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A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of: Master of Public Health (MPH) School of Public Health Faculty of Health Sciences University of the Witwatersrand 19 June 2017 / Background In order to achieve the Millennium Development Goals, South Africa embarked on a strategy in 2011 to re-engineer its Primary Health care (PHC) system. This included the creation of Ward-based Outreach Teams (WBOTs). Each team comprises six community health workers (CHWs) led by a professional nurse linked to a clinic. The national guidelines prescribe that each municipal ward should have at least one WBOT to improve access to health care and strengthen the decentralised district health system. Implementation of the WBOT policy has varied across the country. Methodology This qualitative study explored WBOT staff and manager views on initial WBOT implementation in the Ekurhuleni health district. Research methods included five focus group discussions with CHWs; 14 in-depth interviews with team leaders and managers; and ethnographic observations. Using the framework analysis approach, data were coded based on themes relevant to the National Implementation Research Network’s (NIRN) Implementation Drivers’ Framework, including: competency, leadership and organizational drivers of the initial implementation processes. The context in which implementation occurred was also an important theme, as derived from the NIRN formula for successful implementation. Results There were significant weaknesses underscoring the current implementation of WBOTs in the district. The experiences of WBOT staff and managers illustrate that competence to perform the ideal roles was compromised by poor staff selection, inadequate training and limited coaching. CHWs complained of precarious working conditions, payment delays and uncertainty of employment contracts. Within the community context, CHWs experienced both positive and negative attitudes from the community and clinic staff from inter alia: traditional beliefs; stigma; and, the perception that CHWs were increasing clinic workloads. Despite this, CHWs valued their expanded role, including the ability to refer to services beyond the clinic such a social services, police and home affairs, and felt motivated by the impact of their work in the communities they serve. Weak organisational processes, compounded by poor planning, budgeting and rushed implementation, resulted in problems with procurement of resources. The lack of support for robust data management led to poor data verification, quality and use for decision-making. Communication challenges revealed leadership deficiencies at the national and implementation levels. This led to confusion about the ownership of the programme and poor integration of WBOT into the service delivery package in traditional clinic settings. Conflicting departmental mandates (between provincial and municipal departments), fragmented leadership and accountability, all lack of insight into the policy objectives and a disabling and ill-prepared context, constrained efforts of WBOTs at the local level. This also affected the embeddedness and acceptance of the programme in clinics and the community, impacting on implementation fidelity. Conclusion Sustainable systemic change requires clear, detailed planning guidelines, defined leadership structures, budgetary commitments, and continuous communication strategies. Furthermore, successful change is dependent on the on-going commitment to human resources development and capacity building, including investment in supervision, quality training, organisational support and competent staff. This study highlights the critical importance of organisational readiness that includes health systems and actor readiness when implementing policies across decentralised systems. Furthermore, adaptation to local contexts must be heeded in policy processes. This study further illustrates that in order to re-engineer PHC, to achieve the vision and values set out by the Alma Ata Declaration, and, to strengthen outreach services across relevant sectors, participation of all relevant actors in the implementation process. / MT2017

Thesis (MPH) -- University of Limpopo, 2011. / Introduction STIs, including easily treatable bacterial infections such as syphilis and gonorrhoea, continue to cause a huge burden of ill health in both developing and developed countries. Syndromic management is currently the best approach for the management of sexually transmitted infections in developing countries, but its successful implementation is often questionable Objectives The overall aim of this study was to assess and compare the quality of STI services in the primary health care clinics in Leribe district, Lesotho. The specific objective of the study was to assess the availability of STI drugs, clinicians’ knowledge of STI management, and the availability of STI examination equipment Methods A descriptive cross-sectional quantitative study was conducted with 23 nurse clinicians in PHC clinics in Leribe district of Lesotho. This study explored the gaps and issues around the provision of syndromic management of STIs using the DISCA tool. Results Most of the facilities have inadequate and non reliable equipment and supplies as well poor and inadequate infrastructure. There is lack of continuous training on STI management, low complete treatment to STI clients with only a few of the health centres giving complete treatment and there was also poor contact tracing of partners. Almost all clinicians cited the correct treatment for managing male urethral syndrome. Conclusion The lack of continuous training compromised STI management because nurse clinicians lacked skills to provide quality services. In general, although the principles of syndromic management are well understood by most clinicians, there are no systems in place to support the use of these guidelines

Thesis (M Med (Family Medicine)) -- University of Limpopo,2011.

What constitutes quality of learning in primary care? A social systems view of that central question regards the relationships between dimensions of learning, purposes of primary care, and quality of practice. The question of learning quality was approached in three ways. First, perceptions of learning quality were elicited through recorded interviews with fifteen participants representing diverse roles in a primary care medical clinic. Analysis of the interviews indicated learning sources, factors, and functional dimensions of learning. Second, because learning is constituted in a social practice, the social context of learning in primary care clinics was modeled with qualitative systems diagrams. This exposed systemic barriers and facilitators of learning in practice. Third, learning is directed toward fulfilling the purposes of primary care. The nature of those purposes is not well articulated. A framework of seven core purposes was developed from the perspective of systems phenomenology. This framework extends the biopsychosocial framework in several regards. Perceptions of learning quality, the structural situation of learning in clinical practice, and the core purposes of primary care, all contribute to a social systems understanding of what constitutes learning quality, and how primary care organizations might procure it and assess it. Systems phenomenology represents a significant innovation in social systems science methods. / Graduation date: 2002

Thesis (MSc (Epidemiology, School of Health Systems and Public Health))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.

No description available.

Thesis (M.S.)--University of Missouri--Columbia, 2000. / "May 2000." Typescript. Includes bibliographical references (leaves [32]-35). Also available on the Internet.

Background: Diabetes remains an incurable disease and as the search for a cure continues, the need to minimise complications and enhance the quality of life of patients is essential. A key UK policy initiative in the management of diabetes is empowerment through education. However, implementation of policy in the context of healthcare delivery in general may be challenging at times and the provision and uptake of diabetes education is not an exception. Aims: This thesis aims to examine the barriers and enhancing factors that are associated with the uptake of structured patient education for patients newly diagnosed with type 2 diabetes. Methods: The study used a sequential mixed methods approach. The data were collected using a focus group and face-to-face individual interviews of multiprofessionals delivering the education, a questionnaire/survey of patients and individual face-to-face interviews of referring practitioners working in GP surgeries within a PCT. Findings: Factors influencing non-attendance at diabetes education centres relate to barriers associated with the patients, practitioners and government regulations. The patients were affected by their healthcare beliefs and personal circumstances such as work patterns, childcare problems, forgetfulness, bad weather and ill health. The practitioners’ barriers were mainly around patient versus practitioner communication, inter-professional collaboration and administrative protocols. The barriers associated with the government directives relate to government regulations and funding issues. In contrast to barriers, the predictors of attendance are personal motivation, individual perceptions and beliefs coupled with the guidance given by the practitioners. Whilst it may be difficult to avoid non-attendance completely, positive steps to reduce nonattendance include enhanced communication, a positive pay-for-performance system and adequate support to develop a positive attitude towards diabetes education. Conclusion: The results indicate that barriers to attendance are multifactorial and complex; therefore, response to improve uptake requires diverse interventions.