Thesis (MBA (Business Management))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The democratic government of South Africa inherited a healthcare system that was fragmented and inequitable. The Department of Health was mandated by the Constitution and the Bill of Rights to implement a system whereby quality, affordable healthcare could become available to all citizens of the country within the constraints of the available resources. The objective of government, through reform legislation, is to establish a social health insurance (SHI) system for the country which will ultimately lead to the implementation of a national health insurance (NHI) system in order to achieve universal coverage. Medical schemes have been identified as an important component of this transformation process. The private healthcare industry, represented largely by medical schemes, acknowledges that SHI is the ideal pathway chosen by government to achieve universal coverage, but is concerned with the process being used to achieve this aim, the pace at which transformation is occurring, and the effect of this on medical schemes. The movement towards an equitable healthcare system required the introduction of reform legislation necessary for the establishment of an enabling environment. The implementation of community rating, open enrolment and prescribed minimum benefits (PMBs) reforms, succeeded in ending the risk-rating of those medical schemes that were excluding members who were considered vulnerable. However, these legislations were not followed by a risk equalisation mechanism in the form of a proposed risk equalisation fund (REF) for the South African environment. The main purpose of this fund is to ensure that equity within the medical schemes industry is maintained through the equalisation of the risks that had resulted from the implementation of the first components of reform legislation. The research into the experiences of other countries shows that South Africa is the only country in the world that has implemented the above legislation without a system of risk equalisation. All indications are that the proposed implementation of the REF has been delayed to beyond 2009. In addition, the reform legislation regarding the statutory solvency ratio requires medical schemes to maintain this ratio at 25 percent. This, together with the delay in REF is placing financial pressure on medical schemes. Low income medical schemes (LIMS) legislation is pending implementation. Its purpose is to provide basic medical cover to the lower income market until such time that the components of SHI have been fully negotiated; it is thus an interim measure, but no indication to implement LIMS has yet been given. The average number of years for a country to implement SHI is 70. The South African situation is only 13 years old and though some success has been achieved during this relatively short period, much more still needs to be accomplished. The research shows that, the approximate timelines and intended sequence of implementing the reform legislation were perhaps too ambitious. This has caused the industry stakeholders to be disillusioned about the current state of affairs. Given the time that has elapsed, and considering the progress that has been made thus far, it is recommended that the existing plan be revised or even replaced with a more realistically timed one. This will restore some of the confidence into the “future healthcare vision of universal coverage” for South Africa intended by the government, through a system of social health insurance. / AFRIKAANSE OPSOMMING: Die demokratiese regering van Suid-Afrika het ‘n gesondheidsorgstelsel geërf wat gefragmenteerd en onregverdig was. Die Departement van Gesondheid het in die Grondwet en die Handves van Menseregte die mandaat gekry om ‘n stelsel te implementeer waarvolgens bekostigbare gesondheidsorg van goeie gehalte vir alle landsburgers beskikbaar kon word binne die beperkinge van die beskikbare hulpbronne. Die regering se doelwit met hervormingswetgewing is om ‘n maatskaplike gesondheidsversekeringstelsel (SHI) vir die land daar te stel wat uiteindelik sal lei tot die implementering van ‘n nasionale gesondheidstelsel (NHI) met die oog op universele dekking. Mediese skemas is geïdentifiseer as ‘n sleutelkomponent van hierdie transformasieproses. Die privategesondheidsorgindustrie, wat grotendeels deur mediese skemas verteenwoordig word, erken dat SHI die ideale weg is wat deur die regering gekies is om universele dekking te bereik, maar is besorg oor die proses wat gebruik word om hierdie doelwit te bereik, die pas waarteen transformasie geskied, en die uitwerking hiervan op mediese skemas. Die beweging na ‘n regverdige gesondheidsorgstelstel het vereis dat hervormingsgswetgewing ingestel word soos nodig vir die daarstelling van ‘n omgewing wat dit moontlik maak. Die implementering van gemeenskapsevaluering, oop lidmaatskap en hervorming van voorgeskrewe minimum voordele (PMB’s) was suksesvol vir die beëindiging van die risikoevaluering van daardie skemas wat lede uitgesluit het wat as kwesbaar beskou is. Maar hierdie wetgewing is nie opgevolg deur ‘n risikogelykstellingsmeganisme in die vorm van ‘n voorgestelde risikogelykstellingsfonds (REF) vir die Suid-Afrikaanse omgewing nie. Die hoofdoelwit van hierdie fonds is om te verseker dat gelykheid binne die mediesefondsindustrie gehandhaaf word deur die gelykstelling van risiko’s wat die gevolg was van die implementering van die aanvanklike hervormingswetgewing. Navorsing oor die ondervinding in ander lande toon dat Suid-Afrika die enigste land in die wêreld is wat sodanige wetgewing geïmplementeer het sonder ‘n stelsel van risikogelykstelling. Alle tekens dui daarop dat die voorgestelde implementering van die REF uitgestel is tot na 2009. Daarbenewens vereis die hervormingswetgewing ten opsigte van die statutêre solvensieverhouding dat mediese skemas hierdie verhouding op 25% handhaaf. Tesame met die vertraging in REF plaas dit finansiële druk op mediese skemas. Lae-inkomstemedieseskemas (LIMS) is verdere hervormingswetgewing wat wag op implementering. Die doel daarvan is om basiese mediese dekking te voorsien aan die laer-inkomstemark totdat die komponente van SHI ten volle onderhandel is. Dit is dus ‘n oorgangsmaatreël, maar daar is nog geen aanduiding gegee van die implementering van LIMS nie. Die gemiddelde tyd wat dit neem vir ‘n land om SHI te implementeer, is 70 jaar. Die Suid-Afrikaanse situasie is net 13 jaar oud, en hoewel daar heelwat sukses behaal is in hierdie relatief kort tydperk, moet daar nog baie meer bereik word. Navorsing toon dat die geskatte tydperk en voorgenome opeenvolging van die implementering van die hervormingswetgewing dalk te ambisieus was. Dit het veroorsaak dat die belanghebbers in die industrie ontnugter is oor die huidige stand van sake. Met inagneming van die tyd wat verloop het en die vordering wat tot dusver gemaak is, word daar aanbeveel dat die bestaande plan hersien word of selfs vervang word deur een met ‘n meer realistiese tydsbeperking. Dit sal ‘n mate van vertroue herstel in die Suid-Afrikaanse Regering se “toekomsvisie van universele gesondheidsdekking” deur ‘n stelsel van maatskaplike gesondheidsversekering.

Thesis (MPhil)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The practice of medicine has always been a big area of interest as a profession. The focus ranges depending on issues at hand - it may be on the educational, training, humanistic, economic, professional ethics and legal aspects. One area of medicine that is under the spotlight around the world is that of the maintenance of clinical competency, followed very closely and almost linked to professional ethics. This study follows the introduction of a system of Continuing Professional Development (hereinafter also referred to as CPD), in South Africa and an overview of how it has been introduced in a few other countries. The main areas of focus being the extrication of inherent values of CPD, relating this aspect to quality improvement in medical health care. The medical profession as well as most of the interested parties, has different perspectives regarding the fact that the system is regulated through legislation. There is also the doubt whether the CPD system will be effective in achieving the goals that it has been set to achieve. Although a system of Continuing Medical Education has been a tradition in all countries, which implies that the CPD system is not totally new as far as the educational principles are concerned, the values accruable need to be exploited. It is the possible success of this kind of evaluations that may foster more understanding of the inherent values in this CPD system. / AFRIKAANSE OPSOMMING: Beroepsgewys het die praktyk van geneeskunde nog altyd groot belangstelling gelok. Die fokus verskuif na gelang van die onderwerpe ter sprake. Dit wissel van opvoedkunde, opleiding, humanisme, ekonomie, en professionele etiek tot regsaspekte. Dwarsoor die wêreld word daar gefokus op die handhawing van kliniese vaardighede, gevolg deur professionele etiek wat ook daarin verweef is. Hierdie studie bespreek die instelling van 'n stelsel van Voortgesette Professionele Ontwikkeling (hierna verwys na as VPO) in Suid-Afrika asook oorsig oor die wyse waarop dit in 'n paar ander lande ingestel is. Die klem lê op die inherente waardes met betrekking tot die verbetering gehalte in mediese gesondheidsorg. Die mediese beroep, asook meeste van die belangegroepe het verskillende opvattings oor die feit dat die stelsel deur wetgewing gereguleer word. Daar is ook twyfel of die VPO-stelsel in sy vooropgestelde doelwitte sal slaag. Wat die opvoedkundige beginsels betref, is die VPO-stelsel nie totaal en al nuut nie. Alhoewel VPO in ander lande tradisie is, is dit nodig om die totstandkoming van waardes te ontgin. Die moontlike sukses van hierdie tipe van evaluasies mag dalk beter begrip ten opsigte van die inherente waardes in die VPO-stelsel bevorder.

Text in English / The aim of the study was to explore the experiences of adult offenders living with HIV (OLWHIV) not qualifying for antiretroviral therapy (ART). Such offenders are put on the pre-antiretroviral therapy (pre-ART) program after HIV diagnosis. Follow up of OLWHIV is done every six months to ensure prompt treatment. Research objectives include exploration of experiences of OLWHIV on the pre-ART program, the accessibility of the program and the challenges thereof. An exploratory, qualitative study with face-to-face interviews was conducted. Purposive sampling of the eight participants was done to conduct the study. Seven out of eight participants accessed the pre-ART program well but had little knowledge of the pre-ART program. Furthermore, participants experienced little support from partners and health care workers. The study showed institutional constraints such as poor diet, shortage of staff and humiliation from Correctional officers. Participants portrayed commitment in the support group irrespective of the challenges experienced. The study further showed that the self-care theory could enhance the pre-ART program but that institutional constraints deterred the progress. Participants made recommendations such as strengthening of partnerships for support groups, good diet, and an increase of staff capacity. Overall study recommendations include implementation of universal test and treat and mixed methods for future studies. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Text in English / Professional nurses are regarded as the backbone of the health care system and quality patient care is linked to patient safety.The purpose of the study was to describe and explore the perceptions of professional nurses on impact of shortage of resources for quality patient care. The resources include health professionals, equipment and drugs. The study was conducted in Mankweng hospital which is a public hospital in the Capricorn district in Limpopo Province. Qualitative descriptive exploratory design was used which provided the researcher with in-depth information regarding phenomena under study. Data was collected from ten (10) professional nurses who have 5 to 20 years of nursing experience allocated in medical and surgical wards. Unstructured face-to-face interview was conducted using field notes and audio tape. Data was analysed following Creswell (2014) Tesch method. Five themes and eighteen subthemes emerged from data. The findings revealed that the shortage of health professionals and inadequate resources has a negative impact on provision of quality patient care. / Health Studies / M.A. (Health Studies)

Compassionate care is a crucial component of patient care in nursing practice in the broad context of holistic care. However, it is seemingly difficult for nurses to identify what exactly comprises compassionate care and how to provide it to patients. The purpose of the study was to explore the experiences of professional nurses on how they provide compassionate patient care. A qualitative descriptive study design based on narrative analysis was used. Thirteen professional nurses (PNs) from a private hospital were purposefully recruited to participate. Data was collected using written stories and professional lifelines. Data was analysed using thematic and narrative analysis. The following themes were identified such as treating the patient as a whole, inadequate knowledge and skills, and barriers to providing compassionate care. Future research using quantitative approach and large samples was recommended. / Health Studies / M.A. (Health Studies)

The purpose of this study was to determine case managers’ understanding of their role in a managed care organisation and to develop recommendations for the improvement of case management practice. Quantitative descriptive research was conducted to explore perceptions of case managers regarding their role. A self-administered questionnaire was used as a formal data collection instrument and 25 respondents participated in the study. The findings revealed that the majority of case managers know what is expected of them in their job but that they do experience some barriers. There appears to be uncertainty with quite a number of respondents regarding certain aspects of their role. Recommendations were made for improved case management practice.

Transcultural nursing refers to the provision of nursing care to patients whose values, beliefs and life-style differ from those of the nurse. To enable nurses to honour their ethical obligation to provide quality care, they must have the necessary knowledge to nurse patients across cultural boundaries. This study was conducted to determine the nurse's knowledge of and attitudes towards the culturally different patient. A questionnaire was used to collect the data. Although nurses see it as a challenge to nurse patients from different cultures, it was found that they do not have the necessary knowledge to provide culture-sensitive care. Other factors, such as the nurse's attitude towards culturally different patients, communication problems, mistrust, prejudice and a lack of understanding of cultural uses and traditions, contribute to the lack of culture-sensitive care. The nursing profession should pay attention to these problems. / Health Studies / Van Tonder, Sally / M.A. (Nursing)

Adolescent reproductive health services (ARHS) in Gauteng Province are not meeting the reproductive health needs of adolescents. There is also no formalised adolescent/youth policy laid down to assess the quality of care given to adolescents attending these clinics although the policy is currently in the process of being finalised. The purpose of the study therefore was to critically analyse the ARHS in Gauteng Province to determine which adolescents attended the clinics, whether the clinics were accessible and available and whether they provided comprehensive care, gave information and counselling to the adolescent and whether the clinics \\·ere adolescent-friendly. Using the quality care model as the conceptual framework for the study, the following research questions were asked to determine the quality of care in terms of the adolescent's needs at these clinics: Who is the adolescent using ARHS in Gauteng Province') Are the ARHS in Gauteng Province accessible and available to adolescents? Do the ARHS in Gauteng Province provide comprehensive care to adolescents? Are adolescents receiving information and counselling from the ARHS in Gauteng Province? Are the ARHS in Gauteng Province adolescent-friendly? A quantitative cross-sectional exploratory, descriptive research design using a self-administered, researcher­ designed questionnaire was used to collect data from a 203 nonprobability convenient sample, at selected ARHS in Gauteng Province. The analysed data indicated that females in the older age group. ie 18-19 years used the ARHS more than the female adolescents in the younger age group and males. Findings also indicated that the ARHS in Gauteng Province are geographically accessible and available to adolescents. However, there appeared to be a need to extend the days and hours of functioning of the ARHS so as to make them more accessible and available to adolescents. Comprehensive care is not given to adolescents attending ARHS. Adolescent gave contradictory mformation especially with regard to the attitudes of service providers. Recommendations made include management strategies that will attract the adolescent in the younger age group and in particular the male adolescent. This necessitated that service providers at ARHS be equipped with the appropriate information given in an outcome-based format in adolescent care. / Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016. / The delivery of healthcare services should be of a high standard for everyone. For people in the location of Mantunzeleni this is not the case as there are still challenges that they go through in order to gain access to sufficient healthcare services. The location consists of four villages and the other nine which surround the four, in total this makes thirteen villages that are served by one clinic. These villages are divided by forest, rivers and mountains, people have to cross these and walk long distances to get to the clinic. Gaining access to basic healthcare services in rural areas has never been easy, hence this study seeks to understand the role telehealth could play to help improve the situation. It has been reported in the literature that telehealth has potential to address some of the problems experienced by healthcare service providers located in the rural areas. Research questions were posed to address the problem of limited access to healthcare services of under-served communities in rural areas. The study adopted an interpretive approach to understand how the people using healthcare services in the setting attach meaning to their experiences of the healthcare service. The study therefore seeks to understand how telehealth could improve healthcare service delivery through the participants’ views, perceptions and experiences. The research strategy for this study is a single case study without attempting to generalise the findings. Qualitative data was gathered using unstructured interviews, observations and co-design methods. The current state of telehealth and challenges of healthcare services in rural under-served communities was established through a review of relevant literature. It was important to actively involve the respondents in the research process for them to feel a sense of ownership. Data was analysed using a thematic analysis. The findings revealed the challenges currently hampering the delivery of healthcare in the research setting include poor infrastructure, high cost, the shortage of medical professionals, travelling distance, time management and lack of communication about the services. It was also revealed the role telehealth could play a role to improve access to healthcare and the findings indicate that the nurses feel that extending the healthcare service to include alternative access methods to health information, education and expertise could lead to a sense of appreciation, knowledge gain, dealing with distance problems and improved referrals, cost saving to improve healthcare service delivery.

The major socio-economic development challenges facing most African countries include economic diversification, poverty, unemployment, diseases and the unsustainable use of natural resources. The challenge of quality healthcare provisioning is compounded by the HIV/AIDS pandemic in Sub Saharan Africa. However, there is a great potential in using electronic healthcare (e-health) as one of the supportive systems within the healthcare sector to address these pressing challenges facing healthcare systems in developing countries, including solving inequalities in healthcare delivery between rural and urban hospitals/clinics. The purpose of this study was to compile a Provincial E-health Framework (PEHF) based on the feedback from electronic healthcare readiness assessments conducted in selected rural and urban hospitals/clinics in the North West Province in South Africa. The e-healthcare readiness assessment was conducted in the light of effective use of ICT in patient healthcare record system, consultation among healthcare professionals, prescription of medication, referral of patients and training of healthcare professionals in ICT usage. The study was divided into two phases which were phases 1 and 2 and a qualitative design supported by a case study approach was used. Data were collected using different techniques to enhance triangulation of data. The techniques included group interviews, qualitative questionnaires, photographs, document analysis and expert opinions. The outcome of the assessment led to the compilation of the PEHF which was based on Service Oriented Architecture (SOA). SOA was chosen to integrate the hospitals/clinics‟ ICT infrastructure yet allowing each hospital/clinic the autonomy to control its own ICT environment. To assist hospitals/clinics integrate their ICT resources, this research study proposed an Infrastructure Network Architecture which clustered hospitals/clinics to share common ICT infrastructure instead of duplicating these resources. Furthermore, processes of the e-health services (e-patient health IV record system, e-consultation system, e-prescription system, e-referral system and e-training system) were provided to assist in the implementation of the PEHF. Finally, a set of guidelines were provided by the research study to aid the implementation of the PEHF.