<p>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.</p>

Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction Homoeopathy is recognised as a well established form of alternative medicine in the private healthcare sector of South Africa (Caldis, McLeod, Smith, 2001). Whilst local research supports the viability of homoeopathy as a primary healthcare resource; patient perception and experience with the homoeopathic service remain largely unknown (Smillie, 2010). The study addresses shortfalls in existing literature on homoeopathy, providing a qualitative evaluation of the homoeopathic healthcare service in the context of public healthcare in South Africa. The task of the study was to develop substantive theory with the aim to better understand health behaviour of patient’s utilising homoeopathic and allopathic healthcare services. Methods The study employed a qualitative study design, and explored the perceptions and experiences of patients receiving homoeopathic care at the Kenneth Gardens Homoeopathy Clinic, within the context of primary healthcare services and public sector healthcare. Data was generated through in-depth, semi-structured interviews conducted with 14 participants. Data was systematically analysed using grounded theory methods to generate substantive theory (Glaser and Strauss, 1967; Schreiber and Stern, 2001; Holloway and Wheeler, 2010). Results Data analysis revealed five main themes of influences affecting the utilisation of homoeopathic services at the Kenneth Gardens Clinic; these include context specific factors to healthcare utilisation, factors influencing healthcare utilisation, health beliefs and practices, health outcome factors and trust. The study results illustrate that participants trusted their homoeopathic provider and homoeopathic treatment outcomes; and subsequently demonstrate the direct positive influence which trust had on the utilisation of homoeopathic services in the study population. Discussion The discussion explores the significance of influences, barriers and discerning factors identified in the study on decision-making pathways in healthcare utilisation behaviour of homoeopathic and allopathic healthcare services. The significance of trust in healthcare utilisation behaviour is explored as the principle finding of the study. The study’s conceptual model is based on Anderson’s (2005) behavioural model of health service utilisation and has been adapted to demonstrate the relationship in health seeking behaviours between homoeopathic and allopathic care modalities. Recommendations The relationship between the variables illustrated in the study’s proposed adapted model need to be further tested using quantitative research methods. Trust in healthcare, and in particular with homoeopathy, is a subject which merits further exploration. / M

A mini-dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Nursing, Technikon Natal, 2002. / Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme. / M

M.Com. (South African & International Taxation) / The tax system in South Africa makes provision for everyday South African citizens to contribute to a greater or lesser extent towards health care funding in South Africa. However, as a result of the high unemployment rate, a large gap exists between tax contributors and non-tax contributors. This raises the question of whether it is fair that the burden to fund the proposed National Health Insurance (NHI) initiative in South Africa is borne by the small percentage of current tax contributors. The purpose of this research was to provide a taxation perspective on the different funding models and financing options available to the South African government for consideration in developing the NHI implementation strategy. The study evaluated the four traditional health care models used worldwide and assessed existing health care systems in selected first and third world countries in order to contribute towards the development of the proposed NHI system in South Africa. The health care models used by France, The United States, The United Kingdom, Brazil and Spain were evaluated in order to achieve an understanding of the funding approaches followed by these countries. It was found that although it is inevitable that South African tax contributors will have to be more heavily taxed in order to fund the NHI, as there are only limited possibilities for distributing the tax burden evenly. The main stumbling block in finding an equitable funding solution is the fact that there is a large disparity in South African income tax contributors.

Orientador: Adriano Dias / Resumo: Introdução: Com o envelhecimento populacional, há uma tendência ao aumento das doenças crônicas não transmissíveis, principalmente, da Hipertensão Arterial Sistêmica (HAS) e do Diabetes Mellitus (DM), exigindo cada vez mais a melhoria da organização dos serviços de Atenção Primária à Sáude (APS) para tal enfrentamento. Os serviços da APS são a principal porta de entrada e ordenadora do sistema de saúde, devido a sua proximidade com o território, apresenta-se como o local mais adequado para o diagnóstico e acompanhamento da HAS e DM. Objetivo: Avaliar a organização da assistência à Hipertensão Arterial e ao Diabetes Mellitus em serviços de atenção primária de uma Rede Regional de Atenção à Saúde (RRAS 12), segundo os diferentes arranjos organizacionais existentes na região. Método: Pesquisa avaliativa de abordagem quantitativa da organização dos serviços de atenção primária da RRAS 12 (DRS Araçatuba e São José do Rio Preto). Utilizou-se o banco de dados resultante da aplicação do instrumento QualiAB, em 2017. Foram selecionadas do QualiAB 16 variáveis referentes à caracterização dos serviços respondentes e 78 indicadores de organização dos serviços, específicas para a atenção à HAS e DM, conforme documentos publicados sobre o tema pelo Ministério da Saúde. Estes indicadores após separados em: 1) caracterização geral dos serviços e 2) caracterização da estrutura e procedimentos dos serviços quanto à atenção às doenças crônicas não transmissíveis – Hipertensão Arterial e Diabete... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: With the aging of the population, theres is a tendency to increase non-communicable chronic diseases, such as Systemic Arterial Hypertension (HDS) and Diabetes Mellitus (DM), increasingly demanding an improvement in the organization of Primary Health Care (PHC) for coping with theses diseases. PHC services ares the main gateway to the health system, due to its proximity to the territory, it is the mos suitable place for the diagnosis and monitoring of SAH and DM. Objective: To evaluate the organization of assistence to hypertension and diabetes mellitus in primary care services of a Regional Health Care Network (RRAS 12), according to the different organizational arrangements in that region. Method: Evaluative research on the quantitative approach of the primary care services organization of RRAS 12 (DRS Araçatuba and São José do Rio Preto). The database that resulted from the application of the QualiAB instrument was used in 2017. QualiAB was selected from 16 variables related to the characterization of the respondent services and 78 indicators of service organization specific to the attention to Hypertension and Diabetes Mellitus, as recommended in the documentos on the subject, published by the Ministry of Health. These indicators are separated into: 1) general characterization of services and 2) characterization of the structure and procedures of the services regarding chronic non-communicable diseases - Hypertension and Diabetes Melitus, will be analyzed ac... (Complete abstract click electronic access below) / Mestre

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2014. / Developing countries are faced with a number of health-care challenges: long waiting hours of patients in long queues is just one of such challenges. The key cause of this has been identi ed to be a lack, or uneven distribution human resources among health facilities. This sets the stage for poor and ine cient delivery of quality primary health care, especially to the rural dweller as they usually have a fewer medical professionals in their area. The impact of this a ects not only the state of health of the population, but also the economy, and population growth of the a ected community. To try and address this, the introduction of Information Technology (IT) into health-care has been suggested by many health governing bodies like theWorld Health Organization (WHO) and other authorities in health care. The ability of IT to go beyond physical boarders and extend professional care has been the key characteristic that supports its integration into health-care. This has eventually lead to the development of Health Information Systems (HIS) that support remote consultation. Despite all these innovations, there is still evidence of poor and ine cient delivery of services at health facilities in many developing countries. We propose a completely di erent approach of addressing the problem of poor and ine cient delivery of health-care services. The key challenge we address is that of lengthy queues and long waiting hours of patients in health facilities. To cut down on the use of nancial resources (whose lack or shortage is a major challenge in developing economies), we propose an approach that focuses on the routing of patients within and between health facilities. The hypothesis for this study is based on a suggestion that alterations to the routing of patients would have an e ect on the identi ed challenges we seek to address in this study. To support this claim, a simulator of the health system was built using the OMNET++ simulation package. Analysis of test-runs for di erent scenarios were then tested and the simulation results were compared against controls to validate the functioning of the simulator. Upon validation of the simulator, it was then used to test the hypothesis. With data from the di erent health-care facilities used as input parameters to the simulator, various simulation runs were executed to mimic di erent routing scenarios. Results from the di erent simulation runs were then analyzed. The results from the simulator and analysis of these results revealed that: In a case where patients where not given the liberty to consult with a doctor of their choice but rather to consult with the next available doctor/specialist, the average time spent by patients dropped by 26%. The analysis also revealed that moving a receptionist from the rst stage upon patient entry into the health facility reduced the average patient life time by 85%. This was found to be a consequence of a drop in queue length (a 28% drop in queue length). On the other hand, the analysis also revealed that the total removal of a general receptionist increased patient life-time in a facility by 30.19%. This study also revealed that if specialists were deployed to certain health facilities rather than having referred patients come to them in the urban health facilities, patient population in the urban health centers will drop by 32%. This also saw a drop in patient waiting time in the rural health centers as more doctors were available (a reduced patient-to-doctor ratio in rural health facilities). The results from the analysis support our hypothesis and revealed that indeed, alterations to the way patients are routed does have an e ect on the queue lengths and total waiting time of patients in the health system.

Background: The recognition of growing health disparities globally and, in particular Sub-Saharan’s continued poor health outcomes, has been responded to with a call to revitalise primary health care (PHC) 30 years after the Alma-Ata Declaration. Despite some limitations, and although not the only solution, community health workers (CHWs) have been shown to be able to reduce factors that can act as barriers to accessing care. However, CHW programmes (often provided by non-governmental organisations in South Africa) have historically been poorly regulated and fragmented. The South African government has proposed to address the health inequities through a series of health system reforms. One of these has been a current attempt to strengthen PHC through the use CHWs in order to reach underserved communities. The capacity of CHWs to provide effective outreach services remains unclear. This work examined the experiences of CHWs in their efforts to improve access to care through community participation and outreach services that work across sectors. Aim: The study aimed to examine the implementation of community health worker-provided services through the comparison of three case studies in order to identify enabling and constraining factors. Methodology: A case study method was used to compare three CHW programmes. Qualitative methods such as key informant interviews, participant observations, focus group discussions and network maps, were used to collect data. A thematic content analysis was used to identify a priori and emergent themes. Results: CHWs operate in communities with multifaceted needs (food, transport, health and social welfare services) requiring a comprehensive approach. The experiences of households in this thesis illustrate the various barriers to accessing services. The success and sustainability of CHW programmes depends on the ongoing commitment of resources, including investment in quality training, supervision, mentoring and organizational support. Furthermore, government institutional contexts with poor cross-sectoral integration, conflicting departmental mandates and poor accountability constrain the efforts of CHWs at local level. Operating within a community with strong social cohesion and social capital provided an enabling environment for CHWs to mobilise the community and facilitate community participation, which is crucial for implementation of cross-sectoral outreach activities. Conclusion: The study indicates that CHWs provide services in communities that live in poverty which results in multiple problems that contribute to ill health. The study goes further to illustrate that in order to strengthen outreach services across relevant sectors, the role of central government is crucial. These findings indicate a need for greater understanding about how to strengthen institutional contexts both in government and in non-governmental organisations.

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Although the nursing sector has not been spared the effects of human resource shortages and Human Immune-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) crisis in Lesotho, it still remains the backbone of the primary health care delivery. There is a well-established linkage between oral health and HIV/AIDS with many of the early symptoms of HIV manifesting in the oro-facial region. However, the lack of oral health personnel at primary health care levels in Lesotho makes Primary Health Care Nurse Practitioners (PHCNPs) often the first health care providers to consult, manage and refer patients with such oral lesions. Aim: To assess the “knowledge, attitude and practice” (KAP) of the PHCNPs regarding oral health and oral HIV lesions in Queen Elizabeth II (QE II) and Roma health service areas (HSA) of Maseru district in Lesotho. Objectives: To assess the demographic profile of PHCNPs in the target health facilities, their knowledge, attitude and practice regarding oral health and oral HIV lesions. Methods and Materials: The research was a descriptive cross-sectional survey. A convenience sample of 57 primary health care nurse practitioners (PHCNPs) from QE II and Roma health service areas were identified. During their monthly PHC meeting, a questionnaire was administered to assess the knowledge, attitude and practice regarding oral health and oral HIV lesions. The information gathered was both quantitative and qualitative. Data was entered and analysed using the SPSS statistical package. Results: The response rate was 87.7%. There was 100% consensus regarding the importance of oral health to the total well being of individuals. The majority of the PHCNPs recognised oral candidiasis (OC) (94.7%), bleeding gums (87.7%), herpes lesions (71.9%) and dental caries (75.4%). Lesions such as acute necrotizing ulcerative gingivitis (ANUG) (40.3%), angular cheilitis (AC) (56.1%) and apthous ulcerations (24.6%) were also recognised but to a lesser extent. The respondents associated OC (84%), herpes (61%), AC (54%), Oral Hairy Leukoplakia (OHL) (49%), Kaposi‟s‟ sarcoma (KS) (49%) with HIV/AIDS. OC was the most common lesion associated with HIV. Some lesions commonly seen in the clinics such as apthous ulceration and ANUG were not significantly associated with HIV (18% and 33%, respectively). The majority of PHCNPs (81%) indicated that they had knowledge about oral HIV lesions. Twenty nine 6 respondents (50.8 %) reported having received this knowledge through training institutions. Mass media (Radio (53%), TV (40%), and newspapers/magazines (49%)) was one of the major sources of information. Forty-four PHCNPs (77.2%) saw only Zero or one (0-1) HIV patients with oral lesions. Similarly, 15.8 % and 7% of the PHCNPs saw 11 to 20 and more than 20 (21+) HIV patients with oral lesions, respectively. The two thirds of the PHCNPs (67%) said they would not advise patients to seek care from Traditional Health Practitioners (THP) due to their lack of trust and confidence in the practices, knowledge and the patient management of the THPs. However, 16% of them reported that they would refer because they thought traditional medicine boosts the immune system. Only seven respondents (12.3%) routinely washed their hands with antiseptics. However, 44 of respondents (77.2 %) cleaned their instruments with bleach and disinfectants. The majority (89.5%) washed their hands with water and soap. Forty three respondents (75.4%) wore gloves during examination. Routine use of facemasks was limited to only 12 respondents (21.1 %). Ninety eight percent of the PHCNPs stated that they would like to learn to manage oral lesions at health centres. The majority (79%) of the respondents said that they would like to receive more training on the management of oral lesions through workshops. Conclusions: There was an observable correlation between PHCNPs self-assessment of oral health knowledge and the objective knowledge as assessed by ability to identify the oral lesions on a chart ( 2 –sided Fischer‟s test-0.000-0.261).This needs to be confirmed by undertaking a study with a larger sample size. OC was the most common lesion associated with HIV as reported by the PHCNPs. The majority of the participants (94.7%) identified OC and associated it (84%) with HIV infection. The finding indicated that with training and/or mentoring, PHCNPs are likely to confidently diagnose oral HIV lesions. PHCNPs showed a positive attitude towards learning more about the oral manifestations of HIV/AIDS. PHCNPs should be utilised more effectively in the diagnosis and management of HIV/AIDS.

Discourse for the partial fulfillment of the requirements for the degree of Master of Science (Development Planning) at the University of the Witwatersrand, Johannesburg, / A definition of development includes improving living conditions and the quality of life. There is an interrelationship between health and social and economic development. "Health Leads to and at the same time is dependant on a progressive improvement in conditions and quality of life". (World Health Organisation). Therefore a dIscussion on health has to take into account the socio-economic and political context. In assessing the health profile of the homeland populations one finds them to be the least healthy. The problem is that the level of health of the rural population is low and the health care situation follows that of a developing society, where poverty-related diseases and infant mortality rates are high and life expectancies are unacceptably low. The rationale of this discourse is to express the need of action by governments, and health Bnd development workers, to protect and promote health. The aim is to examine the primary health care approach in Q sample area and see how it can be used to achieve an acceptable level of health. Background on the state of health will be addressed. The health services under apartheid is discussed in the first section, with attention given to statistical information and health indicators. / AC2017

Violent and traumatic events are a regular occurrence in many South Africans’ lives. The term 'continuous traumatic stress’ was coined by South African anti-apartheid health professionals in the 1980’s to explain the continuous nature of violence and trauma happening within the country. Although the political agenda may have shifted, many South Africans are still living within a context in which violent and traumatic events regularly occur. However, little is known about how health workers respond to continuous trauma within the South African setting. The Community Health Workers - within this study - are part of the South African health model called ‘Primary Health Care Re-engineering’ that is currently being piloted. The research was exploratory in nature and used a mixed methods design. Twenty three Community Health Workers who participated in the study were from two sub-districts within the Ekurhuleni district, Gauteng, Johannesburg. The research included two face to face semi-structured individual interviews. The first included qualitative questions and completion of the quantitative Stressful Life Events Screening Questionnaire (1998) to explore past trauma experiences. Over a seven month period, the participants were asked to document traumatic event exposure and responses through the adapted Life Events Checklist (1995) and personal journaling. At the end of this period, participants were interviewed again to explore their current traumatic experiences. Qualitative data were analysed through thematic content analysis and quantitative data were used to substantiate information from the interviews and checklists. Results show that Community Health Workers – within this study - have a high prevalence of exposure to traumatic events (directly experiencing, witnessing and hearing about). Prominent events included physical and sexual assault, transport accidents, fires and explosions. Media played a powerful role in exposure to events. Traumatic and unexpected losses were key experiences that need to be considered when working with trauma in the South African context. Acknowledgement of experiences (peer and external) is an essential element in developing support structures. These findings – from the context of Ekurhuleni, South Africa - contribute to exploring and understanding the experience of ‘continuous traumatic stress’ for Community Health Workers.