Since 1994 a number of health reforms took place in furthering democracy. These changes included the decentralisation of Primary Health Care Services. This study is a phenomenological research that chronicles the Primary Health Care decentralisation experiences in the Bophirima District of the North-West Province. Using a descriptive phenomenological orientation, the purpose of this study was to describe the experiences of participants associated with decentralisation in the Bophirima District. Also, to illustrate how the participants perceive these experiences in relation to Primary Health Care services. Furthermore, to provide scientific evidence regarding factors related to the decentralisation of PHC services in the Bophirima District. These and other issues remain of paramount importance given the current state of health care in the South Africa. This study took place in the outskirts of the semi-rural area of Bophirima and Central District in the North-West Province. The investigation followed qualitative research design that was descriptive, exploratory, contextual and phenomenological in nature. The sampling procedure involved non-probability purposive, sampling technique with a sample size of five participants. Data was collected by using an unstructured interview technique. The modified Giorgi method of analysis was used for qualitative data analysis. These are contained in Burns and Grove (2001:596) and Polit and Beck (2004:394) are fully explicated in Chapter Four. Guba model (in Babbie & Mouton, 2001:180) was utilised to ensure the trustworthiness of the study. Ethical requirements were considered throughout and these are reflected in chapter four of the thesis.Three forms of decentralisation: deconcentration, delegation and devolution were identified in the findings. The investigation further indicated that the integration of primary health care services was also underway at the time of decentralisation. This integration triggered different psychological and emotional states amongst research participants. Most importantly, the research revealed that the interest of leadership across three spheres of government played a key role in the decentralisation of PHCs and integration of PHCs, while highlighting the importance of community participation in health service delivery (CP). In conclusion, the decentralisation process was generally perceived as empowering although, nationally, leadership needs to be strengthened to support provinces and districts regarding major policy issues such decentralisation. Key recommendations were made and further research was suggested. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of this study was to investigate whether patients were satisfied with midwifery services rendered at the two Community Health Centres in the Eastern Cape Province.The study sites were Empilweni Gompo and Nontyatyambo Community Health Centres. Descriptive quantitative study design was employed, using a questionnaire with closed and open ended questions as the data collecting tool. Likert Scale was used to measure the following variables: quality care variables to measure level of satisfaction with midwifery services rendered and to determine positive and negative perceptions regarding quality of care received during antenatal, labour and postnatal period. Non-random convenience sampling of sixty pregnant women, thirty from each Community Health Centre, with two or more antenatal subsequent visits and forty postpartum women, twenty from each health facility, six hours after delivery if there were no complications. Out of 60 participants interviewed n=60 (100 percent) agreed that individual counseling and importance of HIV testing was explained.The majority of participants n=53(88 percent) disagreed that they were educated about focused antenatal visits. Out of 60 participants interviewed n=41(68 percent) agreed that delivery plan formed part of their ANC visits and n=18 (30 percent) disagreed. Of the 60 participants interviewed n=11(18 percent) agreed that they were told that they had the right to choose labour companions and n=48 (80 percent) disagreed.Out of 60 participants interviewed n=23 (38 percent) stated that they waited a long period of time without being attended to by midwives. In general, the study revealed high satisfaction level with intrapartum and postnatal care due to functional accessibility of both Community Health Centres. Both health centres delivered normal healthy babies and mothers. However, the participants were dissatisfied with antenatal care rendered at the two facilities. The researcher’s recommendations were based on the closing of gaps that were identified with regard to the implementation of Basic Antenatal Care; birth companions: health education deficiency; community involvement and participation.

MCur / Department of Advanced Nursing Science

In the following chapters, I will discuss the effectiveness of radio and audiotapes as appropriate tools for health communication particularly suited to reaching deprived and isolated communities. I will refer to the striking achievements in radio and audiotape projects by drawing on the experiences of more than sixty radio and cassette projects concerned with primary health care in developing countries. I will present a detailed description of my Argentinean and South African radio experiences, focussing on how the two programmes came into existence, the different stages they have gone through, the problems and constraints encountered as well as their strengths and successes. I will describe the audiotape project I am involved in, and demonstrate how audiotapes can be used alone or in conjunction with radio for primary health education.

Thesis (M. (Nursing)) -- University of Limpopo, 2022 / Background: The referral system is an essential component of the health system. The system meant to complement the Primary Health Care (PHC) principle of treating patients close to their homes at the lowest level of care with the needed expertise. Aim of the study: The aim of the study is to develop the strategies that will facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala district, North West Province, South Africa. Objectives of the study: To explore the referral system of high-risk pregnant women between public sectors within the Bojanala District, North West Province, South Africa. To develop strategies that will facilitate the referral system of high risk pregnant women in the Bojanala District, North West Province, South Africa. Methods: The researcher first obtained permission from the University of Limpopo Turfloop Research Ethics Committee (TREC), and further requested permission from the North West Department of Health, Bojanala District to conduct the study and was granted the permission. Qualitative, exploratory and descriptive designs were used to explore the referral system of high-risk pregnant women and to describe the strategies to facilitate the referral system of high-risk pregnant women in between public sectors in the Bojanala District, North West, South Africa. Non-Probability Purposive sampling method was used to select the midwives and obstetricians to participate in the study until data saturation was reached. Data were collected through one-on-one interviews using semi structured Interview Guide. The data were analysed using Tesch‘s eight steps of data analysis. Results: The results of this study revealed that the participants are knowledgeable about the referral system though they are many challenges that they encounter when managing high-risk women and having to refer them. They are aware of the current state of referral system and made their own suggestions on how to improve the referral system. Recommendations: Recommendations were made to facilitate the referral system of high-risk pregnant women in the North West Province, Bojanala District. The Department of Health must prioritise the provision of human and material resources to the district in order to achieve a better referral system and reducing the maternal and neonatal mortality as one of the millennium developmental goals. Conclusion: The referral system of high-risk pregnant women in the Bojanala District still has some challenges that need the intervention of the North West Department of Health to provide enough material and human resources to the Maternity Section in order to improve current status and to have an effective referral system

Thesis (Ph.D. (Nursing Science)) -- University of Limpopo, 2017 / The aim of this study was to develop a model to ensure the integration of Tuberculosis (TB) and Human Immune Deficiency Virus (HIV) services in the Primary Health Care (PHC) facilities of Limpopo Province. An explanatory sequential mixed method was used in this study to develop a model for ensuring the integration of TB and HIV services in the PHC facilities of the Limpopo Province. The researcher collected quantitative data followed by qualitative data. Quantitative data was collected through administration of questionnaires to 450 PHC nurses in the five districts of Limpopo Province. The qualitative data was collected by conducting focus group discussions to five groups of Community Home Based Carers (CHBCs) and five groups of TB/HIV co-infected patients in the five districts of Limpopo Province. Audiotape and field notes were used to capture verbal and non-verbal cues. The Statistical Package for Social Sciences (SPSS) computer programme version 22.0 was used for capturing and analysis of the quantitative data. Content analysis was used to analyse the qualitative data from the CHBCs and the TB and HIV co-infected patients’ focus group discussions. The study revealed lack of knowledge and skills on TB and HIV management due to insufficient training of PHC nurses about TB and HIV management. Staff shortage of PHC nurses in the facilities was also indicated by PHC nurses. Furthermore, TB and HIV coinfected patients are faced with challenges in the PHC facilities and in the community. Challenges that are faced by CHBCs and the TB and HIV co-infected patients include negative attitudes of some clinic staff members towards them. The patients’ families also have some negative attitudes towards the CHBCs as they leave the patients to them without assisting them in the caring duties. The community members also has negative attitudes as they do not accept the CHBCs in their homes to support the patients. Based on the results, a model was developed to ensure the integration of TB and HIV services. The model was validated by PHC nurses and the experts in research and model development. The validation results showed that the model was clear and simple to be used in the PHC facilities for integration of TB and HIV services. The study recommends that the model should be used by PHC facilities for integration of TB and HIV services. The PHC nurses should attend TB and HIV capacity-building courses.

Curative primary health care nurses are the first level of contact with health personnel the patient has when entering the district-driven health system of South Africa. It is imperative that these nurses are competent, or patients may suffer. Several factors exist as barriers to competent curative care. Donabedian's structure-process-outcome framework has been used in the study of these factors. Literature were selected from international and national studies of nursing to discover barriers and enablers in general nursing care but also specifically in curative primary health care. The curative primary health care nurses in the Southern Cape/Karoo region were used as a sample for the study. Data gained from questionnaires were organised to present the findings: Barriers to a curative PHC service seem to be multifactorial, with scarce resources causing great stress for the workforce. This have a negative impact on relationships between employer and employee, CPHCNs and their patients, the type of managing that take place, and the quality of the examination and treatment of patients. Slow changes frustrates workers, causing more stress and poor attitudes, feelings of not being valued, and not being motivated (internally and externally). Enablers examined showed that although the workforce may be discontented and overworked, they still try to deliver their best, with few medical mistakes. Patients still have a lot of respect for their healthcare deliverers, but this trend may not continue for much longer. Patients are already returning more often to clinics, causing even more stress for staff. / Health Studies / M.A. (Health Studies)

Curative primary health care nurses are the first level of contact with health personnel the patient has when entering the district-driven health system of South Africa. It is imperative that these nurses are competent, or patients may suffer. Several factors exist as barriers to competent curative care. Donabedian's structure-process-outcome framework has been used in the study of these factors. Literature were selected from international and national studies of nursing to discover barriers and enablers in general nursing care but also specifically in curative primary health care. The curative primary health care nurses in the Southern Cape/Karoo region were used as a sample for the study. Data gained from questionnaires were organised to present the findings: Barriers to a curative PHC service seem to be multifactorial, with scarce resources causing great stress for the workforce. This have a negative impact on relationships between employer and employee, CPHCNs and their patients, the type of managing that take place, and the quality of the examination and treatment of patients. Slow changes frustrates workers, causing more stress and poor attitudes, feelings of not being valued, and not being motivated (internally and externally). Enablers examined showed that although the workforce may be discontented and overworked, they still try to deliver their best, with few medical mistakes. Patients still have a lot of respect for their healthcare deliverers, but this trend may not continue for much longer. Patients are already returning more often to clinics, causing even more stress for staff. / Health Studies / M.A. (Health Studies)

Health practitioners collect health data on a daily basis at health facility levels in order to monitor and evaluate the performance of priority national health programmes (District Health Plan 2012:6). Routine data quality for health programmes monitoring need a collective intervention to ensure clear understanding for what data to be collected at primary health care setting. The aim of the study is to explore the understanding of routine health data, determine the use of routine data and feedback mechanism at primary health care clinic setting. Quantitative descriptive research design was used to answer the research question on this research study. Structured data collection questionnaire was used for the study to accomplish the research purpose and reach the study objectives. A total of 400 participants was sampled, and 247 responded. One of the findings was that the understanding of routine health data by Health Practitioners was at 82.6% (% = f/n*100, f= 3242 and n= 3926). / Health Studies

Health practitioners collect health data on a daily basis at health facility levels in order to monitor and evaluate the performance of priority national health programmes (District Health Plan 2012:6). Routine data quality for health programmes monitoring need a collective intervention to ensure clear understanding for what data to be collected at primary health care setting. The aim of the study is to explore the understanding of routine health data, determine the use of routine data and feedback mechanism at primary health care clinic setting. Quantitative descriptive research design was used to answer the research question on this research study. Structured data collection questionnaire was used for the study to accomplish the research purpose and reach the study objectives. A total of 400 participants was sampled, and 247 responded. One of the findings was that the understanding of routine health data by Health Practitioners was at 82.6% (% = f/n*100, f= 3242 and n= 3926). / Health Studies