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.

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

Thesis (MTech (Environmental Health))--Cape Technikon, 2003 / This is a retrospective (descriptive) study ofclinic delivery trends rendered in Cape Town Central District between July 1995 and June 2002. The study describes the history of clinic service delivery in Cape Town Central District, which includes the Primary Health Care model, as well as the District Health system. Clinic delivery trends for the following three periods are determined: I:] Before the implementation ofthe New Health Plan: July 1995 - July 1996; I:] During the implementation of the New Health Plan: July 1997 - June 1998; I:] After the implementation of the New Health Plan: July 1998 - June 2002. The study also determines and compares the nature ofpublic health clinic services delivered during the study period. No official annual health reports were compiled by Cape Town Administration since July 1997. This study therefore serves to determine disease and clinic trends for the periods where no such aonual reports are available. It is important to determine health delivery trends for future strategic plaoning purposes. Changes to the nature and extent ofservices rendered by public health clinics were brought about by the following factors: Cl One approach of Primary Health Care is to refer more patients to public health clinics in order to release pressure from the major tertiary hospitals. If this Primary Health Care (PHC) model is provided appropriately, about 80% ofhealth problems should be solved without referral to another level of care; Cl A number of free public health clinic services have been introduced since the democratization of South Africa in 1994, such as free services to expectant mothers as well as free clinic services to children younger than six years; Cl New clinic services have been added, such as provision ofmedication to stabilized mental health patients; Cl HIV/AIDS has become an international pandemic over the past decade and has shown a 660.8% increase in Cape Town Central District; Cl A limited (19.8%) increase in the population for that area during the study period; Cl Clinic services have been legislated as a nurse driven service since 1997, with an additional emphasis on the curative roles of nurses (traditional roles of nurses at public health clinics were largely preventive and promotive).

Thesis (M.Cur.) --University of Limpopo, 2010 / In this study, a qualitative, descriptive and contextual research methodology was applied to describe the problems faced by newly diagnosed diabetes mellitus patients at the primary healthcare facilities of the Mopani district in the greater Giyani municipality, Limpopo Province, South Africa. Purposive sampling was used and phenomenological interviews were held with newly diagnosed diabetes mellitus patients after investigations within the first six months. The data were analyzed using Tesch’s open coding method of data analysis for qualitative research. The findings indicated that newly diagnosed diabetes mellitus patients faced a number of problems, such as emotional disturbance, fear, anger, denial, frustration, depression, uncertainty, and poor interpersonal relationships with nurses. This study found that lack of support and proper health education for newly diagnosed diabetes mellitus patients demand government intervention, and thus proposes guidelines and recommendations for more effective healthcare practices and education for implementation at primary healthcare facilities.

This research is an endeavour to highlight the state of healthcare in South Africa as seen through the eyes of professional health care workers who are at the cold face of healthcare. Having worked in an environment of inequities and unjust circumstances, healthcare workers expressed their attitudes and beliefs that healthcare are in need of radical change. There appears to be insight from these professionals that the private and public healthcare sectors should forge a relationship, ultimately benefiting South African society. More research needs to be done on a major scale to determine more deeply the attitudes and beliefs of healthcare professionals. Such an endeavour will provide a stimulus for policymakers to harness this energy and direct it in a meaningful way in the transformation of healthcare in South Africa. Chapter 1 focused on several relevant perspectives and definitions on healthcare in South Africa and other countries. In Chapter 2, attention was given to socio-economic rights as per the South African Constitution and the states obligations to fulfil these rights. These rights were examined in the context of landmark Constitutional Court cases, viz. Soobramoney versus the State; TAC versus the State; and Grootboom versus the State. These cases give one the essence of interpreting rights and the constitutional obligation of the state to deliver on them. Healthcare developments in South Africa and other countries together with the RDP and GEAR considerations are outlined in Chapter 3. Research Methodology is outlined in Chapter 4, emphasizing also the limitations of this study. Chapter 5 examines the responses to the questionnaires and analyses its findings. Chapter 6 provides the conclusions and recommendations as well as a critique of healthcare in South Africa. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

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.

The provision of health in communities and their inhabitants are very important / Thesis (M.A.)-University of KwaZulu-Natal, 2007.

<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>

A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.

Thesis (MTech (Public management))--Cape Technikon, Cape Town, 2004 / The evolution of the South African health system has been characterised by inequities, imbalances as well as fragmentation. The unification of South Africa in 1910 did not consolidate public health administration, which was characterised by increasing institutionalisation, professionalism and organisation. This was the status-quo up until after 1990, whereby there were marked efforts and endeavours to effect defragmentation. In the context of the dramatic political changes that the country has seen over recent years, many aspects of local health care have been upgraded. Issues such as policy making and planning, the development of human resources and training for health care and the establishment of health systems and structures requires a different approach from the previous. Effective human resources development and management in consultation with communities, can contribute towards improvement of service delivery around health issues. Personnel matters and skills development should be considered in the exercise to boost employee morale and job satisfaction. The challenge facing South Africa has been to design a comprehensive programme to redress social and economic injustices, to eradicate poverty, increase efficiency and reduce waste. In the health sector this has been ongoing to involve the complete transformation of the national health care delivery system and the relevant institutions. Health care workers jointly, require the right skills, knowledge and expertise with attitude in their duties and obligation to serve the community.