Thesis (MPH) -- University of Limpopo, 2010. / Background Namibia is one of the country most affected by HIV/AIDS epidemic in the world and in Sub¬Sahara Africa with an adult prevalence of 19,7 %, and 210.000 people estimated to be living with HIV/AIDS at the end of 2003. The Caprivi region adult prevalence in adult pregnant wom~n is estimated at 43%. The health care services are overstrained with patients and home-based care (HBC) is seen a possible solution. The scale up of HBC and expansion of coverage to patients has lessened the burden of public hospitals to deal with all these chronically ill patients. The challenges that volunteers are facing impact in the quality of care people living with HIV I AIDS receive. Objectives This study assessed the utilization of home-based care service, knowledge and perception of People living with HIV and AIDS (PL WHA) toward home-based care services. The views of volunteers towards home-based care service are also reported. Methods This is a qualitative study that utilized Focus Group Discussions (FGDs) for the home-based care-givers and in-depth interview with the clients accessing antiretroviral treatment at Katima State Hospital. A total of four focus group discussions were organized with care-givers comprising 31 adult participants (15 males and 16 females) and 18 in-depth interviews were conducted with the people living with HIV and AIDS accessing antiretroviral treatment (ART) at Katima State Hospital. All FGDs were tape recorded and one-to-one interview was hand written. Result The study demonstrates that most of the participants have positive attitudes toward utilization of HBC service. However, few people are still afraid to disclose their health status. In general, the community participation has tremendously reduced stigmatization. The self-reported health status by the HBC givers in order to have access to nutrition support may have played a role in reducing the stigma associated with HIV and thus increased the number of people utilizing the HBC service. The HIV -positive participants valued the assistance received from the volunteers and volunteers appreciate the training received to enable them to undertake their duties with more confidence. The dress code of volunteers when visiting patients was perceived to disclose HIV status but did not influence patient attitude to access the service. Conclusion The improvement in community knowledge about HIV and HBC service has enhanced the positive attitude toward utilization of home-based care service which has consequently reduced the stigma associated with HIV. Advocacy is required to improve the working condition of volunteer care-givers home-based care by policy markers. The collaboration between different stakeholders will advance and sustain the HBC service in focusing on prevention of HIV infection.

The purpose of the current study was to determine the constraints to and opportunities for organising the gendered home-based care sector in post apartheid South Africa. Also the gender aspect of care work has been closely examined and the study has revealed that societal stereotypes that view care work as women work in the private sphere have to a greater extent contributed to the devaluation of care work in both society and as a form of paid care work. Qualitative research methodology was used in the form of documentary analysis, interviews and participant observation. The research findings demonstrate that unions themselves, resources and legislation/ policy issues pose as major barriers to organising these atypical workers. Generally, most unions are not yet ready to embrace informal workers into the mainstream as it entails innovation of new organising strategies that could be out of their comfort zone, the pumping out of a vast amount of resources and the avoidance of the huge obligation of breaking through legal barriers. Grassroot mobilising around gender needs has been proposed as the most appropriate strategy for organising the newly emerging mobile and precarious workforce which comprises principally of women. An undeniable link between the formal and informal economy has also been confirmed as formal institutions such as NGOs, hospital, clinics and private companies through the Expanded Public Works Programme here in South Africa make use of informal labour to execute their obligations in the HBC sector. From a gender perspective, this study argues that female jobs are despised by society let alone trade unions where democracy and gender sensitivity should be practiced. Devaluation of female jobs herein care work could be the reason why NEHAWU has taken too long to organise the HBC sector. Finally, results of the study have demistified the societal stereotypes that female jobs are difficult to organise as HBC workers were more than willing to join NEHAWU.

Magister Public Health - MPH / Background: The Zambian anti-retroviral therapy (ART) program has successfully enrolled over 770, 000 people living with HIV (PLWH), out of a population of 1.2 million PLWH. This tremendous success has overburdened the clinic system resulting in many challenges for both patients and healthcare staff. To promote ART initiation, adherence, and retention and at the same time relieve pressure on the health system, a home-based ART delivery model (HBM) was piloted in two urban communities of Lusaka. This study explored levels of acceptability of the model and factors influencing this among PLWH living in the two communities. Acceptability was defined as degree of fit between the patient’s expectations and circumstances and the home-based delivery model of ART, taking into consideration all the contextual elements surrounding the patient. Methodology: A qualitative study of HBM acceptability was nested within a clusterrandomized trial comparing outcomes in patients receiving HBM intervention compared to the standard of care in two communities in Lusaka, Zambia. Using an exploratory qualitative study design and a purposive sampling technique, qualitative data were collected using observations of HBM delivery (n=12), in-depth interviews with PLWH (n=15) and Focus Group Discussions with a cadre of community health workers called community HIV care providers (CHiPs) administering the HBM (n=2). Data were managed and coded using Atlas.ti 7 and analysed thematically. Results: Overall, the HBM was found to be a good fit with the lives and expectations of PLWH and therefore highly acceptable to them. This acceptability was influenced by a combination of cross cutting clinic based, program design and socio-economic factors that have been categorized into push and pull factors. Push factors were those related to the challenges that PLWH faced when accessing ART from the clinic and included congestion, long waiting times, confidentiality breaches and stigma arising from attending a dedicated clinic. These factors resulted in considerable direct and indirect livelihood opportunity costs. The HBM as an alternative had a number of ‘pull factors’. PLHW described services offered through the model as convenient, confidential, trusted, personalized, less stigmatizing, comprehensive, client centred, responsive, and respectful. Disclosure of client’s HIV status to people they lived with was found to be critical for the acceptability of the model. Conclusions and recommendations: The HBM is highly acceptable and this acceptability is influenced by a combination of crosscutting push and pull factors. Key to the HBM’s acceptability was its delivery design that was responsive to individual patient needs and the steps CHiPs took to minimize the ever-present threat of disclosure and stigma. Future adoption and scaling up of HBM should recognize the importance of these design features.

No abstract available / Dissertation (MA(Theology))--University of Pretoria, 2008. / Practical Theology / unrestricted

Master of Public Health - MPH / In 2018 within the Kingdom of Eswatini, there were an estimated 1 074 new cancer cases and 660 cancer-related deaths. For some time, there has been a growing trend away from the provision of palliative care within an institutional setting to providing palliative care to the patient within the context of their own home. As a result, the majority of dying patients spend their final days at home with much of the care being provided by family caregivers. In Eswatini, little is known about the impact that managing a terminally ill patient has on the family caregiver and whether they experience receiving sufficient support from the local health services. This study aimed to explore the needs and challenges of family caregivers in providing palliative care for their relatives living with cancer in Hhohho Region, Kingdom of Eswatini.

This study seeks the views of care workers working with older people about what impact social support resources has on the living conditions of older people. Social support was conceptualised in the study as support received from family members or close friends of the older people. Care workers were asked to share their views about social support for older people receiving care support in institutional setting or receiving home-based support services. This qualitative investigation involved eight care workers working with older people in Sweden. It has been argued in the study that care workers proving support for older people could have useful information about the social support of older people because they would have witnessed interactions between older people and their immediate network members. Qualitative interviews were conducted with eight care workers providing care support in institutions and home-based to explore their perspectives on the impact of social support on older people. Data from the interviews were analysed using thematic analysis. It was revealed from the views of care workers that both family and friends were engaged in different ways to provide support for older people, although not at all times. Managing loneliness, satisfaction with life and feeling better about themselves emerged as the ways social support impacted on the living conditions of older people. The care workers highlighted certain activities or areas that could ensure continuity of social support for older people. These included family members having regular contact with older people, older people acknowledging the need for support. Implications of the study for the practice of care for older people were highlighted.

Introduction: Home-based care is an important part of the health care sector globally. But there is a lack of studies of the working conditions for health care workers within home-based care. Aim: The aim of the study is to illuminate the different experiences of working within home-based care for healthcare workers in economically poor communities.   Method: A qualitative research, data was collected through six semi-structured interviews and data was analysed by content analysis. Results: Three categories and eight sub-categories was identified in the data analysis: The Community; Working Conditions in the Community, Safety in the Community & Attitudes in the Community, The Family; The Family Affects the Patient & The Family Affects the Work Tasks and The Health Care Worker; Helping Beyond the Work Tasks, Emotional Involvement & Job Satisfaction. Conclusion: The study presents different challenges such as safety- and attitudes in the community but also the love for the work in the community.

Magister Artium (Development Studies) - MA(DVS) / In South Africa, since 2000, an increase of awareness in community involvement has become apparent, owing to the response from people to the need to be more engaged in decisions pertaining to their community. This positive move echoes an increasing acknowledgement by those in authority that community participation is essential to the main demands of renewing democracy, expanding service provision and constructing robust communities. The development of innovative patterns of participation development means that local communities should be empowered to participate in decision making, whilst government establishments need to have the determination and ability to respond to various community needs. The Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic has placed an enormous responsibility on public health services, such as South African hospitals, which are already functioning with limited resources. This has shifted the load of nursing to family members and communities as public health services are often stretched beyond their limits. Several community or home-based care programmes and facilities have materialised in reply to this necessity. In the context of participation of communities, the duty of community involvement in health plays a vital role in the future of public health in South Africa. Accordingly, this research was conducted to explore the nature and extent of community participation within the HIV/AIDS context in the Dunoon suburb in the Western Cape. An empirical research design, which consisted of qualitative methods, was used in this exploratory study to investigate the nature and extent of home-based care as an alternative strategy to institutional care. The research population was comprised of community members at the Dunoon informal settlement, the home-based workers employed at Heavenly Promise NGO, as well as staff and management of the Caltex/Chevron Refinery, members of Project Management 4 Africa (PM4A) and representatives of the Department of Social Development (DSD), which together constitute the partnership that is dedicated to combating the spread of HIV/AIDS in Dunoon. In general, the research findings demonstrate that home-based caregivers displayed strong levels of participation right from the outset of the project. The findings also established that participation among the community members was a combination of passive, weak and non-participatory, whereas home-based carers displayed a level of active participation. Furthermore, home-based care staff played a key role in decision making, while carers essentially undertook the work in the community. Hence, home-based care and communities participating in health matters are considered to be substantial as home care focuses primarily on palliative care of the patient at home, with the support of the family and the immediate community. Consequently, it is hoped that this research will prove significant and will enhance the existing knowledge of the potential benefits of home-based care as an alternative strategy to institutional care.

Magister Artium (Social Work) - MA(SW) / Ever since United Nations’ declaration of 1994 as the Year of the Family, the study and understanding of families has taken center stage, albeit with constant references to ‘normal’ versus ‘deviant’ families based on structural functionalism theory’s rigid definitions of what a ‘normal’ family should be. On the other hand HIV/AIDS has attracted much attention too because of its life threatening traits, especially in Sub-Saharan Africa where Zimbabwe lies. Efforts to fight the epidemic have seen the mushrooming of innovative programs, which include home–based care (HBC) services for those infected with HIV. However, although HIV and AIDS has clearly had adverse impacts on families, it is rarely discussed within perspectives that integrate family dynamics. To fill this gap this study has explored how HBC, as a response to HIV and AIDS, may change our understanding of families. Research data was gathered within the participatory action research design through methods such as focus group discussions by 35 HBC volunteers and patients, interviews of 26 of these, review of relevant family policies and other interactive participatory exercises by which research participants expressed their opinions through drawings. The evaluation showed that households were not always synonymous with families, although a thin line divided the two. Further, survival considerations are the leading priority why people find themselves in families within HBC settings. However, survival options available to women are exploitative and this has kept those in HBC settings reeling under the burden of demanding but unrewarded care work and domestic household jobs. The study teaches that families cannot be understood in aggregated terms and that individuals dictate what families become, not the other way round. The research essentially recommends policy revisions to reflect unique realities found in HBC settings, and among female HBC volunteers. This should be coupled with awareness campaigns in communities and further research on families.

Thesis (M.Dev.) --University of Limpopo, 2011 / Refer to document.