Background: Long waiting times and the quality of care are sometimes compromised by the ineffective systems caused among others by the bottlenecks at the reception and the treatment areas. The Hospital management of the Kopanong Hospital was concerned about the long queues and waiting times in the Hospital’s out-patient department. Therefore, the Hospital management would like to reduce the long queues and the length of the waiting times. The information from the customer care system showed that the average waiting times in the out-patient department was about five hours and that much of this time was spent at reception area waiting for files. However no study was done to systematically measure the waiting time in the OPD and the factors that might have influence on it. This study was planned in this setting to assist the Hospital management in setting the baseline that could be used in benchmarking for monitoring the situation. Aims: To evaluate factors affecting waiting times at the Out-patient department (OPD) of Kopanong Hospital Methodology: The setting of this study was Kopanong Hospital, in the Sedibeng District in the Gauteng Province. This was a cross-sectional study that looked at broad issues pertaining to the waiting time at the Out-patient Department of Kopanong Hospital, a district hospital in a the rural district in the Gauteng Province during three-year study period. The OPD has three sections: General OPD, Paediatric OPD and Antenatal Clinic (ANC). The MS excel software based data extraction tool was designed to obtain data from Hospital Information System. Results: The majority of the patients came from poor socio-economic class and had no medical aid. Therefore, these patients are dependent on public health facilities for their health care and would not be able to pay for their health care. The majority of the patients were self referred except ANC. This might be due to a well-functioning referral system for maternity patients in the District. The majority of the patients attended the General OPD and Paediatric OPD for medical reasons. The analysis of data showed that the patients spent a significant amount of time in the system before they were seen by the nurses and doctors. However, they were also spending a significant amount of time in the Pharmacy. The reasons for efficient record keeping for ANC and Paediatric OPD patients might be due to the fact patients caries their own cards (ANC cards and Road to Health cards). Similar system should be introduced for General OPD patients. Further study is necessary to identify the cause for delay in the Pharmacy. Conclusion: This study was the first of its kind to be done in this Hospital and the Sedibeng Health District. The study identified the areas where patients spent time in the OPD. This would assist the Hospital Management to develop appropriate measures to reduce waiting time in the Hospital OPD. In addition, further study is necessary at the PHC facilities in the District to identify reasons for high self-referral.

Background: South Africa has a high Maternal Mortality Ratio (MMR) and is not on track to meet Millennium Development Goal (MDG) 5, target 5A (to reduce by three quarters between 1990 and 2015 the MMR). Along with gathering crucial information about maternal deaths, it is also important to understand the experiences and opinions of those who have almost died during their pregnancy or delivery - termed near-misses in maternal health services - to recommend relevant interventions aimed at bringing down South Africa's MMR. Aim: The overall aim of the study was to explore patient experiences and perspectives of maternal near-misses and their opinions of how these could have been prevented. Methods: Using a case study design, where the case was women who had experienced severe acute maternal morbidity (a near-miss event), in-depth interviews were conducted with nearmisses until a point of saturation was reached after the ninth woman. Each woman was interviewed twice on two separate occasions between 1st April and 30th September 2009 about their experiences and opinions of the near-miss event, and access to reproductive health services and the health system more broadly. Their social and economic circumstances were also explored.MAXqda was used for data management and a thematic analysis was carried out on the interview data. Results: Bureaucracy in accessing reproductive health services, lengthy referral processes, lack of transport and resources in clinics were seen as major health system barriers that contributed in women being near-misses. Inadequate knowledge about reproductive health and warning signs of serious morbidity; although seen as patient factors, were also be attributed to health system factors. The desire to or not to fall pregnant was not the only factor that influenced contraceptive use. Power relations between women and their partners affected most women who were in lower positions of power. Cessation of menstruation as a side effect of contraception resulted in failure to recognize absence of menstruation during pregnancy. Lack of service integration affected women irrespective of their demographic characteristics. Patients are at risk of abuse in health facilities although this is not the norm. Little attention was given to postnatal care of women. Conclusion: Health systems' issue which according to the AAAQ framework were not satisfactory contributed in women being near-misses. Women's limited knowledge on reproductive health issues which might be as a result of inadequate information offered at the clinic affected use of reproductive health services. Educating women and their families about obstetric emergencies may result in early recognition of warning signs of obstetric emergencies and prevention of near-misses.

Following the successful introduction of antiretroviral therapy (ART) in resource-limited settings, we have observed an unprecedented explosion in the expansion of ART programs throughout sub-Saharan Africa, resulting in a 13-fold increase in coverage since 2004. In spite of these achievements, uptake of ART remains low. The gap in treatment coverage is approximately 50% of those who need ART in South Africa, while the country boasts the largest ART program worldwide. Rural areas are particularly prone to lower ART coverage rates, largely a result of existing health care inequities. The ART coverage gap will widen given the recent introduction of new treatment guidelines, which allows for ART commencement at CD4 350 cells/mm3. Furthermore, approximately one-third of ART patients are lost to follow up after two years of treatment initiation in sub-Saharan Africa. This study explores factors associated with ART access and utilisation in a rural area, in order to reduce the gap in knowledge on patient and health system factors. Unaddressed, these factors may continue to hinder adoption of rigorous interventions to improve ART uptake and retention. This research employs the A-Framework to conceptualize access to health care, where dimensions of access include availability (physical access), affordability (financial access), and acceptability (cultural access). A data triangulation approach was adopted as very little was known on the utilization patterns of health care by HIV/AIDS patients. Quantitative research (2008-2010) employed a four-site rural-urban comparative analysis of 1266 participants, and was part of a 5-year project Researching Equity and Access to Health care (REACH).This was complemented by a more in-depth qualitative assessment (2006-2007) that followed the treatment experience of 32 patients before and after ART initiation in the rural Bushbuckridge site. We found plural utilisation of health care to be a cross-cutting theme throughout this thesis. While the movement of patients between providers at various levels within the traditional and formal health sector may be a sign of agency, it may also result in excessive health costs that threaten the livelihoods of individuals and their households. We discuss a number of strategies to improve ART initiation and adherence including the need to incorporate metrics for pluralism into routine assessments; the importance of decentralized, humane and high quality care and support services; support for efforts to enhance patient self-efficacy through education, awareness and social support interventions; the incorporation and regulation of traditional healers into the formal system; risk protection mechanisms that reduce financial barriers and consequences of HIV care including grants, subsidies and National Health Insurance, and support for wider efforts to reduce urban-rural inequalities.

This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

M.Cur. (Nursing Administration) / With the Declaration of Alma Ata in September, 1978, a new era in health care delivery, the primary health care era with its slogan of "health for all by the year 2000' dawned. Much thought had to be put into new legislation and reorganizing of health services in South Africa. Soweto, devastated by riots in 1976, suffered badly when all health care services collapsed. Out of this crisis was born a primary health care service that provides Soweto with preventive, promotive, curative and rehabilative health care. The researcher has attempted to give an introduction into primary health care, as practiced world wide, with a review of the historical development of the primary health care service in Soweto. These services were analysed, drawing conclusions on the present service and the status of the health care in Soweto and concluding with proposals for further improvement of the health care services.

Introduction Midwifery obstetric units (MOUs) have been established in South Africa in response to the health needs of pregnant women. Although various types of MOUs currently exist, the function of the MOU and the quality of midwifery care rendered, have never been documented. This study aims to describe and compare four different types of MOUs in the Pretoria region. This will contribute towards providing and evidence base, needed for effective policy-making. The researcher believes that MOUs should play an important role in the reduction of maternal morbidity and mortality. Methods and procedures A comparative and descriptive design was used to reach the aim of the study. Both qualitative and quantitative methods were used, to contribute to a comprehensive picture of the functioning of MOUs and midwifery care rendered. Three objectives were set at the onset of the study. Objective one was to describe and compare the function of the MOUs with regard to: specific criteria: the number of admissions, the number of referrals, the number of deliveries, birth mass of babies delivered, number of perinatal deaths before admission and after delivery, neonate deaths, episiotomies rate, oxytocin use, pain relief rate, apgar score at 5 minutes of <8, neonatal referral rate, pregnancy complications (e.g. postpartum haemorrhage, retained placenta, birth trauma), management of third stage of labour, fetal monitoring type (doptone, Pinard stethoscope), referral criteria of each institution, indication for referral, and compliance to management protocol. Objective two was to describe and compare staffing and work load, which include the number of staff per shift in the labour ward, number of deliveries per shift, level of training, number of midwives with PEP training, number of advanced midwives, and availability job description of staff in labour ward. Objective three dealt with the description and comparison of the quality of care, with specific regard to the quality of the partogram and patient satisfaction. Triangulation of data collection methods were used to ensure trustworthiness of data. To attain the objectives, stated above, the data collection methods included: monthly statistical forms for objective one, structured individual interview with unit managers and job analysis of all categories of staff in the MOU, for objective two and for objective three a structured individual interview with patients was used to determine patient's satisfaction, and an audit of the partogram, to determine quality of care. A sample of four MOUs in the Pretoria region was purposively selected, because of their unique characteristics, resembling four different types of MOUs. To achieve objective one, statistics were obtained for a twelve-month period. To attain objective two a convenient sample of unit managers of the four MOUs were used. To attain objective three, a simple random sampling was used, to select patients' records (n=50) from each MOU, a total of (n=200) 200 records were selected. Convenient sampling was done for the interviews with patients, (n= 120) and again, a further interview was held with patients who bypassed the MOUs, of a period of 2 months. The content validity of the statistical form was based on the current format used in the MOUs and according to the "Guidelines for Maternity Care in South Africa" (Department of Health). The interview guide, used for interviews with the unit managers, was structured according to the study objectives. The interview guide, used to interview the patients, was based on an instrument developed by Steyn (1998), to assess patient's satisfaction in antenatal care, and adapted for the purpose of the study. All the methods used for data collection was tested during a pilot study. Descriptive and inferential statistics, as well as Tesch's approach towards the analysis of qualitative data, was used to examine differences between the four MOUs. Within the scope of this study, the researcher does not intend to generalize the findings. Conclusion The uniqueness of the study lies in the relevance of MOUs in the provision of maternity care, as one of the priorities of National Health. Up to date, little scientific knowledge is available on the functioning of the MOUs, In the Pretoria region. This study provides valuable information for the functioning of MOUs to effectively manage resources, and improve the quality of maternal care. It may further assist midwifery educators, to embark on hands-on, training on site, approach on the management criteria of each institution, indication for referral, and compliance to management of women in labour. / Dissertation (MSc (Advanced Midwifery and Neonatal Care Nursing Science))--University of Pretoria, 2005. / Nursing Science / unrestricted

No description available.

Sex work is a crime in South Africa. With the prevalence and deleterious social and economic effects of HIV, in health literature sex work has often been understood in relation to the way that it intersects with the transmission of the epidemic. This positioning of sex work then inadvertently stigmatises sex workers who are often cast outside the rights-based discourses that characterise South Africa’s post-apartheid democracy. In order to address this problem, this study explored the perceived barriers and facilitators to sex workers’ accessing sexual and reproductive healthcare (SRHC), gaps in the current service offerings relating to sex worker’s sexual and reproductive health (SRH) and the general experiences of SRHC amongst 11 female sex workers in Johannesburg, South Africa. Semi-structured in-depth interviews were conducted with these sex workers, who were based in Johannesburg City Deep. The resultant data were transcribed and subjected to a thematic analysis. The study shows that various structural and individual level barriers are perceived to prevent access to SRH. In particular, the analysis suggests that the disease-specific focus on sex worker-specific projects poses a barrier to sex workers’ accessing a complete range of SRHC services. Violence enacted by healthcare professionals, police and clients fuelled a lack of trust in the healthcare sector and displaced the participants from their basic human rights. It is also worrying that religion posed a threat to effective SRHC because some religious discourses label sex workers as sinners who are perceived to be excluded from forgiveness and healing. Finally, motherhood proved to be a point at which the participants actively managed their health and engaged with and in broad-based SRHC. Participants frequently only sought SRHC at the point at which an ailment affected their livelihood and ability to provide for a family. Taken together, these findings seem to show a range of formidable challenges to sex workers’ understanding of themselves in a human rights discourse. This study’s findings are of particular importance to rethinking the legislation that criminalises sex work, as well as healthcare initiatives geared both towards sex workers and women in general.

A research report submitted in partial fulfilment of the requirements for the degree of Master of Arts in Psychological Research in the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2017. / Mental ill-health constitutes a substantial burden of disease worldwide, representing more than the burden of disease caused by all cancers combined. However, the provision of mental health care remains inadequate around the world. To address the shortages in mental health care expenditures, the WHO-HEN (2003) proposed treatment priorities and policy goals in different contexts, based on their financial resources. This study investigates the state of mental health treatment provision in high-, middle-, low-income and the South African contexts, in order to assess the efforts that have been made in these contexts to counter the shortages in mental health care provision, and to promote public mental health, following the WHO-HEN (2003) suggestions. This study uses the mixed methods approach to review literature published between 2004 and 2016 within the AJCP, AJP, CMHJ, SAJPs and SAJP. The findings reveal that treatment trends across contexts align with, and extend beyond the WHO-HEN (2003) suggestions in most cases, and that the balanced care approach is progressively being implemented in the delivery of integrated mental health services in highincome countries and South Africa specifically. These results prove that efforts are being made across contexts to provide effective mental health care, and to ensure the promotion of mental health and prevention of mental disorders. / XL2018