Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: BACKGROUND: A functional gait forms an integral part of life, allowing individuals to function within their environment and participate in activities of daily living. The evaluation of gait forms an essential part of a physical examination and can help screen for physical impairments. To the researchers‟ knowledge no 3D gait analysis studies of this nature have been conducted in South Africa. South African gait analysis laboratory protocols and procedures may differ from laboratories in other countries; therefore a South African data base of normative values is required to make a valid assessment of South African children‟s gait. OBJECTIVE: The aim of this study is to describe kinematics and spatiotemporal parameters of gait of typically developed children between the ages of 6-10 years in the Cape Metropole of the Western Cape, South Africa. METHODOLOGY: A descriptive study was conducted. Twenty-eight typically developed children were conveniently sampled from aftercare facilities and schools were performed in the Cape Metropole in the Western Cape, South Africa. The three-dimensional (3D) lower limb kinematics and spatiotemporal parameters of gait were analyzed. For data capture, the lower limb Plug-in-Gait (PIG) marker placement was used. Participants were asked to walk bare footed at self-selected speed. Due to a small sample size, children were also sub-divided into two groups (Group A: 6-8 years and Group B: 9-10 years) for comparison. Means and standard deviations (SD) were calculated for all outcomes, followed by statistical tests to determine significant differences between the two sub-groups for spatiotemporal parameters and kinematics. RESULTS: There was a significant difference between the sub-groups for all the non-normalized spatiotemporal parameters. A statistical significant difference between the sub-groups for the mean hip rotation minimum values (p=0.036) was found. There was no significant difference between the sub-groups for any other kinematic parameter or when comparing the normalized spatiotemporal parameters. CONCLUSION: This study provides descriptive gait parameters that can be used for comparison or gait analysis purposes. Our results suggest that normalized spatiotemporal parameters showed no significant difference between the age groups and are consistent with international children‟s spatiotemporal parameters. Kinematic values showed significant changes with hip rotation. Older children had more external rotation at their hips. KEYWORDS: 3D gait analysis, walking, children, spatiotemporal parameters, kinematics. / AFRIKAANSE OPSOMMING: INLEIDING: „n Funksionele stap is „n essensiële deel van die lewe wat mens toelaat om in jou omgewing te funksioneer en om deel te neem aan daaglikse aktiwiteite. Evaluasie van stap is „n belangrike deel van die fisiese evaluasie en kan help om te sif vir fisiese verswakking of abnormaliteite. So ver hierdie navorsers weet, is hierdie die eerste loop analise studie van sy soort wat in Suid-Afrika onderneem is. Suid-Afrikaanse stap-evaluasie-labrotorium protokols en prosedures mag ook dalk verskil van die in ander lande. Dus is „n Suid-Afrikaanse databasis vir normale waardes van loop nodig om „n gegronde evaluasie van Suid-Afrikaanse kinders se loopgang te kan maak. DOELWIT: Die doel van hierdie studie is om die kinematika en spatiotemporale parameters van loop te omskryf in tipies ontwikkelde kinders tussen die ouderdom van 6-10 jaar in die Kaapse Metropool en om die bevindinge tussen die twee ouderdomsgroepe te vergelyk. METODE: „n Beskrywende studie is uitgevoer. Ag-en-twintig tipies ontwikkelde kinders is van skole en nasorgfasiliteite in die Kaapse Metropool in die Wes-Kaap, Suid-Afrika gewerf. Die drie-dimensionele (3D) onderste ledemaat se kinematika en spatiotemporale parameters van loop is geanaliseer. Vir data insameling is die onderste ledemaat Plug-in-Gait (PIG) merker-plasing gebruik. Deelnemers is gevra om kaalvoet teen hulle eie spoed te stap. Die kinders is in die verskeie ouderdomsgroepe verdeel, maar as gevolg van klein toetsgroepgetalle, is hulle sub-verdeel in twee groepe (Groep A: 6-8 jaar en Groep B: 9-10 jaar). Beskrywende statistiese tegnieke is gebruik vir alle uitkoms maatreëls. Gemiddeldes en standaardafwykings (SA) was bereken, om beduidende verskille tussen die ouderdomsgroepe en sub-groepe te bepaal. RESULTATE: Daar is „n beduidende verskil tussen die jonger en ouer kinders vir nie-genormaliseerde spatiotemporale parameters, asook „n beduidende verskil tussen die sub-groepe vir die gemiddelde heuprotasie minimum waardes (p=0.036). Daar was geen beduidende verskil tussen die twee groepe met die ander kinematiese parameters of met genormaliseerde spatiotemporale parameters van die sub-groepe nie. GEVOLGTREKKING: Hierdie studie verskaf beskrywende statistiese data van stap-parameters wat gebruik kan word vir vergelyking met ander kinders van dieselfde ouderdomme of loop-analise doeleindes. Ons bevindinge stel voor dat genormaliseerde spatiotemporale parameters geen beduidende bevindings aandui tussen die verskeie ouderdomsgroepe nie. Dit is ook konsekwent met internasionale kinders se spatiotemporale parameterwaardes. Kinematisie waardes het beduidende verskille in heuprotatsie getoon. Ouer kinders het meer eksterne rotasie in hulle heupe in vergelyking met jonger kinders. Soos die kinders ontwikkel, verminder die heup-anteversie en die heup beweeg vanaf interne rotasie na „n relatiewe eksterne rotasie.

Thesis (DPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The anthropological investigation of masculinities remains an understudied dimension of transnational migration and xenophobia studies in post-apartheid South Africa. This thesis sets out to examine the interface between xenophobia, migrant experiences and masculinities among Zimbabwean male migrants in Cape Town and Stellenbosch. Drawing from the conceptual ideas of Critical Studies of Men (CSM) and on the basis of conversations with Zimbabwean male migrants in Cape Town and Stellenbosch, the thesis explores the relationship between the perceived threat of xenophobia and the production of enclaved, subaltern, troubled and aspirational masculinities. The thesis assesses how “xenophobia talk” among the Zimbabwean male migrants appears to produce socio-spatial separations with South African nationals. We see in the football-playing migrants in Stellenbosch an attempt to circumvent perceived exclusion by establishing enclaved male domains that assert their ‘authority’ as Zimbabwean men. The thesis therefore demonstrates the productivity of talk in the construction of xenophobia, male identities and identifications. There is literature suggesting that sections of South African nationals refer to African migrants derogatively as amakwerekwere. Conversely, evidence from Cape Town and Stellenbosch show how Zimbabwean male migrants openly talk about South Africans in equally adverse terms. This raises questions about the role migrants play in the production of reverse xenophobia and their contribution towards the perpetuation of processes of othering that transnational migration often engenders. The thesis draws the conclusion that the threat of xenophobia does not deter Zimbabwean male subjects from migrating to South Africa. However, it compels them to map South African urban spaces in very specific ways. / AFRIKAANSE OPSOMMING: Die antropologiese ondersoek na vorms van manlikheid is ʼn dimensie van studies oor transnasionale migrasie en xenofobie in postapartheid Suid-Afrika waaroor daar steeds min navorsing gedoen word. Hierdie tesis ondersoek die skeidingsvlak tussen xenofobie, migrante se ervarings en vorms van manlikheid onder manlike Zimbabwiese migrante in Kaapstad en Stellenbosch. Gebaseer op die konsepsuele idees van Critical Studies of Men (CSM) en gesprekke met manlike Zimbabwiese migrante in Kaapstad en Stellenbosch, ondersoek die tesis die verhouding tussen die waargeneemde bedreiging van xenofobie en die totstandkoming van ingeslote, ondergeskikte, ongeruste en ambisieuse manlikhede. Die tesis evalueer hoe “xenofobie-taal” onder manlike Zimbabwiese migrante sosio-ruimtelike afstande tussen hulle en Suid-Afrikaanse burgers skep. Ons sien onder die sokkerspelende migrante in Stellenbosch dat daar ʼn poging is om waargeneemde uitsluiting te omseil deur die daarstelling van ingeslote manlike domeine wat hulle ‘outoriteit’ as Zimbabwiese mans handhaaf. Die tesis demonstreer dus die manier waarop taal bydra tot die konstruksie van xenofobie, manlike identiteite en identifikasies. Daar bestaan literatuur wat suggereer dat sekere segmente van Suid-Afrikaanse burgers op ʼn neerhalende wyse na migrante uit Afrika verwys as amakwerekwere. Daarteenoor is daar bewyse uit Kaapstad en Stellenbosch wat toon dat manlike Zimbabwiese migrante openlik na Suid-Afrikaners in ooreenstemmende verkleinerende terme verwys. Dit laat vrae ontstaan oor die rol wat migrante speel in die daarstelling van omgekeerde xenofobie en hulle bydrae tot die voortbestaan van prosesse van vervreemding wat dikwels spruit uit transnasionale migrasie. Hierdie tesis kom tot die slotsom dat manlike Zimbabwiese persone nie deur die bedreiging van xenofobie afgeskrik word om na Suid-Afrika te migreer nie. Dit dwing hulle egter om Suid-Afrikaanse stedelike gebiede op baie spesifieke maniere te karteer sodat hulle in hierdie gebiede kan bly sonder om daardeur gebind te word.

Thesis (MPhil (Public Management and Planning))--University of Stellenbosch, 1998. / ENGLISH ABSTRACT: In the past the policy for the provision of low-cost housing was not very effective because the context of development planning was characterised by fragmentation, segregation and isolation from the targeted communities. The reasons for this are that these development programmes were not participatory and that they contributed to dependency rather than empowerment of communities. Selected case studies have shown that without the involvement of the community in planning and decision-making low-income housing projects cannot meet the needs and demands of the community for improvement in an effective and efficient way. One of the basic principles of The Reconstruction and Development Programme is that development projects should be people-driven. The policy framework clearly states that delivery systems in housing will depend upon community participation. This current study sought to determine whether delivery systems in low-income housing projects have made this paradigm shift - that they are participatory and need-driven. The study is descriptive and issue-oriented limiting itself to understanding the process of low-income housing provision to newly-urbanised Africans in Mfuleni, a peri-urban settlement in the Cape-Metropole. Interviews were conducted with 100 respondents male or female heads of households, using a semi-structured questionaire. The study gave respondents an opportunity to share their experiences regarding the process of community participation in housing provision.

Thesis (MPhil)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Integrating the poor into the fibre of the city is an important theme in housing and urban policies in post-apartheid South Africa. In other words, the need for making place for the ‘black’ majority in urban spaces previously reserved for ‘whites’ is premised on notions of equity and social change in a democratic political dispensation. However, these potentially transformative thrusts have been eclipsed by more conservative, neoliberal developmental trajectories. Failure to transform apartheid spatialities has worsened income distribution, intensified suburban sprawl, and increased the daily livelihood costs of the poor. After a decade of unintended consequences, new policy directives on informal settlements were initiated through Breaking New Ground (DoH 2004b). Local governments have nevertheless been slow to implement this new instrument despite more participatory, flexible, integrated and situational responsive policies contained therein. The City of Cape Town was one of the first applicants for Upgrading of Informal Settlements Programme (DoH 2004a, DHS 2009) funding in upgrading Hangberg’s informal settlement after effective lobbying by local civic Hout Bay Civic Association (HBCA) assisted by the Cape Town-based NGO, Development Action Group (DAG). However, in September 2010 the upgrading project came to a standstill when Metropolitan Police clashed violently with community members who allegedly broke a key agreement when building informal structures on the Sentinel Mountain firebreak. Using the case study research methodology, the study seeks to unravel the governance complexities elicited by this potentially progressive planning intervention. Four theoretical prisms are used to probe and investigate the primary case study (Hangberg) due to the different ways of ‘seeing and grappling’ and ‘narrating’ a complex tale. This is characterised by the dialectics of power and powerlessness; regime stabilisation and destabilisation; formalisation and informalisation; continuity and discontinuity. These prisms are: urban informality, urban governance, deepening democracy, and socio-spatial justice. By utilising these four theoretical prisms, the study found the Hangberg case to be atypical of development trajectories, on the one hand, and conforming to the enduring neoliberal governance logics, on the other. In the concluding chapter, the study critically engages prospects of realising post-apartheid spatialities by considering recent policy shifts and programmes with the potential of realising the poor’s ‘right to the city’. / AFRIKAANSE OPSOMMING: ‘n Belangrike tema in post-apartheid behuising- en stedelike beleide is die integrasie van arm mense in die weefsel van die stad. Anders gestel, die nodigheid om plek te maak vir die ‘swart’ meerderheid in stedelike spasies wat voorheen vir ‘wittes’ uitgesonder is, is gebaseer op die uitgangspunt van regverdigheid en sosiale verandering in ‘n demokratiese bedeling. Hierdie potensiële hervormings-nosies is egter verduister deur meer konserwatiewe, neo-liberale ontwikkelings-trajekte. Die mislukte pogings om apartheids-ruimtes te omvorm, beteken dat inkomsteverdeling vererger is, wydstrekkende verstedeliking in meer intensiewe vorms voorkom, en die daaglikse lewenskoste van die armes verhoog het. Na ‘n dekade van onopsetlike gevolge is nuwe beleids-riglyne vir informele nedersettings voorgestel deur Breaking New Ground (DoH 2004a). Plaaslike owerhede was egter tot dusver traag om hierdie nuwe instrument te implementeer, ten spyte daarvan dat meer deelnemende, buigsame, geïntegreerde en situasioneel-aanpasbare beleide daarin vervat is. Die Stad Kaapstad was een van die eerste applikante vir Upgrading of Informal Settlements Programme (DoH 2004b, DHS 2009) befondsing om Hangberg se informele nedersetting te opgradeer, nadat effektiewe druk uitgeoefen is deur die Hout Bay Civic Association (HBCA), met ondersteuning van die NRO, Development Action Group (DAG), wat in Kaapstad gebaseer is. Maar in September 2010 het die opgradering-projek tot stilstand gekom nadat die Metropolitaanse Polisie gewelddadig met gemeenskapslede gebots het, omdat die gemeenskap na bewering ‘n belangrike ooreenkoms gebreek het deur informele strukture op die brandstrook te bou. Deur van die gevalstudie navorsing-metodologie gebruik te maak, beoog hierdie studie om die bestuurskompleksiteite te ontrafel wat deur hierdie potensiële omvormde beplannings-intervensie uitgelok is. Vier teoretiese prismas word gebruik om die primêre geval (Hangberg) te ondersoek in die lig van die verskillende maniere waarop hierdie komplekse narratief gesien kan word. Dit word gekenmerk deur die dialekte van mag en magteloosheid; stabilisasie en destabilisasie van die staatsbestel; formalisering en deformalisering; samehangendheid en onsamehangendheid. Die prismas is: stedelike informaliteit, stedelike bestuur, verdieping van demokrasie en sosio-ruimtelike regverdigheid. Deur van hierdie vier prismas gebruik te maak, wys die studie tot watter mate die Hangberg geval aan die een kant atipies tot ontwikkelings-trajekte is, en aan die ander kant konformeer tot die voortdurende neo-liberale bestuurslogika. In die slothoofstuk, is die studie krities bemoei met die vooruitsig om die post-apartheid-stad te realiseer deur huidige beleidsveranderinge en programme te ondersoek met die vergrootglas op hul potensiaal vir transformasie en om die armes se ‘reg tot die stad’ te bevorder.

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.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Mounting pressure on waste management has forced the City of Cape Town (CCT) to progressively move towards achieving an integrated waste management system (IWMS). This system presents a holistic approach of dealing with waste issues. The waste management hierarchy indicates that the ‘cradle-to-cradle’ approach of waste management is more ideal as compared to the traditional ‘cradle-to-grave’ approaches of waste management, example landfilling. However the challenges that have transpired in the rollout of waste minimisation initiatives highlight the need to continuously improve the system. This thesis investigates the municipal solid waste (MSW) minimisation programmes initiated by the CCT Solid Waste Management Department. A systems approach that combined both quantitative and qualitative methodologies was employed in the analysis. A material flow analysis (MFA) model was used to trace the flow of waste through the waste management system. The benefit of applying the MFA approach for waste management problems has been highlighted in literature in terms of identifying potential recycling, and other, waste-treatment technologies, and predicting the outcomes of waste treatment and disposal initiatives. The main objective of this study was to apply an adapted MFA method in order to determine the progress of the existing waste minimisation programmes and to also determine the opportunities to utilise biodegradable and other recyclable components of the waste streams; thereby improving the IWMS of the CCT. The MFA provided a conceptual understanding of the flow of waste materials in the CCT. The mass assessment of waste minimisation facilities, such as the Bellville compost plant and Athlone material recovery facility and refuse transfer station, unveiled that there is still a large amount of biodegradable and recyclable municipal solid waste that ends up in landfills regardless of the waste minimisation facilities available. However, it is still immature at this stage to conclude the success of the Think Twice campaign, since this is a fairly new initiative that relies on the response rate of the public. There are challenges associated with the recyclable waste recovery rates such as public awareness, proper advertising, operational problems that still need to be addressed. The MFA results also showed the final sinks of the different waste types that are sent through the different waste minimisation facilities run by the CCT. The current institutional arrangements and legislative environment have been greatly improved but there are still a number of challenges that need to be addressed. The largest, overall challenge is devising a practical plan of ‘closing the loop’ in order to develop a circular economy. The concept of ‘cradle-to-cradle’ seems to be premised on extended producer responsibility and other stringent control mechanisms, which are currently believed, will yield negative consequences in the South African context. A lot more work needs to be done to achieve a genuinely integrated and sustainable solid waste management system. / AFRIKAANSE OPSOMMING: Die Stad Kaapstad streef na ‘n geïntegreerde afval beheer sisteem (GABS) as gevolg van toenemende druk op die bestuur van afval. Hierdie stelsel bied 'n holistiese benadering tot die hantering van afval-probleme. Die afvalbestuur-klassifikasie wys dat die “wieg-tot-wieg” benadering meer ideaal is as die tradisionele “wieg-tot-graf” benaderings van afvalbestuur, byvoorbeeld die bestaande sorteringsterreine. Die uitdagings wat voor-gekom het in die bekendstelling van afvalbeperkingsinisiatiewe het getoon dat daar ‘n voortdurende behoefte is om die stelsel te verbeter. Hierdie tesis ondersoek die munisipale vaste-afvalbeperkingsprogamme wat deur die Stad Kaapstad se Departement Vaste-Afvalbestuur geïnisieer is. Beide kwantitatiewe en kwalitatiewe metodes is gebruik om die analises uit te voer. ‘n Materiaal vloei-analise model (MVM) is gebruik om die vloei van afval deur die afvalbestuur-sisteem te volg. Die voordeel van die toepassing van die MVM-model word uitgelig in die literatuur in terme van identifisering van potensiële herwinning en ander afvalbehandelings-metodes en die voorspelling van die uitkomste van afval-behandeling en wegdoen-inisiatiewe. Die hoofdoel van die studie was om ‘n aangepaste MVM-metode toe te pas om die vordering van die bestaande afvalbeperkings programme vas te stel asook om die gebruik van bioafbreekbare en ander herwinbare komponente van die afvalstrome beter te kan benut en daardeur ‘n verbetering van die GABS van die Stad Kaapstad teweeg te bring. Die MVM het goeie insig gebied in die vloei van afvalmateriaal in die Stad Kaapstad. Die massa-waardebepaling van afvalverminderings-fasiliteite, soos die Belville kompos-aanleg en die Athlone materiaalherwinningsfasiliteit asook die afval-oordragstasie, het onthul dat daar nog groot hoeveelhede biodegradeerbare munisipale vaste-afval in die stortingsterreine beland ten spyte van die afvalbeperkings-fasiliteite wat beskikbaar is. Dit is egter nog te vroeg om ‘n gevolgtrekking oor die sukses van die “Think Twice” veldtog te maak aangesien dit 'n redelike nuwe inisiatief is wat op die terugvoer van die publiek staatmaak. Daar is uitdagings wat verband hou met die herwinbare afvalhersteltempo’s soos byvoorbeeld: openbare bewustheid, goeie advertering asook operasionele probleme wat nog aangespreek moet word. Die MVM resultate het ook ‘n daling in die verskillende afval-tipes wat deur die verskillende afvalbeperkingsfasiliteite van die Stad Kaapstad gestuur word, getoon. Die huidige institusionele reëlings en wetgewende omgewing het baie verbeter, maar daar is nog 'n aantal skuiwergate wat aangespreek moet word. Die grootste algehele uitdaging tans is die ontwerp van ‘n praktiese plan om die skuiwergate te oorkom en om ‘n kringloop in die ekonomie te ontwikkel. Die "wieg-totwieg" benadering berus op uitgebreide produsente verantwoordelikheid en ander streng beheermaatreëls wat waarskynlik negatiewe gevolge in die Suid-Afrikaanse konteks gaan oplewer. Daar is egter nog baie werk wat gedoen moet word om ‘n geïntegreerde en volhoubare stelsel vir die bestuur van vaste-afval daar te stel.

Thesis (MPhil)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The migratory flow of Africans to South Africa form the north of Africa was restrained until the early 1990's. Before this period the political ideology of apartheid discriminated against African immigrants, while favouring the migration of people of European descent. Although numerous studies have drawn attention to the implications of the influx of African immigrants to South Africa and their socio-economic adaptation, not much research has been done on reasons for international migration as provided by the migrant. The demographic and economic implications of African migration not only dominate most of the work in this field, but it even seems to be the only concern of researchers investigating international immigration of Africans. The study focuses on factors underlying the decision of African immigrants to migrate to South Africa and who choose Cape Town as their place of destination. Data from in-depth interviews are analysed to determine the motivations for migration to Cape Town. Attention is being paid to the circumstances in the migrants' home countries that motivated their decision to emigrate, the role of social networks in providing information regarding the choice of destination and migration routes, the obstacles they encountered, their adaptation in Cape Town and their perceptions of Cape Town as a place of permanent residence. From the literature review on reasons for migration, is emerges that there are two dominant theoretical approaches (i.e. macro and micro theories) for explaining why international migration begins. The macro theories focus on migration stream, identifying the conditions under which large-scale movements take place and describing the demographic, economic and social characteristics of the migrants in aggregate terms. Micro theories focus on the socio-psychological factors that differentiate migrants from non-migrants, together with theories of motivation, decision-making, satisfaction and identification. Although each theory ultimately seeks to explain the same phenomenon, they employ different concepts, assumptions and frames of reference. The various explanations offered are not necessarily contradictory in nature but are, in fact, a reflection of how social realities could be studied and understood from various angles. This study employs an eclectic approach by using insights from both macro and micro levels of analysis. The study also considers the appropriateness of a qualitative research design in researching specific aspects of migration and employs a qualitative case study method. This method allows for a deeper reflection on the part of the individual on factors responsible for their decision to move. Semi-structured in-depth interviews have been conducted with four African immigrants in the central business district of Cape Town. The study found that in certain instances the immigrants migrate for different reasons, but under similar circumstances. It emerged from the case material that the same issues sometimes hold different significance for each migrant. One aspect shared by all four immigrants, is that it seems that circumstances in their countries of origin forced them to move and that they did have much of a choice - their lives were threatened. Their relatively high level of training and access to funding most probably assisted them in their move. Those people in not such a favourable position are left behind. The study also found that exchange and free flow of information and social networks directs destination of movement, rather than determine whether migration takes place. However, the information immigrants receive is not always correct and tends not to focus on the negative aspects of immigration. Once in Cape Town the immigrants felt isolated, experienced prejudice, and suffered hostility and discrimination at the hands of South Africans. It appears that many South Africans do not distinguish between asylum seekers, refugees and economic migrants. The common denominator of their "foreignness" appears to be all that is necessary for many to harbour negative attitudes. Xenophobia not only manifests itself in negative attitudes, but also increasingly in victimisation against the immigrants. Because of these factors and the problems they experience in finding jobs where they can apply their skills, the immigrants indicated that they do not intend staying permanently in South Africa. / AFRIKAANSE OPSOMMING: Die migrasie van inwoners van die noorde van Afrika na Suid-Afrika was tot die vroeë 1990s relatief beperk. Voor hierdie tydperk het die politieke ideologie van apartheid gediskrimineer teen inwoners van die res van Afrika, terwyl die migrasie van Europeërs aangemoedig is. Alhoewel verskeie studies die aandag gevestig het op die sosio-ekonomiese aanpassing en die implikasies van die invloei van immigrante uit Afrika na Suid- Afrika, bestaan daar weinige navorsing oor die redes vir internasionale migrasie soos verskaf deur die migrant self. Die demografiese en ekonomiese implikasies van immigrasie domineer nie slegs die meeste van die werk in hierdie verband nie, maar blyk ook die enigste besorgdheid te wees van navorsers wat die internasionale migrasie van Afrikane bestudeer. Die studie fokus op onderliggende faktore wat immigrante uit Afrika motiveer om na Suid-Afika te immigreer en Kaapstad as bestemming kies. Data van indiepte onderhoude word ontleed ten einde die motiverings vir migrasie na Kaapstad vas te stel. Aandag word gegee aan die omstandighede in die migrante se lande van oorsprong, die rol van sosiale netwerke in die verskaffing van inligting oor die keuse van 'n bestemming en migrasieroetes, die struikelblokke langs die pad, hulle aanpassing in Kaapstad en hulle persepsies oor Kaapstad as 'n permanente bestemming. Dit blyk uit die literatuuroorsig oor redes vir migrasie dat daar twee dominante teoretiese benaderings (makro en mikro benaderings) vir die verduideliking van internasionale migrasie bestaan. Die makro benaderings fokus op migrasiestroom en identifiseer die omstandighede waaronder grootskaaaise bewegings plaasvind en beskryf ook die demografiese, ekonomiese en sosiale eienskappe van die migrante in groepsverband. Daar teenoor fokus mikro teorieë op die sosiaal-sielkundige faktore wat migrante van nie-migrante onderskei, tesame met teorieë oor motivering, besluitneming, bevrediging en identifikasie. Alhoewel elke teorie uiteindelik dieselfde verskynsel verduidelik, word verskillende konsepte, aannames en verwysingsraamwerke toegepas. Hierdie studie gebruik 'n eklektiese benadering waarin insigte uit beide mikro- en makrovlak ontledings gebruik word. Die studie oorweeg ook die geskiktheid van 'n kwalitaitiewe navorsingsontwerp vir die bestudering van spesifieke aspekte van migrasie en maak gebruik van 'n kwalitatiewe gevallestudie metode. Die metode fasiliteer 'n dieper refleksie van individue betreffende die faktore wat bygedra het tot hulle besluit om te migreer. Semi-gestruktureerde indiepte onderhoude is met vier immigrante gevoer. Daar is vasgestel dat immigrante oor verskillende redes migreer, maar onder dieselfde omstandighede. Uit die materiaal van die gevallestudies blyk dit dat dieselfde kwessies partykeer uiteenlopende betekenis vir elke migrant het. Een aspek wat deur al vier immigrante gedeel word, is die feit dat omstandighede in hulle lande van herkoms hulle forseer het om te migreer - hulle lewens is bedreig. Hulle . relatiewe hoë opleidingspeil en toegang tot fondse het hulle heel waarskynlik daartoe in staat gestelom te trek. Diegene in 'n minderbevoorregte posise het agtergebly. Die studie bevind ook dat die uitruil en vrye vloei van inligting en sosiale netwerke eerder die plek van bestemming bepaal as om die besluit om te migreer beïnvloed. Dit blyk egter dat die inligting wat immigrante ontvang soms verkeerd is en nie op die negatiewe aspekte van migrasie fokus nie. Wanneer die immigrante eers in Kaapstad is, voel hulle geïsoleerd, ervaar hulle vooroordeel, vyandigheid en diskriminasie van Suid-Afrikaners. Dit wilook voorkom asof baie Suid-Afrikaners nie 'n onderskeid tref tussen asielsoekers, vlugtelinge en ekonomiese migrante nie. Net die feit dat hulle vanaf 'n ander Afrika land afkomstig is, maak baie mense negatief teenoor hulle. Xenofobie manifesteer egter nie slegs in negatiewe ingesteldhede nie, maar daar is ook toenemende viktimisasie. Weens hierdie faktore en die probleme wat hulle ondervind om werksgeleenthede te vind waarin hulle hul vaardighede kan toepas, dra daartoe by dat immigrante Suid-Afrika nie as 'n permanente tuiste beskou nie.

Thesis (MBA)--University of Stellenbosch, 2010. / According to the 6th State of Logistics Survey for South Africa (2009: 5), logistics costs for 2008 reached R339 billion, equivalent to 14.7% of GDP. Transport represents 50.4% of these logistics costs compared to a world average of 39%. This major gap between South Africa and the world average shows that there are inefficiencies in this domain that need improvement. This report focuses on the issues faced by the port of Cape Town, the benefits that could be generated by the implementation of an inland port in the Cape Town area and the key success factors for this implementation. The Centre for Supply Chain Management of the University of Stellenbosch created a forecast model for South Africa and expects a demand of over 2.4 million Twenty-foot Equivalent units (TEUs) in 2039 for the port of Cape Town with a current throughput of 740,000. In 2012, this capacity will reach 1.4 million TEUs thanks to an on-going project that includes the widening of berth, investment in equipment, training of operators and a better utilization of the available storage space. The port therefore has to find a solution to increase a throughput on the long term. Along with capacity, the port is facing other issues such as low productivity, poor infrastructure and congestion in the port area that causes increased delivery time and trucking costs. The inland port has to bring solutions to these issues. Capacity must be addressed with a large piece of land that can accommodate growing volumes and also large investment in equipment and training to increase the productivity and therefore the throughput of the supply chain. In order to decrease congestion in the port area, the inland port has to be located out of the city in an area that can sustain growing traffic. Belcon is a Transnet Freight Rail facility located in Bellville that can offer sufficient storage capacity in a low traffic area. Investments must be made in order to increase its throughput but it has the potential to absorb a large part of the flows going through the port of Cape Town and a management with the will to develop the inland port concept. At the same time, this inland port is an opportunity to develop intermodal transport for a more sustainable transport system in South Africa. Belcon being a TFR terminal, it is the best location to implement this inland port and offer a competitive intermodal solution for the stakeholders of the South African transport industry.

Thesis (MBA)--Stellenbosch University, 2008. / ENGLISH ABSTRACT: This is a report on the implementation of the Balanced Scorecard (BSC) in the City of Cape Town. Based on the experiences and perceptions of a sample of middle managers. the report highlights the various issues which impact on the BSC at local government level. The report focuses on the implementation of the BSC in one Directorate. namely the Community Services Directorate. Appropriate reccmmendations are made based on the findings of the research. The literature review places the BSC in the ccntext of the infonmation age. where companies were seeking a more holistic tool to plan, monitor and measure how strategy is implemented. The theoretical basis of the BSC is outlined. This contains a brief overview of how the public sector internationally adopted the BSC. The report proceeds by addressing the legislative framework within which municipalities operate in South Africa with regard to Performance Management. It is within this context that the City Of Cape Town adopted the BSC. The implementation of the BSC for the City of Cape Town is placed within the context of its Organisational Performance Management System. This literature review concludes by highlighting the challenges and critical success factors with the implementation of the BSC. The methodology used in the research was content analysis. The experience and perception of the research population. in relation to the implementation of the BSC in the City of Cape Town. was analysed. Data was collected through open ended, semi-structured interviews. The issues highlighted in the literature review were used as the basis for the interviews. Inferences were drawn from responses solicited in the interviews. The report found that there is a correlation between the issues highlighted in the literature and what emerged in the course of the research. The issues that impact on the implementation of the BSC revolve around process. structure and people. Accordingly the researcher makes appropriate recommendations to address these issues in the City of Cape Town. Finally, areas for future research are identified. / AFRIKAANSE OPSOMMING: Hierdie verslag handel oor die implementering van die Gebalanseerde Prestasie Skedule (GPS) vir die Stad Kaapstad. Die verslag beklemtoon verskeie aspekte wat 'n impak het op die GPS by plaaslike owerhede en is baseer op 'n steekproef oor die ondervindinge en persepsies van 'n bepaalde middelvlakbestuursgroep. Hierdie verslag fokus op die implementering van die GPS in een van die Direktorate, naamlik die Direktoraat: Gemeenskapsdienste. Toepaslike aanbevelings word gemaak opgrond van die navorsingsbevindinge. Die literatuur oorsig plaas die GPS in die konteks van die inligtingsera, waar maatskappye opsoek is na 'n holistiese benadering vir beplanning, monitering en om implementeringstrategiee te meet. Die teoretiese basis van die GPS word ook uiteengesit. Dit bevat 'n kort oorsig oor hoe die openbare sektor die GPS internationaal aanvaar het. Voorts handel die verslag oor die wetgewende raamwerk waarbinne munisipaliteite in Suid-Afrika moet beweeg rakende Prestasiebestuur. Dit is binne hierdie konteks wat die Stad Kaapstad die GPS aanvaar het. Die implementering van die GPS vir die Stad Kaapstad vind plaas binne die konteks van sy Organisatoriese Prestasiebestuurstelsel. Die literatuur oorsig eindig deur die uitdagings en kritiese sukses faktore met die implementering van die GPS te beklemtoon. Die metodologie wat tydens die navorsing gebruik was, is die inhoud-ontleding. Die ondervindinge en persepsies van die navorsings steekproefgroep, in venhouding tot die implementering van die GPS by die Stad Kaapstad, was ontleed. Inligting is bekom deur middel van oop vrae tydens semigestruktureerde onderhoude. Aspekte wat tydens die literatuur oorsig beklemtoon was, is gebruik as basis vir onderhoudvoering. Gevolgtrekkings is gemaak van respondente se kommentaar en antwoorde tydens onderhoudvoering. Die verslag dui aan dat daar 'n korrelasie bestaan tussen die aspekte wat beklemtoon word in die literatuur en wat tydens die navorsing aan die lig gebring is. Aspekte wat 'n impak het op die implementering van die GPS is prosesse, strukture en mense. Gevolglik maak die navorser toepaslike aanbevelings om hierdie aspekte binne die Stad Kaapstad aan te spreek. Laastens word sekere areas geidentifiseer vir toekomstige navorsing.

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background A need for primary care practitioners to utilise clinical research evidence in practice has been identified and is well described. However a chasm between evidence and practice still exists in primary health care (PHC). Although clinical practice guidelines have been shown to improve the quality of clinical practice and attempt to bridge the gap between evidence and practice, practitioners are often not aware of practice guidelines and fail to access, adopt or adhere to evidence-based recommendations contained in them. Central question How can the implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole? Aim This research aimed to improve the implementation of clinical research evidence in PHC, by learning from the specific example of the national evidence-based asthma guideline in PHC practice in the Metro District Health System (MDHS) of the Cape Town metropole, and to make recommendations to key stakeholders regarding the future implementation of evidence-based guidelines. Objectives  To gain insight into the current quality of asthma care in PHC in the MDHS of the Cape Town metropole.  To determine whether the process of implementation of the new asthma guideline contributed to an improvement in the quality of care in the MDHS.  To explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS.  To gain insight into the perceptions, attitudes and knowledge of asthmatic patients regarding their asthma management.  To explore how EBP is understood and perceived by doctors in PHC. Stellenbosch University https://scholar.sun.ac.za  To understand how PHC doctors in the public and private health sectors gain access to and use guidelines.  To explore the experiences, perspectives and understanding of family physicians (FPs) (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice.  To gain insight into the understanding of FPs regarding the perceived problems and main barriers to EBP and their views of the process of guideline implementation in PHC.  To gain insight into the knowledge, perceptions and attitudes of clinical nurse practitioners in the public sector with regard to EBP and the process of guideline implementation. Methodology This study was conducted in the PHC setting of the Cape Town metropole. This research was conducted in three phases and used cross-sectional surveys, quality improvement (QI) cycles, qualitative research methods, such as interviews with FPs, and participatory action research (PAR). Phase 1 involved a cross-sectional survey, which looked at the knowledge, awareness and perspectives of doctors, regarding evidence-based practice (EBP) and guideline implementation using the national evidence-based asthma guideline published in 2007. It also involved QI cycles conducted over a period of five years to assess the baseline quality of asthma care in the PHC sector and to evaluate improvement in asthma care as a result of the QI cycles and associated educational workshops. Phase 2 involved interviews conducted with FPs in academia as well as in the private and public health care sectors who were responsible for clinical governance in PHC in the Cape Town metropole. During this phase of the research the experiences, perspectives and understanding of FPs (academic, private and public sector) with regard to EBP and the implementation of guidelines in PHC practice were explored. Phase 3 involved PAR with primary care practitioners at community health centres (CHCs) using a co-operative inquiry group (CIG) to improve asthma guideline implementation in PHC. The CIG investigated how to improve the implementation of the asthma guideline in their respective CHCs and completed four cycles of planning-action-observation-reflection. The four cycles focused on implementation of an asthma self-management plan (ASMP), exploring the capability of clinical nurse practitioners to implement the guidelines, exploring the views of patients on their asthma care and implementing better patient education. A final consensus of the CIG’s learning was then constructed. Results With regard to quality improvement of asthma care in PHC: The first objective of the study was largely addressed through the baseline audits conducted in 2007 and 2008. This showed that the baseline quality of asthma care, with specific reference to the assessment of the patient’s level of control, measuring the patient’s peak expiratory flow rate (PEFR), assessing the patient’s inhaler/ spacer technique, recording the smoking status, the adequate prescription of controller and reliever metered dose inhalers (MDI) refills during visits and particularly the issuing of an ASMP during visits, was poor. The second objective was addressed through the annual audits conducted in 2007, 2008, 2010 and 2011 during the period of implementation. This showed that although clear cause and effect reasoning cannot be inferred, overall statistically and clinically significant improvements in the quality of care occurred in conjunction with the process of asthma guideline implementation. Despite the improvement in structural and process criteria there was no corresponding improvement in the outcome criteria and in fact the utilisation of facilities for emergency visits significantly increased, while the hospitalisation of patients remained constant. The third objective was to explore ways of improving the process of implementation of the national asthma guideline in PHC in the MDHS. This was largely addressed through the action-research process at selected CHCs. This showed that implementation could be improved by ongoing educational support and formal interactive training workshops with the staff members who were directly involved with patients. The development and use of educational aids and ASMPs based on the guideline recommendations were useful and encouraged patient participation in decision making regarding their care. The fourth objective, specific to asthma care, addressed by means of a survey and showed that even though the majority of asthma patients participated in decisions regarding their asthma and felt satisfied with the quality of care they received, the prevalence of smoking among asthma patients was high and opportunities for smoking cessation counselling were missed. Even though documentation of peak flow recordings and patients’ knowledge of the difference between the reliever and controller MDIs were good, patients’ perceptions with regard to education on the inhaler technique, the assessment of the level of control, the issue of written information regarding asthma and the use of ASMPs remained poor and could be improved. With regard to EBP and asthma guideline implementation in PHC: The fifth objective of the study was addressed by means of a survey which showed that the doctors in PHC used evidence in clinical decision making and agreed on the usefulness and importance of EBP in improving the quality of patient care in South Africa. There was a difference in the engagement with activities related to EBP between the public and private sector PHC doctors and there is a need for formal training in the skills and processes of EBP. The sixth objective was addressed by means of a survey which showed that a good proportion of both public and private sector doctors in the Cape Town metropole were well aware of the asthma guideline, had used the guideline and had adopted, acted on and adhered to specific guideline recommendations. There was a high level of general awareness of the asthma guideline and recommendations were being adopted in practice, although the lack of formal disease registers, monitoring and evaluation of asthma care and the utilisation of an ASMP could be improved on. The seventh objective was addressed by qualitative research which showed how the views and perspectives of FPs regarding EBP and the process of guideline implementation contributed to the development of a conceptual framework for the process of guideline implementation. The eighth objective was addressed by qualitative research, which identified barriers present in each step of the implementation process. Time constraints, practitioner workload, lack of financial resources, lack of ownership, the lack of timeous organisational support and practitioner resistance to change were important barriers to guideline implementation in an already overburdened PHC setting. A conceptual model was developed which showed that the process of guideline implementation should be tailored to the barriers identified. The ninth objective was addressed by means of a survey which showed that the concept of EBP was fairly new to CNPs in PHC and identified a need to learn more about it. CNPs agreed that clinical research evidence is useful in the daily management of patients, that their decision making is based on evidence, that evidence-based nursing can improve the quality of patient care, that there is a place for evidence-based nursing in their practices at their respective CHCs, that EBP will make a difference in the quality of care of their patients and that evidence-based nursing practice has an important role to play in South Africa. Although the awareness of CNPs with regard to the asthma guideline was poor, the vast majority reported that they personally educated patients on the difference between reliever and controller MDIs, recorded the smoking status of patients in the records, demonstrated the inhaler technique to all their asthma patients, assessed the level of control and agreed that inhaled corticosteroids are the mainstay of treatment in patients with chronic persistent asthma. However only a small minority (mainly at the CHCs where action research occurred) started issuing patients with ASMPs. In answering the central question: “How can the process of implementation of clinical research evidence, using the example of the national evidence-based guideline on asthma, be improved in the PHC sector in the MDHS of the Cape Town metropole?”, this thesis concludes that the process of guideline implementation can be improved in the PHC sector by an in depth understanding and systematic approach to the whole process. A conceptual framework is provided as a model which attempts to guide and make sense of this process of guideline implementation. A stepwise approach is presented and provides a summary of the main research findings. The model shows that the initial process of evidence creation should not only deal with research evidence of high quality, but should incorporate research evidence that is relevant to the particular context of care. In addition the model shows that guideline development should be inclusive and involve a wider spectrum of stakeholders as well as patients; that guideline contextualisation, dissemination and implementation should be carefully planned. Special consideration should be given to local decision making about adoption or prioritisation of specific recommendations as part of ongoing quality improvement cycles and the conversion of published guidelines into practical tools for practitioners to use in consultation, prior to dissemination. Implementation should anticipate that members of the PHC staff will differ in their readiness to change and that strategies should consciously embrace principles of behaviour change and build up a sense of ownership, choice and control over local adoption of the guidelines. Academic centres, such as universities and professional bodies, have a role to play in identifying, appraising and synthesising the evidence, and giving input into guideline development. They can also assist by innovating and evaluating practical tools as part of the contextualisation stage and by providing continuing education during implementation as part of their social responsibility. The health care organisation (HCO) should prevent unnecessary delays in guideline implementation by ensuring that policy, resources and recommendations are aligned during the contextualisation stage; that barriers encountered should be dealt with throughout the entire process, and that ongoing monitoring and evaluation of the quality of care occurs. Conclusion This research used different methods and innovative PAR to bridge the gap between evidence and practice. A new conceptual model for guideline implementation is recommended for use to assist with implementation and knowledge translation in PHC locally, nationally and in similar Low Middle Income Countries (LMIC) in Africa. / AFRIKAANSE OPSOMMING: Agtergrond ‘n Behoefte om kliniese navorsingsbewyse in die praktyk te benut, is by primêre – sorg praktisyns geïdentifiseer en word goed beskryf. Daar bestaan egter steeds ‘n gaping tussen bewyse en die praktyk in primêre gesondheidsorg. Alhoewel getoon kon word dat kliniese praktykriglyne die kwaliteit van kliniese praktyk verbeter, en poog om die gaping tussen bewys en praktyk te oorbrug, is praktisyns dikwels nie bewus van praktykriglyne nie, en faal daarin om toegang te verkry tot bewysgebaseerde aanbevelings wat daarin vervat is, asook om dit aan te neem en na te kom. Sentrale vraag Hoe kan die implementering van kliniese navorsingbewyse, deur die voorbeeld van nasionale bewysgebaseerde riglyne oor asma te gebruik, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool? Doel Die doel van hierdie navorsing was om die implementering van kliniese navorsingbewyse in die primêre gesondheidsorg te verbeter, deur te leer vanuit die spesifieke voorbeeld van die nasionale bewysgebaseerde asmariglyne in die primêre gesondheidsorgpraktyk in die Metropooldistrik – gesondheidstelsel van die Kaapstad - metropool, en om aanbevelings aan sleutel – rolspelers te maak aangaande die toekomstige implementering van bewysgebaseerde riglyne. Doelwitte  Om insig te verkry in die huidige kwaliteit van asmasorg in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel van die Kaapstad – metropool.  Om vas te stel of die implementeringsproses van die nuwe asmariglyne bygedra het tot ‘n verbetering in die kwaliteit van sorg in die Metropooldistrik – gesondheidstelsel.  Om maniere te verken om die implementeringsproses van die nasionale asmariglyne in die primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter.  Om insig te verkry in die opvattings, houding en kennis van asmatiese pasiënte met betrekking tot hul asma – bestuur.  Om te verken hoe bewysgebaseerde praktyk verstaan en deur dokters in primêre gesondheidsorg toegepas word.  Om te verstaan hoe primêre gesondheidsorgdokters in die openbare - en privaatgesondheidsektore toegang tot, en die toepassing van riglyne verkry.  Om die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademies, privaat en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, te verken.  Om insig te verkry in die begrip van gesinspraktisyns met betrekking tot die probleme wat waargeneem is, hoofhindernisse tot bewysgebaseerde praktyk, asook hul persepsies van die proses van riglyn – implementering in primêre gesondheidsorg.  Om insig te verkry in die kennis, persepsies en houding van kliniese verpleegpraktisyns in die openbare sektor, met betrekking tot bewysgebaseerde praktyk en die proses van riglyn – implementering. Metodologie Hierdie studie is uitgevoer in die primêre gesondheidsorg - instellings van die Kaapstad – metropool. Hierdie navorsing is in drie fases uitgevoer, en het deursnee – ondersoeke, kwaliteitverbeteringsiklusse, kwalitatiewe navorsingsmetodes soos onderhoude met gesinspraktisyns, en deelnemende aksienavorsing gebruik. Fase 1 het ‘n deursnee – ondersoek behels oor die kennis, bewusmaking en perspektiewe van dokters met betrekking tot bewysgebaseerde praktyk en riglyn – implementering , deur die nasionale bewysgebaseerde asmariglyne te gebruik wat in 2007 gepubliseer is. Dit het ook kwaliteitverbeteringsiklusse behels wat oor ‘n tydperk van vyf jaar uitgevoer is, om die basislyn – kwaliteit van asmasorg in die primêre gesondheidsorg te assesseer, en om die verbetering in asmasorg te evalueer as ‘n uitvloesel van die kwaliteitverbeteringsiklusse en geassosieerde opvoedkundige werkswinkels. Fase 2 het onderhoude behels met gesinspraktisyns in akademia, sowel as in die privaat - en openbare gesondheidsorgsektore wat verantwoordelik was vir kliniese staatsbestuur in primêre gesondheidsorg in die Kaapstad – metropool. Gedurende hierdie fase van die navorsing was die ervaringe, perspektiewe en begrip van gesinspraktisyns (akademia, privaat – en openbare sektor) met betrekking tot bewysgebaseerde praktyk, en die implementering van riglyne in primêre gesondheidsorg, verken. Fase 3 het deelnemende aksienavorsing met primêre sorg – praktisyns by gemeenskaps – gesondheidsentrums behels, deur ‘n koöperatiewe ondersoekgroep te gebruik om die asmariglyn – implementering in primêre gesondheidsorg te verbeter. Die koöperatiewe ondersoekgroep het ondersoek ingestel hoe om die implementering van die asma – riglyne in hul onderskeie gemeenskaps – gesondheidsentrums te verbeter, en het vier siklusse van beplanning – aksie – observasie – refleksie voltooi. Die vier siklusse het gefokus op die implementering van ‘n asma – selfbestuurplan, die bekwaamheid van kliniese verpleegpraktisyns om die riglyne te implementeer te verken, die persepsies van pasiënte oor hul asmasorg te verken, en die implementering van beter pasiënt – opvoeding. ‘n Finale konsensus van die koöperatiewe ondersoekgroep se studie was toe opgestel. Resultate Met betrekking tot gehalteverbetering van asmasorg in primêre gesondheidsorg: Die eerste doelwit van die studie is hoofsaaklik aangespreek deur die basislyn – oudit wat in 2007 en 2008 uitgevoer is. Dit het getoon dat die basislynkwaliteit van asmasorg, met spesifieke verwysing na die assessering van pasiënte se vlak van beheer, meting van die pasiënt se piek ekspiratoriese vloeitempo, assessering van die pasiënt se inhaleringstegniek, optekening van die pasiënt se rookstatus, die voldoende voorskryf van reguleerder - en verligter gemeterde dosis inhaleerderhervullers tydens besoeke, en veral die verskaffing van ‘n asma – selfbestuurplan tydens besoeke, swak was. Die tweede doelwit is aangespreek deur die jaarlikse ouditte wat uitgevoer is in 2007, 2008, 2010 en 2011 gedurende die periode van implementering. Dit toon dat, hoewel duidelike oorsaak en effek – argumentering nie afgelei kan word nie, algehele statisties en klinies - beduidende verbeterings in die kwaliteit van sorg voorgekom het, in samewerking met die proses van asmariglyn – implementering. Ten spyte van die verbetering in strukturele – en proseskriteria, was daar geen ooreenstemmende verbetering in die uitkomskriteria nie. In werklikheid het die benutting van fasiliteite vir noodbesoeke aansienlik verhoog, terwyl die hospitalisasie van pasiënte konstant gebly het. Die derde objektief was om maniere te verken om die implementeringsproses van die nasionale asmariglyne in primêre gesondheidsorg in die Metropooldistrik – gesondheidstelsel te verbeter. Dit was hoofsaaklik aangespreek deur ‘n aksienavorsingproses by geselekteerde gemeenskaps – gesondheidsentrums. Dit het getoon dat implementering verbeter kon word deur deurlopende opvoedkundige ondersteuning en formele interaktiewe opleidingswerkswinkels met die personeellede wat direk betrokke was met die pasiënte. Die ontwikkeling en gebruik van opvoedkundige hulpmiddels, en asma - selfbestuurplanne gebaseer op die riglyn – aanbevelings was nuttig, en het pasiëntdeelname in besluitneming rakende hul sorg, aangemoedig. Die vierde doelwit, spesifiek met betrekking tot asmasorg, is aangespreek by wyse van ‘n opname. Dit het getoon dat, alhoewel die meerderheid van asma – pasiënte deelgeneem het aan besluite rakende hul asma, en tevrede was met die kwaliteit van sorg wat hulle ontvang het, die voorkoms van rook onder asma – pasiënte hoog was, en geleenthede vir rookstaking – berading was gemis. Alhoewel dokumentasie van piekvloei – opnames en pasiënte se kennis van die verskil tussen die verligter en kontroleerder - gemeterde dosis inhaleerders goed was, was pasiënte se persepsies met betrekking tot opvoeding in die inhaleringstegniek, die assessering van die vlak van beheer, die uitreiking van geskrewe inligting ten opsigte van asma, en die gebruik van asma – selfbestuurplanne steeds swak en kon dit verbeter word. Met betrekking tot bewysgebaseerde praktyk en asmariglyn – implementering in primêre gesondheidsorg: Die vyfde doelwit van die studie is aangespreek by wyse van ‘n opname wat getoon het dat die dokters in primêre gesondheidsorg bewyse in kliniese besluitneming gebruik het, en saamgestem het met die nuttigheid en belangrikheid van bewysgebaseerde praktyk in die verbetering van die kwaliteit van pasiëntsorg in Suid – Afrika. Daar was ‘n verskil in omgang met aktiwiteite wat verband hou met bewysgebaseerde praktyke tussen die openbare – en privaatsektordokters. Daar is dus ‘n behoefte aan formele opleiding in die vaardighede en prosesse van bewysgebaseerde praktyke. Die sesde doelwit is aangespreek by wyse van ‘n opname wat getoon het dat ‘n goeie proporsie van beide openbare en privaatsektordokters in die Kaapstad- metropool wel bewus was van die asmariglyn en het spesifieke riglyn – aanbevelings aangeneem, daarop gereageer en nagekom. Daar was ‘n hoë vlak van algemene bewustheid van die asmariglyn, en aanbevelings was aangeneem in die praktyk, alhoewel daar verbeter kon word op die gebrek aan formele siekteregisters, monitering en evaluering van asmasorg, en die benutting van ‘n asma – selfbestuurplan. Die sewende doelwit is aangespreek deur kwalitatiewe navorsing wat getoon het hoe die persepsies en perspektiewe van gesinspraktisyns ten opsigte van bewysgebaseerde praktyk en die proses van riglyn – implementering bygedra het tot die ontwikkeling van ‘n konseptuele raamwerk vir die proses van riglyn – implementering. Die agste doelwit is aangespreek deur kwalitatiewe navorsing, wat hindernisse in elke stap van die implementeringsproses identifiseer het. Tydbeperkings, praktisynswerklading, gebrek aan finansiële hulpbronne, gebrek aan eienaarskap, die gebrek aan tydige organisasie – ondersteuning en praktisynsweerstand ten opsigte van verandering, was belangrike hindernisse in riglyn – implementering in ‘n reeds oorlaaide primêre sorg – omgewing. ‘n Konseptuele model is ontwikkel wat getoon het dat die proses van riglyn – implementering aangepas moet word by die geïdentifiseerde hindernisse. Die negende doelwit is aangespreek by wyse van ‘n opname wat getoon het dat die konsep van bewysgebaseerde praktyk betreklik nuut was vir kliniese verpleegpraktisyns in primêre gesondheidsorg, en het ‘n behoefte geïdentifiseer om meer hieroor te leer. Kliniese verpleegpraktisyns het saamgestem dat kliniese navorsing nuttig is in die daaglikse bestuur van pasiënte, dat hul besluitneming gebaseer moet wees op bewyse, dat bewysgebaseerde verpleging die kwaliteit van pasiëntsorg kan verbeter, dat daar ‘n plek is vir bewysgebaseerde verpleging in hul praktyke by hul onderskeie gemeenskap-gesondheidsentrums, dat bewysgebaseerde praktyk ‘n verskil sal maak in die kwaliteit van sorg van hul pasiënte, en dat bewysgebaseerde verpleegpraktyk ‘n belangrike rol kan speel in Suid – Afrika. Alhoewel die bewustheid onder kliniese verpleegpraktisyns met betrekking tot die asmariglyne swak was, het die oorgrote meerderheid verslag gegee dat hulle die pasiënte persoonlik opgevoed het oor die verskil tussen verligting – en beheerder gemeterde dosis - inhaleerders, die rookstatus van pasiënte in die verslae opgeteken het, die inhaleringstegniek aan al hul pasiënte gedemonstreer het, die vlak van beheer geassesseer het, en saamgestem dat geïnhaleerde kortikosteroïede die staatmaker van behandeling is in pasiënte met chroniese, aanhoudende asma. Slegs ‘n klein minderheid (hoofsaaklik by die gemeenskap – gesondheidsentrums waar aksienavorsing geskied) het egter begin om pasiënte van asma – selfbestuurplanne te voorsien. In die beantwoording van die sentrale vraag: “Hoe kan die proses van implementering van kliniese navorsingsbewyse, deur die voorbeeld van die nasionale bewysgebaseerde riglyne oor asma, verbeter word in die primêre gesondheidsorgsektor in die Metropooldistrik - gesondheidstelsel van die Kaapstad – metropool?”, kom hierdie tesis tot die gevolgtrekking dat die proses van riglyn – implementering in die primêre gesondheidsorg verbeter kan word deur ‘n in – diepte begrip en sistematiese benadering tot die hele proses. ‘n Konseptuele raamwerk word voorsien as ‘n model wat poog om te lei en sin te maak van hierdie proses van riglyn – implementering. ‘n Stapsgewyse benadering word aangebied en verskaf ‘n opsomming van die hoof – navorsingbevindinge. Die model toon dat die aanvanklike proses van bewyse – skepping nie slegs navorsingbewyse van hoë kwaliteit moet oorweeg nie, maar navorsingbewyse moet inkorporeer wat relevant is tot die bepaalde konteks van sorg. Boonop toon die model dat riglyn – ontwikkeling inklusief behoort te wees, en behels dit ‘n wyer spektrum van rolspelers sowel as pasiënte; dat riglyn – kontekstualisering, verspreiding en implementering versigtig beplan behoort te word. Spesiale oorweging moet gegee word aan plaaslike besluitneming oor die aanneming of prioritisering van spesifieke aanbevelings as deel van volgehoue kwaliteitverbeteringsiklusse, en die omskakeling van gepubliseerde riglyne na praktiese hulpmiddels vir praktisyns om te gebruik in die konsultasiefase, alvorens verspreiding daarvan plaasvind. Implementering behoort te verwag dat lede van die primêre gesondheidsorg sal verskil in hul gereedheid om te verander, en dat strategieë doelbewus die beginsels van gedragsverandering sal insluit en ‘n gevoel kweek van eienaarskap, keuse en beheer oor plaaslike aanneming van die riglyne. Akademiese sentrums, soos universiteite en professionele liggame, het ‘n rol om te speel in die identifisering, gehalteversekering en sintetisering van die bewyse, en om insette te lewer in die riglyn - ontwikkeling. Hulle kan ook behulpsaam wees deur praktiese hulpmiddels te innoveer en te evalueer as deel van die kontekstualiseringfase, en om deurlopende opvoeding te verskaf gedurende implementering as deel van hul sosiale verantwoordelikheid. Die gesondheidsorg – organisasies moet onnodige vertragings in riglyn – implementering voorkom deur te verseker dat beleid, bronne en aanbevelings in lyn is gedurende die kontekstualiseringsfase; dat hindernisse wat teëgekom word, regdeur die hele proses hanteer word, en dat volgehoue monitering en evaluering van kwaliteitsorg plaasvind. Gevolgtrekking Hierdie navorsing het van verskillende metodes en innoverende deelnemende aksienavorsing gebruik gemaak om die gaping tussen bewyse en praktyk te sluit. ‘n Nuwe konseptuele model vir riglyn – implementering word aanbeveel vir gebruik om behulpsaam te wees met die implementering en kennis -translasie in primêre gesondheidsorg plaaslik, nasionaal en in soortgelyke lae - en middel - inkomstelande in Afrika.