This research is an endeavour to highlight the state of healthcare in South Africa as seen through the eyes of professional health care workers who are at the cold face of healthcare. Having worked in an environment of inequities and unjust circumstances, healthcare workers expressed their attitudes and beliefs that healthcare are in need of radical change. There appears to be insight from these professionals that the private and public healthcare sectors should forge a relationship, ultimately benefiting South African society. More research needs to be done on a major scale to determine more deeply the attitudes and beliefs of healthcare professionals. Such an endeavour will provide a stimulus for policymakers to harness this energy and direct it in a meaningful way in the transformation of healthcare in South Africa. Chapter 1 focused on several relevant perspectives and definitions on healthcare in South Africa and other countries. In Chapter 2, attention was given to socio-economic rights as per the South African Constitution and the states obligations to fulfil these rights. These rights were examined in the context of landmark Constitutional Court cases, viz. Soobramoney versus the State; TAC versus the State; and Grootboom versus the State. These cases give one the essence of interpreting rights and the constitutional obligation of the state to deliver on them. Healthcare developments in South Africa and other countries together with the RDP and GEAR considerations are outlined in Chapter 3. Research Methodology is outlined in Chapter 4, emphasizing also the limitations of this study. Chapter 5 examines the responses to the questionnaires and analyses its findings. Chapter 6 provides the conclusions and recommendations as well as a critique of healthcare in South Africa. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2004.

This study was aimed at identifying and exploring the perceptions of traditional healers particularly izangoma and izinyanga, on the integration of their practices into the South African National Health System. The main reason behind this research was to establish the position of traditional healers as well as to study their opinions on the issue of integration. The paucity of previous research studies on the 'perceptions of traditional healers on the integration of their practice-s into the national health care system, was the main motivation behind this study. Participants were drawn from the Pietermaritzburg area and selection was based on purposeful sampling. The data of the study was collected by means of semi-structured interviews, which employed open- ended questions. This study was conceptualized within the African world-view and cosmology. The interactive model design by Maxwell (1996) was employed in the design of this study. According to this model the purpose, conceptual context, research questions and methods as well as issues of validity and reliability, are all essential for the coherence of any qualitative study. The ethical considerations of this study were mainly around the issue of informed consent, and this was negotiated and discussed with the participants until they could understand the process of consent. The results of the study reflect the fact that traditional healers are positive about the process of integration. However, the participants were in favol of integration as a process of collaboration and co-operation as opposed to total integration, which was perceived as a process in which one system w0ll-Id dominate and oppress the other. The participants in this study perceive themselves as equal to their western counterparts because oftheir training and ability to treat "spiritual illnesses". Further, they view their role as that of providing alternative healing as well as acting as a medium between people and their ancestors. Education and negotiations were identified as the possible solutions to most problems in the process of integration. The findings of this study further reveal that there is mistrust and suspicion about western healers form traditional healers. As a result of this, improved collaboration between traditional and modem health care systems seems to be the only process, which could benefit all the people of the country. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2000.

This thesis examines how the recent socio-economic and political arena in Cuba informs the relationship among the idea of population health, national statistics, and the everyday lives of individuals. Post-revolutionary Cuba has used measures of the health of individuals as a metaphor for the health of the body politic, effectively linking the efficacy of socialism and its governmental apparatus to the health conditions of the population. The creation of a model of health care that was informed by the revolutionaries' vision of a new social order, which in turn would help to create an ' hombre nuevo' (new man and new woman), effectively shaped a model of citizenship that was associated with a particular notion of health, and in addition defined a system of socialist values and ideals. Thirty months of ethnographic field research in the city of Havana focused specifically on the Family Physician-and-Nurse Program---an innovative primary health care program in which family physician-and-nurse teams live and work on the city block or in the rural community they serve. Drawing on my ethnographic findings, I explore two key themes. First, I examine how state policy, enacted through the government's public health campaigns, has affected individual lives, changing the relationship among citizens, government institutions, public associations and the state. Secondly, I examine how the collapse of the Soviet bloc (post-1989) and the strengthening of the US embargo is changing the relationship between socialist health-policies and individual practices and how it has redefined how state power becomes enacted through and upon individual bodies. In particular, I examine how individual practices play an important role in the maintenance of Cuba's population-health profile, as individual citizens give priority to their own health care needs, both material (such as food, medicines and medical supplies) and spiritual (including the re-emergence of religious

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state.

This study examined hospital governance in British Columbia. Considered to be one of the most important issues facing the health care industry today, hospital governance is nevertheless an ill-defined and poorly understood concept. Foundational and exploratory in nature, the study’s primary objectives were: a) to define hospital governance within the context of British Columbia; b) to examine the structural and functional relationships among key participants; c) to investigate decision-making responsibilities; d) to investigate what, if any, variations exist in the governance of acute care, long term care, and specialized care hospitals; and e) to explore the critical issues which face hospital governance today and in the future under New Directions policy initiatives. All hospitals (N=107) in the province were studied, with the exception of diagnostic treatment centers, private for-profit facilities, military, and federal institutions. Utilizing documentary examination, survey administration, and interview techniques, the study included hospital chief executive officers (N=106), hospital board members (N=735), hospital board chairs (N=106), and selected high ranking senior officials from the Ministry of Health who had direct responsibility for hospital activities (N=15). Results of the study provide for in-depth demographic board profiles, and show that hospital governance is similarly defined across all hospital categories as “a complex relationship of overlapping structures and activities which has the responsibility and the authority to oversee the organization’s operation and to ensure its commitment of providing optimum health care to its residents.” The study identifies the key participants of hospital governance and delineates sixteen activities considered to be under the hospital board’s domain. Seven issues are identified as being critical for hospital governance in the future. Although there was general agreement as to the individuals most often responsible for recommending and implementing activities brought before the board, there were considerable perceptual differences between participants as to who possesses final decision-making responsibility. Data results consistently demonstrated important differences in responses between the hospital and Ministry populations. The study shows that overall, the participants of hospital governance are generally satisfied with the traditional roles and structures of hospital boards and are overwhelmingly dissatisfied with New Directions policy initiatives. This study further suggests that due to the discrepancies in priorities, perceptions, and ideologies of the hospital and Ministry populations, hospital governance is in a highly volatile and transitive state.

How are Centre parties distinct from Left and Right parties in term of their policy preferences? The scholarship on political parties either ignores Centre parties or treats them as a residual category. In this study, I attempt to rescue Centre parties from obscurity by looking at a quintessential Centre party: the Chilean Christian Democratic Party (PDC). Between 1990--2000, the PDC led two centre-left Concertacion coalition governments under Patricio Aylwin (1990--1994) and Eduardo Frei (1994--2000). It was the PDC's responsibility to negotiate the 'Chilean paradox': a country that had achieved economic success with neoliberalism and become a "model" for Latin America but where the "social debt" increased exponentially during 17 years of military rule under Augusto Pinochet (1973--1990). Health was one of the main concerns for Chileans through the decade but there was little headway made in the policy arena. My study seeks to explain why this was so. / I make a distinction between (1) the "defensive" Centre which aspires to be neither left nor right; and (2) the "encompassing" Centre parties that are both left and right. Christian Democratic parties are "encompassing" Centre parties par excellence since they incorporate elements of both left and right ideologies in a manner consistent with their social Catholic beliefs. They are known to combine a conservative position on social and moral issues with a pro-poor orientation on welfare issues. The main policy dilemmas of the PDC emerged from its status as an "encompassing" Centre Party as it sought to reconcile left and right. During the 1990s, the PDC shifted allegiance from state-led development policies to neoliberalism. As a result, the scope of the party's commitment to welfare issues was defined within the range of options available within the neoliberal model. However, while neoliberals dominated key policy positions, statists retained influence in the Congress and within the party organization. The uneven nature of adaptation to neoliberalism became one of the main obstacles in reaching a consensus for reform. My study also gives due emphasis to the constraints introduced by the country's institutional framework, notably the 1980 Constitution inherited from the military regime.

This dissertation has explored the problem of a yawning gap between policy and the implementation of lay participation in health development activities in Ghana, using data from 577 households in 22 rural communities. / A Health Systems model has been applied to data, to explain relationships and four sets of variables--household need for health services, predisposing attributes, participatory patterns, enabling factors--on household use of available health facilities and services. / Overall, results indicate a complex interdependence of factors which influence modern health services use. A multiple regression procedure identifies the presence of children under 5 years, the household's perception of its influence in the community, household participation in community health-related activities, household socio-economic and educational levels, to be significantly related to services use. Results suggest that Need for services is Not a sufficient condition for the Use of available health services.

This research evaluates Quebec's health care policy by analyzing how the partnership metaphor is implemented in policy and practice. The partnership construction is identified in 4 interpretive communities within long-term community services to the elderly population. This analysis focuses on the placement decision for cognitively impaired clients in home care. Interpretive policy analysis is employed to examine 3 policy documents and 3 client files, while grounded theory serves to analyze 13 semi-structured interviews with 2 administrators and 3 open triads of client, caregiver, and case manager. The findings show partnership to be an egalitarian, collaborative ideal widely adopted but with little consensus on the pertinent objects and actors. Important differences emerge in how partnership is applied to the placement decision, indicating a too flexible application. Specific restrictions are recommended on the application of the partnership metaphor in order to improve community services and organizational structures in health care.

In this dissertation we present mathematical models that help answer health policy questions relating to HIV and Hepatitis C (HCV), and analyze bias in Markov models of disease progression. We begin by developing a Markov decision process model that examines the timing of testing and treatment for diseases with asymptomatic periods such as HCV. We explicitly consider secondary infections, false positives and negatives, and behavioral modification from information from test results. We derive sufficient conditions for testing and/or treating in a dynamic environment, i.e., when unscheduled patients arrive. We also develop a detailed simulation model for general testing and/or treating for HCV. A key finding is that the current policy recommendations on testing for HCV may be too restrictive, and that it is cost-effective to test the overall population if done at the appropriate times. The Markov models used in the study of HCV motivated the next topic where we examine bias in Markov models of diseases. We examine models in which the progression of the disease varies with severity and find sufficient conditions for bias to exist in models that do not allow for transition probabilities to change with disease severity. We apply the results to HCV and find that the bias is significant depending on the method used to aggregate the disease data. We close with a discussion on a specific question in HIV policy where we develop a Bernoulli process transmission model in which, for a given individual, each risky person-to-person contact is treated as an independent Bernoulli trial. Using the model and data from the Urban Men's Health Study, we estimate the affect that interventions at venues, namely bathhouses, in which high-risk behavior takes place would have on HIV transmission.

Typescript. / Thesis (Dr.P.H.)--University of Hawaii, 1986. / Bibliography: leaves [302]-313. / xxi, 313 leaves, bound ill., maps 29 cm