This dissertation examines the intersecting changes of African decolonization and the post-World War II internationalization of public health by showing how Cameroonian and French health officials shaped global health programs on the ground in the 1950s and 60s. I approach this topic through the lens of two tightly interwoven developments in Cameroon: the history of colonial mobile health teams created by French military doctors and the advent of postwar global disease eradication campaigns. While colonial medicine and international health are typically treated as distinct historical subjects, I argue that global disease eradication programs in this period in Cameroon relied entirely on colonial mobile health teams and their reformulation after independence as a basis of infrastructure, personnel and knowledge. I specifically assert that Cameroonian and French health officials positioned mobile health teams as cornerstones of national health policy and regional health coordination in Central Africa and, in turn, as the basis for operations of attempted global disease eradication programs within Cameroon. As Cameroonian, French and international health officials negotiated the work of the mobile health teams through decolonization and the first decade of the independence, they were moreover charting new structures of authority and control over medicine and public health between the global and the local, and forging an international politics of public health rooted in the particular tensions of decolonization in the country. My project thus demonstrates how Africans charted new models for public health through decolonization, models that reflected both the deeply enduring impact of empire and a new post-colonial politics.

Thesis (MPA.) -- University of Limpopo, 2018 / The study was about the knowledge and attitudes of offenders towards the performance of medical male circumcision in prisons. The aim of the study was to determine and asses the knowledge and attitudes of offenders towards the performance of medical male circumcision in prisons. A quantitative study was conducted by using researcher-administered questionnaires at Leeuwkop Management area, maximum centre. A simple random sampling of two hundred and twenty-three male respondents was selected from all races and only two hundred and three managed to complete the questionnaires correctly. Data was analysed using Statistical package for the social sciences software program. Data was presented using descriptive and inferential statistics. More than half of the respondents were medically circumcised and less than half of the medically circumcised respondents had performed it in prisons. Most respondents were between the ages of 25-35 years and majority of them have shown fair knowledge and negative attitude towards the performance of medical male circumcision in prisons. It was recommended that thorough health education on the benefits of medical male circumcision should be stressed to offenders. For medical male circumcision programme to succeed, offenders should have adequate knowledge on male circumcision and its benefits.

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As healthcare and health systems become increasingly complex, expectations of what constitutes high quality care continue to evolve. Stakeholders now require contemporary and meaningful measures of system performance. As such, valid healthcare quality metrics are rapidly becoming essential for those providing and receiving healthcare to assess performance and motivate change. This thesis investigates the utility of quality indicators in trauma care. Multiple in-hospital indicators have been promulgated by various bodies for assessing quality of trauma care. The properties of ideal indicators have been widely documented however few published data have reported these properties for many trauma measures. The emphasis on trauma process measures (eg. time to interventions) highlights the need for indicators with known links to patient outcomes. This process-outcome link may be viewed as a measure of an indicator’s construct validity. As this property is unknown for many trauma indicators, this thesis focuses on the construct validity of a number of routinely utilised trauma indicators. In this thesis, the available in-hospital indicators proposed by The American College of Surgeons Committee on Trauma and additional indicators used in the Victorian State Trauma System were investigated for their relationships with patient outcomes. A small number of indicators were found to have statistically significant relationships with patient outcomes, however many indicators demonstrated counter-intuitive relationships, whereby high quality care was linked with poorer patient outcomes. These results suggested that links between indicators and outcomes may not be best measured using individual indicators for individual patients. Rather, a strategy for measuring patient outcomes at the hospital level may be needed. To combine multiple indicators into a single measure of hospital level performance, a number of composite methods were explored using two trauma registries. Three composite weighting schemes were employed. As composite measures are often used for provider ranking or benchmarking, the stability of hospital ranks between providers and over time was investigated. The composites were found to have moderate to strong correlations (0.76-0.99) however variability in composite hospital rankings existed, particularly for middle ranking facilities. The construct validity of each available indicator and composite score was investigated through the relationship with hospital level risk-adjusted mortality using Poisson regression models, risk adjusting for expected deaths using the TRISS formulation. Each composite measure demonstrated a significant association with mortality, with the mortality decrease across the middle 50% of each composite score ranging from 12.06% – 16.13%. These findings suggest that complex measures such as trauma composite indices may be better able to measure the interactions between processes within complex systems that influence quality of care. This thesis adds valuable insight into the use of indicators for assessing quality of care in trauma systems. The combination of individual indicators into composite forms appears to strengthen the construct validity of these measures. By demonstrating the process-outcome link for trauma composite indices, this thesis has identified a means of utilising process measures to assess hospital level performance that may become important for future public reporting and hospital funding schemes.

Changes in demographic patterns and the burden of chronic illness have challenged palliative care clinicians to engage populations other than those with malignant disease. This new paradigm has promoted the development of a population based approach to service delivery which aims to extend the reach of palliative care to hard to reach populations, including older people in residential aged care. In Australia, the high levels of disability and death experienced by older people in this care setting has resulted in policy promoting the delivery of a palliative approach to care. Achieving health care reform in this complex health care environment has traditionally been difficult to realise due to a range of workforce, training, funding, variable organizational philosophies and legal factors. The “Residential - Palliative Approach Competency” (R-PAC) Project aimed to collaboratively develop, implement and evaluate a sustainable model of care to facilitate the delivery of a palliative approach to care for older people admitted to residential aged care facilities, in regional Australian. Action research, with a focus on improving care and involving participants, was used to promote the delivery of a palliative approach in residential aged care facilities. The R-PAC Project was designed to follow the action research sequence of reflection, assessment, planning, action and observation. Nested within the action research method are eight distinct but interrelated studies in a mixed method design. Study A, a focused needs assessment undertaken as part of the preliminary investigations, confirms that older people in aged care have unmet palliative care needs. The three studies conducted during Phase One provide a greater understanding of delivering palliative care in the residential aged care setting. Study B, a chart audit identified the strengths and gaps in end-of-life care provision in the local aged care setting. While, Study C identified that aged care nurses and care assistants are committed and compassionate about delivering palliative care but desired greater palliative care competencies. The palliative care attitudes, values and learning needs of aged care providers were explored in greater depth in Study D. The data from these investigations guided the development and implementation of a multifaceted intervention during Phase Two. Following the implementation of the multi-faceted intervention and during Phase Three another series of investigations was undertaken to measure the impact of the collaborative intervention. Focus groups were used to determine the perceptions of aged care providers toward the multi-faceted intervention (Study E) and to seek the views of general practitioners (Study F). These data revealed that aged care nurses and general practitioners wanted to establish a more collaborative approach to care planning and delivery. The survey (Study G) and chart audits (Study H) were repeated in Phase Four in order to measure the impact of the action. The findings of the survey of aged care nurses and care assistants shown an increase in palliative care competencies, while the chart audit demonstrated positive trends in improving end-of-life care. Although, some aspects of care, particularly advance care planning and routine use of pain assessment tools required ongoing attention. This data propel the R-PAC Project into Phase Five and the development of a model of care to promote the delivery of a palliative approach, which was informed by the research findings. The R-PAC Project use of the action research method has facilitated a cascade of engagement and participation of all residential aged care facilities in this regional community and enabled practice innovation. The project has seen the sharing of valuable insights into usual practice and collaboratively engaging aged care nurses, care assistants and general practitioners in developing practical solutions to end-of-life care. This process has allowed for the acknowledgement and validation of the role of aged care providers, fostered personal empowerment and identified the importance of collaboration. This research has provided greater insight into the palliative care needs of people in residential aged care and collaboratively developed an intervention to improve the outcomes of older people. Study findings have also identified important issues requiring ongoing evaluation, particularly multidisciplinary team meetings and care planning. / Doctor of philosophy (PhD)

The fundamental aim of any regulatory system for professional services should be the provision of quality professional services that serve the public interest. The public interest element is paramount to determine what services are regulated and how those services are regulated. This thesis suggests that the current regulatory structure is dominated by the public interest as defined by orthodox medicine (OM). This has skewed the regulatory structure against consumer choices that favour greater reliance upon complementary and alternative medicine (CAM). A postmodernist perspective suggests the need to revisit the current regulatory structure to embrace perspectives on health derived from individuality and personal empiricism free of the modernist outlook characteristic of OM.

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This thesis is about change, community and the health system. It is about women. It is about challenging the status quo and advocating for and with the less powerful. It is about fore grounding previously silenced voices, valuing the subjugated knowledge of people other than those who make the decisions. Many voices are woven together, including those of the author, community health workers, non-government agency workers, people who use community health services, and members of the public. This is a narrative of a group of people researching the issue of community participating in community health, concentrating on the Blue Mountains district of NSW. The inquiry centred on the premise that community participating is both desirable and achievable. The group spoke to over 100 people, and the conclusion was reached that, while community participation is promoted by the NSW Health Department, at present it is an idea that has not been thought through, is ill defined, and lacks support in practice. Debates about health and illness take place within a medical discourse, and there must be a reorientation to viewing health as a social phenomenon if community participation in decision making is to occur / Doctor of Philosophy (PhD)

This study reports the positive and negative aspects identified by registered nurses (RNs) working with older people in public hospital aged care units and was conducted in 4 public hospitals in Sydney, Australia. Qualitative data using questionnaires and telephone interviews was collected from 26 female and 4 male RNs of which 46% (n 14) had worked in an aged care unit for 10 years or more. The participants identified positive perceptions within three major themes: a genuine liking of older people; the stories older people tell and the complexity of the older patient’s illnesses. Positive responses were a focus as it was identified that this was a gap in the literature which required addressing at the time. These findings are significant and have implications for nursing practice for several reasons: Data was collected exclusively from RNs and focused on their positive perceptions about aged care nursing in public hospitals. Participants reported a genuine liking for older people. Patients’ telling their stories was reported by 60% (n 18) of participants as being interesting in their work and meaningful to the patient and should be considered more as a therapeutic process during hospitalisation to assist support and enhance patient outcomes and therapy. The participants reported that aged care nursing is complex, rewarding and requires mature nurses, with current nursing knowledge and skilled in the art of caring for older people. These findings can be used to improve recruitment and retention of RNs within aged care nursing. / Master of Health Science (M.Sc.(Hons) Health)