As a clinic supervisor overseeing a cluster of clinics in the Nelson Mandela Bay Health District (NMBHD), the researcher observed a number of problems with the implementation of the re-engineering of the primary health care (RPHC) programme. The problems observed include inadequate supervision of RPHC staff, poor communication and conflict between clinic and RPHC staff, failure to filter RPHC statistics into clinic statistics and the incorrect management of patients by RPHC staff. Therefore, the purpose of this study is to explore and describe the experiences of professional nurses regarding the implementation of the RPHC programme in the NMBHD and to make recommendations the district manager could use to address the research findings. The study used a qualitative, exploratory, descriptive and contextual design. The research population consisted of professional nurses who are implementing the RPHC programme in the NMBHD, and the sampling technique was a non-probability, purposive technique for the selection of the research sample. Semi-structured interviews were used to collect the data and Tesch’s model respectively. The researcher adhered to ethical considerations throughout the study and ensured trustworthiness of the data by using the criteria of credibility, transferability, dependability and conformability. Three themes were identified; namely; the professional nurses expression of their concerns regarding poor working conditions; issues regarding the community health workers and their positive experiences associated with the RPHC programme. The study concludes with recommendations made to the District manager with regard to nursing practice, as well as recommendations to nursing education and research.

Thesis (MTech (Public Management))--Cape Peninsula University of Technology, 2017. / The purpose of this study was to examine the problem of access to health care centres in the Western Cape and to forward recommendations that will improve access to health care facilities in the Western Cape. The first objective of the study was to identify trends in primary health care looking at Nigeria, with the view of learning lessons of experience. Secondly, the study provided an overview of the South African health care system. The study further examined the problems around access to Gugulethu Community Health Clinic. The research objectives were directly linked to the composition of chapters. The study utilised a mixed-method approach of quantitative and qualitative approaches. This method is called multi-method approach. The purpose of combining the two approaches was to understand the research problem from a subjective and objective point of view, as well as to provide an in-depth understanding of a research topic, which led to more reliable research results. Data collection was acquired by utilising a structured questionnaire and personal observations. Two groups of respondents participated in the study inter alia: the patients and the staff of Gugulethu Community Health Clinic.

Public health impacts of storm water canals in Nelson Mandela Bay communities

Primary health care has been the cornerstone of South Africa's health policies since its transition to democracy in 1994. In order to optimise the effectiveness of primary health care, the South African government introduced community health committees hich were intended to facilitate primary health care at the grassroots level through community participation. As statutory bodies outlined in the National Health Act, 61 of 2003, and in provincial legislation, Community Health Committees were to be the liaison between communities and government and assist government in improving health services in communities. Since being re-established in 2010, Community Health Committees in the Nelson Mandela Bay Health District, Eastern Cape Province, South Africa have sought to fulfil this role and have remained sustainable. This research was aimed at investigating the strategies and approaches which sustain Community Health Committees in Nelson Mandela Bay Health District. It focused on eliciting information regarding the factors that sustain Community Health Committees, factors that threaten their sustainability and factors that motivate continued membership in Community Health Committees. Qualitative research methods of key informant interviews, observations and focus groups were used and analysed to identify these factors. The findings indicated that Community Health Committees struggle to remain sustainable because of various threats to their functioning. The major threat identified was the disengagement of the Department of Health in the operations of the Community Health Committees. The Department of Health was not visible; rather it was passive and unresponsive to the reports submitted by Community Health Committees on behalf of their communities and provided no re-imbursement for administration costs. Despite threats to sustainability, these Community Health Committees had commitment, passion and drive to assist with the health improvement of their communities in partnership with health facilities in their communities. Good interpersonal relationships in the Community Health Committees, good professional relationships with the health facility staff and the liaising role played by health facility management are some of the factors that contributed to sustainability. Recommendations were made at the end of the study that may assist the Nelson Mandela Bay Health District and the Department of Health to create a working environment that will be conducive to the sustainability of Community health Committees.

The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.

This study addresses the healthcare needs of employees and their families living in the Kruger National Park (KNP). A quantitative, explorative, descriptive research design was used to interview respondents who comprised of 75 male and female employees with children of various ages. The findings revealed that physical, psychological, environmental, socio-cultural, and behavioural needs of the employees and their families living in the KNP is probably unattainable as healthcare services are poorly distributed throughout the KNP, being mostly concentrated in the main camp of Skukuza. A number of respondents indicated that they required consultations about psychological and socio-cultural stresses in their lives. These services are not available in the KNP. / Health Studies / M.A. (Health Studies)

Submitted in fulfillment of the requirement for the Masters Degree of Technology (Public Relations Management), Durban University of Technology, Durban, South Africa, 2015. / The growing number of HIV/AIDS infections amongst the youth is a cause for concern, particularly with prevention messages being communicated through various media platforms. This signals gaps between the senders and receivers of these messages. Therefore, people are either not learning the message about the dangers of HIV, or are unable or unwilling to act on it. Mthatha is in the centre of the old Transkei region of the Eastern Cape. It falls under the King Sabata Dalindyebo Local Municipality and the OR Tambo District Municipality. Teenage pregnancy is a major challenge in this area, which indicates that most teenagers do not use protection during sexual intercourse. This suggests that the HIV infection rate may be too high. With there being no cure for this disease, communication has been identified as an ideal method of helping to curb the spread of this disease. The purpose of the study was to assess communication tools used to educate high school learners about HIV/AIDS in the Mthatha area. Data was collected through questionnaires administered to 341 high school learners. Three out of the eight high schools from the Mthatha Central Business District (CBD) in the Eastern Cape were identified for the study. The selection of these high schools was based on the demographics of the learners, which are age, gender and background. The findings have revealed that there are numerous methods used to educate learners about the HIV/AIDS pandemic. Learners identified mostly with three sources as the accurate tools of communication in HIV/AIDS education; Health education/curriculum, Entertainment-education and Peer Education.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introduction Access to effective health care is at the heart of the discourse on how to achieve the health related Millennium Development Goals. Lesbian and gay persons are affected by a range of social and structural factors in their environment, and as a result have unique health needs that might not be met by existing health care services. Sexual stigma remains a barrier to seeking appropriate health care. Lesbians and gays might delay seeking health care when needed or avoid it all together, because of past discrimination or perceived homophobia within the health care system. Aim of the study The aim of the study was explore and describe the accessibility of primary health care services to lesbians and gays in Umlazi in the province of KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive study was conducted which was contextual in nature. Aday and Andersons’ theoretical framework of access was chosen to guide this study. Semi-structured interviews were conducted with 12 lesbian and gay participants. The findings of this study were analysed using content analysis. Results Four major themes that emerged from the data analysis were discrimination of homosexual men and women by health care providers and community members in PHC facilities; attitudes of homosexual men and women towards health care providers; homophobic behaviour and equality of PHC services. Few participants were satisfied with the primary health care services they received. Intervention by the Department of Health, Department of Education, curriculum planners and Health Professionals Councils is recommended wherein homosexuality education should be addressed during pre-service and in-service education sessions so as to familiarise health care providers with such clients’ health care needs and to decreased homophobic attitudes.

The aim of the study was to explore the perceptions of nurses regarding communication with nurse managers in the workplace. The design of the study was a generic qualitative. The methodology of choice was qualitative, explorative method. The sample was non-probability and the approach or technique used was purposive sampling method. It comprised of thirty nurses, ten of each category. The category was a component of professional nurses, enrolled nurses and enrolled nursing auxiliary nurses. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The data collection method used in the study was in-depth interviews using a self-designed interview guide. Face to face interviews was conducted in a quiet room within the hospital ward as a natural setting. Data was collected using a voice recorder for the sake of protecting the missing of information which may be important. The data analysis was with the help of employing transcribing and coding of voice recorded data and observation noted during the collection of data. The findings showed that there were dynamics in communication from all nurse categories and that also indicated that there was a need to conduct a research so that the root cause may be identified and suggestions to be put in place to curb the challenges. In conclusion it showed that communication is the key problem of all and it is a worldwide problem. / Health Studies / M.A. (Health Studies)

Thesis (MPA)--University of Stellenbosch, 2001. / ENGLISH ABSTRACT: The South African Government of National Unity, through its adoption of the Reconstruction and Development Programme (RDP) in 1994, committed itself to the development of a District Health System (DHS) based on the Primary Health Care (PHC) approach as enunciated at Alma Ata in 1978. This approach is the philosophy, on the basis of which many health systems around the world have been reformed, and out of which has developed the concept of the DHS. District-based health systems are now applied successfully in many countries, and have been adapted to a wide variety of situations, from developing countries on our own continent, to more sophisticated systems elsewhere. A National Health System based on this approach is as concerned with keeping people healthy as it is with caring for them when they become unwell. The concepts of "caring" and "wellness" are promoted most effectively and efficiently by creating decentralised comprehensive management units of the health system, adapted to cater for local needs. These units will provide the framework for our district-based health system, in which a district health authority can take responsibility for the health of the total population in its area. This population-based model allows for constant assessment and monitoring of health problems in the district, the facilities and system provided, and leads to efficient and rational planning. The researcher conducted interviews with key stakeholders, used structured questionnaires and observation and reviewed the relevant National and Provincial documentation and performed a literature review, to assess the feasibility of implementing DHS in the City of Cape Town. The main findings of this research are that the City of Cape Town does have the capacity to implement and sustain the DHS, that it is necessary to implement the DHS in the CCT in order to improve the quality of life of the population, and that there is enough personnel to take the process forward. The main recommendations include the need for training of staff, the promotion of communication and transparency in relation to finances and an ongoing support system from the provincial and national health departments. The research assignment has revealed that the move towards DHS has the blessings of the top management and politicians of the eeT. In addition, it has been established that the Cï.T possesses good infrastructure, technical skills, and human resource capacity. There is also willingness on the part of the unions to take this process forward. There are also challenges that need to be addressed, such as difficulties around staff attitudes, and the training of officials so as to accommodate the requirements of a comprehensive primary health care system, effective and efficient utilisation of available resources and change management. / AFRIKAANSE OPSOMMING: Die Suid-afrikaanse regering van nasionale-eenheid het met die aanvaarding van die Herekonstruksie en Ontwikkelings program (Hop) in 1994, Suid Afrika tot die ontwikkeling van gesondheidsdistrik stelstel verbind. Hierdie stelsel is gebaseer op die primere gesondheidsorg (POS) benadering wat te Alma Alta in 1978 geformuleer is. Die POS is die dryfkrag agter die verandering van verskeie gesondheidstelsels die wereld oor. Vanuit hierdie POS het die distriksgesondheidstelsel ontwikkel. Hierdie distriksgesondheidstelsel word tans suksesvol in baie lande toegepas en is aanpasbaar by verskillende omstandighede, van die Afrika kontinent tot meer gesofistikeerd stelsels op ander kontinente. 'n Nasionale gesondheidstelsel gebaseer op hierdie benadering is ewe besorg om mense gesond te hou asook om na hulle om te sien wanneer hulle ongesond is. Die begrippe van besorgheid en welsyn word effektief en doeltreffend bevorder deur die skepping van n gedesentraliseerde omvattende bestuurseenheid van die gesondheidstelsel wat aangepas is vir plaaslike behoeftebevrediging. Hierdie eenhede voorsien die raamwerk vir n eie distriksgebaseerde gesondheidstelsel, waarbinne die distriksgesondheidsregeerders verantwoordelikheid vir die gesondheid van die totale bevolking en hul gebied aanvaar. Hierdie bevolkingsgebaseerde model laat toe vir voortdurende beoordeling en monitering van gesondheidsprobleme binne die distrik. Dit bepaal watter beskikbare fasiliteite en dienste voorsien moet word sodat doeltreffende en rasionele beplanning kan geskied. Navorsing is onderneem om die lewensvatbaarheid van die implementering van n distrikgesondheidstelsal binne die stad Kaapstad, met 'n speciale fokus op finansiele en menslike hulpbronne, te bepaal. Die navorser het gebruik gemaak van 'n gestruktureerde vraelys en literatuurstudie om die lewensvatbaarheid tydens die implementering van die distrikgesondheidstelsel vir die stad Kaapstad te bepaal. Die belangrikste gevolgtrekking met betrekking tot hierdie navorsing is dat die stad Kaapstad oor die vermoe beskik om 'n distrikgesondheidstelsel te implementeer en te onderhou ten einde die lewenskwaliteit van mense te verseker. Daar is verder bevind dat daar genoeg personeel is om hierdie proses te voltooi. Die belangrikste aanbeveling sluit in die opleiding van personeel, die bevordering van kommunikasie en deursigtigheid in verhouding tot finansies en voortdurende ondersteuning vanaf provinsiale en nasionale gesondheids departmente.