Thesis (M.A. (Clinical Psychology)) -- University of Limpopo, 2020 / The integration of mental health care (MHC) into primary health care (PHC) has been identified as a practical intervention to: increase accessibility to mental health care; reduce stigma and discrimination against people living with mental illnesses; improve the management of chronic mental illness; and, to reduce the burden of comorbidity of mental illnesses with other chronic illnesses. In the South African context, integrating MHC into PHC also seeks to respond to numerous legislative reforms, with the aim of providing comprehensive health care, particularly to previously disadvantaged populations. The aim of the present study was to explore the perceptions of facility managers in the Tshwane District (Gauteng Province) towards the integration of mental health into PHC. Fifteen participants from the Tshwane district facilities participated in the study. The participants were selected through a non-probability purposive sampling method. Data was collected through in-depth interviews using a semi-structured questionnaire, and analysed using the thematic coding approach. Significant findings suggested that the major hindrances to the realisation of the policy objectives may be due to: the lack of rehabilitation and psychotherapeutic services; insufficient skill and knowledge of mental health on the part of staff; insufficient or unsuitable practice space in the facilities; and, poor cooperation between South African Police Services, Emergency Medical Services and Primary Health Care. Inter-facility communication, district implementation support and policy knowledge has notably increased over the years and were deemed to be amongst the biggest enablers.

Depuis de nombreux siècles, médecin et patient sont unis sous le prisme de la confiance, principe qui a connu des vicissitudes face à la judiciarisation de la relation de soins et la mutation de l’exercice médical. L’essor du tourisme ainsi que la création du premier hôpital transfrontalier participent à ce phénomène, et montrent que désormais le patient n’hésite plus à franchir les frontières pour recevoir des soins de qualité. C’est dans un contexte d’étroite collaboration entre la France et l’Espagne que s’inscrit l’étude des relations contractuelles et extracontractuelles dans le secteur médical. Elle met en avant un enchevêtrement de jeu d’acteurs entre établissements publics et privés de santé, professionnels de soins, compagnies d’assurance de prestations de services sanitaire et patient. Il est donc difficile d’identifier la nature des relations qui les unit et le régime d’indemnisation applicable. L’impact des droits des patients et la recherche de la qualité des soins dans les deux pays frontaliers démystifient l’aspect contractuel de la relation et amènent à une nouvelle lecture en faveur d’une qualification unitaire. L’approche institutionnelle doit être privilégiée, caractérisée par l’intromission constante des législateurs français et espagnols, sur l’exécution des soins mais également sur l’indemnisation des dommages médicaux, mais à quel degré ? / Since the early ages, doctors and patients are bonded together under the lens of trust, principle that has suffered tribulations faced with the increasing litigiousness in the caring relationship and the professional medical practice changes.The rise of tourism as well as the creation of the first transborder hospital play an important role in this phenomenon, and show that from now on the patient does not hesitate to cross the borders in order to benefit from high quality medical care. The study of contractual and extra-contractual relationships in the medical field falls within a context of close collaboration between France and Spain. It reveals an entanglement in the interactions between public and private health care facilities, healthcare professionals, health care services insurance providers and the patient.Thus, it is difficult to identify the nature of the relationships federating them, as well as the practicable compensation system. The patients’ rights impact and the search for high quality medical care in both transborder countries explain the contractual aspect of the relationship and bring in a new point of view in favour of unitary qualification. The institutional approach must be given priority through the constant insertion of French and Spanish legislators, regarding the accomplishment of medical care as well as the medical damages compensation, but to which degree?

Magister Public Health - MPH / Background: Tuberculosis (TB) poses a major public health challenge in South Africa and in the Northern Cape Province. The province has the third highest in TB incidence rate in the country. Poor adherence to TB treatment impacts negatively on treatment outcomes. Siyanda district in the Northern Cape Province has the second highest number of TB defaulters in the province despite the fact that 79.9% of these patients are on Community Based Direct Observation of Treatment (CBDOT). Aim: To explore the reasons for defaulting of TB patients from TB treatment in the CBDOT Programme in the Siyanda district, Northern Cape Province Study design: This was a qualitative exploratory study. Study population and sampling: Two TB nurses with varying years of experience in the TB Control Programme serving as key informants were selected from the participating facilities in the study area. Ten TB defaulters who were on the CBDOT programme were selected from the Electronic TB Register. Two focus group discussions (FGDs) comprising of purposively selected DOT Supporters (five in one group and six in the other) from different NGOs in the community were selected for maximum variation. Data collection: Key informant interviews were conducted with the TB nurses. Records of all defaulters in the study population were reviewed including clinic progress notes and patient TB treatment cards. In-depth interviews were conducted with the TB patients. FGDs were conducted with DOT supporters. Analysis: Analysis commenced simultaneously with collection of data. This enabled the researcher to continuously review and reflect on the data collected. Thematic content analysis was done.Categories emerged through the inductive process of the data analysis. Notes that were kept during data collection, reflections, audiotapes and transcripts were used to support the thick description of the findings. Results: The participants generally appreciated the programme and mostly had a good relationship with the DOT supporters. However, the quality of care exacerbated by inadequate health services such as lack of adherence counselling training of health professionals, low levels of education amongst TB defaulters, were found to be major contributory factors to TB defaulting. The patients interrupted treatment several times before defaulting, were not counselled during the interruption phase and understood TB messages differently. TB defaulters in the Siyanda District face socio economic challenges which include alcohol abuse, a major historic ill in the district and the grape farming community in the region. The impact of the disability grant on TB treatment adherence remains anecdotal and requires further research as TB defaulters did not admit to defaulting so that they could continue benefiting from the disability grant although these statements were refuted by the DOT supporters and key informants. The attitude of employers and fear of losing employment were also contributing factors. Conclusion and recommendations: It has become evident that TB in the Siyanda District is a public health issue. The predominantly rural, impoverished and transient community that moves to the farms to seek employment requires a CBDOT programme that will address pertinent challenges in the district to achieve a positive reduction in the TB defaulter rate. It will require collaboration with stakeholders including farmers, to address the challenges posed by the disease. Improved staff allocation, staff capacity development and community education are also recommended to improve quality of care.

The aim of the diploma thesis is a description of accreditational process in health care facility, namely in a medical institution, finding of potentional problems by accreditational standards implementing and the influence of accredidation on health care quality in health care facility.

This thesis acquaints the reader with specifics in health care business, it defines closely a field of influence of a medical rehabilitation and also describes a provision of health care services in the field of physiotherapy. The main goal of the thesis is to prepare basis and elaboration of the business plan for establishing of a private health care facility and an independent physiotherapeutic practise in Tachov district in the Czech Republic. The theoretical part describes the health care system in the Czech Republic, further defines medical rehabilitation and it specifies field of physiotherapy closely. At the same time in my thesis, I mentioned a theoretical basis for establishing of a company including a brief and clear instruction on how to proceed in setting up a private health care facility "step by step". In the practical part, an analysis of the internal and external environment in the area of the newly developed health care facility in Tachov district is performed. Furthermore, in this part, a SWOT analysis is processed and described, which determines the strengths, weaknesses and opportunities and threats for the new enterprise. In this part of thesis it is crucial the preparation of the business plan, which takes into account demographic data, the location of health care facility and...

No description available.

The background and problem statement focuses on antiretroviral therapy (ART) and the use of mobile technology to improve compliance within a primary health care (PHC) context in South Africa. South Africa is one of the countries, globally, with the highest HIV incidence and prevalence and ART enrolled patients visiting PHC facilities. Compliance to ART plays an integral part in effective HIV/AIDS management. HIV/AIDS management entails a complex process of patient education and pharmacological control to improve ART compliance in South Africa. Studies were done in South Africa on reminder messages as most studies focused on chronic conditions in general. A literature review explored what is known about ART and mobile technology to improve compliance. Literature confirmed that compliance through reminder messages were done worldwide and in Sub-Saharan countries. Previous research indicated that the compliance rate of the patients increased through reminder messages. Yet there is a gap in the literature regarding reminder messages combined with health education on ART compliance. The aim of the study was to determine the impact of reminder messages combined with health education on ART compliance among patients receiving ART at a PHC facility Methodology: The study followed a quantitative, experimental, intervention, randomised multi-group, pre- and post measurement design (Creswell, 2012:1, Welman et al., 2012:80). The research design is experimental because the researcher applied an intervention (reminder messages) to two experimental groups. Random sampling was applied and participants were grouped into three groups: Group A, (control group), Group B, (reminder messages only) and Group C (reminder messages combined with health education). A preand post-measurement design is followed as each participant’s pill count and return date were measured before and after the reminder messages with/without health education were given. The sample size was 202 eligible patients receiving Regime 1 and 2 ART’s (Lamuvidine, Tenofovir, Efavirenz, Nevirapine, Alluvia® and Zidovudine) at a PHC facility in the North West, South Africa (N=202). The sample size was determined with guidance of statistical services to ensure that results obtained from the study would be reliable and significant. Data collection was done in three phases. Phase one (1) consisted of collecting the biographical data and a pre-measurement of pill count and return dates for participants in Groups A, B and C. Phase two (2) consisted of sending bi-weekly messages (Group B) via WinSMS and with health education (Group C) for three (3) months. Phase three (3) consisted of post-measurement of participants’ pill count and return date for Groups A,B and C. Data collection stretched over six months (October 2013-March 2014), namely three months pre-measurement, then activation of intervention combined with another three months post-measurement. Descriptive and inferential statistical analysis was conducted through SPSS (SPSS Inc., 2013). Descriptive statistics indicated that more female patients visited the PHC facility for ART on a more regular basis. It was concluded that the experimental group proved a slight increase in compliance with regards to return date after the SMS intervention. No difference was noted in compliance to pill counts. It can also be concluded that pill counts is a complex monitoring procedure with room for error from the patients’ aspect. / MCur, North-West University, Potchefstroom Campus, 2015

The background and problem statement focuses on antiretroviral therapy (ART) and the use of mobile technology to improve compliance within a primary health care (PHC) context in South Africa. South Africa is one of the countries, globally, with the highest HIV incidence and prevalence and ART enrolled patients visiting PHC facilities. Compliance to ART plays an integral part in effective HIV/AIDS management. HIV/AIDS management entails a complex process of patient education and pharmacological control to improve ART compliance in South Africa. Studies were done in South Africa on reminder messages as most studies focused on chronic conditions in general. A literature review explored what is known about ART and mobile technology to improve compliance. Literature confirmed that compliance through reminder messages were done worldwide and in Sub-Saharan countries. Previous research indicated that the compliance rate of the patients increased through reminder messages. Yet there is a gap in the literature regarding reminder messages combined with health education on ART compliance. The aim of the study was to determine the impact of reminder messages combined with health education on ART compliance among patients receiving ART at a PHC facility Methodology: The study followed a quantitative, experimental, intervention, randomised multi-group, pre- and post measurement design (Creswell, 2012:1, Welman et al., 2012:80). The research design is experimental because the researcher applied an intervention (reminder messages) to two experimental groups. Random sampling was applied and participants were grouped into three groups: Group A, (control group), Group B, (reminder messages only) and Group C (reminder messages combined with health education). A preand post-measurement design is followed as each participant’s pill count and return date were measured before and after the reminder messages with/without health education were given. The sample size was 202 eligible patients receiving Regime 1 and 2 ART’s (Lamuvidine, Tenofovir, Efavirenz, Nevirapine, Alluvia® and Zidovudine) at a PHC facility in the North West, South Africa (N=202). The sample size was determined with guidance of statistical services to ensure that results obtained from the study would be reliable and significant. Data collection was done in three phases. Phase one (1) consisted of collecting the biographical data and a pre-measurement of pill count and return dates for participants in Groups A, B and C. Phase two (2) consisted of sending bi-weekly messages (Group B) via WinSMS and with health education (Group C) for three (3) months. Phase three (3) consisted of post-measurement of participants’ pill count and return date for Groups A,B and C. Data collection stretched over six months (October 2013-March 2014), namely three months pre-measurement, then activation of intervention combined with another three months post-measurement. Descriptive and inferential statistical analysis was conducted through SPSS (SPSS Inc., 2013). Descriptive statistics indicated that more female patients visited the PHC facility for ART on a more regular basis. It was concluded that the experimental group proved a slight increase in compliance with regards to return date after the SMS intervention. No difference was noted in compliance to pill counts. It can also be concluded that pill counts is a complex monitoring procedure with room for error from the patients’ aspect. / MCur, North-West University, Potchefstroom Campus, 2015

Unsafe and unnecessary injections are administered in many developing and transitional countries. Injection device security is recommended in order to improve injection safety. Injection device stock depletions have been reported to contribute to unsafe injection practices. Poor distribution of health products has been reported in many parts of Uganda including Mpigi district. As a way of improving injection safety, this study explored the challenges encountered in maintaining an effective distribution system. A Cross-sectional, descriptive study of public and private-not-for-profit health care units in Mpigi district was conducted. 38 health care facilities were selected by stratified disproportionate sampling. Data on device security, the use of equipment and the distribution system were collected and analysed using descriptive statistics. / Health Studies / M.A. (Public Health)

Unsafe and unnecessary injections are administered in many developing and transitional countries. Injection device security is recommended in order to improve injection safety. Injection device stock depletions have been reported to contribute to unsafe injection practices. Poor distribution of health products has been reported in many parts of Uganda including Mpigi district. As a way of improving injection safety, this study explored the challenges encountered in maintaining an effective distribution system. A Cross-sectional, descriptive study of public and private-not-for-profit health care units in Mpigi district was conducted. 38 health care facilities were selected by stratified disproportionate sampling. Data on device security, the use of equipment and the distribution system were collected and analysed using descriptive statistics. / Health Studies / M.A. (Public Health)