Includes bibliographical references (leaves 159-168). / The South African National Department of Health (NDoH) has committed itself to ensure that there is equity in the distribution of health workers especially to rural areas primarily through service requirements and incentives. Despite all initiatives put in place, the national health system struggles to recruit and retain health workers in rural health system struggles to recruit and retain health workers in rural health facilities. While the majority of health workers choose to practise in urban areas, some choose to pursue and persist in a career in rural health practice. This study determines, in the South African context, factors that motivate health workers to choose and maintain a career in rural health practice. It establishes what makes health workers choose to work in rural areas, what encourages them to stay in rural health practice and what tempts them to leave rural health practice. These factors interact at different levels, at the level of an individual health worker, of a rural health organisation or level of a rural community, to influence the decision of a health worker to choose, stay in or leave rural health pratice. The study combines both quantitative and qualitative methods in a cross-sectional survey to identify these factors from the perspective of rural health workers. It invites rural health workers to identify those factors that are applicable to them from the list of factors and rank them according to the degree of importance in their decision-making. A self-administered structured questionnaire and key informant interviews were used to collect data. The findings of this study show that rural background, desire to gain work experience, family obligations, prior interest in underserved area practice, desire or requirement to perform community service, desire to live in a rural area, family friendly enviornment and having friends living in a rural area are very important factors motivating health workers to choose a career in rural health practice.

Obesity is a public health concern in both high- and low-middle income countries. In South Africa obesity is not only limited to adults but is also evidenced in children. In order to contribute useful insights for developing effective obesity policy and programme interventions, this study assesses socioeconomic (SE) inequalities related to childhood obesity in South Africa. Using data from the South African National Income Dynamics survey (2012), the study assesses the extent of SE inequalities in obesity using concentration index (CI). The study also assesses the determinants that underpin these inequalities using decomposition analysis of the CI. Overall, the positive CI from the results indicates that the burden of obesity is more concentrated among the rich compared to the poor with girls having slightly greater SE inequalities compared to boys. The decomposition analysis further indicated that the determinants of these inequalities were an interplay of individual (i.e. race), household (i.e. household head characteristics) and contextual (i.e. household location) level factors. These findings suggest that there is a continuous need for surveillance of obesity in children over time across different social economic status (SES) especially in low- and middle- income countries. Finally, the results suggest that both childhood obesity and inequalities are complex issues with different underlying determinants that vary with the different SES, gender and may require coordinated policy and programmatic interventions at individual, household and contextual level.

This thesis is a systematic review using realist methodology. It emerged out of an original protocol that proposed an exploration of the barriers to a healthy lifestyle in poorer peri-urban communities. The purpose of that protocol was to design more effective lifestyle interventions, and participatory action research was identified as a potentially effective methodology to encourage behaviour change in contexts where self efficacy may be low. That development itself raised questions about what exactly was meant by action research, participatory action research and community based participatory methodologies and how effective they were. Given these questions, it was decided to undertake a systematic review of published literature and it is that review that is presently submitted as a thesis.

The main aim of this study was to assess the relative cost-effectiveness of the hospital, clinic and community based distribution of family planning services in central Lusaka. The data collection process involved the administration of a multiple-choice questionnaire to 208 randomly selected family planning clients at the three delivery modes under study.

Includes bibliography. / The aim of this study was to critically analyse the funding and expenditure patterns of institutions training health personnel. This included an investigation of the distribution of income from the various sources by geographic areas (i.e. by province), between historically white and black training institutions and between those institutions that are attached to academic hospital complexes and those which are not. The study also attempted, where possible, to determine the unit costs of training different cadres if health personnel. The methodology included a review of the literature on health personnel education and training, a questionnaire survey of nursing colleges and PDoHs in South Africa, and analysis of the Department of Education's South African Post-secondary Education (SAPSE) data base, which records and monitors the funding, staffing and student data of universities and technikons in South Africa.

Includes bibliographical references. / The aim of this study was to explore the factors that contribute to TB patient's adherence to the Directly Observed Treatment Short-Course (DOTS) strategy and the factors that serve as barriers to adherence. The study was set in a historically disadvantaged township, KhayeIitsha, a sub-district of the City of Cape Town in the Western Cape Province. A qualitative, phenomenological research design, which is part of an ethnographic tradition, was used.

Includes abstract. / Includes bibliographical references. / Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behaviour of health care providers in their treatment of insured and uninsured clients.

Bibliography : leaves 102-109. / This research project was undertaken to identify the factors that are cons!dered in the formula for allocating resources in the health sector in Zambia as compared to those ones identified in international literature some of which are: population size, demographic composition of population, morbidity/mortality profile, and the socioeconomic status of population.

Includes bibliographical references (leaves 96-105). / User fees were introduced in Zambia as an additional source of revenue in response to the economic down-turn that the country experienced in the early 1990s. There is increasing evidence that user fees are a major barrier to accessing health services especially for the poor and in response the Zambian government abolished user fees in all public health facilities in rural based districts in April 2006. The aim of this study is to provide empirical evidence on the immediate impact of the abolition of user fees in the context of the Zambian health sector so as to identify optimal strategies in the delivery of health care. Both qualitative and quantitative data collection techniques were used to address the research objectives. The study focused on six 6 health facilities in two rural districts. The data collection tools included utilisation data reviews, patient exit polls, providers interviews, focus group discussions, informant interviews and drug availability data reviews. The results demonstrated that, the impact of the abolition of user fees at the district level was dependent on location of the district. Information flow was mainly cited as one of the reasons for the quick response to the user fee policy change. This brings in the need for a more deliberate and appropriately managed communication process when such policy change is being planned. The results of the study revealed that there was an impact on facility utilisation after the removal of user fees. In addition, there were shortages of drugs, low staff morale and poor maintenance of the surroundings. Patient-provider relationships seemed to be strained as a result of the increase in provider workload.

Includes bibliographical references (leaves 74-78). / The main aim of the study is to evaluate the management of essential drugs in thepublic health facilities in Uganda. This is a cross-sectional study carried out in the districts of Kampala and Mbale employing both qualitative and quantitative methods. Standard outcome indicators as described in the WHO Operational Package for Monitoring and Assessing the Pharmaceutical Situation in Countries are adapted and used in this study.