Submitted in fulfillment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, 2014. / Brief background to the study The national guidelines for maternity care in South Africa recommend that a standardised maternity case record be used by all facilities at all levels of care in order to improve the quality of care for pregnant women. According to the National Department of Health, this will facilitate continuity and quality of care for women during pregnancy, labour and post-partum. Aim of the study The aim of the study was to assess whether the implementation of the new maternity case record has improved the quality of care for pregnant women. Methodology An exploratory, descriptive study using both quantitative and qualitative design was used to conduct the study. Data was collected through a retrospective record review using a checklist for the quantitative strand, and from midwives using unstructured interviews for the qualitative strand. The quantitative data set was analysed using the Statistical Package for the Social Sciences version 21.0 and the qualitative strand was analysed using the Tesch’s method of data analysis. Results The results of the record review revealed that although the recording was done fairly well, there were a number of activities and interventions that were recorded poorly or not recorded at all in some primary health care clinic. The midwives verbalised that many mistakes and mismanagement of ante-natal care clients emanated from the structure and the design of the new maternity case record. Recommendations Recommendations include the following: communication of policies and protocols to the midwives should be done timeously, provision of in-service education and/or updates on new developments, strengthening of supportive supervision, the Nursing colleges be kept up-to-date with new developments in nursing practice and that a broader study involving other districts and provinces be conducted.

Submitted to the faculty of Health Sciences in fulfilment of the requirements for M.Tech.: Nursing, Durban University of Technology, 2011. / Background The South African health care system is guided by the primary health care approach (PHC), which is based on the principles of accessibility, availability, affordability, equity and acceptability which are the cornerstone of primary health care. The Comprehensive PHC Service Package for South Africa is the guiding document for transforming PHC in South Africa standardizing services and increasing access to PHC services. This study will focus on the “Clinic: Fast Queue/Repeats” component of the Package. This is the protocol which guides the management of chronic disease care for adults, geriatrics and paediatrics. According to the Package, this service is for patients who have been assessed previously either at a CHC or at a clinic. For repeat medicines no assessment is required except after three months, and waiting time is minimized through the use of pre-packaged drugs. Methods A cross sectional qualitative design using a descriptive method was used to explore the experiences of the clinic users of the fast queue. A two stage sampling technique was used namely cluster and purposive sampling. In the first instance cluster sampling technique was used to sample clinics in each of the three sub-districts namely south, north and west sub districts of eThekwini municipality and purposive sampling was used to select PHC facilities, those with the highest number of attendees seen over a period of three months and the users of fast queue. Results The findings of the study revealed that there were positive factors which contributed to the satisfaction of participants and negative factors which caused dissatisfaction among participants.

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / In order to make mental health care more accessible and even out the skewed distribution of services, policies were put in place to integrate mental health services into primary health care. For this to be effective, more trained mental health personnel needed to be employed in the public sphere as well as non-governmental and community organizations; and in state services. The BPsych degree which was instituted to meet this need has however, been plagued with controversy since its inception. This study aims to determine the employment patterns of BPsych graduates in the Western Cape so as to ascertain whether the expressed goals for establishing the degree, that is, addressing the need for primary mental health care workers, is in fact being met. Combinations of quantitative and qualitative methods were employed in this study. A self-constructed questionnaire was used for obtaining data. Quantitative data was analysed using SPSS and qualitative data was analysed by means of thematic content analysis. The quantitative data suggest that most of the respondents are employed and have completed the board exam. The majority of respondents are female and are employed within either community or NGO settings, or the private sector. Just over one third of respondents are employed as counsellors. A qualitative analysis of the data has suggested that the majority of employers are unaware of the category of registered counsellor. Respondents placed a large emphasis on the value of the practical component of the course. Based on the results obtained, one could argue that access to mental health care has not been significantly improved by the implementation of this category of registration.

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / An immense burden is placed on families caring for a member with a mental disorder as a result of deinstitutionalisation in South Africa. The aim of present study was to identify resilience factors in families living with and caring for a member with a mental disorder. The focus was on families living in an underprivileged, semi-rural area; caring for a patient using the state-sponsored psychiatric services. Using a cross-sectional survey design, interviews were conducted with 34 family representatives. During these interviews, qualitative and quantitative data was gathered by means of a biographical questionnaire, an open-ended question and set of self-report questionnaires. The results yielded from the data analysis are in keeping with findings from international and South African family resilience studies. After content analysis of the qualitative data, three themes related to resilience factors emerged: internal factors within the home, external factors outside of the home and factors related to the member with a mental disorder. The most commonly mentioned resilience factors cited by the family representative were religion and spirituality, characteristics of individual family members (excluding the patient), family characteristics, and social support. Spearman’s correlations and best subsets multiple regression analysis were performed on the data to ascertain which factors are significantly correlated or associated with family adaptation. In both statistical analyses, communication styles of the family unit were the most important. Spearman’s correlations further revealed that in addition to family communication, the ability of the family to work together, and communication between the marital couple had the strongest correlation with adaptation. Passive acceptance of problematic issues in the family has a negative correlation with family adaptation. The two most significant predictor variables of family adaptation are the family’s style of family communication during crises and the family’s use of passive appraisal as a coping style.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Environmental Health, Durban University of Technology, Durban, South Africa, 2016. / South Africa, like many other developed countries, is challenged by the under attendance and delay in initiation of antenatal care (ANC) services among pregnant adolescents. Adolescents are more vulnerable to pregnancy related complications, which may contribute to maternal and child mortality and morbidity. This study aimed at evaluating the under attendance and/or delay in initiation of ANC services among young pregnant adolescents (13-16 years old) as a risk for adverse maternal and birth outcomes. The research was based at a district hospital on the North Coast of Kwazulu-Natal. A retrospective review of all young adolescent (13-16 years old) maternity case records for the period from 2011-2013 was conducted. Data collected included ANC trends in attendance, obstetric and perinatal outcomes. A total of 314 pregnancies were recorded among young adolescents at this single hospital over a period of 3 years. Adolescent pregnancy was associated with a risk of late ANC booking and reduced ANC visits. The prevalence of anaemia (32%) was relatively high among the girls. Fifty percent of all adolescents received episiotomies while, 45(14%) experienced perineal tears. Logistic regression models found that the condition of perineum was significantly associated with HIV status (OR= 0.36; 95% CI=0.16; 0.84; p<0.05). HIV positive mothers were more likely to have an intact perineum post-delivery. However, HIV positive adolescents were twice as likely to be diagnosed with anaemia compared HIV negative mothers (results not significant). Underutilisation of ANC (i.e less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR=2.64; 95% CI=1.04; 6.74; p<0.05). Fifteen percent of young mothers delivered early (< 37 weeks), 10% delivered babies with a low birth weight (< 2500g) and 15% of the neonates suffered fetal distress. Low birth weight, low Apgar scores as well as the incidence of maternal anaemia and Pregnancy Induced Hypertension (PIH) were found to be related to late ANC booking. Qualitative findings highlighted the perceived barriers of ANC by pregnant adolescents. Interviews identified the following as factors that hindered access of care; financial barriers, attitudes of Health Care Workers (HCW), system barriers and fear of HIV testing. Urgent population based strategies are required to encourage timeous initiation of ANC among adolescents. Strengthening of health education programs on the benefits of ANC attendance among adolescents can be utilized as part of an approach to address the current public health concern. / M

submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, faculty of Health Sciences, Durban University of Technology, Durban, South Africa, 2016. / Globally antenatal care is advocated as the cornerstone for reducing children’s deaths and improving maternal health. The World Health Organization designed and tested a Focussed Antenatal Care model for the developing countries to improve their quality of antenatal care services. South Africa has not successfully implemented this approach, referred to by South Africa as the Basic Antenatal Care approach. A convergent parallel mixed methods design was used to assess how the Basic Antenatal Care approach was implemented in the eThekwini district. Data were collected from 12 Primary Health Care clinics using observations, retrospective record reviews and semi-structured interviews conducted with pregnant women. The quantitative data was analysed using version 21.0 of the Statistical Package of Social Services and qualitative data was analysed using Tech’s method of data analysis. The Basic Antenatal Care approach was not being successfully implemented in the Primary Health Care clinics. Several aspects of planning, people, processes and performance were not done according to the Basic Antenatal Care Principles of Good Care and Guidelines. Although good communication was observed between the clinic staff members and the referral institutions, communication problems existed between the Primary Health Care clinics and the Emergency Medical Rescue Services and also with the pregnant women. Antenatal care and delivery plans and the midwives’ counter checking of maternity charts were not recorded. Some pregnant women had positive perceptions about the antenatal care services but others had negative perceptions. Recommendations pertaining to institutional management and practice, nursing education and research were made. A tailored practice framework and an implementation guide were developed based on setting and client-specific factors to facilitate the implementation of the Basic Antenatal Care approach. The framework highlights the importance of cooperation between management and administration, in-service education and skills development departments/units and the operational level. Effective implementation of the Basic Antenatal Care approach could help to reduce South Africa’s high maternal and neonatal mortality rates. Thus the tailored practice framework and implementation guide, developed as part of this study, could help to improve maternal and neonatal health-related outcomes in South Africa. / D

Thesis (MPhil) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Legislation encourages local government! municipalitiesl local authorities in South Africa, to fulfil a development role. One of the main objectives of municipalities performing a development role is to empower communities, especially previously disadvantaged communities. This study argues that the services delivered by municipalities are an essential component of a development orientation. In view of this fact, the study proposes an operational framework, whereby community empowerment can be achieved through municipal service delivery. The operational framework suggest that for community empowerment to be achieved through municipal service delivery, requires that the empowerment enabler (municipalities or departments within municipalities) should assure that: disadvantaged communities have access to services, services must be delivered in a non-discriminatory manner, the community should understand the rationale as to why the service is delivered, opportunity should be given for community participation in the delivery process, there should be a constant information channel between the giver (enabler) and receiver of services, and human resources from the local community should be utilised where possible in the delivery process. Lastly, a descriptive evaluation is undertaken of the health department's approach (at the Stellenbosch Municipality) to the delivery of primary healthcare services and service infrastructure. The purpose of the evaluation is to ascertain whether the principles as proposed in the operational framework are present in the health department's approach to service delivery. The evaluation reveals that most of the proposed principles of the operational framework features in the health department's approach to the delivery of primary healthcare services and services infrastructure. Thereby, concluding that the health department follows to a certain extent an approach to service delivery that could ultimately lead to community empowerment. / AFRIKAANSE OPSOMMING: Wetgewing vereis dat plaaslike regering/ plaaslike owerhede/ munisipaliteite in Suid-Afrika, 'n ontwikkelingsrol moet vervul. Een van die doelstellings van 'n ontwikkelingsrol vir munisipaliteite, is om gemeenskappe te bemagtig, spesifiek gemik op agtergeblewe gemeenskappe. Hierdie studie argumenteer dat die dienste gelewer deur munisipaliteite 'n essensiële komponent vorm van 'n ontwikkelings-orientasie. Gevolglik, stel hierdie studie 'n operasionele raamwerk voor, waarvolgens gemeenskapsbemagtiging bewerkstellig kan word deur middel van munisipale dienslewering. Die operasionele raamwerk stel voor dat om gemeenskapsbemagting deur dienslewering te bewerkstellig, vereis dat die bemagtiger (munisipaliteite of departemente binne munisipaliteite) moet toesien dat: agtergeblewe gemeenskappe toegang het tot diente, dienste moet gelewer word op 'n niediskriminerende wyse, die gemeenskap moet verstaan waarom die diens gelewer word, geleentheid moet geskep word vir gemeenskapsdeelname aan die diensleweringsproses, 'n kommunikasie kanaal tussen die ontvanger en leweraar (bemagtiger) van dienste, moet geskep word en laastens moet daar van plaaslike arbeid (waar moontlik), in die diensleweringsproses gebruik word. Laastens word 'n beskrywende evaluering onderneem na die Gesondheidsdepartement (by die Stellenbosch Munisipaliteit) se benadering tot die lewering van primêre gesondheidssorgdienste asook diens infrastruktuur. Die doel van die evaluering is om te bepaal of enige van die faktore, soos beskryf in die operasionele raamwerk, teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Die resultate van die ondersoek toon aan dat die meeste van die faktore, soos voorgestel in die operasionele raamwerk, wel teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Gevolglik kan daar afgelei word dat die gesondheidsdepartement wel tot 'n mate, 'n benadering tot dienslewering volg, wat kan lei tot gemeenskapsbemagtiging.

Thesis (MA)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The topic of perinatal depression (i.e. depression during and after pregnancy) remains a subject of continued research interest, as a broad literature body reports that a large proportion of women suffering from this mental disorder do not receive appropriate treatment. This is worrisome, firstly, because mental health treatment is often readily available to the public and at no cost. Secondly, untreated perinatal depression not only holds dangerous consequences for the mother but also for the infant and the rest of the family. It is therefore important to identify those factors that act as barriers to mental health care utilization for perinatal depression. Although this is a persistent problem within the South African context, to date, little is known about the barriers to the utilization of available mental health services experienced among pregnant South African women. For this reason, the Perinatal Mental Health Project (PMHP) aims to provide mental health services at the same location where women receive obstetric services. However, despite their efforts, the number of women who decline available treatment is still of great concern. The present study offers a unique perspective on counselling for perinatal depression appointment-keeping barriers as it provides a holistic view of these barriers that exist not only within the women but also in their multi-levelled environments. Secondly, it addresses the problem of nonattendance to mental health care treatment offered by the PMHP and consequently also addresses the gap in South African research on the topic. The sample for this study was selected from PMHP files of those patients who failed to attend scheduled counselling appointments. The participants included in this study were selected by means of purposeful sampling to participate in face-to-face and telephonic semi-structured interviews. Participants were assured of confidentiality and anonymity. The semi-structured interviews were audio-recorded and transcribed after which transcriptions were entered into MS Word for textual analysis. Transcriptions were thematically analysed. The main themes that emerged from the present study included individual-related barriers, social-related barriers, institution-related barriers, community-related barriers and poverty-related barriers. The results of the present study reflect the motivations for depressive pregnant women to decline available and free mental health services provided by the PMHP, according to five main themes. These themes were then discussed according to Bronfenbrenner’s (1977; 1979) Ecological Systems Theory, which categorised the main themes identified according to the different systems operating within the patient’s environment, i.e. the individual-, micro-, meso-, exo-, and macrosystem. The individual system comprised the individual-related barriers, which included poor mental health, and ambivalent feelings toward the pregnancy. The microsystem comprised the social-related barriers, which included low social support and self-help strategies. Community-related barriers were considered within the mesosystem of the patient’s ecological environment, with stigma and pity as sub-barrier. The exosystem comprised the institution-related barriers, including referral protocol barriers, lack of information provided by the nurses, and nurses’ attitudes as experienced by participants. Lastly, poverty-related barriers were considered within the macrosystem, with financial life hardship, constant child-care demands, and transportation barriers as sub-barriers. The significance of this study lies in the original perspective offered on mental health care appointment-keeping behaviour within the South African context. Future research could, in addition to conducting interviews with hospital patients, include health care professionals and focus groups as this will allow for triangulation of the perspectives of all significant players. Also, having identified the problems and concerns with regards to attending counselling appointments, future research direction may be aimed at creating interventions designed to reduce the identified barriers to mental health care service use. / AFRIKAANSE OPSOMMING: Perinatale depressie (d.w.s. depressie voor en na swangerskap) bly ʼn onderwerp van voortdurende navorsings belang, aangesien ʼn breë navorsingsveld aandui dat ʼn groot proporsie van vroue wat aan hierdie geestesversteuring lei, nie die gepaste behandeling ontvang nie. Dit is kommerwekkend, eerstens, aangesien behandeling vir geestesgesondheid meestal openlik verkrygbaar is aan almal sonder enige koste. Tweedens, onbehandelde perinatale depressie hou nie slegs gevaarlike gevolge vir die moeder in nie, maar ook vir die baba en die res van die gesin. Dit is daarom belangrik om daardie faktore te identifiseer wat as hindernisse optree tot geestesgesondheid sorg diensgebruik vir perinatale depressie. Alhoewel dit ʼn voortdurende probleem binne die Suid-Afrikaanse konteks is, is daar tot op hede geen navorsing wat hindernisse tot gebruik van beskikbare geestesgesondheidsdienste bekend gemaak nie, veral wat ervaar word onder swanger Suid-Afrikaanse vroue nie. Vir hierdie rede, beoog die Perinatal Geestesgesondheid Projek (Perinatal Mental Health Project - PMHP) om geestesgesondheidsdienste te lewer by dieselfde plek waar vroue verloskundige dienste kan ontvang. Nietemin, ten spyte van hul pogings, is die getal vroue wat beskikbare behandeling van die hand wys steeds van groot kommer. Dié studie bied ʼn unieke perspektief op hindernisse tot berading vir perinatale depressie afspraak-ooreenkoms gedrag, aangesien dit ʼn algehele uitkyk bied op hindernisse wat nie slegs binne die vroue bestaan nie, maar ook in hul veelvlakkige omgewings bestaan. Tweedens, spreek dit die probleem van nie-bywoning van geestesgesondheidsbehandelingsdienste wat aangebied word deur die PMHP aan en gevolglik ook die gaping wat binne Suid-Afrikaanse navorsing rakende dié onderwerp bestaan. Die steekproef vir die studie was gekies van PMHP lêers van daardie pasiënte wat nie hul geskeduleerde terapie afsprake bygewoon het nie. Die deelnemers ingesluit in die studie is deur middel van doelgerigte-steekproefneming geselekteer om aan aangesig-tot-aangesig of telefoniese semi-gestruktureerde onderhoude deel te neem. Deelnemers is van hul vertroulikheid en anonimiteit van die proses verseker. Die semi-gestruktureerde onderhoude was oudio-opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in MS Word gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer. Die hooftemas wat na vore gekom het, sluit in individuele-verwante hindernisse, sosiale-verwante hindernisse, institusie-verwante hindernisse, gemeenskapsverwante hindernisse en armoede-verwante hindernisse. Resultate van dié studie reflekteer die motiverings van depressiewe swanger vroue om beskikbare en gratis geestesgesondheidsdienste wat verskaf is deur die PMHP van die hand te wys, volgens die vyf hooftemas. Hierdie temas is toe volgens Bronfenbrenner (1972) se Ekologiese Sisteemteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die individuele-, mikro-, meso-, ekso-, en makrosisteem. Die individuele sisteem het die individuele-verwante hindernisse ingesluit, wat swak geestesgesondheid, en teenstrydige gevoelens teenoor die swangerskap omvat het. Die mikrosisteem het die sosiale-verwante hindernisse ingesluit, wat swak sosiale ondersteuning, en self-help strategieë omvat het. Gemeenskapsverwante hindernisse is binne die mesosisteem van die pasiënt se ekologiese omgewing beskou, en het stigma en jammerte as sub-hindernisse ingesluit. Die eksosisteem het die institusie-verwante hindernisse ingesluit, wat verwysing protokol hindernisse, gebrek aan inligting verskaf deur die verpleegsters, en verpleegsters se houdings soos ervaar deur die deelnemers omvat het. Laastens is die armoede-verwante hindernisse binne die makrosisteem beskou, en het finansiële lewens swaarkry, konstante kindersorg eise, en vervoer-verwante struikelblokke as sub-hindernisse ingesluit het. Die belang van dié studie lê in die oorspronklike perspektief van geestesgesondheidsbehandeling dienste afspraak-ooreenkoms gedrag binne die Suid-Afrikaanse konteks, wat aangebied is. Toekomstige navorsing kan, bykomend tot die voer van onderhoude met hospitaal pasiënte, fokus daarop om gesondheidsorg kenners en fokus groepe in te sluit, aangesien dit die triangulasie van perspektiewe moontlik maak van al die belangrike rolspelers. Ook, aangesien die probleem en bekommernisse rakende bywoning van terapie afsprake reeds geïdentifiseer is, mag toekomstige navorsing in die rigting beweeg met die doel om intervensies te omskep wat beoog om die geïdentifiseerde hindernisse tot geestesgesondheidsorg diensgebruik te verminder.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The Department of Health estimates that 80 percent of South Africans consult traditional healers before consulting modern medicine. The aim of this study is to investigate the extent of the use of traditional medicine in local communities in the Limpopo Province, and add value to a draft policy that was introduced by the Minister of Health. (South Africa, Department of Health 2007a) Traditional healers are regarded as an important national health resource. They share the same cultural beliefs and values as their patients. They are respected in their communities. In South Africa, traditional healers have no formal recognition as health care professionals. Despite the advantages of modern medicine, there is a dramatic evolution in traditional medicine developing and developed countries. In recognition of the value that traditional medicine has added to people’s health needs, government organisations have realised the gap and needed to embark on public participation to bring to light the solution, by implementing a relevant policy (Matomela 2004). According to research done by Pefile (2005), positive outcomes that resulted from the use of traditional medicine include a more holistic treatment, a wider choice of health care that suits people’s needs, and scientific advancement, this paves a way forward for a policy to be put into place for the legal recognition of traditional medicine. New legislations have been brought about in regulating traditional medicine and practitioners. This paper provides a synopsis of government initiatives to close the gap and address the concerns of integrating traditional and modern medicine. The thesis addresses the challenges involved in incorporating the two disciplines for the best possible impact of local communities in accessing their rights as vested in the constitution. The study is a qualitative study where relevant practicing traditional healers, users, Western doctors, nurses, managers and government policy makers were interviewed regarding the draft policy on traditional medicine. This was to obtain information on the challenges, gaps and possible solutions regarding the integration of African traditional medicine into the health care system of Southern Africa. Findings show the following: a majority of traditional healers do not agree to scientific trialling and testing on the herbs that they prescribe, and Western doctors feel that traditional healers should only treat patients spiritually unless they have a scientifically tested scope and limitations on their field. The study also found that traditional healers want to be registered and integrated into the health care system, but do not agree to have regulated price fixing. Other conclusions included that the communities seek traditional help for cultural reasons and more benevolent purposes, but are changing their focus towards seeking medical help from clinics where it is provided for them. However, people within the communities are still confused whether to seek traditional or western medicine and therefore seek both. It was found that medications are not readily available in district clinics and hospital waiting times force people into seeking traditional help. Nurses, doctors and caregivers acknowledge that traditional healers are hampering the health care of patients by delaying hospital treatment of patients hence progressing illnesses. However, they also state that traditional healers help people spiritually and mentally. Therefore policy makers have found solutions to educate healers and create regulatory boards to limit and create a scope of practice for traditional healers. Recommendations and solutions for the relevant policy are as follows: It is recommended that traditional health practitioners should only be allowed to practice and train over the age of 21. They must be prohibited from certain procedures, for example: drawing blood, treating cancers, and treating AIDS/HIV. They should only be allowed to practice midwifery if they have had training. They should be prohibited from administering injections and supervised drugs, unless trained at a tertiary level traditional healers can be used as home caregivers, spiritual healers, and traditional advice counselling entities in the communities. Traditional healers must be prevented from referring to themselves as a ‘doctor’ or ‘professor’. This misleads people into believing that they are allopathic doctors. ‘Traditional health practitioners’ must realise that they are holistic healers, and must be addressed as such. A strong recommendation is to rename ‘traditional health practitioners’ as ‘spiritual practitioners’. With regards to regulations, it must be imperative that every practicing traditional health practitioner be registered annually with the relevant board. A good suggestion is for traditional health practitioners (THP) to attend formal training courses, under an experienced herbalist, and it should be documented on paper. A written record of the location of practice, and specialty must also be documented. There must be policies on health and safety, hygiene and sterility that need to be in place. It is suggested that training on patient confidentially must be taught and implemented. A code of conduct and a standard of professional ethics must also be implemented. Health and safety regulations pertaining to the profession and the citizens must be listed. Efforts towards dispelling myths and making people aware, thereby filtering out the positive side of the traditional medicine (e.g. medical benefits with some herbs), and rooting out the ‘quack’ practices (e.g. the use of amulets around a patient’s body to cure diseases) should be practiced. Pertaining to co-operative relationships between modern medical doctors and traditional practitioners, it is recommended that the use of exchange workshops between the two professionals needs to be developed. Also scientific information and technology must be available to traditional healers. A continued professional development (CPD) programme should be a mandatory requirement, as for all other health care professionals. It seems the development of traditional hospitals, in which a scope of practice is defined, can be used as a recovery ward and a spiritual guidance centre. The above recommendations will encourage a healthier, safer and transparent health care system in South Africa, where all disciplines of medicine co-exist in one National Health Care System. / AFRIKAANSE OPSOMMING: Nadat navorsing deur die Departement van Gesondheid gedoen is, is daar gevind dat 80 persent van Suid-Afrikaners tradisionele genesers besoek. Die doel van hierdie navorsing is om ondersoek te doen na die gebruik van tradisionele medisyne deur landelike gemeenskappe in die Limpopo Provinsie, en om ook ‘n bydrae te lewer tot die konsepbeleid wat deur die Minister van Gesondheid bekendgestel is (South Africa, Department of Health 2007a). Tradisionele genesers kan beskou word as ‘n belangrike hulpbron in die nasionale gesondheidsdiens. Hulle deel in kulturele gelowe en waardes van hulle pasiente en word ook gerespekteer in hulle gemeenskappe. Suid-Afrika egter, gee geen erkenning aan tradisionele genesers of die feit dat hulle in die gesondheidsdiens is nie. Ondanks die feit van moderne geneesmiddels, is daar ‘n dramatiese evolusie wat besig is om plaas te vind in die Westerse Wêreld. Die erkenning en waarde van tradisionele medisyne wat bydra tot mense se gesondheidkwaliteit, het daartoe gelei dat Staatsorganisasies begin insien het dat daar ‘n gaping is en dat publieke peilings gedoen word om ‘n oplossing te vind en ‘n beleidsdokument saam te stel wat tradisionele genesers insluit (Matomela 2004). Die ondersoek wat Pefile (2005) gedoen het, het positiewe resultate getoon by die gebruik van tradisionele medisyne wat ‘n holistiese behandeling in ‘n wyer verskeidendheid van medisyne insluit by gebruikers. Ook die wetenskaplike vooruitgang van tradisionele medisyne het daartoe bygedra dat ‘n beleidsdokument in plek gesit word vir die wettige erkenning daarvan. Nuwe wetgewing is in werking gestel om beheer uit te oefen oor tradisionele genesers en tradisionele medisyne. Hierdie dokument verskaf ‘n sinopsis van die Staat se inisiatiewe om die gaping tussen moderne medisyne en tradisionele medisyne aan te spreek en ook om landelike gemeenskappe toe te laat om hulle reg uit te oefen soos wat in die Grondwet vervat is. Die studie is kwalitatief waar relevante praktiserende tradisionele genesers, verbruikers, Westerse dokters, verpleegkundiges, bestuurders en staatsdiensbeleidvormers ondervra is oor ‘n konsep beleidsdokument oor tradisionele medisyne. Dit was gedoen om informasie rakende die uitdaging , gapings en 'n moontlike oplossing te vind vir die integrasie van Afrika se tradisionele medisyne in die gesondheidsorgsisteem van Suidelike Afrika. Belangrike bevindings sluit die volgende in: die meerdeerheid tradisionele genesers stem nie saam dat wetenskaplike toetse gedoen word op kruie wat hulle voorskryf nie; tradisionele genesers will geregisteer en geïntegreer word in die gesondheidsorgsisteem maar stem nie saam oor prysregulering en prysvasstelling nie; Westerse dokters is van mening dat tradisionele genesers net pasiënte geestelik moet kan behandel tensy hulle ‘n wetenskaplik getoetse doel en beperkings in hulle veld het; Westerse dokters glo dat tradisionele genesers dwarsboom die gesondheidsorgsisteem deurdat hulle behandeling vetraag; die gemeenskap soek tradisionele hulp op vir kulturele redes en ander welwillendheidsredes maar gaan soek mediese hulp by klinieke waar dit aan hulle verskaf word; mense van gemeenskappe is verward en raadpleeg beide tradisionele genesers en Westerse dokters vir hulp; sommige medisyne is nie altyd by klinieke beskikbaar nie en mense sien nie kans om in lang rye te wag by hospitale nie en dit noop dat hulle tradisionele medisyne gebruik; verpleegkundiges en gesondheidswerkers erken dat tradisionele genesers mense vertraag om gesondheidsorg en behandeling by hospitale te kry, maar verstaan ook dat tradisionele genesers aan mense geestelike hulp verleen; en besleidskrywers moet oplossings vind om tradisionele genesers op te voed en om komitees te stig wat tradisionele genesers se ruimte van praktisering in toom te hou. Die volgende word as voorstelle tot aanpassing van die genoemde beleidsdokument geïdentifiseer:- Tradisionele genesers mag alleenlik praktiseer en opleiding verskaf na die ouderdom van 21 jaar. Hulle moet verbied word om sekere prosedures, byvoorbeeld die trek van bloed; behandeling van HIV/VIGS; om voor te gee dat hulle mediese praktisyns is; om vroedvroue te wees slegs indien gekwalifiseer daartoe; om inspuitings toe te dien en medisyne uit te reik slegs indien hulle tersiëre opleiding gehad het. Tradisionele genesers se dienste kan gebruik word as gemeenskapsgesondheid hulpwerkers, geestelike genesers, en kan tradisionele advies en begeleiding aan die gemeenskap lewer. Tradisionele genesers moet belet word om die titels “Dokter” en “Professor" te gebruik. Tradisionele genesers moet daarop let dat hulle holistiese genesers is en moet daarvolgens aangespreek word. Hulle moenie pasiënte mislei deur voor te gee dat hulle allopatiese geneeshere is nie. “Tradisionele genesers” moet hernoem word na “geestelike genesers”. Tradisionele genesers moet by ‘n erkende organisasie geregistreer word en moet so-ook jaarliks registrasie hernu. Formele onderrig wat deur ‘n ervare kruiegeneser aangebeid word moet bygewoon en gedokumenteer word. ‘n Geskrewe rekord van die ligging van die praktyk en betrokke spesialisering moet bygehou word. Beleidsvoorskrifte wat verband hou met gesondheid en veiligheid, hygiene en sterilisasie moet in die tradisionele gesondheidgeneserspraktyk geïmplementeer word. Opleiding in pasiëntkonfidensialiteit moet aangeleer en toegepas word. Samewerking en werkswinkels tussen moderne mediese dokters en tradisionele gesondheidgenesers moet geïmplementeer en ontwikkel word. Mediese wetenskapsinligting en tegnologie moet aan tradisionele genesers bekendgemaak word. Voorts moet ‘n voortgesette professionele ontwikkelingsprogram (POP) aan alle gesondheidswerkers voorgeskryf word. Dit blyk wenslik te wees om tradisionele hospitale tot stand te bring waar die bestek van praktyk gedefinieer word. Sulke hospitale kan dien as plekke waar pasiënte aansterk en geestelike onderskraging geniet. ‘n Etiese kode en standaard vir professionele etiek moet geskep word vir tradisionele genesers. Gesondheids- en sekureitsregulasies moet van toepassing wees en geïmplementeer word. Pasiënte moet ingelig word oor die wegdoen van mites en fabels. Daardeur kan die positiewe sy van tradisionele medisyne (byvoorbeeld mediese voordele van kruie), en uitroei van “kwakke” (byvoorbeeld dra van gelukbringers om die lywe), verdryf word. Dit sal die aanmoediging van ‘n gesonder, sekuriteitbewuste en deursigtige gesondheidsorg sisteem bewerkstellig in Suid-Afrika waar alle dissiplines van medisyne saam bestaan in die Nasionale Gesondheidsorgsisteem.

Thesis (MPhil)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: The purpose of this study was to identify possible viable future healthcare models for South Africa, using the techniques and methodologies advocated in the field of future studies by futurists and erudite academics such as Ackoff, Drucker, De Jouvenel, Slaughter, Dostal and Roux. This topic necessitated a problem-orientated approach to future studies based on the complexities inherent thereto. A great deal of emphasis was therefore placed on the tools of rational analysis, which are supported by unregarded worldview assumptions about the ability of humans to regulate and control the world and therefore the framing of new laws, rules and regulations. The forward view was generated by using the appropriate methodologies such as environmental scanning and the analysis of trends and outcomes. Enrichment to the foresight work, beyond the respective models, was furthermore achieved by acknowledging the cultural and social-political arena wherein the current healthcare models in South Africa operate. The focused scan of salient and credible material and publications was extended to include research into healthcare outcomes achieved in countries with comparable economic and demographic profiles to South Africa. Supplementary research was also conducted into comprehensive aspects such as ethics and health economics in conjunction with recognised international healthcare models. The drivers of quality healthcare at primary and secondary healthcare levels and therefore also representing the constraining factors in the South African milieu being available healthcare practitioners, training, physical infrastructure, technology, access to facilities and the affordability of healthcare were explored to ensure the viability of the futures healthcare models contemplated. The identification of probable futures was accomplished by means of scenario development which focussed on the critical uncertainties of healthcare funding models and nationalisation as opposed to free market models competing for available resources in a semi-regulated environment. Thereafter Delphi techniques were used to acquire consensus from specialists currently working in the field of public and private healthcare along with stakeholders such as leaders of enterprise, healthcare funders and regulators as regards the identification of preferred future healthcare models that will meet, in a sustainable manner, the constitutional right to basic healthcare and enhance the quality of life and life expectancy of all South Africans. The relevance and credibility of the consensus opinions of the selected experts who participated in the research was again tested against the futures discourse publicised in the press to ensure that personal, cultural and organisational factors were not disregarded in the process. The study concluded on the fact that additional research and debate are required to ensure that the societal, organisational and individual aspects of the system wherein healthcare operates are comprehensively addressed by all relevant stakeholders in a manner that void of the neuroses caused by anxiety when thinking of the future. / AFRIKAANSE OPSOMMING: Die doel van die studie was om moontlike volhoubare toekomstige gesondheidsorgmodelle vir Suid-Afrika te identifiseer deur gebruik te maak van tegnieke en metodologieë soos voorgehou deur deskundiges en hoogs belese akademici in die veld van toekomstudies, soos Ackoff, Drucker, De Jouvenel, Dostal en Roux. Die studie het, as gevolg van die kompleksiteit daarvan, ´n probleem-gerigte benadering tot toekomstudies verlang. Gevolglik is baie klem geplaas op rasionele analise-tegnieke, wat ondersteun word deur wêreldsiening-aannames aangaande die mens se vermoeë om die wêreld te reguleer en te beheer deur middel van nuwe wetgewing, reëls en regulasies. Die toekomsgerigte siening is gegenereer deur die gebruik van toepaslike metodologieë, soos byvoorbeeld omgewingskandering en die analise van tendense en uitkomste. Die toekomsgerigte werk is aangevul deur erkenning te gee aan die kulturele en sosio-politiese milieu waarbinne die huidige gesondheidsorgmodelle in Suid Afrika funksioneer. Die gefokusde skandering van kredietwaardige bronne en publikasies is uitgebrei ten einde navorsing oor gesondheidsorguitkomste, soos behaal in lande met vergelykbare ekonomiese en demografiese profiele, soos Suid Afrika, in te sluit. Aanvullende navorsing is verder onderneem en was gerig op omvattende aspekte soos etiek en gesondheidsekonomie, tesame met erkende internasionale gesordheidsorgmodelle. Die kernbepalers van kwaliteit-gesondheidsorg op primêre en sekondêre gesondheidsorgvlak, wat dus ook die beperkende faktore in die Suid-Afrikaanse milieu verteenwoordig, naamlik beskikbaarheid van mediese praktisyns, opleiding, fisiese infrastruktuur, tegnologie, toegang tot fasiliteite en die bekostigbaarheid van gesondheidsorg, is ondersoek ten einde die volhoubaarheid van die toekomsgesondheidsmodelle te verseker. Die identifiserings van waarskynlike toekomste is bereik deur scenario-ontwikkeling wat gefokus het op die kritiese onsekerhede van gesondheidsorgbefondsing en nationalisering, teenoor ´n vryemarkstelsel wat meeding om beskikbare hulpbronne in ´n deels-gereguleerde omgewing. Daarna is Delphi-metodieke gebruik om konsensus te verkry onder kenners wat tans in die veld van openbare en privaat gesondheidsorg werksaam is, asook belanghebbendes soos leiers in besighede, gesondheidsorgbefondsers en reguleerders, ten opsigte van voorkeur-toekomsgesondheidsorgmodelle wat op ´n volhoubare wyse die grondwetlike regte tot basiese gesondheidsorg en die verbetering van die kwaliteit van lewe en lewensverwagting van alle Suid-Afrikaners sal bevorder. Die toepaslikheid en geloofwaardigheid van die konsensusmenings van die gekose kenners wat deelgeneem het aan die navorsing is weer getoets teen toekomsgesprekke soos gepubliseer in die media ten einde te verseker dat persoonlike, kulturele en organisatoriese faktore nie in die proses misken is nie. Die studie het tot die slotsom gekom dat verdere navorsing en debat nodig is ten einde te verseker dat die sosiale, organisatoriese en individuele aspekte van die stelsel waarbinne gesondheidsorg funksioneer omvattend aangespreek word deur alle belanghebbendes, en op ´n wyse wat enige neurose wat tot angstigheid oor toekomsdenke kan lei, die hok slaan.