The Canadian Council of Ministers of the Environment (CCME) developed guidelines for petroleum hydrocarbon (PHC) impacted field soils based on the “worst case” scenario of a fresh petroleum spill (CCME, 2001b; CCME, 2008b). Therefore, when these guidelines are applied as remedial benchmarks, they may be too conservative to be used as realistic targets as they do not account for weathering, which has been shown to decrease the toxicity of PHCs in soil. Chronic toxicity tests were performed using weathered PHC-impacted field soil from three different field sites (ON1, AB1 and BC1) and Folsomia candida. The highest PHC concentration of soil obtained from ON1 (635 mg/kg F2 and 12,000 mg/kg F3) and AB1 (610 mg/kg F2 and 2,900 mg/kg F3) did not affect F. candida survival and reproduction. However, when F. candida were exposed to PHC-impacted soil obtained from the BC1 site, a LC25 of 2,809 mg F2 + F3/kg was calculated for adult survival while an IC25 of 1,030 mg F2 + F3/kg was calculated for juvenile production. The toxicity at BC1 was postulated to be caused by the F2 concentration (it was the only site with high F2). Heat extraction and floatation methods were compared using the soil obtained from the ON1 field site. The number of adults obtained using the floatation method was always higher than the total number of adults obtained from the heat extraction method; however, only two of these results were statistically significant. This suggests that the floatation method is the best method to use to extract Folsomia candida and also indicates either method can be used with no significant effect on the conclusions. Chronic toxicity tests usually focus on measuring sub-lethal endpoints; however, only juvenile production was included in the Environment Canada protocol (Environment Canada, 2005; Environment Canada, 2007a). The endpoints of weight, length and width were added to chronic toxicity tests on AB1 and BC1 soils to determine if they were suitable endpoints. The highest concentration tested for AB1 (610 mg F2/kg and 2,900 mg F3/kg) had no effect on the weight, length or width of the adults. However, the toxicity data obtained for the BC1soils provided an EC25 of 421 mg F2 + F3/kg, 13,750 mg F2 + F3/kg and 17,425 mg F2 + F3/kg for weight, length and width, respectively. The EC25 of 421 mg F2 + F3/kg obtained for the weight of adults is lower than the IC25 of 1,030 mg F2 + F3/kg obtained for juvenile production which indicating that weight is a more sensitive endpoint than juvenile production. Avoidance-response tests involved placing a control and test soil on either side of a cylindrical container and adding 20 Folsomia candida to the midline (Environment Canada, 2007a; Liu et al., 2010). The results using soil obtained from AB1 showed no trend between soil avoidance and increasing PHC concentration. However, the avoidance-response test, using soil obtained from BC1, indicated that F. candida avoidance increased with increasing petroleum concentration. These results show that avoidance-response tests were able to predict the outcome of the chronic toxicity tests. Overall, the above results indicate that the CCME guidelines are too conservative to apply to weathered PHC-impacted field soil when the impacts are primarily F3. Results also indicate that F2 and F3 concentrations of 250 mg/kg and 2,900 mg/kg, respectively would not adversely affect F. candida adult survival, juvenile production or adult weight.

This thesis investigates the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in low-income countries. There is a lack of in-depth empirical research into the health information systems planning and implementation process in low-income countries which develops an understanding based on existing theory and research. Furthermore, a training package for managers, which is intended to strengthen health information management in low-income countries, has been introduced without independent evaluation. In order to understand the practice and attempts at improving information support to district level management in low-income countries, two ethnographic case studies are presented. The first follows the introduction of PHC MAP, the package mentioned, and the second follows the implementation of a non- computer-based health management information system in Uganda. The research methodology is informed by several approaches which fit within the interpretative, rather than the positivist tradition. Hence, the research question developed from the desire to understand and examine empirical situations. Furthermore, an exploratory approach was utilised rather than identifying theoretical frameworks prior to the field investigation. After the initial fieldwork, the diffusion of innovation framework, the concept of organisational forces existing in dynamic equilibrium, and different information systems development methodologies proved useful in interpreting the evidence collected. My research indicates that the design of PHC MAP and the health management information system focused on technological issues, to the detriment of the wider issues of technological innovation management, and organisational change. The implications of this research, for the practice of introducing new information strategies in order to develop an informational approach to management, are explored.

The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. Copyright / Dissertation (MBA)--University of Pretoria, 2008. / Gordon Institute of Business Science (GIBS) / unrestricted

The Canadian Council of Ministers of the Environment (CCME) endorsed the Reference Method for the Canada-Wide Standard (CWS) for Petroleum Hydrocarbons (PHC) in Soil – Tier 1 Method in 2001. The purpose of the CWS is to provide laboratories with analytical methods for producing accurate and reproducible PHC soil chemistry analysis results. CWS PHC concentrations are reported according to the following carbon ranges/fractions: F1 (C6-C10), F2 (C10-C16), F3 (C16-C34) and F4 (>C34). The Canada-wide Standards for Petroleum Hydrocarbons (PHC) in Soil provide generic soil quality guidelines for the each of the four PHC fractions. The CWS PHC extraction solvents inadvertently co-extract natural biogenic organic compounds (BOC) from organic soils. BOCs, such as waxes and fatty acids, are produced by living organisms such as plants, animals and microbes. PHC analysis of highly organic clean soils and manure compost can cause false exceedences of the F3 soil quality guidelines. This thesis presents a new mathematical Tier 2 approach to resolving biogenic interferences through the use of biogenic versus petrogenic Gas Chromatography - Flame Ionization Detector (GC-FID) chromatogram patterns produced by the CWS PHC Tier 1 method. This approach is based on the results of four studies: i) 300-day crude oil contaminated peat and sand microcosm experiment; ii) 300-day diesel drilling waste contaminated manure compost and sand microcosm experiment; iii) PHC analysis of 14 light to heavy crude oils and iv) Canadian background PHC soil field survey. These studies determined that the clean soils and compost had F3 ranges that were dominated by the F3b sub-fraction range (C22-C34). In contrast, the F3a (C16-C22) and F3b sub-fraction ranges were evenly distributed in the 14 fresh light to heavy crude oils. The diesel drilling waste was strongly dominated by the F3a sub-fraction range. The second important trend was that F2 concentrations were either non-detectable or slightly detectable in all of the clean soils and compost samples. In contrast, F2 concentrations were strongly prevalent in all of the crude oils and in the diesel drilling waste. F2 and F3b concentrations were applied to the F2:F3b ratio, which identified PHC absence in the clean materials (<0.10 ratio) and PHC presence (>0.10 ratio) in the contaminated materials. The %F3a:%F3b distributions were applied to the BOC-adjusted PHC F3 calculation, which estimated true PHC F3 concentrations in the clean and contaminated soils and manure compost. The combination of these two approaches provided an accurate and efficient solution to resolving false detections of crude oil and diesel PHCs and false exceedences of F3 soil toxicity guidelines by in clean soils and compost.

The Canadian Council of Ministers of the Environment (CCME) endorsed the Reference Method for the Canada-Wide Standard (CWS) for Petroleum Hydrocarbons (PHC) in Soil – Tier 1 Method in 2001. The purpose of the CWS is to provide laboratories with analytical methods for producing accurate and reproducible PHC soil chemistry analysis results. CWS PHC concentrations are reported according to the following carbon ranges/fractions: F1 (C6-C10), F2 (C10-C16), F3 (C16-C34) and F4 (>C34). The Canada-wide Standards for Petroleum Hydrocarbons (PHC) in Soil provide generic soil quality guidelines for the each of the four PHC fractions. The CWS PHC extraction solvents inadvertently co-extract natural biogenic organic compounds (BOC) from organic soils. BOCs, such as waxes and fatty acids, are produced by living organisms such as plants, animals and microbes. PHC analysis of highly organic clean soils and manure compost can cause false exceedences of the F3 soil quality guidelines. This thesis presents a new mathematical Tier 2 approach to resolving biogenic interferences through the use of biogenic versus petrogenic Gas Chromatography - Flame Ionization Detector (GC-FID) chromatogram patterns produced by the CWS PHC Tier 1 method. This approach is based on the results of four studies: i) 300-day crude oil contaminated peat and sand microcosm experiment; ii) 300-day diesel drilling waste contaminated manure compost and sand microcosm experiment; iii) PHC analysis of 14 light to heavy crude oils and iv) Canadian background PHC soil field survey. These studies determined that the clean soils and compost had F3 ranges that were dominated by the F3b sub-fraction range (C22-C34). In contrast, the F3a (C16-C22) and F3b sub-fraction ranges were evenly distributed in the 14 fresh light to heavy crude oils. The diesel drilling waste was strongly dominated by the F3a sub-fraction range. The second important trend was that F2 concentrations were either non-detectable or slightly detectable in all of the clean soils and compost samples. In contrast, F2 concentrations were strongly prevalent in all of the crude oils and in the diesel drilling waste. F2 and F3b concentrations were applied to the F2:F3b ratio, which identified PHC absence in the clean materials (<0.10 ratio) and PHC presence (>0.10 ratio) in the contaminated materials. The %F3a:%F3b distributions were applied to the BOC-adjusted PHC F3 calculation, which estimated true PHC F3 concentrations in the clean and contaminated soils and manure compost. The combination of these two approaches provided an accurate and efficient solution to resolving false detections of crude oil and diesel PHCs and false exceedences of F3 soil toxicity guidelines by in clean soils and compost.

The study examined the effectiveness of asynchronous video-otoscopy by a telehealth facilitator, for diagnosing ear disease in an underserved community at a primary health care clinic. Study I explored whether video-otoscopy images by a facilitator provided accurate asynchronous diagnosis. Onsite otoscopy was performed by an otolaryngologist on 61 adults. Video-otoscopy images were taken by the facilitator with no formal health care training, and by the otolaryngologist. Images were uploaded to secure server from which the otolaryngologist rated and made a diagnosis six weeks later. More otolaryngologist acquired images (83.6%) were graded as acceptable or better than facilitator images (75.4%). Moderate concordance was measured between asynchronous diagnosis from video-otoscopy images acquired by the otolaryngologist and facilitator (κ = 0.596). Lack of depth perception was considered a limitation of video-otoscopy images. Study II investigated asynchronous video-otoscopy recordings made by a facilitator in children at primary health care. Onsite otomicroscopy of 140 children (2-16 years) by an otologist was the gold standard. Video-otoscopy recordings were completed by a facilitator. Four and eight weeks later, an otologist and general practitioner asynchronously graded and made a diagnosis from online recordings. Video-otoscopy recording quality was acceptable or better in 87% of cases. Asynchronous diagnosis from recordings was not possible for 18% of ears. There was substantial agreement between asynchronous video-otoscopy and onsite diagnoses (κ = 0.679-0.745). Variability of asynchronous diagnosis accuracy was similar to inter- and intra-rater diagnostic variability. Study III examined the point prevalence of otitis media in the children from study II. Onsite otomicroscopy was completed by an otologist. Prevalence of otitis media was 24.8%, with OME the most prevalent (16.5%). Despite AOM prevalence of 1.7%, caregivers reported otalgia for 7.4% of children within two weeks of assessment. Caregivers did therefore not typically seek medical opinion for otalgia. Lack of medical opinion is problematic as the sample demonstrated high CSOM prevalence (6.6%). A telehealth facilitator with limited training was capable of acquiring good quality video-otoscopy measures in children and adults. Asynchronous video-otoscopy recordings may be used within a telehealth clinic in a primary health care clinic to reduce morbidity and mortality associated with CSOM. / Thesis (DPhil)--University of Pretoria, 2015. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

In this dissertation, I report the results of my research on twisted moiré photonic crystals which can be formed through multi-beam holographic interference without a physical rotation and later fabricated by electron-beam lithography. Their optical properties, such as photonic bandgaps, multiple resonance modes, and quality factor are presented. Randomized moire photonic crystals in lattice are also studied. The applications of moire photonic crystals in improving light extraction efficiency are simulated and verified in light emitting devices. Furthermore, I simulated the light extraction efficiency in OLED when the Al layer is patterned with a triangular GPSC, square moiré PhC with defects in the uniform area, and random locations of the photonic lattice, and obtain light extraction efficiency of 78.9%, 79.9%, 81.7%, respectively. Also, the ratios of photoluminescence intensity of LED integrated with twisted moiré PhCs and random moiré PhCs over that without moiré PhCs are measured to be (1.3-1.9) and 1.74, respectively, in a good agreement with simulated ratios of 1.69 and 1.8.

Historicamente, no Brasil e no mundo, o setor saúde tem se relacionado de forma ambivalente com travestis e transexuais (TT) promovendo acesso ao processo transexualizador, por um lado, mas condicionando-o ao diagnóstico de Tanstorno de Identidade de Gênero (TIG), patologizando assim a experiência da diversidade de gênero. As medidas preventivas adotadas na década de 80 com a epidemia do HIV, também acentuaram o estigma sofrido por este grupo, segregando o acesso aos serviços de saúde especializados. Pesquisas revelam, no entanto, necessidades de saúde relacionadas, não apenas ao acesso às tecnologias mais especializadas, mas de forma integral, associadas às marcas de opressão sofridas por essa população, à necessidade de vínculo aos serviços de saúde e à possibilidade de desenvolver autonomia. No que diz respeito, especificamente, aos dados epidemiológicos, essa população apresenta altos índices de transtornos mentais, uso de substâncias, violência e uso indiscriminado de hormônio. Apontam, ainda, a invisibilidade no que se refere à Atenção Primária à Saúde (APS) e a população TT. A Política Nacional de Atenção à Saúde Integral da População Lésbicas, Gays, Bisexuais, Travestis e Transexuais (LGBTT) vem como resposta a estas necessidades de cuidado integral, indo além do estigma patologização. Em consonância com esta política, o presente estudo teve como objetivo geral: elaborar um manual de acolhimento à população travesti e transexual para a APS e objetivos específicos: caracterizar o perfil da população TT; identificar os motivos pelos quais o usuário usa ou deixa de usar a APS; identificar barreiras que dificultam o acesso da população à APS; propor estratégias de superação das barreiras de acesso da população TT à APS. O projeto de pesquisa foi submetido ao Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo (EEUSP) e da Secretaria Municipal de Saúde de São Paulo (SMSSP), bem como à gestão do Centro de Cidadania LGBT (CCLGBT) Luiz Carlos Ruas. Método: trata-se de um estudo qualitativo exploratório que realizou entrevistas semiestruturadas na Unidade Básica de Saúde-Sé (UBS-Sé) e no CCLGBT-Luiz Carlos Ruas, ambos na região central de São Paulo. O conteúdo das entrevistas foi registrado e, posteriormente submetido à diversas leituras para análise temática de conteúdo segundo a proposta de Bardin (2006). Análise dos dados: foram identificadas categorias empíricas a partir do referencial teórico relativo ao acesso enquanto dispositivo transformador da realidade, segundo Abreu de Jesus (2006) e às barreiras no acesso aos serviços de saúde à população LGBTT (Albuquerque et. al, 2016).Com relação aos dados quantitativos estes foram organizados em uma planilha para a análise dos dados. Resultados: Foram entrevistadas vinte pessoas trans, entre elas, treze se identificaram como mulheres trans, uma como travesti e seis como homens trans. Com idade média de 33 anos, em sua maioria solteiros (80%), com baixo grau de escolaridade (40% da amostra, referiram ter ensino médio incompleto ou menor grau de escolaridade) e apenas 30% inseridos no mercado de trabalho formal, evidenciando o panorama de vulnerabilidades da população trans. Com relação às barreiras no acesso à APS foram identificadas barreiras tecnoassistenciais relacionadas: 1) ao paradigma heteronormativo e de gênero como equivalência de sexo na APS; 2) pouca oferta do cartão do SUS com nome social e não uso do nome social; 3) falta de uma escuta qualificada; além de barreiras relacionadas às: 4) implicações da transfobia no acesso do serviço de saúde; 5) educação permanente: desconhecimento dos fluxos e conceitos da rede da pessoa trans; e 6) Transfobia nos serviços da APS. A partir das barreiras identificadas foram elaboradas proposições de superação das mesmas que integraram o Manual de acolhimento de Transexuais e Travestis à Atenção Primária à Saúde. Dentre as propostas de superação com relação às barreiras tecnoassitencias: estratégias de uso correto do nome social, a superação de paradigmas biologizantes e a valorização da dimensão relacional do trabalho em saúde, como o uso de uma comunicação responsiva e do acolhimento. Com relação às barreiras associadas à educação permanente, destaca-se a necessidade de ampliar o conhecimento dos trabalhadores com relação às informações a respeito das características da população TT, tais como: conceitos básicos envolvidos na temática, suas principais demandas e fluxos de apoio na rede. Investindo em metodologias ativas de ensino que se pautem em um modelo de saúde ampliado, evidenciando a visão política transformadora do trabalho no SUS. A superação da transfobia nos serviços de saúde está relacionada à promoção de educação permanente neste contexto. Outros estudos poderão avaliar a compreensão e utilização do Manual pelos profissionais da APS e a satisfação das necessidades da população TT. / Historically, in Brazil and in the world, health has related itself in an ambivalent way with transsexuals and transvestites (TT). Understood as pathology and not as diversity and freedom of gender by international disease manuals, this diagnosis allows access to medical procedures for changes in sexual characteristics. In Brazil, health places attention on the TT population beginning at the HIV / AIDS epidemic in the 80\'s, increasing this group\'s stigma and segregation, limiting access to specialized services, marking the ambivalence of the health system. Research describe, however, health care needs that go beyond HIV and physical transformations desired by trans people: high rates of mental disorders, substance use, violence, and indiscriminate use of hormones. Research also point out the invisibility in relation to Primary Health Care (PHC). The National Policy for Attention to Comprehensive Health Care for the Lesbian, Gay, Bi-sexual, Transvestite, and Transsexual (LGBTT) Population comes as a response to these needs for comprehensive care, going beyond the stigma and pathologization of gender identity. In line with this policy, the present study had as general objective: develop a manual for embracing the transvestite and transsexual population in the PHC; and specific objectives: characterize the TT population\'s profile, identify the reasons why users use or not the PHC, identify barriers that hinder the population\'s access to the PHC, and propose strategies for overcoming the TT population\'s access barriers to the PHC. Method: this is a qualitative and exploratory study in which 20 semi-structured interviews were carried out in Sé\'s Basic Health Unit - (BHU) and in Center for LGBT Citizenship (CLGBTC), both in the downtown area of Sao Paulo. The empirical material was analyzed through thematic analysis. Results: Twenty trans people were interviewed, among them thirteen identified themselves as trans women, one as transvestite and six as trans men. With a mean age of 33 years, mostly unmarried (80%), with a low level of schooling (40% of the sample, reported having incomplete high school or lower education) and only 30% inserted in the formal job market, evidencing the panorama of vulnerabilities of the trans population. Technical-care barriers were identified related to: 1) the paradigm of hetero-normative and gender as sex equivalence in the PHC; 2) offer little of the SUS (Brazilian Public Health Care System) card with social name social printed and the non-use of the social name; 3) lack of qualified listening. In addition to the related barriers: 4) implications of transphobia in access to the health service; 5) permanent education: lack of knowledge of flows and concepts of the trans person\'s network; 6) Transphobia in the PHC services. Based on the barriers identified, proposals were made to overcome them, which integrated the \"Handbook on the reception of Transsexuals and Transvestites for Primary Health Care\". Among the proposals for overcoming in relation to the tecnoassitencias barriers: strategies of correct use of the social name, the overcoming of biologizing paradigms and the valorization of the relational dimension of health work, such as the use of a responsive and welcoming communication. Regarding the barriers associated with lifelong education, the need to broaden workers\' knowledge regarding information about the characteristics of the TT population, such as: basic concepts involved in the theme, its main demands and support flows in the public health system. Investing in active teaching methodologies that are based on an expanded health model, evidencing the transformative political vision of the SUS work. The overcoming of transphobia in the health services is related to the promotion of permanent education in this context. Other studies may assess the understanding and use of the Manual by PHC professionals and the satisfaction of the needs of the TT population. From the identified barriers, propositions for improvement of these were built, as well as the Embracing Transvestites and Transsexuals (TT) in Primary Health Care (PHC) Manual.

Submitted by Franciele Moreira (francielemoreyra@gmail.com) on 2018-04-17T13:51:14Z No. of bitstreams: 2 Dissertação - Regiane Machado de Sousa Pinheiro - 2018 .pdf: 6278566 bytes, checksum: 38a42e62e5a4108422a728af8742e859 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-04-18T11:12:21Z (GMT) No. of bitstreams: 2 Dissertação - Regiane Machado de Sousa Pinheiro - 2018 .pdf: 6278566 bytes, checksum: 38a42e62e5a4108422a728af8742e859 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-04-18T11:12:21Z (GMT). No. of bitstreams: 2 Dissertação - Regiane Machado de Sousa Pinheiro - 2018 .pdf: 6278566 bytes, checksum: 38a42e62e5a4108422a728af8742e859 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-21 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The present research analyzes how the historical process of constructing the concept of a cell is presented in Biology textbooks approved in the National Program Textbook (PNLD). This investigation was developed with books of the first year of high school of the nine Biology collections approved in the PNLD 2015, whose analysis based on the didactics of Historical- Critical Pedagogy (PHC). In order to analyze the data, a matrix of analysis was built based to the Statutes Structuring of Biology proposed by Nascimento Júnior (2010), with technical and pedagogical aspects, that made possible to understand the world view, Science and Biology in these books. The results obtained make it evident that the construction of the cell concept is permeated through an ontological-mechanistic view of biology, in which science is considered linear, and scientific production, an individual activity. Thus, this research contributes to unveiling the textbook as a didactic resource that can lead to an alienating teaching work, since it reveals the presentation mode of knowledge, which can be uncritically and a-historical in opposition to proposed by the PHC. / A presente pesquisa analisa como o processo histórico de construção do conceito de célula é apresentado nos livros didáticos de Biologia aprovados pelo Programa Nacional do Livro Didático (PNLD). Tal investigação foi desenvolvida com livros da 1a série do Ensino Médio das noves coleções de Biologia aprovadas pelo PNLD 2015, cuja análise é fundamentada na didática da Pedagogia Histórico-Crítica (PHC). Para analisar os dados, foi construída uma matriz de análise pautada nos Estatutos Estruturantes da Biologia propostos por Nascimento Júnior (2010), com aspectos técnicos e pedagógicos, que possibilitou compreender a visão de mundo, Ciência e Biologia nesses livros. Os resultados obtidos deixam evidente que a construção do conceito de célula é permeada por meio de uma visão ontológico-mecanicista da Biologia, na qual a Ciência é considerada linear, e a produção científica, uma atividade individual. Com isso, esta pesquisa contribui para desvelar o livro didático como um recurso didático que pode levar a um trabalho docente alienante, já que revela o modo de apresentação do conhecimento, que pode ser acrítico e a-histórico em oposição ao proposto pela PHC.

Internationally, governments have recognised the constraints facing their citizens with regards to access to affordable, quality healthcare services. This development is evident in South Africa where the majority of the population have limited access to affordable, quality healthcare due to the healthcare inequality between the insured and uninsured. To address this lack of access to quality healthcare, medical experts recommend a focus on patient-centred primary healthcare as opposed to the current system of provider-centred healthcare. This research aims, through the development of a patient-centred framework, to assist in advising healthcare systems for the delivery for patientcentred primary healthcare. In order to develop a holistic view, all stakeholders involved in the delivery of healthcare were considered in answering the main research question. The study comprised of 43 interviews in total, of which 28 interviews were with uninsured patients who use healthcare facilities in South Africa and 15 medical expert interviews. This information was then consolidated into a framework, and further refined through the literature collected, to form a holistic service quality framework that allows for the delivery of patient-centred primary healthcare. The holistic service quality framework acts as a mechanism to ensure that the delivery of patient-centred primary healthcare has a positive impact on patient satisfaction. Patient satisfaction can be improved or increased through the levers, available to the providers, identified in the framework. This allows healthcare systems to improve the service quality of the healthcare delivered / Dissertation (MBA)--University of Pretoria, 2014. / zkgibs2015 / Gordon Institute of Business Science (GIBS) / Unrestricted