Ph.D. (Community Nursing Science) / The provision of reproductive health promotion services to females in South Africa is the responsibility of the national and provincial governments, while in primary healthcare (PHC) settings the local government is responsible for the provision of free reproductive health promotion services to females. The prevalence of sexually transmitted infections (STIs), the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) led to the development and provision of noncollaborated vertical PHC reproductive health programmes. The purpose of this study was to develop a model to collaborate the provision of reproductive health promotion services in PHC settings. A qualitative, descriptive phenomenological design, exploratory and descriptive approaches and contextual and theory generating design were used. The study was conducted in three phases. In phase 1, data collection consisted of individual indepth interviews and focus group interviews. Non-probability purposive sampling was used to include three population groups: females who utilised the reproductive health promotion services and reproductive health promotion service providers and those who provide clinical teaching regarding reproductive health promotion in two different PHC settings who were sampled through non-probability convenience sampling methods. Throughout the study, ethical principles were strictly adhered to and trustworthiness was ensured. Data analysis was done according to Tesch’s open coding data analysis method. The findings revealed four emerging themes: service provision factors that impact on reproductive health promotion provision; barrier factors towards safer sex practice; low health literacy of females regarding reproductive health promotion, and disclosure of positive HIV status. In phase 2, the conceptual framework was described according to the survey list of Dickoff, James and Wiedenbach (1968) and the Research Model in Nursing as described in the Theory for Health Promotion in Nursing (University of Johannesburg, 2009). In phase 3, the described conceptual framework served as the guideline for the model development guided by Chinn and Kramer’s (2008) theory and model generating design. Two phases of model evaluation was done: firstly by clinical experts and secondly by academic experts. The model that was developed was based on collaboration, community participation, and cooperative decision making processes and was named: A model to collaborate the provision of reproductive health promotion services in PHC settings. The outcomes from implementing this model envisaged to be the reduction of unintended pregnancy, STIs, and HIV and AIDS among females and males.

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background. Unintended pregnancy is a major global challenge among sexually active women of childbearing age. Non-use of modern contraception and inconsistent use of short term contraceptive methods are the main reasons associated with unintended pregnancy. Long acting reversible contraceptives (LARCs) have proven to be highly effective with good continuation rates, and are cost-effective compared to other methods, when used more than one year. However, there is low uptake of LARC methods globally and in South Africa. Aim of the study. The aim of the study was to determine factors influencing the uptake of LARC methods among women at the primary health care (PHC) clinics in eThekwini District. Methodology. A quantitative, descriptive survey was used in this study. Purposive sampling of six fixed PHC clinics from the three sub-districts was done. Convenience sampling resulted in 371 participants. A survey questionnaire in English and isiZulu was used to collect data. Data was analysed using SPSS version 23.0. Inferential statistics were used to determine the relationship between the variables. Results. The results of this study revealed that the contraceptive injection was most common LARC used, and the least used method was the intrauterine contraceptive device. The side effects were the main reasons for discontinuation with LARCs and all other contraceptive methods. Irregular vaginal bleeding was the main side effect cited by respondents associated with contraceptive implant usage. The respondents had positive attitudes and perceptions towards LARCs; however, the majority of respondents were not interested in using LARC methods. Common myths and misconceptions were not negatively associated with LARCs, since respondents disagreed with them all. / M

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

The South African Department of Health, like the health departments of many other countries, has reviewed its policies to focus on the delivery of comprehensive Primary Health Care (PHC). The South African health care sector is undergoing major restructuring in an attempt to address the inadequacies resulting from the fragmentation and duplication of health services in apartheid South Africa. Following this restructuring, the decentralisation to health services has been adopted as the model for both the governance and management of health issues (Department of Health, 2002:7). Before 1994, local government health departments were rendering certain primary health care services in terms of the Health Act 63 of 1977. Post 1994, the Constitution of the Republic of South Africa 1996 (Act 108 of 1996) classified primary health care as a provincial function. Based on this classification, primary health care services in South Africa are now being provided by two authorities, namely local government and provincial government, in the same community. Thus, in the Nelson Mandela Bay Municipality District, primary health care services are rendered by two authorities, namely the Nelson Mandela Bay Municipality and the Nelson Mandela Health District of the Eastern Cape Department of Health. These authorities are targeting the same community, with the same PHC package, with different sets of conditions of service, salary structures, infrastructure, accountability and authority. Such differences are believed to have impeded functional integration, depleted human resource capacity in rendering an effective and efficient PHC system and resulted in inefficient budget spending by both authorities. The problems of location, duplication and fragmentation of primary health care provision in the Nelson Mandela Bay Municipality District are not conducive to optimal service rendering. This will be resolved only once a unified, single integrated health service has been established. This study was undertaken to explore and describe the views of health practitioners with respect to the location of primary health care within the Nelson Mandela Bay Municipality District. The research design of this study was a quantitative, explorative, descriptive survey. Healthcare practitioners, like management, doctors and nurses, were asked to respond to a structured questionnaire. The findings of the study indicate that while health practitioners may hold diverse views on where primary health care should be located, they agree that a unified, single PHC authority would be desirable. Although primary health care is a combination of task-orientated basic health services and the process of community development, it is important that the authority of choice should ensure the highest possible quality through an integrated process, taking into account local needs. The recommendations made by the researcher on the conclusion of this study cover the principles on which a successful strategy for implementing primary health care should be based, including the need to create sustainable communities. It is hoped that the recommendations offered, will contribute to the more effective and efficient implementation of comprehensive primary health care services in Nelson Mandela Bay and also elsewhere in South African local government.

Purpose of this treatise- This Paper aims to investigate the Sustainability of Health Facility Committees in the Nelson Mandela Bay Health District. Design/methodology/approach – This study consists of a literature review and a pilot study. Qualitative research approach was used in order to obtain descriptive data from the targeted group. The primary sources of data collection the researcher used were from the members of the committee, health facility manager, chairperson and the health promoter who are members of the health committees. Focus group discussions with health committees were conducted to provide rich in-depth data. Literature and journal articles were also used to provide secondary data to corroborate findings. Research limitations- A major limitation to this study is that due to the nature of the nature of the research report it was not possible to assess the sustainability of health Facility Committees from other areas in the Nelson Mandela Bay Health District. Findings-The study has revealed that Community Health committees are sustained by the commitment and passion members have for the work done in the facilities and health committees. The study also revealed that social cohesion plays a major part in the sustainability of Community Health Committees (CHC). Lack of involvement by ward councilors, support from the Health Department, uncertainty of responsibilities by the health committees and limited skills were indicated as major setbacks threatening the sustainability of Community Health Committees. It can thus be concluded that these limitations must be properly addressed in order to enable and uphold the sustainability of Community Health Committees. Original/value -So far, there has been limited research which has been undertaken with regards to the subject of Sustainability of Health Facility Committees in Nelson Mandela Bay Health District. This study will aid in enabling a better understanding of what sustains Community Health Committees and the Challenges facing such communities in order to enable individuals and the parties involved to better formulate solutions to overcome these challenges in Nelson Mandela Bay.

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Thesis (MCur)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Nationally and internationally emphasis is placed on quality care in health services. The researcher identified a need to evaluate a component of primary health care service in the Northern province. A study based on the combination of qualitative and quantitative methods was conducted to formulate and evaluate structure, process and outcome standards for selected clinics in the Northern Province. The most important results are: • The standard relating to the structure was suboptimal. Physical and human resources are of critical importance to the rendering of quality patient care. However this did not comply with the pre-set standard norm of 80%. • Process standards focused on physical examination of patients taking into account the age of the client and the systems involved. Substandard care was found in all these aspects. • Outcome standards determined by the patient questionnaire also revealed negative findings. Recommendations include the development of a quality improvement model for the Northern Province Health Services, formulation of standards for all disciplines of health care, annual evaluation of patient care and the institution of a formal staff development programme. Key words: quality care, formulation of standards, structure, process, outcome / AFRIKAANSE OPSOMMING: Nasionaal en internasionaal word die belang van gehaltesorg in gesondheidsdienste beklemtoon. Die navorser het enbehoefte ge'identifiseer om en component van prirnerre gesondheidsorgdienste in die Noordelike provinsie te evalueer. en Kombinasie van kwalitatiewe en kwantitatiewe metodes is gebruik om struktuur-, proses en uitkomsstandaarde in geselekteerde klinieke in die Noordelike provinsie te formuleer en evalueer. Die belangrikste resultate was: • Die standard ten opsigte van die standard was suboptimal. Fisiese en menslike hulpbronne is van kritiese belang vir gesondheidsdienslewering. Die standaard hiervan het nie voldoen aan die voorafbepaalde norm van 80% wat gestel is nie. • Prosesstandaarde het op fisiese ondersoek van die pasiente gefokus met inagneming van die ouderdom van die klient en die simptome waarmee pasiente presenter. Sub-standaardsorg is ten opsigte van al hierdie aspekte gevind. • Uitkomsstandaarde is deur middel van en pasientevraelys gemeet en he took negatiewe bevindinge opgelewer. Aanbevelings sluit in die ontwikkeling van engehalteversekeringsmodel vir die Noordelike Provinsie se gesondheidsdienste, die formulering van standaarde vir aile dissiplines van gesondheidsorg, jaarlikse evaluering van pasientesorq en die instelling van enformele personeelontwikkelingsprogram. Kernwoorde: Gehaltesorg, formulering van standaarde, struktuur, proses, uitkomsstandaarde.

Background: This study is located within a complex network of paradigmatical methodological, and institutional relationships, and draws concepts from a range of scholastic traditions. The hermeneutical tradition within Sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. The concept of the lifeworld/ healthworld as a description of the complex of health beliefs and behaviours of individuals in relation to the ailing body is used to describe chronic illness and healthcare access, both as lived experience and as fields for public health intervention. Aim: To understand how women living with chronic illness experience their illness and access healthcare in an urban and rural context. Methods: This study is a mixed-methods comparative case study of the healthcare access experiences of women with chronic illness in an urban and rural area in South Africa. The core of the study methodology is a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The urban component of the study was conducted in Birth to Twenty (Bt20), a birth cohort study located in Johannesburg-Soweto. The rural component of the study was conducted in Agincourt, a sub-district of the Bushbuckridge district in Mpumalanga Province. The quantitative context for the Soweto case study uses secondary data collected by Bt20 to construct a historical overview of the use of formal and informal healthcare services in Soweto. It also uses the findings of a large scale cross sectional survey of the primary caregivers of the Bt20 cohort, conducted between November 2008 and June 2010. The rural case study is contextualised by a detailed review of research conducted in the Agincourt sub-district. For the qualitative case studies I employed a qualitative methodology incorporating serial narrative interviews to present an experience-based overview of concepts of disease causation, self treatment and coping. Results: The cross-sectional survey describes a low resource population with a high prevalence of chronic noncommunicable disease (NCDs). Over one third (37.3%) of the population in Soweto could be categorised as having a low socio-economic status, defined as access to only one or less of 5 socio-economic items. Slightly over half the respondents in Soweto (50.7%) reported having at least one chronic illness. Only around a third (33.3%) of the survey participants with chronic illnesses reported accessing formal healthcare services in the last 6 months. Similar trends were found in the review of research carried out in Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how the medicine from the clinic interacts with the body. The search for alternative remedies took place not as an attempt to cure disease, but to reach a deeper understanding of the diseased state of the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. In both study sites there is evidence that traditional healers were consulted for social purposes rather than health-related purposes. Discussion: Soweto and Agincourt share similar patterns of healthcare utilisation and healthcare belief. Both study sites were characterised by increasing trends in formalisation. At the same time, only a small portion of individuals in both study sites with chronic illness utilised formal healthcare services. A consideration of the findings suggests five broad themes for further research: (1) Processes of constructing body narratives; (2) Encounters with purposive-rational systems; (3) Encounters with traditional medicine; (4) Encounters with contemporary informal medicine; and (5) Religion and healthcare. These five themes constitute the beginning of a comprehensive map of the lifeworld/ healthworld schema. Such a schema has implications for healthcare policy and practice, particularly with regard to the development of integrative paradigms in South Africa as exemplified by Community Oriented Primary Care (COPC). Conclusion: The aims and objectives of the study were met through the development of an initial lifeworld/ healthworld schema, which suggests that the coexistence of diverse public healthcare concerns of high NCD prevalence and low formal healthcare utilisation is best addressed through the adoption of integrated healthcare approaches based on lifeworld/ healthworld rationalistion.

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)