This research is an endeavour to highlight the state of healthcare in South Africa as seen through the eyes of professional health care workers who are at the cold face of healthcare. Having worked in an environment of inequities and unjust circumstances, healthcare workers expressed their attitudes and beliefs that healthcare are in need of radical change. There appears to be insight from these professionals that the private and public healthcare sectors should forge a relationship, ultimately benefiting South African society. More research needs to be done on a major scale to determine more deeply the attitudes and beliefs of healthcare professionals. Such an endeavour will provide a stimulus for policymakers to harness this energy and direct it in a meaningful way in the transformation of healthcare in South Africa. Chapter 1 focused on several relevant perspectives and definitions on healthcare in South Africa and other countries. In Chapter 2, attention was given to socio-economic rights as per the South African Constitution and the states obligations to fulfil these rights. These rights were examined in the context of landmark Constitutional Court cases, viz. Soobramoney versus the State; TAC versus the State; and Grootboom versus the State. These cases give one the essence of interpreting rights and the constitutional obligation of the state to deliver on them. Healthcare developments in South Africa and other countries together with the RDP and GEAR considerations are outlined in Chapter 3. Research Methodology is outlined in Chapter 4, emphasizing also the limitations of this study. Chapter 5 examines the responses to the questionnaires and analyses its findings. Chapter 6 provides the conclusions and recommendations as well as a critique of healthcare in South Africa. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

Perceptions of health and illness which include the perceived cause and recourse play an important role in diagnosis and management of illness. Traditional and allopathic medicines are used simultaneously and sometimes without the knowledge of the health professional and this has an impact on clinical outcomes. Overlooking patients’ subjective experience, health providers’ biases and prejudice may pose a negative impact on clinical outcomes. This study explores patients’, traditional healers’ and psychological counselors’ perception of illness by conducting interviews and administering open-ended questionnaires. The data is analyzed both qualitatively and quantitatively through the use of content analysis and non-parametric statistical procedures. The results indicate that the concept of illness is complex and multidimensional with physical and socio-spiritual aspects. Effective management requires a joint approach between indigenous and western health systems. The results further show that traditional healers fully embrace the integrated health approach while there is some skepticism and uncertainty from psychological counselors which could be stemming from their training. There is still work to be done in terms of health planning and policy but also the training of health professionals. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

The aim of the study was to explore nurses' experiences, attitudes and perceptions regarding the care of patients with the Acquired Immunodeficiency Syndrome (AIDS) before and after the introduction of Anti-Retroviral Therapy (ART) in a rural KwaZulu-Natal hospital .. A secondary aim was to investigate psychosocial stressors that nurses experience and the support they receive in this regard. A qualitative study was conducted and three focus group discussions were conducted before the introduction of ART and five individual interviews were used for in-depth exploration of the health care workers' perceptions of caring for AIDS patients after the introduction of ART. Special attention was paid to nurses' experiences with AI DS patient care and with attention to stress and coping. The AACN Synergy Model was used as a broad theoretical framework for the study to guide the exploration regarding the influence of both nurse and patient characteristics influence the care process within a rural South African context. The findings suggested that before the introduction of ARV-therapy most patients had limited knowledge and understanding of HIV/AIDS disease and its processes. They and other significant others who could be a family member or even friends were marginally involved in the care process. Voluntary Counseling and Testing (VCT) seemed to impact negatively on this situation, and patients were not willing to test and disclose their status to health workers. The knowledge around HIV/AIDS among nurses seemed to be inadequate due to the lack of support and training. They reported being inadequately equipped to deal effectively with caring for their AIDS patients. After the introduction of ARV-therapy, greater involvement of patients on ARV treatment was noted. The participation of significant others in patient management also improved possibly due to their involvement as treatment associates, a requirement of the ART programme. However, the nurses still reported inadequate knowledge not only around AIDS in general but also pertaining ART as well as in the provision of psychosocial support to their patients. The study also revealed that the Synergy Model for patient care, which compares the patient characteristics to nurse competencies can be used to gain insight into patient care and its demands. This model has also suggested weaknesses in nurses' training that need attention. Nurses are expected to use insight into patients needs to improve their competencies to meet the challenges of AIDS patient care and to fulfill their mandate as the key stakeholders on patient care. Lazarus and Folkman's (1984) views on stress and coping were useful in identifying the nurses' coping strategies. The study highlighted specific areas in need of intervention. Formal and informal teaching for both nurses and the patients on HIV and AIDS management needs to be introduced. Patients and families' involvement in decision making and HIV/AIDS disease management should be expanded. HIV counseling and all its components, which are pre- and post-counseling as well as on-going disease management counseling needs to be re-evaluated. There is a need to advocate for a more patient orientated counseling rather than test orientated counseling. Psychosocial support to nurses should be a priority to help them cope with their stressful AIDS caring work. Advocacy for a worker friendly Employee Assistance Program (EAP) should be encouraged by the managers of the institution. Intra-disciplinary and inter-disciplinary communication needs to be improved through innovative strategies. The address of the AI DS stigma within the healthcare system remains a priority and this aspect needs to be incorporated at different levels i.e. basic training, in counseling and within the psychosocial support efforts directed at nurses. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.

Child sexual abuse (CSA) is a problem of increasing intensity both internationally and within the context of South Africa. While various studies have investigated the post-rape experiences of CSA survivors, few have studied these experiences from a child-centred perspective. The current study thus seeks to explore the personal views of children and their ways of seeing the world in relation to their helpful and harmful experiences in the aftermath of disclosure. The sample was taken from an NGO, located on the south coast of KwaZulu-Natal, which deals specifically with issues affecting abused children. The sample consisted of 20 child rape survivors, between the ages of 5 and 17. Qualitative interviews were conducted in isiZulu by a trained Counselling Psychologist, who served the role of both interviewer and counsellor. Interview transcripts were translated into English and analyzed thematically. Data were organized within an ecosystemic framework in an attempt to conceptualize experiences at various systemic levels. Results indicate varying helpful and harmful experiences with regard to familial, community, institutional, and broader macrosytemic levels of influence. Harmful experiences at the institutional level appeared to have to do with the lack of information shared with the children as to the nature of the proceedings, and what was expected of them, rather than with the post-rape medical examination. Reactions of significant others, in particular the primary caregiver, were found to have a significant impact upon the child’s own feelings towards the sexual abuse. Fear of revictimization, disbelief regarding the minimum punishment afforded to the perpetrator, and feelings of being tricked, deceived, and let down by the perpetrator, were other common themes within the data. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Durban, 2010.

Prevention of HIV following sexual assault is an important aspect of rape care. This includes taking Post Exposure Prophylaxis for 28 days. The present study aimed to provide an in-depth understanding of social and environmental factors that predisposed, promoted and also served as barriers to adherence to post exposure prophylaxis to prevent HIV infection after sexual assault in women in the Eastern Cape Province. The study involved a purposive sample of women who were offered Post Exposure Prophylaxis (PEP) after a sexual assault. Sixteen women were accessed at the Sinawe Referral Centre and participated in the study. Their ages ranged from 16 to 73 years. An interview guide was developed to assist the researcher, and semistructured, in-depth interviews were used to collect data. These women were interviewed at the end of 28 days of taking the prophylactic medication. The data were analyzed inductively using grounded theory. Only three women completed the 28 days of PEP treatment. Participants gave different explanations for why they did not complete the treatment with only four participants returning to the centre for their medication. Some reported having no money for transport; others mentioned deciding to discontinue the medication because of its side-effects. Poor support systems, both within the community and the health services, including the provision of conflicting information also played a role. The study showed that few women were able to complete their PEP medication and knowledge about the service and access to it were the main factors that lead to non-adherence. There is an urgent need for the improvement of PEP services particular in the support to the women during the period of taking the PEP treatment to ensure protection from HIV after a sexual assault. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

Submitted in fulfilment of the requirements for D.Tech: Nursing in the Faculty of Health Sciences, Durban University of Technology, 2009. / BACKGROUND In South Africa, Integration of Services Policy was enacted in 1996 with the aim of increasing health service utilization by increasing the accessibility of all services at Primary Health Care (PHC) level. However, the problem with the policy arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. Hence, there is a need for shared views on this phenomenon. METHODS A cross-sectional study, using a qualitative approach was employed in this study in order to analyze IPHC in KwaZulu-Natal (KZN). A grounded theory approach was selected as it is a method known for its ability to make the greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations and interviews. The sample size for interviews was comprised of 38 participants. RESULTS It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop. Based on the findings of the study, it was concluded that the phenomenon, IPHC meant different things in different contexts.

Micro Finance Institutions are being advocated as vehicles to provide poor people with loans to start business enterprises. Micro Health Insurance is offered to insure against the risk of ill-health in the enterprise. An interesting aspect of this initiative is that it is donor driven to service the needs of the poor and the 'unbankable.' However, it was the researcher's considered view that it may not be easy to build a sustainable Micro Health Insurance Scheme for poorer people. The study thus sought to explore the possibility of developing a sustainable Micro Health Insurance Scheme in the context of acute poverty, free health care, the burden of HIV/AIDS and other diseases, the growing informal sector, erratic and unreliable incomes and the nature of risks faced by these prospective clients. To develop a thorough understanding of the subject matter, extensive reading was carried out. The researcher then designed an interviewer-administered questionnaire. The study had a total of 34 respondents, most of whom where members of a Financial Service Co-operatives, which are community-banking structures that provide a range of financial products for poorer people and those in the informal economy. It is clear from the study that these people are faced with a number of risks. There are several problems that may affect the possibility of building a sustainable health insurance scheme. The present study does not provide any statistical evidence but explores the theme of using the concept of risk and vulnerability to understand the poverty in which Micro Finance and Micro Health Insurance is located. The study provides an array of policy options that can be explored to provide for the health care needs of poorer people, as well as suggestions for future research. / Thesis (M.Dev. Studies)-University of Natal, Durban, 2003.

The provision of health in communities and their inhabitants are very important / Thesis (M.A.)-University of KwaZulu-Natal, 2007.

<p>This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners.</p>

<p>Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives.</p>