Background: Accessibility to health care in rural areas is globally impeded by physical, material, human, financial and managerial resources and societal barriers in the health care system. The Systems Model formed the backbone to developing a strategic action plan to address the challenges experienced by all stakeholders involved. Purpose: The purpose of this study was to describe accessibility to health care in rural areas to develop a strategic action plan to enhance accessibility to health care in these areas of Zimbabwe. Methods: A multiple methods approach combining qualitative and quantitative components during 4 phases. Phase 1 collected quantitative data with questionnaires from professional nurses and health care users who were conveniently sampled. Phase 2 collected qualitative data with a nominal group from national health directors who were conveniently sampled. Phase 3 was based on the findings from Phases 1 and 2 with a literature control to develop a draft strategic action plan. During phase 4 the strategic plan was amended and validated with a validation tool by members of the parliamentary portfolio committee on health in Zimbabwe with all-inclusive sampling. Framework: The Systems Model Framework was adopted for this study as outcomes and impact on people’s health is determined by inputs, processes and outputs. This model was relevant and applicable to accessibility to health care. Research findings: Accessibility to health care in rural areas of Zimbabwe is affected by inadequate distribution of physical resources, shortage of material and human resources, and a lack of financial resources. The strategies identified contributed to the strategic action plan which was amended and validated. The strategic action plan includes improving the health infrastructure, providing appropriate medical drugs, training and retention of health workers, providing medical equipment at the rural health facilities, reviewing the health worker workload and addressing staff shortages, providing free health care services in rural areas, and improving the capacity of the health care system. Conclusion: The strategic action plan was developed based on the inputs of the relevant stakeholders and the System Model. The inclusion of the parliamentary portfolio committee on health (members of parliament of Zimbabwe) might enhance the possibility for implementation which can enhance the accessibility to health care in rural areas of Zimbabwe. / Health Studies / D. Litt. et. Phil. (Health Studies)

See the attached abstract below

MRDV / Institute for Rural Development / Traditional medicine still plays a bigger role in people dealing with health and disease. Research shows that in some Asian and African countries, traditional medicine forms the primary mode of health care for 80% of the population. This is actively promoted in South Africa and is used by at least 70% of the country’s population. This study investigated the contributory factors leading mental health care users to use a combination of traditional and modern medicine in rural areas. The study was conducted using qualitative research methods. The population of this study were MHCUs, Mental health practitioners and traditional healers. Purposive sampling was used to select participants. Data was analyzed through a computer programme called Atlas TI. The results revealed the following as contributory factors leading mental health care users to use modern and traditional medicine in rural areas : cultural factor , belief in witch craft , influence by significant others (family members and friends), poor PHC intervention and treatment method. Recommendations to the health care practitioners and policy makers around the use of traditional and modern medicine was made based on the findings.

Text in English / The purpose of the study was to describe and explore the experiences of student nurses in caring for mental health users with profound intellectual disabilities in one of the care and rehabilitation centre at Gauteng province incorporating the Common Sense Model. Qualitative descriptive and explorative research was conducted to explore the experiences of student caring for mental health care users with profound intellectual disabilities and to recommend the best practices in caring for mental health care users with profound intellectual disabilities. Data collection was done using reflective diaries and in depth interviews. Twelve participants participated in the study. The study composed of student nurses (n=12) caring for mental health care users with profound intellectual disabilities. Five themes emerged from the study i.e. emotionally challenging, communication difficulties, lack of knowledge on the nature of intellectual disability, burden of care and mixed feelings. Findings of the study revealed that completing nurses find working with profound intellectual disabilities to be emotionally challenging and that negative experiences outweigh the positive experiences, resulting in their reluctance to want to work with profound intellectual disability users. It is therefore incumbent upon policy makers and hospital administrators to take cognisance of these negative feelings so that ways of minimising these frustrations and promoting the wellbeing of nurses caring for mental health care users with profound intellectual disabilities are promoted. / Health Studies / M.A. (Health Studies)

Text in English / The purpose of the study was to describe and explore the experiences of student nurses in caring for mental health users with profound intellectual disabilities in one of the care and rehabilitation centre at Gauteng province incorporating the Common Sense Model. Qualitative descriptive and explorative research was conducted to explore the experiences of student caring for mental health care users with profound intellectual disabilities and to recommend the best practices in caring for mental health care users with profound intellectual disabilities. Data collection was done using reflective diaries and in depth interviews. Twelve participants participated in the study. The study composed of student nurses (n=12) caring for mental health care users with profound intellectual disabilities. Five themes emerged from the study i.e. emotionally challenging, communication difficulties, lack of knowledge on the nature of intellectual disability, burden of care and mixed feelings. Findings of the study revealed that completing nurses find working with profound intellectual disabilities to be emotionally challenging and that negative experiences outweigh the positive experiences, resulting in their reluctance to want to work with profound intellectual disability users. It is therefore incumbent upon policy makers and hospital administrators to take cognisance of these negative feelings so that ways of minimising these frustrations and promoting the wellbeing of nurses caring for mental health care users with profound intellectual disabilities are promoted. / Health Studies / M.A. (Health Studies)

MCur / Department of Advanced Nursing Science

PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / iii Abstract The Mental Health Act is the law which sets out when you can be admitted, detained, and treated in hospital against your wishes. It is also known as being “sectioned”. For this to happen, certain people must agree that you have a mental disorder that requires a stay in hospital. In South Africa, the Mental Health Act of 1973 was noted to have many gaps. Due to all the shortcomings, in 2004 the Mental Health Care Act No. 17 of 2002 came into being in order to protect human rights of the mental health care users. This study sought to determine the knowledge and explore the experiences of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002. Secondly, based on the findings, to develop a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors in Vhembe District. The population of this study consisted of all medical doctors working in Vhembe District Hospitals with mental health units and at a specialized mental health hospital as well as all documents completed by medical doctors during admission, care and discharge of mental health care users were purposively sampled. The study was conducted in two phases. In phase 1, where quantitative and qualitative designs were followed to do situational analysis. In phase 2, the programme was developed using results from phase 1, the theoretical framework and approaches outlined by Dickoff, James and Wiedenbach (1968); Chinn and Krammer (1999); Walker and Avant (1995). Individual in-depth interviews and questionnaires checklist were used to collect data which was analysed through opened coding method and SPSS. The findings of this study indicate that medical doctors have knowledge and skills deficit regarding implementation of the Mental Health Care Act No. 17 of 2002 during the admission, care, and discharge of mental health care users. Based on these, a programme to facilitate the implementation of the Mental Health Care Act No. 17 of 2002 by medical doctors during admission, care and discharge of mental health care users was developed. The study concludes that this is a significant contributor in supporting the vision of the National Department of Health to ensure improved mental health for all in South Africa. The study recommends a longitudinal study, tracking the impact of a developed programme, the knowledge of medical doctors regarding the implementation of Mental Health Care Act No. 17 of 2002, and its contribution to the improvement of mental health for all should be conducted over a period of 5 (five) to 10 (ten) years

Mental illness remains one of the most devastating condition affecting the social functioning of individuals and families. The affected individuals and their caregivers expressed dissatisfaction in mental health service delivery. The mental health system is medically oriented and does not involve caregivers as partners in the provision of mental health services. Although the developmental approach has been adopted to guide the provision of services recognising human rights and social justice, the medical model remains a challenge in the provision of comprehensive mental health services. This is compounded by the Mental Health Care Act (Act No. 17 of 2002) that is silent on the role of families in the mental health system. Additionally, social workers are unable to provide adequate services due to lack of resources. A qualitative study using the exploratory, descriptive and contextual designs was undertaken. Purposive sampling was used to select 28 participants from three groups, namely ten MHCUs, nine caregivers and nine social workers. The goals of the study were to understand the experiences of MHCUs, caregivers and social workers in mental health service delivery; and to proffer guidelines for social work practice to enhance partnership between the family and mental health care providers. Data was gathered through semi-structured interviews and analysed according to Tesch’s (in Creswell, 2009:186; 2014) framework. Data verification was guided by Lincoln and Guba’s (in Krefting, 1991:214-222) model to enhance trustworthiness. The findings suggest that MHCUs and caregivers received inadequate psychosocial support which is attributed to lack of involvement in service delivery. Furthermore, social workers lack adequate training to provide effective mental health care. As a result, guidelines were developed for the establishment and enhancement of partnership between families and mental health service providers to offer comprehensive and sustainable mental health services. Future exploration of the role of the family in mental health services is required. / Social Work / D. Phil. (Social Work)

À partir de la notion de projet parental, nous souhaitons déconstruire, en droit, l'assignation des femmes aux questions reproductives. En effet, le corpus juridique relatif à la reproduction participe à la perpétuation des stéréotypes de genre et en particulier, ceux liés à la division sexuée du travail. Le projet parental est une notion qui a émergé avec les techniques reproductives. Pour autant, l'analyse du cadre relatif aux techniques de PMA montre de quelle manière celui-ci renforce les stéréotypes de genre. Les conditions d'accès aux méthodes de PMA sont empreintes de naturalisme et une comparaison entre le droit français et le droit suisse montre le caractère construit de ces références constantes à la nature. L'établissement du lien de la filiation renforce le cadre naturaliste : d'un côté, la filiation est établie pour les projets parentaux réalisés dans le cadre légal selon les règles du droit commun et renforce la différenciation des fondements à la filiation selon le sexe du parent ; de l'autre, les projets parentaux qui s'écartent du cadre naturaliste sont relégués aux marges du droit de la filiation, même s'ils doivent aujourd'hui être reconnus sous la pression du législateur en matière de PMA et de la CEDH concernant la GPA. En dépit de l'état actuel du droit, la notion de projet parental pourrait promouvoir au sein du droit de la reproduction l'égalité entre les sexes et la liberté reproductive. En prenant appui sur le principe d'égalité entre les sexes et la liberté reproductive nous proposons de faire évoluer le droit de la reproduction, afin qu'il y ait davantage d'autonomie et d'égalité, tant en matière de filiation que d'accès aux actes médicaux non thérapeutiques en matière de reproduction que sont l'IVG, la contraception, la stérilisation et la PMA. Nous préconisons en particulier de modifier le droit commun de la filiation en y intégrant les techniques de PMA et en faisant de la volonté le fondement principal de l'établissement de la filiation. La promotion de l'autonomie reproductive lors de la mise en œuvre des droits reproductifs se traduit par un renforcement des droits des usagers du système de santé en matière de reproduction. À travers l'exemple du droit de la reproduction, nous montrons in fine de quelle manière le droit peut contribuer à favoriser au sein de la société l'autonomie des individus et l'égalité entre les sexes. / Starting from the concept of "parental project", we aim to deconstruct the traditional roles of women in reproductive matters from a legal standpoint. Gender stereotypes, especially those related to gendered division of labour, are indeed sustained by the current reproductive legal framework. The parental project is a concept introduced by law regulating the new reproductive technologies and yet, the analysis of legal aspects of medically assisted reproduction (MAR) stresses how gender stereotypes are in fact strengthened. The legal criteria to access MAR methods are defined based on Nature and comparing French and Swiss legal frameworks shows there are no fixed rules and thus, that references to Nature are not unbiased. Moreover, when it comes to rules of filiation, the naturalistic framework is further reinforced: on the one hand, when the parental project is carried out within the legal framework, filiation is established based on general law, corroborating the gendered legal basis of filiation; on the other hand, parental projects outside of the naturalistic framework are marginalized, and if nowadays filiation should also be recognized for children born in such conditions, it is only because of legal and jurisprudential developments. In spite of this, we think that the concept of "parental project" should promote, within the legal framework of reproduction, both gender equality and reproductive autonomy. Based on the principle of sex-equality and reproductive autonomy, our proposals aim to change dispositions regarding filiation and reproductive medical acts so that they could improve gender equality and reproductive autonomy. In particular, MAR should be addressed by the general law of filiation in order to make of will the main basis of parentage. Likewise, promoting autonomy in reproductive medical acts cannot proceed without rights of the health care users. Finally this research in reproductive law could be seen as a striking example of how law could foster gender equality and individual autonomy in society.

High prevalence of mental illness in South African and limited Mental Health Care (MHC) resources call for ways to supplement the overburdened system to meet the rehabilitative and supportive needs of service users as stipulated in the MHC Act no. 17 of 2002. Various psychological, social, and financial difficulties plaguing MHC users require holistic treatment intervention to help them cope with their conditions. This study explored the meaning of a Tshwane District community-based support group for MHC out-patients to help illuminate the value the group had for the members. A Social Constructionist epistemology informed the qualitative research approach. Data were collected by conducting semi-structured interviews and employing a collage-making method. The main themes illuminated by thematic analysis suggest that the group provided the members with a sense of belonging, mental and physical mobilisation and stimulation, a source of support, multiple learning experiences, and contributed to personal transformation and growth. / Psychology / M.A. (Social Science (Research Consultation))