Thesis (MHSc)--Unitec New Zealand, 2008. / Coda (electronic version) title-page has 2009 date. Includes bibliographical references (leaves 162-173).

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

Thesis (M. Communication Pathology)--University of Pretoria, 2006. / Summary in English and Afrikaans. Includes bibliographical references.

Magister Public Health - MPH / Ensuring a good performance of health workers is one of the key components for provision of quality health care services in order to progress toward one of the priorities of MDGs namely improving maternal health care. In 2005, Rwanda adopted the “Performance Based Financing (PBF)” program to remunerate and motivate health professional based on their job performance. This lead to increase in the number of health workers by 62% between 2005 and 2008 and public subsidies for health worker remuneration tripled. Despite promotion of this motivation mechanism to enhance job performance in maternal health care, recent data in Rwanda show that MMR is still high with 383 per 100,000 live births and high rates of postpartum complications. All these problems have been attributed to poor performance of staff. To date, little research has been conducted on the factors that affect job performance among health care providers in low income countries and particularly in Rwanda. The present study assesses factors that influence job performance of health care providers working in postpartum care in two public hospitals of Rwanda. Ninety six nurses and midwives were observed providing early and late postpartum care and interviewed about the presence or absence of the performance factors within their work environment. Data were analyzed to determine if there is an association between observed providers performance and variables of interest. Observation revealed that staff performed poorly in the use of guidelines for the management in the postpartum care. The bivariate analysis showed that (a) receiving feedback about job performance (b) receiving training in postpartum care management, (c) training in the use of the tools for the daily work, (d) being satisfied with the way the work is organized, and (e) finding the organization interested in the staff creativity in general, are factors associated with good performance. In conclusion, the study identified important factors that need to be taken into consideration when planning strategies to improve the quality of care and reducing morbidity and mortality in the postpartum wards of the two hospitals.

Health reformers, especially in developing countries, have applied decentralisation to enhance the performance of health systems which in turn improve health outcomes. Proponents of decentralisation argue that increasing the authority of local government promotes resource allocation according to local needs. Yet critics point out that decentralisation is harmful as resources are more likely to be redistributed in favour of poorer areas in countries with centralised governments. Shedding light on those endless debates, this study aims to examine the association between decentralisation, performance of health providers and health outcomes in Indonesia. In 2001 Indonesia embarked on decentralisation in the form of devolution and fiscal decentralisation. Devolution transfers the responsibilities of providing health services from central government to local government, while fiscal decentralisation allows local government to manage its local economies. Following those reforms, Indonesia raised the authority of public hospitals’ managers through corporatisation in 2004. Those reforms aim to provide better health services for the population. Evaluating whether all three forms of decentralisation in Indonesia have achieved their aim or not, this study uses both primary and secondary data. The primary data was collected in 54 public hospitals in East Java province during summer 2013. The secondary data combined individual and household level data and local government data. The Indonesia socio-economic survey (Susenas) 2004-2013 and Indonesian Family Life Survey (IFLS) 2007 are the sources of individual and household data, while the national village census (Podes) 2003-2010 provides district-level data. I supplement these with local government fiscal data from the Ministry of Finance and the consumer price index 2004-2013. The assembled data possesses a multilevel structure in which individuals or households are nested within districts. The main findings show that health outcomes among Indonesians continue to vary across districts after decentralisation. Passing authority down from central government to lower-level institutions does not automatically bring about better performance of health providers and health outcomes regardless of the type of authority devolved and the characteristics of the delegated institutions. However, further analysis on multiyear data suggests that there is an important learning curve throughout the process of decentralisation implementation. Both local governments and hospital managers need time to learn how to utilise the authority they are given after decentralisation. These findings suggest that improving capacity and accountability of local authorities and an understanding of why some local authorities are better than others at learning during the process of decentralisation are vital to improve performance of health providers and health outcomes in decentralised Indonesia.

The aim of this study is to identify green logistics (GL) best practice leading to the efficient management of resources and waste in Thai public hospitals. This work is influenced by and is aligned with the Thailand’s 2nd National Logistics and Supply Chain Research Strategies (2012-2016). The GL practices of six public hospitals were investigated, chosen to give coverage of the different types/sizes, locations and a range of environmental performance issues. Hospital visits were undertaken to collect data by interview, documentation and observation approaches. The GL best practices were principally identified by using developed indicators and a cross-case analysis method. The results of this study showed that resource and waste flows appeared very complicated within Thai hospitals. Thus, effectively introducing and managing GL within these settings requires the coordination of all staff (clinical and other), and the consideration of all environmental impacts from product purchasing through to waste disposal. Many beneficial practices for successfully reducing resource consumption and waste were identified. Key findings were that green initiatives need to be supported by: sufficient environmental education; two-way communication; effective evaluation and recording systems; and Director-level support. Importantly, GL adoption in the Thai context should be grounded in the Sufficiency Economy Philosophy concept (e.g. moderation, wisdom, and happiness), as well as contemporary hospital logistics theory and practice. Finally, it is recommended that the current Hospital Accreditation process is changed to integrate sustainable best practices, and that some pertinent government regulations and policies should be reviewed and changed as they were seen to be counterproductive and indeed in many cases it was proven that the enactment of the policies themselves actually increased waste. / Faculty of Management Sciences, Khon Kaen University.

Η πραγματικότητα είναι ότι στη σημερινή εποχή τα Δημόσια Νοσοκομεία αντιμετωπίζουν σοβαρά προβλήματα διαχείρισης και εκσυγχρονισμού των παρεχόμενων υπηρεσιών υγείας με κύριο αποτέλεσμα την αναποτελεσματικότητα της λειτουργίας τους και δυστυχώς το χαμηλό βαθμό ικανοποίησης των πολιτών. Ο πολίτης που καταφεύγει σε ένα Δημόσιο Νοσοκομείο ζητώντας την απαραίτητη υγειονομική φροντίδα και περίθαλψη δηλώνει σιωπηρά την εμπιστοσύνη του στις υπηρεσίες παροχής υγείας, καθώς και την αποδοχή του στο σύστημα της Δημόσιας Διοίκησης. Το σύστημα όμως δημιουργεί παραλείψεις, καθυστερήσεις, χαοτική γραφειοκρατία και υπέρογκες χρηματικές και μη-επιβαρύνσεις που έχουν σαν αποτέλεσμα τη χαμηλή απόδοση παραγωγής υπηρεσιών υγείας και την άναρχη λειτουργία του ιδιωτικού τομέα. Στην παρούσα διπλωματική εργασία θα μελετήσουμε τις αιτίες των προβλημάτων αυτών καθώς και τον Ιατρικό Φάκελο μέσα από τη σκοπιά της Πληροφορικής και λιγότερο της Οικονομίας. Όπως γνωρίζουμε τα τελευταία χρόνια η ανάπτυξη της τεχνολογίας έχει επιβάλλει μια διαφορετική παρουσίαση και οργάνωση της πληροφορίας. Ολοένα και περισσότερα εργαλεία δημιουργούνται ώστε να εξυπηρετήσουν τις ανάγκες για διαχείριση και διάθεση πληροφοριών. Οι εξελίξεις, τα συμπεράσματα καθώς και οι προβληματισμοί που αφορούν τον ηλεκτρονικό φάκελο υγείας αποτελούν και τον επίλογο της παρούσης διπλωματικής εργασίας. / The reality is that in today's era public hospitals are facing serious problems of management and modernization of health services with primary outcome inefficiency of operation and unfortunately the low degree of satisfaction. The citizen who resorts to a Public Hospital seeking necessary health care and care implicitly declares its confidence in the health services and the acceptance of the system of public administration. But the system creates omissions, delays, chaotic bureaucracy and excessive monetary and non-charges have resulted in a low yield health services and the uncontrolled operation of the private sector. In this particular paper we will study the causes of these problems and the medical records through the perspective of IT and less of the economy. As we know in recent years the development of technology has imposed a different presentation and organization of information. More and more tools are created to serve the needs for management and disposal information. These developments, findings and concerns relating to electronic health records is also the epilogue of this paper.

Submitted in fulfillment of requirements for the Degree of Master of Health Sciences: Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Through centuries the birth of a baby has been considered as a deeply felt spiritual experience. Childbirth is not merely a physiological experience; it also embraces social, emotional, psychological, spiritual and religious aspects. In most Western societies the sacred moment of birth dissipates within the context of a pressured hospital environment. Whilst literature and empirical research has proliferated on midwifery very little has been done to explore how women experience childbirth personally and more importantly how spirituality interfaces within the context of the childbirth experience and midwifery care. There is a growing body of literature on spiritually sensitive care. However, there remained a need to inquire about mother’s personal experience and how spirituality interfaces with the childbirth experience in the hospital context. Problem statement Whilst empirical research in the field of midwifery, has grown, research pertaining to the spiritual aspects related to women’s diverse spiritual needs during childbirth is sparse (Crowther and Hall 2015). Furthermore little attention has been paid to issues relating to how women experienced childbirth in the public sector, and how religion and spirituality influence and impact on childbirth. It is against this background that the current study was conceived. Purpose of the Study The purpose of this study was to explore and describe the experience of childbirth amongst women from diverse spiritual or religious backgrounds viz. Christianity, Islam, African Traditional Religion and Hinduism, at public hospitals in the uMgungundlovu District of KwaZulu-Natal. Methodology A qualitative, explorative, descriptive and contextual study design was used. A total sample of twenty-two postnatal mothers from the following common spiritual backgrounds in South Africa viz. Christianity, Islam, African Traditional Religion and Hinduism were purposively chosen. Data was collected until saturation. Participants were selected from three public hospitals in the uMgungundlovu District of KwaZulu-Natal. Data was collected by means of semi-structured interviews conducted six weeks post-delivery at the six-week health check, but within three months of delivery. Interviews were transcribed manually; the data was analysed through thematic analysis. Findings The main themes drawn from the data reflected that childbirth was a deeply personal and meaningful experience. It was seen as a spiritual experience and spirituality was seen as a vital support system in enabling mothers to cope better with pain and other challenges. Emotional and comfort needs were also identified by mothers as being very important to cope with pain and an easier delivery. The presence of midwives and the need for partner and family support were also seen to be important. More importantly the study found that their spirituality and spiritually based activities and rituals were an important aspect of the overall birth experience. The study found a diverse range of spiritual practices and rituals that were salient across all the spiritual worldviews during childbirth and post-delivery. It also found that mothers often resorted to alternate and traditional therapies to help cope with labour and delivery all of which have salience to midwifery practice that is both respectful and sensitive to the diverse worldviews of mothers. Conclusion Collectively the data reflected that childbirth was a holistic experience that cannot be separated also from partner, family and medical support. Whilst traditionally effective midwifery practice may have been so to focus on primarily physical care, the study found that the physical component is interrelated with the psychological, social and cultural aspects as well. Hence effective and ethical midwifery practice is inseparable from these facets but most importantly inseparable from the spiritual worldviews that most mothers follow and ascribe to. Contemporary education needs to recognize the current move towards spiritual care and provide knowledge and skill to deal with patients from diverse spiritual backgrounds. Finally it needs to recognize as this study has found, that childbirth is a multifaceted experience which is spiritual in nature. Viewed in this way both midwives and the management of public hospitals should then make every effort to create spiritually sensitive care during the childbirth experience. / M

>Magister Scientiae - MSc / Background and Objectives: The reporting of adverse drug reactions (ADRs) is a major public health necessity. It is estimated that only six to 10 percent of all ADRs are reported worldwide. This number is far less than the actual cases of ADRs which occur in healthcare facilities. There appears to be lack of knowledge, awareness and willingness of healthcare professionals to report ADRs, which prompted some countries to nominate a person for ADR reporting in facilities. The objectives of this study were to ascertain which facilities had a nominated person or committee for ADR reporting, describe the knowledge and training of these individuals, describe the processes followed by the facilities for ADR reporting, determine the most commonly reported ADRs and causative drug classes, and, determine the factors which facilitate or hinder ADR reporting. Method: This was an exploratory, multicenter study. A structured questionnaire with closed and open-ended questions was used for data collection. The study was conducted in Gauteng province, where stratified non-random sampling was used to collect data in the selected regional and district public hospitals. Results: Six regional hospitals and five district hospitals participated in the study. Five (45.5%) of these hospitals had a person nominated for ADR reporting, of which all were pharmacists. All the respondents nominated for ADR reporting stated their knowledge and confidence in identification of ADRs as average and above. One (20%) of the nominated persons for ADR reporting did not have pharmacovigilance training. The reported number of ADRs over the past 12 months ranged between zero and 199. Only two (40%) of the hospitals with a nominated person for ADR reporting received feedback on the submitted reports from a committee. Only one (16.7%) of the six hospitals that did not have a nominated person or committee for ADR reporting had plans to nominate a person for this function. ADR reporting in these hospitals were performed by the pharmacy that collated the identified ADRs into a report and distributed these to the Pharmacy and Therapeutics Committee (PTC) and South African Health Products Regulatory Authority (SAHPRA). Only one hospital out of all the hospitals (n=11) did not use the national ADR reporting form and rather used an incident report. Out of all the participating hospitals, only two (18.2%) of the hospitals had an algorithm in place to assist with the identification of ADRs. The researcher went through the file where ADR reporting forms were kept for the past 12 months, and reported that the most commonly reported ADR type across participating facilities was allergic reactions such as rash and angioedema reported by eight of the facilities, followed by administration errors and quality issues each from three facilities. While the most frequently reported drug class associated with these ADRs included antiretrovirals (ARVs) and angiotensin converting enzyme (ACE) inhibitors reported at eight and six facilities, respectively. The most common challenge to ADR reporting at participating facilities was non-reporting of ADRs, followed by fear of litigation and patient’s unwillingness. Although all the hospitals in this study had facility PTCs, only one hospital had a pharmacovigilance subcommittee and the others included ADRs as an agenda point of the PTC meetings. Conclusion: Less than half of the facilities had a person nominated for ADR reporting. Pharmacists and the pharmacy were synonymous with ADR reporting as all nominated persons were pharmacists and in facilities were there were no nominated person, the responsible pharmacist was identified as the contact person for ADR reporting. Although all hospitals had PTCs, there was rarely a subcommittee dedicated to pharmacovigilance or ADR reporting, which culminated in a lack of feedback to healthcare workers that could promote it in the facility. Underreporting of ADRs by health care workers was the major challenge to effective ADR reporting as this function was considered to be too time consuming.

Thesis (MDEV) --University of Limpopo, 2007. / The study sought to develop guidelines that are aimed at improving Termination of Pregnancy (TOP) services that are rendered by public hospital based midwives. The researcher applied a qualitative and descriptive design. The study targeted midwives in the Bohlabela District, which has three hospitals. A non-probability purposive sampling was used to 6 midwives who are currently conducting TOP services in the hospitals. Data collection was both in-depth and conducted in face-to-face interviews with each participant. The findings of the study were analyzed, categorized into sub-themes, and revealed that midwives who conduct TOP services experience the following challenges, namely: inadequate human resource, poor infrastructure, lack of equipments, poor management support, and lack of support from doctors. Based on the findings of the study, it is imperative that all hospitals be designated centres for TOP services, so as to reduce the workload in the few hospitals that currently are inundated. The infrastructure needs to be improved, information about TOP services to the public has to be disseminated through awareness campaigns, and scarce skills allowances must be introduced. In addition, more staff members need to be employed. The study further recommends that the TOP policy guideline be reviewed in terms of allowing other competent health professionals to perform TOP. Chapter two discusses the literature review regarding the challenges that affect midwives who conduct TOP. In this study, theresearch compares the practice of TOP by the developing and developed countries, looks at related to laws at on TOP; gives an overview of sterilization Act in South Africa; mentions the amendments of laws on TOP; considers other legal restrictions; presents mandatory counseling for TOP clients; focuses on religious, cultural and traditional beliefs. The researcher has consulted different literatures, journals articles and website on challenges that affect midwives in rendering TOP in Limpopo, South Africa and world wild. Chapter three presents research methodology that consists of research design; area of study; population; sampling method; data collection method and procedure; ensuring trust worthiness; and ethical consideration, to be followed by limitation of the study. Chapter deals with data analysis and interpretation. Chapter five presents the researcher’s conclusions and recommendations. / Not listed