No description available.

<p>According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients&rsquo / perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients&rsquo / experiences regarding provision of these services. The aim of this study&nbsp / therefore was to explore the persons with physical disabilities&rsquo / experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health&nbsp / District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed&nbsp / by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical&nbsp / isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and&nbsp / transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results&nbsp / of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers,&nbsp / &nbsp / particularly information regarding disability and support services available for them. Experiences regarding participants&rsquo / involvement in their rehabilitation were generally positive. Generally, the&nbsp / participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards&nbsp / &nbsp / regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers&nbsp / should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved.</p>

Submitted in fulfilment of the requirements for D.Tech: Nursing in the Faculty of Health Sciences, Durban University of Technology, 2009. / BACKGROUND In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization by increasing the accessibility of all services at Primary Health Care (PHC) level. However, the problem with the policy arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. Hence, there is a need for shared views on this phenomenon. METHODS A cross-sectional study, using a qualitative approach was employed in this study in order to analyze IPHC in KwaZulu-Natal (KZN). A grounded theory approach was selected as it is a method known for its ability to make the greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews was comprised of 38 participants. RESULTS It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop. Based on the findings of the study, it was concluded that the phenomenon, IPHC meant different things in different contexts.

This collection of papers represents the author's maturing reflection on systemic engagements with three different organizations within the latter half of the first decade in post-Apartheid South Africa. The first two papers deal with two different systemic engagements: the first with a rural community development organization in a rural area of KwaZulu-Natal south of Durban and the second with the implementation of a district health system by a provincial health authority, also in KwaZulu-Natal. The last three are concerned with the theoretical and practical aspects of a single critical systems intervention (CSI) for policy development within the KwaZulu-Natal Nature Conservation Service, a parastatal nature conservation organization. The first paper, Designing a Management System for a Rural community Development Organization Using a Systemic Action Research Process describes the use of Soft Systems Methodology (SSM) for the development of a Human Activity System (HAS) Model, that is, a conceptual model of purposeful human activities, to facilitate debate regarding a 'problem situation' faced by the community development organization. A Critical Systems Intervention to Improve the Implementation of a District Health System in KwaZulu-Natal is the second paper. As the title suggests, this paper describes a Critical Systems Intervention in a district health system implementation process. By using Concept Maps and Sign-Graph diagrams with SSM this paper contributes theoretically to the growing body of literature on methodological pluralism. Paper 3, Towards a critical systems approach to policy formulation in organizations contributes to the literature on organizational policy. It is noted in this paper that whilst there is a substantial body of literature on organizational strategy as well as on public policy, there is a dearth of literature on organizational policy. The thrust of the paper is twofold. Firstly, it draws a distinction and shows the relationship between organizational policy and organizational strategy. Secondly, building on this distinction, it develops a critical systems approach to policy formulation. Paper 4, Environmental Paradigms, Biodiversity Conservation and Critical Systems Thinking develops a framework of environmental paradigms which may be used for any CSI in nature management as a tool for values clarification. The collection concludes with Paper 5, A Critical Systems Intervention for Policy Development within a Nature Conservation Organization. It discusses the process undertaken in the nature conservation organization - Ezemvelo KwaZulu-Natal Wildlife - intervention and shows how the approach to policy formulation (developed in Paper 3) and the framework for environmental paradigms (developed in Paper 4) were used in the intervention. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

No abstract available. / Thesis (M.D.)-University of KwaZulu-Natal, Durban, 2007.

In presenting a Geography of Health of the Durban Metropolitan Area, the researcher has chosen a conceptual framework within which to sharply challenge the definition of health in a perfunctory/ functionalist way. Thus, the Geography of Health is, at the outset, locationally positioned in a socio-economic and environmental context of society. This argument is developed through a multi-conceptual approach that leads the thesis into building a framework with the central arching principles of biomedicine, social and humanistic philosophy in three randomly selected informal settlement contexts. The specific focus of this approach is on the growing poverty and homelessness, the inadequate health delivery system and the relationship between disease, physical, social and residential environments and structural inequalities. Thus, this study is embedded in numerous related contexts, the most important of which is the spatial! geographical and the social context in which health and health care is seen in relation to the nature of society and everyday life. To some extent this research endeavour is concerned with health and health care issues amongst specific categories of people within marginalized communities rather than some homogenous, non-existent category called "poor people". The key questions raised in the study relate thus to several variables that impact informal dwellers with the specific objective of determining socio-economic profiles, housing and environmental circumstances; the location and nature of health services; health status of people; the ways in which people conceptualise and prioritise health and the need for and possibility of community involvement in health and health care. In dealing with the above issues, a multi-faceted methodological approach allowed for the generation of 155 tabulations from the quantitative empirical data to be triangulated with the qualitative data produced through focus group interviews and also with the secondary data obtained. The most significant finding emerging from the study was the fact that the relationship between health and abject poverty is bi-directional. Respondents identified numerous factors that affected their health, the most important of which was poverty in respect of poor dwellings, lack of basic services, access to certain health services and the prevalence of disease. It is hardly surprising that a biomedical perspective largely prefaced the respondent's understanding of health. This can be attributed to locational factors but more specifically to the overriding socialising influence of biomedicine in South African society. In the focus group interviews with informal dwellers, the ranking exercises demonstrated that high health risks emerge from multiple and complex factors related to personal, economic, social, environmental and political factors. It is the contention of this thesis that health status improvement and the reduction of health risks of disadvantaged individuals and communities needs a multi-pronged approach with multiple solutions drawing on resources from international, national and local agencies and organisations. Finally, the study concludes by presenting an extensive pool of more concrete systematic and holistic interventions that would not only improve the quality of public health care, but also redefine the Geography of Health in South Africa. These, it is argued are seldom attainable in the short term as it is a continuous process underpinned by priorities, possibilities and planning. / Thesis (Ph.D.)-University of Durban-Westville, 2002.

The delivery of primary health care (PHC), as promulgated by the World Health Organization (WHO) and in South Africa, is of fundamental importance. Physiotherapy is an essential component of the health care delivery system and must promote PHC during clinical training and practice. In KwaZulu-Natal (KZN), PHC service delivery has been a problem for various reasons such as the history of the country (apartheid era pre- 1994), financial constraints, lack of human resources, physical infrastructure and time constraints. Service delivery within the health sector is reported frequently in the media as physiotherapists and radiographers embarked on a strike latter part of 2009 in KZN due to a discrepancy in the Occupation Specific Dispensation (OSD). Physiotherapists have highlighted that they were overworked, carrying the strain of vacancies, due to frequent resignations to migrate to the private sector. The aim of the research was to explore the promotion of PHC delivery in KZN. The objectives explored the empowerment of students and staff in the Health Science Disciplines to PHC service delivery. In addition, managers at provincial and local levels were included in the study. Barriers and factors that enhance the promotion of PHC were identified. The research design comprised of a survey, a quantitative and qualitative case study of KZN, using questionnaires or semi-structured interviews. The findings indicated that the physiotherapy staff lacked PHC training (p=0.000) and 48.7% of the Disciplines in Health Sciences indicated that the rural needs were not being addressed with regards to PHC service delivery (p=0.018). Each discipline operated within its own silo, without any consultation and inter-disciplinary collaboration, to the detriment of effective delivery of PHC services. Fragmentation and duplication of PHC services existed between Provincial and Local Governments as indicated by 46% of the managers, which is disconcerting post 15 years of democracy in South Africa. The main objective of the National Health Plan and Reconstruction and Development Programme (RDP) was to readdress the inequalities and fragmented health services. Numerous recommendations are made which will improve the journey towards transformation, comprehensive PHC service delivery, and the quality of life of all citizens / Thesis (Ph.D.)-University of KwaZulu-Natal, Westville, 2009.

The aim of this study was to describe the clients' satisfaction with Primary Health Care (PHC) Services in Lilongwe Health District with regard to client involvement in health care delivery and the accessibility of PHC services. It was hoped that the information generated would be used in the evaluation of PHC Services in Lilongwe. A quantitative and qualitative research was done using an outcome analysis evaluation design. The study utilised Kawale and Chiwamba Health Centres and their catchment population. Systematic random sampling was used for the clients making use of the health centres, convenience sampling for those not using the health centres and purposive sampling for the focus group participants. Quantitative data was collected using self-administered questionnaires while qualitative data was collected using an interview guide in focus group sessions. Quantitative data was analysed using SPSS and percentages and frequencies were calculated while qualitative data was analysed through a template style of analysis. The findings of the study revealed that in both Health Centres Clients were satisfied with some aspects of PHC such as, cultural accessibility, health education and listening abilities of health workers but there was still some evidence of dissatisfaction, and misunderstanding of the concept of Community Involvement in Health care delivery. This calls for a need to reorient communities on PHC delivery and what it means. / Thesis (M.N.)-University of Natal, Durban, 2004.

The study was designed to examine and describe mental health care provided by the nurses in the primary health care settings of Swaziland. The study sought to answer one main questions namely: • what was the nature of mental health care provided by nurses in the primary health care clinics? A sample of 31 primary health care clinic nurses was used to generate data for the study. The sample consisted of registered nurses with only one having a mental health qualification. The study used both qualitative and quantitative methods for data collection. Data analysis involved simple frequency and percentage counts using SPSSmanual as well as descriptive narratives using NVIVO computer analysis methods. Findings revealed that mental health care in the primary health care clinics was mainly traditional involving immunizations, family planning and antenatal services, Limited mental health care was provided by the only mental health nurse involved in the study, Nurses stated that the care they provided was in line with their job descriptions, The study concluded that the mental health care provided at the primary health care clinics was based on the traditional approach that did no encompass mental health care, Recommendations made were related to the promotion of the integration of mental health care into the services provided in the primary health care scttings with nurses being prepared for the role. / Thesis (M.Cur.)-University of Natal, Durban, 2000.

HIV is major public problem in the world and in Sub-Saharan Region in particular. The literature has shown that mental disorders and particularly depression are common among people living with HIV/AIDS, but that little is known about the prevalence of depression and factors associated with it, among people living with HIV/AIDS in Rwanda. A descriptive, cross-sectional study was done to assess the prevalence of depression, the clinical profile and the factors associated with depression among people living with HIV and attending a primary health care centre in Kigali-Rwanda. This study was informed by the stress and vulnerability framework. A questionnaire was used to collect socio-demographic and HIV related medical information, while depression was assessed using the Beck Depression Inventory Scale, with a cut off of less than 10 for no depression and above 10 scoring positive for depression. Respondents were randomly selected from the patient appointment list for patients who were scheduled during the period of data collection and according to the sample selection criteria. The sample consisted of 96 people living with HIV. Permission to conduct the study was requested and obtained from the University of Kwazulu-Natal Ethics Committee, from the CNLS Research and Ethics Committee in Rwanda and from the management of the health care centre to consult patients' files. Data was analyzed using the Statistical Package for the Social Sciences (SPSS for window, 15). Descriptive data was analyzed by means of frequencies, mean and standard deviation. Cross tabulation using Pearson' chi-square test was performed to test the association between sociodemographic factors and HIV related medical information and depression for categorical variables, while t-test for independent simple test was performed for continuous variable. Multi logistic regression analysis was performed to test further association between the above mentioned factors with depression, while controlling for confounders. The results were presented by means of tables, histograms and graphs. The findings of the study revealed that depression is very high among HIV-infected patients attending a primary health care centre in Kigali, with a prevalence of 41.7%. The most frequent depressive symptoms presented were pessimism, fatigability, sad mood; lack of satisfaction, somatic preoccupation, loss of libido, crying spells, work inhibition, irritability, social v withdrawal and loss of appetite. The majority of respondents scored mild to moderate depression, whereas few had moderate to severe depression and only very few scored severe depression. Having considered all other socio-demographic and HIV related medical factors that were studied, being a female, having presented many HIV-related symptoms in the month prior to data collection, and having less than 250 CD4 counts were statistically associated with depression. On the other hand, having high social and family support was a protector factor to depression. Although the results of this study are not generalizable to the Rwandan population living with HIV, they underscore the importance of integrating mental health in HIV/AIDS services for the care of those who present mental problems related to HIV such as depression. / Thesis (MN)-University of KwaZulu-Natal, Durban, 2010.