M.Com. / Please refer to full text to view abstract

M.A. / Through experience and interviews held with industrial social workers and because of changes in the environment, it was found that the industrial social worker is unsure of what is expected of him/her and of the direction in which the profession is going. The future and priorities are vague and there is uncertainty regarding how to prepare for it. The aim of this study is to define the role and function of the industrial social worker as it currently exists in the industrial environment and to provide a future scenario for industrial social work ...

M.Tech. Construction Management / The delivery of low income housing in South African Public Subsidized Schemes is plagued with quality issues, inevitably leading to poor levels of client and more importantly, end-user satisfaction. The characteristics of Small and Medium Enterprise (SME) contractors who operate in this sector, together with external factors in the operating environment, all contribute to poor quality. Quality Management (QM) practices among the contractors are not widely documented hence, this study aimed to explore these practices in the Gauteng low income residential sector. Therefore, the objectives of the study aimed to establish the following: current QM practices; adequacy of such practices; barriers to effective QM practices and the presence of critical success factors for effective QM practices...

The objective of this dissertation is to examine and evaluate the effects on housing supply of the fragmented administration and expenditure methodology of the Gauteng government. The interrelationship between the supply and demand for houses in a country such as South Africa with its dualistic economy is for historical, as well as socioeconomic reasons, complex. Differences in the supply and demand of housing for the racial groups as identified in the socio-economic policy, known as apartheid, determined expenditure of all administrations up to the beginning of the nineties. Not only were the policy objectives of that time mainly aimed at looking after the interests of the white component of the population, but the outspoken objective for many years, if not for decades, was to keep the standard of accommodation for blacks at a level that would enhance their desire to return to the so-called Homelands or National States. Migrant workers, mostly blacks from the Homelands, were accommodated in hostels run by government (in most cases) or the private sector (mainly mines). It was single-sex accommodation (men only). Their families had to remain in the homelands as their permanent residence. The living conditions in these hostels were poor with an approximate bed:person ratio of 1:2,8 and toilet:person ratio of 1:100. The aims of the hostels were to keep wages low as well as to control black urbanisation. (Rust 1996:139) In its “Policy for the Upgrading of Public Sector Hostels” of 1994, the Department of Housing defined several objectives for the upgrading of the hostels. / Prof. A.G. Nieuwenhuizen

This study investigated the extent and scope of citizen voice in public decision-making in the Gauteng Provincial Legislature (GPL) from two theoretical perspectives. It is structured around three components; an in-depth exposition of the literature on citizen participation, application of two theoretical frameworks applied to the scope of citizen voice in the GPL and an applied case study approach. This study found that the literature ascribes multiple meanings to citizen participation and that there are incongruities in the manner in which the literature conceptualises, describes the mechanisms, and outlines the intentions, and outcomes of citizen participation. Citizen voice in the GPL is deemed to be contextual to and influenced by the interplay of the socio-political environment, multiple interests, values and sub-systems. The case study approach allows for an expanded analysis of the implicit power dynamics in the GPL and the institutional political processes on the nature and extent of citizen voice. In this study citizen voice is regarded as an opportunity for direct, representational and/or institutional expression of citizen interests in public decisions consolidating democracy, citizenship and legitimate government.The GPL’s policy documents point to a stated intent of democratic public participation conceived and pursued as citizen control, empowerment and partnership. However the conclusion is that this participation vacillates between information sharing and consultations, but not decisionmaking control. The study asserts that the theory on citizen voice in public decision-making is under-developed and there is a disconnection between the literature and citizen experiences.

Faculty of Humanities School of Social Science / Since its inception in 1994, South Africa’s federal system of government has been the subject of intensive scholarly debates and wide-ranging academic writing. In particular, the functioning of the country’s provincial institutions has engendered heated public debates over the years about whether or not they have played their proper role as institutions of democratic governance. The major challenge that faced the framers of the country’s new constitution, and which continues to face policy makers currently, was to create functioning and effective democratic institutions of government at sub-national level. In addition to their role as democratic/political institutions of governance, the provinces are also agents of socio-economic development and the delivery of basic social services to citizens. In the course of attempting to fulfil their functional responsibilities since 1994, the provinces have encountered enormous political, constitutional, administrative and logistical problems that have led to widespread dissatisfaction about their performance and effectiveness. In fact, this dissatisfaction has also led to fundamental questions being raised about the future of the provinces in South Africa. This thesis seeks to evaluate the performance and effectiveness of the provincial system during the 1994-2004 period, by looking at the question: to what extent has the provincial system of government fulfilled its responsibilities of promoting democratic governance and ensuring effective delivery of social services to citizens at sub-national level? It also provides an in-depth examination and analysis of the development of South Africa’s federal system of government between 1994 and 2004. The study utilised a wide range of research materials gathered through in-depth interviews, an opinion survey, direct observations, official documents, published and unpublished documents, and numerous other sources.

This study aims to explore the experiences of traditional healers who work in a hospital environment in a different capacity. A secondary aim of this inquiry is to look at how participants' perceptions of the interface between traditional and modern medicine in a hospital context influences their practices as both traditional healers and hospital employees. A snowball sampling strategy was employed and five suitable participants were identified through referral and post-interview selection. Participants were selected from a sample of South African-born women who have experienced an ancestral calling and initiation into African traditional healing, have been initiated as an Inyanga/iSangoma (diviner), and are presently working in a different vocational capacity in a hospital environment. All participants work and reside in Gauteng. Data was collected through two semi-structured interviews per participant. Interviews were based on an interview guide. In looking at participants' experience as traditional healers who work in a hospital and how their perceptions on the interface between traditional and modern medicine influence their traditional healing practices, four research questions have been identified: 1. How do participants perceive themselves as a traditional healer? 2. How do participants perceive and experience their work in the hospital? 3. How do participants perceive the interface between traditional and modern approaches to healing in a hospital context? 4. How do participants experience the perceptions of others at work? A qualitative approach was adopted in order to gain an in-depth understanding of participants' experiences. Data analysis was guided by narrative and thematic approaches. Thus results are presented in accordance with principles of narrative and thematic content analysis. Interpretation of data focused on the ways in which these women relate to their role as traditional healer in a different vocational capacity and how their perceptions reflect a broader dialogue on the relationship between traditional and modern healing modalities in a modern health care context. Participants felt empowered by some colleagues who consulted them on traditional healing skills and applied them to patients without constraint upon their working duties. All felt they needed their jobs to support a decent living as full-time work as traditional healers would not provide for all their needs. Implications for future research and collaboration between western and traditional healing systems are considered.

Faculty of Humanities School of Social Sciences 9304636m kalombo@hse.pg.wits.ac.za / The objective of this study was to unveil the effectiveness of current strategies put in place to thwart the root causes of corruption and its damaging effects on economic growth and political development in the Gauteng Provincial Government. To achieve this purpose, this thesis looked at the incidence of political corruption in South Africa in general and Gauteng in particular, in an attempt to ascertain the implication of the political and historical legacy of corruption on democratic governance. This work is an attempt to raise awareness and understanding of the problem of corruption, more a step toward transparency and accountability. The research project is positioned within the qualitative paradigm at the preliminary stage to establish a historical background of political corruption. And within the quantitative research at the second stage that required establishing from the preliminary research a sizeable sample of (approximately 100) key individuals and people in the field of corruption to which detailed questionnaires were distributed. The main findings as shown from the Gauteng experience were that in Gauteng, cases of corruption were widespread in almost all departments where public servants exploited state structures and used them to extract benefits for their own gains. However, the departments the most vulnerable to corrupt practices were those of Housing, Safety and Security, Transport and Public Works, Education, Welfare, Local Government and Health. As discovered, areas such as affirmative action, tendering or the expanded provision of benefits (e.g. in Housing, Welfare or Education) are areas that are vulnerable to corruption and are all associated with transformation/democratization projects. However, the incidence of corruption in the province can be explained by Gauteng’s lack of a “traditional” culture base that may make leaders especially susceptible to acquisitive and individualistic forms of behaviour. As a result corruption impacts negatively on the political process by undermining the legitimacy of the state and economically by impeding developmental strategies, as “corruption leads to loss of much needed revenue and human talent for development, distorts priorities for public policy, and shifts scarce resources away from the public interest … Political instability, corruption, and underdevelopment are mutually reinforcing” (Elliot: 2001:926). vi In terms of anti-corruption measures, the study has found that Gauteng is on the right path, as anti-corruption measures applied in the province suit those applied at the national level, that in turn are in the same line with international practices. The study argues that while Gauteng anti-corruption measures have succeeded in reducing corruption levels, they have not stopped it, as new cases surface almost every week in the local press. Thus there is still room for improvement if the Gauteng government aims to succeed. The researcher has recommended that there is a need for common guidelines and coordination strategies amongst internal departmental anti-corruption units that have been established and the initiation in each department of its own monitoring and evaluation capacity. This means the build-up and the improvement of internal audits and controls by higher authority applicable to both officialdom and the business sector. Finally the study assumes that many other examples of strategies to fight corruption could be provided, however, the ones provided are sufficient to argue the point that in many cases the fight against corruption cannot proceed independently from the reform of the state. In many ways it is the same fight. The study’s major conclusions concern those general assumptions about the relationship between democracy and good governance, which characterize certain theories concerning the causation of corruption, need to be revised. Even the most authoritarian systems, as was apartheid, were able to control the levels of corruption and keep it at an economically viable level. To this end, other mechanisms such as accounting standards and audits and direct accountability of leadership in government need to be strengthened alongside with the protection of whistleblowers. But the end result is that several factors associated with these mechanisms have highlighted the fact that transparency and the resulting exposure have increased opportunities for graft. In more democratic and open societies, besides greater civic engagement, the chance of closer monitoring and exposure of corrupt officials and politicians is higher than in no democratic society. Freedom of the press and of association leads public interest groups to expose abuses of power. While democracy seems to decrease corruption, both variables interact strongly with the level of transition. Hence the needs for more research on the actual effect of democratization in government departments that will serve the cause of anti-corruption campaign better.

In November 2003, the Department of Health launched the Operational Plan for Comprehensive Care, Management and Treatment (CCMT) for South Africa. This policy has as its central goal universal access to antiretroviral therapy to 1 million people living with HIV by the end of 2007. National implementation of the operational plan began in April 2004 and as at the end of October 2006, South Africa had initiated 213 828 people onto ART through the Plan, making it the biggest programme in the world. Of these, 55 580 people had been placed on treatment in Gauteng Province. Despite these early achievements, there are concerns as to whether the South African public health sector can rise to the challenge of universal access while achieving good clinical outcomes and programme performance. As Venter (2006: 298) states, “the health sector is buckling under the current load, and currently does not have the capacity to do anymore than dent the numbers needed to treat, unless a radical restructuring of health services occurs.” A crucial factor in providing a comprehensive approach to HIV/AIDS is the reorientation of service delivery from acute to chronic disease care. In addition to the shift in focus to chronic disease management of HIV/AIDS, health system constraints need to be addressed. These include inadequate health system infrastructure and human resources. This study aimed to comprehensively assess organisational capacity to provide antiretroviral therapy (ART) in two public sector CCMT sites in Gauteng Province and the influence of these organisational factors on follow-up and adherence to ART, with the view to understanding whether public sector CCMT sites are able to deal with new challenges posed by the Plan. The objectives were to assess: (1) levels of follow-up and adherence in patients registered at the CCMT site, (2) dimensions of organisational capacity, drawing on internationally recognised chronic disease care frameworks, namely the Wagner Chronic Care Model (CCM) and Innovative Care for Chronic Conditions (ICCC). These dimensions were: presence of motivated and adequately staffed teams; delivery systems design; the quality of support systems; and facility information systems. 3) the similarities and differences between the two sites with respect to organisational capacity, follow-up and adherence. The two sites were selected through a stratified (CHC and hospital) random sample of CCMT sites in Region A of the province, excluding the long–standing and well-established academic hospital CCMT sites in the sampling frame. The two sites, located in a District Hospital in the West Rand and a Community Health Centre (CHC) in Central Witwatersrand, were visited between May and July 2006. They had initiated 540 and 1001 patients on ART respectively since October 2004. A multi-method health service evaluation of capacity in the HIV related services (ART/Wellness, VCT, PMTCT, and TB) was conducted. This consisted of 11 semi-structured interviews with facility and programme managers; review of registers and routine facility data; an observation checklist and mapping to assess the physical infrastructure of the facility, presence of management and health information systems; 35 self administered questionnaires to assess the levels of motivation of nursing staff at each site. Data on self-reported adherence and viral loads were obtained from a separate study involving exit interviews with 356 patients who had been attending the services for at least four months in the two sites.1 Of the 540 and 1001 patients enrolled in the two services, 69.8% and 69.3% were still in the service after 18 months at the hospital and CHC, respectively. The monthly drop-out rate at the hospital had risen fairly sharply towards the end of the 18 month period, attributed by the staff to growing difficulties in access to the site by new enrolments. Nevertheless, based on self-reports (3- day recall period), viral load measures, and loss to follow-up, adherence levels at both sites appeared to be in line with national and international best practice. The percentage of patients with undetectable virus was 76.2% and 74.4% at the hospital and CHC, respectively. Staffing of the CCMT sites matched the pre-requisites outlined by the National Department of Health for a ‘core’ health care team treating 500 patients. The CHC CCMT site, however, had more than 500 patients on ART and moreover was providing two services within one unit, i.e. ART/Wellness and VCT thus increasing the patient load. Sites were reaching saturation and this was due to the lack of sufficient space coupled with the high volumes of patients, shortage of certain scarce skills (in particular pharmacy staff), and the multiple responsibilities of nursing staff. In general, the staffing situation at the hospital appeared better. More staff had joined than left the hospital over the year prior to March 2006, and clinical workloads both in the ambulatory services and the CCMT site were less than at the CHC. Vacancy rates were low, at 13.8% and 4.8% for the hospital and CHC, respectively. Strong leadership of CCMT sites by motivated ART programme managers was displayed; site managers were highly respected and revered by staff. Based on ratings in a self-administered questionnaire, overall levels of motivation and organisational commitment at both sites appeared good, although, worryingly, a sizeable proportion of respondents in both sites agreed with statement “I intend to leave this hospital/clinic.” Lack of external support (from the HIV/AIDS, STI, TB Programme) and debriefing systems for programme managers and nursing staff was identified as weaknesses. With some exceptions, both sites showed evidence of strong ‘horizontal’ mechanisms of referral and coordination between HIV and AIDS related services within sites; however the PMTCT programme at the hospital was less co-ordinated and networked with other services. In addition, ART and PMTCT programme managers at the hospital indicated that the relationship between hospital services and surrounding clinics was poor. Apart from the lack of space at the CHC CCMT site, support systems were adequate. There were no reported drug stock outs and supply of drugs and general supplies was good at both sites. Both sites were able to offer a range of routine and HIV specific tests. A combination of paper and electronic based information systems were used at both sites, however, the hospital CCMT site used a mixture of standard and locally designed data collection forms compared to the CHC which mainly used standard Department of Health forms. The information systems were adequate in monitoring and evaluating patients and programme performance; however, the study highlighted the absence of a clear patient register for individual and programme monitoring and only cross sectional patient data was reported. There was also considerable duplication at the hospital in collecting and compiling patient information. The findings of the study suggest that the two sites, located in the ‘routine’ public sector environment of Gauteng Province have demonstrated ability to build organisational capacity for ART provision, through a degree of systems integration and design, decision support systems, generation and local use of information and motivated local champions. Through these elements of organisational capacity, both sites have achieved good adherence rates. The key factors to achieving this good programme performance were motivated local champions who drove programmes forward and good working relationships between the CCMT and other players. In light of the weaknesses identified, the following key recommendations are proposed: Review sites to identify the reasons for the high-drop out rate and address these issues Due to evidence of early saturation at the CHC, it is suggested that additional roll-out sites be established, or alternatively increase staffing and space at the CHC to meet the needs of the high patient load. In addition, well patients should be decanted to lower level services e.g. community based care organisations, thus reducing the burden on the site Pay attention to the physical infrastructure needs of clinic based sites, especially as they become saturated Foremost, the current Employee Assistance Programme (EAP) implemented in Gauteng Province should be strengthened and marketed so that staff members are more aware of the service and make use of it accordingly. Alternatively, a culture of “caring for the caregivers” should be cultivated, through for example, specialist assistance, debriefing sessions, and better external programme support from HIV/AIDS, STI, TB (HAST) managers Improve support and supervision of ART programmes by facilitating greater communication and feedback between sites and district, national and provincial levels of government. Adopt a strategy of “task shifting”, through better use of lay workers, counsellors, and mid level workers such as pharmacy assistants. Facilitate greater integration and coordination between the PMTCT programmes and other services, including the provision of VCT and training of staff. In addition, it is imperative that there is good integration between services provided by local and provincial Departments of Health Simplify and standardise information systems, particularly the development of clear patient registers to allow for cohort analysis.

MPH, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Introduction: There are high levels of dental caries, gingival and periodontal diseases and a lack of oral health awareness in the wider South African population. Thus every district’s oral health strategy must include disease prevention and health promotion approach. Oral hygienists are the main drivers of these services in the public sector. Aim: To determine the activities of oral hygienists in the public sector in Gauteng and KwaZulu – Natal provinces. Objectives: 1) To obtain the demographic profile of oral hygienists employed in Gauteng and KwaZulu -Natal provinces. 2) To determine their current duties, tasks and responsibilities. 3) To identify factors that may hinder the provision of services. Methods: This was a cross sectional descriptive study and data was collected by means of a self administered questionnaire that was hand delivered to all oral hygienists employed in Gauteng and in KwaZulu - Natal provinces in 2005. Results: Thirty two oral hygienists (78%) responded to the questionnaire, 94% of whom were female with an average age of 37 years. Twenty three (72%) were Black, 6 (19%) White, 2 (6%) Indian and 1 (3%) Coloured, with an average iv working experience of 10 years. Almost half (47%) were employed as chief, 16% as senior and 37% as junior oral hygienist. Almost all (94%) complained of poor salaries and 78% said that there were no opportunities for promotion. Oral hygienists performed both clinic-based and community-based services. The majority (95%) of the community-based services was preventive; the most common preventive services being rendered to the community was oral health education (84%), brushing programs (75%) and examination, charting and screening (69%). Seventy seven percent (77%) of clinic-based services included preventive procedures the most common being scaling and polishing or root planing (88%), examination and charting (84%) and oral hygiene instructions (75%). The majority of oral hygienists (94%) worked in the public sector to provide a service to the community. Seventy six percent (76%) had experiences that hindered the provision of services. Almost all (97%) wanted to study further, the main area of interest being the dental field. Conclusion: It is evident that the duties, tasks and responsibilities of oral hygienists in both KZN and GP include activities associated predominantly with the prevention and control of oral diseases and oral health promotion. In South Africa, a decline in oral diseases (dental caries and periodontal diseases) can be achieved by enhancing the use of oral hygienists in the public sector.