Magister Philosophiae - MPhil

Magister Public Health - MPH / In the context of human resource crisis in African countries, the World Health Organization has proposed task-shifting as an approach to meet the ever-increasing need for HIV/AIDS care and treatment services. Rwanda started the process of task shifting towards nurse-based care in ART services in June 2010. After one year of implementation, a need to determine whether task shifting program has been implemented as intended and if it achieved its primary goal of increasing accessibility of people living with HIV to ARV therapy and improving nurse capacity in HIV patient care was imperative.A multi-method program evaluation study design, combining cross sectional, retrospective review and retrospective cohort sub-studies were used to evaluate the implementation,maintenance processes and outcomes of task shifting in 13 Health Centres (HCs) located in the catchment area of Kibagabaga District Hospital, in Rwanda. The study population consisted of HCs providing task shifted care (n=13), nurses working in the ART services of the 13 HCs(n=36), and more than 9,000 patients enrolled in ART care in the 13 HCs since 2006. All 13 HCs and 36 nurses were included in the evaluation. Routine data on patients enrolled in the pre-task shifting period (n=6 876) were compared with the post task shifting period (n=2 159), with a specific focus on data in the 20-months periods prior to and after task shifting. A cohort of patients 15 years and older, initiated onto ART specifically by nurses from June to December 2010 was sampled (n=170) and data extracted from patients medical files.Data collection was guided by a set of selected indicators. Three different data collection tools were used to extract data related to planning, overall programmatic data and individual data from respectively, the program action plans/reports, HIV central databases and patients medical files. Descriptive analysis was performed using frequencies, means and standard deviations (SD). The paired and un-paired t-tests were used to compare means, and chi-square test was used to compare categorical variables. To compare and to test statistical difference between two repeated measurements on a single sample but with non-normally distributed data, Wilcoxon signed rank test was used. To judge if current task shifted care is better, similar or worse than non-task shifted care, comparisons were made of program outputs and outcomes from the central database prior to and after the period of task shifting, and also with the cohort of nurse initiated patients.Results showed that 61% of nurses working in the ART program were fully trained and certificated to provide ART. Seven out of 13 HCs met the target of a minimum of 2 nurses trained in ART service delivery. Supervision and mentorship systems for the 13 HCs were well organized on paper, although no evidence documenting visits by mentors from the local district hospital to clinics was found. In term of accessibility, the mean number of patients newly initiated on ART per month in the HCs increased significantly, from 77.8/month (SD=22.7) to 93.9/month (SD=20.9) (t test (df=38), p=0.025). A small minority of patients was enrolled in late stages of HIV, with only 15% of the patient cohort having CD4 counts of less than 100 cell /μL at initiation on ART. The baseline median CD4 cell count was 267.5 cells /μL in the cohort as a whole. With respect to quality of care, only 8.8% of patients in the cohort had respected all appointments over a mean follow up period of 17.2 months; and although follow up CD4 counts had been performed on the majority of patients (80%), it was done after a mean of 8.5 months(SD=2.7) on ART, and only a quarter (24.7%) had been tested by 6 months (as stipulated by guidelines). From central ART program data, a small but significant increase of patients on 2nd line drugs was observed after implementation of task shifting (from 1.98% to 3.00%, 2=13.26,p<0.001), although the meaning of this shift is not entirely clear.The median weight gain was 1 kg and median CD4 increase was 89.5 cells /μL in the cohort after 6 months of receiving task shifted care and treatment. These increases were statistically significant for both male and female patients (Wilcoxon signed rank test, p<0.001). With regard to loss to follow up, only three of the 170 patients in the cohort followed up by nurses had been lost to follow-up after a mean of 17.2 months on treatment. The routine data showed a decrease of patients lost to follow up, from 7.0% in the pre-task shifting period to 2.5% in the post-task shifting period. In general, the mortality rate was slightly lower in the post-task shifting period than in the pre-task shifting (5.5% vs 6.9% respectively), although this was not statistically significant (2=2.4, df=1, p=0.1209).This study indicates that, after over one year of implementation of task shifting, task shifting enabled the transfer of required capacity to a relatively high number of nurses. In an already well established programme, task shifting achieved moderate improvements in uptake (access) to ART, significant reductions in loss to follow up, and good clinical outcomes. However,evaluation of process quality highlighted some concerns with respect to adherence to testing guidelines on the part of providers and follow up visits on the part of patients. Improvements in processes of monitoring and follow up are imperative for optimal mid-term and long-term task shifting in the ART program.

Magister Legum - LLM / This is a desktop based study which will analyse relevant books and chapters in books relating to supervision of local governments by national and other higher level governments. It will also examine legislation, journal articles, newspaper articles and press statements in the field of multi-level government. The study will examine three Ministerial directives in chapter four. Due to challenges in accessing government policies the study will assess two directives that the author has on file. The study will rely on secondary sources such as newspaper articles for the third directive.

Philosophiae Doctor - PhD / Over the course of the past three decades bi-lateral and multi-lateral donor agencies, academics and practitioners have expressed the conviction that decentralisation of administrative and political authority to the local level is of central importance to public sector reform programmes in developing states both as a means to improve service delivery and to deepen democracy. However, many states in Africa have had disappointing experiences with decentralisation which have variously been attributed to the underfunding of local governments, a lack of administrative capacity and corruption. In the light of this, a number of scholars have argued that decentralisation in Africa has achieved little in the delivery of basic services and in the deepening democracy at the local level. This has raised concerns that decentralisation, whilst necessary, is not a sufficient condition for ensuring local socio-economic development and participatory governance. This thesis sets out to examine the process of administrative and political decentralisation in Tanzania since it attained independence in 1961, paying particular attention to the current local government reform programme which consists of a parallel system of devolved and de-concentrated government authority implemented through the Tanzania Social Action Fund (TASAF). This hybrid model of decentralisation, which is heavily reliant on donor aid, has been in place for over a decade and a half. The thesis considers the extent to which the combination of decentralised and de-concentrated forms of administration represents an accommodation between the neo-liberal agenda of donors (concerned with the diminution of central state power) and the policy interests of the Tanzanian government (concerned about a lack of local capacity and domestic politics). Based on a case study of three municipalities (Tanga city, and the Lindi and Morogoro district councils) the thesis examines the extent to which the hybrid model is meeting its stated objectives of strengthening local government, improving service delivery, and promoting effective citizen participation. In so doing it examines the particular role of TASAF and the extent to which its activities are supporting the development of effective local government. Empirical evidence, which was generated through a mixed methods approach based on both quantitative and qualitative research, suggests that, notwithstanding the concerns of some local politicians that the model has undermined the authority of local councils, the v combination of local administrative coordination and the technical and financial support of TASAF, has led to significant improvements in the delivery of social services since the reform programme was launched. The thesis also found that the majority of respondents believed that the hybrid model had served to deepen local democracy to a far greater extent than decentralisation reforms of the past. It also concluded that, in spite its evident potential, the future of the hybrid model in Tanzania is highly uncertain, given that it remains heavily reliant on donor funding and is subject to the aid conditionalities imposed upon it. Unless the government is able to increase its own funding of TASAF, the hybrid model is likely to collapse due to the changed funding priorities of bi-lateral and multilateral donor agencies.

Magister Commercii (Industrial Psychology) - MCom(IPS) / Research evidence suggests that strengthening the cultural roots of an organisation (Organisational Culture) can lead to the observance of increased behaviours that goes beyond the call of duty (Organisational Citizenship Behaviour) across all sectors within a given organisation. Organisational cultures that encourage innovation, sense of togetherness and positive competition, are ideal in encouraging employees to perform beyond normal expectations in organisations. Organisational culture is therefore a critical element that contributes to organisational success and effectiveness. The focus of this study is to determine the impact that the organisational culture of the South African Police Service, as an organisation, has on the Organisational Citizenship Behaviour of its members in the Western Cape. The empirical study involved the participation of 127 respondents from three of the largest police stations in the Western Cape. A survey was conducted using the Organisational Culture Assessment Instrument (OCAI) and the Organisational Citizenship Behaviour Scale (OCBS) to assess the hypothesised relationship between the variables. An analysis of the results suggests that all of the dimensions of Organisational Culture (Clan, Adhocracy, Hierarchy and Market) are positively related to all of the dimensions of Organisational Citizenship Behaviour (Altruism, Sportsmanship, Civic Virtue, Conscientiousness and courtesy).

Mobile technologies are seen as an emerging technology that affects individuals and organizations. These technologies are becoming more affordable and accessible over time with advanced designs and computing capabilities. These technologies affect how people use and access the internet, how people create and access content or services, and how people choose to communicate. In addition these technologies have infiltrated the educational sector, and effected how educational institutions such as a university deliver services to academics, students and staff. As these technologies are effecting educational institutions academic libraries that support such educational institutions have had to embrace these technologies by adapting and adding additional services to accommodate users. Examples of such new and emerging services can be seen through the establishment of mobile library websites, mobile library applications available for users from various types of mobile devices such as cell phones, mobile tablets, and e-readers. Libraries are adapting traditional services such as catalogues, resources and other services to be accessible and usable from such devices. This study is focused on a South African academic library, taking a closer look at mobile library service delivery, to investigate whether library services delivered from mobile devices can enhance service delivery. The study is focused on an established mobile library website, and looks at the post implementation of the mobile library website from the perspective of Natural and Agricultural Sciences students at the University of Pretoria, South Africa. / Mini-dissertation (MIT)--University of Pretoria, 2013. / Information Science / Unrestricted

Service delivery NGOs (SD-NGOs) have long been criticised for promoting ‘technocratic’ and ‘depoliticised’ forms of development. However, some commentators have begun to argue that such agencies, and even their ‘technocratic’ interventions, can have positive impacts on political forms and processes. This study investigates these two opposing perspectives through the lens of state building and citizenship formation in the global South. Primary research into the activities of a prominent SD-NGO in Uganda called The AIDS Support Organisation (TASO), through its “mini-TASO Project” (MTP), finds that the project delivered important citizenship gains for People with HIV/AIDS (PWAs). This was visible in four main areas, namely, enhanced ability of PWAs to exercise voice, increased associationalism among previously unorganised and marginalised PWAs, increased voluntarism and more participation of PWAs in political contests. Yet, the project’s state-capacity building effects were more uneven. On the one hand, the programme played an important role in strengthening the bureaucratic ability of targeted hospitals to deliver HIV/AIDS services, enhanced PWAs’ legibility to the state as well as increased state’s embeddedness in society. On the other hand, however, it was less successful in expanding the infrastructural reach of the state in rural Uganda. The overall conclusion is that while SD-NGOs emerge as more political actors than critics claim, their potentially progressive effects are contingent on and remain limited by intervention and contextual factors. While intervention factors encompass issues such as the expertise of SD-NGOs, programme design and funding, the contextual ones include the pre-existing state-society relations, operating environment for civil society, influence of donors, and the character of both formal and informal political institutions, among others.

The essence of this study is to review and to assess the extent to which transformation has materialized in the South African public service. Transformation has implied a fundamental reframing of the South African public service, replacing an old system with a new one. Through different legislations, objectives to improve the lives of the South Africans were set. The Department of Health, amongst others, was selected to pilot service delivery initiative because an improved health system would contribute directly to the improvement and expansion of human resource potential of the country. After a decade, it is still essential to assess a government’s performance in order to observe if there is progress in terms of services delivered to the people. The purpose is not really to pass or fail a particular initiative but to identify weaknesses and to suggest how these can be remedied and also to inform the community about the developments made. / Dissertation (MAdmin (Public Administration))--University of Pretoria, 2007. / School of Public Management and Administration (SPMA) / unrestricted

The dispensation of hearing aids in the public sector of South Africa is burdened with problems such as lack of provision of batteries for hearing aids, poor repair services and inadequate follow-up. This affects the maximum benefit derived from the hearing aid. Hearing loss which affects communication also negatively impacts on speech and language development, cognitive development, pragmatic skills, and employment opportunities i.e. all aspects of daily living. A hearing aid is an example of an assistive listening device that attempts to minimise the consequences of hearing loss. It is a restorative mechanism that amplifies sound to compensate for hearing loss. For the greater part of the population with hearing loss it is the most cost-effective solution. Therefore, the hearing aid must be correctly fitted and used. It is vital that the client knows how the instrument operates, how to handle it, how to care for it, and, most importantly, how to use it. This involves a great deal of information giving, practice, and counselling by the speech-language pathologist and audiologist. An effective orientation and rehabilitation programme should constitute of the following: a discussion of the types of hearing loss, the facilitation of understanding of the audiogram; information on troubleshooting and using hearing aids effectively; as well as information on the expectations of the hearing aid/s. Speech-reading techniques, coping and communication repair strategies are also important. It is hypothesized that many individuals who are fitted with government hearing aids cannot adequately utilise and maintain their devices. Furthermore, this problem could be related to the initial hearing aid orientation and lack of follow-up rehabilitation as this when information regarding utilisation and maintenance is usually disseminated to clients. This study therefore aimed to examine the maintenance and utilisation of hearing aids given to clients attending provincial hospitals in Tshwane and to probe factors that impacted on the aural rehabilitation and the hearing aid fitting process, in order to contribute to the formation of service delivery guidelines. Both a qualitative and quantitative research approach was utilised. The type of research was cross-sectional and analytical. The nature of the investigation was a descriptive survey utilising face-to-face interviews. A method of non-probability purposive sampling was employed. Fifty seven adult hearing aid users were interviewed with a structured interview schedule. Quantitative results were analysed using statistics and qualitative data was categorised into main themes and ideas. Results showed that there was a general consensus about the self-image and wearing of hearing aids, as most participants were embarrassed to wear their devices. This could be due to inadequate and lack of counselling and public awareness. Furthermore, it was found that most government fitted hearing aids and accessories were poorly cared for and maintained. There were several factors which negatively influenced the utilisation and maintenance of hearing aids. One of these factors was finance i.e. the cost of travelling to and from hospitals, the cost of batteries as well as the cost of repairs to hearing aids played a significant role in how the hearing aid was utilised and cared for. Distance from hospitals also impacted on the maintenance as all hearing aid services were only available at tertiary institutions and not at community level. Furthermore, the issue of multilingualism presented an obstacle in terms of utilising hearing aids correctly and to their full benefit, as most participants were not instructed on hearing aid care and use in their first language. The results from this study were utilised in the development of service delivery guidelines for the dispensation of government hearing aids. / Dissertation (MCommunication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted

The aim of this study was to explore and describe the perceptions of registered nurses regarding the factors that influence service delivery in expansion programmes in a primary health care setting. A qualitative approach was used to conduct this study. Purposive sampling methods were used to select participants from the registered nurses who had been working in the clinics for more than two years and had been exposed to the expansion programmes in the clinics. The researcher collected data by means of focus group interviews, conducted in a neutral setting. Data were analysed,according to the Tesch method of data analysis, by the researcher and an independent co-coder. Categories, sub-categories and themes were identified. The categories that form the basis of the discussion are: disabling factors, enabling factors, client related factors, service related factors and solutions of problems. It was recommended that the integration and coordination of programmes at provincial level should be planned in conjunction with the training. The regional information system should introduce an electronic recordkeeping system, which links all clinics to one database, allowing these clinics to monitor clients who shop around and move between clinics. Training in expansion programmes should be continually conducted in the region in the form of in-service training. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted