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.

Thesis ( MPH.) -- University of Limpopo, 2018 / Background: Contraception is the pillar in reducing teenage pregnancy. Birth control methods are aimed at improving the lives of women and young girls; through minimising unplanned pregnancies and subsequent termination of pregnancy. Teenage pregnancy is a major public health problem worldwide therefore the purpose of the study was to determine knowledge, perceptions and attitudes of secondary school going girls towards implanon contraceptive. Methodology: The current study was conducted using quantitative study approach and cross-sectional study design. Data collection was done using self-administered questionnaire and data analysis was done using SPSS version 24.0. A total of 404 school going girls from grade 8-11 participated in the study. Results: The findings of the study showed that majority of participants in the study were from rural area and are black. Nearly quarter of the school girls had menarche between the ages of 12-14 and third of them received health reproductive education from school and parents. Prevalence of teenage pregnancy among study participants was low. Participants had low knowledge, displayed positive attitude and positive perception towards implanon method of contraception. Discussions: Low knowledge on what an implanon is, how it works and its side effects can serve as a barrier to its usage among teenagers. The common contributory factor to discontinuation and non-use of implanon is fear of side effects. The participants viewed implanon as effective and reliable. Conclusion: School going girls had insufficient knowledge on implanon, which may lead to non-use and early termination in the use of the method. Participants displayed positive attitude and positive perception towards implanon indicating that proper health education can increase uptake among adolescent girls. Recommendations: Provision of adolescents and youth friendly services in public health facilities can contribute to school going girls accessing implanon contraceptive method. Health education on the implanon should be strengthened by health care providers, school programs and educators to empower them and to increase the uptake of implanon.

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

Pharmacovigilance is “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem”. To date, no comprehensive study has been performed to evaluate the pharmacovigilance system in the public health sector in South Africa. The primary aim of this study was to evaluate the current status of pharmacovigilance systems within the public healthcare sector in South Africa, and the level of functioning of these systems, in order to provide relevant recommendations, where necessary, for improvement, using the Indicator-based Pharmacogivilance Assessment Tool (IPAT). National and provincial entities were deemed compulsory (n=14), while facilities were selected via random, stratified sampling to obtain a representation at each facility level (n=101). The IPAT was amended for relevance at each level of data collection. Indicators are classified as core and supplementary and compliance with core indicators shows the level of functioning National entities obtained an IPAT score of 36 out of a maximum of 72, achieving 50% compliance. Province D and Province G obtained overall IPAT scores of 29 and 12 respectively out of a maximum of 40, achieving an overall 72.5% and 30% compliance respectively Results at provincial and facility levels were not fully representative due to a limited response rate of 22.2% and 65.3% respectively. Regional/tertiary facilities and district facilities displayed increased awareness and implementation of pharmacovigilance activity than the lower levels of Community Health Centres (CHCs) and Primary Health Centres (PHCs). South Africa”s public healthcare system possesses the infrastructure for a well functioning pharmacovigilance system. However there are gaps in level of functioning at a national, provincial and facility level. Addressing these gaps would show a marked improvement in the system and go a long way towards the contribution of medicine safety information not only locally, but to aid other developing nations.

Community participation is a concept that has been advocated for by bodies such as the World Health Organization (WHO) for over two decades. In South Africa, community participation was included in the National Health Act (61 of 2003). Clinic and Community health facility committees were legislated as a method of involving communities in promoting health and improving health outcomes. During the year 2010, a process was initiated by the Nelson Mandela Bay Municipality (NMBM) to establish and train health committees at all health facilities. The purpose of this research report was to evaluate the effectiveness of community health committees within the Nelson Mandela Bay Municipality, since 2010. Guidelines given in the Policy on the Establishment and Functioning of Clinic and Community Health Centre Committee (2009) were utilized as a point of reference for this study. The results showed that the community health committees trained in 2010 were functioning effectively as a result of the policy guidelines given. There still needs to be an improvement in the involvement of ward councilors, as stipulated in the National Health Act (61 of 2003), as well as in the implementation of the fundraising role, as set out in the Health Departments policy guidelines for health committees to implement.

Human Immuno-Deficiency Virus and Acquired Immune-Deficiency Syndrome communication remains one of the most significant tools in the fight against HIV/AIDS given the absence of the cure to fight the growth and spread of the global pandemic. Through the use of information, HIV/AIDS communication seeks to empower recipients or societies with skills that will help reduce their risk of infection. South Africa has seen a high visibility of HIV/AIDS communication programmes or campaigns aimed at empowering different audiences, whilst paying particular emphasis on the most vulnerable. Young people, in particular young women, have a higher prevalence of HIV/AIDS in South Africa. This has prompted the development of many youth focused communication campaigns which have sought to address factors that increase young people`s vulnerability to HIV infection. However, despite the high visibility of HIV/AIDS communication campaigns targeting young people, high risk behaviours are still being seen among young women. Important to note are the high teenage pregnancy rates, growing abuse of substances and even the premature engagement of sexual activities among female youths. This, therefore, raises questions on the effect of HIV/AIDS communication programmes in encouraging protective behaviour against risky behavioural practices amongst young women. Using both quantitative and qualitative research approaches to this study, an investigation was conducted into whether current HIV/AIDS communication campaigns have been limited (in terms of effectiveness) when it comes to communicating with young women on issues relating to HIV/AIDS. Awareness of HIV/AIDS and HIV/AIDS communication programmes, relevance of HIV/AIDS communication programmes, the factors that influence the use and understanding of HIV/AIDS messages and the impact of HIV/AIDS communication on attitude and behaviour change amongst female youths is measured. A total of 350 questionnaire copies were self-administered to 350 participants, with a 100 percent response rate. From the 350 participants, seventy five took part in focus group discussions. Data obtained was analysed using SPSS (for descriptive statistics), and the grounded theory. The results of the study indicate that all participants were aware of HIV/AIDS with at least 60% of the participants aware of at least three HIV/AIDS communication campaigns. When measuring the relevance of HIV/AIDS communication campaigns, participants (58%) indicate that issues discussed in most HIV/AIDS communication campaigns increased the relevance of HIV/AIDS messages to young women although such relevance was, for some respondents, affected by limited access to communication campaigns. Results also show that levels of knowledge and understanding of factors that expose young women to HIV infections differed amongst participants in as much as the factors that hinder the use of advice contained in HIV/AIDS messages also differed. Sixty-nine percent of the participants have knowledge and a better understanding of factors that expose young females to HIV infections. Twenty-five percent of the participants identified peer pressure, whilst 23% identified limited access to HIV/AIDS communication campaigns and another 18% identified a disregard of HIV/AIDS messages as significant factors that limit the ability of individuals to implement advice contained in HIV/AIDS messages. The results also indicate that although HIV/AIDS communication campaigns seem to have played a role in empowering some participants, there is still a significant minority whom communication has not effectively communicated with. Based on these findings, the study suggests, amongst other things, the need to intensify current HIV/AIDS communication campaigns through the provision of consistent messages on appropriate condom use, the identification of easily accessible communication channels and the development of thought provoking and attention grabbing campaigns as well as the need to continue to directly involve young women in the processes of their own development.

Data quality is one of many challenges experienced in electronic healthcare (e-health) services in South Africa. The collection of data with substandard data quality leads to inappropriate information for health and management purposes. Evidence of challenges with regard to data quality in e-health systems led to the purpose of this study, namely to prioritise data quality challenges experienced by data users of e-health systems in South Africa. The study followed a sequential QUAL-quan mixed method research design to realise the research purpose. After carrying out a literature review on the background of e-health and the current status of research on data quality challenges, a qualitative study was conducted to verify and extend the identified possible e-health data quality challenges. A quantitative study to prioritise data quality challenges experienced by data users of e-health systems followed. Data users of e-health systems in South Africa served as the unit of analysis in the study. The data collection process included interviews with four data quality experts to verify and extend the possible e-health data quality challenges identified from literature. This was followed by a survey targeting 100 data users of e-health systems in South Africa for which 82 responses were received. A prioritised list of e-health data quality challenges has been compiled from the research results. This list can assist data users of e-health systems in South Africa to improve the quality of data in those systems. The most important e-health data quality challenge is a lack of training for e-health systems data users. The prioritised list of e-health data quality challenges allowed for evidence-based recommendations which can assist health institutions in South Africa to ensure future data quality in e-health systems. / School of Computing / M. Sc. (Computing)

Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo / assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel &reg / . Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo / suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo / health status and ultimate quality of life.

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.