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This thesis explores the story of the Frontier Nursing Service (FNS), a rural health care delivery system established in Hyden, Kentucky in 1925. It is particularly concerned with examining the colonial construction of the organization created by the founder, Mary Breckinridge. This construction created a conceptual framework for the technological infrastructure of the FNS, and influenced interactions of FNS employees and the Appalachians who lived in the area served by them. A case study concerning the clinical trials of the birth control pi11, Enovid, is used to highlight in influence of colonial constructions and mentalities in convincing the trial's investigators that the FNS was a suitable place for them to be conducted. And finally, this thesis critiques two theoretical models of colonialism of by scholars in Appalachian Studies and Science and Technology Studies, and suggests new directions which might be undertaken this area. / Master of Science

Thesis (MBA)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The need for efficient and equitable health provision remains a challenge for all countries and economies of the world. Defining health, healthcare and health provision are contentious issues, and public debate rages on as governments throughout the world attempt to quell public demands and expectations. Healthcare scenarios differ vastly from country to country, each attempting to accommodate its own needs, given the limitations placed on the systems in terms of human and financial resources. These differences are large as will be seen when countries with developed market economies are compared to those in the less fortunate Third World. The financing of healthcare systems is a complex and challenging task. Affordability of healthcare is an issue for all nations of the world. Most countries enjoy a mix of private and public funding to ensure that some degree of good health is attained by the nation as a whole. South Africa has a unique health system in that it has two distinct and separate health systems. This is not by chance. South Africa is a country that boasts enormous diversity but huge inequalities in terms of race, culture, class and income. Systems had therefore developed along very defined lines where the privileged have had access to expensive, modern and private healthcare while the poor and indigent have had to use a poorly structured public service. The purpose of this literature review is to research and to define those issues and concepts which require clearer perspective. It will also look at healthcare. / AFRIKAANSE OPSOMMING: Die noodsaaklikheid vir effektiewe, billike en regverdige gesondheidsvoorsiening bly 'n uitdaging vir alle ekonomieë van die wêreld. Om gesondheid, gesondheidsorg- en gesondheidsvoorsiening te definieër, is 'n kontensieuse aangeleentheid en die openbare debat duur voort, soos regerings in die wêreld poog om te voldoen aan oorweldigende openbare eise en verwagtinge in hierdie verband. Gesondheidsorg-opsies verskil drasties van land tot land, wat elk poog om sy eie behoeftes te akkommodeer, gegewe die beperkings wat die sisteem belas in terme van menslike en finansiële hulpbronne. Hierdie verskille is beduidend, soos wat gesien kan word wanneer lande met ontwikkelde mark-ekonomieë vergelyk word met die lande in die minder bevoorregte derde-wêreld. Die finansiering van gesondheidsorg-sisteme is 'n komplekse en uitdagende taak. Die bekostigbaarheid van gesondheidsorg is 'n aangeleentheid wat al die lande van die wêreld raak. Die meeste lande van die wêreld het 'n gemengde gesondheidsorg-sisteem wat bestaan uit gedeeltelik privaat en gedeeltelik openbare fondse, sodat toegesien word dat 'n mate van goeie gesondheid bereik word deur die land as geheel. Suid-Afrika het 'n unieke gesondheidsorg-sisteem deurdat twee besondere en aparte gesondheidsisteme bestaan, wat beslis nie toevallig is nie. Suid-Afrika is 'n land wat spog met enorme verskeidenheid, maar beduidende ongelykhede in terme van ras, kultuur, klas en inkomste. Gesondheidsorg-sisteme het dus ontwikkel langs baie beslisde lyne waar die bevoorregtes toegang gehad het tot duur, moderne en privaat vesekerings-gebaseerde gesondheidsorg, terwyl die arm en armlastiges gebruik moes maak van 'n swakker gestruktureerde openbare diens. Die doel van hierde nagevorsde oorsig is om navorsing te doen om sisteme uit 'n globale perspektief te identifiseer en daardie beginsels toe te pas, wat voordelig kan wees in 'n plaaslike konteks. Daar word aanvaar dat die Suid-Afrikaanse gesondheidsorg-sisteem baie het om te leer van ervarings in beide die ontwikkelde en ontwikkelende lande. 'n Besondere begrip hiervoor, is die basis waarop 'n suksesvolle gesondheidsorg-sisteem in hierdie land gevestig kan word. Daar word gehoop dat deur die besondere perspektief te hê, sekere werkbare oplossings gevind en bereik kan word.

published_or_final_version / Business Administration / Master / Master of Business Administration

published_or_final_version / Asian Studies / Master / Master of Arts