This study focuses on records management in support of service delivery in the public health sector of Limpopo Province, South Africa. The study sought to investigate whether the current records-keeping practices support or undermine service delivery and the e-health readiness level. Mixed methods were used for the survey. Questionnaires, observation and interviews were used to collect data. Purposive sampling method was used to identify interview participants and stratified random sampling for questionnaire participants. The total population of the study was 324 from which 210 participants were sampled. The response rate was 77% (162). The study discovered that records management negatively affected timely and effective health care services. This resulted in long patient waiting times and patients being treated without their medical history records. The study recommended the introduction of an electronic records management system capable of capturing and providing access to a full patient record and tracking paper record movement. / Information Science

Magister Public Health - MPH / Background Antibiotic resistance is a phenomenon that occurs naturally and is accelerated by use. There have been no studies looking at trends in antibiotic consumption in the public health sector in Namibia, which provides services to 85% of the population. Aim This study described the pattern of antibiotic consumption in the Namibian public health sector based on distribution of antibiotics from Central Medical Stores (CMS) to the 13 regions in the country. Methodology Antibiotic consumption data from distribution records at the Central Medical Store (CMS), public health sector wholesaler, between 1 January 2010 and 31 December 2016 was collated and analysed to describe trends and usage patterns in the public health sector of Namibia. For the purpose of this study DDD per 1000 inhabitants per day (DID) was used as an indicator so as to be comparable with previously conducted studies. DIDs provide information about the proportion of the selected population using a particular medicine per day. The World Health Organization (WHO) recommended anatomical therapeutic classification (ATC)/daily defined dose (DDD) methodology be used to analyse the data and evaluate the consumption. Data was presented using stacked bar charts to demonstrate the variation in consumption by ATC classes in each region and over time.

This study focuses on records management in support of service delivery in the public health sector of Limpopo Province, South Africa. The study sought to investigate whether the current records-keeping practices support or undermine service delivery and the e-health readiness level. Mixed methods were used for the survey. Questionnaires, observation and interviews were used to collect data. Purposive sampling method was used to identify interview participants and stratified random sampling for questionnaire participants. The total population of the study was 324 from which 210 participants were sampled. The response rate was 77% (162). The study discovered that records management negatively affected timely and effective health care services. This resulted in long patient waiting times and patients being treated without their medical history records. The study recommended the introduction of an electronic records management system capable of capturing and providing access to a full patient record and tracking paper record movement. / Information Science

Magister Public Health - MPH / Background: A growing concern about possible age-related inequities in health care access has emerged in the increasing debate on the challenges of population ageing and health in sub-Saharan Africa. Older persons may experience systematic exclusion from health services. Viewed as one of the poorest, most marginalized groups in SSA societies, older people are deemed to lack access to even basic, adequate health care. There is an assumption, furthermore, that older persons have less access to required health services than do younger age-groups. This suggests an element of age-related inequity. One possible indicator of age-related inequity may be found through measuring the relative availability of essential medicines for chronic non-communicable diseases (NCD), relative to the availability of medicines for communicable diseases (CD). Aim and objectives: The aim of the study was to compare the availability of essential medicines for NCD and CD in Kenya, as an indicator of age-related inequities in access to health care in Kenya. The three study objectives were as follows, in public and mission facilities in Kenya: 1. To assess the availability of medicines for the following CD: diarrhoea, HIV, malaria, pneumonia and other infections 2. To assess the availability of medicines for the following NCD common in older populations: arthritis, diabetes, glaucoma, gout, heart disease, hypertension and Parkinson’s disease 3. To compare the availability of medicines for CD and NCD and draw conclusions on possible age-related inequities in access. Study design: Using an adapted version of the HAI / WHO methodology, a cross sectional descriptive survey of medicines availability was conducted. HAI and WHO collaboratively developed a standardized and validated methodology for comprehensively measuring medicines availability, as well as prices, affordability and price components. The survey manual, launched in 2003 and revised in 2008, is available to the public. The methodology involves collecting data on the availability and price of medicines found in a sample of health facilities across sectors of interest within national health systems. If the specific medicine, dose and form being surveyed is available on the day of the survey, then the medicine is documented as being available. Methods: Random sampling was carried out in six of Kenya’s eight provinces, targetting ten facilities per province. Data on availability of the targeted medicines was collected by trained data collectors on pilot-tested data collection forms adapted from the standardized WHO / HAI methodology. The list of medicines included sixteen for communicable diseases to treat infections such as diarrhoea, HIV, malaria, and pneumonia and twelve medicines used to treat non-communicable diseases such as diabetes, arthritis, hypertension, gout, glaucoma, stroke and Parkinson’s disease. Availability of medicines was noted by physical observation by a data collector, and calculated as the percentage of facilities where a medicine was found on the day of data collection. The availability of brands and generics was not distinguished and were combined to establish availability of each medicine. Overall availability of all CD and NCD medicines was compared, and within each category between rural and urban areas and between mission and public facilities. The Ministry of Health was informed of the survey and provided the data collectors with an MOH endorsement letter. The names of facilities participating in the study were recorded on the data collection forms, but not reported. No data on individual patients was collected, and no patients were interviewed for this survey. Data were entered into an Excel file and exported to and analyzed with SPSS. Results: A total of 56 facilities were surveyed: 49 in the public sector and 7 in the mission sector, giving a facility response rate of 93%. Thirty facilities were located in rural settings and 26 were in urban settings. More CD medicines were available than medicines for NCD. Of a total of 896 individual observations of CD medicines, 632 (70.5%) were recorded as available on the day of visit, compared to 306 (45.5%) of 672 possible individual observations of NCD medicines. These differences were highly significant statistically (chi-square=98.8, p<0.001). Furthermore, comparison of availability between urban and rural areas showed statistically significant differences for NCD medicines (40.6% vs. 51.3%, p=0.007), but not CD medicines (72.5% vs. 68.3%, p=0.190). There were no significant differences in availability of medicines in mission compared to public facilities. Conclusions: This study reveals the low relative availability of medicines for NCDs in Kenya’s public and mission sector. Medicines for NCDs were less available in rural vs. urban facilities, but there was no rural vs. urban difference in medicines for CDs. While more research should be carried out to understand the reasons behind these findings, immediate attention to the supply and financing of medicines for NCDs is urgently needed. The relatively lower availability of medicines for NCDs than for CDs may be an indicator of age-related inequities in access to health care in Kenya and calls for more investigations on equity and access to health for older people in Kenya.

Thesis (M.Pharm.) -- University of Limpopo, 2022 / Pharmacy Dispensing Units (PDUs) are automated medicine dispensing systems, which are the first of its kind in South Africa and are operational in the public healthcare sector. At present, the application of automated dispensing technology is still evolving, and it is uncertain how it will impact on pharmacy services and be integrated into different healthcare systems. Aim To determine the attitude and experiences of patients collecting their chronic care medications at various Pharmacy Dispensing Units. Methods A cross-sectional quantitative design using a structured self-administered questionnaire was used to collect data from the participants at three PDU sites; Alexandra Plaza, Ndofaya Mall and Bara Mall. The study encompassed chronic stable patients. Participants were selected based on a simple random sampling method and included 624 participants. The study period was over two months. The researcher recorded the information that was present in the study population, and no variables were manipulated. Data was analysed using the SPSS version 27.0.0. Chi Square Tests, One-way Anova Tests and Microsoft Excel were used to analyze the data. Results Since p<0.05, the results showed that there was an association between responses and demographic information. The difference in distribution of responses seen across the participants at the different PDUs was significant. Most participants (85,4%) found the ATM easy to use as it was a simple system. Majority of the participants (99,6%) were content with the overall service received at the PDU, and 99,3% were pleased with the experience they had speaking through the PDU telephonic system. In comparison to the clinic, 99% of the participants felt they preferred to use the PDU and 99,7% found the PDU system easier to collect their medication from and follow their treatment plan. A few participants (2,7%) did have some negative experiences such as the system being down, network issues, technical challenges, delivery problems and the PDU being too busy. However, all of the respondents stated that they would recommend the PDU to other patients, as well as continue to collect their medicines at the PDU. Conclusion Overall patients had a positive attitude and experience towards the PDU. This research will assist in ensuring pharmacies continue to shift their focus to providing a more holistic approach to healthcare. It will allow for engagement with National and Provincial Departments of Health and NGOs to expand the number of PDUs. Furthermore, it might also help to develop new services and allow for changes to be made within the current models. This study will contribute to the overall improvement in the health sector and prepare for implementation of NHI. / VLIR Foundation

Esta tese argumenta que a Teoria dos Movimentos Sociais com o foco nos protestos como a forma de atuação dos movimentos e com a conceituação restrita da institucionalização mostra-se insuficiente para dar conta dos movimentos sociais que atuam nas instituições políticas. Esta constatação partiu da observação do Movimento Sanitário/pela Reforma Sanitária, que tem se mobilizado, desde os anos 1970, em prol da defesa do acesso universal à saúde no Brasil. A reconstituição da sua trajetória nacional e do seu repertório de ação abrangeu o período entre 1974 a 2006, conduzida por meio de um estudo de caso. Foram analisadas suas transformações e permanências em termos dos diagnósticos e prognósticos, dos atores e dos eventos, bem como das formas de ação. O caso do Movimento Sanitário pela Reforma Sanitária mostra que movimentos sociais podem atuar via instituições, sem deixar de sê-los, e que, nessa atuação, seus atores recorrem aos elementos inovadores que colocam as autoridades diante de situações novas e aumentam a capacidade de mobilização do movimento. / This thesis argues that the Theory of Social Movements which focuses on protests as the expression of movements actions proves to be insufficient to account for the social movements that operate in political institutions. This finding was based on the observation of the Sanitarista Movement, which has been engaged since the 1970s in defense of universal access to health care in Brazil. The case study covers the reconstitution of the movements national trajectory and repertoire of action from 1974 to 2006. We analyze its continuities and transformations in terms of diagnosis and prognosis, the actors and the events, and the forms of action. The case of the Sanitarista Movement shows that social movements do not cease to exist while acting in institutions and that in their institutional repertoire they are able to introduce innovative elements that put the authorities before new situations and increase the social movement capacity to mobilize.

Esta tese argumenta que a Teoria dos Movimentos Sociais com o foco nos protestos como a forma de atuação dos movimentos e com a conceituação restrita da institucionalização mostra-se insuficiente para dar conta dos movimentos sociais que atuam nas instituições políticas. Esta constatação partiu da observação do Movimento Sanitário/pela Reforma Sanitária, que tem se mobilizado, desde os anos 1970, em prol da defesa do acesso universal à saúde no Brasil. A reconstituição da sua trajetória nacional e do seu repertório de ação abrangeu o período entre 1974 a 2006, conduzida por meio de um estudo de caso. Foram analisadas suas transformações e permanências em termos dos diagnósticos e prognósticos, dos atores e dos eventos, bem como das formas de ação. O caso do Movimento Sanitário pela Reforma Sanitária mostra que movimentos sociais podem atuar via instituições, sem deixar de sê-los, e que, nessa atuação, seus atores recorrem aos elementos inovadores que colocam as autoridades diante de situações novas e aumentam a capacidade de mobilização do movimento. / This thesis argues that the Theory of Social Movements which focuses on protests as the expression of movements actions proves to be insufficient to account for the social movements that operate in political institutions. This finding was based on the observation of the Sanitarista Movement, which has been engaged since the 1970s in defense of universal access to health care in Brazil. The case study covers the reconstitution of the movements national trajectory and repertoire of action from 1974 to 2006. We analyze its continuities and transformations in terms of diagnosis and prognosis, the actors and the events, and the forms of action. The case of the Sanitarista Movement shows that social movements do not cease to exist while acting in institutions and that in their institutional repertoire they are able to introduce innovative elements that put the authorities before new situations and increase the social movement capacity to mobilize.

The healthcare strike action that rocked South Africa in 2007 and 2010 highlighted the trend of professional nurses towards exercising their rights as employees to embark on strike actions, often also in solidarity with other categories of employees. This study aimed to highlight the problem brought about by the lack of proactive strategies to maintain a balance between human and professional rights and responsibilities of nurses within the legal framework of South Africa. The theoretical grounding of the study included both organisational change models and transformational leadership models. A descriptive and analytic design was followed, using both qualitative and quantitative non-probability sampling approaches to meet the research objectives of determining factors for nurses‘ involvement in strikes and their impact. Eighty professional nurses were included as the total sample of the study with 53 that did not participate in strike action and 27 that participated in strike action. A sample of eleven nurse managers was also included in the study to determine their views on strikes by nurses and their understanding of the changing work environment. To determine the overall impact of the nurses‘ strike, 40 healthcare consumers were included. The sample was selected from four provinces: Eastern Cape, KwaZulu-Natal; Western Cape and Gauteng. The study was limited to professional nurses, nurse managers within the public-health sector and healthcare consumers using public-health facilities. The findings and the relevant literature referred to in this study indicate that though there are different reasons for strike action in the public-health sector by area or by country, remuneration is undoubtedly the most mentioned reason. Important to note is that salary per se is not the most critical actor but it is a tangible measure of the value that the employer places on people. In the absence of other incentives in the nursing environment, it becomes the focal point. However, addressing salary issues alone will not prevent strike action in the public-health sector / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to examine the extent to which human resources capacity of the Ministry of Health and Social Services (MoHSS), Namibia, influences health care services delivery to the Namibian population. A qualitative research model using exploratory and descriptive study designs was adopted. Data were collected through semi-structured interviews with 46 health workers from two referral hospitals and two directorates in Windhoek District. The study found that there is severe staff shortage in the MoHSS, which has resulted in high workload and poor health care. Health worker migration, new services and programmes, emerging diseases, and population growth were reported to have contributed to staff shortage and high workload in the MoHSS. Study findings suggested a need to create more posts to accommodate emerging needs, and to introduce an effective retention strategy to attract and retain health professionals with scarce skills, and those working under difficult conditions. / Public Administration & Management / M. Tech. (Public Management)

The healthcare strike action that rocked South Africa in 2007 and 2010 highlighted the trend of professional nurses towards exercising their rights as employees to embark on strike actions, often also in solidarity with other categories of employees. This study aimed to highlight the problem brought about by the lack of proactive strategies to maintain a balance between human and professional rights and responsibilities of nurses within the legal framework of South Africa. The theoretical grounding of the study included both organisational change models and transformational leadership models. A descriptive and analytic design was followed, using both qualitative and quantitative non-probability sampling approaches to meet the research objectives of determining factors for nurses‘ involvement in strikes and their impact. Eighty professional nurses were included as the total sample of the study with 53 that did not participate in strike action and 27 that participated in strike action. A sample of eleven nurse managers was also included in the study to determine their views on strikes by nurses and their understanding of the changing work environment. To determine the overall impact of the nurses‘ strike, 40 healthcare consumers were included. The sample was selected from four provinces: Eastern Cape, KwaZulu-Natal; Western Cape and Gauteng. The study was limited to professional nurses, nurse managers within the public-health sector and healthcare consumers using public-health facilities. The findings and the relevant literature referred to in this study indicate that though there are different reasons for strike action in the public-health sector by area or by country, remuneration is undoubtedly the most mentioned reason. Important to note is that salary per se is not the most critical actor but it is a tangible measure of the value that the employer places on people. In the absence of other incentives in the nursing environment, it becomes the focal point. However, addressing salary issues alone will not prevent strike action in the public-health sector / Health Studies / D. Litt. et Phil. (Health Studies)