nÃo hà / A avaliaÃÃo da AtenÃÃo PrimÃria à SaÃde ganha destaque no Sistema Ãnico de SaÃde (SUS), mas enfrenta desafios teÃricos e operacionais decorrentes da complexidade de seus processos e de suas mÃltiplas causas conjunturais e histÃricas. Em Sobral, CearÃ, a construÃÃo do Sistema Municipal de SaÃde, enquanto um conjunto de serviÃos coordenados por gestÃo local, com Ãrea geogrÃfica definida e metas para melhoria da situaÃÃo de saÃde da populaÃÃo claramente estabelecidas, iniciou-se em 1997. Diante disso, nos reportamos ao modelo de atenÃÃo a saÃde vigente em Sobral, completou dez anos de implantaÃÃo, embasado nos pressupostos do Programa SaÃde da FamÃlia, e centrado nas aÃÃes de promoÃÃo da saÃde e prevenÃÃo das doenÃas, no sentido de avaliar como se encontra esse processo de mudanÃa ao longo desse perÃodo. Nos propomos, neste estudo a analisar o cenÃrio da AtenÃÃo PrimÃria à SaÃde à luz do pensamento sistÃmico. Para tanto, desenvolvemos um estudo avaliativo de abordagem qualitativa, a partir dos referenciais do Pensamento SistÃmico (PS). Os atores sociais da pesquisa foram os profissionais que atuam na EstratÃgia SaÃde da FamÃlia de trÃs Centros de SaÃde da FamÃlia de Sobral, CearÃ, os gerentes destes Centros de SaÃde e os usuÃrios do serviÃo de saÃde, que aceitaram participar da pesquisa a partir da utilizaÃÃo do Termo de Consentimento Livre e Esclarecido. As informaÃÃes foram coletadas durante o ano de 2006, a partir de formulÃrio, grupo focal e entrevista. Os dados foram analisados a partir da TÃcnica do Discurso do Sujeito Coletivo. Nos resultados, prevaleceram os fatores facilitadores da satisfaÃÃo dos serviÃos apresentados: acolhimento, sentimento de conforto, limpeza das UBS, satisfaÃÃo com o atendimento, a nÃo existÃncia de dÃvidas pÃs-consulta, confianÃa no trabalho da equipe, respeito demonstrado pela equipe; Sendo os restritivos: limitadas informaÃÃes sobre o funcionamento do serviÃo e pouca receptividade dos usuÃrios para participaÃÃo nas sessÃes educativas. O estudo demonstrou ainda que os profissionais da equipe de saÃde da famÃlia, tem uma forte relaÃÃo estabelecida com a comunidade do territÃrio de abrangÃncia da mesma e isso se apresenta como um determinante da qualidade da assistÃncia prestada, mostra tambÃm a importÃncia do agente comunitÃrio de saÃde como elo de ligaÃÃo entre profissionais e comunidade, a participaÃÃo da comunidade nas tomadas de decisÃo atravÃs do espaÃo da roda de co gestÃo de coletivos, percebemos ainda a dificuldade dos gerentes dos Centros de SaÃde da FamÃlia em assumir dois papÃis gerenciamento e cuidado das famÃlias, a dificuldade de acesso da populaÃÃo em relaÃÃo aos serviÃos mÃdicos. Por fim, o estudo demonstrou que os princÃpios da promoÃÃo da saÃde estÃo presentes em alguns aspectos, mas ainda precisam esforÃos de todas as esferas de governo para que as aÃÃes sejam fortalecidas atravÃs de polÃticas centradas na promoÃÃo da saÃde e prevenÃÃo de doenÃas, permitindo um melhor desempenho dos atores na ESF, inclusive de mais investimentos que priorizem o financiamento dos componentes que dÃo sustentabilidade as polÃticas na atenÃÃo primÃria. / The evaluation of Primary Health Care gains importance in the Unified Health System (UHS), yet it faces theoretical and operational challenges due to the complexity of its processes and its multiple conjunct and historical causes. In Sobral, CearÃ, the construction of the Municipal Health System, as a set of services coordinated by local management, with defined geographic area and goals to improve the populationâs health situation clearly established, began in 1997. Through this, we report on the current health care model in Sobral that has completed ten years of implantation, based on presuppositions from the Family Health Program and centered on health promotion actions and illness prevention, in the sense of evaluating how this process of change is faring throughout this process and socialize, after research, the main indicators of change, enabling the redirecting of actions proposed by the actors involved in the system from the perspective of health care professionals and users. Understanding the intrinsic relationship between the Health Care model developed in Sobral and the presuppositions of Health Promotion, we propose in this study to analyze the Primary Health Care scenario in the light of systemic thinking, taking the year 2006 as reference. For which, we developed an evaluative study with qualitative approach, from the referential of Systemic Thinking (ST). The social actors in the survey were the professionals that perform in the Family Health Strategy in the three Health Centers in Sobral, CearÃ: Pedrinhas, Sumarà and Padre Palhano, the managers of these Health Centers and the health service users, who accepted to participate in the survey by means of a Term of Free and Informed Consent. The information was collected by means of a form, group focus and interview. For the data from interviews, managers and focus groups, we used the Collective Subject Speech technique. In the results, the facilitating factors for the satisfaction of presented services prevailed: reception, sense of comfort, at Basic Health Units, attendance satisfaction, and non-existence of post-consultation doubts, confidence in the work team, respect demonstrated by the team; With limitations being in smaller proportions and overcome by the relevance of facilitating factors, being presented by: limited information on the running of the service and little receptivity from users for participation in educative sessions. The study demonstrated that the professionals from the Family Health Team (FHT) had a strong relationship established with the community in the territory covered and this is presented as a determinant in the quality of assistance provided. Finally, we require articulation from all the governmental and non-governmental spheres to rethink, discuss and redirect strategies that permit better performance and running of (FHTs), including more investments that prioritize the financing of components that give sustainability to policies in primary care.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / PropÃe-se compreender como à cuidar de pessoas com doenÃa em estÃgio terminal no domicÃlio na perspectiva dos familiares e profissionais de saÃde de Sobral/CE, com o objetivo de refletir sobre os cuidados domiciliares no final da vida no Sistema Ãnico de SaÃde (SUS). Considerando os cuidados no final da vida como campo de estudos que engloba um conjunto de teorias e prÃticas que tÃm por objeto central o processo de morrer, esse tema torna-se relevante no contexto atual de transiÃÃo demogrÃfica e epidemiolÃgica, na qual hà um crescente envelhecimento populacional e um aumento da prevalÃncia de doenÃas cronicodegenerativas (doenÃas cardiovasculares e neoplasias), alÃm da maior longevidade proporcional da populaÃÃo de idosos, que demandam uma reorganizaÃÃo dos serviÃos de saÃde. AlÃm disso, observa-se maior visibilidade nacional dos cuidados paliativos, modelo da gestÃo dos cuidados no final da vida, apesar de ausÃncia de uma polÃtica efetiva. Abordar o cuidado no processo de morrer exige um esforÃo interdisciplinar, recorrendo aos estudos histÃricos sobre a morte, a Tanatologia e aos conceitos e teorias das ciÃncias humanas e sociais do campo da SaÃde Coletiva. Por meio de pesquisa de abordagem qualitativa, foram entrevistados sete familiares de pessoas com uma doenÃa terminal ou que jà faleceram, trÃs profissionais da EstratÃgia SaÃde da FamÃlia (enfermeiros e mÃdico) e dois profissionais do serviÃo pÃblico de Home Care do municÃpio. Estabeleceu-se como categorias de anÃlise: os cuidados no final da vida, as necessidades dos doentes e familiares, a relaÃÃo dos familiares com os serviÃos de saÃde, a formaÃÃo e capacitaÃÃo profissional, relaÃÃo dos profissionais de saÃde com a famÃlia; e o papel dos serviÃos de saÃde nos cuidados no final da vida. Considera-se que, apesar do discurso da humanizaÃÃo dos cuidados, refletida na prerrogativa de viver os Ãltimos momentos de vida com a famÃlia, esconde-se um grave problema de descontinuidade dos cuidados. Ao identificar a impossibilidade de cura, o doente à encaminhado para casa, sem a devida referÃncia à ESF ou a outro serviÃo de assistÃncia domiciliar. Desse modo, apesar dos esforÃos da famÃlia e dos profissionais de saÃde, considera-se que pouco se logra melhora na qualidade de vida de quem morre por uma doenÃa.

Campos, S. S. L. HansenÃase no MunicÃpio de Sobral, CearÃ: AnÃlise EpidemiolÃgica e Operacional das AÃÃes de EliminaÃÃo no PerÃodo de 1997 a 2003. Fortaleza-Cearà 2005. DissertaÃÃo de Mestrado em SaÃde PÃblica [Epidemiologia] â Departamento de SaÃde ComunitÃria â Faculdade de Medicina â Universidade Federal do CearÃ. O cenÃrio polÃtico dos Ãltimos 20 anos vem permitindo grandes discussÃes e avanÃos no sentido da descentralizaÃÃo das aÃÃes na atenÃÃo bÃsica. A implementaÃÃo das aÃÃes de controle da hansenÃase no sistema pÃblico brasileiro mantÃm-se como um desafio constante, ainda presente no sÃculo XXI. Nesse contexto, o Programa de SaÃde da FamÃlia vem representando a estratÃgia para a reorientaÃÃo e reestruturaÃÃo do sistema Ãnico de saÃde. O presente estudo tem como objetivo principal descrever, do ponto de vista epidemiolÃgico, os fatores que influenciaram o processo de integraÃÃo das aÃÃes de controle da hansenÃase na atenÃÃo bÃsica no MunicÃpio de Sobral de 1997 a 2003. Tomou-se como base Sobral uma vez que representa um dos municÃpios cearenses considerados prioritÃrios, alÃm de ser um exemplo de sucesso do desenvolvimento da atenÃÃo bÃsica à saÃde. Foi reconstruÃdo o processo de eliminaÃÃo das aÃÃes de controle da hansenÃase na atenÃÃo bÃsica do MunicÃpio de Sobral a partir da descriÃÃo histÃrica no perÃodo de 1997 a 2003. A anÃlise dos indicadores epidemiolÃgicos e operacionais essenciais preconizados pelo Programa Nacional de EliminaÃÃo da HansenÃase no perÃodo de estudo permitiu o reconhecimento de altos coeficientes de detecÃÃo, principalmente em 2003. AlÃm disso, importantes inconsistÃncias relativas à anÃlise mais detalhada de variÃveis como idade, formas clÃnicas e classificaÃÃo operacional em 2003 sinalizam para a possibilidade de inadequaÃÃo diagnÃstica. Por fim, procedeu-se à contextualizaÃÃo do processo de descentralizaÃÃo das aÃÃes de controle da hansenÃase no MunicÃpio de Sobral relacionando-o aos indicadores epidemiolÃgicos no perÃodo. Ressalta-se nesse estudo a potencialidade do desenvolvimento da atenÃÃo integral aos pacientes com hansenÃase na atenÃÃo bÃsica, com efetivo envolvimento e controle dos movimentos sociais. Inclui-se nessa anÃlise a necessidade de se avaliar e monitorar o cenÃrio epidemiolÃgico mesmo em situaÃÃes em que se pressupostamente observa sucesso das aÃÃes de controle, como foi o caso do MunicÃpio de Sobral. / Campos, S. S. L. Leprosy in the Municipality of Sobral, State of CearÃ: Epidemiological and Operational Analysis of Elimination Measures from 1997 to 2003. Fortaleza-Cearà 2005. Dissertation of Master Degree in Public Health [Epidemiology] - Department of Community Health - School of Medicine - Federal University of CearÃ. In the last 20 years, Brazilian health policy has been provoking fruitful discussions on the decentralization of the primary health care system. Even in the 21st century, the implementation of leprosy control measures on the public health level has been an ongoing challenge. In this context, the Family Health Program is a strategy for the reorientation and restructuring of the unified health system. This study has the objective to describe the epidemiologic factors that influenced the process of integration of leprosy control measures in the primary health care system in the Municipality of Sobral from 1997 to 2003. Sobral has been selected, as it represents one of the prioritized Municipalities for leprosy control in Cearà and as it is an example of successful implementation of an effective primary health care system. The process of leprosy elimination in the primary health care of Sobral was analyzed based on a retrospective description in the period from 1997 to 2003. The analysis of the epidemiological and operational indicators favored by the National Program of Leprosy Elimination, revealed high detection rates, mainly in 2003. Besides, considerable inconsistencies in age, clinical forms and operational classification indicate the possibility of diagnostic errors. Finally, in this study the process of integration of leprosy control measures in the Municipality of Sobral has been related to the epidemiological indicators. The possibility to develop integrated health care for leprosy patients in the primary health care system with effective involvement and control of community associations and other nongovernmental organizations is emphasized. The need to evaluate and monitor the epidemiology of leprosy, even in situations in which control measures seem to be successful, as it is the case with Sobral, is also discussed.

O estudo emergiu a partir da experiência da autora como preceptora em Unidade Básica de Saúde que recebe residentes farmacêuticos. Constitui-se como objeto de estudo a construção de competências pelo preceptor de Farmácia na Atenção Primária na formação de residentes farmacêuticos e teve como objetivo construir um manual educativo a ser utilizado como apoio pelo preceptor farmacêutico da Atenção Primária à Saúde a fim de orientá-lo na formação de residentes farmacêuticos. Compreendendo como ocorre o ensino desenvolvido por farmacêutico assistencial em serviços que são cenários para o processo de ensino-aprendizagem, a partir das Diretrizes Curriculares Nacionais, projetos políticos pedagógicos, metodologias de ensino aprendizagem, e suas articulações teóricas e práticas, segundo o modelo de saúde integral preconizado pelo SUS. Trata-se de uma pesquisa documental, com abordagem qualitativa, com consultas em artigos publicados em periódicos nacionais e internacionais indexados nas principais bases de dados, utilizando as questões norteadoras: qual é a atuação do farmacêutico preceptor na Atenção Básica tendo em vista a formação do residente farmacêutico?; que competências o farmacêutico preceptor necessita desenvolver para atuar na formação de residentes farmacêuticos?; que estratégias podem ser utilizadas para o exercício da preceptoria farmacêutica na Atenção Básica? O tratamento dos dados ocorreu por meio da análise de conteúdo de Bardin. Os resultados revelaram que, no \"cenário ideal\" do processo ensino-aprendizagem, os protagonistas são os preceptores, que acolhem e ensinam os residentes ao mesmo tempo que precisam dar conta da demanda do serviço. Simultaneamente, convertem seu local de trabalho em um cenário de aprendizagem para si também, e cedem esse espaço para que se construa algo novo, considerando as opiniões, experiências e os conhecimentos de todos os envolvidos: residentes, preceptores e tutores. / The study emerged from the author\'s experience as a preceptor in the Basic Health Unit that receives pharmaceutical residents. The object of study is the construction of competences by the Preceptor of Pharmacy in Primary Care in the training of pharmaceutical residents and had as objective to construct an educational manual to be used as support by the pharmacist preceptor of Primary Health Care in order to guide him in the training of pharmaceutical residents. Understanding how the teaching developed by pharmacist care in services that are scenarios for the teaching-learning process, from the National Curricular Guidelines, pedagogical political projects, learning teaching methodologies, and their theoretical and practical articulations, according to the health model integral approach advocated by SUS. It is a documentary research, with a qualitative approach, with consultations in articles published in national and international journals indexed in the main databases, using the guiding questions: what is the performance of the pharmacist preceptor in Primary Care with a view to the formation of pharmaceutical resident ?; what competences does the pharmaceutical preceptor need to develop to act in the training of pharmaceutical residents ?; what strategies can be used to exercise the pharmaceutical preceptor in Primary Care? The treatment of the data occurred through the Bardin content analysis. The results revealed that, in the \"ideal scenario\" of the teaching-learning process, the protagonists are the preceptors, who welcome and teach the residents while also having to deal with the demand of the service. Simultaneously, they convert their workplace into a learning scenario for themselves as well, and they give up this space to build something new, considering the opinions, experiences and knowledge of all involved: residents, preceptors and tutors.

Magister Curationis - MCur / As early as 1993, the World Health Organisation declared Tuberculosis (TB) a global emergency and the South African Department of Health confirmed that TB was a national emergency. The primary cause of the rise in TB cases has been attributed to co-infection with HIV. TB is the leading opportunistic infection worldwide and the primary cause of mortality among people living with Human Immunodeficiency Virus (HIV). TB and HIV are two of the highest health threats globally and in South Africa. Tuberculosis and HIV combined are responsible for the deaths of over 4 million people annually. More than 65% of individuals diagnosed with TB in South Africa are co-infected with HIV. The importance of providing quality health services is a human right and non-negotiable. Better quality of health care is fundamental in improving South Africa's poor health outcomes and in restoring patient and staff confidence in the public and private health system. In 1996, the South African Department of Health introduced the topic of quality to raise its awareness and to make it an inherent part of the health care system. The South African health care consumers (patients) are increasingly becoming aware of their rights as patients and the gap between the actual and ideal health practices. They have broad knowledge and great expectations with regard to available care including effectiveness of service and treatment. Patients have desires for quality services when visiting a health care facility, and these desires are directly linked to the success of the healthcare system. If the desires are not met, they can negatively influence the outcome of healthcare processes such as treatment adherence and retention of patients on the system. This could possibly further escalate the TB/HIV co-infection rate in South Africa. The need to address TB and HIV together in the light of quality care is urgent so as to improve the provision of quality health services rendered to people co-infected with TB and HIV. The Institute of Medicine developed a framework that could guide on healthcare dimensions that need to be met for quality of care to be achieved and it is the underpinning theoretical framework for this study. The patients play a critical role in the healthcare system as they are the customers and therefore, the opinions of the patients need to be recognised to ensure that strategies and programmes that are developed are relevant. The purpose of this research was to explore and describe the perceptions of patients co-infected with TB and HIV regarding the quality of care at the Primary Health Care facilities, in the Chris Hani District. A qualitative, explorative and descriptive design was used which enabled the researcher to understand the perceptions of TB and HIV co-infected patients regarding quality of care. The population studied in this research consisted of TB and HIV co-infected patients attending the Primary Health Care facilities at the Lukhanji Sub-district within the Chris Hani District. Purposive sampling was used to select participants with the assistance of nurses working at the selected facilities. The sample size was determined by data saturation, which was reached after 18 semi-structured interviews were conducted. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached an agreement on the main theme, sub-theme and sub-categories. From the research findings, two main themes were identified namely; satisfaction with delivered services and impediments to quality of care. These were further divided in sub themes and categories. The conclusion that could be made on the quality of care provided to the TB and HIV co-infected patients in this study is that the nurses in the facilities aim to provide four of the six IOM aims of quality of care to the TB and HIV co-infected patients namely: equitable, effective, efficient and patient-centred domains. Therefore, the quality of care provided to these patients is partial as they are not provided with all the six aims that are needed to achieve quality of care. Recommendations are made for the field of community health nursing practice and nursing research on how to improve quality of care provided to TB and HIV co-infected patients at Primary Health Care facilities.

Background Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. Results We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011–2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. Conclusions This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions.

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

Magister Public Health - MPH / Primary Health Care (PHC) services in Namibia are based on the principles of equity,availability, accessibility, affordability of services, and community participation and empowerment. According to the Namibian Constitution and the National Health Policy,all Namibians should have equal access to public health services at no cost to the patient.The government places a high premium on the involvement of communities in PHC through communication, consultation and respectful interaction between health workers and patients and communities in the interests of quality service delivery. Services provided at PHC facilities include immunisations, antenatal care, post-natal care, family planning, health education, tuberculosis and malaria treatment, outreach services, antiretroviral treatment (ART), and the Prevention of Mother to Child Transmission(PMTCT) programme. Numerous complaints have been received from patients relating to patients' admissions at clinics, long waiting hours, over-crowded facilities, poor communication between patients and nurses, and non-availability of some medications and medical officers at some of the PHC facilities.This study investigated patient satisfaction and the reasons for reported poor nursepatient relations at PHC facilities in Khomas region in Namibia. The objectives of the study were to describe patient’s perceptions concerning quality of service delivery at PHC clinics, to explore factors related to the clinic environment that might influence perceived quality of care and to describe the nature of nurse-patient relations. Methodology A descriptive, qualitative study was conducted among randomly selected patients (15) and registered nurses (5) at five purposively selected PHC clinics in Khomas region, in the Windhoek district. Five sisters-in-charge from the designated facilities were interviewed as key informants.Data was collected through key informant interviews and focused interviews with nurses and patients, respectively. Data on the participants’ experiences and perceptions of using the health services, as well as factors influencing nurse-patient relations and patient satisfaction was collected. Interview data was recorded on audiotape and transcribed verbatim. Data from key informants was captured in field notes. Thematic analysis of transcribed data was conducted.Results Low patient satisfaction with services was confirmed as a key problem facing four out of the five health facilities visited in Khomas region. Patient dissatisfaction was mostly related to the long waiting times, which in turn, was caused by increased patient numbers as a result of the escalating HIV/AIDS and tuberculosis (TB) epidemics, ART roll out and increased immigration to Windhoek. Other factors attributed to low patient satisfaction were poor communication between health providers and patients, nonavailability of family planning and immunisation services, and frequent stock-outs of some prescribed medicines.ConclusionsThe findings of this study support the need to rethink nurse-patient relations for greater patient satisfaction and quality of service delivery in the public Primary Health Care facilities in Khomas region. Greater care should be taken to inform patients about service days and the staffing limitations at health facilities, and to educate and empower patients for self-care. Communication strategies should target negative perceptions about service delivery at PHC clinics in the communities. In-service training in areas like case management, different PHC disciplines and communication skills are needed to improve the competency of nurses. In addition, motivation of nurses needs to be addressed through recognition and appreciation from management in order to avoid frustrations and negative attitudes towards patients. Motivation of nurses can be improved by paying attention to their work environment and the physical structure of health facilities.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Bell’s palsy (BP), a fairly common disorder predominantly prevalent in the adult age group, affects nerves and muscles in the face causing paralysis or dropping of one side of the face. Clients with Bell’s palsy face many challenges, including psychological, physical and emotional. A long recovery period and/or delayed complete healing could lead to a negative effect on many aspects of an individual's life. How society perceives the person could negatively influence the client’s self-confidence. The management of Bell’s palsy depends on the individual case and may include medication, physiotherapy and as a last option, surgery. The aim of the study was to investigate the management of Bell’s palsy at primary health care level in the Cape Metropolitan District of the Western Cape. The study specific objectives was to investigate the management or treatment protocol of clients with Bell’s palsy, to determine the tendency for referral for physiotherapy, to determine whether an association exists between the type of management or treatment received and the recovery of clients with Bell’s palsy and to explore the impact Bell's Palsy has on the clients. The over-arching design of the study was the sequential explanatory mixed methods design where qualitative data was used to assist in explaining and interpreting the findings of a primarily quantitative study. Stratified random sampling was done proportionately to ensure equal representation. A self-administered questionnaire, comprising of four sections, was used to collect quantitative data that was analysed using SPSS version 21. Descriptive statistics was employed to summarise the data on the socio-demographic information of the clients. Inferential statistics was used to determine the distributions of cases in the various groups. Significant differences tested for using the Chisquare test and effect size through Cramer’s V tests. A semi-structured interview guide was developed based on the results of the analysis of the quantitative data. Focus group discussions were employed to a sub-sample of the clients with Bell’s palsy. Permission an ethical clearance will be obtained from Senate Higher Degrees Committee at the University of the Western Cape (UWC), the Western Cape Department of Health and the facility managers of the participating CHCs.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Rehabilitation is important for persons living with disabilities as it contributes to their sense of autonomy, self-worth, social participation and improving their quality of life. Improving the quality of rehabilitation services requires the incorporation of patients' perceptions with those of service providers regarding these services. Different studies have revealed that persons with disabilities have experienced inaccessibility of rehabilitation services with regards to inaccessibility and unavailability of transport, inadequate provision of information related to their disability. Lack of staff and skills training are the main experienced challenges encountered by the service providers in the rehabilitation service provision. Hence, the current study aims at exploring the persons with physical disabilities and service providers' experiences regarding the rehabilitation services provided at Bishop Lavis Rehabilitation Centre. A qualitative study design was used for data collection. Eleven participants among patients were conveniently selected for the focus group discussion and three key informants among the service providers participated in the in-depth interviews. The focus group discussion and the interviews were tape-recorded and transcribed verbatim and the data was thematically analysed using pre-determined themes. Permission to conduct the study was sought and granted from the Senate Research Grant and Study Leave Committee at the University of the Western Cape, the Western Cape department of Health as well as the facility manager of Bishop Lavis Rehabilitation Centre. Written informed consent was obtained from the participants prior to the focus group discussion and interviews. The results indicated that patients experienced problems of accessing transport to and from the rehabilitation facility. The taxis and buses were either inaccessible or unavailable for persons with physical disabilities. Poor referral systems, shortage of staff, lack of skills training were among the main challenges that arose in the interviews with the service providers. Due to the workload that service providers encountered, they sometimes lacked time to interact and communicate with patients. Participants in both groups reported positive responses regarding patient participation and involvement in the rehabilitation sessions and interaction between patients and service providers. Though some patients expressed the review that the dissemination of information related to group sessions was inadequate, most of the participants in both the focus group discussion and the in-depth interviews stated that, patients were adequately informed on their conditions and treatment. The study concludes by highlighting the need to improve rehabilitation services in terms of increasing the capacity of service providers, equipment, training of service providers and providing transport services for persons with disabilities. There is a need for those planning the rehabilitation services and policy makers to recognise the challenges encountered by those receiving rehabilitation services as well as those providing these services as discussed in this study. Hence, this will help in developing appropriate, accessible and cost effective rehabilitation services that meet the needs of persons with disabilities.