Alternatively, a culture of “caring for the caregivers” should be cultivated, through for example, specialist assistance, debriefing sessions, and better external programme support from HIV/AIDS, STI, TB (HAST) managers Improve support and supervision of ART programmes by facilitating greater communication and feedback between sites and district, national and provincial levels of government. Adopt a strategy of “task shifting”, through better use of lay workers, counsellors, and mid level workers such as pharmacy assistants. Facilitate greater integration and coordination between the PMTCT programmes and other services, including the provision of VCT and training of staff. In addition, it is imperative that there is good integration between services provided by local and provincial Departments of Health Simplify and standardise information systems, particularly the development of clear patient registers to allow for cohort analysis.

ABSTRACT This abstract provides a brief summary of the research study (Nieswiadomy, 2002). The South African report on confidential enquiries into maternal deaths identified delayed and/or infrequent antenatal care as a significant avoidable factor contributing to maternal mortality in South Africa (SA) (Department of Health (DOH), 2001). There are still women in South Africa whose first antenatal care contact with the midwives obstetrical unit (MOU) is in the third trimester of their pregnancy. The aim of this study was to determine the health seeking practices amongst primigravidae at a level 1 MOU, based in a peri-urban area in Gauteng province, SA. The health seeking practice of concern was antenatal clinic attendance. The research design was qualitative, descriptive, exploratory and contextual. The research method implemented was unstructured individual in-depth interviews. The population consisted of primigravidae who were attending antenatal clinic at a level 1 MOU. The sample consisted of primigravidae who booked at the level 1 MOU’s antenatal clinic in the third trimester of their pregnancy. Maximum variety purposive sampling, with inclusion and exclusion criteria, was used and sampling continued until data were saturated. The sample size consisted of 10 participants whereby 2 of them were the pilot study and eight were the interviews that followed the pilot study. Data were collected by means of individual in-depth interviews. One question was asked: ‘What experiences influenced you to go for your first antenatal visit when you did?’ Interviews were audio taped, transcribed and analyzed by using Tesch’s eight steps of data analysis (Creswell, 1994). Lincoln and Guba’s four strategies for trustworthiness were applied and ethical considerations were implemented. The results were discussed under two themes. Those themes were: needs, and delayed booking. The recommendations were made regarding the recommendations that arose from the study, recommendations for research, nursing practice and nursing education.

Emerging broiler famers are faced with the challenge of acquiring contracts with the contract providers in South Africa. The question is, are these emerging farmers able to perform well financially regardless of the availability of contracts to their disposal. Profitability is one of the core issues to the development and sustainability of emerging broiler farmers. A well performing farmer is the one who is able to manage and improve the good financial performance of the farm in general. In order to determine the financial performance of the farm, financial ratios can be useful in determining and analyzing how a farm performs financially. In this study, four financial ratios are used to analyze and determine how emerging broiler farmers in Gauteng perform financially. This is done through a representative farm model which makes use of ten emerging farmers situated in the southern and northern sides of Gauteng. Out of ten emerging broiler farmers that took part in the study, the results show that only two of them are producing under contracts. This is an indication that emerging broiler farmers in Gauteng are characterized by both financial and production risk. This further implies that farmers who do not have contracts are likely to have a poor financial performance in as far as broiler enterprise is concerned. The study establishes the differences between the contract growers and the non contractors that form the representative farm model and this is achieved by looking the results of the financial ratios. The study further distinguishes the financial performances between the southern and northern sides of Gauteng which form the representative farm model. The results indicated that although 80% of the emerging broiler growers in Gauteng do not produce under contracts, they are still able to perform well financially. However the contract growers outperform the no contractors in terms of financial performance due to a well defined market structure. / Dissertation (MScAgric)--University of Pretoria, 2010. / Agricultural Economics, Extension and Rural Development / unrestricted

The primary focus of this thesis is to describe the prevailing atmospheric conditions when heavy rainfall occurs over the Gauteng Province in South Africa. This thesis first describes the characteristics of daily heavy rainfall over Gauteng by defining different heavy rainfall classes and considering the seasonal distribution of these events. Late summer (January, February and March) has considerably more heavy rainfall days than early summer. The change of the character of the atmosphere as the summer season progresses is highlighted by the investigation into the monthly average synoptic circulation patterns when heavy rainfall occurs. The weather systems change from extra-tropical in the first few months of the summer rainfall season to tropical in February months. It is also shown how cyclonic vorticity advection occurs in the upper troposphere whenever heavy rainfall occurs, irrespective of the time of the season. A deep layer of horizontal wind convergence is also present when heavy rainfall occurs and this is replaced by horizontal wind divergence above that. A monthly climatology of sounding-derived parameters associated with heavy rainfall is constructed and it is again apparent how the atmosphere changes from one where conditional instability dominates the production of heavy rainfall in early summer to one where convective instability plays a dominant role in late summer. Twelve sounding-derived variables are identified to describe the thermodynamical profile of the atmosphere when heavy rainfall occurs over Gauteng. They include variables not previously used such as the Elevated K-Index and the meridionial wind component near the surface. Self-organizing maps are used to create a climatology of the vertical profile of the atmosphere during heavy rainfall and this methods captures the changes to the atmospheric state during the progression of the summer season. Favourable sounding-derived parameters and circulation criteria are combined in a self-organizing map to predict daily rainfall frequencies. This method produces encouraging results and methods should be explored to create probabilistic daily rainfall forecast for Gauteng in an operational environment. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Geography, Geoinformatics and Meteorology / unrestricted

A Thesis Submitted In Partial Fulfillment of The Requirements for the Degree: Phd (Community Psychology) in the Department Of Psychology Faculty of Arts at the University of Zululand, 2008. / Hijacking has become an everyday experience in South Africa. Thus, this phenomenoiogical study was done to understand the survivors' feelings and meaning of being hijacked in the Gauteng Province, South Africa. Various authors outlined and described the survivors' experiences as traumatic. The survivors' experiences include shock, disbelief and dissociation, attempts to ensure survival, feelings of terror and helplessness, and heightened sensory alertness, which often result in Post Traumatic Stress Disorder The respondents in this study were hijacked at gunpoint, were manhandled while the hijackers used vulgar language and subjected them to humiliating and fear inducing treatment, which left them completely helpless, angry and defenseless and with the expectancy to die. They were robbed of their possessions and helpless, because they were at the hijackers' mercy, and had to surrender to the hijackers. They could not resist, but, begged, prayed and negotiated to be spared. Onlookers did not dare to help and help only came in non-threatening circumstances. The police were not there to help them either and when they came it was only to take statements. The respondents' experiences and feelings during and after the hijacking serve as guidelines during counselling. Their feelings of helplessness, humiliation, fear and PTSD need to be addressed in counselling in order to assist in restoring the quality and worth of their lives.

Thesis (MPH.) -- University of Limpopo, 2019 / The purpose of this study was to investigate the challenges faced by health care workers caring for patients diagnosed with Tuberculosis at Tertiary 1 Military Hospital, Gauteng Province, South Africa. The quantitative research study was conducted and data was collected from 56 respondents who participated in this study conducted at Tertiary 1 Military Hospital, Gauteng Province, South Africa. Self-administered questionnaires were used to collect data from the respondents through a self-administered questionnaire. Data was then analysed using statistical STATISTICA 7, Software SPSS 23, as well as Microsoft Excel for presentation of tables and graphs. Respondents consisted of 59% females, compared to 41% of males. Majority of respondents (76.4%) were between the ages of 23-32. Respondents who were single were 66% compared to 32.1% married and 1.8% widowed. The findings of this study indicates that the health care workers, work in challenging environment with a lack of resources and need to be supported, as they experience more negative than positive experiences whilst caring for patients diagnosed with TB, further, revealed that, the health care workers did not get support from management. The analysis of the data has shown that management seemed not to understand fully what health care workers at grass-roots level are experiencing. Furthermore, findings of this research revealed that health care workers have never received any formal training on management of patients diagnosed with TB, wherein at times they have questions they have to ask their colleagues/friends, which at times they felt frustrated, the findings of this study furthermore revealed the lack of in-service training. The study concluded that, the respondents fears contracting TB from patients diagnosed of TB: there is compromised TB infection control measures, such as failure to wear protective masks (N95), and lack of adequate resources was also revealed by several respondents. The general findings of this research demonstrate that there should be adequate resources allocated to healthcare workers caring for TB, there should also be an initiatives to establish the health care worker‟s training regarding TB management and regular in-service training especially on TB management. This was also demonstrated in the study conducted by Chung et al, 2005, on the experiences of nurses while caring for Severe Acute Respiratory Syndrome (SARS) patients, the findings revealed a variety of emotions that were experienced, whereby, health care workers considered themselves vulnerable and at risk of contracting the disease themselves especially airborne diseases.

Orientation: Job satisfaction, which is usually lower among healthcare workers than in other types of organisations, has a major influence on job-related behaviour, such as turnover, absenteeism, and self-reported job performance. Research purpose: The aim of this study was to compare the level of job satisfaction between publicly employed and privately employed physiotherapists. Research design: A non-probability research design was used to choose a convenient sample. One group was from the public sector and the other from the private sector all working in Gauteng Province (N=200). A structured self-administered Minnesota Satisfaction Questionnaire (MSQ) (Weiss, et al., 1967), validated by Ian Rothmann for South African circumstances, was identified for this purpose. Main findings: There was a significant difference in support work value factor (supervision, company policies and practices) and work conditions work value (activity, independence, variety, compensation, security and working conditions) between publicly employed and privately employed physiotherapists. The privately employed had a higher mean value 3.59 and publicly employed a smaller mean value of 3.33 on support work value. The mean values of work conditions and value for publicly employed physiotherapists and privately employed physiotherapists were 3.44 and 3.84 respectively. Practical implications: Managers should pay particular attention on the job satisfaction levels of employees in the public sector. Value add: The study adds to the literature and also confirms that there is a difference between publicly employed and privately employed physiotherapists‘ levels of job satisfaction. / MBA (Business Administration), North-West University, Potchefstroom Campus, 2015

Orientation: Job satisfaction, which is usually lower among healthcare workers than in other types of organisations, has a major influence on job-related behaviour, such as turnover, absenteeism, and self-reported job performance. Research purpose: The aim of this study was to compare the level of job satisfaction between publicly employed and privately employed physiotherapists. Research design: A non-probability research design was used to choose a convenient sample. One group was from the public sector and the other from the private sector all working in Gauteng Province (N=200). A structured self-administered Minnesota Satisfaction Questionnaire (MSQ) (Weiss, et al., 1967), validated by Ian Rothmann for South African circumstances, was identified for this purpose. Main findings: There was a significant difference in support work value factor (supervision, company policies and practices) and work conditions work value (activity, independence, variety, compensation, security and working conditions) between publicly employed and privately employed physiotherapists. The privately employed had a higher mean value 3.59 and publicly employed a smaller mean value of 3.33 on support work value. The mean values of work conditions and value for publicly employed physiotherapists and privately employed physiotherapists were 3.44 and 3.84 respectively. Practical implications: Managers should pay particular attention on the job satisfaction levels of employees in the public sector. Value add: The study adds to the literature and also confirms that there is a difference between publicly employed and privately employed physiotherapists‘ levels of job satisfaction. / MBA (Business Administration), North-West University, Potchefstroom Campus, 2015

The challenges facing the health system in South Africa are likely to impact on life-long adherence for patients in the context of the rollout of ART. Smaller ART programs have been able to demonstrate good adherence rates, but the question remains if this can be achieved by large public sector ART programs. Most adherence researchers share the basic understanding that patients are adherent when they take their medications as prescribed by the health provider. An approach to adherence that combines both clinical and social knowledge—a biosocial approach— is likely to move us to a better understanding of adherence and how to improve adherence to ART. This study on social support and ART adherence aims to gather and document information that could be used to improve services and program strategies for strengthening and maintaining adherence at ART rollout sites in Gauteng. The two study sites Carletonville Hospital and Zola Clinic were chosen randomly from all second-generation rollout sites in the Province. Data were collected from a total of 359 respondents, 164 in Carletonville and 195 in Zola. The response rate was 98.3%. The results showed that the majority of the respondents were female (72.1%) and about 44.9% were within the age group 30-39 years. In terms of educational attainment, most respondents (70.1%) had received secondary education and 2.5% had not attended school. Based on assets quintiles scores of 1-5, with 5 being the highest score, about one-third of the respondents scored 1, and only 7% scored 5. Compared with Carletonville, respondents from Zola were more educated and better resourced. At the facilities, treatment preparation and support and adherence assessment procedures are routine features of the ART program and entail pre and post test counseling, group education and adherence counseling and serve as mechanisms for adherence support. This is enhanced by routine follow-up appointments where ART patients are provided information on side effects of ARVs, effectiveness of treatment, CD4 cell and viral load counts and referral to services not provided at the facility. Additionally, support groups accessed by patients undertake a range of educational activities on staying healthy, viral load and CD4 cell counts and ARVs. Although respondents were largely positive about their interactions with health providers and the support they provided, some expressed concern about health workers being too busy to address their problems, not treating patients with enough respect and sometimes patients leaving without receiving treatment because staff were either absent or late or queues were too long. The HIV disclosure rate was high (95.5%). However, respondents were more likely to disclosure to a family member, but less likely to a friend, neighbor or religious leader. Selfreported adherence and viral load adherence rates were high (97.6% and 76.6% respectively) but CD4 adherence was lower at 51.0%. The study did not document a convincing association between social support and ART adherence. Only two variables (receiving food supplements and age groups) were significantly associated with CD4 and viral load adherence. Given the limitations of the study, a longitudinal study is needed in these sites to better understand the predictors of short and long-term adherence and to explore ways to better measure the relevance, content and quality of the social support services being utilized by ART patients at facility and community levels. Interventions and policies are needed to respond to the concerns identified from the study regarding inadequate attention and respect by health providers, absence or lateness of doctors and pharmacists and challenges pertaining to access to food, income and disability grants.