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Masters in Public Administration - MPA / It is often argued that public participation is the cornerstone of constitutional democracy especially in countries such as South Africa with the history of segregation which was characterised by the exclusion of the majority of citizens from the decision-making processes of the state based on race, class and gender. As such, following the introduction of the various pieces of legislation in 1994, the dominant narrative was that the progressive laws that were passed would serve as a ‘panacea’ to the challenges of participatory governance in South Africa. It was inconceivable that 25 years into democracy, South Africa would still be grappling with the concept of public participation and the extent to which citizens could influence, direct and own decisions made by and with government especially at a local level. This study assessed the state of public participation in the Western Cape focusing on Beaufort Municipality in the Central Karoo District. It argued that public participation is a prerequisite for democratic governance and that the state could be deemed illegitimate if it does not prioritize the involvement of communities in its affairs. In this context, a particular focus was placed on the effectiveness of the ward committee system (as state sponsored mechanisms of public participation) in enhancing participatory democracy in Beaufort West Municipality. It refuted assumptions on the institutional arrangements made in the legislative framework governing public participation and ward committees – identifying and outlining some of the unanticipated consequences of these pieces of legislation. The study used qualitative research methods to collect data. Primary and secondary data was gathered to assess the state of public participation in the Western Cape with specific reference on the effectiveness of the ward committee system and the role of legislative and regulatory framework governing public participation, the institutional architecture and the roles of various stakeholders involved in public participation. The primary data was gathered through structured interviews and questionnaires while the secondary data was collected the analysis of the literature on public participation and ward committees including municipal reports, guidelines on public participation, legislation and policy frameworks. The research found that it is precisely the state sanctioned ward committee system that has contributed to the collapse of public participation in South Africa. The ward committee system was identified as a ‘poisoned chalice’ - so compromised that it has become an instrument to legitimise predetermined decisions of the politically connected elite, a rubber v stamp platform to comply with the policy and legislative framework. To address this problem, the study recommended a number of measures and interventions that could be introduced which entails the reconfiguration and overhaul of the legislative framework governing public participation and ward committees including the review of the role of politicians in public participation, training and capacity building, allocation of dedicated budget for public participation etc.

Masters in Public Administration - MPA / It is often argued that public participation is the cornerstone of constitutional democracy especially in countries such as South Africa with the history of segregation which was characterised by the exclusion of the majority of citizens from the decision-making processes of the state based on race, class and gender. As such, following the introduction of the various pieces of legislation in 1994, the dominant narrative was that the progressive laws that were passed would serve as a ‘panacea’ to the challenges of participatory governance in South Africa. It was inconceivable that 25 years into democracy, South Africa would still be grappling with the concept of public participation and the extent to which citizens could influence, direct and own decisions made by and with government especially at a local level. This study assessed the state of public participation in the Western Cape focusing on Beaufort Municipality in the Central Karoo District. It argued that public participation is a prerequisite for democratic governance and that the state could be deemed illegitimate if it does not prioritize the involvement of communities in its affairs. In this context, a particular focus was placed on the effectiveness of the ward committee system (as state sponsored mechanisms of public participation) in enhancing participatory democracy in Beaufort West Municipality. It refuted assumptions on the institutional arrangements made in the legislative framework governing public participation and ward committees – identifying and outlining some of the unanticipated consequences of these pieces of legislation. The study used qualitative research methods to collect data. Primary and secondary data was gathered to assess the state of public participation in the Western Cape with specific reference on the effectiveness of the ward committee system and the role of legislative and regulatory framework governing public participation, the institutional architecture and the roles of various stakeholders involved in public participation. The primary data was gathered through structured interviews and questionnaires while the secondary data was collected the analysis of the literature on public participation and ward committees including municipal reports, guidelines on public participation, legislation and policy frameworks. The research found that it is precisely the state sanctioned ward committee system that has contributed to the collapse of public participation in South Africa. The ward committee system was identified as a ‘poisoned chalice’ - so compromised that it has become an instrument to legitimise predetermined decisions of the politically connected elite, a rubber stamp platform to comply with the policy and legislative framework. To address this problem, the study recommended a number of measures and interventions that could be introduced which entails the reconfiguration and overhaul of the legislative framework governing public participation and ward committees including the review of the role of politicians in public participation, training and capacity building, allocation of dedicated budget for public participation etc.

No / he development, pilot and evaluation of a brief psychosocial training intervention (BPTI) for staff working with people with dementia in an acute hospital setting are described. The project had two phases. Phase one involved adapting an existing competency framework and developing the BPTI using focus groups. For the pilot and evaluation, in phase two, a mixed methods approach was adopted using self-administered standardised questionnaires and qualitative interviews. Qualitative analysis suggested that delivering skills-based training can develop communication, problem-solving and self-directed learning skills; benefit staff in terms of increased knowledge, skills and confidence; and be problematic in the clinical area in terms of time, organisation and the physical environment. These factors must be taken into consideration when delivering training. These changes were not reflected in the quantitative results and measures were not always sensitive to changes in this setting. Definitive conclusions cannot be drawn about the efficacy of the intervention, due to the contradictory outcomes between the quantitative and qualitative data. Further developments and research are required to explore how staff and organisations can be supported to deliver the best possible care.

Thesis (MBA.) --University of Limpopo, 2016 / The Ward Based Outreach Teams (WBOT) Programme is established in South Africa as part of a series of strategies to strengthen Primary Health Care (PHC) and to improve service delivery in the country. The purpose of the study was to gain an understanding of the experiences of Community Health Workers (CHW) in the implementation of the WBOT programme. The objectives of the study were to evaluate the experiences of CHWs in the WBOT, to evaluate factors that facilitate the implementation and to make recommendations and strategies on what can be done to improve the WBOT programme. A quantitative research design was used where self-administered questionnaires were provided to respondents for data collection. Respondents were asked to complete the questionnaires; completed questionnaires were returned by only 12 of the 27 respondents, resulting in a 44% response rate. The study’s findings indicate that the Community Health Workers (CHWs) regarded the WBOT as helping the community in many ways such reducing the long queues at the clinic and providing the care of the patients in their own homes, although concerns about poor participation by the community structures and nurses in the health facilities were expressed. CHWs expressed experiences that were positive and negative when conducting their work in the community. The results from the study have shown that there are successes, challenges and lesson learned. The results of the study further indicated that the programme is being implemented well even though it is still in a pilot phase in the sub-district. The programme has managed to improve and save many lives in the communities of Kgetleng Sub-district. Despite the level of depth in this study, there is a crucial need for more for more in-depth research regarding the experiences of users of the WBOT services and to conduct similar studies looking into urban areas and to compare and contrast the rural and urban findings.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Chronic illnesses, including non-communicable diseases (NCDs), continue to be a public health concern, globally, and contribute to the high burden of diseases. These health challenges have led to the introduction of community health workers (CHWs) in both developed and developing countries as a way of dealing with these challenges. It is more than five years since ward-based outreach teams (WBOTs) were introduced into the Julesburg area in order to respond to the needs of the community, based on the government’s focus on quadruple burden of diseases. The researcher is aware of the increasing workload, unclear roles and responsibilities, different approaches to CHWs’ work taken, and the ever-changing focus of their work, based on the community needs and diseases that the community faces at a particular time. It is for this reason that the researcher is interested in understanding the CHWs’ experiences and the manner in which they cope with challenges when working in their ever-changing environment, workload, work focus and roles and responsibilities. Methods: A qualitative exploratory, descriptive and contextual study approach was used; data was collected using focus group discussions with CHWs and one-on-one interviews with key informants, using their supervisors to gather more information that could not have been shared by CHWs. Result: The findings from the focus group discussions revealed that the CHWs have a high workload, while receiving stipend and are not permanently employed. CHWs have had experiences that make them feel unimportant and not needed, as well as enduring poor working conditions without sufficient personal protective equipment (PPE). Even though they experience dissatisfaction, they are passionate about continuing with their community-based work for many years, evidenced by those who have up to 22 years of service.

Submitted in fulfillment of the requirements for the degree of Doctor in Public Management, School of Public Management and Economics, Durban University of Technology, Durban, South Africa, 2016. / The shortage of staff in hospitals resulted in the overcrowding of outpatients departments (OPDs) and long waiting times. The problems of the current health care system include the lack of access to transportation and high transport fees which cause delays in health seeking behaviours by patients or them resorting to traditional medicine in their neighbourhood. To alleviate the above issues, the new Primary Health Care (PHC) approach provides health care at a ward based and household level through community care giver (CCGs) and outreach teams. The study evaluated the management of rural ward-based primary health care in the UThukela District Municipality (UDM). The study intended to evaluate current performance systems in order to provide effective and efficient PHC; identify the role of the operational manager (OM) in the provision of PHC; and identify the factors affecting the performance of CCGs. A mixed methods approach was used amongst 368 CCGs and 17 OMs. Data was collected from CCGs using questionnaires while an interview schedule was used to collect data from OMs. The study showed that the performance management systems currently being used were not providing the desired performance management outputs. There were no performance bonuses to recognise best performing staff and therefore no increase in performance. The study also showed a significant relationship between the management of referrals and participation in the activities of PHC outreach teams. The clinic was not regularly giving feedback to the respondents and also not consistently conducting performance reviews. The findings indicated that OMs were playing various roles in the provision of PHC, namely policy and strategy implementation; leadership and governance; clinical care; allocation of resources; clinic budget management; supply chain management; and writing clinic reports. The extent of the allocation of resources to the wards varied from 43% for medicines and equipment to 31% for financial resources and only 18% for human resources. More than 95% of the CCGs viewed the availability of transport, resources, training and the provision of a stipend to be strong enabling factors for them to perform their work. Respondents indicated that monitoring and evaluation was done through reporting, performance reviews, feedback and supervision. The findings indicated that ward-based outreach teams are crucial in the delivery of PHC services in rural municipal wards within the Operation Sukuma Sakhe programme. Lack of management and supervisory support contribute to high rates of dissatisfaction amongst CCGs, as well as poor quality of work for community caregivers. There is a need for the Department of Health (DoH) to invest in the ward-based outreach teams (WBOTs) and allocate CCG budgets within the ward-based outreach teams. The study recommended that a review of monitoring and evaluation policy is required to clearly state the tools, activities and benefits of the implementation of the M & E performance management systems. The use of point-of-care technology by the WBOTs should be strengthened especially in deep rural wards. Therefore, biomedical technology will enhance point-of-care diagnosis, for instance, rapid home test kits for HIV diagnosis and pregnancy tests. The KwaZulu-Natal DoH should fast-track development of the sub-districts in order strengthen service delivery at a local level with top management ensuring development of OMs and PHC Supervisors in order to increase the level of competence and thereby improve service delivery at the PHC facilities. Another recommendation was to strengthen implementation of Operation Sukuma Sakhe (OSS) where the war room and the ward committee increase commitment to designing community-specific interventions with the engagement of community structures and government departments and local municipality through social planning, social action and locality development. Therefore, the results of the study should also influence the formulation of policies, programmes, methods and interventions which will enable UThukela District Municipality to improve health outcomes. / D

Philosophiae Doctor - PhD / Introduction: National community health worker (CHW) programmes are to an increasing extent being implemented in health systems globally, mirrored in South Africa in the ward-based outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge impacting the performance and sustainability of scaled-up CHW programmes is ensuring adequate support from and supervision by the local health system. Supervisory systems, where they exist, are usually corrective and hierarchical in nature, and implementation remains poor. In the South African context, the absence of any guidance on CHW supportive supervision has led to varied practices across the country. Improved approaches to supportive supervision are considered critical for CHW programme performance. However, there is relatively little understanding of how this can be done sustainably at scale, and effective CHW supervisory models remain elusive. Research to date has mostly positioned supervision as a technical process rather than a set of relationships, with the former testing specific interventions rather than developing holistic approaches attuned to local contexts. This doctoral study was exploratory in nature, seeking to generate an in-depth and contextualised understanding of the supervision phenomenon in one specific district in the North West Province (NWP) in South Africa. Using co-production methodology in an iterative approach, the study culminated in the formulation of a supportive supervision framework with CHWs and other frontline actors. Methods: The study was based on a holistic conceptual framework of supportive supervision, which was viewed as comprising three core functions ‒ accountability, development and support ‒ embedded in a complex and multi-level system of resources, people and relationships. To address the study objectives, the research used a mix of qualitative and quantitative methods. Three studies were conducted in a phased process: study 1 comprised a qualitative description of policy and practices in two districts related to the supervision of WBOTs; study 2 identified the main actors and mapped the supervisory system of WBOTs in the district, using social network analysis (SNA); and study 3 involved a qualitative exploration of workplace and interpersonal trust factors in the district and the supervisory system of WBOTs in the district. These three studies provided inputs for a workshop aimed at developing recommendations for a district-level, WBOT supportive supervisory framework. Four published papers reporting on the research conducted are presented in this thesis. It should be noted that the research was conducted during a turbulent political and administrative period in the NWP, when the WBOT programme changed from being a flagship programme for the country to one in crisis. This shifting context needs to be borne in mind when the findings are viewed and interpreted. Results: The study identified weaknesses in both the design and implementation of the supervisory system of WBOTs, with the absence of clear guidance resulting in WBOTs and PHC facilities performing their roles in an ad hoc manner, defined within local contexts. The study documented evidence of high internal cohesion within WBOTs and (where present) with their immediate outreach team leaders (OTLs). However, the relationships between WBOTs and the rest of the primary health care (PHC) and district health system were characterised by considerable mistrust – both towards other workers and the system as a whole. This occurred against a backdrop of increasing OTL vacancies, and the perceived abandonment of WBOT training and development systems and career opportunities. These findings are not dissimilar to those reported previously on the WBOT programme in South Africa and in programmes in other low-resource settings. Nevertheless, through its in-depth, exploratory and participatory approaches, this study provides additional insights into the phenomenon of supportive supervision. Firstly, in conceptualising supportive supervision as a set of ‘bundled’ practices within complex local health systems, the findings reflected the complexity of everyday realities and lived experiences. Secondly, through the embedded nature of the research and the phased data-collection process, the study was able to observe the impact of wider health system contexts and crises on the coalface functioning of the WBOT programme. Thirdly, the study emphasised how supportive supervision depends on healthy relational dynamics and trust relationships, and, finally, how a co-production approach can translate broad guidance, experience and theoretical understanding into meaningful, local practice owned by all the actors involved. Ultimately, the process of engagement, building relationships and forging consensus proved to be more significant than the supportive supervision framework itself. Conclusion: The lack of explicit, coherent and holistic guidance in developing CHW supportive supervision guidance and the failure to address supervision constraints at a local level undermine the performance and sustainability of CHW programmes. Effective supportive supervisory systems require bottom-up collaborative platforms characterised by active participation, sharing of local tacit knowledge and mutual learning. Supervisory systems also need to be designed in ways that promote relationships and generate trust between CHW programmes, other actors and the health system.

This study deals with the role of the unit sister in teaching student nurses in KwaZulu hospitals. The aim of the study was to identify the extent of her involvement in managing the unit to ensure clinical teaching and her involvement in the clinical teaching process. The role theory and the clinical teaching process formed the conceptual framework. Data was collected from sisters in charge of units by means of a questionnaire. The results of the study indicated that:- unit sisters regard good management of the unit as essential for effective clinical teaching. unit sisters regard clinical teaching as one of their important roles and functions as they said they were involved in all activities of the clinical teaching process however the responses were confined to what the unit sisters said they do which might not be what they actually do / Health Studies / M.A. (Nursing Science)

This study deals with the role of the unit sister in teaching student nurses in KwaZulu hospitals. The aim of the study was to identify the extent of her involvement in managing the unit to ensure clinical teaching and her involvement in the clinical teaching process. The role theory and the clinical teaching process formed the conceptual framework. Data was collected from sisters in charge of units by means of a questionnaire. The results of the study indicated that:- unit sisters regard good management of the unit as essential for effective clinical teaching. unit sisters regard clinical teaching as one of their important roles and functions as they said they were involved in all activities of the clinical teaching process however the responses were confined to what the unit sisters said they do which might not be what they actually do / Health Studies / M.A. (Nursing Science)