Thesis (MPhil)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: The purpose of this study was to identify possible viable future healthcare models for South Africa, using the techniques and methodologies advocated in the field of future studies by futurists and erudite academics such as Ackoff, Drucker, De Jouvenel, Slaughter, Dostal and Roux. This topic necessitated a problem-orientated approach to future studies based on the complexities inherent thereto. A great deal of emphasis was therefore placed on the tools of rational analysis, which are supported by unregarded worldview assumptions about the ability of humans to regulate and control the world and therefore the framing of new laws, rules and regulations. The forward view was generated by using the appropriate methodologies such as environmental scanning and the analysis of trends and outcomes. Enrichment to the foresight work, beyond the respective models, was furthermore achieved by acknowledging the cultural and social-political arena wherein the current healthcare models in South Africa operate. The focused scan of salient and credible material and publications was extended to include research into healthcare outcomes achieved in countries with comparable economic and demographic profiles to South Africa. Supplementary research was also conducted into comprehensive aspects such as ethics and health economics in conjunction with recognised international healthcare models. The drivers of quality healthcare at primary and secondary healthcare levels and therefore also representing the constraining factors in the South African milieu being available healthcare practitioners, training, physical infrastructure, technology, access to facilities and the affordability of healthcare were explored to ensure the viability of the futures healthcare models contemplated. The identification of probable futures was accomplished by means of scenario development which focussed on the critical uncertainties of healthcare funding models and nationalisation as opposed to free market models competing for available resources in a semi-regulated environment. Thereafter Delphi techniques were used to acquire consensus from specialists currently working in the field of public and private healthcare along with stakeholders such as leaders of enterprise, healthcare funders and regulators as regards the identification of preferred future healthcare models that will meet, in a sustainable manner, the constitutional right to basic healthcare and enhance the quality of life and life expectancy of all South Africans. The relevance and credibility of the consensus opinions of the selected experts who participated in the research was again tested against the futures discourse publicised in the press to ensure that personal, cultural and organisational factors were not disregarded in the process. The study concluded on the fact that additional research and debate are required to ensure that the societal, organisational and individual aspects of the system wherein healthcare operates are comprehensively addressed by all relevant stakeholders in a manner that void of the neuroses caused by anxiety when thinking of the future. / AFRIKAANSE OPSOMMING: Die doel van die studie was om moontlike volhoubare toekomstige gesondheidsorgmodelle vir Suid-Afrika te identifiseer deur gebruik te maak van tegnieke en metodologieë soos voorgehou deur deskundiges en hoogs belese akademici in die veld van toekomstudies, soos Ackoff, Drucker, De Jouvenel, Dostal en Roux. Die studie het, as gevolg van die kompleksiteit daarvan, ´n probleem-gerigte benadering tot toekomstudies verlang. Gevolglik is baie klem geplaas op rasionele analise-tegnieke, wat ondersteun word deur wêreldsiening-aannames aangaande die mens se vermoeë om die wêreld te reguleer en te beheer deur middel van nuwe wetgewing, reëls en regulasies. Die toekomsgerigte siening is gegenereer deur die gebruik van toepaslike metodologieë, soos byvoorbeeld omgewingskandering en die analise van tendense en uitkomste. Die toekomsgerigte werk is aangevul deur erkenning te gee aan die kulturele en sosio-politiese milieu waarbinne die huidige gesondheidsorgmodelle in Suid Afrika funksioneer. Die gefokusde skandering van kredietwaardige bronne en publikasies is uitgebrei ten einde navorsing oor gesondheidsorguitkomste, soos behaal in lande met vergelykbare ekonomiese en demografiese profiele, soos Suid Afrika, in te sluit. Aanvullende navorsing is verder onderneem en was gerig op omvattende aspekte soos etiek en gesondheidsekonomie, tesame met erkende internasionale gesordheidsorgmodelle. Die kernbepalers van kwaliteit-gesondheidsorg op primêre en sekondêre gesondheidsorgvlak, wat dus ook die beperkende faktore in die Suid-Afrikaanse milieu verteenwoordig, naamlik beskikbaarheid van mediese praktisyns, opleiding, fisiese infrastruktuur, tegnologie, toegang tot fasiliteite en die bekostigbaarheid van gesondheidsorg, is ondersoek ten einde die volhoubaarheid van die toekomsgesondheidsmodelle te verseker. Die identifiserings van waarskynlike toekomste is bereik deur scenario-ontwikkeling wat gefokus het op die kritiese onsekerhede van gesondheidsorgbefondsing en nationalisering, teenoor ´n vryemarkstelsel wat meeding om beskikbare hulpbronne in ´n deels-gereguleerde omgewing. Daarna is Delphi-metodieke gebruik om konsensus te verkry onder kenners wat tans in die veld van openbare en privaat gesondheidsorg werksaam is, asook belanghebbendes soos leiers in besighede, gesondheidsorgbefondsers en reguleerders, ten opsigte van voorkeur-toekomsgesondheidsorgmodelle wat op ´n volhoubare wyse die grondwetlike regte tot basiese gesondheidsorg en die verbetering van die kwaliteit van lewe en lewensverwagting van alle Suid-Afrikaners sal bevorder. Die toepaslikheid en geloofwaardigheid van die konsensusmenings van die gekose kenners wat deelgeneem het aan die navorsing is weer getoets teen toekomsgesprekke soos gepubliseer in die media ten einde te verseker dat persoonlike, kulturele en organisatoriese faktore nie in die proses misken is nie. Die studie het tot die slotsom gekom dat verdere navorsing en debat nodig is ten einde te verseker dat die sosiale, organisatoriese en individuele aspekte van die stelsel waarbinne gesondheidsorg funksioneer omvattend aangespreek word deur alle belanghebbendes, en op ´n wyse wat enige neurose wat tot angstigheid oor toekomsdenke kan lei, die hok slaan.

Thesis (MBA)--Stellenbosch University, 2007. / ENGLISH ABSTRACT: This study provides an overview of the medical aid industry in South Africa and highlights the impact of the formation of the Council for Medical Schemes through the implementation of the Medical Schemes Act of 1998. The regulatory framework that governs the medical aids in South Africa is analysed. In this study. different medical aid funds are compared in terms of administration costs, required solvency levels and membership numbers relative to the acceptable industry averages. The main cost drivers of medical aid funds that could also threaten the future of private medical care are identified, as these services may not be affordable to most South Africans in the future. The new vision of government in terms of healthcare is outlined, and the regulations that will be implemented to transform the healthcare sector into a Social Health Insurance system, and ultimately into a National Health Insurance system. are analysed. The proposed mechanisms, such as the Risk Equalisation Fund, the Government Employees Medical Scheme and lowincome medical schemes, are discussed, highlighting all their advantages as well as the associated risks for the sustainability of private medical care. The proposed new legislation and the potential negative financial impact on the private medical industry are analysed with detailed reference to the Medical Schemes Act of 1998 and the Medicines and Related Substance Control and Amendment Act of 1997. The implications of fundamental changes proposed in private health insurance, such as community risk rating versus the traditional individual risk rating, are discussed. The negative impact of prescribed minimum benefits (which include HIV/Aids) on the financial sustainability of the medical aid industry is highlighted. The impact of HIV/Aids on the sustainability of the medical aid industry is discussed and some conclusions and recommendations are made regarding the financial sustainability of the medical aid industry and hence the future of private medical care in South Africa. / AFRIKAANSE OPSOMMING: Hierdie studie is 'n oorsig van die mediesefondsbedryf in Suid·Afrika, en beklemtoon die impak van die totstandkoming van die Raad van Mediese Skemas deur die impJementering van die Wet op Mediese Skemas van 1998. Hierdie regulatoriese raamwerk, wat mediese fondse in SuidAfrika tans reguleer, word in die studie ondersoek. In hierdie studie word van die grootste mediese fondse in tenne van administratiewe koste, voorgeskrewe fondsreserwes en lidmaatskapgetalle relatief tot die aanvaarde bedryfsnonne met rnekaar vergelyk. Die belangrikste koste-items vir mediese fondse wat die voortbestaan van privaat gesondheidsorg kao bedreig, word ontleed cmdat hierdie dienste in die toekoms vir die rneeste Suid-Afrikaners onbekostigbaar kan word. Die regering se nuwe visie vir gesondheidsorg word uiteengesit. asook die regulasies wat germplementeer sal word om die gesondheidsektor na 'n sosiale gesondheidsversekeringstelsel en uiteindelik na tn nasionale gesondheidstelsel te transfonneer. Die voorgestelde meganismes, seos die Risiko-egalisasiefonds, GEMS en laeinkomste-mediesefondse word bespreek, met al die relevante voor- en nadele, tesame met die geassosieerde risiko's vir die voortbestaan van privaat mediese dienste. Die voorgestelde wetgewing en die gevolglike negatiewe finansiele impak op die privaat gesondheidsbedryf, met spesifieke verwysing na die Wet op Mediese Skemas van 1998 asook die Wet op die Beheer van Medisyne en Verwante Middels van 1997, word ondersoek. Die implikasies van fundamentele veranderinge wat in terme van gesondheidsversekering voorgestel word, soos gemeenskapsrisikogradering teenoor individuelerisikogradering, word bespreek. Voorgeskrewe minimum voordele (wat MIV insluit) wat nou ingevolge wetgewing ten volle deur fondse betaal moet word, se potensiele negatiewe impak op die finansiele lewensvatbaarheid van mediese fondse word beklemtoon. Die potensiele negatiewe impak van die MIV-epidemie op die lewensvatbaarheid van die mediesefondsbedryf word bespreek en gevolg deur aanbevelings om die fmansiele lewensvatbaarheid en toekoms van die privaat gesondheidsbedryf in Suid-Afrika te verseker.

Thesis (MBA)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Childhood tuberculosis is an infectious disease that can cause serious illness and mortality in especially young children. Following contact with an infectious adult tuberculosis case, the disease is easily preventable through preventive isoniazid treatment, yet very few exposed and at-risk children currently access this healthcare service in most high-burden settings. Previous research pointed out the multifactorial and complex nature of the barriers to accessing preventive care. Specifically, the lack of a formalised recording and reporting tool, such as the universally used tuberculosis treatment registers, possibly contribute to the operational barriers of preventive care delivery to these children. The purpose of this research was to evaluate the cost-effectiveness of an isoniazid preventive treatment register tool used at community level. The study utilised previously reported data from the study population and other high-burden settings to construct a decision analysis model that included varying probabilities of isoniazid preventive treatment across three high risk age groups (<1 year of age, 1 – 2 years of age, 3 – 5 years of age), coupled with disease probabilities and associated treatment costs. The scenarios simulated included 1) the routine isoniazid preventive treatment service (3% started on treatment, 17% identified as eligible); and 2) an isoniazid preventive treatment service supported by a recording register (15% (adherent to six months of treatment) and 38% (started on IPT treatment)). In addition, two hypothetical simulations were included for 76% and 100% isoniazid preventive treatment uptake; these hypothetical simulations required additional community based healthcare worker resources in addition to the register tool. The observations from the literature indicated that more children were identified (24(17%) vs. 54(38%)) and started (4(3%, base case) vs. 54) on isoniazid preventive treatment following the implementation of the register. As expected, the mean number of tuberculosis cases prevented, increased as the proportion of eligible children that received isoniazid preventive treatment, improved; the change in the number of cases prevented per simulation showed incremental improvements which were all significantly better (p<0.01) than the base case.. The incremental cost-effectiveness ratios incurred savings for each of the scenarios simulated since the mean costs for each of the simulations were significantly less (p<0.01) than the costs associated with the base case. The current evidence suggests that the proposed isoniazid preventive treatment register tool is a cost-effective alternative to the current standard of care in place at community level for at-risk children exposed to tuberculosis. It is therefore recommended that the tool be used incrementally on a bigger scale, until such time that sufficient evidence has been generated to support widespread implementation.

Many parts of South Africa face a shortage of doctors within the public health system. While the PHC system is driven primarily by nursing staff, there is a need for doctors to provide certain services at primary and secondary levels. In 1996, as part of its efforts to address the shortage of doctors, the DoH began recruiting Cuban doctors to work in South Africa. This programme, now underway in eight of the nine provinces, falls under a government-to-government agreement aimed at strengthening the provision of health care in the areas of greatest need: townships and rural areas. The programme has demonstrated tangible success. However, it has also been criticised in some sections of the medical community and the media, where it has been portrayed in a controversial light. All this underlines the importance of an analysis of the programme, but to date, no such evaluation has been carried out.<br /> <br /> This research assesses the Cuban Health Programme in Gauteng province. On the basis of this thorough assessment, the government can take steps to improve the national programme, using Gauteng as a case study. This study was conducted in July 2004, employing qualitative methods to develop an in-depth understanding of recruitment and induction processes in Cuba and South Africa, the scope of practice of Cuban doctors, professional relationships, adaptation to the health system and broader society, and other factors. The researcher also conducted a review of official documents. Gauteng began with two Cuban doctors at the outset of the programme in 1996. The number peaked at 32, and has since dropped to 15. All of these doctors were interviewed in the course of the research, along with five managers and five peers. The study revealed that all the interviewees, except one manager, firmly believe that the programme has achieved its objectives, and should continue. Peers and managers commended the high quality, comprehensive and caring approach of the Cuban doctors, and say they are satisfying a real need. The Cuban doctors, however, believe that because they are providing mostly curative services, they are under-utilised. Flowing from the research are a series of recommendations. These include a proposal that the government recommit to the programme and ensure its continuity, and review the current role of the Cuban doctors, taking into consideration their willingness to provide training and expertise in preventive interventions.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice.

Dissertation submitted in compliance with the requirements for the Masters Degree in Technology: Nursing, Durban University of Technology, 2016. / Introduction Although the South African Government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilization of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. Aim of the study The aim of the study was to determine whether pregnant women from KwaMkhizwana rural community had access to and were utilising antenatal care services. Methodology A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s three delays model. Purposive sampling of the pregnant women and all categories of nurses who were employed in the three health care facilities in the area was done. Data was collected in two phases through in-depth semi-structured interviews with both the pregnant women and the nurses respectively between February and March 2016. The sample size was guided by data saturation. All data were analysed using the Tesch’s method of data analysis. Study findings Six major themes and several sub-themes emerged from the interviews with both Phase 1 and Phase 2 participants. The major themes included: 1) access to health care and emergency services, 2) availability of human and material resources, 3) social and cultural beliefs, 4) past pregnancy experiences, 5) communication and transparency regarding health care service delivery and 6) quality of antenatal care services. Summary of the findings The pregnant women encountered several challenges which led to delays in seeking, reaching and receiving antenatal care. Most of the pregnant women participants related limited access to health care, with under-utilisation of antenatal services. They were unhappy about the antenatal care services they received in the three available health care facilities in the area, which made these facilities to be inaccessible and underutilised. The nurse participants recognised the challenges facing the pregnant women regarding the access and utilisation of antenatal care services, together with the challenges faced by the nurses while working in the three available health care facilities in the area. Recommendations The recommendations that were made included: to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services are delivered in line with the South African Department of Health policies and guidelines and strengthening community education. A further study on provision of antenatal care services in the area is also recommended. / M

M.Cur. (Nursing Management) / Transformational leadership involves the creation of a motivating climate that enhances growth, development, commitment, goal achievement and enjoyment which encourages behaviour based on a set of shared values (Price, 2006:124). In this study transformational leadership referred to concepts of motivation, and change management with regard to the implementation of the Cervical Cancer Screening Programme in a PRe setting. During support visits in Ekurhuleni Health District, the researcher observed a lack of transformational leadership among facility managers in Primary Health Care Clinics to transform the Cervical Cancer Screening Program in line with relevant health care legislation. It was apparent that the problems in implementing the Cervical Cancer Screening Programme were related to poor motivation and lack of implementation of change management principles in the PHC clinics. From the problem statement the following research questions emerged: To what extent is the facility manager perceived as a transformational leader to implement the Cervical Cancer Screening Programme in a PHC clinic? Which actions should the facility manager take to implement the Cervical Cancer Screening Programme in PHe? From the findings guidelines for the facility managers were described to enable them to implement a Cervical Cancer Screening Programme in a Primary Health Care clinic within legal requirements...

Dissertation submitted in fulfillment of the requirements for the Degree in Masters of Technology: Nursing, Durban University of Technology, 2011. / Background Working in the intensive care unit can be traumatic for nursing personnel. Critical care nurses are faced with repeated exposure to death and dying as they are involved in caring for patients who are actively dying or who have been told that they have a terminal illness and are faced with the possibility of impending death. Critical care nurses relate in different ways to the phenomena of death and dying within their nursing profession and their scope of practice. These nurses often have a difficult time coping with the stress that comes with caring for those who are dying or relating to loved ones of those that are dying. Aim of the study The aim of the study was to explore the critical care nurse’s experiences of death and dying. Methodology A qualitative, descriptive phenomenological approach was used to guide the study. Four nurses were recruited and rich descriptions of their experiences were gained through individual face-to-face interviews. One broad question was asked: ‘What are your experiences regarding death and dying of your patients in ICU?’ iii Results The findings of this study revealed that issues such as communication, multicultural diversity, education and coping mechanisms relating to caring for the critically ill and dying patient are essential in nursing education and practice. Critical care nurses need to have support networks in place, not only to assist in providing care, but also for their own emotional support / M

Dissertation submitted in the partial fulfillment for the requirements of the Degree of Master in Public Management, Durban University of Technology, Durban, South Africa, 2015. / The challenges facing the South African public health systems, especially public clinics seem to be increasing. These Primary Health Centres are having to deliver service under difficult circumstances thereby making the “offering” of the service being perceived as poor. The way in which these centres operate is mainly hampered by infrastucture and resource allocation which is seen as sufficient to render appropriate service to the “black communities”. To the eyes of an outsider, this particular service is seen as ideal, yet the people for whom it is meant, do not fully benefit from it. Prior to 1994, South Africans were faced with poor health facilities; with the democratic elections, they thought the delivery of essential services was going to change for the better. In the White Paper for Transformation of the Health System in South Africa, one of the objectives states that various implementation strategies were to be designed to meet the basic needs of all people, given the limited resources available, but this does not seem to be the case. Research has shown a huge discrepancy in the delivery of service between rural and urban areas. Some of the findings are that one nurse will attend to a huge number of patients without any assistance, either from the doctor or other nurses. The literature review contained in this research indicates that there is still a gap between how the service delivery should be made available to the public and how it is currently administered or managed. This research, which is driven by a passion and love for good public service delivery assesses the perceived quality of service in the public clinics of Sobantu and Scottsville. Interviews were conducted within employees of both the clinics and the patients being served by these two clinics to assess the perceived quality of service received in these clinics / An electronic copy of the Thesis is currently unavailable.