M.Com. (Economics) / Access to health care is a basic human right in South Africa. Primary health care is viewed by the South African government as the means to improving access to health care in the country. The concept of primary health care is based on the importance of first contact with a primary health worker. The Department of Health introduced free primary health care because it believes that the most significant barrier to access to health care is poverty. When a service is provided for free there is no income generated from user fees and the issue of funding becomes very important. This study performs an analysis of the free primary health care programme in South Africa and how it is financed. An important feature that characterizes South Africa is high inequality which is reflected in the high level ofpreventable diseases as well as high incidents of chronic diseases. The implementation of free primary health care has led to improved access to health care and somewhat improved the health status of the South African population. In order to address the inequalities in the health sector there must be funding targeted towards the needs of the poor. Government's fiscal policy places limits on the expansion of public expenditure, which poses a strain on resources flowing to the health sector. In addition to that there has not been a significant shift of funds from higher levels of care to primary health care. The funding issue will need to be urgently resolved for primary health care to be sustainable...

The problem this study addresses is the need for nurses to adhere to guidelines on pressure ulcer prevention and treatment, so patients best possible health outcomes. This study created and utilized a new tool to assess nurses’ training, attitudes, knowledge, and skill/ability for adhering to practice guidelines of the National Pressure Ulcer Advisory Panel. The study sought to identity significant predictors of Personal Knowledge Rating Scale (TPKRS-101) and Personal Skill/Ability Rating Scale (TPS/ARS-101). The online study’s convenience sample of nurses (n=190) was 80.5% (n=153) female, 59.5% (n=113) Black, and 18.4% (n=35) Asian—with mean age of 40.27 years (min 23, max 73, SD=10.95). Some 53.2% (n=101) were not born in the US, while 16.8% (n=32) were from Ghana, 7.9% (n=15) from Jamaica, and 7.4% (n=14) from Philippines. Annual household income mean was $50,000 to $99,999 (mean=4.43, category 4, min=2, max=10, SD=1.00). Mean years working in nursing was 8-10 years (mean=4.34, category 4, min=1, max=9, SD=2.14). Nurses rated themselves “good” for performing pressure ulcer care tasks, as follows: (a) Nursing Training Rating Scale (TNRS-101) with global mean of 4.11 (SD=0.60, min= 1.94, max=5.00), or good; (b) Personal Knowledge Rating Scale (TPKRS-101) with global mean of 4.15 (SD=0.57, min=2.79, max=5.00), or good; and, (c) Personal Skill/Ability Rating Scale (TPS/ARS-101) with global mean of 4.13 (SD=0.62, min=2.56, max=5.00), or good. Higher Personal Knowledge Rating Scale (TPKRS-101) scores were significantly predicted by: more positive Attitudes Regarding Practice Guidelines-Relevance Scale (ARPG-R-5) (b = .067, SEB = .029, p = .022); and, higher level of Social Desirability (13 items) (b = .030, SEB = .013, p =.023). For this regression model, R2=.063, and AdjR2=.053, meaning that 5.3% of the variance was explained by model. Personal Skill/Ability Rating Scale (TPS/ARS-101) scores were significantly predicted by: higher level of Social Desirability (13 items) (b = .051, SEB = .014, p = .000). For this regression model, R2=.064, and AdjR2=.059, meaning that 5.9% of the variance was explained by model. Finally, the quantitative data were augmented by qualitative findings for barriers nurses experience to pressure ulcer prevention and treatment, as follows: Category I-External Barriers; and, Category II-Internal Barriers.

M.Sc., Faculty of Science, University of the Witwatersrand, 2011 / Health care funders are seeking managed health care interventions to contain medical inflation. The purpose of this study is to assess the relationship between three health risk factors (smoking status, physical activity and body mass index (BMI)) and inpatient costs among health risk assessment (HRA) respondents at a South African health insurer. The results could inform the design of wellness programmes by ensuring that appropriate health risk factors are being targeted to reduce inpatient costs. This study utilises a two-part regression model to explore the relationships between the health risk factors and inpatient costs. The combined results of the two-part regression model indicate that increasing levels of physical activity and decreasing levels of BMI are associated with lower likelihoods of hospitalisation and lower magnitudes of inpatient costs for those that had a non-zero claim. The results of this study indicate no association between smoking cessation and lower inpatient costs.

Thesis advisor: Alicia Munnell / Since 1975, Social Security retirement benefits have been tied to the Consumer Price Index to adjust for inflation. The CPI measures price changes for a market basket of goods and services designed to replicate the average consumer's expenditures. The elderly, however, consume a market basket different from that of the typical person. In particular, the elderly tend to purchase more medical services than other consumers. Because the price of medical care increases more rapidly than other prices, the inflation rate experienced by the elderly is greater than the inflation rate for the general population, even when controlling for the upward quality bias in the medical care component of pricing data. However, given that this difference in inflation rates is less than the size of the total measurement error in the CPI, recipients of Social Security retirement benefits are actually overcompensated for increases in inflation. Over the course of a beneficiary's retirement, this overcompensation results in a total benefit that is 5.4 – 6.6% greater than what the total benefit would have been under an ideal inflation indexing scheme. / Thesis (BA) — Boston College, 2005. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Economics Honors Program.

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

A research report submitted to the Faculty of Law, Commerce and Management, University of the Witwatersrand, in 50% fulfilment of the requirements for the degree of Master of Management (in the field of Security). June, 2016 / This study explores civilians’ perceptions on the impartiality of the international humanitarian organization (IHO) Médecins sans Frontières (MSF). This is done through engaging participants from countries where MSF operates and has experienced different challenges in delivering humanitarian aid to civilians. The countries include the Democratic Republic of Congo, Ethiopia and Somalia. A basic interpretive approach was used to explore and interpret participants’ perceptions. Interviews were conducted with groups of participants based on their respective countries of origin. The interview questions and guide were developed using indicators of impartiality which the researcher formulated based on varying literature and definition of impartiality, independence and neutrality as the core humanitarian principles that guide the work of MSF together with many other IHOs. Participants expressed their perceptions on the impartiality of MSF through reflecting on associations they made between the IHO and parties they considered to have vested interests in humanitarian crises. These parties included Western countries, the military and persons perceived to have discriminatory and colonial intentions. Upon analysis of these perceptions, it becomes clear that MSF, as an IHO that holds itself to operate according to the humanitarian principles of independence, neutrality and impartiality, needs to reflect on how it builds its identity in order to mitigate perceptions that may have potential to hinder its ability to access and assist civilians affected by humanitarian crises. / MT2016

The research aim is to contribute to scholarly inquiry on best practices for institutional leaders in health care organizations who are leading improvement work. The goal is to investigate how a specific sustainable continuous improvement methodology—lean management (LM)—is experienced by leaders charged with implementing it to improve health care locally. Adult development can be understood as stage-based theory of growth across the human life-span and has been successfully applied to enhance understanding of how adults approach uncertainty and complexity, yet it has not been applied to understand how institutional leaders go about understanding, implementing, and leading improvement work via LM. The primary research focus is how improvement leaders in an academic health care organization describe the implementation experience of LM and how, if at all, LM varies as a function of improvement leaders’ stage of development, as represented by their assessed action-logic. This study represents the first step in an exploratory agenda to integrate adult developmental theory with LM application in health care by first understanding how LM’s application in hospital settings may vary with individual project leaders’ stages of development and how their descriptions of LM implementations during key implementation points within an advanced and internally offered Black Belt training program may match the intent of LM as a systemic, principle-based approach to health care change within an organization implementing it as organization-wide strategy for improvement.

Acute medical patients constitute the single largest group of patients in hospitals. The processes by which they are cared for in the United Kingdom (UK) have changed over the past few decades and now the majority of acute medical care is delivered within acute medical units (AMUs). The AMU model is also increasingly being adopted outside of the UK, including in Ireland, Australasia and Europe. AMUs emerged as a result of local service innovations and there is evidence to suggest that care within AMUs varies across settings. Although there are published recommendations for care delivery, empirical evidence is lacking. In this thesis I aim to examine the concept of the AMU model with regard to the literature; its definition; its components; and how these components are delivered across Scottish sites. This is with the aim of informing service provision and contributing to the development of an evidence base relating to AMUs. Firstly, I undertook a systematic review of the evidence relating to the effectiveness of and variation in the AMU model. I found limited, observational and possibly confounded evidence that the AMU model was associated with reductions in hospital length of stay and mortality compared to other models of care in European and Australasian settings. I also found variation in the admission criteria, entry sources, functions and staff work patterns across the 12 AMUs described in the literature. Given this finding that AMUs do not operate in a uniform way, I undertook a second systematic review to assess the published evidence evaluating different methods of delivery of care within AMUs. I identified nine studies of ten interventions. From this I concluded that there was little discerning evidence pertaining to how best to deliver care in AMUs. This led me to undertake a qualitative descriptive study of all the AMUs in Scotland with the aim of further delineating the AMU model. During a visit to each AMU, I collected data through semi-structured interviews with healthcare professionals working in the units. This totalled 171 interviews of 275 participants across 29 sites. I used this data to provide a report detailing how care was delivered in each AMU. I then thematically analysed these reports using framework analysis. There were three principal findings from this qualitative study. Firstly, I found that acute medical care was delivered in acute medical services rather than single AMUs. Secondly, I identified a framework of 12 key components of AMU care that were integral to the functioning of the AMU irrespective of the setting. Examples include nurse staffing and the physical areas contained within the AMU. Lastly, I described how these components were delivered across Scottish AMUs and, where possible, identified distinct models of care delivery. For example, I identified 13 models of AMU functions and seven models of consultant work patterns. In summary, I found that care in Scottish AMUs is delivered variably. The reasons for the variation are unclear. The findings of this thesis are the first in-depth study into AMUs. They provide a useful foundation for discussions and onward planning of resources, capacity and standards of care at both a national and local level. These findings are also an impetus for further research to delineate how best to deliver care in AMUs, and form an essential precursor to such work.

Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1979. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING. / Includes bibliographical references. / by Peter A. Bonee, Jr. / B.S.

Thesis. 1979. M.Arch.--Massachusetts Institute of Technology. Dept. of Architecture. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. / by William L. Kasdon. / M.Arch.