Post-graduate students specializing in Community Health, are attached to different health authorities during their training. During these attachments they are exposed to the day-to-day management of health services and experience at first hand, the difficulties as well as the successes that are encountered in tending to the health needs of communities. It is also expected that post-graduate students do research projects during their attachments, usually on topics on which the health services managers need information. The topic discussed in this report was an assignment given to the author at the start of his attachment to the department of Hospital (Health) Services of the Cape Provincial Administration. The period of attachment was from February to May 1987. The whole question of the regionalization of health services is a complex one, and it is necessary that any proposals for a system of regionalization benefit from the inputs of many experts in different fields. However, as has been the experience in the United States of America, such inputs are no guarantee -that a successful system of regionalization will result. (1) In the local front, the Department of Works, at the request of the Director of Hospital Services, began an investigation into the existing system of regionalization of hospital services in 1985. This attempt was aborted, possibly because of the magnitude of the task, among other things. (2). What follows hereafter should therefore be seen as merely a framework for the development of a system of regionalization rather than as a blueprint for such a system. Perhaps a few remarks about the age-old problem of line-staff conflict would not be amiss at this stage. During the development of this framework, it became apparent that line officials might be expecting a quick proposal of regions and/ or sub-regions for the delivery of health services based on a purely management approach. As a staff official, the author naturally had different expectations. The report is an attempt to marry the two sets of expectations and it is left to the reader to judge to what extent, if at all, the author has succeeded in this attempt. Much of the data used in the study are new, and computation was done largely by hand. The generation of the data, was therefore time-consuming and much of the first phase of the study was devoted to the generation of the data and collection of data that were available from other sources. The study has proved to be a fascinating one and it is hoped that permission will be obtained to pursue the study in more detail. This report should therefore be seen as a preliminary report which addresses the question of regionalization of health services in the Cape Province in 'macro' terms. And finally, the author hopes that some of the information in this report may prove of value to those responsible for the delivery of health services to the people of the Cape Province.

Submitted in fulfillment of the requirements of the degree of Masters in Public Management, Durban University of Technology, Durban, South Africa, 2016. / South Africa is facing a universe challenge in managing HIV/AIDS epidemic as it is the worst affected country in the world with the largest number of people affected and infected with HIV/AIDS. While significant numbers of stakeholders have come on board to help the South African government fight the disease, the setting up of effective and efficient Monitoring and Evaluation (M&E) systems has been a challenge. The study focussed on Monitoring and Evaluation (M&E) systems of Non-Governmental Organisations (NGOs) managing HIV/AIDS in the uMngeni Local Municipality. NGOs normally operate using resources from funders who in turn requires robust accountability of their fund utilisation. Robust accountability can only be achieved by reporting with the aid of an effective and efficient M&E system. The aim of the study was to evaluate the current M&E systems of NGOs implementing HIV/AIDS programs in the uMngeni Local Municipality; investigate the reporting mechanism of NGOs implementing HIV/AIDS programmes; identify monitoring and evaluation challenges faced by NGOs implementing HIV/AIDS programmes in the uMngeni Local Municipality, KwaZulu Natal; and to make recommendations for the improvement of M&E implemented by NGOs. A questionnaire was distributed to senior managers at NGO’s in the uMngeni Local Municipality, KwaZulu Natal, South Africa. The data collected were analysed with SPSS version 22.0.The results were presented in the form of graphs and cross tabulations, with other figures being used for data collected from open ended questions. The study revealed that NGOs managing HIV/AIDS in the uMngeni Local Municipality face a number of challenges including a lack of statistical skills; a shortage of qualified staff; a lack of M&E knowledge; a dearth of M&E systems within organisations; inadequate resources; a lack of commitment by staff members; poor stakeholder involvement; poor quality data; and a lack of appropriate M&E tools. The results of the study also revealed that NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality were not referring to best practices when managing M&E systems for their programmes. Recommendations were drafted using the findings of the research, literature reviewed and best practices for monitoring and evaluating HIV/AIDS programmes. It is highly recommended that through more effective capacity building, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality will be able to improve existing M&E systems. Designing of the M&E plan along with stakeholder involvement is also crucial in managing HIV/AIDS M&E systems. The allocation of adequate resources for M&E activities should be prioritised for approximately ten percent of the total programme budget. Indicators should be carefully selected and aligned to collect relevant data. NGOs managing HIV/AIDS in the uMngeni Local Municipality could also monitor and evaluate programme activities on a regular basis. They should also have a standard of operation procedure (SOP) for data quality management. Emphasis on programme data quality could also be an action point for effective management of HIV/AIDS M&E system and this can be further strengthened by conducting data quality audits. Finally, NGOs managing HIV/AIDS programmes in the uMngeni Local Municipality should disseminate M&E findings to stakeholders and use data to make informed programme decisions. / M

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.

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.

This study addresses the healthcare needs of employees and their families living in the Kruger National Park (KNP). A quantitative, explorative, descriptive research design was used to interview respondents who comprised of 75 male and female employees with children of various ages. The findings revealed that physical, psychological, environmental, socio-cultural, and behavioural needs of the employees and their families living in the KNP is probably unattainable as healthcare services are poorly distributed throughout the KNP, being mostly concentrated in the main camp of Skukuza. A number of respondents indicated that they required consultations about psychological and socio-cultural stresses in their lives. These services are not available in the KNP. / 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.

This thesis was born from a concern the researcher had with regard to negative reports in the media emanating from 4 babies that died at Cecilia Makiwane Hospital Peadiatric ICU unit due to power supply failure. The most significant of these negative reports was in 2007 when the Daily Dispatch ran a series of articles regarding what they termed avoidable deaths over the last 14 years. The ease with which staff communicated with the media together with the high absenteeism rate and high turnover was a cause for concern. When the researcher analysed the history of the problem, it immerged from the respondents’ responses that the rationalistion process undertaken by the Eastern Cape Department of Health (ECDoH) was a significant root cause to the problem. The literature review focused on three areas viz.: Organisational Culture, Organisational Change, Foundations of Satisfaction. This focus was used to confine the problem to a manageable project but secondly each of the aspects are interwoven. Routledge (2010) notes that culture is the reflection of the values advocated by a founder or leader by way of his/her day to day actions. This is done by the leader creating a perception or viewpoint that assists the employees to achieve the organisation’s mission, vision and goals. In any organisation change is a constant and it needs to be effectively managed. With government institutions like the East London Hospital Complex (ELHC) directives come from the top and are implemented by an unprepared and untrained leadership and management cadre and clear communication of vision and objective of the desired outcomes never happens. The aim of the research was to: describe the existing Organisational Culture present at ELHC (Perform an organisational diagnosis); describe the impact of change (rationalisation) and to analyze why there was such a high staff turnover. It is clear from the results of the survey conducted that significant dissatisfaction prevailed relating to how the institution was managed. Dissatisfaction amongst the health professionals was general but also specific to the following: leadership and management issues, fairness, remuneration and lack of resources. The recommendations therefore focused on developing management and leadership within the proposal of Dubrin’s model (2001).

This study addresses the healthcare needs of employees and their families living in the Kruger National Park (KNP). A quantitative, explorative, descriptive research design was used to interview respondents who comprised of 75 male and female employees with children of various ages. The findings revealed that physical, psychological, environmental, socio-cultural, and behavioural needs of the employees and their families living in the KNP is probably unattainable as healthcare services are poorly distributed throughout the KNP, being mostly concentrated in the main camp of Skukuza. A number of respondents indicated that they required consultations about psychological and socio-cultural stresses in their lives. These services are not available in the KNP. / Health Studies / M.A. (Health Studies)

This study applied the theory of reasoned action (TRA) and its extension, the theory of planned behaviour (TPB) to the design of a workplace HIV/AIDS health promotion programme. The purpose of the study was to determine if the variables of the TRA and TPB would predict intentions to change HIV/AIDS health behaviour, whether a theory-based intervention would result in health behaviour change over time and if there would be any significant health behaviour differences among participants who received a theory-based intervention and those who received an information-only intervention. In a longitudinal, quasi-experimental study, 170 government employees were divided into two groups. One group comprised 92 employees who participated in a HIV/AIDS health promotion workshop based on the theories of reasoned action and planned behaviour. The other group comprised 78 employees who took part in an educational information session about HIV and AIDS. An elicitation study was conducted with a sample of 38 employees from the research population two months prior to the commencement of the study. The findings of the elicitation study informed the design of research questionnaires and an intervention workshop. Both groups of participants (theory-based workshop and information-only workshop) were measured on HIV/AIDS health behaviour intentions and HIV/AIDS health behaviour (condom use, seeking HIV testing and monogamy) across three measurement periods over a six month period. The results of the study showed that the combined theoretical variables predicted intentions to use condoms and to seek HIV testing, with attitudes having the main effect on intentions. There was, however, no significant health behaviour change across the three measurement periods. There were also no health behaviour differences between the two intervention conditions at one month and six months post-intervention. The study concludes that the intervention based on the theories of reasoned action and planned behaviour did not produce health behaviour change. The study also identified barriers to AIDS health behaviour in the South African context that the theories of reasoned action and planned behaviour cannot explain. Ways in which the theories of reasoned action and planned behaviour can be adapted to HIV/AIDS education in collectivist cultures are proposed. / Psychology / Thesis (D. Phil. (Psychology))

Text in English / The purpose of this study was to explore and describe the experiences of community members regarding their participation in hospital boards in Dr Kenneth Kaunda district, North West Province. A qualitative exploratory-descriptive research was conducted on a purposively selected sample of community members who served in the board for a minimum period of two years. Data were collected by means of individual interviews and analysed by means of thematic data analysis. Three themes that emerged from data analysis were creation of opportunities, benefits and challenges. A mix of positive and negative experiences was expressed by community representatives regarding their participation in hospital boards. Participants described their experiences as enjoyable and empowering while others described it as a learning experience through which they acquired knowledge and new skills. The challenges experienced whilst serving in hospital boards included ineffective communication, poor relations and role conflict as a result of lack of role clarification. The findings from the study may be used to enhance the effectiveness of hospital governing boards through the participation of community members. / Health Studies / M.A. (Public Health)