Data quality is one of many challenges experienced in electronic healthcare (e-health) services in South Africa. The collection of data with substandard data quality leads to inappropriate information for health and management purposes. Evidence of challenges with regard to data quality in e-health systems led to the purpose of this study, namely to prioritise data quality challenges experienced by data users of e-health systems in South Africa. The study followed a sequential QUAL-quan mixed method research design to realise the research purpose. After carrying out a literature review on the background of e-health and the current status of research on data quality challenges, a qualitative study was conducted to verify and extend the identified possible e-health data quality challenges. A quantitative study to prioritise data quality challenges experienced by data users of e-health systems followed. Data users of e-health systems in South Africa served as the unit of analysis in the study. The data collection process included interviews with four data quality experts to verify and extend the possible e-health data quality challenges identified from literature. This was followed by a survey targeting 100 data users of e-health systems in South Africa for which 82 responses were received. A prioritised list of e-health data quality challenges has been compiled from the research results. This list can assist data users of e-health systems in South Africa to improve the quality of data in those systems. The most important e-health data quality challenge is a lack of training for e-health systems data users. The prioritised list of e-health data quality challenges allowed for evidence-based recommendations which can assist health institutions in South Africa to ensure future data quality in e-health systems. / School of Computing / M. Sc. (Computing)

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This report provides a broad overview of the health industry, and the dental industry in particular, identifying trends and searching for possible solutions to problems posed by these trends. It attempts to offer perspectives of importance to all the stakeholders in health care - the patients, the providers of care and third party payers. The current focus of healthcare industry is not actually the health of the patient. Practitioners (the providers) focus too much on treatment, while insurance companies and governments (the payers) emphasise cost containment. As national health care costs spiral, it is ironic that the main reasons for the dramatic health improvements over the last few decades are improvements in socio-economic factors and changes in lifestyle, rather than better treatment. The willingness of insurers to cover new or improved services has acted as a continuing stimulus to cost-increasing advances in medical technology and in tum to spending growth. Managed care has evolved to attempt to improve resource allocation in health care. Thirdparty private-sector regulators have wrested power from government regulators. Their gain in power relative to private practitioners has shifted the power balance from the supply side to the demand side of health care. By leveraging their power in the use of information technology, the practitioner has been forced into a defensive, reactive stance. Managed care is being implemented by profit-driven third parties that benefit from the cost savings. As health providers are the ones who have to implement the cost-savings; it is proposed that they are the ones who should manage healthcare. The ideal would be a coordinated approach with funders and service providers working toward a common goal. Financial accountability is forcing dental practitioners to evaluate their mode of practice in a critical manner. Promoting health, by educating and evoking behaviour change will create a better world for current and future generations. There is a shift in focus from the health of the individual at all costs, to the health of the population. There should be a special emphasis on the dental health of children for whom prevention offers the most gain in outcome. Evidence-based care evolved from the search for the best care, in terms of quality and price, outcome and process, and attempts to reduce variability and subjectivity in clinical decisions, by using systematic reviews of quality evidence to increase objectivity. Emphasis on improved outcomes provides earlier, more valuable, long-term improvements for a patient, than the later, short-term benefit of a cure. Because most canes and gum disease is preventable, dental health professionals should accentuate health promotion and education of patients. The benefits would be to the advantage of all stakeholders in health. A focus on prevention for children could be the ideal form of dental private practice to instil oral wellness in children. / AFRIKAANSE OPSOMMING: Hierdie verslag is 'n breë oorsig van die gesondsheidsindustrie, en van die tandheelkunde industrie in besonder om tendense te identifiseer en na moontlike oplossing te soek vir probleme wat hieruit mag spruit. Dit poog om perspektiewe aan te bied wat van belang is vir die betrokke rolspelers - die pasiënte, die diensverskaffers en die befondsers. Die huidige fokus van gesondheidsorg is nie eintlik die gesondheid van die pasiënt nie. Die die voorsieners van sorg fokus meestal op behandeling, terwyl versekeringsmaatskappye en die regering (die betalers) fokus op die besnoeing van koste. Terwyl nasionale gesondheidskostes styg, is dit ironies dat die belangrikste redes vir die dramaties verbetering in gesondheid oor die laaste paar dekades eerder verbeteringe in sosioekonomiese faktore en veranderinge in leefwyse is as beter behandeling. Die bereidwilligheid van versekeraars om nuwe en verbeterde dienste te dek, is die oorsaak van die aanhoudende stimulus vir mediese tegnologiese vooruitgang en koste stygings. Bestuurde sorg het ontwikkel om te probeer om bron toewysing in gesondheidsorg te verbeter. Derde party privaatsektor-reguleerders het die mag van regering-reguleerders ontruk. Hul invloed, relatief tot die van privaat praktisyns, het die mags-ewewig verskuif van die voorsienings- na die aanvraagkant van gesondheidsorg. Deur die gebruik van hulle voordeel op die gebied van inligtingstegnologie, het hulle die praktisyn in 'n defensiewe houding gedwing. Bestuurde Gesondheidsorg word beheer deur winsgedrewe derde partye wie baat vind by kostebesparings. Aangesien gesondheidsverskaffers die kostebesparings moet implementeer, word daar aanbeveel dat hulle gesondheidsorg moet bestuur. 'n Gesonde samewerkings ooreenkoms tussen befondsers en diensverskaffers is wenslik. Finansiële verantwoordelikheid dwing tandartse om hulle praktyke krities te evalueer. Daar is 'n fokus verskuiwing vanaf die gesondheid van die individu, ten alle koste, na die gesondheid van die bevolking. Besondere klem behoort geplaas te word op die mondgesondheid van kinders, vir wie voorkoming die meeste baat inhou. Bewys-gebaseerde Gesondheidsorg het ontwikkel uit die soektog na die beste sorg in terme van kwaliteit en koste, uitkoms en proses, en pogings om wisselvalligheid en subjektiwiteit in kliniese besluite te verminder. Klem op beter resultate gee vroeër, meer waardevolle langtermyn verbeteringe vir die pasiënt, as die later kort-termyn voordele van genesing. Omdat tandbederf en tandvleissiektes voorkombaar is, behoort tandheelkundiges die bevordering van mondgesondheid te beklemtoon. Voorkoming by kinders word gesuggereer as die ideale vorm van privaat praktyk om mondgesondheid te bevorder.

MPM / Oliver Tambo Institute of Governance and Policy Studies

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.

M.Com. (South African & International Taxation) / The tax system in South Africa makes provision for everyday South African citizens to contribute to a greater or lesser extent towards health care funding in South Africa. However, as a result of the high unemployment rate, a large gap exists between tax contributors and non-tax contributors. This raises the question of whether it is fair that the burden to fund the proposed National Health Insurance (NHI) initiative in South Africa is borne by the small percentage of current tax contributors. The purpose of this research was to provide a taxation perspective on the different funding models and financing options available to the South African government for consideration in developing the NHI implementation strategy. The study evaluated the four traditional health care models used worldwide and assessed existing health care systems in selected first and third world countries in order to contribute towards the development of the proposed NHI system in South Africa. The health care models used by France, The United States, The United Kingdom, Brazil and Spain were evaluated in order to achieve an understanding of the funding approaches followed by these countries. It was found that although it is inevitable that South African tax contributors will have to be more heavily taxed in order to fund the NHI, as there are only limited possibilities for distributing the tax burden evenly. The main stumbling block in finding an equitable funding solution is the fact that there is a large disparity in South African income tax contributors.

A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Applied Ethics For Professionals, July 2017 / Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely debated and controversial topic that, to date, remains unresolved. Where third-party private funding organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by perceived conflicts between the ethical frameworks that govern corporate organisations versus those that govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare decision-making. The report shows why health is an important social value and examines the key models and principles that dominate the rationing debate as well as why the conflict between healthcare ethics and organisational ethics create additional complexities that must be considered when making these funding decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on the parameters and validity of AFR. The report concludes that even though the AFR framework may be a legitimate and just process that can effectively frame decision-making and provide a platform to drive transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important ethical principles that currently govern the field. / XL2018

The majority of persons within South Africa (of whom 16% have claimed to have suffered from common mental disorders such as depression) that use medical treatment do so through primary care (Patel et al., 2007; Williams et al., 2007). However, studies have shown that general practitioners (GPs) often overlook, ignore, misdiagnose and even offer inappropriate treatment for mental illness (c.f. Lotrakul & Saipanish, 2009; Qwabe, 2009). Since South Africa is comprised of a multitude of diverse peoples from varying culture backgrounds, cultural diversity needs to be considered within every interaction, especially when GPs consult with individuals with depression. This study, thus, aims to explore GPs’ management of depression by investigating diagnosis or detection, treatment and referral patterns of GPs where their considerations of patient’s cultural worldviews are also investigated. This study utilised a semi-structured interview schedule on a convenient sample of six GP’s. Thematic content analysis was used to analyse salient themes from the data. Eight themes were found, namely: diagnosing, treating and referring patients with depression, cultural implications in general practice, training of GPs, the evolution of the medical field and its practices, disadvantaged communities and access to health care resources as well as the ethics of practice. These results are discussed in relation to local and international literature in the field.

Perceptions of health and illness which include the perceived cause and recourse play an important role in diagnosis and management of illness. Traditional and allopathic medicines are used simultaneously and sometimes without the knowledge of the health professional and this has an impact on clinical outcomes. Overlooking patients’ subjective experience, health providers’ biases and prejudice may pose a negative impact on clinical outcomes. This study explores patients’, traditional healers’ and psychological counselors’ perception of illness by conducting interviews and administering open-ended questionnaires. The data is analyzed both qualitatively and quantitatively through the use of content analysis and non-parametric statistical procedures. The results indicate that the concept of illness is complex and multidimensional with physical and socio-spiritual aspects. Effective management requires a joint approach between indigenous and western health systems. The results further show that traditional healers fully embrace the integrated health approach while there is some skepticism and uncertainty from psychological counselors which could be stemming from their training. There is still work to be done in terms of health planning and policy but also the training of health professionals. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

Prevention of HIV following sexual assault is an important aspect of rape care. This includes taking Post Exposure Prophylaxis for 28 days. The present study aimed to provide an in-depth understanding of social and environmental factors that predisposed, promoted and also served as barriers to adherence to post exposure prophylaxis to prevent HIV infection after sexual assault in women in the Eastern Cape Province. The study involved a purposive sample of women who were offered Post Exposure Prophylaxis (PEP) after a sexual assault. Sixteen women were accessed at the Sinawe Referral Centre and participated in the study. Their ages ranged from 16 to 73 years. An interview guide was developed to assist the researcher, and semistructured, in-depth interviews were used to collect data. These women were interviewed at the end of 28 days of taking the prophylactic medication. The data were analyzed inductively using grounded theory. Only three women completed the 28 days of PEP treatment. Participants gave different explanations for why they did not complete the treatment with only four participants returning to the centre for their medication. Some reported having no money for transport; others mentioned deciding to discontinue the medication because of its side-effects. Poor support systems, both within the community and the health services, including the provision of conflicting information also played a role. The study showed that few women were able to complete their PEP medication and knowledge about the service and access to it were the main factors that lead to non-adherence. There is an urgent need for the improvement of PEP services particular in the support to the women during the period of taking the PEP treatment to ensure protection from HIV after a sexual assault. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

Micro Finance Institutions are being advocated as vehicles to provide poor people with loans to start business enterprises. Micro Health Insurance is offered to insure against the risk of ill-health in the enterprise. An interesting aspect of this initiative is that it is donor driven to service the needs of the poor and the 'unbankable.' However, it was the researcher's considered view that it may not be easy to build a sustainable Micro Health Insurance Scheme for poorer people. The study thus sought to explore the possibility of developing a sustainable Micro Health Insurance Scheme in the context of acute poverty, free health care, the burden of HIV/AIDS and other diseases, the growing informal sector, erratic and unreliable incomes and the nature of risks faced by these prospective clients. To develop a thorough understanding of the subject matter, extensive reading was carried out. The researcher then designed an interviewer-administered questionnaire. The study had a total of 34 respondents, most of whom where members of a Financial Service Co-operatives, which are community-banking structures that provide a range of financial products for poorer people and those in the informal economy. It is clear from the study that these people are faced with a number of risks. There are several problems that may affect the possibility of building a sustainable health insurance scheme. The present study does not provide any statistical evidence but explores the theme of using the concept of risk and vulnerability to understand the poverty in which Micro Finance and Micro Health Insurance is located. The study provides an array of policy options that can be explored to provide for the health care needs of poorer people, as well as suggestions for future research. / Thesis (M.Dev. Studies)-University of Natal, Durban, 2003.