Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Background: In Africa, internet access and use is plagued by numerous barriers. Whilst South Africa (SA) boasts a better population penetration than the rest of Africa there is a lack of regulation regarding the internet and e-mail use amongst health professionals and their patients. The aim of this study was to assess the use of the internet amongst dietitians and medical doctors (MDs) in clinical practice in SA and draft a policy on such usage amongst health professionals and their patients. Methods: A cross-sectional analytical web-based survey was conducted amongst registered dietitians and MDs. A cover letter including a hyperlink to the self-administered questionnaire was e-mailed to all dietitians and a proportionate, stratified random sample of MDs with contactable e-mail addresses. The questionnaire consisted of open and closed questions, including demographics, influence of the internet on the quality of care of patients, quality control with web resources and aspects of information technology (IT) which were recommended by health professionals to be incorporated as part of undergraduate health science education Results: A total of 176 health professionals participated in the study (106 dietitians and 70 MDs). The mean age of the dietitians was 32.6± (8.0) and the MDs 50.5± (8.9). The majority of the respondents in this study population were White (82%) females (67%). On average, practitioners had been in practice for 9.1(8.0) years. The majority of dietitians (58%) and MDs (68%) had access to the internet at both their practice or workplace and their home. More dietitians (65%) than MDs (41%) were using e-mail or internet. MDs did not use the internet for research purposes, whilst a fifth of dietitians (21%) reported using the internet as a research tool. A greater percentage of the sample [MDs (69%) and dietitians (82%)] reported that, the internet had improved the quality of care of their patients. The dietitians (60%) and MDs (53%) in this study sample were unclear about how to source information and determine the reliability or accuracy of the information obtained from internet resources. Conclusion: Internet is incorporated into the practice of most dietitians and to a lesser extent by MDs. In this study, the need for training amongst health professionals regarding the use of the internet was highlighted. The study reflects that even though health professionals were unsure of the credibility of the internet information resourced, it did not stop the use of the internet in the practice. This is an area of concern, since it could potentially result in the distribution of misinformation. This warrants regulation on the use of the internet in health practices in SA. A policy on the use of IT in health care practice has been drafted. Further research on the use of IT in the healthcare practice is required before the policy can be finalized. The advantage is that some elementary information is now available. The challenge is to ensure that the time lapse between additional research, policy finalization and policy implementation is kept to a minimum. / OPSOMMING: Agtergrond: In Afrika is internet toegang en gebruik met baie hindernisse belas. Alhoewel Suid-Afrika (SA) met ‘n beter bevolkingspenetrasie as die res van Afrika spog is daar ‘n gebrek aan regulasie in verband met internet en e-pos gebruik tussen gesondheidswerkers en hul pasiënte. Die doel van hierdie studie was om die gebruik van die internet deur dieetkundiges en mediese dokters (MDs) in kliniese praktyk in SA te assesseer en om ‘n konsepbeleid rakende sulke gebruik tussen gesondheidswerkers en hul pasiënte op te stel. Metode: ‘n Dwarssnit analitiese web-gebaseerde opname is met geregisteerde dieetkundiges en MDs onderneem. ‘n Dekkingsbrief met ‘n webskakeling (hyperlink) tot die selfgeadministreerde vraelys is aan alle dieetkundiges en aan ‘n eweredig, gestratifiseerde ewekansige steekproef van MDs met kontakbare e-pos adresse gestuur. Die vraelys het uit oop en toe vrae bestaan, insluitend demografie, invloed van die internet op die kwaliteit van sorg van pasiënte, kwaliteitskontrole met web-hulpmiddels en aspekte van informasie tegnologie (IT) wat deur gesondheidswerkers aanbeveel was om deel te word van voorgraadse gesondheidswetenkaplike onderrig. Resultate: ‘n Totaal van 176 gesondheidswerkers het aan die studie deelgeneem (106 dieetkundiges en 70 MDs). Die gemiddelde ouderdom van die dieetkundiges was 32.6± (8.0) jaar en die MDs 50.5± (8.9) jaar. Die meerderheid respondente in hierdie studie populasie was blank (82%) en vroulik (67%). Oor die algemeen was praktisyne vir 9.1± (8.0) jaar in praktyk. Die meerderheid dieetkundiges (58%) en MDs (68%) het toegang tot die internet by beide hul praktyk of werkplek en hul huis. Meer dieetkundiges (65%) as MDs (41%) het e-pos of internet gebruik. MDs het nie die internet vir navorsingsdoeleindes gebruik nie, terwyl ‘n vyfde van dieetkundiges (21%) raporteer het dat hulle die internet vir navorsingsdoeleindes gebruik het. ‘n Groot persentasie van die populasie [MDs (69%) en dieetkundiges (82%)] het gerapporteer dat die internet tot ‘n verbetering in sorg van hul pasiënte gelei het. Die dieetkundiges (60%) en MDs (53%) in hierdie studie was onseker hoe om informasie te verkry en die betroubaarheid en akuraatheid van die informasie vanaf internetbronne te bevestig. Opsomming: In hierdie studie word internet in die praktyke van die meerderheid dieetkundiges en tot ‘n mindere mate in die van MDs geinkorporeer. Die noodsaaklikheid vir opleiding in die gesondheidsberoepe met betrekking tot die gebruik van die internet is aan die lug gebring. Hierdie studie weerspieël dat alhoewel gesondheidswerkers onbewus was van die geloofwaardigheid van internet informasie, dit nie die gebruik van die internet in hul praktyk gestop het nie. Dit is ‘n area van kommer aangesien dit potensieel na die verspreiding van misinformasie kan lei. Dit motiveer dus reguleering van die gebruik van die internet in gesondheidspraktyke in SA. ‘n Beleid oor die gebruik van IT in gesondheidspraktyke is in konsepvorm opgetrek. Verdere navorsing oor die gebuik van IT in gesondheidspraktyke word benodig om die konsepbeleid te finaliseer. Die voordeel is dat basiese inligting nou beskikbaar is. Die uitdaging is om te verseker dat die tydsduur tussen addisionele navorsing, beleidsfinaliseering en beleidsimplementering tot ‘n minimum gehou word.

Submitted in fulfillment of the requirements for the Degree in Master in Technology: Marketing, Technikon Natal, 2003. / Managed care is defined by Chetty (1999: 1) as "the practice of evidence based medicine with an approach to managing both the quality and cost of medical care". Managed care was introduced into South Africa in the last decade due to increasing cost of healthcare. All forms of managed care represent attempts to control costs by modifying the behaviour of general practitioners. / M

When the current South African government came into power two decades ago they inherited a fragmented health care system whose main focus was on the tertiary care level. The strategy of the current government was to re-focus the whole health care system and prioritize primary health care system. That included setting up district health care systems and building primary health care centres in the areas within the communities in order to make health care accessible to everybody. Due to financial difficulties the majority of the people staying in these communities solely depend on these clinics as they cannot afford to buy health care services in the private sector. The study seeks to assess the current medication supply chain to these clinics with a view of coming up with recommendations that, when implemented, will ensure that the supply of medication by the clinics is able to meet the demands of their patients. Lean management is a system that was started in the manufacturing sector and because of its success there it was later adopted by the service industry. Lean is a system that seeks to eliminate all forms of waste and improve the quality of the service rendered to the satisfaction of the customer/patient. Literature review and discussion of lean implementation is discussed extensively. The findings of the study are presented, analyzed and discussed. In these findings it is noted that the system is functioning very well but there are challenges in these clinics that need to be addressed. Recommendations of how lean management can be implemented successfully to optimize the functioning of the current system are discusse The permission received from the Department of Health to conduct this study came with contractual obligations that the researcher promised to honour. One of those requirement stated clearly that the findings of the study should not be published anywhere without the permission of the Department (see addendums A & C). It is under that premise that the researcher wants to bring this to the attention of the relevant university departments, with the hope of ensuring that this contractual obligation is honoured.

South Africa possesses a highly fragmented health system with wide disparities in health spending and inequitable distribution of both health care professionals and resources. The national health system (NHI) of South Africa consists of a large public sector and small private sectors which are overused and under resourced and a smaller private sector which is underused and over resourced. In broad terms, the NHI promises a health care system in which everyone, regardless of income level, can access decent health services at a cost that is affordable to them and to the country as a whole. The relevance of this study is to contribute to the NHI debate while simultaneously providing insights from other countries which have implemented national health care systems. As such, the South African government can then appropriately implement as well as finance the new NHI system specific to South Africa’s current socio-economic status. The objective of this study was to examine health care financing models in different countries in order to draw lessons for South Africa when implementing the NHI. A case study was conducted by examining ten countries with a national health insurance system, in order to evaluate the health financing models in each country. The following specific objectives are pursued: firstly, to review the current health management system and the policy proposed for NHI; secondly, to examine health financing models in a selected number of countries around the world and lastly to draw lessons to inform the South African NHI policy debate. The main findings were firstly, wealthier nations tend to have a much healthier population; this is the result of these developed countries investing significantly in their public health sectors. Secondly, the governments in developing nations allocate a smaller percentage of their GDP and government expenditure on health care. Lastly, South Africa is classified as an upper middle income developing country; however, the health status of South Africans mirrors that of countries which perform worse than South Africa on health matters. In other words the health care in South Africa is not operating at the standard it should be given the resources South Africa possesses. The cause of this may be attributed to South Africa being stuck in what is referred to as the “middle income trap” amongst other reasons.

Human Immune Deficiency Virus (HIV), which results in Acquired Immune Deficiency Syndrome (AIDS), has many manifestations. Literature reveals that some of these manifestations may compromise the infected individual’s sense of well-being and negatively impact on health related quality of life. As the number of people living with HIV/AIDS disease grows, so does the need for their care. In the early days of the AIDS epidemic, care was primarily handled by special agencies, hospitals and clinics. These agencies have been inundated with the demands of people living with HIV/AIDS, while their resources are shrinking. As it stands now, the total assistance given to people living with HIV/AIDS is provided by relatives and this responsibility of caregiving will more increasingly rest with families. This situation is particularly salient for the rural community in South Africa, which has been disproportionately affected by the AIDS epidemic. AIDS has a tremendous impact on the entire family system, particularly on the individual who has primary responsibility for caregiving. The caregiver must cope with many circumstances that are frustrating and often beyond their control. Caring for a Person Living with HIV/AIDS (PLWHA) appears to be a major stressor in the lives of caregivers, and can be very demanding, impacting on carers financially, physically, emotionally and socially. Given the lack of research on HIV/AIDS family caregiving from a salutogenic approach, this study aimed to explore and describe the sense of coherence and coping of family caregivers of HIV/AIDS patients in the Kwazakhele area in Port Elizabeth. The sample consisted of 50 participants aged between 21 and 65 years, recruited via the Kwazakhele Masizakhe Project. An exploratory-descriptive design was employed. Data was obtained by a biographical questionnaire, the Coping Resources Inventory (CRI) and the Sense of Coherence (SOC-29) Questionnaire. A non-probability convenience sample of adult male and female family caregivers were sampled. Descriptive statistics and correlation coefficients were utilized to describe and explore the coping and sense of coherence of the family caregivers and the correlation between these constructs, respectively. The data obtained from the biographical questionnaire was analysed by using descriptive statistics and frequency counts. Key findings include the following: Results from the coping resources measure indicated that this sample perceived themselves as having an average level of coping resources. The sample tended to rely more readily on spiritual resources and less on cognitive resources. Results from the SOC-29 revealed fairly high mean scores. There is no positive relationship between the SOC-29 and the CRI for the current sample. No significant relationship existed between the SOC and the subscales of the CRI. Suggestions are made for future research, the limitations and value of research were outlined.

M.Comm. / Health care in South Africa has been well described in terms of structure. However, to what extent would it be possible to describe the health care sector in South Africa in terms of that used to describe an industry? What conclusions could be drawn at the end of the study if this was or was not possible? Strong emphasis in industry analysis is placed on the nature of the competitive forces and on levels of profitability. Can the South African health care sector also be described in those terms? The following objectives can be identified in this study: To complete a literature review on the structure of health care in South Africa in terms of facilities, geographic location, services offered, manpower, financing, remuneration, population served and legislation. To complete a literature review on models and methods that can be used to analyse industries. To determine to what extent it is possible to apply Porter's model (and others) of industry analysis to the South African health care industry. To identify key success factors for the industry. To draw conclusions from the study and make some recommendations.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introduction Access to effective health care is at the heart of the discourse on how to achieve the health related Millennium Development Goals. Lesbian and gay persons are affected by a range of social and structural factors in their environment, and as a result have unique health needs that might not be met by existing health care services. Sexual stigma remains a barrier to seeking appropriate health care. Lesbians and gays might delay seeking health care when needed or avoid it all together, because of past discrimination or perceived homophobia within the health care system. Aim of the study The aim of the study was explore and describe the accessibility of primary health care services to lesbians and gays in Umlazi in the province of KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Aday and Andersons’ theoretical framework of access was chosen to guide this study. Semi-structured interviews were conducted with 12 lesbian and gay participants. The findings of this study were analysed using content analysis. Results Four major themes that emerged from the data analysis were discrimination of homosexual men and women by health care providers and community members in PHC facilities; attitudes of homosexual men and women towards health care providers; homophobic behaviour and equality of PHC services. Few participants were satisfied with the primary health care services they received. Intervention by the Department of Health, Department of Education, curriculum planners and Health Professionals Councils is recommended wherein homosexuality education should be addressed during pre-service and in-service education sessions so as to familiarise health care providers with such clients’ health care needs and to decreased homophobic attitudes.

Thesis (MBA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: This thesis researches World Class Manufacturing Techniques (WCMT) and their applicability in a Non-Production Environment such as an inbound call centre in the financial services sector. These WCMT involve a set of innovative techniques and principles, which are applied by foremost manufacturing companies. These techniques however, are not sacred and one always needs to refer back to the objectives of World Class Manufacturing, namely to (a) Eliminate waste, (b) Improve quality, (c) Shorten lead times, (d) Reduce costs, and (e) Improve morale and seek other improvements. The importance lies in attaining the objectives in the context of the necessary manufacturing tasks. Companies applying these techniques demonstrate significant productivity gains, production synergies, reduced rework and more reliable on-time delivery. In the highly competitive global market, these offer a competitive advantage for such companies. A critical and essential element of a company's strategic vision is a clearly defined and healthy competitive advantage. It is imperative that a company's vision is clearly aligned to its business objectives and goals. The WCMT is a tool that aligns the business vision and strategic objectives to realize its competitive advantage. By aligning the vision to its competitive advantage, it is crucial that the company challenge its existing production processes and the way in which it operates. Existing production processes need to be continuously reviewed and adjusted where necessary to sustain the competitive advantage. This paper is a practical example of how a non-production organisation can apply these WCMT to sustain its competitive advantage. The WCMT such as Theory of Constraints (TOC), Just in Time (JIT) and Total Quality Management (TQM) are discussed and applied in the inbound call centre of a medical aid administration company. In a relatively short time span, some remarkable sustainable productivity improvements were achieved. This would imply that these WCMT could be applied in traditional non-production environments. / AFRIKAANSE OPSOMMING: Hierdie navorsings werkstuk ondersoek Wêreld Klas Vervaardigings Tegnieke (WCMT) en die moontlike toepassing daarvan in 'n nie-vervaardigings omgewing, soos 'n inbeldienssentrum in die finansiële dienste sektor. Hierdie WCMT omsluit 'n groep innoverende tegnieke wat huidiglik aangewend en toegepas word in die meeste vervaardigings ondernemings. Hierdie tegnieke is nie beperk nie en verwys altyd terug na die doelstellings van WCMT naamlik (a) Vermindering van afval, (b) Verbetering van kwaliteit, (c) Verkorting van wag periodes, (d) Verlaging van kostes, en (e) Verbeterende personeel moraal en die voortdurende soeke na ander verbeteringe. Die belangrikheid van WCMT lê in die bereiking van hierdie bogenoemde doelwitte binne die konteks van die noodsaaklike vervaardigings metodes. Ondernemings wat hierdie tegnieke toepas vind groot produksiekapasiteit verbeteringe, produksie sinergie, 'n verlaging in die oordoen van foutiewe werk en ondervind ook grotendeels meer gereelde op-tyd aflewering. In die hoogs kompeterende globale mark bied die WCMT die broodnodige mededingende voordeel aan hierdie ondernemings. Die kritieke en belangrike bestanddeel van 'n onderneming se strategie en visie is die onderneming se vermoë om 'n deeglike en gesonde mededingende voordeel bo sy mededingers te hê. Dit is van kardinale belang dat die onderneming se visie behoorlik in lyn is met die onderneming se strategiese doelwitte. Hierdie WCMT is 'n instrument wat die onderneming kan aanwend ten einde sy visie en strategiese doelwitte, asook sy kompeterende voordeel, te bereik. Dit is krities belangrik dat 'n onderneming se visie en sy kompeterende doelwitte gesinkroniseer en gelykgestel is en verder dat die onderneming ook sy huidige produksie prosesse herevalueer, asook die manier waarop die onderneming opereer. Huidige produksie prosesse moet voortdurend geherevalueer en aangepas word waar nodig, ten einde die onderneming se voortdurende kompeterende voordeel te behou. Hierdie navorsings stuk is 'n voorbeeld van die praktiese toepassing van WGMT en hoe hierdie tegnieke 'n onderneming behulpsaam kan wees ten einde sy kompeterende voordeel te behou. Die WGMT soos die Teorie van Beperkings (TOC), Net Betyds (JIT) en Totale Kwaliteit Beheer (TQM) word deeglik ondersoek en bespreek. Die navorser ondersoek voorts die moontlikheid om hierdie tegnieke toe te pas in 'n in beldienssentrum by 'n administrateur van mediese fondse. In 'n relatiewe kort periode het die navorser noemenswaardige en voortdurende produksie verbetering teweeg gebring deur die toepassing van WGMT. Die navorser het afgelei dat hierdie WGMT nie net beperk is tot die vervaardigings sektor nie, maar dat dit ook in die nie-vervaardigings sektor doeltreffend aangewend kan word.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

Thesis (MBA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Since the first democratic elections in 1994, the emphasis in corporate and public life has been on transforming practices previously advocated by the apartheid government. As the service provider to the public there has been significant emphasis placed on the major sectors such as health and education. In addition to policy documents which focus specifically on health service delivery and the transformation envisaged, policy has also extended to transforming service delivery in all sectors of government. In designing policy for the transformation initiative little if any attention has been paid to the particular needs of the health sector as a whole and the public health sector in KwaZulu-Natal. Research conducted revealed that most employees were unaware of the results required in order to effect transformation within the public health sector of KwaZulu-Natal. To effect change and transformation, an internal marketing strategy and plan had to be designed. This strategy and plan would align the activities of each and every employee to the vision, mission and values of the KwaZulu-Natal Department of Health. The plan seeks to address issues such as performance management, communications, control, and budgeting considerations in order to market transformation to the 52 000 employees of the Department who serve the health needs of 26 percent of the country's population. / AFRIKAANSE OPSOMMING: Sedert die eerste demokratiese verkiesing in 1994 val die klem in beide die korporatiewe en publieke sektore op die transformasie van gebruike/praktyke wat voorheen deur die apartheidsregering onderskryf is. As openbare diensverskaffer is daar aansienlike klem geplaas op sekere hoofsektore soos gesondheid en onderwys. Bo en behalwe beleidsdokumente wat spesifiek fokus op dienslewering en die beoogde veranderings in gesondheid, is beleid ook uitgebrei om verandering in dienslewering in alle regeringsektore in te sluit. In die ontwikkeling van beleid vir die transformasie inisiatief, is weinig of geen aandag geskenk aan die spesifieke behoeftes van die gesondheidsektor in die algemeen en spesifiek die openbare gesondheidsektor in KwaZulu-Natal. Navorsing bevind dat die meeste amptenare onbewus is van welke resultate nodig is om transformasie in die openbare gesondheidsektor in KwaZulu-Natal te verseker. Ten einde verandering en transformasie te laat plaasvind, was dit nodig om 'n interne bemarkingstrategie en-plan te ontwerp. Hierdie strategie en plan sal die aktiwiteite van elke amptenaar fokus op die visie, missie en waardes van die Departement van Gesondheid van KwaZulu-Natal. Die plan poog om aangeleenthede soos prestasie-bestuur, kommunikasie, kontrole en begrotingsimplikasies aan te spreek en sodoende die transformasieproses te bemark aan die 52 000 werknemers van 'n Departement wat die gesondheidsbehoeftes van 26 persent van die land se bevolking bedien.