There has been a lot of research highlighting the plight of street children throughout the world in the past few years. A review of the literature on street children reveals that the problem is worse in developing countries. The number of street children can be expected to increase in South Africa as a result of rapid urbanisation and development. This will certainly pose a problem for the government and other organisations concerned with the welfare of street children. In order to combat the proliferation of the number of children in the streets, concerned parties need to know more about street children before intervention and effective policies can be designed. This study was initiated to serve that purpose: to provide information on how street children perceive themselves. The information gathered and results of the study can be used by service providers to design effective intervention programmes. Twenty street children from the Pietermaritzburg central business district and the comparison group of twenty children from a "place of safety" in Pietermaritzburg were interviewed and assessed. Children from the "place of safety" were chosen as a comparison group because their familial histories have many factors which are common to street children as well. Assessment ofthe two groups of children entailed measuring the children's self-concepts by using the Piers-Harris Children's Self-Concept Scale. Human Figure Drawings were used to identify signs and levels of emotional distress using the Koppitz Emotional Indicators procedure. Furthermore, an unstructured interview was conducted with each child. The data was analysed quantitatively using statistical sub-programs of the Statistical Package for the Social Sciences (SPSS). The following statistical tests were computed: means to measure central tendency, independent t-tests to determine the statistical significance of the difference between the two groups' self-concept scores and emotional indicators. Quatro Pro and Harvard Graphics software packages were used to analyse the data qualitatively and present it graphically . Statistical analyses of the results reveal no significant differences between the self-concept of street children and that of the comparison group of placed children. Both groups' scores on the Piers-Harris Children's Self-Concept Scale are within the average range. This means that street and placed children's perceptions of themselves, as measured by the Piers-Harris Children's Self-Concept Scale, are similar to those of other children in the general population. Signs and levels of emotional distress as measured by Koppitz' list of Emotional Indicators are within the non-pathological range for both groups. This indicates that street and placed children's levels of emotional distress are similar to those found in other children in the normal population. It is therefore concluded that despite being exposed to hazardous situations and having lived in deprived and abusive situations, street children do not display significant levels of measured emotional distress. Street children are found not to be as disturbed as previously assumed by journalists and fiction writers who tend to romanticise or politicise their plight. Placed children, who also share some of the predicaments that street children have endured in terms of turbulent childhoods, do not seem to show deficits in their self-concepts and emotional functioning either. Recommendations on how to plan intervention programmes for street children are also offered. Moreover, the standardisation of the Piers-Harris Children's Self-Concept Scale on local populations is recommended. / Thesis (M.Soc.Sci.)-University of Natal, Pietermartizburg, 1996

In the midst of hope and suffering due to the challenges posed by HIV and AIDS in South Africa, communities have literally witnessed a glimmer of hope in women volunteers who have readily and willingly provided care and support to people living with HIV and AIDS (PLWHA) and their families. Policy-makers have maintained that if the care of sick people is to be both comprehensive and cost-effective, it must be conducted as much as possible in the community, with hospitalization only when it is necessary. However, the strains on those caring for people with HIV and AIDS are enormous. This paper argues that neo-liberal policies are reinforcing the divide between the 'haves' and the 'have-nots', by placing strain on women volunteers in the field of community home-based care. The study was conducted in the area of Mpophomeni Township, in KwaZulu-Natal province. The research participants consisted of 10 community home-based care (CHBC) volunteers and their supervisor, 3 CHBC trainers, and 1 counselling trainer. Using a qualitative design, this study examines a specific CHBC training course and how effectively it prepares voluntary caregivers for the challenges experienced in individual homes. Ascertaining how the training helped caregivers to confront their own fears and problems before dealing with those of others, and exploring how community caregivers coped with the stress inherent in their jobs was the primary focus of this study. For these purposes, a qualitative methodology was deemed most appropriate for it allowed me to gain in-depth information through observations, semistructured interviews, a review of relevant documents, and training materials. Inspired by feminist perspectives, the findings revealed that already overburdened and poor people provide the bulk of voluntary services in the area of CHBC. Consequently, they are unable to provide quality care for people living with HIV and AIDS without external support from the government. The findings further established a mismatch between the training content and the reality of work of caregivers. The training puts more emphasis on practical aspects, by providing basic nursing care, often only relevant in helping a bedridden patient. However, many voluntary caregivers reported that the demands placed on them do not end with the death of the patient. This poses a challenge for those in the CHBC training environment as they need to offer relevant and well-researched information linked to the reality of voluntary caregivers' work. The study also highlighted a need to consider the personal long-term goals of volunteer caregivers and begin to realize the importance of using the training to put them on a career path. I therefore argue that the burden of care for people living with HIV and dying from AIDS in resource-poor settings cannot be shifted entirely to communities with the false assumption that they are able to cope. As we continue to grapple with moral and ethical issues in the context of HIV and AIDS, we also need to be concerned about moving women volunteers' efforts from invisibility to visibility through a social transformation agenda. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.

Since 1994 all education policy documents that have emerged in South Africa have stressed the principles of social justice and inclusion by foregrounding issues of equity, redress, quality education for all, equality of opportunity, and nondiscrimination. This study examined inclusionary and exclusionary attitudes and practices at a School of Industry for Girls in South Africa. The research was conducted in the qualitative research paradigm, and took the form of a small-scale ethnographic case study. The data collection techniques included observations and used observations, document analysis, questionnaires and semi-structured interviews. The findings revealed that learners experience various barriers to learning and participation that are clearly embedded in the ethos, curriculum and cultures of the school. Various discriminatory attitudes and practices play themselves out and reflect an intersection of racism, gender discrimination and ableism. The study points towards the need for management and staff in collaboration with learners to interrogate and work towards minimising these exclusionary attitudes and practices prevalent at the school. / Thesis (M.Ed.)-University of KwaZulu-Natal, Durban, 2001.

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.

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 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.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Background: Evidence-based medicine (EBM) involves the care of patients using the best available evidence from the results of good quality clinical research to guide clinical decision making 1 – 3. By incorporating the principles of Evidence-based Medicine (EBM), the family practitioner would be able to treat a patient according to the best clinical research available. This principle is implemented widely in the USA, Canada, the United Kingdom and Europe. In South Africa, however, EBM is not yet as widely incorporated into family practice. This is so despite the plethora of websites available to practitioners and the relative ease with which applicable research evidence can be found. Very few published studies are available regarding EBM or Evidence–based Practice (EBP) in the South African context. The findings of this study would thus highlight reasons and/ or barriers preventing family practitioners from implementing EBM in their respective practices. This could also lead to further research into possible methods of implementation of EBM into South African family practices. Aim: The aim of the study was to describe the perceptions, knowledge and attitudes of private practitioners regarding evidence based practice and to identify the barriers encountered in evidence based practice. Methods A questionnaire survey of general practitioners in Gauteng, South Africa, was conducted. Questionnaires were distributed to a random sample of practitioners in the Gauteng region. Two hundred and twenty one (221) practitioners participated in the survey and responded to questionnaires mailed to them. The questionnaire was mailed, faxed or e-mailed to the practitioners, which they then completed and returned for statistical analysis. Study design The study design is that of quantitative, statistical analysis (descriptive cross-sectional survey). Setting General practitioners were randomly selected from a list of practitioners in the Gauteng Province. Doing a nationwide survey would have been a mammoth undertaking. It was therefore decided to limit the research to one province and therefore it was only concentrated on practitioners practicing in the Gauteng area. Results It is interesting to note that of the two hundred and twenty one participants in this study; only 10% of the practitioners were against using EBM in their practices. This, however, stands in stark contrast to the 56% of practitioners who do not implement EBM in their practices or make use of the EBM principle at all. The major barriers preventing practitioners from implementing EBM is depicted in the following graph: Lack of time and the training in aspects of Evidence-based medicine were the main barriers preventing the full scale implementation of EBM in family practices in Gauteng. Conclusion Participating Gauteng doctors were in principle, very positive towards the implementation of EBM in their respective practices. Most of the participants agreed that EBM would benefit their patients’ care and treatment. Very few of the participants, however, make use of EBM in practice. A lack of training and time constraints were the main barriers with regards to the implementation of EBM. Proper training of medical students at undergraduate level at faculties of health sciences, would go a long way assisting prospective doctors in mastering the concept of EBM and increasing their overall awareness of EBM. Further definitive research would assist in establishing whether such awareness would be associated with improved implementation of evidence in the form of evidence based guidelines in practice.

Thesis (MPhil)--Stellenbosch University, 2012. / Introduction Under-5 year mortality in South Africa is increasing and effectiveness of primary care is a key factor. Adherence to IMCI guidelines by primary care nurses is critical. The IMCI guidelines provide a standardized integrated approach to delivering quality care. Nurses in South Africa are currently using a paper-based guideline. The automated guideline in the format of a convertible personalised computer tablet aimed to improve training in IMCI and the quality of clinical decision making. The automated guideline was designed to systematically guide the nurse through the algorithms thus reducing errors and making care more effective. This study evaluated the use of automated guidelines in improving the training of nurses. Methods A sample size of thirty Professional Registered Nurses (PNs) was selected from the one year Postgraduate Diploma in Clinical Nursing Science at Stellenbosch University. Observational study design compared 15 PNs who used and 15 who did not use the automated guidelines during training. Nurses were compared in terms of their knowledge of IMCI after classroom based teaching and adherence to IMCI in clinical training practices. Results Both groups improved their knowledge of IMCI, but were not significantly different at the end of the classroom teaching. Nurses in the automated group showed significant improvement in their clinical practice (p<0.05): gathering information on HIV risk (50% vs. 93%) or immunisations (68% vs. 93%); making a complete assessment of the patient (61% vs. 100%), prescribing correct medication (50% vs. 85%), correct dose (42% vs. 85%) and safety netting (78% vs. 96%). Conclusion The use of automated guidelines showed potential for improving adherence to IMCI in the Western Cape. Further research is needed to determine if the widespread use of the automated version by PNs translates into better quality of care and improved health outcomes.

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

As a clinic supervisor overseeing a cluster of clinics in the Nelson Mandela Bay Health District (NMBHD), the researcher observed a number of problems with the implementation of the re-engineering of the primary health care (RPHC) programme. The problems observed include inadequate supervision of RPHC staff, poor communication and conflict between clinic and RPHC staff, failure to filter RPHC statistics into clinic statistics and the incorrect management of patients by RPHC staff. Therefore, the purpose of this study is to explore and describe the experiences of professional nurses regarding the implementation of the RPHC programme in the NMBHD and to make recommendations the district manager could use to address the research findings. The study used a qualitative, exploratory, descriptive and contextual design. The research population consisted of professional nurses who are implementing the RPHC programme in the NMBHD, and the sampling technique was a non-probability, purposive technique for the selection of the research sample. Semi-structured interviews were used to collect the data and Tesch’s model respectively. The researcher adhered to ethical considerations throughout the study and ensured trustworthiness of the data by using the criteria of credibility, transferability, dependability and conformability. Three themes were identified; namely; the professional nurses expression of their concerns regarding poor working conditions; issues regarding the community health workers and their positive experiences associated with the RPHC programme. The study concludes with recommendations made to the District manager with regard to nursing practice, as well as recommendations to nursing education and research.