Text in Afrikaans / Verpleegktmdiges het 'n etiese en professionele verantwoordelikheid om elke bej aarde se reg op selfbeskikking te erken, bulle in die uitvoering daarvan te ondersteun en op volgehoue basis te ontwikkel met die oog op die bereiking van die hoogste moontlike vlak van onafhanklikheid in die daaglikse lewe. Die doel van hierdie studie was om die mate te bepaal waarin professionele verpleegkundiges werksaam in geregistreerde, gesubsidieerde tehuise vrr bejaardes in die Pretoria-omgewing hierdie verantwoordelikl1eid uitleef Ontleding van die data, wat deur 'n vraelys ingewin is, dui daarop dat verpleegktmdiges sonder twyfel die bejaarde se reg op selfaktualisering erken. V erpleegkundiges ervaar egter onsekerheid oor die praktiese wyse van selfsorgondersteuning sowel as die wenslik11eid van gesondheidsbevordering by die gelnstitusionaliseerde bejaarde. Ten einde die sinvoll1eid van die gelnstitusionaliseerde bejaarde se bestaan te verseker, sentreer die belangrikste aanbevelings in hierdie studie rondom die voorsiening van opleidingsprogramme aan gerontologiese verpleegktmdiges asook gesondheidsvoorligting aan die bejaarde self / Nurses have an ethical and a professional responsibility to acknowledge the elderly's right to self-determination, to support them in this regard and to ensure ongoing development so that they may attain the highest possible level of independence in their daily life. The purpose of tllis study was to determine to what extent nurses working in registered, subsidized homes for the aged in the Pretoria area live up to tllis responsibility. Analysis of tl1e data, obtained by questimmaire, has clearly shown that nurses acknowledge the right of the elderly to self-actualization, but they feel uncertain about the practical ilnplementation of self-care support and tl1e desirability of promotil1g health amongst the il1stitutionalized aged. In order to ensure that tl1e institutionalized aged person leads a meanil1gfullife, the mail1 recommendations of tllis study centre on providil1g educational progrmes for gerontological nurses as well as health education for the elderly. / Health Studies / M.A. (Nursing)

South African nurses have accepted the challenge that was brought about by the Health Reform Policy of 1990 which opened health service centres to people of all racial and cultural groups. However, recent studies on multicultural nursing have revealed that problems have occurred when delivering care across cultural barriers. Most of these studies have approached these problems from the patients point of view, where issues of dehumanized care, labelling and discrimination have been reported. Therefore, this study was an attempt to look into these problems from the nurses point of view, by exploring the source of these problems, their effect on health care delivery and possible solutions. The researcher focussed on three critical issues, namely, lack of cultural knowledge, negative attitudes, as well as difficulty in communication. Through focus group interviews (FGI) and responses to given scenarios, student nurses who had experienced problems with culturally different patients were given a chance to reflect on their experiences, report on these experiences and recommend possible solutions to the experienced problems. The results revealed that: 1. The major source of the problems was lack of experience due to inadequate exposure to culturally diverse groups which in tum led to inappropriate decisions and actions at care delivery level. 2.Difficult perceptions and negative attitudes lead to the formation of stereotypes which block the delivery of culturally congruent care. 3 .Inability to communicate due to differences in spoken language lead to difficulty in building the trust relationship and hence inadequate care delivery. / Health Studies / M.A. (Nursing Science)

Submitted to the faculty of Health Sciences in fulfilment of the requirements for M.Tech.: Nursing, Durban University of Technology, 2011. / Background The South African health care system is guided by the primary health care approach (PHC), which is based on the principles of accessibility, availability, affordability, equity and acceptability which are the cornerstone of primary health care. The Comprehensive PHC Service Package for South Africa is the guiding document for transforming PHC in South Africa standardizing services and increasing access to PHC services. This study will focus on the “Clinic: Fast Queue/Repeats” component of the Package. This is the protocol which guides the management of chronic disease care for adults, geriatrics and paediatrics. According to the Package, this service is for patients who have been assessed previously either at a CHC or at a clinic. For repeat medicines no assessment is required except after three months, and waiting time is minimized through the use of pre-packaged drugs. Methods A cross sectional qualitative design using a descriptive method was used to explore the experiences of the clinic users of the fast queue. A two stage sampling technique was used namely cluster and purposive sampling. In the first instance cluster sampling technique was used to sample clinics in each of the three sub-districts namely south, north and west sub districts of eThekwini municipality and purposive sampling was used to select PHC facilities, those with the highest number of attendees seen over a period of three months and the users of fast queue. Results The findings of the study revealed that there were positive factors which contributed to the satisfaction of participants and negative factors which caused dissatisfaction among participants.

Thesis (MBA)--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The aim of the study was to assess the adult patients' perception of the quality of care received, following a visit to a doctor at Mthatha General Hospital Outpatients Department to establish whether it meets the patients' expectations, and to derive recommendations to improve the quality and assure that it is maintained. A cross-sectional survey was used to obtain the relevant data. A structured interview questionnaire was administered to a systemic sample of 204 adult patients attending the General Outpatients clinic at Mthatha General Hospital after a consultation with a doctor. Data was gathered and analyzed on the 204 patients' records using a Statistical package for Social sciences. This study has revealed that most patients are female (59%), aged between 16 and 70 years, with the majority in the 41 to 50 year age group. The majority of patients are unemployed (55.4%), with grade 1-8 level of education, have presence of long-standing illness or disability (54.9%), and are married (53.4%). The patients' perception of the quality of care was positive. The interpersonal aspects of care was judged by patients to be the most important, followed by technical aspects. Socio-demographic influences on perception of care were significant in those patients with long-standing illness or disability in respect of outcome aspects of care. It is recommended that patients' perception of the care provided to them be periodically assessed to ascertain if it meets their needs. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die volwasse pasient se persepsie van die kwaliteit van versorgingsdiens, soos ervaar na 'n besoek aan 'n dokter by die Mthatha Algemene Hospitaal Buitepasiente Afdeling, te bepaal om gevolglik vas te stel of aan die pasient se verwagtinge voldoen is en om aanbevelings hiervan af te lei om kwaliteit te verbeter en te verseker dat dit volgehou word. 'n Deursnee peiling is gebruik om toepaslike data te bekom. 'n Gestruktureerde onderhoud-vraelys is aan 'n sistemiese monster van 204 volwasse pasiente by die algemene buitepasiente kliniek van die Mthatha Algemene Hospitaai gedoen na 'n besoek aan 'n dokter. Data uit die 204 pasienterekords is versamel en analiseer deur middel van 'n statistiese pakket vir die sosiale wetenskappe. Resultate toon dat die meerderheid pasiente vroulik (59%) en tussen 16 en 70 jaar oud is en oorwegend in die 41 tot 50 jaar ouderdomsgroep val. Die meerderheid pasiente is werkloos (55.4%), het 'n graad 1-8 vlak-opvoeding, vertoon met 'n langtermyn siekte toestand of ongeskiktheid (54.9%) en is getroud (53.4%). Die pasiente se persepsie van die kwaliteit van versorging was positief. Interpersoonlike aspekte van versorging is deur pasiente as die belangrikste beskou, gevolg deur tegniese aspekte. Sosiodemografiese invloede op die persepsie van uitkoms-verwante aspekte van versorging was betekenisvol by pasiente met langtermyn siekte toestande of ongeskikthede. Daar word aanbeveel dat pasiente se persepsie aangaande die versorging wat hulle ontvang periodiek beoordeel word om vas te stel of aan hulle behoeftes voldoen word.

Thesis (MBA)--Stellenbosch University, 2006. / ENGLISH ABSTRACT: South Africa's healthcare industry is at a crossroad as pressure in both the public and private sectors is increasing. The extent of change in the industry is overwhelming and it is seen as a very turbulent and unstable environment. Healthcare professionals must reconsider their position in the industry and adapt in this ever-changing environment. The physiotherapy profession forms a small part of the healthcare value chain, but it fulfils an important role in the healthcare system. Unfortunately the profession shows no clear direction and purpose. There also exists a mismatch between the current healthcare environment demands and the physiotherapy service delivery. If they do not adapt in this environment which is in turmoil and have a clear strategy for the way forward, they will be pushed out of the healthcare value chain and become obsolete. The aim of this research report was then to do an in depth analysis of the private healthcare industry in which physiotherapy is operating, to analyse the external physiotherapy industry and an internal analysis of the profession so as to construct a generic strategy for the physiotherapy profession in the private healthcare sector in South Africa. To achieve this aim, it was determined that qualitative, investigative research would be conducted. The research methodology used in this research report was a combination of primary and secondary research. Firstly, secondary research in the form of a literature review was conducted to provide a comprehensive insight into the provision of health care in South Africa. Thereafter, primary research was conducted through semi-structured, in-depth interviews with a purposive sample of physiotherapy industry experts to analyse the external physiotherapy Industry as well as the internal profession environment. Main findings include that the physiotherapy industry is becoming less attractive as competitive forces in the physiotherapy and private healthcare industry are moderate to strong. Deconstruction of the healthcare value chain in the private sector is increasing intra- and inter-professional competition. Government plays a major role in the attractiveness of the industry as they are restricting competitive and market forces and minimising profits through legislation. Medical schemes are trying to contain costs and managed healthcare is coming to the forefront. The physiotherapy market is stagnating and the clients' needs and requirements are changing. Opportunities that were identified we~e the expansion into new markets, involvement in other industries and broadening the scope of practice. Threats are mainly from governmental legislation and policies, vertical integration from the hospital and medical scheme industries and the threat of substitutes, especially alternative health. From the internal profession analysis a current strategy was identified and a strategic intent was formulated as the physiotherapy profession wants to be the preferred and relevant health care service provider in prevention, management and rehabilitation of potential and actual movement impairments of individuals. Strengths to help build this vision included their high regard and profile, quality training, increase in research and evidence and their whole service package. Weaknesses that must be overcome include poor business, managerial and marketing skills, limited role models and leaders and the high levels of intra-professional competition leading to the demise of the profession. Having completed the analysis, major strategic thrusts with a focussed differentiated approach for the profession could then be formulated: • Define physiotherapy and the scope of practice. • Reinstate physiotherapy in the healthcare system. • Develop leadership. • Cooperate within the profession. • Maintain professional autonomy. • Develop business skills. / AFRIKAANSE OPSOMMING: Gesondheidsprofessies moet hul posisie in die industrie herevalueer en aanpas in hierdie steeds wisselende omgewing. Die fisioterapie professie beslaan 'n klein deeltjie van die gesondheidsorg waardeketting, maar dit vervul 'n baie belangrike rol in die gesondheidsorg stelsel. Ongelukkig blyk dit asof die professie geen rigting en doeleindes het waarna dit beweeg en streef nie. Verder bestaan daar ook 'n wanbelyning tussen die huidige gesondheidsorg omgewingvereistes en die dienste wat fisioterapie verrig. Indien die fisioterapie professie nie aanpas in hierdie onstuimige omgewing nie en 'n duidelike strategie ontwikkel vir die toekoms nie, staan dit in gevaar om te verval uit die gesondheidsorg-waardeketting en te vergaan. Die doel van hierdie navorsingswerkstuk is dan om 'n in diepte analise te doen van die privaat gesondheidsorgindustrie waarin fisiolerapeute funksioneer, om die eksterne fisioterapie-industrie sowel as die interne professie te analiseer; ten einde 'n generiese strategie vir die fisiolerapie-professie in privaat gesondheid in Suid Afrika te ontwikkel. Om hierdie doelwitte te bereik is daar besluit om kwalitatiewe navorsing te doen. Die navorsingsmetodologie wat gebruik is bestaan uit 'n kombinasie van primere en sekondere navorsing. Sekondere navorsing is gedoen in die vorm van 'n literatuuroorsig om 'n omvattende oorsig te gee van die gesondheidsorg dienslewering in Suid Afrika. Daarna is primere navorsing gedoen in die vorm van gedeeltelike gestruktureerde, in diepte onderhoude met 'n doelbewuste steekproef van fisioterapie-kundiges om die eksterne omgewing en interne professie te evalueer. Hoof bevindings uit die analise is dat die fisioterapie-industrie se aantreklikheid besig is om te verminder as gevolg van gemiddelde tot sterk kompeterende kragte. Dekonstruksie van die gesondheidsorg-waardeketting in die privaatsektor lei tot verhoogde intra- en inter-professionele kompetisie. Die regering speel ook 'n groot rol in die aantreklikheid van die industrie en hulle beperk natuurlike kompetisie en markkragte en minimaliseer winste deur middel van wetgewing. Mediese fondse probeer kostes beperk en besturende gesondheidsorg begin ontluik. Die huidige fisioterapiemark is besig om te stagneer en kliente se behoeftes en vereistes is besig om te verander. Geleenthede wat geidentifiseer is sluit in die uitbreiding na nuwe markte, betrokkenheid by ander industrie; en die verbreding van fisioterapie se bestek van praktyk. Bedreigings bestaan hoofsaaklik vanaf regeringswetgewing en regulasies, vertikale integrasie van die hospitaal en mediese fonds industriee en die bedreiging van plaasvervangers, veral alternatiewe gesondheid. Vanaf die interne professie-analise is daar 'n huidige strategie geidentifiseer en 'n strategiese intensie kon geformuleer word. Hierdie intensie is dat die fisioterapieprofessie die gewenste en relevante gesondheidsorg diensverskaffer sal wees in die voorkoming, bestuur en rehabilitasie van potensiele en werklike bewegingsaantastings van individue. Sterkpunte in die professie wat hierdie intensie kan ondersteun, sluit in hul goeie profiel en agting, kwaliteit opleiding, toename in navorsing en hul volledige dienspakket. Swakpunte wat oorkom moet word is swak besigheids-, bestuur - en bemarkingsvaardighede, beperkte rolmodelle en leiers en die intra-professionele kompetisie wat die professie as 'n geheel ondermyn. Nadat die analise gedoen is kon daar hoof strategiese rigtings geformuleer word met 'n gefokusde differensiasie benadering: • Definieer fisioterapie en bestek van praktyk. • Hervestig fisioterapie in die gesondheidsorgstelsel. • Ontwikkel leierskap. • Samewerking in die professie. • Behou professionele outonomiteit. • Ontwikkel besigheidsvaardighede.

Thesis (MPA (School of Public Management and Planning))--University of Stellenbosch, 2009. / This study examines the key success factors in the Public Private Partnerships (PPP) field in the Healthcare Sector in South Africa. It gives health departments insight into the factors which should be considered when using PPP procurement and when looking at possible PPP opportunities. The development of PPP’s around the world has urged governments to look at alternative service delivery methods because of increased pressures on government budgets. Public Private Partnerships presents governments with a means of generating private funds for health service delivery whilst government manages the relationship via a negotiated PPP agreement to monitor the quality of services rendered. Different PPP models are applied all over the world depending on the specific needs of countries. Different factors impact on the success of these partnerships and it is essential that government share knowledge and best practices. The study showed that in order for PPP’s to be successful the public institution must do its homework thoroughly and that the legal framework should be conducive for private sector involvement in service delivery. The study showed that the government of a country plays a pivotal role in the PPP process by giving the necessary political support to ensure the trust of foreign investors. The legislative framework is a critical factor in the advancement of PPP procurement and the allocation of risk as an important consideration when pursuing this type of procurement. The study examined three concluded PPP Health Sector agreements in South Africa and looked at lessons learnt, mistakes which were made and what should be avoided in the future. The three PPP’s in South Africa in this study were the first though there are other health sector PPP agreements concluded. The other PPP’s are still in the commencement stage and it is too early to make an assessment at this stage. However, the three case studies conducted give departments a clear picture of the process, the lessons learnt and the impediments in the PPP process. The uniqueness of the South African Health sector also prompted the Government to look at a model which will be best suited to the local market. Best practices from other countries provide useful information and lessons learnt from other countries are also important in a developing PPP environment.

Thesis (MBA)--Stellenbosch University, 2007. / ENGLISH ABSTRACT: This study provides an overview of the medical aid industry in South Africa and highlights the impact of the formation of the Council for Medical Schemes through the implementation of the Medical Schemes Act of 1998. The regulatory framework that governs the medical aids in South Africa is analysed. In this study. different medical aid funds are compared in terms of administration costs, required solvency levels and membership numbers relative to the acceptable industry averages. The main cost drivers of medical aid funds that could also threaten the future of private medical care are identified, as these services may not be affordable to most South Africans in the future. The new vision of government in terms of healthcare is outlined, and the regulations that will be implemented to transform the healthcare sector into a Social Health Insurance system, and ultimately into a National Health Insurance system. are analysed. The proposed mechanisms, such as the Risk Equalisation Fund, the Government Employees Medical Scheme and lowincome medical schemes, are discussed, highlighting all their advantages as well as the associated risks for the sustainability of private medical care. The proposed new legislation and the potential negative financial impact on the private medical industry are analysed with detailed reference to the Medical Schemes Act of 1998 and the Medicines and Related Substance Control and Amendment Act of 1997. The implications of fundamental changes proposed in private health insurance, such as community risk rating versus the traditional individual risk rating, are discussed. The negative impact of prescribed minimum benefits (which include HIV/Aids) on the financial sustainability of the medical aid industry is highlighted. The impact of HIV/Aids on the sustainability of the medical aid industry is discussed and some conclusions and recommendations are made regarding the financial sustainability of the medical aid industry and hence the future of private medical care in South Africa. / AFRIKAANSE OPSOMMING: Hierdie studie is 'n oorsig van die mediesefondsbedryf in Suid·Afrika, en beklemtoon die impak van die totstandkoming van die Raad van Mediese Skemas deur die impJementering van die Wet op Mediese Skemas van 1998. Hierdie regulatoriese raamwerk, wat mediese fondse in SuidAfrika tans reguleer, word in die studie ondersoek. In hierdie studie word van die grootste mediese fondse in tenne van administratiewe koste, voorgeskrewe fondsreserwes en lidmaatskapgetalle relatief tot die aanvaarde bedryfsnonne met rnekaar vergelyk. Die belangrikste koste-items vir mediese fondse wat die voortbestaan van privaat gesondheidsorg kao bedreig, word ontleed cmdat hierdie dienste in die toekoms vir die rneeste Suid-Afrikaners onbekostigbaar kan word. Die regering se nuwe visie vir gesondheidsorg word uiteengesit. asook die regulasies wat germplementeer sal word om die gesondheidsektor na 'n sosiale gesondheidsversekeringstelsel en uiteindelik na tn nasionale gesondheidstelsel te transfonneer. Die voorgestelde meganismes, seos die Risiko-egalisasiefonds, GEMS en laeinkomste-mediesefondse word bespreek, met al die relevante voor- en nadele, tesame met die geassosieerde risiko's vir die voortbestaan van privaat mediese dienste. Die voorgestelde wetgewing en die gevolglike negatiewe finansiele impak op die privaat gesondheidsbedryf, met spesifieke verwysing na die Wet op Mediese Skemas van 1998 asook die Wet op die Beheer van Medisyne en Verwante Middels van 1997, word ondersoek. Die implikasies van fundamentele veranderinge wat in terme van gesondheidsversekering voorgestel word, soos gemeenskapsrisikogradering teenoor individuelerisikogradering, word bespreek. Voorgeskrewe minimum voordele (wat MIV insluit) wat nou ingevolge wetgewing ten volle deur fondse betaal moet word, se potensiele negatiewe impak op die finansiele lewensvatbaarheid van mediese fondse word beklemtoon. Die potensiele negatiewe impak van die MIV-epidemie op die lewensvatbaarheid van die mediesefondsbedryf word bespreek en gevolg deur aanbevelings om die fmansiele lewensvatbaarheid en toekoms van die privaat gesondheidsbedryf in Suid-Afrika te verseker.

Thesis (MBA)--Stellenbosch University, 2012. / Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.

Thesis (MBA)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Childhood tuberculosis is an infectious disease that can cause serious illness and mortality in especially young children. Following contact with an infectious adult tuberculosis case, the disease is easily preventable through preventive isoniazid treatment, yet very few exposed and at-risk children currently access this healthcare service in most high-burden settings. Previous research pointed out the multifactorial and complex nature of the barriers to accessing preventive care. Specifically, the lack of a formalised recording and reporting tool, such as the universally used tuberculosis treatment registers, possibly contribute to the operational barriers of preventive care delivery to these children. The purpose of this research was to evaluate the cost-effectiveness of an isoniazid preventive treatment register tool used at community level. The study utilised previously reported data from the study population and other high-burden settings to construct a decision analysis model that included varying probabilities of isoniazid preventive treatment across three high risk age groups (<1 year of age, 1 – 2 years of age, 3 – 5 years of age), coupled with disease probabilities and associated treatment costs. The scenarios simulated included 1) the routine isoniazid preventive treatment service (3% started on treatment, 17% identified as eligible); and 2) an isoniazid preventive treatment service supported by a recording register (15% (adherent to six months of treatment) and 38% (started on IPT treatment)). In addition, two hypothetical simulations were included for 76% and 100% isoniazid preventive treatment uptake; these hypothetical simulations required additional community based healthcare worker resources in addition to the register tool. The observations from the literature indicated that more children were identified (24(17%) vs. 54(38%)) and started (4(3%, base case) vs. 54) on isoniazid preventive treatment following the implementation of the register. As expected, the mean number of tuberculosis cases prevented, increased as the proportion of eligible children that received isoniazid preventive treatment, improved; the change in the number of cases prevented per simulation showed incremental improvements which were all significantly better (p<0.01) than the base case.. The incremental cost-effectiveness ratios incurred savings for each of the scenarios simulated since the mean costs for each of the simulations were significantly less (p<0.01) than the costs associated with the base case. The current evidence suggests that the proposed isoniazid preventive treatment register tool is a cost-effective alternative to the current standard of care in place at community level for at-risk children exposed to tuberculosis. It is therefore recommended that the tool be used incrementally on a bigger scale, until such time that sufficient evidence has been generated to support widespread implementation.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>