The Human Immunodeficiency (HIV) epidemic in South Africa is disproportionately distributed by gender. Although women lead in the number of infections they are at an advantage when it comes to seeking and receiving care. Men's poor health seeking behaviour finds them seeking care late, testing at lower rates, defaulting from treatment and eventually having worse health outcomes. More men than women fail to enter and stay in the HIV cascade of care. The HIV cascade is a metaphor used to describe the steps that include HIV testing, initiation of antiretroviral therapy (ART), adherence, viral suppression and good health outcomes. As health care providers (HCPs) are the ones who interact directly with men in the health system their view of the factors that hinder men's movement through the HIV cascade are valuable to better understanding how men interact with the care system. In this research semi-structured interviews were held with eleven HCPs working with HIV positive patients (6 women, 5 men) across 2 health facilities and 1 non-governmental organisation (NGO) within the Klipfontein sub-district. Health care workers were found to share some of the more commonly held notions regarding the barriers men face in HIV care. However, their experiences offer some challenging ideas and the health systems appears to be realising the need to tailor HIV services to the needs of men. The experiences and perspectives of HCPs should be further explored and the findings used to influence health policies and clinical practice.

Includes bibliographical references. / The midwifery model of care is a safe, effective, inexpensive, holistic, woman and baby centered-approach to maternal and infant health. It is widely used in developing and developed world contexts and has proven to have birth outcomes that are comparable to hospital-based, obstetric models. In many settings however, application of the independent midwifery model of care has become increasingly difficult to maintain. Tensions surrounding perceived skills and competencies of midwives, the increasing acceptance of hospital-based, obstetric models of childbirth, controversy over necessity and use of medical interventions, rising insurance premiums, and competition over clients in private sector scenarios are all factors contributing to both low availability and utilization in many countries, including South Africa. In order to consider the role of this model in maternity services in South Africa and to potentially make this model available on a wider scale, it is necessary to understand the demographics of current utilization of existing independent midwifery services, as well their as birth outcomes. This retrospective cohort study documents the total number of deliveries attended by independent midwives, the socio-demographic and reproductive characteristics of women using independent midwives and the birth outcomes and delivery types in the greater Cape Town region among the 16 independent midwives who have practiced during the six and a half year period of January 2003 - end of June 2009. It identifies factors associated with normal vaginal deliveries, instrumental deliveries and caesarean sections, as well as documents the socio-demographic and professional characteristics of the 16 independent midwives. Ethical approval for this research was granted by the University of Cape Town. Anonymous client data was collected from midwifery practices' Maternity Registers and transferred onto a data abstraction sheet. Midwife data was collected via an interviewer-administered questionnaire. All data was entered into Microsoft Excel and analyzed using Stata. The findings of this study will be used to inform maternal and infant health care policy, as well as provide statistics for independent midwives' quality assurance and auditing of services.

Includes bibliographical references (leaves 79-84). / Voluntary or induced termination of pregnancy (TOP) is a common reproductive health phenomenon worldwide, whether legal or illegal (WHO, 2004; Schenker and Cain, 1999). Although some countries, including South Africa, have liberalized TOP laws to allow legal and safe provision of abortion, many barriers continue to impede successful rollout of services. Key among these are the following: * recruiting and retaining staff to provide such services, * incorporating TOP observation and training into medical training curricula, preventing burnout, * addressing negative attitudes and stigma of health providers, * diminishing professional discrimination and harassment, and * offering more TOP training modules, counselling workshops, and values clarification workshops over a spread of geographic areas (Adamo, 2003). Identifying future health professionals who may be interested in training and eventually providing TOP care has thus been prioritized by the South African Department of Health. Examining the knowledge, attitudes, beliefs, and intentions of medical students in training could make an important contribution to policy initiatives with respect to abortion provision. The current study measured these parameters among medical students in one of the eight medical training institutions in South Africa. With the liberalization of TOP legislation in South Africa, future health professionals' attitudes and intentions towards abortion services is a critical determinant to equity, access, and availability of women's reproductive care and to the successful implementation of TOP law.

Includes bibliographical references / There is a need to build the capacity of professionals in low- to middle- income countries (LMICs) in order to reduce pesticide risks on human and environmental health. To address these risks, the University of Cape Town (UCT) introduced the Post Graduate Diploma in Pesticide Risk Management (DPRM). This programme utilises a mixed teaching mode including an e-learning component which includes virtual seminars/discussion forums. The DPRMs' discussion forum aimed to strengthen skills in managing and reducing pesticide risks. Due to the shortage of skilled professionals in LMICs, e-learning can facilitate the on-going training and skills development in pesticide management to address pesticide related challenges. The study focus was on evaluating the impact of the DPRMs' e-learning Discussion Forum bi-monthly sessions on the decision-making processes of professionals in LMICs working in pesticide risk management. The sample for this study was obtained from a population of working professionals, who either completed or were currently enrolled for the DPRM programme (N=37). Twenty-two participants completed the online questionnaire anonymously. These participants were employed by governments, non-governmental organizations (NGOs), research institutes and private companies in Africa and Fiji. This mini-dissertation is divided into four parts. The protocol (Part A) provides the study justification and describes the methodology for collecting the data and the analysis thereof. The literature review (Part B) describes e-learning and how it relates to capacity building of pesticide risk management (PRM) professionals in LMICs countries. It looks at the challenges of implementing and maintaining successful capacity building and the role e-learning plays. The manuscript of a journal ready article (Part C) presents the research findings on the perceived effectiveness of the e-learning based DPRM discussion forum and whether it aided PRM professionals in making better decisions. There are four appendices (Part D) which include the questionnaire, consent form, ethical approval and instructions for writing the manuscript. The study found that participants reported improved application of information gained through e-learning in a practical and effective manner, thereby improving their skills for real world scenarios. Overall benefits acknowledged by participants included establishing a knowledge resource, improved communication with colleagues and stakeholders, as well as improved ability for knowledge application in their work and pesticide use in context. An important finding was that just over half of respondents (55%) felt that they were able to contribute to policy change in their countries as a result of the discussion forum. Unfortunately, no statistical significance could be established between variables due to the limited sample size. It is recommended that a follow-up study with a larger sample be conducted, to establish whether the discussion forum has a long-term and sustainable impact in decision- making processes and policy implementation.

HIV prevention has received renewed attention with the release of results from clinical trials dealing with the efficacy and safety of HIV pre-exposure prophylaxis (PrEP), particularly once daily Truvada, within the last decade. The results seemed to suggest that PrEP is efficacious with high levels of adherence. This culminated in the South African Medicines Control Council (MCC) approving use of Truvada as HIV PrEP in December 2015, coupled with the release of SA HIV Clinicians Society guidelines in February 2016. Several issues were found to be involved in prescribing Truvada as PrEP, including clinical monitoring, adherence counselling, and potential for patient behavioural disinhibition. The objective of this thesis is to discuss the results of an online survey administered to South African doctors, on their opinions on the use of Truvada as PreP. Part A deals with the survey protocol and focuses on (1)ethical issues such as approval by the University of Cape Town Research Ethics Committee, and obtaining consent, (2) method of data collection and (3) procedure of data analysis. Part B is a literature review expanding on the topics described in the Background section, including extent of problem posed by HIV, failure to develop a viable HIV vaccine, need for HIV PrEP, review of previous research on HIV PrEP, and the need for a study on South African doctors' opinions on PrEP. Part C is a manuscript that shows the results of the survey, analysis of the data and a discussion on the possible implications.

Bibliography: leaves 64-71. / To develop a questionnaire for evaluating dietitians' knowledge and practices with regard to the use of dietary supplements. A cross-sectional validation study was carried out in two phases, namely 1) questionnaire planning and development and 2) test evaluation. The study sample comprised 48 nurses, 105 dietetic interns and 367 registered dietitians. An expert academic group comprising 9 dieticians with research and teaching experience rated the academic relevance and importance of knowledge questions in an item pool of 355 questions, in order to ensure face and content validity.

Includes bibliographical references. / Lower to middle-income countries are often unable to provide comprehensive health care to their citizens, and weak health systems have increasingly been identified as a key factor in this failure. Many interventions are being implemented to strengthen the health systems of lower to middle-income countries. Public-private partnership (PPP) in health care has been identified as one such key strategy and solution. Although the specific rewards of-or obstacles to PPP have not yet been strongly evidenced, PPP interventions are being advised and adopted in many countries as a key health systems intervention. It is therefore important to assess and understand the effects of such PPP efforts. This study focuses on a particular PPP arrangement in Cameroon –between non-profit faith-based providers and the Cameroonian Ministry of Health. This partnership is based primarily on the secondment of government-employed health workers into the faith-based health system. This case study focuses in particular on this arrangement as it is experienced in the Catholic Maroua-Mokolo Diocese in the Far North Region of Cameroon. This study finds that although PPP is considered to be helpful in strengthening the national health systems functioning –in this case, all of the focus has been on the secondment mechanism and visible resourcing. Not enough attention has been given to the less visible aspects of partnership such as clashes between workers’ aspirations or organisation cultures. This study demonstrates the problems inherent in an applied systems intervention that disrupts existing modes of operation, and does not answer to individuals' aspirations. It is demonstrated that such an intervention mainly results in various forms of resistance rather than immediately strengthened partnership.

Bibliography: leaves 71-74. / Provincial Health Accounts describe the sources, uses, and channels for all funds utilized in the health sector and are a basic requirement for optimal management of the allocation and mobilization of health sector resources. This study emphasises the concept of National Health Accounts at provincial level in order to get a full picture of the financial organization of the health care system in the selected province, Northern Cape, and assesses its achievement of efficiency and equity objectives.

Includes bibliographical references (leaves 85-89). / According to the 2000/2001 Zambia Demographic and Health Survey (ZDHS), HIV/AIDS prevalence is 16% and is expected to be higher in the next five years. The disease is quite pervasive across all sectors of economic activity, but the impact is especially acute on the Zambian health sector, which is faced with increasing demands on healthcare for not only HIV/AIDS but other diseases such as malaria, tuberculosis, cholera, diarrhoea, to mention but a few. It is therefore essential that expenditure on HIV-related care among different health care systems be analysed so as to determine areas of relatively greater need. It is against this background that this study entitled, "An analysis of expenditure on HIVIAIDS patients in Zambia", was conducted. The main objective of the study is to analyse expenditure on HIV-related care and treatment among the different health care systems and geographical localities in Zambia. The study used utilisation data on total and HIV-related outpatient visits and inpatient days collected from the country's facility based database called the Health Management Information System (HMIS); and HIV-prevalence data compiled from the Central Statistics Office's report on Epidemiological Projections. Expenditure data on the other hand was compiled from the National Health Accounts (NHA) report for 1999-2002 and separate data on HIV/AIDS expenditure was collected from the District Health Boards reports for 2003. Utilisation and HIV-prevalence data were then combined with expenditure data to estimate the overall utilisation of services by HIV-positive patients and the annual expenditure required to meet the burden of HIV/AIDS. Both utilisation and expenditure statistics were analysed and compared according to different levels of healthcare and geographical localities. Data analysis was exploratory and descriptive.

The objectives were to evaluate the validity and reliability of four neurobehavioral instruments used in the study and to test three models hypothesised as possible causal pathways between OP exposure and depression, impulsive behaviour and suicidal ideation.