The provision of health in communities and their inhabitants are very important / Thesis (M.A.)-University of KwaZulu-Natal, 2007.

Thesis (Ph. D.)--University of Adelaide, 2005. / Title from PDF title page (viewed on Nov. 30, 2006). Includes bibliographical references (p. 491-509).

M.Cur. / The aim with this study is to describe guidelines for curriculation, with primary health care as departure point. This study is based on the Judeo-Christian human and world premise and philosophy. The Nursing Theory for the Whole Person serves as meta-theoretic departure point, while the theoretic assumptions are based on: The Nursing Theory for the Whole Person (Oral Roberts University, Anna Vaughn School of Nursing, 1990). Van Niekerk's, Accompaniment Guidelines for Theory - Practice Correlation (1993). Curriculation Models of Malan & Jorrisen (1990) and Uys (1983). Klopper's Model for Accompanied selfstudy in Nursing Science (1994). The Botes's Model for Research in Nursing Science serves as methodological departure point (1991). Emphasis is placed on participative decision making regarding basic needs, including health care, within the ideology of the new Government of National unity (ANC, 1994:45) The Reconstruction and Development Programme, (RDP) accepted within the new political dispensation of South Africa, supports primary health care as total departure point, such as the National health Plan (ANC, 1994: 45). This, however, is not a new concept in health care services. The South African Nursing Council (SANC) has been supporting this principle for a considerable time. However there is little or no existing literature regarding the curriculation of the four year diploma programme, with primary health care as the departure point. This Qualitative study is executed in four phases. The first and second phase explore and describe the perceptions and interpretations of the share holders of the curriculum, in respect of primary health care as departure point, within curriculums, in terms of focus group interviews. The third phase describes a conceptual framework, according to a comprehensive literature study. Phase four describes guidelines for the facilitation of meso and micro curriculation, with primary health care as departure point, in respect of inferential data obtained from focus group interviews, the literature study and conceptual framework. The study's unique contribution, within the context of the Mpumalanga region is embodied in the manner in which the researcher succeeds to describe guidelines for curriculation for the four year diploma programme, that leads to registration as Professional Nurse (General-, Psychiatric-, and Community-) and Midwife, with primary health care as the departure point. This was achieved through inductive deliberation and cross triangulation in all four phases, which increases the trustworthiness of the study.

The aim of this study was to explore and describe the perceptions of registered nurses regarding the factors that influence service delivery in expansion programmes in a primary health care setting. A qualitative approach was used to conduct this study. Purposive sampling methods were used to select participants from the registered nurses who had been working in the clinics for more than two years and had been exposed to the expansion programmes in the clinics. The researcher collected data by means of focus group interviews, conducted in a neutral setting. Data were analysed,according to the Tesch method of data analysis, by the researcher and an independent co-coder. Categories, sub-categories and themes were identified. The categories that form the basis of the discussion are: disabling factors, enabling factors, client related factors, service related factors and solutions of problems. It was recommended that the integration and coordination of programmes at provincial level should be planned in conjunction with the training. The regional information system should introduce an electronic recordkeeping system, which links all clinics to one database, allowing these clinics to monitor clients who shop around and move between clinics. Training in expansion programmes should be continually conducted in the region in the form of in-service training. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

The South African Department of Health, like the health departments of many other countries, has reviewed its policies to focus on the delivery of comprehensive Primary Health Care (PHC). The South African health care sector is undergoing major restructuring in an attempt to address the inadequacies resulting from the fragmentation and duplication of health services in apartheid South Africa. Following this restructuring, the decentralisation to health services has been adopted as the model for both the governance and management of health issues (Department of Health, 2002:7). Before 1994, local government health departments were rendering certain primary health care services in terms of the Health Act 63 of 1977. Post 1994, the Constitution of the Republic of South Africa 1996 (Act 108 of 1996) classified primary health care as a provincial function. Based on this classification, primary health care services in South Africa are now being provided by two authorities, namely local government and provincial government, in the same community. Thus, in the Nelson Mandela Bay Municipality District, primary health care services are rendered by two authorities, namely the Nelson Mandela Bay Municipality and the Nelson Mandela Health District of the Eastern Cape Department of Health. These authorities are targeting the same community, with the same PHC package, with different sets of conditions of service, salary structures, infrastructure, accountability and authority. Such differences are believed to have impeded functional integration, depleted human resource capacity in rendering an effective and efficient PHC system and resulted in inefficient budget spending by both authorities. The problems of location, duplication and fragmentation of primary health care provision in the Nelson Mandela Bay Municipality District are not conducive to optimal service rendering. This will be resolved only once a unified, single integrated health service has been established. This study was undertaken to explore and describe the views of health practitioners with respect to the location of primary health care within the Nelson Mandela Bay Municipality District. The research design of this study was a quantitative, explorative, descriptive survey. Healthcare practitioners, like management, doctors and nurses, were asked to respond to a structured questionnaire. The findings of the study indicate that while health practitioners may hold diverse views on where primary health care should be located, they agree that a unified, single PHC authority would be desirable. Although primary health care is a combination of task-orientated basic health services and the process of community development, it is important that the authority of choice should ensure the highest possible quality through an integrated process, taking into account local needs. The recommendations made by the researcher on the conclusion of this study cover the principles on which a successful strategy for implementing primary health care should be based, including the need to create sustainable communities. It is hoped that the recommendations offered, will contribute to the more effective and efficient implementation of comprehensive primary health care services in Nelson Mandela Bay and also elsewhere in South African local government.

Primary health care (PHC) is an effective way to "optimize and reorganize the health care service system" and solve the "difficulty in obtaining expensive medical services". In the process of China's promotion of health care reform, PHC has been placed at the core part. In this paper, by tracing the history of the development of China's PHC, and evaluating, analyzing and comparing the current similar policies in the field of PHC in China and Britain, a certain understanding of the effects of China's current PHC policies has been presented. In the end, some suggestions inspired by UK experiences been proposed for the future development of PHC in China. Keywords Primary health care; China; health care reform; UK primary health care

The 2008 World Health Report emphasises that we need “primary health care (PHC) now more than ever”. Competent primary health care providers who “put people first” are required in the front line in order to make a difference. The need for widely accessible, competent and caring professional nurses thus places expectations on training programmes and health services. In South Africa, a number of studies have been conducted on primary health care and methods of teaching clinical competence to nursing students (Truscott 2010; Magobe et al. 2010; Naledi et al. 2010) but not on the experiences of nursing students during PHC practice. The researcher observed that the emphasis on the positive, supportive and helpful experiences of nursing students in coping with challenges during their clinical practice was distinctly lacking. The objective of the study was to explore and describe the experiences of nursing students during the clinical practice in PHC settings. It was expected that this information will enable the researcher to formulate recommendations to support nursing students to cope with challenges during clinical practice in a PHC setting. A qualitative descriptive inquiry, with an appreciative approach was used. Five semi-structured focus group interviews were conducted to obtain data. The population comprised of 4th year nursing students who were selected using purposive sampling with the assistance of a mediator, namely the Head of the Department for PHC at a Nursing College. The sample size was determined by data saturation. Data analysis was carried out simultaneously with the collection of data. Fifteen main themes were identified during a consensus discussion between the researcher and the co-coder. The main findings related to the meaning students attached to being placed in a PHC clinic; positive, supportive and helpful experiences; how they can be supported and what help them cope irrespective of challenges they experienced. Conclusions were drawn which pertained to: placement in a PHC setting for clinical practice; positive, supportive and helpful experiences; support when placed at a PHC setting for clinical practice and coping measures when placed at a PHC setting for clinical practice; and recommendations were formulated for nursing education, nursing research and nursing practice that focused on supporting and empowering nursing students to cope with challenges experienced at a PHC setting. / MCur, North-West University, Potchefstroom Campus, 2015

The 2008 World Health Report emphasises that we need “primary health care (PHC) now more than ever”. Competent primary health care providers who “put people first” are required in the front line in order to make a difference. The need for widely accessible, competent and caring professional nurses thus places expectations on training programmes and health services. In South Africa, a number of studies have been conducted on primary health care and methods of teaching clinical competence to nursing students (Truscott 2010; Magobe et al. 2010; Naledi et al. 2010) but not on the experiences of nursing students during PHC practice. The researcher observed that the emphasis on the positive, supportive and helpful experiences of nursing students in coping with challenges during their clinical practice was distinctly lacking. The objective of the study was to explore and describe the experiences of nursing students during the clinical practice in PHC settings. It was expected that this information will enable the researcher to formulate recommendations to support nursing students to cope with challenges during clinical practice in a PHC setting. A qualitative descriptive inquiry, with an appreciative approach was used. Five semi-structured focus group interviews were conducted to obtain data. The population comprised of 4th year nursing students who were selected using purposive sampling with the assistance of a mediator, namely the Head of the Department for PHC at a Nursing College. The sample size was determined by data saturation. Data analysis was carried out simultaneously with the collection of data. Fifteen main themes were identified during a consensus discussion between the researcher and the co-coder. The main findings related to the meaning students attached to being placed in a PHC clinic; positive, supportive and helpful experiences; how they can be supported and what help them cope irrespective of challenges they experienced. Conclusions were drawn which pertained to: placement in a PHC setting for clinical practice; positive, supportive and helpful experiences; support when placed at a PHC setting for clinical practice and coping measures when placed at a PHC setting for clinical practice; and recommendations were formulated for nursing education, nursing research and nursing practice that focused on supporting and empowering nursing students to cope with challenges experienced at a PHC setting. / MCur, North-West University, Potchefstroom Campus, 2015

As a result of the recent NHS reforms following the white paper, liberating the NHS (Department of Health, 2010a), which subsequently became the Health and Social Care Act 2012, it is clear that primary care, led by GPs, faces a considerable change to how healthcare to the population is delivered. Meeting these challenges proves to be difficult due to the nature of primary care contracting, in that GPs are responsible for their own organisations and are required to reconfigure their organisations accordingly. Due to the traditional structure of primary care, GPs appear to lack skills in business management and leadership. The study gains an understanding of the qualities GPs have, and need, from a business perspective, in relation to primary care management, and further develops a qualities framework for use by both current and future GPs. This has been achieved through a qualitative study making use of both structured and unstructured research methods, with the use of thematic analysis drawing meaning from the data. Findings indicate that doctors who have chosen to become a GP tend to not consider their role as business leaders, and opt to learn these skills while on-the-job, although since the implementation of the recent NHS reforms, newly qualified doctors are undertaking business skills training to support their applications for partnership posts. Findings also indicate that GPs see the need to hold business skills as partners within their own organisations as a necessary evil, but see the need to hold these same skills for their membership of the CCG as unnecessarily imposed. A qualities framework has been developed to support GPs with their need to obtain business management and leadership skills, from a general practice perspective. This maps six key qualities across nine domains, measured through a number of competencies for each mapping. It is recommended that the qualities framework developed as part of this research study is applied in general practice in relation to both organisational development and educational strategy. It is anticipated that this will contribute to both general practice performance and improvements in primary healthcare service delivery, from a general practice perspective.

The work described in this thesis concerns the use and quality of primary care service use by people living beyond a diagnosis of breast, colorectal and prostate cancer and long-term risks associated with cancer. Firstly, the thesis provides a background for this work, with a definition of long-term survivors as those living at least five years past cancer, and the role of primary care in the care of this population. The second section describes use of the General Practice Research Database amongst a cohort of cancer survivors compared to a control population. Breast and colorectal cancer survivors consult more frequently than controls up to 10 years post-diagnosis, while prostate survivors continue to see their GP up to 3 times more for at least 15 years. Most survivors receive adequate preventative care and chronic disease monitoring, excepting mammography for long-term breast cancer survivors. Cancer survivors receive more prescriptions for pain relief, anti-depressants and erectile dysfunction, suggesting higher rates of pain, depression and sexual dysfunction. Breast cancer survivors have an elevated risk of incident heart failure, coronary artery disease and hypothyroidism, while colorectal survivors experience increased risk of dementia and diabetes. All three groups of cancer survivors had higher risks of osteoporosis and second cancers, all-cause, non-cancer and cancer mortality compared to controls. The third section describes a qualitative study of the primary care usage and unmet needs of 40 long-term survivors of breast, colorectal and prostate cancer. Most respondents did not need active GP involvement. Others had ongoing information and psychological service needs. Some felt that their GPs did not have the right expertise for cancer related issues or were too busy, while others had concerns about continuity of GP care. Overall, this thesis provides a background on how the increasing numbers of cancer survivors use and experience primary care in the UK, areas of good practice, and areas where care can be improved in the future.