The object of this research is to investigate in detail the origin and growth of Natal Hospitals - their design and function. The 19th Century saw the birth of the Republic of Natalia, and with it the establishment of towns and villages where public institutions, including hospitals, were being founded paraliel with private dwellings. Twofold development of the colony by Voortrekkers and English settlers resulted in different cultural influences, which can be observed in the architecture of that time. Whereas public, commercial, religious, domestic and collegiate buildings in Natal were, in their own scaled-down fashion, comparable with their counterparts in the United Kingdom, matters of public hygiene, mental health and prison systems were seriously neglected. The importance of the problem was recognised only in the late 1850's. The change in thinking was caused by the radical improvements in European Hospitals which were considered to be: "....essentially creations of the era beginning in the mid-18th century (for before this date the accommodation was provided in ad hoc premises), and all possessed the common quality of demanding, that certain clearly defined functions be fulfilled. The new hospitals imposed an overriding demand for maximum ventilation. It was in buildings such as these, that modern functionalism best expressed itself, and as a result, the 19th century subjected to a considerable amount of architectural research." Natal Hospitals represent an interesting group of institutions. Their layouts and architectural styles originating in Europe, they were brought here by Dutch and English settlers. Though the study of the function and design of the hospitals included in this research is focused on a limited range of buildings, the general conclusions-are related to the overall situation in Natal. In addition the research is done only on some specific aspects, covering the most important issues regarding the quality of hospital services and general standard of design. In the complex environment of the Natal hospital, the influence of design upon function is very significant, although it is often believed that function has dictated the design. / Thesis (M.Arch.)-University of Natal, Durban, 1988.

National healthcare departments all over the world are facing the problem of rationing very limited resource to achieve acceptable levels of health care for their citizens. At the centre of healthcare challenges is the problem of an increasing disease burden, increasing pharmaceutical prices, increasing healthcare worker remuneration and the globalisation of healthcare services. Under such restrictive and competitive conditions, healthcare organisations need to find more efficient ways of working. This puts healthcare managers at the forefront of efforts to improve healthcare services and to find new ways to do more with shrinking resources. The need for well-trained managers is at its most critical level, especially in Third World countries like South Africa. This study set out to establish whether training needs existed amongst Medical Managers in public hospitals in the Province of KwaZulu-Natal, South Africa. Should training needs be found to exist, the aim was to establish where those needs may be. The study then identified what Medical Managers perceived as the preferred training methods for delivering the necessary training. The study had a sample size of 30 respondents out of the 54 potential respondents. This represents a response rate of 55.5 percent. The research method that was chosen for the study combined both the quantitative and qualitative methods through a questionnaire that listed 37 tasks. Each Medical Manager had to rate these tasks on their relevance, their own perceived performance of the task, the likelihood of receiving any required training through a formal training method like courses for each task and finally the likelihood of receiving training through on the job training for each task. The quest ionnaire also included an openended question that asked respondents to list up to ten additional training needs which had not been covered by the questionnaire. The study found that all the tasks which were audited were relevant, that the perceived level of overall performance was high and there was an almost equal preference for both formal and informal training method. Based on this study‟s findings, training initiatives targeting this group of managers should ideally combine both formal and informal training methods. A recommendation for further research with a more qualitative approach is being made to better understand the context within which the training needs exist. The minimisation of subjectivity of ratings through the involvement of Medical Manager Supervisors might also reveal a more objective overall outcome to the analysis of the problem. / Thesis (MBA)-University of KwaZulu-Natal, Durban, 2012.

In KwaZulu-Natal, South Africa, many of those who search for solace from mental illness draw on one or more of the three vigorous therapeutic traditions of healing to which the region is heir. Western psychiatry and its formal institutions have a long history in this region: in 1868, the Colony of Natal passed southern Africa's first 'lunacy legislation'; and in 1880, the Natal Government Asylum was opened on the Town Hill, Pietermaritzburg. Although founded on the precepts of nineteenth century liberalism, by 1910, the Pietermaritzburg Mental Hospital (as it was now known) increasingly reflected a national concern with a racialised 'mental science' and Natal psychiatry became somewhat marginalized within a broader network of national asylum administration. During World War 1, too, the white citizens of Pietermaritzburg sought to have future expansion of the asylum halted, and its inmates hidden from public view. Although the story of Western psychiatry in Natal and Zululand is important for any history of mental illness in South Africa, in the nineteenth and early twentieth centuries, colonial psychiatry had relatively limited significance for the majority of people. Since the nineteenth century, African understandings of and treatments for illness have proved especially resilient, interacting with and at times adopting - and adapting - elements of Western biomedicine, as well aspects of healing strategies whose origins lie in Indian concepts of health and medicine first brought with indentured workers from the 1860s. For whites, as well as for Africans and Indians, committal to the asylum came, most typically, at the end of a lengthy quest to find a cure for mental illness. Throughout the nineteenth and early twentieth centuries, other sectors of healing proved to be remarkably flexible, offering new explanations for apparently new forms of illness - including insanity - that accompanied the political, economic and social upheavals of the time, as well as producing new therapies, strategies, and specialists to meet them. It is this variety of responses to mental illness, and ways of attempting to negotiate a path to a state of mind that might be termed 'mental health', that this dissertation traces. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

The aim of the study was to explore the practice of caring in human resource management of nurses. Both the qualitative and quantitative research approaches were used to ensure that the richness and the complexities of caring is reflected in the study. A qualitative analysis of the interviews vvth nurse managers and nurses indicated that they saw caring as an important part of their task. They saw caring in human resource management of nurses mainly as dealing with the interpersonal aspects- personal problem-solving-, development and growth-, welfare needs-, and HIV/AIDS issues related to nurses. A quantitative survey of nurses from different levels was done to explore the presence and enactment of caring in the formulating strategies, structuring the work, workforce planning, staffing process and in the utilising and maintaining of nurses. It was found, according to respondents that caring was not present to satisfactory levels in the human resource management process of nurses, although caring concepts, as well as Christian principles, were present and clearly described in the mission, philosophies and goals and objectives of the hospitals. The fact that nurse managers are not solely responsible for the experiences of nurses and the way nurses expressed themselves on the caring issues in human resource management in the study should be emphasised. Organisational factors such as salaries and benefits of nurses, shortage of nurses at national and international levels, organisational structures and other financial ccnstrains in hospitals, contribute to the experiences of nurses in this study. Health service administrators, nurse managers and nurses should all take the responsibility to find means to improve and instil caring in hospitals. Therefore the decision to train nurse managers and to upgrade the management knowledge and the implementation of caring concepts in nursing management with relevant care and support to HIV/AIDS nurses, is of the utmost importance to equip nurse managers to survive in these demanding circumstances in the hospitals. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

Primary health care (PHC) is the first component of the health system that provides patients with first-level care. PHC must be supported by a strong referral system whereby PHC nurses can refer patients with conditions beyond their capabilities to medical officers for further management using referral letters. The medical officers also using referral letters refer stable patients back to the PHC clinics for follow up and management. The aim of study was to determine factors related to patients bypassing primary health care facilities and accessing the district hospital as point of first contact in the Umuziwabantu health sub-district of KwaZulu-Natal. This research investigates the referral patterns of patients as well as the factors affecting the referral patterns of patients between PHC facilities and the district hospital. The study was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient department. The following groups were excluded from the study: any patients who arrived at the clinic with a referral letter from another facility, any children who were brought there by another child, and any who were unwilling to take part in the study. The researcher made use of open-ended and structured questions to interview 720 patients over a period of six months. The overall findings show that a large part of the Umuziwabantu sub-district is still served by mobile clinics. Since mobile clinics do not visit each point daily, patients from mobile points often go to the hospital for any health-related problems. There is the widespread perception that a hospital provides better service than a PHC clinic. The Local Government (LG) clinic only sees a limited number of patients. The main reasons given by patients for bypassing their local PHC clinics are: 1. Mobile clinic unavailability on that day; 2. The hospital is closer. 3. Patients are used to coming to the hospital. 4. Patients are doing things in town and then decide to combine this visit with hospital visit. Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients surveyed should have been seen at the Hospital. Conclusions from the study were that patients would use their local PHC clinics if there were enough fixed clinics and the LG clinic had more staff to attend to more patients than the number they are currently attending. The clinic-upgrading programme needs to be improved and fast-tracked. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Introduction Health-care service in South Africa, especially in the public sector, is fraught with numerous problems, including ineffective operations management in health care facilities. This contributes to poor service delivery and a lackluster work environment. Non-value-adding activities result in, inter alia, long cycle and waiting times, and low staff morale. With Lean thinking, health care managers could tackle specific issues to improve operational efficiency. Aim The purpose of the study was to apply Lean thinking, and to determine its effect on efficiency and staff morale within the outpatient department at Catherine Booth Hospital, in order to inform recommendations to improve operational efficiency in rural district hospital outpatient departments. Methods An operational action-research study design was used. The study sample consisted of all service nodes and employees of the outpatient department in Catherine Booth Hospital. Cycle and waiting times were iteratively measured for all service nodes. Statistical analyses on pre- and post-intervention results were carried out. Results Cycle and waiting time targets were met and exceeded in three service nodes, but only the Investigations node showed statistically significant results (cycle time reduced from 16.7 to 12.2 minutes; p=0.04; and waiting time reduced from 11.93 to 10 minutes; p=0.03). The waiting time for Consulting Rooms improved significantly (80.95 to 74.43 minutes; p<0.0001). Significant decreasing trends in waiting times over the study period were found in Patient Administration (p=0.04), Patient Screening (p<0.0001) and Consulting Rooms (p<0.0001). The trend in average operational efficiency improved over time from 16.35% to 20.13%. The implementation of Lean had a positive impact on the proportion of OPD staff satisfied with their jobs (increased from 21.1% to 77.8%; p<0.0001) and proportion of staff that felt motivated (increased from 15.8% to 77.8%; p<0.0001). Discussion Rural public sector hospitals require a novel and evidence-based approach to improving operational efficiency and staff morale in OPDs and other departments. Lean implementation had a positive impact on cycle and waiting times in all service nodes. Attitude towards teamwork and communication strength are positively impacted by the process of Lean implementation. However, factors such as differing priorities and logic among staff in the OPD and management negatively affect the outcomes of Lean implementation. Conclusion and recommendations The application of Lean principles, tools and techniques is possible in a rural district hospital OPD, without any demands on staff in terms of learning and adopting a new quality-improvement management approach by which to improve operational efficiency. The lessons learnt from the implementation of Lean thinking at a rural hospital used in this study may be emulated for quality improvement across similar hospitals and its sustainability can be assessed further. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

The Natal/KwaZulu Health Services Liaison Committee (HSLC) has been established to co-ordinate health care delivery in Natal and KwaZulu. This body has defined eight geographical Health Planning SubRegions (HPSRs) (Annexure E) of which each is a unit for planning and prioritising health service delivery in respect of its resident population. The HSLC considered that a study of inpatient catchment populations of hospitals under the control of the statutory Health Authorities would provide information which was essential to the planning processes of those authorities. The Department of Community Health was requested by the HSLC to undertake this study. A previous study, co-ordinated by the Department of Community Health (September 1987), dealt with "Outpatient Catchment Populations of Hospitals and Clinics in Natal and KwaZulu" (E DADA). No previous similar study on inpatients has been undertaken in South Africa. The expansion and improvement of basic services - particularly health care, water supply and basic education - should be perceived as essential elements in a strategy designed to enable all residents of a region to meet basic human needs and enjoy a minimum standard of living. Thus increased efforts have to be made to utilise health care resources effectively and efficiently and to plan future facilities carefully with regard to accessibility and appropriateness . This will require careful and objective management by all Authorities responsible for delivering health care to the people of Natal and KwaZulu. Accurately predicting the utilisation of hospital inpatient facilities is critical to efficient resource allocation in Health Services management. Catchment population studies and cross boundary flow characteristics provide valuable information on the utilisation of available facilities. This information is of value in the development of existing health services and the planning of additional health facilities with regard to size, situation and service type. Studies in other areas on utilisation of health service facilities, suggest that distance strongly influences hospital choice in both rural and metropolitan areas (Inquiry 1984 21(1) : 84-95) and this could explain some of the findings of this study with regard to cross boundary flow between Magisterial districts and HPSRs. For the efficient planning of resources, particularly with regard to situation and size, knowledge of the population size and demographic composition are important, as is a knowledge of the profile of disease in a community. The objectives of this study are directed to making available this information to each of the health authorities responsible for health care delivery and thus, to facilitate the management process. / Thesis (M.Med.)-University of Natal, Durban, 1988.

No abstract available. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Introduction Tuberculosis (TB) is a major cause of death worldwide. Control of Tuberculosis is a serious challenge to global health. A new and potentially devastating threat to TB control is the emergence of multi-drug resistant TB (MDR-TB). South Africa was ranked fourth among the countries with the highest number of confirmed MDR-TB cases. Aim The aim was to investigate the annual MDR-TB prevalence and associated risk factors for MDR-TB from 2001 to 2007 at the Prince Cyril Zulu Communicable Disease Centre. To investigate previous TB treatment duration, previous TB treatment outcome, and duration of previous TB treatment interruption in a subgroup of patients who were previously treated for TB. To determine the average length of time from diagnosis of TB to diagnosis of MDR-TB and commencement of MDR-TB treatment. Methods An observational analytic nested case-control study design was used. All patients who were diagnosed with pulmonary TB and who had a sputum culture performed between 2001 and 2007 were included in the study. The cases were all MDR-TB cases diagnosed on sputum culture between 2001 and 2007. The controls were drug susceptible TB cases which had a sputum culture done at diagnosis, and were diagnosed in the same month as the MDR-TB case Results There were 10 205 sputum cultures performed from 2001 to 2007. MDR-TB was found in 445 patients. An increase in the prevalence of MDR-TB occurred in 2007, due to a significant increase in prevalence among new TB cases. The MDR-TB prevalence was 11.7% among new TB cases and 4.7% among previously treated TB cases in 2007. There was no significant association between demographic characteristics and MDR-TB. Previous TB treatment failure and a duration of previous TB treatment of greater than 32 weeks was found to be significantly associated with MDR-TB. The median time from TB diagnosis to MDR-TB diagnosis was 98 day and from MDR-TB diagnosis to MDR-TB treatment 10 days. Discussion Delays in the diagnosis of MDR-TB, long waiting times before MDR-TB treatment commencement and lack of isolation have contributed to the spread of primary MDR-TB and was most likely responsible for the increase in prevalence of MDR-TB among new TB cases. Recommendations It was suggested that a sputum specimen should be obtained for culture and sensitivity from all new TB patients in areas which have an MDR-TB prevalence of greater than 3% among new TB patients. Ensure patient education on basic infection control measures. Improve MDR-TB diagnosis and reduce waiting times for MDR-TB treatment. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Globally HIV and AIDS are considered to be a major health and developmental challenge facing humanity. The HIV infection of children is not only an area of great concern for families but for the future of humankind. Caring and nurturing of children generally is considered as a challenging responsibility. Caregivers of HIV infected children are faced with the added responsibility of ensuring that these children have access to life saving health care at all times. Caregivers who are responsible for the health and well being of HIV infected children face constant challenges in their care giving role and this has implications for the quality of care of the child. The needs of HIV infected children are complex and vital to their basic needs is the administration of antiretroviral therapy (ART). This study aimed to explore, describe and interpret the experiences of caregivers, caring for HIV infected children and accessing services from a public hospital in Durban. Using the ecosystems theory, this qualitative study explored the experiences of thirty caregivers caring for HIV infected children. The data was collected using semi structured interviews with the caregivers. Four main themes emerged from the data analysis; namely: The caregivers’ intrapersonal experiences, their perspectives on HIV and ART, their access to health and social services and their coping strategies. This study concludes that caregivers of HIV infected children within the public hospital setting, experience numerous psycho-social and economic challenges on a daily basis. Subsequently, these challenges impacted on the quality of care to the HIV infected child. It was evident that respondents dealt with challenges differently, as the older respondents were more equipped emotionally and psychologically than the younger respondents. Generally, all respondents were negatively affected by poor psychological and socio-economic circumstances that prevented them from ensuring the wellbeing of the child. The challenges that they faced on the micro level (economic and psycho-social experiences), the mezzo (stigma, community and family support) and exo levels (health and welfare services) together with the macro level (DOH strategic plans and childcare legislations) determined how they provided for the care of the HIV infected child. Despite these challenges respondents’ resilience and commitment to providing for the health and wellbeing of the HIV infected child was consistent and remained a priority. Multi-level intervention programmes are required to help caregivers cope with their challenges. As such social work practitioners need to take cognizance of the psycho-social, emotional and material support required by caregivers of HIV infected children. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.