<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning.

Thesis (MScEng)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: South Africa has a great number of patients and not enough medical expertise to attend to their patient needs. The South African Department of Health (DoH) has recognised the potential benefit of the Picture Archiving and Communication System (PACS) to address the health needs of rural patients who do not have access to specialised medical care. PACS allows specialist remote access to patient information to assist the diagnosis and treatment process remotely. South African healthcare institutions have been implementing PACS for over a decade, in an attempt to address the health needs of rural patients that do not have access to specialised medical care. Despite numerous deployment attempts, and the DoH’s support for PACS, the system is not operating successfully in South Africa. PACS was chosen due to its proven success as an appropriate technical system in most international hospitals of first and third- world countries (van Wetering, 2008) (Horri, 2010). However, specifications, guidelines and best practice operational methods for the appropriate PACS technical structure are lacking in South African literature and in governmental strategies. Additionally, there are no guidelines for implementation or support for hospital decision makers to manage the system and enterprise change. The purpose of this thesis is to (a) define a PACS technical and operational structure suited for the South African public healthcare environment and, (b) to develop guidelines for implementation and optimisation of PACS for managing the system and the enterprise change and progressively reach the defined structure. A combination of literature research, field observations and focus group discussions led to the understanding of the current (“As-Is”) PACS healthcare delivery system in South Africa and its barriers. Three types of PACS structures were found to be currently available: a DICOM-only image management system; a vendor supplied PACS; and a super-PACS. It was found that currently very few PACS systems in South Africa are operational and integrated with other healthcare institutions. This was due to a combination of factors: a) the complex, long chain of interdependent process steps and domains; b) vendor imposed limitations and propriety data formats; in combination with c) a lack of governing standards to ensure integration of digital PACS systems within the healthcare delivery environment; and lastly d) key decision makers lack the expert knowledge necessary to make informed decisions to deploy and manage PACS optimally. Further research led to establishing the (“To-Be”) PACS technical and operational structure suited for the South African public healthcare environment. Research has shown that the suited PACS technical and operational structure is a hospital-owned PACS system, free from vendor-imposed limits. The system consists of two databases, one with patient information and the other with patient images. The two databases are integrated by a hospital-owned server, which accesses the separate data files by means of patient identity keys. The requirements for the PACS implementation and optimisation guidelines for managing the system and the enterprise change to progressively reach the defined structure were developed. Different Enterprise Architectural Frameworks, as improvement and optimisation guidelines, were considered and compared in accordance with the requirements established. A maturity model (MM) was deemed as the appropriate framework to offer guidelines for managing PACS implementation and optimisation in the public medical sector of South Africa. After establishing that the available MMs were not sufficient in process or technical system detail, a new MM was developed for the deployment and maturation of PACS. The study was validated by means of usability study, user acceptance and goal checking, through focus group discussion and expert review. Users found the model to be a suitable deployment and optimisation guide, as well as a strategic planning tool. Verification was achieved by means of requirement analysis and consistency checking through the focus group discussions. It was found that it is needed to define a PACS technical and operational structure is suited for the South African public healthcare environment and that the guidelines for implementation and optimisation of PACS for managing the system and the enterprise needs to change to reach the defined structure functional. Implementing the use of PACS MM to reach the defined structure in South Africa will assist in improving healthcare delivery in South Africa and improving PACS system operation. / AFRIKAANSE OPSOMMING: Suid-Afrika het 'n groot aantal pasiënte en nie genoeg mediese kundiges om aan hul pasiënt behoeftes te voorsien nie. Die Suid-Afrikaanse Departement van Gesondheid (DvG) erken die potensiële voordeel van ‘n Foto Argief en Kommunikasie Stelsel (PACS) om die gesondheidsbehoeftes van alle Suid-Afrikaners aan te spreek – tot die landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie. PACS laat spesialiste toe om toegang te kry tot afgeleë pasiënt inligting, en daardeur fasiliteer dit die diagnose- en behandelingsproses. Suid-Afrikaanse gesondheidsorginstellings poog al vir meer as ‘n dekade om PACS te implementeer, om daardeur die gesondheidsbehoeftes van landelike pasiënte wat nie toegang tot gespesialiseerde mediese sorg het nie, aan te spreek. Ten spyte van talle ontplooiings pogings, en die DvG se steun vir PACS, is die stelsel steeds nie suksesvol in Suid-Afrika nie. PACS is gekies as ‘n oplossing, as gevolg van die sisteem se bewese sukses as 'n geskikte tegniese stelsel in meeste internasionale hospitale in eerste en derde wêreld lande (van Wetering, 2008) (Horri, 2010). Suid-Afrikaanse regering strategie en literatuur het egter ‘n gebrek aan spesifikasies, riglyne en beste- praktyk operasionele metodes vir die toepaslike PACS tegniese struktuur. Benewens is daar geen riglyne vir die implementering en ondersteuning van die stelsel en die onderneming se verandering vir hospitaal besluitnemers nie. Die doel van hierdie tesis is om (a) 'n PACS tegniese en operasionele struktuur, geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing te definieer, en (b) riglyne vir die implementering en afronding van PACS vir die bestuur van die stelsel en die onderneming se verandering teen doel om progressief die gedefinieerde struktuur te bereik. 'n Kombinasie van literatuur navorsing, veldwaarnemings en fokusgroepbesprekings het gelei tot die begrip van die huidige ("as- is") PACS gesondheidsorg proses in Suid-Afrika en die hindernisse daarvan. Drie tipes PACS strukture is tans beskikbaar in SA: 'n DICOM (net-mediese- beelde) beheer stelsel, 'n verkoper verskafde PACS, en 'n super-PACS. Deur uitgebreide navorsing is daar gevind dat baie min PACS stelsels in Suid-Afrika tans operasioneel en geïntegreer is met ander gesondheidsorg instellings. Dit was te danke aan 'n kombinasie van faktore: a) die kompleks, lang ketting van interafhanklike proses stappe en gebiede; b) ondernemer opgelê beperkings en ordentlikheid data formate; in kombinasie met c) 'n gebrek aan beheer standaarde integrasie van digitale PACS stelsels om te verseker binne die lewering van gesondheidsorg-omgewing, en laastens d) sleutel besluitnemers nie die deskundige kennis wat nodig is om ingeligte besluite te sit en te bestuur PACS optimaal te benut. Verdere navorsing het gelei tot die vestigting van die geskikde("to-be") PACS tegniese en operasionele struktuur, vir die Suid-Afrikaanse openbare gesondheidsorg omgewing. Die geskik PACS tegniese en operasionele struktuur bestaan uit ‘n hospitaal-besitde PACS stelsel, vry van ondernemer-opgelegde grense. Die stelsel bestaan uit twee databasisse, een met 'n pasiënt inligting en die ander met dei pasiënte se mediese beelde. Die twee databasisse geïntegreer deur 'n hospitaal-besitde-rekenaarbediener, wat toegang tot die afsonderlike data lêers het deur middel van die unieke pasiënt nommers. Die vereistes vir die PACS implementering en afrondings riglyne, vir die bestuur van die stelsel en die ondernemings veranderinge, is ontwikkel. Verskillende ondernimings argitektuur raamwerke is oorweeg en vergelyking in terme van hulle vermoe om aan die gesigde vereistes et voldoen. As ‘n resultaat is die volwassenheid model (MM) beskou as die toepaslike raamwerk om riglyne vir die bestuur van PACS implementering en afronding in die openbare mediese sektor van Suid-Afrika te bied. Na die beskikbare MMs geasseseer was en nie voldoende bewys is, was 'n nuwe MM ontwikkel vir die implementeering en afronding van PACS. Die studie was gevalideer deur middel van die bruikbaarheid studie, gebruikers aanvaarding en doelwit asseseering, deur middel van fokusgroep besprekings en kundige oorsig. Gebruikers het gevind dat die model geskikte as implementeerings en afrondings gids, sowel as 'n geskikte strategiese beplanning hulpmiddel is. Verifikasie is bereik deur middel van vereiste-ontleding en konsekwentheid analiseering deur die fokusgroep besprekings en spesifikasie analise. Die PACS tegniese en operasionele struktuur wat definieer was, is geskik vir die Suid-Afrikaanse openbare gesondheidsorg omgewing en dat die riglyne vir die implementering en afronding van PACS funksioneel is . Die implementering en gebruik van die gedefinieerde struktuur deur mideel van die PACS MM in Suid-Afrika, sal help in die verbetering van gesondheidsorg dienslewering en die verbetering van PACS stelsel operasie.

Thesis (MPhil)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: One of the main objectives of the new South African government who came into power in 1994 was to improve the daily living conditions of its citizens. To what extent did the government succeed in this objective? This is the basic research question informing the present study. In order to keep it within manageable proportions, the study investigated a very specific area of service delivery, namely the delivery of public health services. This was further narrowed down to the Western Cape and more specifically, to the role of public hospitals in the area. The Western Cape promised to be an interesting case, because although the government of national unity was dominated by the ANC, the Western Cape was ruled by a NNP dominated coalition. On the national level, the Province had to follow national policy guidelines, while on the provincial level it had more freedom to formulate and implement its own policies. The study itself consists of two parts. The first concerns policy formulation, the second policy implementation. As far as policy formulation is concerned, a study was made of basic documents articulating the fundamental values, national priorities and main objectives informing government policy. These included the Freedom Charter, the Constitution, and the Reconstruction and Development Program. It was found that these values and priorities were in general well translated into policy options on both the national and provincial level, especially in the various documents aimed at transforming the national health system. The second part of the study investigates the implementation of the broad policy guidelines in the area of public heath in selected public hospitals in the Western Cape. The main method of investigation was the use of structured interviews with representative employees from all different levels. The findings were therefore of a qualitative rather than a quantitative nature. The focal areas selected were personnel management issues, human resource planning, labour relation issues and human resource development issues. The main findings were that the formulation of policy both from basic values to the level of health care policies and from the national to provincial level in general was quite successful. On the other hand, there were serious shortcomings in the implementation of these policies on various levels. The investigation revealed a mixed and often contradictory picture. Although some hospitals made good progress in some respects, there is still a long way before quality health care will be delivered to all patients. A commitment to equity in the health services of the country implies a commitment to correcting the historical gender, class and racial imbalances in the development of human recourses for health care. Of necessity, a compassionate and caring health service will address the issue of corrective action. There is a real need to provide proper planning of those most disadvantaged by apartheid in managerial skills to fill managerial positions in the health sector. It is therefore is necessary to introduce as a matter of urgency new health management programmes, which will promote efficient and effectiveness management at all levels of health care service delivery. Current health managers need to be reoriented from the predominantly bureaucratic, rule-based approach towards a participative approach. The development of managerial capacity in areas such as participative and change management, leadership development, strategic planning, programme management and evaluation, and policy development and implementation is of crucial importance. The study concludes with a series of specific recommendations with regard to affirmative action, managerial and institutional capacity, human resource planning, and training needs for various sectors. / AFRIKAANSE OPSOMMING: Een van die hoofdoelstellings van die nuwe Suid-Afrikaanse regering wat in 1994 aan bewind gekom het, was om die leefomstandinghede van al die land se inwoners te verbeter. Tot watter mate het die regering geslaag in hierdie doelwit? Dit is die basiese navorsingsvraag onderliggend aan hierdie studie. Ten einde die ondersoek binne hanteerbare grense te hou, is op slegs een aspek van dienslewering gekonsenteer, naamlik die lewering van gesondheidsdienste. Hierdie terrein is verder vernou tot die Wes-Kaap en meer spesifiek tot die rol van openbare hospitale. Die Wes-Kaap was interessant omdat hoewel die regering op nasionale vlak deur die ANC beheer is, die Wes-Kaap basies deur die NNP in die periode van ondersoek geregeer is. Die provinsie was verplig om nasionale beleidsriglyne te volg, maar op provinsiale vlak het dit 'n sekere speelruimte geniet om eie beleid te formuleer en te implementeer. Die studie bestaan uit twee dele. Die eerste het te doen met beleidsformulering, die tweede met beleidsimplementering. Wat beleidsformulering betref, is 'n studie gemaak van die basisdokumente wat die kernwaardes, nasionale prioriteite en hoof doelstellings van die regering bevat. Dit het ingesluit die Vryheidmanifes, die Konstitusie en die Heropbou- en Ontwikkelingsprogram. Daar is bevind dat hierdie waardes en prioriteite in die algemeen suksesvol vertaal is in beleidsopsies op beide die nasionale en provinsiale vlak, veral in die dokumente wat gerig was op die transformasie van die nasionale gesondheidsektor. Die tweede deel van die studie het die implementering van die breë beleidsriglyne in die area van openbare gesondheid in geselekteerde publike hospitale in die Wes-Kaap ondersoek. Die hoof-ondersoekmetode was gestruktureerde onderhoude met verteenwoordigende werknemers van alle vlakke. Die bevindinge was gevolglik meer van 'n kwalitatiewe as kwantitatiewe aard. Die fokusareas waarop geskonsentreer is, was personeelbestuur, menslike hulpbronbeplanning, arbeidsverhoudinge en die ontwikkeling van menslike potensiaal. Die hoofbevindinge was dat die formulering van beleid beide van basiese waardes na gesondheidsbeleid en van die nasionale na provinsiale vlak in die algemeen suksesvol was. Aan die ander kant het ernstige gebreke aan die lig gekom sover dit die implementering van beleid op verskillende vlakke betref. Die resultaat was 'n gemengde en dikwels kontrasterende prentjie. Hoewel sommige hospitale goeie vordering gemaak het in sekere opsigte, laat die lewering van gehalte-diens aan alle pasiënte nog veel te wense oor. Die verbintenis to gelykheid in gesondheidsdienste veronderstel 'n verbintenis tot die regstelling van geslags-, klas- en rasse-ongelykhede in die ontwikkeling van menslike hulpbronne in die gesondheidsektor. Dienslewering gebaseer op sorg en empatie is van deurslaggewende belang in hierdie opsig. Daar is 'n groot behoefte aan behoorlike beplanning vir die verbetering van bestuur- en ander vaardighede van agtergestelde groepe. Die implementering van behoorlike bestuursopleidingsprogramme is van die uiterste belang, wat kan bydra tot effektiewe en goeie dienslewering. Die huidige oorwegend burokratiese en reëlsgebonde bestuurstyl behoort in 'n deelnemende benadering omgeskakel te word. Die ontwikkeling van bestuurskapasiteit in gebiede soos deelnemende veranderingsbestuur, leierskapsontwikkeling, strategiese beplanning, programbestuur en -evaluering en beleidsformulering is van die grootse belang. Die ondersoek sluit af met 'n reeks konkrete aanbevelings met betrekking tot regstellende aksie, verbetering van bestuurskapasiteit, menslike hulpbronontwikkeling en die opleidingsbehoeftes van die verskillende afdelings.

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))

Evidence suggests that the prevalence of certain non-communicable diseases, such as hypertension, is increasing rapidly, and that patients with these diseases are making significant demands on the health services of the nations in sub-Saharan Africa. However, these countries also face other health-related challenges such as communicable diseases and underdevelopmentrelated diseases. Developing countries like South Africa have limited resources, in terms of man power and financial capital, to address the challenges that they are facing. Non-communicable diseases cannot be ignored and since health care providers cannot meet the challenges, it is worthwhile to empower patients to be involved in the management of their conditions. Patient education is a tool that can be used to enable patients to manage their chronic conditions and thereby reduce the morbidity and mortality rates of these conditions. The aim of this study was to investigate the effect of a patient education intervention on participants’ levels of knowledge about hypertension and its therapy, beliefs about medicines and adherence to anti-hypertensive therapy. The intervention consisted of talks and discussions with all the participants as one group and as individuals. There was also written information given to the participants. Their levels of knowledge about hypertension and its therapy were measured using one-on-one interviews and self-administered questionnaires. Beliefs about medicines were measured using the Beliefs about Medicines Questionnaire (BMQ) whilst adherence levels were measured using pill counts, elf-reports and prescription refill records. The participants’ blood pressure readings and body mass indices were also recorded throughout the study. The parameters before and after the educational intervention were compared using statistical analyses. The participants’ levels of knowledge about hypertension and its therapy significantly increased whilst their beliefs about medicines were positively modified after the educational intervention. There were also increases, though not statistically significant, in the participants’ levels of adherence to anti-hypertensive therapy. Unexpectedly, the blood pressure readings and body mass indices increased significantly. The participants gave positive feedback regarding the educational intervention and indicated a desire for similar programmes to be run continuously. They also suggested that such programmes be implemented for other common chronic conditions such as asthma and diabetes. This study proved that patient education programmes can be implemented to modify patients’ levels of knowledge about their conditions and the therapy, beliefs about medicines and adherence to therapy. However, such programmes need to be conducted over a long period of time since changes involving behaviour take a long time.

Institute for Rural Development / PhDRDV

Text in Afrikaans / Drug dependent adolescents do not display a clear understanding regarding the value of social work intervention during the process of rehabilation, causing them to not utilize the profession of social work effectively during drug rehabilitation. This study aimed to explore and describe the nature and contribution of social work service delivery to drug dependent adolescents from their own perspective. A qualitative research approach, an explorative research design, and a snowball sampling technique were implemented. The sample consisted of drug dependent adolescents from the Western Cape. Semi-structured interviews were executed determining the participant’s perception of the nature and contribution of social work service delivery. Amongst others, the findings indicate that: • social workers are not sufficiently prepared, trained or committed to render effective, professional services to drug dependent adolescents; • social workers need to continuously revisit their knowledge, skill and attitude regarding this specialised field of service rendering. / Social Work / M.A. (Maatskaplike Werk)

Thesis (MPA (School of Public Management and Planning))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The purpose of this thesis is to determine the perceptions and expectations of employees at regional offices about the service delivered to them by central head office. A further objective is to establish what employees at regional offices expect from head office, attempting thereby to establish the current position of the head office (perceived image) in relation to their expectations (ideal image). The method of data collection is quantitative with a survey design technique in the form of questionnaires to be completed by all employees at regional offices in order to assess their perceptions and expectations. The basis of the theoretical and legislative framework of this research is service delivery. It is within the context of service delivery that internal customer service within the organisation, in particular, is conferred. The legislative framework is also dedicated to Batho Pele and the eight principles to highlight public service delivery. These principles should equally be applied when it comes to internal customer service. The main findings from this study are that employees and the four regional offices per se have different perceptions and expectations about the internal service delivered by central head office. This must be taken cognisance of because perceptions can be the core element of most organisational behaviour and the expectations that employees hold is important for the morale and effectiveness of organisations. The following objectives were achieved: A review of the policies, documents and annual reports to determine to what extent the central head office delivers an internal service to the regional offices. An evaluation as to how internal service delivery is being perceived. An evaluation of the ideal central head office. Established the shortcomings of the current internal service being delivered. It is also recommended that future research can be to ascertain how those negative feelings impacts on job satisfaction and commitment to the organisation and how it affects employee turnover. / AFRIKAANSE OPSOMMING: Die doel van hierdie tesis is om die persepsies en verwagtinge van werknemers by die streekkantore, oor die diens wat aan hulle verskaf deur sentrale hoofkantoor, te bepaal. 'n Verdere doel is om vas te stel wat werknemers by die streekkantore verwag van hoofkantoor. Sodoende probeer om vas te stel wat die huidige stand van die hoofkantoor (waargenome beeld) in verhouding tot hul (werknemers) verwagtinge (ideaal beeld) is. Die metode van data-insameling is kwantitatief met 'n opname ontwerp in die vorm van vraelyste. Hierdie vraelyste sal deur alle werknemers by die streekkantore voltooi word, om hul persepsies en verwagtinge te assesseer. Die basis van die teoretiese en die wetgewende raamwerk van hierdie navorsing is dienslewering. Dit is binne die konteks van dienslewering wat interne kliënte diens binne die organisasie, in die besonder, toegeken word. Die wetgewende raamwerk is ook toegewyd aan die agt beginsels van Batho Pele en dus openbare dienslewering te versterk. Hierdie beginsels moet ook toegepas word wanneer dit kom by die interne kliënte diens. Die belangrikste bevindings van hierdie studie is dat die werknemers en die vier streekkantore as sulks het verskillende persepsies en verwagtinge oor die interne diens gelewer deur die sentrale hoofkantoor. Dit moet kennis geneem word want persepsies kan die kern element van meeste organisatoriese gedrag wees en die verwagtinge wat werknemers hou is belangrik vir die moraal en doeltreffendheid van organisasies. Die volgende doelwitte was bereik: „n Hersiening van die beleid, dokumente en die jaarlikse verslae om te bepaal tot watter mate die sentrale hoofkantoor „n interne diens aan die streekkantore lewer. „n Evaluering oor hoe interne dienslewering waargeneem word. „n Evaluering van die ideale sentrale hoofkantoor. Die tekortkominge van die huidige interne diens wat gelewer word is vasgestel. Dit word aanbeveel dat toekomstige navorsing toegewy word om vas te stel hoe negatiewe gevoelens impak op werkstevredenheid en verbintenis tot die organisasie en ook hoe dit werknemer omset beïnvloed.

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: This study gives us insight into the daily lives and battles for survival of poor women in an age of HIV/AIDS in rural areas of the Western Cape, South Africa. I set out to get an understanding of the shortcomings of the current interventions aimed at combating HIV and AIDS. Soon after I commenced my fieldwork I realised that it is the socio-economic circumstances of the people I encountered that was mostly responsible for their HIV positive status or the reason why they are living with HIV/AIDS rather than the choices they make. However, most of the interventions aimed at combating the global HIV/AIDS epidemic focuses on behavioural interventions or the provision of medical care. By entering the spheres in which women living with HIV/AIDS live their daily lives I aimed to get a better comprehension of the challenges they encounter and why the interventions that focus on behaviour and medical treatment fail to address the needs of these women. In doing so I learned about their struggles to merely stay alive and that protecting yourself against a disease like HIV/AIDS can appear as a luxury. A luxury you cannot afford when your only means of an income is your body which you need to barter in exchange for money or food and shelter. I learned about their powerlessness in protecting themselves against the disease and the loneliness they have to endure once they learn they are infected with the virus. In addition to this, it also came to my attention that their conditions of poverty are of such an extent that even ‘free’ medical treatment can sometimes be too expensive for them to afford because of hidden costs such as transport. At the end of my study it was my conclusion that we need to pay more attention to the root causes of the spread of the HIV/AIDS epidemic in order to combat it successfully, also at the entry levels of the healthcare system. / AFRIKAANSE OPSOMMING: Die studie bied insig in die daaglikese lewens en stryd om oorlewing van arm vroue in ‘n tyd van MIV/VIGS in die landelike gebiede van die Wes-Kaap, Suid-Afrika. Ek het die studie begin met ‘n poging om die tekortkominge van die huidige intervensies om MIV/VIGS te bekamp beter te verstaan. Kort nadat ek met my veldwerk begin het het ek reeds tot die besef gekom dat die die sosio-ekonomiese omstandigehede die oorsaak is dat die vroue met die virus leef, eerder as die keuses wat hulle vrywilliglik maak. Ten spyte van my bevinding fokus meeste intervensies tans op gedragsveranderinge en mediese behandeling. Ek het die lewensruimtes van hierdie vroue binnegegaan in ‘n poging om die daaglikse uitdagings te verstaan, asook die redes hoekom die huidige intervensies nie hierdie vroue se behoeftes aanspreek nie. Deur dit te doen het ek geleer hoe dit as ‘n luuksheid beskou kan word om jouself teen infeksie met die virus te beskerm. ‘n Luuksheid wat jy nie kan bekostig indien jou lyf jou enigste bron van inkomste is wat jy moet gebruik om geld mee in te win of kos en woonplek te verseker nie. Vroue is dikwels magteloos om hulself teen infeksie met MIV/VIGS te beskerm en die eensaamheid waarmee hul moet saamleef wanneer hul wel met die virus ge-infekteer is. Dit het ook onder my aandag gekom dat die armoede van so ‘n aard is dat selfs ‘gratis’ mediese behandeling soms onbekostigbaar is as gevolg van versteekte kostes, soos vervoer. Aan die einde van my studie was dit my gevolgtrekking dat daar meer aandag geskenk moet word aan die oorsake wat aanleiding gee tot die verspreiding van die MIV/VIGS epidemie indien ons dit suksesvol wil bekamp, ook op die intreevlakke van die gesondheidstelsel.