Thesis (MPhil) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Legislation encourages local government! municipalitiesl local authorities in South Africa, to fulfil a development role. One of the main objectives of municipalities performing a development role is to empower communities, especially previously disadvantaged communities. This study argues that the services delivered by municipalities are an essential component of a development orientation. In view of this fact, the study proposes an operational framework, whereby community empowerment can be achieved through municipal service delivery. The operational framework suggest that for community empowerment to be achieved through municipal service delivery, requires that the empowerment enabler (municipalities or departments within municipalities) should assure that: disadvantaged communities have access to services, services must be delivered in a non-discriminatory manner, the community should understand the rationale as to why the service is delivered, opportunity should be given for community participation in the delivery process, there should be a constant information channel between the giver (enabler) and receiver of services, and human resources from the local community should be utilised where possible in the delivery process. Lastly, a descriptive evaluation is undertaken of the health department's approach (at the Stellenbosch Municipality) to the delivery of primary healthcare services and service infrastructure. The purpose of the evaluation is to ascertain whether the principles as proposed in the operational framework are present in the health department's approach to service delivery. The evaluation reveals that most of the proposed principles of the operational framework features in the health department's approach to the delivery of primary healthcare services and services infrastructure. Thereby, concluding that the health department follows to a certain extent an approach to service delivery that could ultimately lead to community empowerment. / AFRIKAANSE OPSOMMING: Wetgewing vereis dat plaaslike regering/ plaaslike owerhede/ munisipaliteite in Suid-Afrika, 'n ontwikkelingsrol moet vervul. Een van die doelstellings van 'n ontwikkelingsrol vir munisipaliteite, is om gemeenskappe te bemagtig, spesifiek gemik op agtergeblewe gemeenskappe. Hierdie studie argumenteer dat die dienste gelewer deur munisipaliteite 'n essensiële komponent vorm van 'n ontwikkelings-orientasie. Gevolglik, stel hierdie studie 'n operasionele raamwerk voor, waarvolgens gemeenskapsbemagtiging bewerkstellig kan word deur middel van munisipale dienslewering. Die operasionele raamwerk stel voor dat om gemeenskapsbemagting deur dienslewering te bewerkstellig, vereis dat die bemagtiger (munisipaliteite of departemente binne munisipaliteite) moet toesien dat: agtergeblewe gemeenskappe toegang het tot diente, dienste moet gelewer word op 'n niediskriminerende wyse, die gemeenskap moet verstaan waarom die diens gelewer word, geleentheid moet geskep word vir gemeenskapsdeelname aan die diensleweringsproses, 'n kommunikasie kanaal tussen die ontvanger en leweraar (bemagtiger) van dienste, moet geskep word en laastens moet daar van plaaslike arbeid (waar moontlik), in die diensleweringsproses gebruik word. Laastens word 'n beskrywende evaluering onderneem na die Gesondheidsdepartement (by die Stellenbosch Munisipaliteit) se benadering tot die lewering van primêre gesondheidssorgdienste asook diens infrastruktuur. Die doel van die evaluering is om te bepaal of enige van die faktore, soos beskryf in die operasionele raamwerk, teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Die resultate van die ondersoek toon aan dat die meeste van die faktore, soos voorgestel in die operasionele raamwerk, wel teenwoordig is in die gesondheidsdepartement se benadering tot dienslewering. Gevolglik kan daar afgelei word dat die gesondheidsdepartement wel tot 'n mate, 'n benadering tot dienslewering volg, wat kan lei tot gemeenskapsbemagtiging.

Thesis (MBA)--Stellenbosch University, 2012. / Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.

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.<br /> <br /> 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.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

M.Cur. (Nursing Management) / Transformational leadership involves the creation of a motivating climate that enhances growth, development, commitment, goal achievement and enjoyment which encourages behaviour based on a set of shared values (Price, 2006:124). In this study transformational leadership referred to concepts of motivation, and change management with regard to the implementation of the Cervical Cancer Screening Programme in a PRe setting. During support visits in Ekurhuleni Health District, the researcher observed a lack of transformational leadership among facility managers in Primary Health Care Clinics to transform the Cervical Cancer Screening Program in line with relevant health care legislation. It was apparent that the problems in implementing the Cervical Cancer Screening Programme were related to poor motivation and lack of implementation of change management principles in the PHC clinics. From the problem statement the following research questions emerged: To what extent is the facility manager perceived as a transformational leader to implement the Cervical Cancer Screening Programme in a PHC clinic? Which actions should the facility manager take to implement the Cervical Cancer Screening Programme in PHe? From the findings guidelines for the facility managers were described to enable them to implement a Cervical Cancer Screening Programme in a Primary Health Care clinic within legal requirements...

Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015. / The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics / An electronic copy of the Thesis is currently unavailable.

Dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Nursing, Technikon Natal, 2002. / The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested. / M

Thesis (M. Cur.) --University of Limpopo, 2015 / The purpose of this study was to determine the factors that were contributing to selfreferrals of antenatal women at the Dilokong Hospital in the Tubatse Local Municipality. By employing a quantitative, non-experimental research method, 360 women completed and submitted a structured questionnaire. Validity and reliability were insured by pre-testing the data collection instrument on respondents who were not part of the main study. Data was analysed by using the SPSS and Excel computer programs with the assistance of a statistician. The age group between 21 and 30 years 197 (54.7%) was larger than the other age groups. Primigravida women represented less than half 147 (40.3%) of the respondents. These women were also supposed to be referred to the hospital for delivery; however, only 23.3% of the women were referred to the hospital for delivery. The choice of the delivery site was influenced by a lack of women’s knowledge about the referral system and of services offered at the clinics, as well as the unavailability of doctors, midwives, food, equipment, enough space for delivery at the clinics, and the perceptions that nurses and midwives were rude. The government should ensure that the clinics are provided with adequate human resources and other resources that are needed for providing these health services. Pregnant women should be given referral letters and information with regard to where they are supposed to deliver. Key concepts: Antenatal women, self-referral, referral system, and Primary Health Care (PHC).

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

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.<br /> <br /> 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.