The research problem in this study was to look at barriers confronting small and micro tourism enterprises of the previously disadvantaged entrepreneurs in the Nelson Mandela Metropole. To achieve this objective, literature on the barriers confronting these enterprises, was reviewed. The empirical results obtained indicate a strong concurrence with the literature study emphasizing the importance of the barriers identified and the possible ways of resolving them. The main problems identified in the literature review were: lack of institutional support, legislation, lack of access to finance, and lack of entrepreneurial skill (planning and organizing, marketing, training and human resources, time management, conflict resolution and negotiation skill). These barriers identified in the literature study were then used to develop a questionnaire to test the extent to which small and micro tourism enterprises are constrained by barriers when starting up and how these barriers can be resolved. A sample of 18 small and micro tourism businesses was taken, one from Uitenhage and 17 from Port Elizabeth. The main results were that there are few small and micro tourism businesses of the previously disadvantaged entrepreneurs in the Nelson Mandela Metropole. The main reason for this is that previously disadvantaged entrepreneurs are not given adequate support by government institutions created for that purpose. iv Most of these businesses are not getting enough financial support during start-up because of problems with the owners’ credit records. The results also indicate that small and micro tourism businesses of the previously disadvantaged entrepreneurs view legislation intended to develop them, as actually stifling their development, such as the municipal credit laws. The study recommends that more institutional support should be given to small and micro tourism businesses that are starting up, and government institutions responsible for the development of small and micro businesses need to target the previously disadvantaged communities with their marketing. The Nelson Mandela Metropolitan Municipality and the Small Enterprise Development Agency (SEDA) need to conduct research on alternative non-collateral financing for small and micro businesses. More training programmes on business skills have also to be conducted.

The harsh realities currently facing public hospitals such as budget cuts, understaffing and poor working conditions, have resulted in nurses experiencing low morale and finding it increasingly difficult to stay in the public health sector. The obvious targeting of South African nurses by recruitment agencies with job offers to work overseas is causing a massive skills’ drain that the country cannot afford. The situation is further compounded by the fact that the government is freezing posts of those nurses who have resigned. Consequently, nurses who are currently working in these hospitals have to cope with unreasonable workloads. Public hospitals are nowadays faced with the challenge of delivering quality health care within the constraints of gross staff shortages, and an increasingly competitive global health environment. The main objective of this study was to identify strategies that can be implemented by hospitals in order to reduce turnover, thereby enhancing retention of staff. Interviews were conducted with the matrons-in-charge of the hospitals under study to investigate strategies that are in place to improve retention. Secondary data regarding staff turnover in the hospitals under study was collected and analysed. It emerged that there are no concrete strategies in place to lower turnover. Hospitals are indeed experiencing staff turnover and posts that were vacated by those nurses that have resigned are frozen. The literature survey revealed three strategies that can be utilised to retain employees, namely, motivation strategies, effective leadership strategies and human resources strategies. Based on various literature reviews, it was concluded that the three strategies are interrelated. The empirical survey was conducted at the three selected hospitals, to determine the extent to which the retention strategies identified in the literature survey are being utilised. All three are invariably used in the hospitals. It is evident that the leadership behaviour in these hospitals affects the level of motivation of employees. The extent to which some of the human resources strategies are utilised invariably leads to low morale and dissatisfaction among employees. Lastly, research findings were assessed with the aim of drawing conclusions so that appropriate recommendations could be made. Recommendations focused on the retention strategies that can be implemented to boost morale of employees and enhance retention.

The purpose of this study was to study marital turnarounds by focusing on the exploration of the reasons for couples remarrying each other. A comprehensive approach based on human ecology provided a framework for exploring the reasons for marital turnarounds ranging from micro to macro level factors. Data was collected through six semi-structured interviews, with two African marital turnaround couples from the Nelson Mandela Metropole. Data analysis was carried out systematically through a stepwise process. Data verification and trustworthiness was also performed. Five major themes emerged from the data analysis of the interviews as follows: Culture and religious influences, individual influences, personal growth, family influences and the influence of friends. Culture and religion emerged as powerful theme in shaping decisions about marital turnaround. An important sub-theme was that, in a culture that continues to value marriage as a permanent commitment, spouses internalised the social and religious norm of marriage as a permanent commitment.

Presently in the South African automotive industry competition is becoming more fierce. It is becoming more important for companies to concentrate on thier competitive strategies to ensure that they remain competitive in this industry. Military strategy techniques have always been successful in defeating an anemy opponent. An enemy in a military sense could be considered as a competitor in a business sense. There is currently a potential for an improvement of the competitive strategies that South African organisations, in particular the South African automotive industry uses to remain competitive. Military strategists such as Sun Tzu and Carl von Clausewitz have provided valuable strategy theories and philosophies to many military institutions. Military strategies such as Attrition and Maneuver have long been used by these institutions in battle to defeat the enemy. Military strategies could provide the edge that companies ranging from manufacturers, suppliers of components and dealerships need, to remain competitive in the automotive industry.

The purpose of this study was to measure and evaluate GPs' practices, perceptions, and beliefs with regard to chronic childhood asthma management and to identify GPs' attitudes towards practice guidelines in particular the SACAWG (South African Childhood Asthma Work Group) guideline (Motala et al., 2000). In 2001 a single period cross-sectional survey was conducted among 300 GPs in the Nelson Mandela Metropole (NMM) which comprised the Port Elizabeth, Uitenhage, and Despatch regions. GPs in clinical practice in the NMM were identified from the register of the Health Professions Council (HPC) CD-ROM (2000). The register contains names and professional information on all physicians in South Africa who have completed or in the process of completing requirements to practice medicine. GPs meeting the following criteria were identified: (1) primary self-designated practice specialty of general practice; (2) practice location in Port Elizabeth, Uitenhage, and Despatch areas; and (3) engaged in direct patient care. The HPC register contained listings for 300 GPs that matched the study criteria. Data were collected by means of a structured self-administered questionnaire. Questionnaires with a return envelope were mailed to the GPs' practices. Questionnaires were returned by 89 of the 300 eligible NMM GPs, reflecting a 29,7 % response rate. A 43-item Chronic Childhood Asthma Management questionnaire was developed and validated to assess the delivery of asthma care by GPs in the NMM. Forty-four per cent of the respondents reported performing spirometry on patients with newly diagnosed asthma as part of their initial evaluation. For patients with moderate persistent asthma prescribing of inhaled corticosteroids (ICSs) varied by patient age, with 57,4% of physicians routinely prescribing them for patients < 5 years, compared with 76,5% of physicians prescribing them for patients 5 years. Awareness of the SACAWG guidelines among these GPs was high, with 76,8% reporting that they have heard of the guidelines, and 59,4% reporting having read them. 14,5 per cent of the GPs reported developing written treatment plans for patients with moderate or severe asthma. To achieve the best results with their asthma patients, 68,1% of the physicians reported that patient compliance was imperative, 49,3% reported education as the most important, pharmacotherapy / good products was reported as most important by 29,0% of the group, environmental control was cited by 18,8% of the GPs. Several aspects of the SACAWG guidelines appear to have been incorporated into clinical practice by GPs in the NMM, whereas other recommendations do not appear to have been readily adopted. This information suggests areas for intervention to improve primary care for asthma in the NMM.

At present, the Eastern Cape is the only province in South Africa lacking a clinical hospital-based hyperbaric facility. East Cape Hyperbaric, to be situated at Greenacres Hospital in the Nelson Mandela Metropolitan, will offer the Eastern Cape community access to a world-class facility that will offer their patients Hyperbaric Oxygen Therapy and a Wound-Healing Facility. The objective of this study was to assess the viability of establishing a Hyperbaric Oxygen Therapy (HBOT) facility for the Nelson Mandela Metropolitan Municipality (NMMM), using sound business planning principles. A business plan precisely defines the business, identifies the goals, and serves as the firm's resume. A business plan will assist in allocating resources effectively, handle unforeseen complications, and assist in making sound business decisions. Because it provides specific and organized information about the company and how the company will repay borrowed money, a good business plan is a crucial part of business planning. In order to quantify the demand for a Hyperbaric Oxygen Therapy facility, a questionnaire was designed, in such a manner as to identify the current demand for a HBOT facility. The questionnaires were distributed to all medical practitioners within the NMMM by means of fax, e-mail and hand-delivery. Research conducted indicates that the results are promising enough to warrant the expedient creation of this business facility.

Managing cultural differences in today’s work environment has received the attention of researchers all over the world. What has received far less attention is the managing of the cultural differences between service provider workers and customers and how this is perceived to lead to achieving great service quality. This research project focuses on the cultural differences between culturally diverse South African service provider workers and South African customers, with some reference to international customers. The questionnaire used in this research includes questions embodying the service quality instruments developed by Parasuraman, Zeithaml, and Berry (1988) and Hofstede’s (1991) cultural dimensions. The questionnaire was completed by 81 students of the East Cape Midland College in the Nelson Mandela Metropole. A Pearson’s correlation coefficient was calculated for each service quality instrument and each cultural dimension. The resulting correlation coefficients were analysed and a positive or negative correlation between each service quality instrument and each cultural dimension is shown. The implications of each positive and negative correlation are shown and how it impacts on perceived service quality delivery. The implications for service quality management are shown, followed by recommendations for the management of a culturally diverse workforce.

About 30.00% of schizophrenic patients fail to respond to conventional antipsychotics. Clozapine shows superior efficacy, for both the positive and negative symptoms of schizophrenia, over conventional antipsychotics. The reputation of clozapine lies mainly with its repeated proven efficacy in the treatment of refractory schizophrenia. However, clozapine has quite a severe side effect profile. Patients receiving clozapine therapy may develop serious adverse effects such as agranulocytosis, neutropenia and metabolic syndrome. Therefore guidelines are required which recommend that regular haematological and metabolic monitoring be performed. These monitoring guidelines should assist medical practitioners in the early detection and reporting of serious adverse effects associated with clozapine therapy. South Africa lacks uniform provincial or national guidelines regulating practices in the treatment of mental disorders. International guidelines may be considered, which are not specifically adapted for the South African setting. These guidelines recommend both the haematological and metabolic monitoring of clozapine. At present there are no South African guidelines recommending the metabolic monitoring of clozapine. The general aim of the study was to determine the prescribing and monitoring patterns of clozapine at Elizabeth Donkin Hospital in the Nelson Mandela Metropole. Due to the absence of specific South African guidelines and the severe side effect profile of clozapine, some of the research objectives were to determine whether the initiation of clozapine, as well as the haematological and metabolic monitoring performed, was compliant with international clinical guidelines. In this pharmacoepidemiological study a retrospective drug utilisation review was performed. The study was observational in design and included quantitative data. Data were collected from the files of 65 patients (N=65) discharged on clozapine between 1 December 2010 and 29 February 2012. Follow-up investigations were performed at the clinics and long-term care centres both three months and six months after discharge. In 52.30% (n=34) of the cases clozapine was previously prescribed. Compliance with the National Institute for Health and Clinical Excellence (NICE) guidelines for the appropriate initiation of clozapine was 63.10% (n=41). Compliance with the Standard Treatment guidelines for the initiation of clozapine by a psychiatrist was 63.10% (n=41). Noncompliance with the recommended guidelines for haematological monitoring occurred in 77.40% of patients in the hospital setting (n=48) as well as in 95.70% of patients during the three-month follow-up at the clinics (n=44). Non-compliance with the guidelines for metabolic monitoring occurred in all the observed patients in the hospital setting (n=62) as well as in 45.70% of patients in the clinic setting (n=21). It was found that 71.00% (n=46) of patients were still on clozapine three months after discharge and 65.00% (n=42) were still on clozapine six months after discharge from hospital, resulting in discontinuation rates of 29.00% and 35.00% respectively. It was found that clozapine was inadequately monitored although in most cases the initiation of clozapine was compliant with the recommended guidelines. However, practitioners should be trained on the existing prescribing and monitoring guidelines to promote the rational use of clozapine in the public health sector of South Africa. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

About 30.00% of schizophrenic patients fail to respond to conventional antipsychotics. Clozapine shows superior efficacy, for both the positive and negative symptoms of schizophrenia, over conventional antipsychotics. The reputation of clozapine lies mainly with its repeated proven efficacy in the treatment of refractory schizophrenia. However, clozapine has quite a severe side effect profile. Patients receiving clozapine therapy may develop serious adverse effects such as agranulocytosis, neutropenia and metabolic syndrome. Therefore guidelines are required which recommend that regular haematological and metabolic monitoring be performed. These monitoring guidelines should assist medical practitioners in the early detection and reporting of serious adverse effects associated with clozapine therapy. South Africa lacks uniform provincial or national guidelines regulating practices in the treatment of mental disorders. International guidelines may be considered, which are not specifically adapted for the South African setting. These guidelines recommend both the haematological and metabolic monitoring of clozapine. At present there are no South African guidelines recommending the metabolic monitoring of clozapine. The general aim of the study was to determine the prescribing and monitoring patterns of clozapine at Elizabeth Donkin Hospital in the Nelson Mandela Metropole. Due to the absence of specific South African guidelines and the severe side effect profile of clozapine, some of the research objectives were to determine whether the initiation of clozapine, as well as the haematological and metabolic monitoring performed, was compliant with international clinical guidelines. In this pharmacoepidemiological study a retrospective drug utilisation review was performed. The study was observational in design and included quantitative data. Data were collected from the files of 65 patients (N=65) discharged on clozapine between 1 December 2010 and 29 February 2012. Follow-up investigations were performed at the clinics and long-term care centres both three months and six months after discharge. In 52.30% (n=34) of the cases clozapine was previously prescribed. Compliance with the National Institute for Health and Clinical Excellence (NICE) guidelines for the appropriate initiation of clozapine was 63.10% (n=41). Compliance with the Standard Treatment guidelines for the initiation of clozapine by a psychiatrist was 63.10% (n=41). Noncompliance with the recommended guidelines for haematological monitoring occurred in 77.40% of patients in the hospital setting (n=48) as well as in 95.70% of patients during the three-month follow-up at the clinics (n=44). Non-compliance with the guidelines for metabolic monitoring occurred in all the observed patients in the hospital setting (n=62) as well as in 45.70% of patients in the clinic setting (n=21). It was found that 71.00% (n=46) of patients were still on clozapine three months after discharge and 65.00% (n=42) were still on clozapine six months after discharge from hospital, resulting in discontinuation rates of 29.00% and 35.00% respectively. It was found that clozapine was inadequately monitored although in most cases the initiation of clozapine was compliant with the recommended guidelines. However, practitioners should be trained on the existing prescribing and monitoring guidelines to promote the rational use of clozapine in the public health sector of South Africa. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Masters of Art / This project suggested that HIV people in Region A (Nelson Mandela Metropole, formerly Port Elizabeth) health district of the Eastern Cape, seek HIV testing when they are already in stages three (late disease) and four (AIDS) of HIV infection. Data had been obtained from the AIDS Training Information and Counselling Centre in the Nelson Mandela Metropole in 2000. The consequences of diagnoses only in the advanced stages of HIV infection will have a devastating impact on case management. Therefore, this paper yielded important data for South African policy makers to write health and welfare policies that might improve the quality of life of those terminally infected with HIV. / South Africa