Introduction Midwifery obstetric units (MOUs) have been established in South Africa in response to the health needs of pregnant women. Although various types of MOUs currently exist, the function of the MOU and the quality of midwifery care rendered, have never been documented. This study aims to describe and compare four different types of MOUs in the Pretoria region. This will contribute towards providing and evidence base, needed for effective policy-making. The researcher believes that MOUs should play an important role in the reduction of maternal morbidity and mortality. Methods and procedures A comparative and descriptive design was used to reach the aim of the study. Both qualitative and quantitative methods were used, to contribute to a comprehensive picture of the functioning of MOUs and midwifery care rendered. Three objectives were set at the onset of the study. Objective one was to describe and compare the function of the MOUs with regard to: specific criteria: the number of admissions, the number of referrals, the number of deliveries, birth mass of babies delivered, number of perinatal deaths before admission and after delivery, neonate deaths, episiotomies rate, oxytocin use, pain relief rate, apgar score at 5 minutes of <8, neonatal referral rate, pregnancy complications (e.g. postpartum haemorrhage, retained placenta, birth trauma), management of third stage of labour, fetal monitoring type (doptone, Pinard stethoscope), referral criteria of each institution, indication for referral, and compliance to management protocol. Objective two was to describe and compare staffing and work load, which include the number of staff per shift in the labour ward, number of deliveries per shift, level of training, number of midwives with PEP training, number of advanced midwives, and availability job description of staff in labour ward. Objective three dealt with the description and comparison of the quality of care, with specific regard to the quality of the partogram and patient satisfaction. Triangulation of data collection methods were used to ensure trustworthiness of data. To attain the objectives, stated above, the data collection methods included: monthly statistical forms for objective one, structured individual interview with unit managers and job analysis of all categories of staff in the MOU, for objective two and for objective three a structured individual interview with patients was used to determine patient's satisfaction, and an audit of the partogram, to determine quality of care. A sample of four MOUs in the Pretoria region was purposively selected, because of their unique characteristics, resembling four different types of MOUs. To achieve objective one, statistics were obtained for a twelve-month period. To attain objective two a convenient sample of unit managers of the four MOUs were used. To attain objective three, a simple random sampling was used, to select patients' records (n=50) from each MOU, a total of (n=200) 200 records were selected. Convenient sampling was done for the interviews with patients, (n= 120) and again, a further interview was held with patients who bypassed the MOUs, of a period of 2 months. The content validity of the statistical form was based on the current format used in the MOUs and according to the "Guidelines for Maternity Care in South Africa" (Department of Health). The interview guide, used for interviews with the unit managers, was structured according to the study objectives. The interview guide, used to interview the patients, was based on an instrument developed by Steyn (1998), to assess patient's satisfaction in antenatal care, and adapted for the purpose of the study. All the methods used for data collection was tested during a pilot study. Descriptive and inferential statistics, as well as Tesch's approach towards the analysis of qualitative data, was used to examine differences between the four MOUs. Within the scope of this study, the researcher does not intend to generalize the findings. Conclusion The uniqueness of the study lies in the relevance of MOUs in the provision of maternity care, as one of the priorities of National Health. Up to date, little scientific knowledge is available on the functioning of the MOUs, In the Pretoria region. This study provides valuable information for the functioning of MOUs to effectively manage resources, and improve the quality of maternal care. It may further assist midwifery educators, to embark on hands-on, training on site, approach on the management criteria of each institution, indication for referral, and compliance to management of women in labour. / Dissertation (MSc (Advanced Midwifery and Neonatal Care Nursing Science))--University of Pretoria, 2005. / Nursing Science / unrestricted

A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, November 2015 / The aim of this study was to give an account of what it means to be a hospital consultant in a national health service that has been undergoing change for almost three decades. Classic grounded theory was used to identify the main concern of hospital consultants sampled for the study and how they resolved this concern on a routine basis. Data were obtained from three sources: interviews, observation and document analyses. Classic grounded theory procedures of constant comparison and theoretical sampling were used and Rolling with the Punches emerged as the pattern of behaviour through which the hospital consultants dealt with their main concern, which was managerialism. Rolling with the Punches involves four modes: Stabilising Temporarily, Resisting, Limiting the Impact and Adjusting to/Living with. The mode of behaviour was contingent on a central and on-going Weighing-up process, in which the hospital consultants used their personal narratives, beliefs and commitment structures to make sense of what was happening and what they could possibly do about it. Hence, the mode of behaviour was contingent, historicised and in flux. The Weighing-up process can set off triggers that can lead to a change of mode that need not be linear. Key words: doctors, managers, grounded theory, weighing up, stabilising temporarily, resisting, subverting, quibbling, limiting the impact, lying low, faking it, living with, adjusting to, going with the flow, complying, waiting it out. / MB2016

The Department of Health (DOH) has embarked on a noble initiative to address the disproportionate distribution of resources and spending within the public and private healthcare sectors. Social Health Insurance (SHI) has thus been mooted as the vehicle to obtain a more equitable healthcare dispensation. This thesis explores the state of preparedness of the DOH, for the implementation of SHI. Ten aspects of health have been identified which will assist in determining if sufficient reforms have been implemented to facilitate the successful implementation of SHI. The prospective mechanism of financing of SHI is compared to the highly acclaimed model employed by the Australian Department of Health. Two research methodologies have been utilized viz. the case study approach and semi structured interviews, to provide comprehensive data. This enabled the researcher to adequately answer the research question. The responses from the respondents on the 10 aspects of healthcare have been arranged into themes to facilitate a greater understanding of the issues being highlighted. Established strategic management instruments have been utilized to analyze the data obtained and evaluate the preparedness of the DOH for the implementation of SHI. Following the data analysis, recommendations are proposed that would facilitate the successful implementation of SHI, thereby promoting its viability and sustainability in providing quality healthcare to all who call South Africa home. / Thesis (MBA)--University of KwaZulu-Natal, 2006.

Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

South Africa has a complex healthcare system. The provision and financing of health care in South Africa occur within two fundamentally different systems: the public healthcare sector and non-governmental not-for-profit organisations, on the one hand, and the private healthcare system, on the other hand. The socioeconomic status of an individual in South Africa is the primary determinant of the system through which he or she will receive access to healthcare. The healthcare services provided by the public and private sectors are perceived to be unequal. The introduction of healthcare reforms by the South African government through the National Health Insurance (NHI) aims to address these disparities. The primary objective of this study was to contribute to the successful implementation of the proposed South African NHI by identifying critical success factors that would impact such implementation. A sample of managerial representatives of the following healthcare institutions in the Nelson Mandela Bay Municipality (NMBM) was drawn: Large private hospitals groups; Eastern Cape Department of Health; Independent medical practitioners groups; South African Dental Association; Pharmacy Association of South Africa; Optometrist Association of South Africa. A total of 250 questionnaires were distributed among these institutions and approximately 233 usable questionnaires were returned (response rate 93.2 percent). A literature review was conducted to identify the various viewpoints (critical success factors, as well as positive and negative perceptions) on NHIs in other countries, as well as the proposed one in South Africa. About 43 of such viewpoints were identified. The 233 respondents were surveyed on these 43 viewpoints. The empirical results revealed the following three critical success factors for the successful implementation of the South African NHI: The projected benefits for stakeholders, with specific reference to medical aid schemes; the projected benefits to the private healthcare sector in servicing the public sector; and strategic leadership. The empirical results also showed that the healthcare managers, who serve the poor versus the affluent geographical areas of the NMBM, differ with regard to their projected success of the NHI. Finally, the study highlighted these health managers’ general perceptions about the envisaged benefits and shortcomings of the NHI.

This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)

This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)