Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015. / The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics / An electronic copy of the Thesis is currently unavailable.

There is a very limited literature examining transport and access to health care, especially in the South African context. The existing literature does not provide an analysis of the influence of transport on access to health care and the utilisation of referrals by the patients. In the context of the HIV/AIDS and Tuberculosis epidemics which have already increased the demand for health care and utilisation of referrals, transport is a critical issue to take into account with regard to access to health care. The case study presented in this dissertation examines the influence of transport (either public or private) on patient's access to health care facilities, particularly the referrals and Emergency Medical services (EMS). The findings are based on a sample of 30 EMS providers, 15 clinic and hospital nurses, doctors and senior administrators, as well as 200 patients (clients) seeking health care in the three clinics which were chosen as study sites. Using qualitative and quantitative methods, this study focuses on patients seeking health care as well as those who provide health care routinely at clinics and hospitals and in emergencies. The focus of interest was transport needs and services and its role in patient access in the context of HIV/AIDS and TB epidemics. Findings of this study confirm research undertaken in other developing contexts. They show that in rural and some remote urban settlements, transport is a serious barrier to equitable access to health care. Race and locality combine to generate a hierarchy of access to care in South Africa. The study concludes that there is a need to reallocate resources in the health sector in order to increase access. Transport needs have to be taken into account when access to services is planned. And alternative models of health care provision in the context of the epidemics have to be conceived, emphasising the provision of well-equipped and resourced primary health care facilities. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Thesis (MPH.) -- University of Limpopo, 2016 / The purpose of this study was to determine the attitudes and experiences of nurses when implementing the 24-hour on call strategy in clinics. A quantitative descriptive research was conducted. A stratified random sampling approach was used to divide the nurse’s population into homogeneous strata from which elements were selected randomly. Three groups of respondents participated in the study, namely, professional nurses (n=99), enrolled nurses (n=32) and enrolled nursing assistants (n=35). The study highlighted the areas that the respondents felt needed to be strengthened in order to provide quality care when implementing the strategy. The findings revealed that there were some personal and management factors that needed to be addressed and improved in order to ensure continuity of services to the communities in rural areas. The study also identified positive areas which the respondents felt supported the implementation of the strategy. KEY CONCEPTS 24-hour on call strategy, Integrated Primary Health care approach, experience, attitudes.

Thesis (MPH.) -- University of Limpopo, 2015 / The success of antiretroviral therapy for HIV infection through widespread and resounding has been limited by inadequate adherence to its unforgiving regimens especially over a long term. While health care professionals may not be able to predict adherence, they can help overcome barriers to adherence and take steps to improve it. The aim of the study was to explore and describe the strategies that are utilised by professional nurses in the primary health care facilities regarding adherence to antiretroviral therapy, Capricorn District, Limpopo Province, South Africa. A qualitative research approach was used to describe the strategies that are utilised by professional nurses in the primary health care facilities in the Capricorn District Limpopo Province, referring to Mankweng Hospital. The descriptive qualitative design was used. Unstructured interviews were used to collect data until saturation was reached. Informed consent was obtained prior the data collection. The data was analysed qualitatively using Tesch’s open coding method. 18 (eighteen) professional nurses working in the primary health care facilities participated in the study. The findings revealed that the strategies utilised by professional nurses in the primary health care facilities to improve adherence to ART were described. Information and education, health worker and adherence guidelines, use of adherence partner or treatment buddy, addressing religious beliefs, communication skills, community mobilisation and continuous counselling, were the strategies that were utilised by professional nurses in the primary health care facilities to improve adherence of patients to ART.

MPH / Department of Public Health

A qualitative, exploratory, descriptive and contextual study was conducted to explore health care unit managers’ view of their role as leader-managers, and to determine the challenges they experience and the skills they need to be effective leader-managers in the 21st century, the Quantum Age. Semi-structured interviews were conducted with eight health care unit managers from a selected public hospital in the Western Cape Province. The findings revealed that health care unit managers experience workforce challenges, with staff shortage being a serious concern; personal challenges, such as an increased workload and role diversity; and organisational challenges with regard to the management of equipment. Desired attributes and skills for leader-managers as indicated by unit managers concur with Shelton’s (1999) Quantum Skills Model. Recommendations were made for nursing practice, education and research, including recommendations on the development of the seven quantum skills. / Health Studies / M.A. (Health Studies)

A qualitative, exploratory, descriptive and contextual study was conducted to explore health care unit managers’ view of their role as leader-managers, and to determine the challenges they experience and the skills they need to be effective leader-managers in the 21st century, the Quantum Age. Semi-structured interviews were conducted with eight health care unit managers from a selected public hospital in the Western Cape Province. The findings revealed that health care unit managers experience workforce challenges, with staff shortage being a serious concern; personal challenges, such as an increased workload and role diversity; and organisational challenges with regard to the management of equipment. Desired attributes and skills for leader-managers as indicated by unit managers concur with Shelton’s (1999) Quantum Skills Model. Recommendations were made for nursing practice, education and research, including recommendations on the development of the seven quantum skills. / Health Studies / M.A. (Health Studies)

Thesis (MPA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: The South African Government of National Unity, through its adoption of the Reconstruction and Development Programme (RDP) in 1994, committed itself to the development of a District Health System (DHS) based on the Primary Health Care (PHC) approach as enunciated at Alma Ata in 1978. This approach is the philosophy, on the basis of which many health systems around the world have been reformed, and out of which has developed the concept of the DHS. District-based health systems are now applied successfully in many countries, and have been adapted to a wide variety of situations, from developing countries on our own continent, to more sophisticated systems elsewhere. A National Health System based on this approach is as concerned with keeping people healthy as it is with caring for them when they become unwell. The concepts of "caring" and "wellness" are promoted most effectively and efficiently by creating decentralised comprehensive management units of the health system, adapted to cater for local needs. These units will provide the framework for our district-based health system, in which a district health authority can take responsibility for the health of the total population in its area. This population-based model allows for constant assessment and monitoring of health problems in the district, the facilities and system provided, and leads to efficient and rational planning. The researcher conducted interviews with key stakeholders, used structured questionnaires and observation and reviewed the relevant National and Provincial documentation and performed a literature review, to assess the feasibility of implementing DHS in the City of Cape Town. The main findings of this research are that the City of Cape Town does have the capacity to implement and sustain the DHS, that it is necessary to implement the DHS in the CCT in order to improve the quality of life of the population, and that there is enough personnel to take the process forward. The main recommendations include the need for training of staff, the promotion of communication and transparency in relation to finances and an ongoing support system from the provincial and national health departments. The research assignment has revealed that the move towards DHS has the blessings of the top management and politicians of the eeT. In addition, it has been established that the Cï.T possesses good infrastructure, technical skills, and human resource capacity. There is also willingness on the part of the unions to take this process forward. There are also challenges that need to be addressed, such as difficulties around staff attitudes, and the training of officials so as to accommodate the requirements of a comprehensive primary health care system, effective and efficient utilisation of available resources and change management. / AFRIKAANSE OPSOMMING: Die Suid-afrikaanse regering van nasionale-eenheid het met die aanvaarding van die Herekonstruksie en Ontwikkelings program (Hop) in 1994, Suid Afrika tot die ontwikkeling van gesondheidsdistrik stelstel verbind. Hierdie stelsel is gebaseer op die primere gesondheidsorg (POS) benadering wat te Alma Alta in 1978 geformuleer is. Die POS is die dryfkrag agter die verandering van verskeie gesondheidstelsels die wereld oor. Vanuit hierdie POS het die distriksgesondheidstelsel ontwikkel. Hierdie distriksgesondheidstelsel word tans suksesvol in baie lande toegepas en is aanpasbaar by verskillende omstandighede, van die Afrika kontinent tot meer gesofistikeerd stelsels op ander kontinente. 'n Nasionale gesondheidstelsel gebaseer op hierdie benadering is ewe besorg om mense gesond te hou asook om na hulle om te sien wanneer hulle ongesond is. Die begrippe van besorgheid en welsyn word effektief en doeltreffend bevorder deur die skepping van n gedesentraliseerde omvattende bestuurseenheid van die gesondheidstelsel wat aangepas is vir plaaslike behoeftebevrediging. Hierdie eenhede voorsien die raamwerk vir n eie distriksgebaseerde gesondheidstelsel, waarbinne die distriksgesondheidsregeerders verantwoordelikheid vir die gesondheid van die totale bevolking en hul gebied aanvaar. Hierdie bevolkingsgebaseerde model laat toe vir voortdurende beoordeling en monitering van gesondheidsprobleme binne die distrik. Dit bepaal watter beskikbare fasiliteite en dienste voorsien moet word sodat doeltreffende en rasionele beplanning kan geskied. Navorsing is onderneem om die lewensvatbaarheid van die implementering van n distrikgesondheidstelsal binne die stad Kaapstad, met 'n speciale fokus op finansiele en menslike hulpbronne, te bepaal. Die navorser het gebruik gemaak van 'n gestruktureerde vraelys en literatuurstudie om die lewensvatbaarheid tydens die implementering van die distrikgesondheidstelsel vir die stad Kaapstad te bepaal. Die belangrikste gevolgtrekking met betrekking tot hierdie navorsing is dat die stad Kaapstad oor die vermoe beskik om 'n distrikgesondheidstelsel te implementeer en te onderhou ten einde die lewenskwaliteit van mense te verseker. Daar is verder bevind dat daar genoeg personeel is om hierdie proses te voltooi. Die belangrikste aanbeveling sluit in die opleiding van personeel, die bevordering van kommunikasie en deursigtigheid in verhouding tot finansies en voortdurende ondersteuning vanaf provinsiale en nasionale gesondheids departmente.

Submitted in fulfillment of requirements for the Degree of Master of Technology: Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introducion Mental health nurses face challenging positions in practice. They are required to support and care for people hospitalised for treatment of mental illnesses on their recovery journeys but are also expected to manage ward administrative tasks, admit patients, attend meetings, dispense medication and communicate with patients (Gunasekara, Pentland, Rodgers and Patterson 2014: 101; Fourie, Mc Donald, Connor and Bartlett 2005: 135). It has been suggested that mental health nurses spend more time managing the ward environment and staff matters resulting in little time to develop and maintain therapeutic patient relationships (Fourie et al. 2005: 135). Problem Statement Research conducted in other countries identified the roles of the psychiatric nurse and mental health care nurses as attending to patients’ basic needs, assistance with self-care activities, monitoring and administering medication, ensuring safe environments in the health care setting and health education (Rungapadiachy, Madill and Gough 2004; Bowers 2005; Seed, Torkelson and Alnatour 2010). Although there is evidence of studies in psychiatric and mental health nursing locally, little is known about the roles of registered nurses and psychiatric nurses at in-patient facilities. OBJECTIVES • To explore which mental health problems are most commonly seen amongst psychiatric patients at these facilities. • To investigate the challenges faced by psychiatric nurses when caring for psychiatric patients. • To investigate what specialized knowledge and skills are required when nursing such patients. • To investigate whether their education and training prepared them adequately to deal with psychiatric patients and suggest guidelines to strengthen nursing education. METHODOLOGY The study utilized a quantitative non-experimental descriptive design to survey registered nurses and psychiatric nurses at in-patient psychiatric facilities in KwaZulu-Natal. A census was utilized in this study as the entire population was sampled. Data were collected using survey questionnaires. Phase two of the study, qualitative content analysis of Psychiatric nursing curricula strengthened the survey findings. FINDINGS Findings of this study showed that 98.4% of respondents believe psychiatric nursing care is an important aspect of holistic nursing practice. Respondents agree that challenges are commonly encountered in psychiatric nursing practice and that they are prepared to deal with these patients. However the aspects most frequently identified as needing greater attention in the Psychiatric nursing curricula were The Mental Health Care Act no 17 of 2002 and practical management of aggression, violence and de-escalation / M

This study explored and described the perception of clinical psychologists regarding thebarriers to the provision of psychological services in urban public health settings for people with first-episode schizophrenia. The qualitative research study utilised an explorative, descriptive interpretive research design. Purposive sampling was utilised to gain access to clinical psychologists, who had at least two years of public health experience working with people recently diagnosed with schizophrenia. Data was gathered from 11 participants from the Nelson Mandela Bay Health District of the Eastern Cape by means of in-depth interviews that were conducted in English by the researcher until data saturation had occurred. A computer-assisted qualitative thematic analysis of the collected data was conducted using NVIVO software. The findings have been categorised according to three broad domains: 1)contextual barriers 2)health care system-related barriers and 3)first-episode schizophrenia syndrome-related barriers. Several specific sub-themes were identified for each of these main domains allowing for recommendations and suggestions to be provided for attending to and overcoming these perceived barriers.