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A research report submitted to the Faculty of Management, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Management (in the field of Public and Development Management). / This thesis attempts to look at delinkage and decentralisation in health care reforms taking place in Zambia. While an attempt has been made to look at the international context, the main focus is on Zambia with its donor issues, manpower constraints and liquidity problems. The issues are looked at through the actors in the reform process. The findings are interpreted in light of organisational and administrative factors, behavioural factors, political circumstances and the financial and human resource situation. Zambia's reform efforts are viewed in the light of current worldwide trends is health care reform. / AC2017

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, September 2013 / ABSTRACT Background: Education, training and development plays a critical role in the socio-economic development of any nation. South Africa as a country is faced with ever growing challenges to produce the human resources (HR) that will contribute meaningfully to its economic stability and prosperity. In addition, for the Public Service to succeed in its mandate of providing effective and efficient service delivery for the citizens of the country, it needs to invest in training and development of its employees. For example, in terms of health services, a hospital is supposed to be comprised of multi skilled personnel so that it is able to deliver a package of health services to its population. In the Lehurutshe/Zeerust District Hospital Complex it is necessary to assess the skills of employees and develop them where necessary. Aims: To describe the levels of education and training of employees working in Lehurutshe/Zeerust Hospital Complex in 2011 and their future training needs to inform the skills development plan (SDP) for the Hospital Complex Methodology: A cross sectional study design based on a retrospective record review was used for this study. The setting of this study was Lehurutshe/Zeerust Hospital Complex in Ngaka Modiri Molema District in the North West Province. The study populations were the employees employed at the hospital complex at the time that the skills audit was conducted. This audit of hospital complex employees was conducted by the Human Resources Department (HRD) in April 2011. The data related to the study was retrieved from the skills audit documentation using a data collection tool. Data on the following variables was collected: profile of employees, their formal and informal education and their training needs. The collected, validated data was analysed using the Epi- Info 8 software. Results: Out of three hundred and fourteen (314) employees working at the hospital complex, only one hundred and twenty two (39%) completed the skills audit survey from the HRD. The data provided an overview of current training and education of employees and their future needs. Out of 122 employees who responded to the skills audit, sixty-two had post matric qualifications. Most of the post matric qualifications were in nursing field. Eleven employees (9%) are currently registered for post matric qualifications. Most of the employees completed grade twelve at 64.2 percent and only 1 (0.8%) was registered to advance their schooling. Twenty (16.4%) employees received informal training outside of the hospital whilst 52 (43%) employees received training that was inside the hospital, and training outside the hospital occurred less frequently. Sixty-two employees (51%) wanted to have more training and specified the type or types of training they wanted to have. Clinical type of training was at 65%, academic type of training was at 55% and management and communication types of trainings were at 60% each. Conclusion: The study did not only provide the hospital and provincial management with input in relation to the training and development of its staff, but will also serve as a basis for the department’s SDP. The SDP is meant to assist employees of the Hospital Complex, through training and education, to optimally provide patient care and ultimately improve services. The information and the recommendations made from the research will assist the health planners at various levels like the district, provincial and national level, in prioritizing training and development for health employees.

by Colin Wong Chung. / Bibliography: leaf 68 / Thesis (M.B.A.)--Chinese University of Hong Kong, 1985

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<p> The movement toward an integrated approach to healthcare professionals' education, interprofessional education (IPE), has been advancing over the past 60 years in the United Kingdom, Canada, and more recently in the United States. Support for IPE as a mechanism to positively impact collaborative practice and patient outcomes comes from international and national healthcare and educational leadership agencies as well as professional medicine and nursing thought leaders. Theories have evolved to explain the linkages among IPE, collaborative practice, and positive patient outcomes. Researchers have found support for the short term positive impact of IPE on attitudes, perceptions, clarity about roles and responsibilities and knowledge acquisition. However, there is little evidence that demonstrates the link between pre-licensure IPE and professional staff outcomes. In spite of the lack of evidence, many pre-licensure IPE programs continue to be developed and the number of programs is growing. Determining a clear connection between IPE and patient outcomes is unrealistic because of multiple potential intervening variables; however, there is an opportunity to assess the impact of IPE on collaborative practice. </p><p> This grounded theory study was conducted to conceptualize the social process that explains nurse and physician collaborative practice development process as described by those who have experienced formal IPE. A total of 21 clinicians (14 registered nurses and seven medical doctors) who graduated from three university IPE programs participated in interviews and shared their experience from their first months in professional practice to their current experience. The core category, which emerged from the data, was Getting on the Same Page. A model of nurse and physician collaborative practice development also emerged from the data with ten categories that explain the progression of the model. These additional categories explained stages of development over time and include <i>Understanding Others' Roles; Learning to Work Together during the educational experience; Being Nervous, Intimidated, and Frustrated; Recognizing Important Information; Relating to One Another during early practice; Coming Together; Knowing Each Other; Feeling More Comfortable and Confident; Going Back and Forth; and Being a Team in later practice.</i> </p><p> The theory of Getting on the Same Page supports and informs design of interprofessional learning and contributes to a greater understanding of the important link between education and practice. This study will facilitate opportunities for future research as well as education and practice alignment. </p><p>

This research focuses on the ways in which teaching assistants are deployed to support learning in secondary schools and investigates the effect of the different deployment approaches used. Much of the previous policy and research literature conceptualises the relationship between the teacher, teaching assistant and learner as tripartite and hierarchical - a three-way relationship in which the teacher has the major responsibility for promoting learning. Key debates in the literature include whether teaching assistants make a positive contribution to learning, represent good value for money or have an impact on educational attainment. The lack of consensus provided the impetus for this case study which contributes further to the debate. In this case study, the theorisation of the teaching assistant's role is grounded in the constructivist theories of Vygotsky and Bruner and, to a lesser extent, of Piaget. The role is also considered in the light of the theories of Bandura, Malaguzzi, Black & William and James et al. In the classroom this means that the learning is not only focused on what the teaching assistant does to support learners but also how learning is supported through the use of specific approaches. The study suggests that some models of deployment allow teaching assistants more scope to work in particular ways which offer more opportunities for learning. Methodologically, the research takes the form of an exploratory case study. The study was completed within the defined boundaries of three schools and seven lessons. Unlike previous studies which have taken predominantly quantitative approaches and provide a focus on the measurement of learners' attainment, this case study takes a wholly qualitative approach in order to focus closely on the interaction between teachers, teaching assistants and supported learners and how particular models of deployment support learning. The case study involved six teachers, seven teaching assistants and fourteen learners from three state comprehensive schools, located in one local authority. Different deployment models were observed. These included the more typical model where teaching assistants were deployed to support individuals, pairs or groups of learners within the classroom or to work in a different location with a small group of learners withdrawn from the class. Also observed was a higher level teaching assistant team teaching with a teacher in the classroom and a ordinary level teaching assistant deployed in managing a learning support facility and working independently from the teacher. Data were collected through a four stage approach that began with joint semi-structured interviews with pairs of teaching assistants and teachers. Joint interviews were followed by lesson observations. Following this, teachers and teaching assistants were interviewed separately in order to obtain their individual perceptions of the learning of supported learners in the lesson. Lastly, group interviews were conducted with supported learners to obtain their views on the support they had received. The different data sources were examined using four perspectives to identify the various ways in which teaching assistants were being deployed and how these supported learning. The case study provided a range of qualitative data from which it was possible to explore the complexities of the relationships between teachers, teaching assistants, and learners and to identify models of teaching assistant deployment which allow them to contribute more fully to learning. The study also highlighted the importance of building professional relationships. It concluded that the lack of planning between teachers and teaching assistants, the unavailability of training for teachers on managing the work of teaching assistants and for teaching assistants on supporting learners, all have a negative effect on support for learning. The learners suggested that they appreciated the academic and pastoral help they were given while also being able to provide examples where learning was over-supported and, therefore, detrimental to intellectual independence. The study, therefore, has implications at different levels - for example, for policy makers and institutions who determine roles, models of deployment and the training and management of teaching assistants when they are working both inside and outside of the classroom.

Quality is now at the centre of education policy and teacher performance is seen as critical to the enhancement of learning outcomes. Quality has become a particular priority in the developing world following two decades of expansion of access driven by the Education for All (EFA) movement. Teacher quality, performance and effectiveness are widely thought to be dependent on a complex combination of competency and motivation. However, studies have remained heavily focused on competency-related issues, resulting in the neglect of a deeper understanding of motivation in relation to incentives and context. This omission is particularly glaring in the case of research on developing countries – and Cambodia, the focus of the present study, is no exception. This study therefore investigates the complex relationship between teacher motivation and incentives on the one hand, and motivation and context on the other, exploring how teacher characteristics mediate these relationships. This study defines the ‘motivated teacher' as an individual who strives for goals that are closely associated with those of the school in which he or she teaches. To examine these relationships, the study employs a mixed methods approach, combining analysis of national survey data and semi-structured interviews; drawing on responses from a survey of 676 teachers, classroom observations of 284 teachers, and follow-up interviews with 18 teachers. Quantitative datasets reveal larger patterns of association between teacher incentives and motivation, and the qualitative dataset offers a deeper understanding of the phenomenon. This mixed methods approach itself is seen as one part of the contribution of this research: it helps deepen and enrich current understandings of teacher motivation, opening the door for policies that are more sensitive to diverse contexts. The study found that the meeting of basic needs such as an adequate working environment and living salary was insufficient to satisfy most Cambodian teachers. Indeed, it emerged that salary levels were as low as those of factory workers, a situation that leads to the perceived low social status of teachers. Moreover, the data indicate that while teachers – particularly those who work in rural and remote areas – do identify the work environment as a critical motivator, this in itself cannot guarantee sustained motivation. Beyond such basic incentives, the active support of the school director was identified as the most significant motivator across age groups and regions. Two additional factors were also found to be significant, but differed according to age group: firstly, recognition from community and colleagues is most important to mid-career teachers; and secondly, professional development opportunities represent a strong motivator among newly assigned teachers. Within this complex nexus of incentives and motivation, the study found initial intrinsic commitment and motivation to become a teacher to be a consistently powerful factor in shaping higher motivation throughout a teacher's career. This was associated with the impact of incentives on motivation; indeed, the data suggest that newly assigned teachers tend to have higher intrinsic motivation than those who have been in the profession for more than ten years. Thus, the thesis proposes that the same incentives can have different effects on teacher motivation, depending on whether or not the individual is intrinsically driven to enter the profession, and on his or her length of service. The thesis concludes by proposing the following education policy reforms: (i) improvement of basic working conditions and a raise in the salary level; (ii) strengthening of instructional support; (iii) revision of entry requirements for the ‘good teacher award', with greater focus on mid-career teachers; (iv) greater provision of in-service training, as well as induction support for new teachers; and (v) reformation of the current entrance examination for teacher training institutions with greater emphasis on strong intrinsic motivation. Finally, this study seeks to open up further avenues for future research in the area of intrinsic teacher motivation by identifying the phenomenon as a contributory factor in education delivery, and drawing attention to how this variable has hitherto been absent from research on developing countries.