M.Cur. / Daar is nie genoeg effektiewe, bekostigbare oogsorgdienste in Suid-Afrika nie. Suid-Afrika beskik oor meer geregistreerde verpleegkundiges as algemene praktisyns, oftalmoloe of optometriste. Daar bestaan reeds 'n goedgekeurde kursus in oftalmologiese verpleging en daarom is geregistreerde verpleegkundiges die mees geskikte vir opleiding in oftalmologie. Dit sal meer kosteeffektief wees om 'n verpleegkundige in primere oogsorg aan te wend. Tans is daar 'n groot aanvraag vir oogsorg op primere vlak. In Suid-Afrika, wat gedeeltelik 'n derdewereldland en gedeeltelik 'n eerstewereldland is, is primere oogsorg nog heeltemal ontoereikend, aangesien die meeste van die oogsorgdienste in die hoofstede gesentreer is. Dit veroorsaak dat die oftalmologiese departemente heeltemal oorlaai word deur oogtoestande wat op primere vlak gehanteer kan word. Navorsing het getoon dat 85% van pasiente wel op primere of sekondere vlak gehanteer kan word (Community Eye Health Workshop, 1996). Die persentasie mense met belemmerde visie (tydelik of permanent) word jaarliks meer, en die beste manier om dit te verhoed is die vroegtydige opsporing van daardie pasiente op primere vlak. In Suid-Afrika word die dienste van oftalmologiese verpleegkundiges nog nie ten voile benut nie, terwyl hulle, as gevolg van hul opleiding, 'n groot rol behoort te speel in die voorkoming van belemmerde visie. Dit geld veral op plattelandse gebiede, waar die oftalmologiese verpleegkundige die eerste kontakpersoon is. In stedelike gebiede, waar daar lang waglyste is by openbare gesondheidsorghospitale, behoort die oftalmologiese verpleegkundige ook aangewend te word om waglyste te verkort. Die vraag ontstaan dus: Wat is die rol van die oftalmologiese verpleegkundige in primere oogsorg?

The Kingdom of Saudi Arabia (KSA) faces an increasing chronic disease burden. Despite the increase in numbers of primary health care centres (PHCCs) current evidence from the KSA, which is limited overall, suggests that access and utilisation of PHCCs, which are key to providing early intervention services, remain unequal with its rural populations having the poorest access and utilisation of PHCCs and health outcomes. There is a dearth (lack) of information from the KSA on the barriers and facilitators affecting access and utilisation of primary health care services (PHCS) and therefore this study aimed to examine the factors influencing the access and utilisation of primary health care centre (PHCC) in urban and rural areas of Riyadh province of the KSA. The behavioural model of health services use (Andersen’s model) provided the contextual and individual characteristics and predisposing, enabling and need factors which assist with an understanding of the barriers and facilitators to access and utilisation of PHCCs in Riyadh province. A mixed methods approach was used to answer the research questions and meet the objectives of the study. The converged qualitative and quantitative findings show that there are a number of predisposing (socio-demographic characteristics; language and communication and cultural competency) enabling barriers such as; distance from PHCCs to the rural residence, lack of services, new services, staff shortages, lack of training, PHC infrastructure, and poor equipment. Facilitators: service provider behaviour/communication, free PHCS, service provision and improvements, primary health care (PHC) infrastructure, manpower, opening hours, waiting time, and segregated spaces and need (increasing prevalence of chronic diseases, PHC developments in the KSA) factors influencing access and utilisation of PHCS. This study highlights important new knowledge on the barriers and facilitators to access and utilisation of PHCS in Riyadh province in the KSA. The findings have some important policy and planning implications for the MOH in the KSA. Specifically, the findings suggest: the need for clear documentation/guidance on minimum standards against which the PHCS can be measured; an audit of service availability at the PHCCs, regular patient satisfaction evaluations of PHCS, that the MOH take a parallel approach and continue to resource and improve buildings and equipment in existing PHCCs, the recruiting of more GPs, nurses, pharmacists, nutritionists and physiotherapists to meet patient demand and more Saudi health care staff, more targeted health education and interventions for the prevention of chronic diseases in the KSA and the need for an appointment system for attending the PHCCs. There is a need for further research into the barriers and enablers to accessing and utilising health care in Riyadh and the KSA overall. This research would be made easier with a clearer definition of rural and urban in the KSA context which would allow a greater comparability between urban and rural PHCS for future research, audit and evaluation as well as comparison with PHCS in other parts of the world. The Andersen model provided a useful conceptual model to frame this research and provided a structure for contrasting and comparing the findings with other studies that have used the Andersen model to understand the barriers and enablers to accessing and utilising health care services.

Master of Public Health - MPH / Many parts of South Africa face a shortage of doctors within the public health system. While the PHC system is driven primarily by nursing staff, there is a need for doctors to provide certain services at primary and secondary levels. In 1996, as part of its efforts to address the shortage of doctors, the DoH began recruiting Cuban doctors to work in South Africa. This programme, now underway in eight of the nine provinces, falls under a government-to-government agreement aimed at strengthening the provision of health care in the areas of greatest need: townships and rural areas. The programme has demonstrated tangible success. However, it has also been criticised in some sections of the medical community and the media, where it has been portrayed in a controversial light. All this underlines the importance of an analysis of the programme, but to date, no such evaluation has been carried out.This research assesses the Cuban Health Programme in Gauteng province. On the basis of this thorough assessment, the government can take steps to improve the national programme, using Gauteng as a case study. This study was conducted in July 2004, employing qualitative methods to develop an in-depth understanding of recruitment and induction processes in Cuba and South Africa, the scope of practice of Cuban doctors, professional relationships, adaptation to the health system and broader society, and other factors. The researcher also conducted a review of official documents. Gauteng began with two Cuban doctors at the outset of the programme in 1996. The number peaked at 32, and has since dropped to 15. All of these doctors were interviewed in the course of the research, along with five managers and five peers. The study revealed that all the interviewees, except one manager, firmly believe that the programme has achieved its objectives, and should continue. Peers and managers commended the high quality, comprehensive and caring approach of the Cuban doctors, and say they are satisfying a real need. The Cuban doctors, however, believe that because they are providing mostly curative services, they are under-utilised. Flowing from the research are a series of recommendations. These include a proposal that the government recommit to the programme and ensure its continuity, and review the current role of the Cuban doctors, taking into consideration their willingness to provide training and expertise in preventive interventions. / South Africa

Master of Public Health - MPH / The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities. / South Africa

Magister Educationis - MEd / This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / 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 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 experiences regarding provision of these services. The aim of this study therefore was to explore the persons with physical disabilities experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health 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 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 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 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 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 particularly information regarding disability and support services available for them. Experiences regarding participants involvement in their rehabilitation were generally positive. Generally, the 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 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 should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved. / South Africa

Magister Public Health - MPH / Introduction: The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. Aim: The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Methodology: Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. Result: The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Conclusion and Recommendations: Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.

Magister Public Health - MPH / Background and Rationale: Antenatal care (ANC) is vital for accessing prevention of mother to child transmission (PMTCT) services. The timing of the first ANC visit is critical for HIV infected pregnant women to access antiretroviral (ARV) prophylaxis as recommended. In addition pregnant women access other interventions like syphilis screening and treatment, provision of ferrous iron supplements, malaria prevention and treatment, health education, identification and management of risk factors. There is however paucity of information on factors associated with the timing and adequate use of ANC services in Chitungwiza Township, Zimbabwe. Aim: This study aimed to determine the factors associated with early access to and adequate use of ANC services among women attending ANC in the four polyclinics in Chitungwiza Township.Method:The study included a retrospective record review of women who registered for ANC in 2010 and a cross sectional study of pregnant women attending ANC clinic for the first time during the current pregnancy during the survey period. Data on gestation age at first ANC visit, number of ANC visits, age, gravidity, parity, tetanus, iron sulphate, rhesus results, HIV test result, WHO clinical stage, CD4 count, cotrimoxazole, PMTCT option accepted, date of initiation of AZT or ART; partner HIV test results; and infant feeding adherence done was abstracted into an MS Excel spreadsheet from the 2010 ANC registers in the four primary health care clinics. Every fourth record was captured. Exit interviews were also conducted on all women attending ANC for the first time during the current pregnancy using a structured questionnaire. Questions on socio-economic status, pregnancy history, reasons for seeking ANC, knowledge and belief about ANC services and their perception of the service received were asked. The outcome variables were gestation age at first ANC visit and the number of ANC visits. The spreadsheet was imported into Epi Info 7.0.9.7 and STATA 11 for analysis. The questionnaires were captured into an Epi Info 7 database exported to STATA 11 for analysis. A sample of 1,236 of first ANC visit records were abstracted from the 2010 ANC registers in the four primary care clinics and 80 women coming for ANC were interviewed in three clinics. The prevalence of pregnant women attending ANC for the first time at gestation age less or equal to 14 weeks and the prevalence of women with less than 4 ANC visits were computed. Pearson Chi-square tests were used to determine the strength of the relationships between the dependent variable (gestation age at the time of the first visit) and independent variables of age, marital status, level of education, parity, gravidity. All statistical tests were performed at 5% significance level and estimates were calculated at 95% confidence interval. Multiple logistic regression analysis was used to investigate the association between the outcome and the independent variables. Model interpretation was done using odds ratios (OR). Levels of knowledge and perception about ANC services as well as service content during the visit were also summarized. Results: Less than 1% of the women who attended ANC in 2010 came for 1st visit at week 14 or less, while of the women interviewed, 2.5% came at similar gestation age. Thirty-nine percent of women attending ANC in 2010 had at least four visits. Lower parity and tetanus immunization were significantly associated with early ANC initiation, while tetanus immunization and syphilis screening were associated with the number of visits.Among the interviewed women (n=80), 72.1% believed that a pregnant women should start ANC at 14 weeks or earlier. Most women (61.7%) cited having no money for booking as the reason for not coming earlier. Need for husband or partners permission, procrastination and not having any health problems with previous pregnancies were also a barrier to access. Uptake of HIV testing was very high at 94.7% of the women. However partner testing was very low at 2.1%. Knowledge of the appropriate time of the first ANC visit was somewhat high but not universal. Conclusions and Recommendations: Timely and adequate uptake of ANC services is very low in Chitungwiza Township. The user-fees appeared to be a major barrier to accessing ANC timely. While correct knowledge about when to go for ANC and the health problems women face during pregnancy and childbirth is prevalent,other factors like the need for permission from spouse or partner and procrastination were barriers to seeking service. Abolishing maternity fees should be seriously considered in order to increase access to timely ANC services. Sustainable means of financing services without reducing quality should be sought. There was variable uptake of various interventions in the ANC package due in part to supplies stock outs. There is need for strengthening the procurement and distribution systems so as to ensure continuous supplies at service delivery level.

Magister Curationis - MCur / The purpose of the study will be to explore the discharge referral pathway for patients that have been discharged from hospital to home in the Western Cape Province. A mix of quantitative and qualitative research, using a descriptive design will be undertaken. Quantitatively, following the patient paper trail from Tertiary Hospital to grassroots level. Qualitatively, to identify whether the referral pathway was user friendly. Records of discharged patients from the Tertiary Hospital will be used as the study population. Patient information will be accessed from patient files at the hospital. Interviews will be conducted with the relevant discharge liaison officers at the Tertiary Hospital, and Primary Health Care level. Relevant staff members within the non–governmental –organisations (NGOs), will also be interviewed in order to determine their perception of the discharge referral pathway. The findings of the study will be used to inform policy guidelines. Challenges encountered by staff members in referring patients for continuum of care, and the perception of consumers will also be described and documented.

Magister Public Health - MPH / Background: Point of Care Testing (POCT) refers to qualitative or quantitative tests done in health facilities where the patient is being attended to (on-site), and not in the conventional hospital laboratory setting. As a consequence of many developing countries not having access to conventional laboratory services (with trained laboratory personnel), diagnostic testing often relies on the availability of valid POC tests. All pregnant women attending antenatal care clinics in the Sedibeng District Primary Health Care (PHC) centres should be screened for syphilis, anaemia and HIV. This can be done by means of POC testing, which is easy to perform. These POC tests provide results promptly allowing treatment to be commenced immediately, if required. Despite this highly desirable benefit of POCT, there is circumstantial evidence which suggests that staff is choosing to send specimens to the laboratory for testing, instead of doing POCT themselves. The extent to which this happens and the factors contributing to this practice are not clear. Aim: The aim of this study was to assess the prevalence of screening for syphilis, anaemia, and HIV amongst pregnant women during their first antenatal care visit to PHC facilities in the Sedibeng District, and to establish the factors affecting the prevalence of appropriately using POCT for screening tests. Methodology: Study design: A quantitative, analytical, cross-sectional study was conducted. Study Population and Sample: Patient registers, staff expected to perform POCT and facility managers. 33 District’s health care workers expected to perform POCT on pregnant women during the first ANC visit and 30 facility managers from these facilities; 360 patient records (these were collected from a total of 7 200 patients’ records). The data was collected over a six month period (from 1st July 2012 to 31st December 2012). Data collection: Data was collected from 360 patient records to determine the rate, appropriateness and mechanism of screening for syphilis, anaemia and, HIV in pregnant women on their first antenatal visit. Interviewer-administered closed-ended questions was asked from 30 antenatal care clinic staff tasked with performing POC tests and from 30 PHC facility managers to determine the factors affecting the rate of conducting POCT. Data analysis: Data was analysed using univariate, bivariate and multivariate analyses. Ethical considerations: No harm was anticipated to anyone participating in the study or from the findings of the study. A major benefit of the study was that clarity on the factors affecting the rate of screening and the use of POCT was gained. This will hopefully facilitate the implementation of evidence–based interventions to improve POCT uptake if required.