Magister Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

Master of Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

This qualitative case study explored how school district and campus-level administrators coordinate resources and services for currently enrolled homeless students. Participants in this study included three district-level administrators designated as the homeless liaison and three campus principals. Data collected and analyzed included audio recordings of semi-structured interviews of each participant, documents at the district and campus-levels, school board meeting notes, and research field notes. The findings suggested that district and campus stakeholders embraced a shared vision of collaborative policy implementation to support the needs of students living in homelessness conditions. Findings also suggested that moral purpose is reflected through the intentional, collaborative efforts of district and campus administrators. Additionally, the findings suggested that social capital develops in the collaborative processes between district and campus leaders while they broker resources to foster developing social capital of this student population. Mobilization of resources through collaborative policy implementation can foster cohesion while supporting students and can counter the impact of living in homelessness conditions.

The purpose of this study is to explore how education policy on information and communication technology (ICT) influences teaching and learning in South African schools. An instrumental case study applying backward mapping principles as a strategy of inquiry was used. Utilizing a social constructivist lens and guided by a theoretical framework of a socio-cultural approach to policy analysis, this exploratory qualitative research study set out to investigate how teachers in South African schools appropriate education policy on ICT. The case study included three schools from diverse socio-cultural settings, with two participating teachers at each of the identified research sites. The principal at each school and e-learning specialists (officials) at the District and Provincial Departments of Education constituted additional data sources. Data collection methods included interviews, classroom observations, field notes and document analysis. Constructivist grounded theory methods and computer assisted qualitative data analysis software (CAQDAS)were employed in the analysis of data. It was found that, teachers’ professionalism and agency are crucial in formulating and implementing a school-based e-education policy in practice. The national e-education policy currently exists as an “invisible policy” within the school context. Secondly, teachers reposition themselves as social and cultural actors of school-based policy appropriation and formulation rather than as recipients of, or reactors to the national e-Education policy. Thirdly, the lack of systemic support to teachers acted as the catalyst for the emergence of communities of practice between schools. The notion of “our” system as opposed to an imposed system prevails. Fourthly, teachers’ ignorance of the national e-Education policy indicates the need for policy development and implementation at school level and denotes a new construct to policy appropriation. I theorise that teachers’ beliefs, attitudes, professionalism and will to improve teaching and learning through the use of ICT are integral and necessary conditions for effective policy implementation. / Thesis (PhD)--University of Pretoria, 2010. / Science, Mathematics and Technology Education / unrestricted

The education of girls is hampered by many challenges among them teenage pregnancy. The Zambian government introduced the re-entry policy in 1997 to allow girls that get pregnant to return to school and complete their education. Even after the policy was introduced, many girls that get pregnant fail to return after their maternity leave. Therefore, this study investigated how the re-entry policy is implemented in Zambian secondary schools in Monze District using a qualitative-interpretivist-case approach. Hence data was collected using semi-structured interviews, field notes and document analysis to understand the implementation process through the eyes of the purposively selected Ministry of Education (MOE) officials, head teachers, teachers, teenage mothers, learners and parents. The collected data was coded sing a computer software Nvivo and analysed using thematic analysis. The research findings show the nature of current school re-entry policy implementation, opportunities through the re-entry policy, Weaknesses of the re-entry policy, challenges faced by teenage mothers and the existing support systems in place for teenage mothers. A framework for the effective implementation of the re-entry policy in schools was designed. The study findings on re-entry policy implementation for teenage mothers concluded that, more remains to be done in terms of its implementation by various stakeholders. The re-entry policy is not well implemented as there are no re-entry policy guidelines in schools, lack of clarity on the guidelines compelling stakeholders to implement it their own way. Nonetheless, the findings show that the re-entry policy had notable achievements such as the re-admission and completion of teenage mothers’ education, awareness of the re-entry policy, strengthening of comprehensive sexuality education (CSE) in schools and collaborations between schools and civil society organisations (CSOs) and other government departments. The recommendations include: Government to ensure that the development of policies and implementation is inclusive and sustainable. School implementers should be given orientation on the implementation of re-entry policy; strengthening the re-entry policy and other supporting policies and laws that can promote gender equality and inclusion to enhance educational opportunities; CSOs, department of social welfare ties and parental and pupil support should continue collaborating to promote the education of the vulnerable that include teenage mothers. / Thesis (PhD)--University of Pretoria, 2020. / Education Management and Policy Studies / PhD / Unrestricted

Magister Administrationis - MAdmin / The study aims to investigate whether delays occur within the pipeline of pension pay-outs, where these delays occur and what the policy implementations and management gaps are within the pension administration system. The study intends to produce findings that assist in reducing the aforementioned delays and increasing efficiency. The specific objectives of the study are threefold. Firstly, the study intends to outline the Government Pension Administration Agency’s (GPAA) current policy and pipeline of procedures with specific reference to pension pay-out times. Secondly, it will identify pension pay-out delays and trends with reference to categories and periods of delay. Finally, it will identify the major areas of complaints, pipeline problems and constraints. The methodology used is both a qualitative document analysis (QDA) and a descriptive analysis of the data. It is appropriate, suitable, cost-effective and common for desktop research. The corroboration of findings and confluence of evidence give credibility and thus triangulation of information is of immense value. The limitation of methodology, findings and results is specific to the Western Cape Education Department (WCED) which is the largest employer in the Western Cape Province. This study found that the Government Employees Pension Fund (GEPF) and the GPAA adopted New Public Management (NPM) values and strategies. Furthermore, pension pay-outs exceeding 60 days have been reduced when compared to the period prior to modernisation in 2010. Despite this, delays in payment remain very high. Internal sources include the GEPF Benefits Admin Committee; email and / or telephonic portals (GEPF Call Centre – reactive). External sources include the Public Protector and the Presidential hotline. Finally, total interest paid on late payments in 2010 was R1,054 billion and increased to R1,901 billion by 2017. The implication of these findings is expected to be further reductions in waiting times, as modernisation of the organisation continues. However, this cannot be a foregone conclusion because it will depend on the management of implementation.

This study focused on a policy that promotes educational stability for foster children in a southern state in the US. At the time of this study, this policy had not been fully adopted across the state which resulted in foster children not routinely receiving the interventions necessary for improving academic outcomes. Using the diffusion of innovation theory as a framework, the purpose of this qualitative case study was to explore how local-level leaders impacted the successful adoption of education policy in one county office of a statewide child welfare agency. Data were collected from a sample of 5 case managers and a review of the literature. The data were coded and analyzed using Colaizzi's 7-step method of data analysis. Results revealed the specific actions that were taken by county-level leaders to impact the successful adoption of the policy. Such actions included the allocation of resources and the intentional inclusion of informal leaders in decision-making around policy implementation. The social change implications stemming from this study include recommendations made to program leadership to consider practical changes to policy implementation that may result in successful adoption of this policy. Such changes may lead to foster children across the state receiving the benefits of the evidence-based supports outlined in the policy and may lead to an improvement in the delivery of services to vulnerable populations served by the child welfare agency.

Trinidad and Tobago is one of 15 small developing states that comprise the regional integration grouping known as the Caribbean Community. Several agencies were recently created outside of the government using a strategy known as agencification to support the implementation of public policy in the Republic of Trinidad and Tobago. However, there is little available information explaining the rationale for the choice of the strategy, no evidence-based scholarly evaluation found on the effectiveness of these types of agencies, and therefore limited information on whether this strategy results in effective public policy. The purpose of this case study was to gain an in-depth understanding of these semi-autonomous agencies in the implementation of public policy in Trinidad and Tobago as part of the Caribbean Community. The central research question sought to explore the successes, failures, and experiences with executive agencies created through agencification. Principal-agent theory provided the theoretical framework for this qualitative case study. Using a purposive sampling strategy, data were acquired through interviews with 10 individuals representing public servants, agency officials, and academics and a review of public documents. The data were inductively coded and then organized across themes. The findings indicated that while the agencification strategy is being utilized with varying levels of success, several barriers and constraints hamper successful policy implementation. Positive social change implications of this study include direct recommendations for greater autonomy for the directorate of all agencies in the Republic of Trinidad and Tobago. These recommendations would serve to facilitate the implementation of the policies that they were created to support.

In 1995, Ghana’s education policymakers imposed a ban on all extra classes initiated and organized on school premises and public buildings, by individual teachers or groups of teachers, for which students were charged extra fees. The ban is referred to as the “policy on extra classes.” This study examined the genesis and justification of the said policy, including the current phenomenon of extra classes in Ghana. The study analyzed the policy’s impact on secondary education in the country, particularly Northern Ghana, using the lens of education stratification in a qualitative interpretive policy analysis approach. Interviews of leading Ghana education officials conducted in 2010 were the predominant source of data in this research, with corroboration from analysis of policy texts and review of the media. The conclusions and recommendations that emerged from this study included: accountability, the responsible use of school time and instructional time, and education equity and adequacy. Other issues concerned social justice, teacher remuneration and motivation, and the need for equitable national education policies that reckon with the disparities in the country. In particular, this study took issue with the culture of nonimplementation of education policies in Ghana, with particular reference to the policy on extra classes. The study contended that the partial or non-implementation of education policies deepens education stratification in the country.

The connection between the built environment and physical activity has gained newfound attention. Plenty of research and several administrations highlight that how we plan our environments can nudge more people into active living. In Sweden, the act of planning in ways that promote physical activity has been on the agenda a few decades and many local administrations include this perspective in their spatial policies. This intrigues that spatial measures that promote physical activity should be well-known for Swedish planning officials, in addition to being noticeable in the built environment. However, there is often a considerable gap from accepted policies to applied practices as strategic spatial planning and especially the act of implementation are challenging. This thesis sheds light on how accepted spatial policies that promote physical activity have been considered and implemented in the built environment of Katrineholm. Results have been achieved by studying spatial policies, conducting in-depth interviews with planning officials and by analyzing the material thematically via the SPlaMI-framework. The results emphasize that the weakness of policy documents was a reoccurring challenge in the implementation-phase. Further, different actors, so called policy entrepreneurs, was pivotal for the outcomes and connected legal framework also played a crucial role. A surprising finding was that no cooperation between health experts and the planning department had been present, although these types of partnerships are highlighted in previous research. Finally, the absence of evaluation also presented a concern for further advancements.