In this study, county level data for three time periods (1970, 1985, and 1989) are examined to determine the factors affecting the distribution of primary care physicians in rural counties of Virginia. Consistent predictors of proportions of physicians to the population were identified: golf holes per capita and the ratio of hospital beds to population were the most consistent predictors. Per capita income and the elderly population were only significant for some of the years. Variables deemed to be controllable by the community (in the short run) were generally more consistent in predicting the proportions of physicians to population. Policy implications are discussed, and several strategies for improving access to health care in rural areas, thus altering the massive imbalance in physician to population ratio in urban and rural areas are suggested. / Master of Science

Submitted in fulfillment of the requirements for the degree of Doctor in Public Management, School of Public Management and Economics, Durban University of Technology, Durban, South Africa, 2016. / The shortage of staff in hospitals resulted in the overcrowding of outpatients departments (OPDs) and long waiting times. The problems of the current health care system include the lack of access to transportation and high transport fees which cause delays in health seeking behaviours by patients or them resorting to traditional medicine in their neighbourhood. To alleviate the above issues, the new Primary Health Care (PHC) approach provides health care at a ward based and household level through community care giver (CCGs) and outreach teams. The study evaluated the management of rural ward-based primary health care in the UThukela District Municipality (UDM). The study intended to evaluate current performance systems in order to provide effective and efficient PHC; identify the role of the operational manager (OM) in the provision of PHC; and identify the factors affecting the performance of CCGs. A mixed methods approach was used amongst 368 CCGs and 17 OMs. Data was collected from CCGs using questionnaires while an interview schedule was used to collect data from OMs. The study showed that the performance management systems currently being used were not providing the desired performance management outputs. There were no performance bonuses to recognise best performing staff and therefore no increase in performance. The study also showed a significant relationship between the management of referrals and participation in the activities of PHC outreach teams. The clinic was not regularly giving feedback to the respondents and also not consistently conducting performance reviews. The findings indicated that OMs were playing various roles in the provision of PHC, namely policy and strategy implementation; leadership and governance; clinical care; allocation of resources; clinic budget management; supply chain management; and writing clinic reports. The extent of the allocation of resources to the wards varied from 43% for medicines and equipment to 31% for financial resources and only 18% for human resources. More than 95% of the CCGs viewed the availability of transport, resources, training and the provision of a stipend to be strong enabling factors for them to perform their work. Respondents indicated that monitoring and evaluation was done through reporting, performance reviews, feedback and supervision. The findings indicated that ward-based outreach teams are crucial in the delivery of PHC services in rural municipal wards within the Operation Sukuma Sakhe programme. Lack of management and supervisory support contribute to high rates of dissatisfaction amongst CCGs, as well as poor quality of work for community caregivers. There is a need for the Department of Health (DoH) to invest in the ward-based outreach teams (WBOTs) and allocate CCG budgets within the ward-based outreach teams. The study recommended that a review of monitoring and evaluation policy is required to clearly state the tools, activities and benefits of the implementation of the M & E performance management systems. The use of point-of-care technology by the WBOTs should be strengthened especially in deep rural wards. Therefore, biomedical technology will enhance point-of-care diagnosis, for instance, rapid home test kits for HIV diagnosis and pregnancy tests. The KwaZulu-Natal DoH should fast-track development of the sub-districts in order strengthen service delivery at a local level with top management ensuring development of OMs and PHC Supervisors in order to increase the level of competence and thereby improve service delivery at the PHC facilities. Another recommendation was to strengthen implementation of Operation Sukuma Sakhe (OSS) where the war room and the ward committee increase commitment to designing community-specific interventions with the engagement of community structures and government departments and local municipality through social planning, social action and locality development. Therefore, the results of the study should also influence the formulation of policies, programmes, methods and interventions which will enable UThukela District Municipality to improve health outcomes. / D

University of Macau / Institute of Chinese Medical Sciences

Source: Masters Abstracts International, Volume: 46-05, page: 2668. Adviser: Maria E. Fernandez. Includes bibliographical references

Background. The study objective was to determine how the population located in five remote rural areas responded to HIV testing offered by mobile clinics operating under Family Health International, an international NGO that provides health services, especially HIV prevention and family planning. The study sought to identify how different segments of the population, classified according to their socio-demographic characteristics, responded to HIV testing. The analysis is based on secondary data, collected between October 2009 and September 2010, on clients who came to seek health services at mobile clinics. The population is geographically located in five districts: OR Tambo in Eastern Cape, Amajuba in KwaZulu-Natal, Gert Sibande and Ehlanzeni in Mpumalanga, and Sekhukhune in Limpopo. Although these mobile clincs provided comprehensive health services, HIV prevention and family planning were the main focus of attention. Methods. A total number of 9015 individuals aged 18 years and older visited the mobile clinics during the period October 2009 to September 2010. Eight socio-demographic characteristics were collected and used to determine the association between HIV testing and the aforementioned eight variables. The association between the independent variables (sex, age, level of education, marital status, occupation, number of living children, district of residence and area of residence) and HIV testing (the dependent variables) was first investigated using a descriptive analysis and then performing a logistic regression. Results. More than 88% of individuals aged 18 years and older who visited the mobile clinics in the areas covered by the FHI project are from rural areas. HIV testing is still low in these areas, even though the services are provided close to their homes by the mobile clinics. It was found that only 34.7% of the mobile clinic’s clients tested for HIV during the period from October 2009 to September 2010. Out of eight independent variables included in the logistic regression model, five were found to have a statistically significant association with HIV testing, being: sex, age, education, occupation and area of residence Although the majority of these mobile clinics’ clients are females (77.1%), males tested in higher proportion than females accross all areas. The results showed that HIV testing decreases with age, with the age category 18 - 24 years testing for HIV in higher proportion than the age group 25 - 34 years and decreasing further when people become older. Individuals are more likely to take an HIV test when their level of education is higher than matric and tend to respond the same to a HIV testing offer when they have no education, primary or secondary level. Employment was found to be an enabling factor to test for HIV. People who are employed tested for HIV in a higher proportion than people who were unemployed or still in school. The area of residence (classified as rural, semi-urban and urban) showed that HIV testing is higher in urban than in semi-urban areas, and low in rural areas. The analysis by sex showed that education is important for women because women who had either primary, secondary or a higher level of education tested for HIV better than women who do not have any level of education. For males, education was not statistically significant regarding HIV testing. The different age groups showed the same pattern for both sexes regarding HIV testing, but young males in the category 18-24 years showed higher odds of testing for HIV than females in the same age category. With occupation variable, females who are either students or employed tested for HIV almost in the same proportion and their odds of testing for HIV were double that of unemployed females. Employed males showed a notably higher difference in testing for HIV than males who were either in school or unemployed. The area of residence showed the same pattern for males and females, with both testing in higher proportions in urban and semi-urban areas than in rural areas. Conclusion. Women from rural areas, with no education, were found to test for HIV less than any other individual in the areas under study. Women tested better when they had been exposed to any form of education. The provision of education to women in the form of an extensive and aggressive door to door HIV awareness campaign should therefore make a difference in increasing the uptake of HIV testing in the five areas covered by the mobile clinics. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.

Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Thesis (Ph.D.)--University of Western Sydney, 2008. / A thesis presented to the University of Western Sydney, College of Arts, Social Justice and Social Change Research Centre, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

Thesis (Ph.D.)--Flinders University, School of Medicine. / Typescript bound. Includes bibliographical references: (leaves 204-216) Also available in electronic format.