Introduction: South Africa is currently experiencing one of the most severe AIDS epidemics in the world with South Africa‘s public sector under great stress and under-resourced whilst there exists a vibrant private healthcare sector. Private healthcare sector doctors have a pivotal role to play in the management of HIV and AIDS infection. However not much is known about the extent of private healthcare sector doctor involvement in the management of HIV and AIDS patients. In addition these doctors need to have an accurate knowledge of the management of the infection, and a positive attitude towards the treatment of persons with HIV and AIDS. With the availability of antiretroviral drugs only since around 1996, many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients, further it is very important that these doctors constantly update their knowledge and obtain information in order to practise high-quality medicine. Although private sector doctors are the backbone of treatment service in many countries, caring for patients with HIV brings a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients, in the private sector in developing countries, have highlighted some problems with management thus it becomes important to ascertain these doctors‘ training needs together with where these doctors source information on HIV/AIDS to stay updated. In South Africa two thirds of the doctors work in the private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness on the part of private sector doctors in the eThekwini Metro of KwaZulu-Natal, to manage public sector HIV and AIDS patients. Though many studies have been undertaken on HIV/AIDS, fewer have been done in the private sector in terms of the management of this disease which includes doctors‘ adherence monitoring practices, their training needs and sources of information and their willingness to manage public sector patients. A study was therefore undertaken to assess the involvement of private sector doctors in the management of HIV, their training needs and sources of HIV information, the quality of HIV clinical management that they provided, together with their strategies for improving adherence in patients. Further the study assessed factors that affect adherence in patients attending private healthcare, and finally investigated whether private sector doctors are willing to manage public sector HIV infected patients. A literature review of the barriers that prevent doctors from managing HIV/AIDS patients was also undertaken. Method: A descriptive cross sectional study was undertaken using structured self reported questionnaires. All private sector doctors practising in the eThekwini Metro were included in the study. The study was divided into different phases. After exclusions a valid sample of 931 participants was obtained in Phase 1. However only 235 of these doctors indicated that they managed HIV infected patients, of which only 190 consented to be part of Phase 2 of the study. In Phase 2 the questionnaires were administered by trained field workers to the doctors after confirming doctors‘ consent. The questionnaires were thereafter collected, the data captured and analysed using SP55 version 15. Results: Although 235 (71.6%) doctors managed HIV and AIDS patients, 93 (28.4%) doctors did not, and of the latter 48 (51.61%) had not encountered HIV and AIDS patients, twenty five (26.88%) referred such patients to specialists, six (6.45%) cited cost factors as reasons for not treating such patients, whilst twelve (12.90%) doctors, though they indicated that there were other reasons for not managing HIV infected patients, did not specify their reasons. Two doctors (2.15%) indicated that due to inadequate knowledge they did not manage HIV and AIDS patients. Significantly younger (recently qualified) doctors rather than older (qualified for more years) doctors treated HIV/AIDS patients (p<0.001). Most doctors (76.3%) expressed a need for more training/knowledge on the management of HIV patients. Eighty five doctors (54.5%) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8%) to initiate therapy. Of the doctors 134 (78.5%) initiated therapy at CD4 count < 200cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI +1 NNRTI combination. Doctors who used CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p<0.001). At initiation of treatment 68.5% of the doctors saw their patients monthly and 64.3% saw them 3-6 monthly when stable. The majority of the doctors (92.4%) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME), textbooks, pharmaceutical representatives, workshops, colleagues and conferences were identified as other sources of information, while only 35.7% of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9% versus 72.7%; p < 0.05) and conferences (48.6% versus 78.8%; p < 0.05) as sources of HIV information. Of the respondents, 78.9% indicated that they monitor for adherence. Comparison of GPs and specialists found that 82.6% of the GPs monitor for adherence compared to 63.6% of the specialists. (p=0.016). Doctors used several approaches with 60.6% reporting the use of patient self reports and 18.3% pill counts. Doctors (68.7%) indicated that their adherence monitoring is reliable, whilst 19.7% stated they did not test the reliability of their monitoring tool. The most common strategy used to improve adherence of their patients was by counseling. Other strategies included alarm clocks, SMS, telephoning the patient, encouraging family support and the use of medical aid programmes. One hundred and thirty three (77.8%) doctors were willing to manage public sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling was the distance from public sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). There was no statistical difference between adherence to treatment and demographics of the respondent patient such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for non-adherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included that tablets would save their lives (83.6%); they understood how to take the medication (81.8%); tablets would help them feel better (80.0%); and that they were educated about their illness (78.2%). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusion: All doctors in the private healthcare sector were not involved in the management of HIV/AIDS patients. Doctors indicated that they required more training in the management of HIV/AIDS patients. However private sector doctors in the eThekwini Metro do obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients, with the majority of private sector doctors being compliant with the current guidelines, hence maintaining an acceptable quality of clinical health care. These doctors do monitor for adherence and employ strategies to improve adherence in their patients who do have problems adhering to their treatment due to various factors. Many private sector doctors are willing to manage public sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

Worldwide, it has been recognised that local governments are uniquely placed to bring about positive environmental change in their areas of jurisdiction. This research was conducted to assess how one South African local municipality, the eThekwini Municipality, Durban, is faring in its efforts to achieve sustainability. Hajer's (1993, 1995, 2003) discourse approach to environmental policy making was used as the key theoretical and methodological basis of the research. This approach recognises the power of discourse in shaping how society's relationship with the environment should be managed and sustained. In global environmental politics, ecological modernisation has emerged as the dominant environmental policy discourse and reflects a weak approach to sustainability. An alternative is the strong sustainability discourse, which argues that sustainability cannot be achieved without giving attention to issues of social and environmental justice and including local communities in environmental policy making. These two discourses are used to structure the assessment of environmental policy discourse in the eThekwini Municipality. A recent municipal project, "eThekwini Catchments 2002: A Strategic Tool for Planning" was used as the research case study. The project provides an assessment of the environmental health of each of the 18 river catchments identified in the municipal area, using environmental indicators. The intention of the project was for this information to be used by municipal planners as a tool for environmental decision-making. Municipal officials, representing several municipal sectors, and the project consultants were interviewed to determine their perspectives on the project. The interview transcripts, as well as the Catchments Project report and other municipal documents, were analysed using Hajer's discourse methodology to uncover the key discourses operating in the municipality that influence environmental policy making. Municipal discourse was then reviewed in terms of the EM and strong sustainability discourses to determine whether the municipality is moving towards stronger sustainability. This research also contributes to an improved understanding of how discourse shapes environmental policy projects and their outcomes. By identifying the environmental discourse dynamics at work, it is possible to stimulate a more deliberate approach to environmental policy making to bring about positive environmental change in the municipality. / Thesis (M.Sc.)-University of KwaZulu-Natal, 2004.

International mass sports gatherings like the FIFA (Federation Internationale de Football Association) World Cup Soccer and Olympics can cause great challenges to local healthcare systems and emergency medical services. History has shown that disasters do occur during these events, whether on a small or large scale. Disaster Management Practitioners from the public health perspective widely recognize that poor planning and a range of other underlying factors, create conditions of vulnerability. These result in insufficient capacity or measures to reduce hazards’ potentially negative consequences. The eThekwini District has to be prepared in the event of a mass disaster. Pre-empting and planning for disasters will lead to the safety and security of our citizens. The aim of this study was to undertake a baseline survey (in a total number of eleven public sector hospitals) to assess the state of hospital readiness, medical preparedness, and emergency care in preparation for the 2010 FIFA World Cup Soccer in the eThekwini District. A general assessment tool in the form of a standard questionnaire, and a walkthrough visit with a checklist, was used to collect data. There is no previous study conducted at the eThekwini District to assess requirements for an international event in terms of a mass disaster. South Africa is a developing country, and this was the first time any developing country had hosted a sporting event on such a large magnitude thus there are no international standards on sports disaster management by any other developing countries to generalise to eThekwini District. The current disaster management operational plan that is being used for the World Cup is based on a United Kingdom integrated management philosophy tool. The study herein adopted a public health approach and incorporates the Yokohama Strategy within its tool along with the use of HMIMMS and MIMMS in the assessment of the clinical criteria. The perceived minimum requirements suggested by the hospitals and a Provincial Task Team, from the Provincial Health Disaster Management office, was used as a guideline. The study showed that although disaster plans and policies are in situ, there still exists a need for resources to be directed toward skills training, attraction and retention of healthcare professionals, revitalisation of emergency and theatre areas and the commissioning of more isolation units. The results of the study would enable the District Office to note any shortcomings and lack of resources in public sector hospitals. The study outcome would be important for the implementation of any strategic planning to aid the hospitals in preparation for mass disasters that may occur during the 2010 FIFA World Cup Soccer. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

In March 1999 the former Durban Metropolitan Council embarked on several pilot studies to test the applicability of some early thinking around a new Land Use Management System with the aim of casting a single and uniform approach to managing and controlling the development of land and buildings within the municipal area. The studies were necessary as post 1994 the municipality and many other municipalities across the Province had inherited fragmented, unequal and incoherent planning systems, which were developed under apartheid. One of such pilot areas is Cliffdale where new land use management approaches were applied to a semi-rural area through the adoption of a new Land Use Scheme. The aim of this dissertation is to evaluate these approaches that were applied to the Cliffdale Land Use Scheme, given that it is 5 years old and new frameworks, ideas and practices have been developed over this period. At the time of compiling the pilot scheme, there were also limited datasets and information available to inform the developing of the new approaches. Subsequent to this pilot study, a similar Provincial wide initiative was launched which resulted in the preparation of a Land Use Management System Manual in 2001. The aim of the manual is to guide municipalities towards applying a uniform approach to land use management and the preparation of municipal Land Use Schemes. The Manual was further reviewed in 2004. This dissertation also looks at the success of the Cliffdale Land Use Scheme in comparison to the existing Town Planning Scheme model and the new Provincial Land Use Management System. In order to achieve this, interviews were conducted with key people who have experience in the new land use management system. Theoretical research was undertaken on other case studies, precedents and new data sets and information. Findings indicated that the new land use management approaches are an improvement to the current Town Planning Scheme model. The approaches however can be further improved through the availability of new datasets, information and concepts that have emerged from other case studies and precedents. / Thesis (M.T.R.P.)-University of KwaZulu-Natal, 2005.

This thesis set out to examine the application of the supporter paradigm in the incremental housing process in South Africa, and the way support for housing consolidation has been orchestrated in practice. It aimed to determine the forms of housing support that constitute preconditions of housing consolidation in the South African low income housing context. The supporter paradigm upon which post-apartheid housing policy is based takes its cue from the proponents of self-help housing, and the institutions that have entrenched it internationally. It outlines the housing support actions that would enable poor households to achieve housing adequacy incrementally . In South Africa, such households would constitute housing subsidy beneficiaries, seeking to achieve housing 'depth' through the process of housing consolidation, where the national subsidy programme would primarily only have delivered housing 'width' , or housing starts. Contrary to the expectations of the policy, the pace of housing consolidation has been slow, and the standard of the resultant housing poor. The thesis ' point of departure is that households which have not improved their dwellings, or whose improvement efforts have only yielded temporary housing, continue to experience housing inadequacy, despite subsidy support. This outcome contradicts the policy 's goal of enabling households to reach housing adequacy. That subsidy support is but one of a number of supports needed to enable housing consolidation is acknowledged by current policy. This study critiques the way support has been lent to households in consolidating situations conceptually and empirically. Conceptually, the study analyses the international and South African policy discourse around the support approach to housing delivery, as well as looks at some precedents in housing support practice internationally for useful lessons. Empirically, the study makes use of qualitative and quantitative research instruments to examine and analyse the housing support experience in three different types of incremental housing projects, located in eThekwini municipality, in the KwaZulu Natal Province of South Africa . The housing support findings are analysed within the context of what both the housing policy and the study 's key informants consider to be a holistic packaging of housing support, that should be attendant to any incremental housing project. On the basis of the study's findings, housing support practice is critiqued on two levels. At policy level, the study reveals that the foundation of South African housing policy in a neoliberal context, in the absence of support targeted at improving the incomes of the mainly very poor beneficiaries, sets them up for failure in their housing improvement efforts. At the implementation level, the study identifies three key areas of weakness. Firstly, there is absence of strategic direction at the National level, resulting in the treatment of housing support as an optional function by the housing implementation levels. Secondly, most housing authorities experience difficulty in understanding what housing support entails, because of its multifaceted nature and lack of specificity . Consequently, the support attendant to incremental housing projects is ad hoc and intermittent in nature, and is delivered on the basis of how the particular authorities or project staff understand housing support. As a result, in any given project, housing support is rarely comprehensively packaged. It is also largely an unfunded mandate. Thirdly, at project level, the thesis establishes that many of the problems that confront consolidating households can be attributed to projects that are poorly planned from the outset, and that support in this regard lies in the development of capacity at municipal level, to plan projects that have the potential to be consolidated in the first instance. As its main contribution, the thesis develops a multidimensional, comprehensive framework for packaging housing support. One dimension specifies upfront, the support elements considered important in the pre- and post-subsidy phases of the project, as well as in the project implementation phase. The exact form these would take in any project would be informed by the project and beneficiary characteristics. The second dimension packages the institutional roles for housing support, thereby removing the institutional ambivalence towards the housing support function, and specifying the institutional and role changes needed to enable housing support to occur. The third dimension packages support according to project type, indicating which forms of support apply to all types of projects, and which to specific modes of delivery in the South African context. The study concludes that while current housing policy is clear on the need to support households to meet consolidation goals, specificity of both process and actions needs to be lent to housing support practice. The multidimensional support package developed by the study is deemed a useful tool in providing such specificity, and clarifying how support for housing consolidation in South Africa should be set up in both policy and practice. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008.

In an effort to protect key environmental assets in the Outer West Region of the eThekwini Municipal area, the Environmental Management Department has embarked on a process to better align environmental concerns into the Consolidated Outer West Town Planning Scheme. The intention is to create sustainable living environments by recognising the importance and value of the environment and its open spaces. Ultimately the research is attempting to understand the difficulties in implementing sustainable development. Sustainable development has been acknowledged at a policy level in the eThekwini Municipality’s Integrated Development Plan; however the translation of sustainable development into implementation is more difficult. Part of the complexity relates to different sectors within the Municipality such as the Environmental Sector and the Economic Sector viewing sustainable development differently. The research focuses on the rapid densification in the Outer West adjacent to environmental resources by private land owners which highlights the lack of understanding by the public on the importance of the environment. Further, the conflicts between the need for economic development and environmental conservation in the context of the Giba Gorge area, show that historical zoning ‘rights’ operate against the protection of bio-diversity. This reinforces the need for better alignment between the environmental protection and land use management. / Thesis (M.T.R.P.)-University of KwaZulu-Natal, Durban, 2008.

Land use management and development control play an important role in achieving integration and sustainability in developing societies such as South Africa today. Town Planning Schemes are generally used as a tool for achieving this by making provision for land uses that are freely permitted, permitted by special consent or prohibited, thereby ensuring that incompatible land uses are not allowed. However, these town planning schemes are interpreted by different officials, with different levels of planning experience and qualification, as well as different opinions in the interpretation, which can result in inconsistency in decision-making and subsequent development patterns. The aim of this dissertation is therefore to investigate a range of special consent applications, the decision-making process applied to them and the applicability of any conditions attached thereto. The spatial focus of this dissertation is the South Municipal Planning Region of the Ethekwini Municipality which was established during the 2000 demarcation process. Inherent is this amalgamation is the fact that there are now thirty eight different town planning schemes in the Municipal area, with nine of them found in the South Municipal Planning Region. / Thesis (M.T.R.P.)-University of KwaZulu-Natal, Durban, 2008.

Disabled people live in a complex world encompassing the same interests and desires that motivate the balance of the earth's population. We have always known this, but as is often the case, society often plans without considering the needs of disabled people. Progress toward the acceptance of disabled persons as total human beings has not come about because equality is not a reality for disabled people. A point of departure for this research is therefore that disablement is a relation to the surrounding world, not a static phenomenon. It should perhaps be emphasized that this “relation” applies not only to the physical but also social environment. It is hoped that this study will demonstrate the inequalities that disabled people have to contend with, with reference to services such as housing, transportation, education, employment and recreational opportunities. The attitudes, value judgments and expectations of society and the disabled themselves contribute to the creation or breakdown of barriers to full participation and equality. It is recommended that a great deal more be done to achieve the equality that disabled individuals so rightly deserve especially in regard to the promotion of self-dependent life leading to enhanced quality of living. / Thesis (M.T.R.P.)-University of KwaZulu-Natal, Durban, 2008.

Small, Medium and Micro Enterprises (SMMEs) are considered to be the engines of growth of any economy. In the light of recent economic events and the recession that is surging rapidly across the globe, more and more attention is being focused on SMME development and support. Whilst there are a number of organisations (both public and private) which provide support to SMMEs within the eThekwini Municipality Area (EMA), the overall impacts of these initiatives on SMME growth and development is minimal and there is a dearth of studies that critically examine business support services for SMMEs which the public and private sectors provided. One of the major reasons for this minimal impact is the lack of communication and coordination between various service providers which often results in fragmentation and duplication of services. This study analyses the support measures offered to SMMEs not only from the perspective of the SMMEs themselves but also examines the perspectives of service providers from both the public and private sectors. This study is also placed within a multi-disciplinary conceptual framework which includes the political economy approach, neoliberalism, the public-private-sector debate and empowerment theories with specific reference to the South African context. This study is unique in that it analyses SMME development and support within the EMA from various perspectives within a single study. The objectives of this study were to investigate the awareness and experiences of SMMEs with regards to their support and development and also to critically examine the attitudes and perceptions of service providers (both public and private) towards SMME development and support. In addition, this study sought to assess the capacity of both the private and public sectors to provide effective support and development to SMMEs. An additional objective of this study was to determine the value placed on support measures by determining SMMEs’ willingness to pay for services provided, but more importantly to determine the attitudes of the public and private sectors towards the payment for services offered. Both qualitative and quantitative methods were adopted. In terms of the latter, quantitative surveys were conducted with 250 SMMEs who attended various fairs and conferences held across the EMA. Semi-structured interviews (qualitative approach) were conducted with representatives from the private and public sectors that provide support or services to the SMMEs in the EMA. In this regard, 53 representatives from the public sector and 50 from the private sector were interviewed. The analysis was undertaken thematically and, where relevant, findings pertaining to the different stakeholders interviewed were compared and discussed. Some of the key findings indicate that SMME respondents were more aware of local government and the services they provide than any other tier of government. Furthermore, SMME respondents within the study did not fully grasp the concept of Business Development Services (BDS) and the associated benefits for their business. SMMEs rely heavily on government to provide services free of charge. The main finding is that private sector service providers are better qualified, positioned and trained to provide BDS than the public sector whose main roles should be that of regulator, facilitator and promoter. Whilst government has been a strong proponent of SMME development and support since 1994, this study presents a strong case for the increased role of the private sector. In addition, this study also motivates that local government through their Municipalities can play a significant role in SMME development and support in partnership with the private sector. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.

After decades of optimistic theories of development, increasing global poverty and inequities remain at troublingly high levels. By the close of the twentieth century the development enterprise was accused of having “…reached an impasse, trapped within its own meta-narratives and unable to capture the diversity of the third world in any relevant and constructive manner” (Abrahamsen, 2000: ix). Similar observations have been made by Binns and Nel, (1999), McMichael (1996), Rivero (2001) and Rihani (2002) among others. These observations raise fundamental suspicions on the traditional approaches to development. The emerging consensus tends to favor bottom up approaches to development, anticipating that these might be better equipped to address underdevelopment. Thus the concepts of democratization and decentralization feature centrally in the prevailing literature. Literature seems to suggest that these emergent discourses have absorbed assumptions and contradictions. This in turn has rendered these discourses potentially deficient of meaningful impact. The specific task of this dissertation is to investigate participation issues in integrated planning. This will be achieved through assessing small businesses related LED in eThekwini municipality. Integrated Development Planning is a process through which South African municipalities prepare a strategic development plan, for a five year period. The Integrated Development Plan (IDP) is a product of the integrated development planning process. The IDP is a principal strategic planning instrument which guides and informs all planning, budgeting, management and decision-making in a municipality. Since the IDP involves participation of a number of stakeholders, it is crucial for the municipality to adopt an appropriate approach and also put in place appropriate structures to ensure effective participation. Here are some principles on participation: · The elected council is the ultimate decision-making forum on IDPs. · The role of participatory democracy is to inform, negotiate and comment on those decisions, in the course of the planning/ decision-making process. · Public participation has to be institutionalised in order to ensure that all residents of the country have an equal right to participate.” (Republic of South Africa, undated). Cornwall (2006:63) has already expressed serious worries on the way participation has navigated the development industry. For its part, she argues, “…contemporary participation discourse represents a reflux of strikingly similar policies, sentiments and pronouncements from a barely-remembered colonial past. Alongside the significant continuities in discourse and practice that span the colonial and post-colonial eras, the genealogy of participation in development reveals discontinuities and dissonances, broken records and broken promises” Within Cornwall’s concerns, this research project sought to understand the degree in which tendencies of top down approaches might still thrive in South Africa’s Local Economic Development discourse in regards to small businesses, despite policy commitments to participatory planning and governance. The findings suggest an urgent need to revisit the conceptualization of participation mechanisms. They further suggest this would impact on the approach to LED programs, and in particular those relating to small business development. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.