Introduction: This study aimed to explore private General Practitioners' perceptions of Managed Health Care CMHC) for health service delivery in the Republic of South Africa (RSA). The specific objectives were to review perceptions regarding issues in MHC including ethics of care, quality of care, design ofMHC programmes and regulation and monitoring ofMHC. The study also reviewed demographic profile of respondents and associations between demographic profile and perceptions. A literature survey indicates that MHC was introduced in a Western context as a means ofregulating cost of healthcare. Models ofMHC generally involve a need to obtain authorization and a restriction of services available. There are ongoing debates about MBC and in particular the potential conflict between managing healthcare provision using business and profit principles and the principles of other stakeholders in health care. Providers, such as General Practitioners, are concerned that their autonomy and their ability to offer best possible care for their patients may be compromised. Patients feel that their ability to access optimal care is not a primary consideration in a model of MBe. The popularity ofMBC in the United States of America is declining and MBC companies have been making financial losses on the Stock Market. MBC has been introduced in South Africa and there has not been any recent assessment of healthcare provider perceptions of the model. This study aimed to address this gap in literature. Methods: The study design was mixed with quantitative and qualitative components. The study population was all private General Practitioners in RSA as this population would have most experience of MBC. The data collection tool was designed by the researcher and comprised closed-ended questions and one open-ended question around perceptions of MBe. Demographic data, and other data relating to experience of MBC, was collected on a separate questionnaire. Questionnaires were posted to a representative sample of private General Practitioners; this constituted 30% of all active private General Practitioners. Results and discussion: The response rate was poor at 13.6%. Respondents generally had negative perceptions of MHe. They cited problems with ethics ofMBC, quality of service and felt that it affected their ability to act independently. They felt that MHC should be monitored by an independent regulatory body and that there should be more teaching around differing models of healthcare. There were no significant associations between gender, place of work, experience oftvtHC and perceptions. However, there was a significant correlation between doctors employed by Iv1HC companies and perceptions. A major limitation of this study was the predominant use of quantitative methodology. A qualitative methodology, using focus group discussion, may have highlighted major issues and following initial qualitative methods a quantitative tool could have been developed. The low response rate is of concern. Respondents may be biased and may have only responded if they felt strongly about the subject. However, respondents did raise some important issues, especially with regards to ethics which must be explored further. There should be ongoing research into differing models of healthcare provision (for example private-public partnerships). Medical school curricula should include training around models of healthcare. Consideration should be given to monitoring MBC using an independent monitoring authority. / Thesis (M.Med)-University of KwaZulu-Natal, Durban, 2008.

Thesis (MPA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The goal of this research was to investigate effective leadership that drives organisational change in the public health sector to meet the changing environmental needs to improve service delivery within the Western Cape Department of Health. Organisational change in the public health sector must lead to improved public health service delivery. The role of leadership is to deal with incompetent personnel as they are the cause of problems regarding inadequate service delivery. Leadership must contribute to the main areas where competency development needs to take place. Healthcare 2030 requires transformational leadership from the ranks of managers and clinicians for collective and distributed leadership across all levels of organisations. The research methodology used in this study was a combination of qualitative and quantitative research methodologies. The methodology included an empirical investigation in the form of a literature review and a preliminary semi-structured interview as well as a nonempirical investigation. The empirical investigation was conducted by using semi-structured interviews as well as a survey questionnaire which was designed to gather information focussing on leader personality traits, task-related traits and understanding the organisation. This study specifically focussed on effective public leadership to drive organisational change in the health sector and to improve service delivery. The results provide support for a cohesive trait-behavioural model of leadership effectiveness. In general, leadership traits associated with task competence are related to task-oriented leadership behaviours, which improve performance-related leadership outcomes. Effective leadership in the public health sector that drives organisational change is based on the general personality traits of a leader, task-related traits and understanding the organisation. These are the elements that are important for effective public leadership to improve service delivery. / AFRIKAANSE OPSOMMING: Die doel van hierdie navorsing was om doeltreffende leierskap, wat organisatoriese verandering in die openbare gesondheidsektor teweeg kan bring, te ondersoek. Sodoende kan in die veranderende omgewingsbehoeftes voorsien word en kan die Wes-Kaapse Department van Gesondheid verbeter. Organisatoriese verandering in die openbare gesondheidsektor moet tot verbeterde openbare gesondheidsdienslewering lei. Die rol van leierskap is om onbekwame personeel te hanteer omdat hulle die oorsaak van probleme met betrekking tot onvoldoende dienslewering is. Leierskap speel ‘n sleutelrol in die bevordering van bevoegdheidsontwikkeling. Healthcare 2030 vereis transformerende leierskap uit die geledere van bestuurders en dokters oor alle vlakke van organisasies heen. Die navorsingsmetodologie wat in hierdie studie gebruik is, was ’n kombinasie van kwalitatiewe en kwantitatiewe navorsingsmetodologieë. Die metodologie het ’n empiriese ondersoek in die vorm van ’n literatuuroorsig en ’n voorafgaande semi-gestruktureerde onderhoud asook ’n nie-empiriese ondersoek, ingesluit. Die empiriese ondersoek is uitgevoer deur van semi-gestruktureerde onderhoude en ’n opnamevraelys gebruik te maak. Die vraelys is ontwerp om inligting met betrekking tot leiers se persoonlikheidseienskappe, taakverwante eienskappe en ’n begrip van die organisasie te ondersoek. Hierdie studie het spesifiek op doeltreffende openbare leierskap gefokus om organisatoriese verandering in die gesondheidsektor te bewerkstellig en dienslewering te verbeter. Die resultate ondersteun ’n samehangende eienskapgedragmodel van leierskapdoeltreffendheid. Oor die algemeen is leierskapeienskappe wat met taakbevoegdheid geassosieer word, verwant aan taakgeöriënteerde leierskapgedrag wat prestasieverwante leierskapuitkomste verbeter. Doeltreffende leierskap in die openbare gesondheidsektor wat organisatoriese verandering dryf, is gegrond op die algemene persoonlikheidseienskappe van ’n leier, taakverwante eienskappe en ’n begrip van die organisasie. Dit is die elemente wat belangrik is vir doeltreffende openbare leierskap om dienslewering te verbeter.

M.Comm. / Health care in South Africa has been well described in terms of structure. However, to what extent would it be possible to describe the health care sector in South Africa in terms of that used to describe an industry? What conclusions could be drawn at the end of the study if this was or was not possible? Strong emphasis in industry analysis is placed on the nature of the competitive forces and on levels of profitability. Can the South African health care sector also be described in those terms? The following objectives can be identified in this study: To complete a literature review on the structure of health care in South Africa in terms of facilities, geographic location, services offered, manpower, financing, remuneration, population served and legislation. To complete a literature review on models and methods that can be used to analyse industries. To determine to what extent it is possible to apply Porter's model (and others) of industry analysis to the South African health care industry. To identify key success factors for the industry. To draw conclusions from the study and make some recommendations.

Thesis (MA)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The deaf community face similar access barriers to health care services and information as do other linguistic minority groups. Amongst others, this includes limited access to English communication, misunderstanding of medical terminology, irregular contact with health care professionals of the same language and cultural background and the need to overcome the challenges experienced by using others as interpreters in a health care setting. Barriers to the written and spoken word limit access to health care information as deaf people cannot overhear conversations, have limited access to mass media and present with low literacy rates. The South African Constitution stipulates that every citizen has an equal right to health care services and should not be unfairly discriminated against, on the basis of language. Unfortunately, despite what is written in the Constitution, the reality is that many South Africans are denied equal access or receive compromised access to health care services because of language barriers. The lack of access to interpreters at health care facilities across South Africa inhibits patients from expressing themselves correctly and limits the providers’ professional ability to make a correct diagnosis and provide relevant information. The current study explores the barriers and facilitators to accessing health care services and health care information for people who are deaf in a relatively well-resourced setting. A sample of deaf participants from the National Institute for the Deaf in Worcester were interviewed to gain an understanding of problems experienced with accessing health care services and health care information. Participants reported communication and socio-economic factors as barriers to accessing health care services. The main barrier to accessing health care information was considered to be the inaccessibility of the mass media. Recommendations were made by participants on ways to improve access to health care services and health care information for the deaf population of South Africa. Keywords: Health care acces, Health care information, Deaf, Worcester, Barriers and facilitators to health care services. / AFRIKAANSE OPSOMMING: Die dowe gemeenskap ervaar soortgelyke struikelblokke as ander linguistiese minderheidsgroepe met toegang tot gesondheidsdienste en inligting. Dit sluit onder andere in beperkte toegang tot Engelse kommunikasie, wanbegrip van mediese terminologie, ongereelde kontak met mediese dienspraktisyne van dieselfde taal en kulturele agtergrond, en die uitdaging wat oorkom moet word om ander mense te gebruik as tussenganger en tolk in ’n mediese situasie. Hindernisse met geskrewe- en spreektaal beperk die toegang tot gesondheidsinligting. Dowe mense kan nie na gesprekke luister nie, het beperkte toegang tot massamedia en vertoon oor die algemeen 'n laer geletterdheidsprofiel. Die Suid Afrikaanse Grondwet stipuleer dat elke burger ’n gelyke reg tot gesondheidsdienste het en verbied onregverdige diskriminasie op grond van taal. Ten spyte van die Grondwet is die realiteit dat baie Suid Afrikaners nie gelyke toegang het nie en ’n laer vlak van mediese dienslewering ervaar as gevolg van taalprobleme. Die ontoereikende beskikbaarheid van tolke by gesondheidsfasiliteite reg oor Suid Afrika beperk die vermoë van pasiënte om hulself behoorlik uit te druk. Dit beperk daarom ook die mediese praktisyn se vermoë om ’n korrekte diagnose te maak en relevante inligting rakende die diagnose aan die pasiënt oor te dra. In die huidige studie is die struikelblokke en fasiliteerders vir toegang tot gesondheidsdienste en inligting ondersoek vir dowe mense in ’n relatief goed toegeruste omgewing. ’n Steekproef van dowe deelnemers is by die Nasionale Instituut vir Dowes in Worcester geselekteer. Deur middel van onderhoude is die probleme wat ondervind word met toegang tot gesondheidsdienste en gesondheidsinformasie geïdentifiseer. Deelnemers het kommunikasie en sosio-ekonomiese faktore as struikelblokke tot die toegang van gesondheidsdienste geïdentifiseer. Die grootste struikelblok met toegang tot mediese inligting was die beperkte toegang tot massamedia. Voorstelle is deur die deelnemers gemaak vir die verbetering van die toeganklikheid tot mediese dienslewering en gesondheidsinligting vir die dowe populasie in Suid Afrika.

Thesis (MNutrition )ITE))--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Introduction: The primary objective was to determine whether pregnant women visiting primary health care clinics (PHCs) were aware of the nutritional supplementation programmes: Nutrition Supplementation Programme (NSP) food, folate-, iron- and vitamin A supplementation. The secondary objective was to determine whether pregnant women qualified for the NSP food-, folate- and iron supplementation. The third objective was to determine whether those who qualified received the prescribed NSP food-, folate-, and iron supplementation and whether they were compliant with these interventions. Design: A cross-sectional descriptive study was conducted at all PHCs hosting basic antenatal clinics in the Cape Town Metropolitan Area of the Western Cape Province, South Africa. Method: One hundred and fourteen pregnant women who met the inclusion criteria were included in the study using a non-random quota sampling strategy. Pregnant women were interviewed using a validated questionnaire. The mid upper arm circumference (MUAC) was measured and the symphysis-fundus (SF) measurement was obtained from the medical files to determine whether participants met the entry criteria for the NSP. Written informed consent was obtained from participants. Results: Fifty per cent of participants were between 12 and 24 weeks of gestation. Most of them (68%) had an MUAC of between 24,7 cm and 34,4 cm. Fifty (44%) of the participants had a sufficient SF measurement. Twenty-one (18%) of the participants indicated that they were aware of the vitamin A Programme, 56 (49%) were aware of the NSP food-supplementation and 79 (70%) knew about the folicand iron supplementation that pregnant women should receive from the clinic. Six (5%) participants qualified for the NSP with an MUAC of below 23 cm. Only one (17%) participant was registered with the NSP and received the food-supplementation. Seventy (61%) of the participants indicated that they received and used the iron- and folic supplements, of which 30 (43%) did not know why they needed to take these supplements. Conclusion: Folate- and iron supplementation appears to be reasonably successfully implemented in the Cape Town Metropolitan Area among pregnant women visiting PHCs. The NSP food-supplementation, however, appears to be unsuccessfully implemented and needs further attention. Resources could be appointed to inform pregnant women about the reasons for and importance of taking these supplements. / AFRIKAANSE OPSOMMING: Inleiding: Die hoofdoelstelling was om te bepaal of swanger vroue wat primêre gesondheidsorgklinieke (PGK’s) bywoon, bewus was van die voeding supplementasie programme: Voedsel Supplementasie Program (VSP) – voedselaanvulling, folaat-, yster- en vitamien A supplementasie. Die tweede doelstelling was om te bepaal of hierdie swanger vroue in aanmerking kom vir die VSP– voedselaanvulling, folaat- en yster supplementasie. Die derde doelstelling was om te bepaal of hierdie swanger vroue die voorgeskrewe VSP – voedselaanvulling, folaat- en yster supplementasie ontvang het en hierdie intervensies nagevolg het. Ontwerp: ʼn Deursnit beskrywende studie is gedoen en data is ingesamel van al die PGK’s wat voorgeboortelike klinieke huisves in die Kaapstadse metropolitaanse gebied, in die Wes-Kaapprovinsie, Suid-Afrika. Metode: Honderd en veertien swanger vroue wat aan die insluitingskriteria voldoen het, is volgens ʼn nie-ewekansige kwotastrategie uitgesoek om aan die studie deel te neem. Onderhoude is volgens ʼn bevestigde vraelys met swanger vroue gevoer. Die omtrek van die middelboarm is geneem en die symphysis-fundus-meting is van die mediese lêers verkry om te bepaal of deelnemers aan die insluitingskriteria vir die VSP voldoen. Deelnemers het ʼn vrywaringsvorm geteken voordat hulle aan die studie begin deelneem het. Resultate: Vyftig persent van die swanger vroue het ʼn gestasie-ouderdom van tussen 12 en 24 weke gehad. Die omtrek van die meeste vroue (68%) se middelboarm was tussen 24,7 cm en 34,4 cm. Vyftig (44%) van die vroue se symphysis-fundusmeting was voldoende. Een en twintig (18%) van die deelnemers het aangedui dat hulle van die Vitamien A-program bewus was, 56 (49%) was van die VSPvoedselaanvulling bewus en 79 (70%) van die deelnemers was bewus van die folaat- en yster supplementasie wat swanger vroue van die kliniek behoort te ontvang. Ses (5%) deelnemers, met ʼn middelboarm-omtrek van minder as 23 cm, het vir die VSP in aanmerking gekom. Slegs een (17%) deelnemer was geregistreer en het die voedselaanvulling ontvang. Sewentig (61%) van die deelnemers het aangedui dat hul wel yster- en folaat supplementasie ontvang en gebruik, waarvan 30 (43%) nie geweet het waarom hulle dié supplemente neem nie. Gevolgtrekking: Dit wil voorkom asof folaat- en yster supplementasie vir swanger vroue wat PGK’s in die Kaapstadse metropolitaanse gebied besoek, redelik suksesvol toegepas word. Daarteenoor word die VSP – voedselaanvulling onsuksesvol uitgevoer en behoort dit verdere aandag te geniet. Hulpbronne kan aangewys word om swanger vroue beter in te lig oor die doel en belangrikheid daarvan om hierdie supplemente te neem.

D.Cur. / Every woman and unborn child has the right to quality antenatal care. Concern is expressed regarding the quality_ of antenatal care currently delivered in South Africa, but due to a lack of formal written standards for antenatal care, this concern cannot be addressed. In view of this, the aim of this study was to generate valid standards for antenatal care. A contextual, exploratory and descriptive research design had been used to complete the research in two phases. An extensive literature exploration was done during the first phase (Development phases 1 and 2) in order to describe a conceptual framework for antenatal care. Concept standards were formulated within this framework and refined with the assistance of a small group of experts. Following changes made to it, it was prepared for validation. The content validity of the standards was tested at national level (validation phase). The concept standards were sent to a group of domain experts in the form of a questionnaire. A purposive, non-randomised and stratified sample had been drawn. The participants were expected to evaluate the content validity of the standards and accompanying criteria and to propose amendments should they deem it to be necessary. A content validity index was calculated for each standard and criterion. A mean of 3,5 and a standard deviation of. 1,0 were regarded as sufficient proof of the content validity of each item. Thereafter, the standards were tested in the clinical practice on the basis of three case studies. Following the necessary adjustment and reformulation, the final standards were formulated. This research does not only make a valuable contribution towards the midwife's practice in the-form of valid standards for antenatal care, but also contributes towards extension of the theoretical basis of the subject discipline by means of the comprehensive description of a conceptual framework for antenatal care by the midwife.

The South African Health Care environment is in state of reform. Government strategy and change in legislation have been the catalyst for the development of new business models in South Africa. This report deals with the feasibility of a proposed model which is to be implemented by the Eastern Cape Department of Health at the Provincial Hospital in Uitenhage. The fundamental challenge in South Africa is the shortage of resources to support the health care industry from a public perspective. The point of departure for this research was to understand the complexity of this industry and investigate models that have evolved in South Africa and internationally. The literature research covers funding mechanisms from both a public and private perspective and takes into account the role the government plays in providing equitable health care for all. The literature provided the foundation to develop the model which is to be piloted at the hospital in Uitenhage. In terms of the research objective, a single case study methodology approach was conducted. Triangulation technique was used to gain insight from different perspectives and to test the model for validity. The core of this research focuses on the viability of the proposed model and the integration of this into the government health reform plan. The research revealed that in comparison to the existing PPP models in South Africa, this model is feasible. As a result of the analysis and the development of the proposed model, the research is concluded by offering suggestions for further research.

M.Cur. / With the announcement of the devolution of primary health care services to the local authority by the Cabinet in 1991, the role fulfilment of the community health nurse becomes more complex and greater demands are continuously made on her. The question, to what extent will the Implementation of primary health care (with the critical elements as framework) make greater demands on her role and function, led to this study. An exploratory, descriptive study, within a contextual framework was carried out. The purpose of the research was to analyse the task of the nursing staff working at local government, to determine which critical elements In primary health care are seen as part of the tasks of the community health nurse and to give guidelines with regard to primary health care and community health nursing. Content analyses done of job descriptions Indicated that some of the critical elements of primary health care are not expected to be performed by the nursing staff. According to the information gained through the questionnaires, nurses do more than is expected of them as Indicated In their job descriptions. " According to the conclusions resulting from this study, most of the critical elements of primary health care is being performed by nurses as part of their duty. The most Important recommendations Include the training of those nurses who feel that they need refresher courses with regard to the examination of patients and the making of diagnoses. Nurses need to know about the changes and what Is expected of them In future as a result of these changes.

This thesis examines the law relating health care in South Africa rather than medical law which is a subset of this field. It attempts to synthesise five major traditional areas of law, namely international, constitutional, and administrative law, the law of contract and the law of delict, into a legal conceptual framework relating specifically to health care in South Africa. Systemic inconsistencies with regard to the central issue of health care across these five traditional fields are highlighted. The alignment of the various pre-existing areas of statutory and common law with the Constitution is an ongoing preoccupation of the executive, the judiciary, the legislature and academia. In the health care context, the thesis critically examines the extent to which such alignment has taken place and identifies areas in which further development is still necessary. It concludes that the correct approach to the constitutional right of access to health care services is to regard it as a unitary concept supported by each of the five traditional areas of law. The traditional division of law into categories of public and private and their further subdivision into, for instance, the law of delict and the law of contract is criticized. It promotes a fragmented approach to a central constitutional construct resulting in legal incongruencies. This is anathema to a constitutionally based legal system. There is no golden thread of commonality discernible within the various public international law instruments that contain references to rights relating to health and it is of limited practical use in South African health law. The rights in the Bill of Rights are interdependent and interconnected. The approach of the courts to the right of access to health care needs to be considerably broader than it is at present in order to fully embrace the idea of rights as a composite concept. Administrative law, especially in the public health sector, offers an alternative basis to pure contract for the provider-patient relationship. It is preferable to a contractual relationship because of the many inbuilt protections and legal requirements for administrative action. Contracts can be unfair but courts refuse to strike them down purely on this basis. Administrative action is much more likely to be struck down on grounds of unfairness: The law of contract as a legal vehicle for health service delivery is not ideal. This is due to the antiquated approach of South African courts to this area of law. There is still an almost complete failure to incorporate constitutional principles and values into the law of contract. The law of delict in relation to health care services has its blind spots. Although it seeks to place the claimant in the position in which he or she found himself prior to the unlawful act whereas the law of contract seeks to place him in the position he would have occupied had the contract been fulfilled, in the context of health care this is a notional distinction since contracts for health services seldom guarantee a specific outcome. / Thesis (LLD)--University of Pretoria, 2004. / Public Law / unrestricted

It was perceived that an imbalance exists between resource allocations for health care within the Ekurhuleni Health District (EHD). This study consequently used a retrospective, quantitative methodology to investigate health equity in the EHD and to collect information on clinic buildings, staffing and budget allocations. Although clinics were oversupplied in terms of the norms set by the National Department of Health, they were found not to be in keeping with population growth in the Ekurhuleni district. The study highlighted an inequitable spread of nursing staff, which would require that nursing personnel be re-deployed. The per capita spending in the different service delivery regions was also found to be inequitable. It was subsequently recommended that spending on clinics be revised (especially in the populous Southern SDR), that staff be reallocated and that budget allocations be reviewed to achieve equity in Ekurhuleni. / Health Studies / Thesis (M.A. (Public Health))