The last few years have seen an increase in the infection rate not only of HIV but also TB. The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub- Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and HIV exert increased pressure on health service delivery thus reflecting the serious problem in the country with regard to health service delivery to people co-infected with TB and HlV/AlDS. Health service delivery is also hindered by negative attitudes of health workers that have been reported towards people living with HIV/AIDS. They entertain a biased view of their own risk, considering risk only from occupational exposure and denying the possibility of infection in their private life. These attitudes of health workers decreases the quality of care and support delivered to patient co-infected with TB and HIV. This result in people not disclosing their illness even in cases were treatment is available like TB for the fear of stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the patient co-infected with TB and HIV. Therefore these patients tend to shy away from health services and isolate themselves due to fear of being stigmatised twice. The need to address TB and HIV together in the light of this dimension is urgent so as to improve the utilization of the health services by people co-infected with Ti3 and HIV. The purpose of this research was to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, to explore and describe the attitudes of health workers towards patients co-infected with TB and HIV, and to formulate guidelines for health workers that will facilitate the health service utilization by patients co-infected with TB and HIV in the Potchefstroom district. The research was conducted in the Potchefstroom district in the North West province of South Africa. A qualitative research design was used to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, and to explore and describe the attitudes of health workers toward co-infected patients. A purposive voluntary sampling method was used to select participants who met the set criteria. Two populations were used, that is the patients co-infected with TB and HIV, and the health workers who were involved in their care. In depth unstructured interviews were conducted with the patient population and semi structured interviews with the health worker population using an interview schedule that was formulated from the background literature. Data was captured on an audiotape, and transcribed verbatim. Field notes were taken immediately after each interview. The researcher and a co-coder did data analysis after data saturation was reached and a consensus was reached on the categories that emerged. From the findings of this research it appeared that there were general perceptions by the patients co-infected with TB and HIV that indicated stigmatisation by the health workers. This perceived stigmatisation was reported as being perpetrated by all categories of health workers. Negative behaviours such as the health workers not having time for the patients and being impatient were reported. Lack of sufficient knowledge was related to these behaviours especially amongst lower categories or non-professional health workers. In spite of the above, the researcher also observed that there was a limited number of health workers who were still being perceived as committed and caring by the patients co-infected with TB and HIV. The researcher concluded that the relationship between the health workers and the patients co-infected with TB and HIV was characterised by conflict. The health workers seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse alcohol, manipulative and not taking responsibility of their illness. These perceptions lead the health workers to have a negative attitude towards these patients and occasionally came across as unsympathetic towards them. On the other hand the researcher observed that there were other health workers who did not present with negative behaviours towards these patients and tried to understand the reasons for their sometimes-unacceptable behaviours. Recommendations are made for the field of nursing education, community health nursing practice and nursing research with the formulation of guidelines for health workers so as to facilitate the utilization of the health services by the patients co-infected with TB and HIV. The guidelines are discussed under three main categories, namely guidelines for the health workers to facilitate the utilization of the health services by the patients co-infected with TB and HIV, guidelines to improve the utilization of the health services more efficiently and adequately by the patients co-infected with TB and HIV, and guidelines to improve the attitudes of the health workers towards the patients co-infected with TB and HIV with the intention of improving the utilization of the health services by these patients. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2006.

The last few years have seen an increase in the infection rate not only of HIV but also TB. The HIV/AIDS pandemic is increasing rapidly mainly in developing countries with 71 % of infections in the Sub-Saharan region of Africa. South Africa, which forms part of the Sub- Saharan region, has the highest infection rate in the world with 3.2 to 3.4 million people living with HIV/AIDS. People with HIV are especially vulnerable to TB, and HIV pandemic is fuelling an explosive growth in TB cases. The increase in the infection rate of TB and HIV exert increased pressure on health service delivery thus reflecting the serious problem in the country with regard to health service delivery to people co-infected with TB and HlV/AlDS. Health service delivery is also hindered by negative attitudes of health workers that have been reported towards people living with HIV/AIDS. They entertain a biased view of their own risk, considering risk only from occupational exposure and denying the possibility of infection in their private life. These attitudes of health workers decreases the quality of care and support delivered to patient co-infected with TB and HIV. This result in people not disclosing their illness even in cases were treatment is available like TB for the fear of stigmatisation. Hence the problem of stigmatisation escalates into a dilemma for the patient co-infected with TB and HIV. Therefore these patients tend to shy away from health services and isolate themselves due to fear of being stigmatised twice. The need to address TB and HIV together in the light of this dimension is urgent so as to improve the utilization of the health services by people co-infected with Ti3 and HIV. The purpose of this research was to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, to explore and describe the attitudes of health workers towards patients co-infected with TB and HIV, and to formulate guidelines for health workers that will facilitate the health service utilization by patients co-infected with TB and HIV in the Potchefstroom district. The research was conducted in the Potchefstroom district in the North West province of South Africa. A qualitative research design was used to explore and describe the experiences of patients co-infected with TB and HIV regarding stigmatisation by the health workers, and to explore and describe the attitudes of health workers toward co-infected patients. A purposive voluntary sampling method was used to select participants who met the set criteria. Two populations were used, that is the patients co-infected with TB and HIV, and the health workers who were involved in their care. In depth unstructured interviews were conducted with the patient population and semi structured interviews with the health worker population using an interview schedule that was formulated from the background literature. Data was captured on an audiotape, and transcribed verbatim. Field notes were taken immediately after each interview. The researcher and a co-coder did data analysis after data saturation was reached and a consensus was reached on the categories that emerged. From the findings of this research it appeared that there were general perceptions by the patients co-infected with TB and HIV that indicated stigmatisation by the health workers. This perceived stigmatisation was reported as being perpetrated by all categories of health workers. Negative behaviours such as the health workers not having time for the patients and being impatient were reported. Lack of sufficient knowledge was related to these behaviours especially amongst lower categories or non-professional health workers. In spite of the above, the researcher also observed that there was a limited number of health workers who were still being perceived as committed and caring by the patients co-infected with TB and HIV. The researcher concluded that the relationship between the health workers and the patients co-infected with TB and HIV was characterised by conflict. The health workers seemed to perceive the patients co-infected with TB and HIV as stubborn, harsh, abuse alcohol, manipulative and not taking responsibility of their illness. These perceptions lead the health workers to have a negative attitude towards these patients and occasionally came across as unsympathetic towards them. On the other hand the researcher observed that there were other health workers who did not present with negative behaviours towards these patients and tried to understand the reasons for their sometimes-unacceptable behaviours. Recommendations are made for the field of nursing education, community health nursing practice and nursing research with the formulation of guidelines for health workers so as to facilitate the utilization of the health services by the patients co-infected with TB and HIV. The guidelines are discussed under three main categories, namely guidelines for the health workers to facilitate the utilization of the health services by the patients co-infected with TB and HIV, guidelines to improve the utilization of the health services more efficiently and adequately by the patients co-infected with TB and HIV, and guidelines to improve the attitudes of the health workers towards the patients co-infected with TB and HIV with the intention of improving the utilization of the health services by these patients. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2006.

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This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration / M.Admin. (Public Admin)

This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration and Management / M.Admin. (Public Admin)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective. / Health Studies / M. A. (Public Health)