Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)

Im Zuge erster Reformbemühungen der UNESCO wurden 1977 die Mittelfristigen Strategien ("C/4-Dokumente") als sechsjährige Planungsinstrumente eingeführt. Durch ihren längerfristigen konzeptionellen Rahmen sollten sie größere Kontinuität und Kohärenz zwischen den bisher bestehenden zweijährigen Programmen und Haushaltsplänen herstellen. Die vorliegende Arbeit stellt die Entwicklung der Funktion der Mittelfristigen Strategien im Lichte ihrer historischen Entwicklung und im Zusammenspiel mit Reformtrends im System der Vereinten Nationen dar; deren Hauptfunktion ist demnach eine bessere Planung der Aktivitäten der UNESCO unter einer möglichst effizienten Mittelverwendung. Der Vorbereitungsprozess dient als Katalysator für eine umfassende Diskussion über die grundlegende Ausrichtung und über die Schwerpunkte der Aktivitäten der UNESCO. Ferner dient sie als Instrument der Legitimation und der Rechenschaft – da sie vorab darlegt, was die UNESCO in einem Zeitraum erreichen wird.

Text in English / In Swaziland, family nurse practitioners (FNPs) are professional nurses who have undergone preparation as general nurse, midwife and FNP. These nurses play an important role in the delivery of primary health care (PHC). Family nurse practice is an evolving concept introduced in Swaziland in 1979. It is a means of exploring nursing roles and primary health care services for deployment in under-served areas and to enable nurses to serve as the primary providers of health care services in clinics, health centres and in the outpatient departments of hospitals. Changing responsibilities within the health care setting require different skills and more knowledge. The expansion and extension of the nurses' role, including the techniques of diagnosing and treating, was a priority of the Ministry of Health and Social Welfare (MOH&SW) in Swaziland's five-year development plan for 1978-1983. It was regarded as a necessary component for raising the quality and effectiveness of PHC services. Some of the major and urgent challenges that confront FNPs today are the advent of the human immune virus/acquired immuno-deficiency syndrome (HIV/AIDS) scourge and the re-emergence of the tuberculosis epidemic. Both these health problems require proficient diagnosis and case management skills as well as new approaches. If FNPs are to remain relevant and to continue to provide quality services in spite of prevailing challenges, they have to engage in continuing education (CE). The main aim of this study was to investigate the perceptions of the FNP role, CE needs and issues relevant to the current practice of FNPs in Swaziland. A further aim was to establish a structure or framework for a CE programme that would contribute to the strengthening of CE for FNPs and identify enabling factors and barriers in the practice and education ofFNPs. Both quantitative and qualitative research methods were used for data collection. A survey was conducted to collect data from 5 7 FNPs and 11 nurse managers and nurse educators. The transcript from the questionnaires was subjected to quantitative-based content analysis. A total of thirty nurse managers, nurse educators and MOH&SW nurse executives participated in the focus group interviews. The collected data was subjected to qualitativebased content analysis. The findings identified the role of the FNP as manager, clinical practitioner, educator and researcher. The analyses highlighted the CE needs of FNPs, and the question of updating and upgrading the skills of practising FNPs. The identified enabling factors and barriers, although perceived as issues that are peripheral and auxiliary to the curriculum, appeared to have a strong bearing on programme planning. The findings from this study have implications for a structured CE programme for FNPs at the University of Swaziland. / Health Studies / D. Litt et Phil. (Nursing Sciences)

Im Zuge erster Reformbemühungen der UNESCO wurden 1977 die Mittelfristigen Strategien ('C/4-Dokumente') als sechsjährige Planungsinstrumente eingeführt. Durch ihren längerfristigen konzeptionellen Rahmen sollten sie größere Kontinuität und Kohärenz zwischen den bisher bestehenden zweijährigen Programmen und Haushaltsplänen herstellen. Die vorliegende Arbeit stellt die Entwicklung der Funktion der Mittelfristigen Strategien im Lichte ihrer historischen Entwicklung und im Zusammenspiel mit Reformtrends im System der Vereinten Nationen dar; deren Hauptfunktion ist demnach eine bessere Planung der Aktivitäten der UNESCO unter einer möglichst effizienten Mittelverwendung. Der Vorbereitungsprozess dient als Katalysator für eine umfassende Diskussion über die grundlegende Ausrichtung und über die Schwerpunkte der Aktivitäten der UNESCO. Ferner dient sie als Instrument der Legitimation und der Rechenschaft – da sie vorab darlegt, was die UNESCO in einem Zeitraum erreichen wird.:Abkürzungsverzeichnis II I. Einleitung 1 II. Entstehungsgeschichte und normative Wirkung der Mittelfristigen Strategie 3 1. Expertenausschuss zur Begutachtung der Finanzen der VN 3 2. Aktivitäten der UNESCO zur Einführung Mittelfristiger Planungsinstrumente – der erste Mittelfristige Plan (1977-1982) 4 3. Völkerrechtlicher Rahmen und normative Wirkung der Mittelfristigen Strategien der UNESCO 6 4. Zwischenergebnis 8 III. Die Genese der Mittelfristigen Strategien 9 1. Der zweite Mittelfristige Plan (1984-1989) – Einführung umfassender Konsultationen 9 2. Der dritte Mittelfristige Plan (1990-1995) – Positions- und Strategiepapier der UNESCO 10 3. Die erste Mittelfristige Strategie (1996-2001) – grundlegende Neuausrichtung 11 4. Zwischenergebnis 12 IV. Die Mittelfristigen Strategien im beginnenden 21. Jahrhundert 13 1. Die Mittelfristige Strategie (2002-2007) als Ausdruck der neuen Reform 14 2. Die Mittelfristige Strategie (2008-2013) 15 3. Zwischenergebnis 15 V. Die Funktion der Mittelfristigen Strategie der UNESCO im Fazit 16 Dokumentenverzeichnis I Literaturverzeichnis III