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The purpose of this thesis is to explore the diverse experiences of accessing health and social services when living with a neurological condition in Manitoba. Using a qualitative research design, I conducted 15 in-depth semi-structured interviews with adults living with a neurological condition in Manitoba. Findings demonstrated how characteristics of patients, and their service providers/systems, either predisposed them to a lack of service coordination or enabled them to successfully navigate health and social services. In the event that those factors contributed to a need or desire for coordination, participants employed strategies to improve their experience accessing services by i. pursuing knowledge to improve access, ii. actively engaging in behaviours to improve services, or iii. mentally coping with inadequate services. To conclude, practical recommendations on possible initiatives to improve the daily experiences of individuals living with neurological conditions are also provided. / October 2015

Cette thèse a pour but de documenter la réorganisation des services effectuée au programme Enfants et adolescents (PEA) du Centre de réadaptation Estrie, Sherbrooke. Une démarche de recherche-action participative (RAP) est utilisée afin de collaborer au développement, à l’implantation et à l’évaluation d’un nouveau modèle de services visant à accroître l’accessibilité et la qualité des services de réadaptation offerts aux enfants ayant une déficience physique. Spécifiquement, les objectifs sont : 1) de documenter les retombées de la réorganisation des services; 2) de réaliser une analyse critique du processus de changement. Des méthodes quantitatives et qualitatives sont utilisées afin d’atteindre ces objectifs. Tout d’abord, la Mesure des processus de soins (MPOC) documente la perception de la qualité avant (2007), pendant (2008) et après (2009) l’implantation du nouveau modèle de services. Au total, cet outil est employé auprès de 222 familles et 129 intervenants. À quatre reprises, les intervenants et les gestionnaires répondent également à un questionnaire sur leurs perceptions des forces, des faiblesses, des opportunités et des menaces au PEA. En 2008 et en 2009, des focus groups et des entrevues téléphoniques sont réalisées auprès des familles (n=5), des intervenants (n=19) et des gestionnaires (n=13) afin de documenter leurs perceptions sur le processus de changement et sur les retombées de la réorganisation des services. Quant à l’observation participante, elle permet de recueillir de l’information sur le processus de réorganisation des services tout au long de ces trois années. Enfin, les informations recueillies sont analysées à l’aide de différentes approches, dont des tests statistiques et des analyses de contenu utilisant une grille de codification inspirée de la théorie des systèmes d’actions organisées. Les résultats indiquent que davantage d’enfants reçoivent des services en 2009 en comparaison à 2007. De plus, la qualité des services s’est maintenue selon les perceptions évaluées par la MPOC (article 1). L’utilisation d’interventions de groupe contribue fort probablement à augmenter le nombre d’enfants qui reçoivent des services, mais plusieurs défis doivent être adressés afin que cette modalité d’intervention soit réellement efficiente (article 2). Les résultats font ressortir que le processus de réorganisation des services est complexe. L’évaluation des forces, des faiblesses, des opportunités et des menaces d’un programme, de même que l’implication des acteurs dans le processus de développement d’un nouveau modèle de services, favorisent l’amélioration continue de la qualité (article 3). Or, les facilitateurs et les obstacles à l’implantation du nouveau modèle de services évoluent durant la réorganisation des services. Considérant cela, il est important de poser les actions nécessaires afin de soutenir le changement tout au long du processus (article 4). En résumé, cette thèse contribue à l’avancement des connaissances en réadaptation en comblant une lacune dans les écrits scientifiques. En effet, peu de projets visant le développement et l’implantation de nouveaux modèles de services sont évalués et documentés. Pourtant, des modèles tels que celui développé par le PEA semblent prometteurs afin d’améliorer l’accessibilité, et éventuellement, la qualité des services de réadaptation chez l’enfant. / This thesis aims at documenting the reorganization of services that took place within the programme Enfants et adolescents (PEA) of the Centre de réadaptation Estrie, Sherbrooke. Participatory action research (PAR) is used to collaborate in the development, implementation and evaluation of a new model of service delivery aimed at increasing the accessibility and quality of rehabilitation services offered to children with physical disabilities. Specifically, the objectives are to : 1) evaluate outcomes of the service reorganization, and 2) critically analyze the change process. Quantitative and qualitative methodologies are used. First, the Measures of processes of care (MPOC) are utilized to document quality-related perceptions before (2007), during (2008) and after (2009) the implementation of the new service delivery model. In total, these tools are utilized with 222 families and 129 clinicians. On four occasions, clinicians and administrators also responded to a questionnaire on the program’s strengths, weaknesses, opportunities and threats. In 2008 and 2009, focus groups and phone interviews are conducted with families (n=5), clinicians (n=19) and administrators (n=13) to document their perceptions of the change process and the service reorganization outcomes. Participatory observation allowed collecting data during the whole process of service reorganization. Finally, all the data collected are analyzed using different approaches, such as statistical tests and content analysis using an emerging coding grid inspired from the organized action systems theory. Results indicated that the program served more children in 2009 compared to 2007. Moreover, service quality was maintained according to perceptions evaluated with the MPOC (article 1). The utilization of intervention groups probably contributed to the increased number of children receiving services, but many challenges have to be overcome to ensure effective use of this service delivery method (article 2). Results highlight that reorganizing services is a complex process. Evaluating strengths, weaknesses, opportunities and threats of a new program, as well as the involvement of stakeholders to develop a new model of service delivery, contribute to quality improvement efforts (article 3). However, the facilitators and barriers to the implementation of a new model of service delivery evolved during the reorganization process, and it is essential to take the required actions to sustain changes through the transformation process (article 4). In summary, this thesis contributes to increasing the knowledge in rehabilitation by providing information in an area of the literature where little has been published. Indeed, few projects aiming at developing and implementing new models of service delivery are evaluated and documented. Models, such as the one developed by the PEA, seem interesting to increase accessibility, and eventually, the quality of rehabilitation services for children.

Public sector decision makers are confronted by pressures to make faster and better decisions as a result of the competitive environment they operate in. However, there is a trend in the public sector, including the Department of Transport (DoT) in South Africa, to invest in management information systems (MIS) that are highly fragmented and not aiding effective and timely decision-making. As a result, the country witnessed several service delivery protests since 2008 which also affected the public transport sector, such as the widespread burning of Metrorail trains several times by angry commuters. In most instances, poor service delivery emanates from the fact that public servants do not have information at their fingertips to make decisions. This quantitative study utilised Control Objectives for Information and Related Technologies 5 (COBIT 5) as a theoretical framework to investigate the integration of MIS at the DoT with a view to enhancing business intelligence for effective decision-making. Data were collected through a questionnaire directed at middle managers and senior managers that were selected through stratification of business units at the DoT, as well as analysis of documents such as system specifications and strategic plans. The study established that the DoT has several systems such as Alfresco, BAS, GIS, Logis and Persal to name a few, which serve different purposes. However, in most instances, the systems are not integrated as the current infrastructure did not support integration needs and plans to accommodate changing requirements. This is compounded by the system policy implementation constraints, as well as ageing legacy systems that are obsolete. The only component where MIS was found to be integrated, was in the financial business units (Supply Chain Management, Finance and Budgeting). Core business units use off-the-shelf systems and, in some cases, custom-made applications that do not integrate with any other system and thus hinder decision-making. In conclusion, decisions are made based on thumb-sucking, as management does not have access to comprehensive information that is stored in fragmented unintegrated systems. The study recommends that governance structures should be set up to deal with a more holistic business, information and technology architecture for the DoT that enable integration of various systems for effective decision-making. Failure to transform this pattern would lead to service delivery protests persisting. A further study on a framework to integrate MIS in the public sector is recommended. / Information Science / M. Inf.

The historic year of 1994 marked the demise of the apartheid government and its replacement with a new era of participative democracy in South Africa. Government in the new South Africa adopted a decentralised structure underpinned by chapter three of the Constitution (1996). Consequently, there are three spheres of government, which are, national, provincial and local levels. These spheres are obliged and mandated to mutually cooperate and support each other through peaceful interactions termed intergovernmental relations (IGR) which are aimed at achieving a cooperative system of government. IGR is institutionalised through forums which cut-across all spheres of government and such structures are established by the Intergovernmental Relations framework Act (No. 13 of 2005). Sustained intergovernmental cooperation can lead to an integrated and coordinated system of government, which can, deliver services effectively while meeting the needs of the citizens and ultimately promoting sustainable socio-economic development in South Africa.The aim of this empirical study was to assess the role played by cooperativegovernment and intergovernmental relations in promoting effective delivery of services in the Amathole District Municipality (ADM). Local government is the ‘grassroots’ government and it is where the actual rendering of services is situated which was reason behind the choice of the study area by the researcher. The study adopted amixed-method research paradigm in which both the quantitative and qualitative research paradigms were triangulated to ensure that the validity and reliability of the research findings is improved. Data in the study was gathered from a representative sample of seventy (70) respondents carefully selected using non-random sampling designs, viz, judgmental and snowball sampling. The study used both primary (questionnaires and interviews) and secondary (documentary analysis) sources of data to achieve the research objectives as validly as possible. Respondents in the study comprised of municipal officials, IGR practitioners, representatives from Community Based Organisations and the residents of ADM. Data analysis was done using the Statistical Package of Social Sciences (SPSS) software and the mains findings of the study were that; ADM has got IGR forums in existence although some of these are dormant and dysfunctional, only three out of the seven local municipalities in ADM are cooperative in IGR, there is general lack of political will on the side of politicians in terms of support of IGR initiatives, political factionism and interferences is crippling IGR and cooperation, the legal framework for IGR needs revision and revamping, there are still communities without access to basic services in ADM, public sector planning cycles are fragmented and need synergisation and IGR is not being monitored and evaluated. The study therefore recommended that; the relevant stakeholders in IGR should be fully dedicated towards cooperation, planning cycles for public entities need to be synergised, the National Planning Commission (NPC) should take an oversight role in the entire planning process, the legislation should be enacted which has a clause for punitive action being taken against those who fail to cooperate in IGR and the national, provincial and local governments should prioritise access to basic services in communities cooperatively.

This research sought to understand the perceptions of the township dwellers who are the beneficiaries of the RDP houses in a selected township, Chris Hani block 3 in Mdantsane, East London, in the Eastern Cape. The study specifically sought to establish whether the houses delivered to the residents through the Reconstruction and Development Programme (RDP) adequately meet the basic standards prescribed by the relevant housing policy of South Africa. During the apartheid era black South Africans were marginalised, their development was separate from that of whites and they had no say in what was provided for them, hence they were inadequately housed. On coming into power, the post-apartheid government undertook through legislation to provide sustainable, adequate housing that would address the needs of the historically disadvantaged citizens/poor people of South Africa. The main finding of this study conducted on a sample of ten RDP housing beneficiaries, through personal interviews is that, the RDP is a good programme; however, its implementation is characterised by corruption and greed. The people, whom the programme is meant to benefit, have never been involved in their own development with the results that the houses provided to them, are of a sub-standard quality. The houses do not adequately address the housing needs of the people. The housing policies are also not adequately implemented. It is the author’s hope that the recommendations made by this study, if implemented, will improve the standard of the RDP houses provided to the poor people of South Africa.

The emergence of Web 2.0 tools has transformed the operation of Knowledge Management (KM) practices in the academic libraries. This study has investigated the application of Web 2.0 tools to enhance KM practices in academic libraries in Tanzania. Eight out of twelve academic libraries located in public universities in Tanzania were purposively selected in this study. The study included two categories of respondents: ordinary library staff and senior library staff (directors, heads of libraries, library managers, and Information and Technology (IT) specialists in the library etc). The findings of the study were determined after applying methodological triangulation within quantitative and qualitative research contexts. This included the use of questionnaires, semi-structured interviews and observations. In the first instance, questionnaires were used to collect data from 278 library staff selected using systematic sampling technique. Interviewing targeted 69 senior library staff was done using purposive sampling technique. In total, 254 (91.4%) ordinary library staff completed the questionnaire; while 57 (82.6%) senior librarians were interviewed. The study findings have indicated the low level of KM application in academic libraries. Muhimbili University of Health and Allied Science (MUHAS) Library showed the strongest application of KM practices, followed by State University of Zanzibar (SUZA) Library. Lack of KM enablers in academic libraries was indicated as one of the significant challenges that hinder the application of KM practices in academic libraries. It was noted that most of the academic libraries visited had websites. On the other hand, the majority of respondents acknowledged that they had personal accounts of the various Web 2.0 tools. The study findings imply that most library staff had some level of experience with a variety of Web 2.0 tools. It was further established that despite the high level of familiarity and use of Web 2.0 tools, respondents were not frequent users of their library websites. The study findings have also indicated a low level of access and use of Web 2.0 tools within academic libraries. Mzumbe University (MU) and SUZA Libraries were the main users of Web 2.0 tools; followed by University of Dar-es-Salaam (UDSM) Library. Knowledge Management System (KMS) Success Model was employed to investigate factors that affect the application of Web 2.0 tools to enhance KM practices. The study findings have demonstrated that the KMS Success Model is suitable for guiding the understanding of the contributing factors with respect to library staff‟s intention to reuse Web 2.0 tools. The study findings supported the KMS Success Model well, whereby seven of the twelve hypothesised relationships were found to be significant. The study recommends that academic libraries in Tanzania should promote and integrate KM practices in their daily operations as well as the use of KM enablers such as; reliable budget, Web 2.0 tools, reliable power supply, internet connectivity availability and adequate ICTs infrastructure. / Information Science / D. Litt. et. Phil. (Information Science)

The research study focused on the service delivery challenges regarding water and sanitation in the Gauteng Province. Two metropolitan municipalities including the City of Johannesburg and the City of Tshwane were investigated and used for this research study. The study used a qualitative research design and the methodology includes literature reviews and structured interviews to highlight the challenges from an international, South African, and provincial perspective, particularly in Gauteng. An interview schedule was developed and structured interviews were conducted to collect primary data from the selected participants. Although the literature review conducted indicate that the provision of water and sanitation in the Gauteng Province had improved, significant challenges remain. Areas such as informal settlements are still experiencing shortcomings as compared to the metropolitan areas. Institutional challenges such as a lack of appropriate skills still exist. Other challenges such as poor financial management and non-payment for services by the communities persist. Furthermore, the literature indicates that community protests over basic services occur more in the Gauteng Province than in other provinces. This indicates that the challenges of providing basic services such as water and sanitation are still persistent. To deal with the challenges of providing water and sanitation services, the government and agencies involved in the provision of these services implemented several measures. To alleviate the challenges, not only government help is needed, but also help from other sectors, including non-governmental organisations, agencies, and communities. The findings of this study might assist the municipalities to improve the services through its recommendations. The study is also meant to help public officials and political office bearers to understand the dynamics and challenges they are faced with when carrying out their duties. This study will be used to add to the current literature on the basic service delivery challenges in the Gauteng Province, it will also contribute to academic and government related publications for further references and broadens research on the subject. / Public Administration / M. Admin. (Public Administration)

The purpose of this study was to identify the relevant factors to develop a framework for optimising public participation to improve service delivery in a metropolitan municipality in South Africa. This approach was undertaken with a view to identify the gaps created through the expectations generated among citizens by the national government and the weaknesses in the capacity of the local government to deliver through its supply chain processes, and hence develop strategies to close the existing gaps as much as possible. There were four samples in the study namely: citizens, managers, businesses and ward committee members (WCM). The data that were collected for citizens were conducted at each Customer Care Centres (CCC). For the other three sets of respondents, it was conducted through email. The research approach was quantitative. Factor analysis was applied in this research study in order to identify significant factors that drive public participation in service delivery by local government. Findings of this study showed that there are two major perceptions of the respondents perceived to affect the optimisation of effective service delivery: 1) the facilitating factor and 2) the impeding factor. This was assisted by Structural Equation Modelling (SEM) where a model was designed which resulted in the development of the public participation framework for effective municipal service delivery. These findings will inform the management of local governments to prioritise inclusion of all citizens by optimising their participation for effective service delivery. Areas where participation in local government was lacking were identified and this study presents well-informed strategies for local governments and for their possible implementation. / Business Management / D.B.L.

In 1994, South Africa adopted intergovernmental relations (IGR) to facilitate service delivery. Sections 40-41 of the Constitution of the Republic of South Africa, 1996, link service delivery with normative aspects of IGR, which include cooperation, transparency, accountability, mutual support, and coherence. A coherent implementation of IGR was subsequently emphasised by the Intergovernmental Relations Framework Act 13 of 2005. However, South Africa continues to experience service delivery challenges, especially in marginalised and poor communities in the current and former informal settlements. The selected Diepsloot was established as an informal settlement in 1995 and has been under an in situ upgrade programme. The study’s focus was on the provision of potable water in the City of Johannesburg with specific reference to Diepsloot. A case study approach was used to assess lived experiences among the actors within the intergovernmental context of cooperative government. A qualitative methodology was utilised to source data about intergovernmental interactions among actors from the public institutions by means of semi-structured interviews and documentary analysis. Lastly, a focus group was utilised for members of the ward committees in Diepsloot. The study concluded that IGR system is not used adequately to support Diepsloot to access potable water in accordance with an established standard. In essence, the IGR system lacks an integrated approach to reverse a legacy of informality. To facilitate an IGR improvement, the study’s recommendations were three-fold: (i) provision of integrated support to the City of Johannesburg for Diepsloot despite erroneous assumption that metropolitan municipalities are self-sufficient, (ii) standardisation of potable water provision in Diepsloot by means of integrating IGR institutional responses, and (iii) institutionalisation of IGR engagements with other cities. To this end, the study proposed a model of integrated intergovernmental support to improve potable water provision and, by extension, other related services in Diepsloot. / Public Administration / D.P.L. (Public Administration)