Introduction A well-functioning primary health care system depends on all three levels of healthcare, that is, the primary, secondary and tertiary levels of care. District hospitals have a major role to play in the development of a strong referral system. This study was undertaken to evaluate whether the primary health care clinics in Area 3 possess all the key essential components for a strong referral system. Area 3 comprises 3 districts in northern KwaZulu-Natal, i.e. the Umkhanyakude, Uthungulu and Zululand districts. Aim The aim of the study was to evaluate referral support systems between fixed clinics and district hospitals in the three districts of Area 3 in KwaZulu-Natal province. Methods A descriptive study was undertaken in 58 randomly selected clinics in Area 3. Data was collected between July and August 2007, on availability of: communication technology, transport for patients being referred to the district hospital, and guidelines. Referral letters were reviewed to determine if they contained adequate information. Professional nurses were interviewed to determine the training they had attended. Results A third (34%) of clinic nurses on duty had been trained in Primary Health Care; 57% of clinics had at least one professional nurse on duty with a PHC diploma. The proportion of nurses trained in short courses ranged between 4% and 47%. Fifty-six out of fifty-eight (97%) of clinics had telephones; 57% reported problems with telephones. Eighty-eight out of one hundred and seven (88%) of selected referral letters did not have adequate information. Only 32% of urgently referred patients were collected by an ambulance within 1 hour. All 58 clinics had the Essential Drug List (EDL) available; availability of the other guidelines ranged between 29% and 79%. Discussion The percentage of clinic nurses with a PHC diploma or trained on short courses indicates that most clinic nurses render health services without or with inadequate knowledge and skills. Poor quality of referral letters and inefficient transportation of referred patients, especially emergencies, confirm a weak referral support system. User perceptions of the referral system have not been explored. Recommendations Training and support of clinic nurses needs to be prioritised to improve patient assessment and management, as well as the quality of referral letters. District management should advocate for improvement of patient transportation. Future studies should explore the use of referral letters by and training of, clinic nurses; as well as determine user perceptions. / Thesis (MMed.)-University of KwaZulu-Natal, Durban, 2010.

No abstract available. / Thesis (M.Med)-University of Natal, Durban, 1986.

This collection of papers represents the author's maturing reflection on systemic engagements with three different organizations within the latter half of the first decade in post-Apartheid South Africa. The first two papers deal with two different systemic engagements: the first with a rural community development organization in a rural area of KwaZulu-Natal south of Durban and the second with the implementation of a district health system by a provincial health authority, also in KwaZulu-Natal. The last three are concerned with the theoretical and practical aspects of a single critical systems intervention (CSI) for policy development within the KwaZulu-Natal Nature Conservation Service, a parastatal nature conservation organization. The first paper, Designing a Management System for a Rural community Development Organization Using a Systemic Action Research Process describes the use of Soft Systems Methodology (SSM) for the development of a Human Activity System (HAS) Model, that is, a conceptual model of purposeful human activities, to facilitate debate regarding a 'problem situation' faced by the community development organization. A Critical Systems Intervention to Improve the Implementation of a District Health System in KwaZulu-Natal is the second paper. As the title suggests, this paper describes a Critical Systems Intervention in a district health system implementation process. By using Concept Maps and Sign-Graph diagrams with SSM this paper contributes theoretically to the growing body of literature on methodological pluralism. Paper 3, Towards a critical systems approach to policy formulation in organizations contributes to the literature on organizational policy. It is noted in this paper that whilst there is a substantial body of literature on organizational strategy as well as on public policy, there is a dearth of literature on organizational policy. The thrust of the paper is twofold. Firstly, it draws a distinction and shows the relationship between organizational policy and organizational strategy. Secondly, building on this distinction, it develops a critical systems approach to policy formulation. Paper 4, Environmental Paradigms, Biodiversity Conservation and Critical Systems Thinking develops a framework of environmental paradigms which may be used for any CSI in nature management as a tool for values clarification. The collection concludes with Paper 5, A Critical Systems Intervention for Policy Development within a Nature Conservation Organization. It discusses the process undertaken in the nature conservation organization - Ezemvelo KwaZulu-Natal Wildlife - intervention and shows how the approach to policy formulation (developed in Paper 3) and the framework for environmental paradigms (developed in Paper 4) were used in the intervention. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

No abstract available. / Thesis (M.D.)-University of KwaZulu-Natal, Durban, 2007.

The delivery of primary health care (PHC), as promulgated by the World Health Organization (WHO) and in South Africa, is of fundamental importance. Physiotherapy is an essential component of the health care delivery system and must promote PHC during clinical training and practice. In KwaZulu-Natal (KZN), PHC service delivery has been a problem for various reasons such as the history of the country (apartheid era pre- 1994), financial constraints, lack of human resources, physical infrastructure and time constraints. Service delivery within the health sector is reported frequently in the media as physiotherapists and radiographers embarked on a strike latter part of 2009 in KZN due to a discrepancy in the Occupation Specific Dispensation (OSD). Physiotherapists have highlighted that they were overworked, carrying the strain of vacancies, due to frequent resignations to migrate to the private sector. The aim of the research was to explore the promotion of PHC delivery in KZN. The objectives explored the empowerment of students and staff in the Health Science Disciplines to PHC service delivery. In addition, managers at provincial and local levels were included in the study. Barriers and factors that enhance the promotion of PHC were identified. The research design comprised of a survey, a quantitative and qualitative case study of KZN, using questionnaires or semi-structured interviews. The findings indicated that the physiotherapy staff lacked PHC training (p=0.000) and 48.7% of the Disciplines in Health Sciences indicated that the rural needs were not being addressed with regards to PHC service delivery (p=0.018). Each discipline operated within its own silo, without any consultation and inter-disciplinary collaboration, to the detriment of effective delivery of PHC services. Fragmentation and duplication of PHC services existed between Provincial and Local Governments as indicated by 46% of the managers, which is disconcerting post 15 years of democracy in South Africa. The main objective of the National Health Plan and Reconstruction and Development Programme (RDP) was to readdress the inequalities and fragmented health services. Numerous recommendations are made which will improve the journey towards transformation, comprehensive PHC service delivery, and the quality of life of all citizens / Thesis (Ph.D.)-University of KwaZulu-Natal, Westville, 2009.

Primary health care (PHC) is the first component of the health system that provides patients with first-level care. PHC must be supported by a strong referral system whereby PHC nurses can refer patients with conditions beyond their capabilities to medical officers for further management using referral letters. The medical officers also using referral letters refer stable patients back to the PHC clinics for follow up and management. The aim of study was to determine factors related to patients bypassing primary health care facilities and accessing the district hospital as point of first contact in the Umuziwabantu health sub-district of KwaZulu-Natal. This research investigates the referral patterns of patients as well as the factors affecting the referral patterns of patients between PHC facilities and the district hospital. The study was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient department. The following groups were excluded from the study: any patients who arrived at the clinic with a referral letter from another facility, any children who were brought there by another child, and any who were unwilling to take part in the study. The researcher made use of open-ended and structured questions to interview 720 patients over a period of six months. The overall findings show that a large part of the Umuziwabantu sub-district is still served by mobile clinics. Since mobile clinics do not visit each point daily, patients from mobile points often go to the hospital for any health-related problems. There is the widespread perception that a hospital provides better service than a PHC clinic. The Local Government (LG) clinic only sees a limited number of patients. The main reasons given by patients for bypassing their local PHC clinics are: 1. Mobile clinic unavailability on that day; 2. The hospital is closer. 3. Patients are used to coming to the hospital. 4. Patients are doing things in town and then decide to combine this visit with hospital visit. Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients surveyed should have been seen at the Hospital. Conclusions from the study were that patients would use their local PHC clinics if there were enough fixed clinics and the LG clinic had more staff to attend to more patients than the number they are currently attending. The clinic-upgrading programme needs to be improved and fast-tracked. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

The purpose of the study was to do a task analysis.of PHC nurse practice by identifying the skills required by nurses working at the primary health care clinic in order to plan staff development programmes. The objectives were: to compile ; an extensive list of possible tasks; engage Primary Health Care Nurses in identifying the frequency of tasks executed; and engage Primary Health Care Nurses in determining how important are the tasks in their practice. This was a descriptive survey. A mail survey was used to collect data. Two stratified random samples of nurses were drawn from the sample frame of Uthukela Health District. The sample consisted of 84 Primary Health Care Nurses; 59 registered nurses, 17 enrolled nurses, and 8 enrolled nursing auxiliaries. The questionnaire was developed based on PHC core package, other literature and services provided at PHC clinics. It had three sections; section one and dealt with demographic data, section two consisted of the list of activities that describe the nursing practice and the respondents had to indicate the frequency of performing the activity and importance of the activity and section three dealt with the activities that the respondent perform but were not included in the list provided. The response from mailed questionnaires was 72%. The results show that . I eleven items were rated very frequent by 70% of the nurses, forty-four items rated frequent by more than 50% of the nurses. Twenty-seven tasks were rated as important by 50% or more of the nurses. In frequency and importance, nineteen items score above 1 standard deviation on this index. In the clinical tasks, promotive and preventive service predominated. A high percentage of these tasks were done very frequently and were seen as important. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

The understanding of the pathways that clients take prior to admission to a mental health institution, is a vital factor in planning to reduce delays in seeking treatment. Studying the pathways may also help in the identification of sources of delays in the receiving of care and suggest possible improvements. Although western medicine plays an important role in the control of disease, traditional medicine continues to play an important role in the health care of black African communities. They, therefore possess unique attitudes, values and beliefs, about health and illness, which integrally infiuence their health behaviour. This study aims to increase the understanding by health professionals of pathways to care taken by clients before they are admitted to a mental health institution, so as to enhance heath service planning. It also aims to determine the socio-cultural and economic factors, as well as satisfaction with different service providers. The sample in this study consisted of 15 clients, who were between the ages of ten and fifty-nine years. These clients were males and females who were admitted for the first time in a mental health institution (MHI) (TownHill Hospital, Pietermaritzburg). The interview questionnaire, was administered, by the researcher.This study has demonstrated that, Africans still believe in traditional and faith healers as their first port of call when they are mentally ill. Their help seeking behaviour is determined by their cultural beliefs and values. The study also demonstrated the high involvement of the South African Police Services (SAPS) in the pathway to mental health institution by intervening to protect family or public and also transporting the client to a mental health institution. The Primary Health Care (PHC) is very seldom used Economic factors like unemployment strongly infiuence the mental health of people and also affect their social functioning, as it is shown by the high levels of unemployment in the sample. Some of these clients resort to living on the streets, because they cannot find employment and are homeless. The study has also shown the importance of education and training of health professionals in PHC, in identifying the first signs of mental illness when clients present themselves and making available the psychotropic drugs at the PHCC as this is the first port of call for clients. Psycho education of traditional healers, spiritual healers, SAPS and community should be implemented on when and how to refer clients, how to handle mentally ill clients. / Thesis (M.Cur.)-University of Natal, Durban, 2001.

No abstract available. / Thesis (M.Med.)-University of Natal, Durban, 1990.

Background HIV infection continues to be a challenge in South Africa with new infections reported at alarming rates. Health Care Workers (HCWs) who are nurses consequently have frequent contact with HIV positive and TB co-infected patients. During this contact their counselling behaviour is influenced by their knowledge, beliefs and attitudes about HIV and AIDS, STIs and TB (HAST) and may influence provision as well as the quality of HAST counselling behaviour. Aim The aim of the study was to assess eThekwini Municipality Health Care Workers’ knowledge, beliefs and attitudes regarding counselling behaviour for HAST and to make recommendations based on the findings of this study. Methods A descriptive cross sectional study design was used in which data about HAST counselling behaviour were collected using self administered questionnaires. The study population was all the nurses working at eThekwini Municipality Health clinics that were on duty at the time of the study and excluded those nurses who were absent or on leave during the period of data collection. Informed consent was signed by each respondent. Data were captured using SPSS version 14 and univariate, bivariate and multivariate analysis was undertaken. The level of significance was P<0, 05. Results The HCWs were well informed regarding counselling behaviour for HAST. HCWs with university education scored higher than those with college level of education but there were no statistically significant differences between the HCWs with the university education and those with college education. However some HCWs’ attitudes and beliefs about poverty were negative and may not be helpful in improving a patient’s health. Results showed that some HCWs’ negative attitudes about HAST counselling resulted from fear of HIV and or TB infection. Age and the level of education showed statistically significant association with beliefs. Older, better educated HCWs with a university education scored higher for knowledge for HAST counselling behaviour. There was no statistical significant difference found between HCWs who see less than 100 patients per day and those who see more than 100 patients per day. Conclusion The findings of the study show that HCWs were well informed regarding counselling behaviour for HAST, even though some HCWs have negative attitudes which are not supportive which need to be addressed. Recommendations It is recommended that HCWs receive continuous training in order to address the negative attitudes about counselling behaviour for HAST. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2012