Thesis (MPA)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: The implementation of national policies is a key function of government
through its various departments. This is very crucial in the health sector
where lives of individuals are involved. The implementation of the national
HIV/AIDS policy is very important in dealing with the epidemic.
This study combined both quantitative and qualitative methods to
analyse the implementation of the South African government’s national
HIV/AIDS policy in the Vhembe District of the Limpopo Province. The
quantitative phase involved the stratified sampling process, resulting in
identifying 2 health workers from each of the 25 health units in the district
comprising of 22 community clinics, the infection control unit, the counselling
unit at the hospital and 2 from among the doctors. A total of fifty respondents
were selected from a workforce of about 500.
The staff profile indicates that 76 % of the health workers interviewed
were below 40 years of age and 28% of them were chief professional nurses.
Of the health workers, 78 % had been in the current position for between 1
and 5 years, 6 % for 6 to 10 years, 6 % for 16 or more years and 10 % for
less than one year. All of them had a diploma as a minimum qualification, 8
% had 2 diplomas, 2 % had 3 or more diplomas, 2% had degrees and 2 %
had a degree plus diplomas.
In terms of HIV/AIDS policy implementation, 100% of all the facilities
provided HIV prevention information to clients, 60% of these facilities worked
with other organisations in HIV prevention, but only 4% had voluntary
counselling and testing (VCT) services. In these health units only 28% had
had staff trained regarding HIV/AIDS issues. In addition 96 % of the health
units had the male condom stocked at any one time and only 12 % stocked
the female condom.
In terms of sexually transmitted diseases (STD) control, all clinics were
using the syndromic approach in management of STDs and also claimed to
have youth-friendly services. On the other hand only 80 % of the facilities
had had staff trained in STD management using the syndromic approach.
In the area of prevention of mother-to-child transmission of HIV, (PMTCT) none of the clinics had VCT services for pregnant women and only
8% of them had PMTCT counsellors. Because of the lack of VCT services only
4% of the clinics had known HIV positive mothers attending the antenatal
care services.
On the issue of post-exposure prophylaxis (P.E.P.) all clinics had
protocols for this and 88% of them had antiretroviral drugs (ARVs) stocked
for post-exposure treatment for health workers. However, only 8% of these
clinics had a betadine douche as the only post-exposure intervention for
raped women.
In the area of treatment care and support for patients none of these
clinics offered ARVs, 24 % had protocols for prevention and management of
opportunistic infections, 4% were involved in any form of home-based care,
4% had HIV/AIDS dedicated services and 24% collaborated with community
non-governmental organisations (NGOs) in HIV/AIDS care.
The qualitative phase of the study highlighted what health workers
perceived as prominent features of the national HIV/AIDS policy and these
included prevention of HIV by use of condoms, faithfulness and pre-test
counselling. The respondents also interpreted the social response by
government to include provision of home-based care, care of orphans, food
provision and safe guarding rights of victims. Other issues that were
perceived to be part of the national HIV/AIDS policy were STD management,
health education, provision of training to health workers in HIV/AIDS issues,
provision of home-based care and occupational health and safety for health
workers.
The government was also perceived to have a negative attitude
towards AIDS NGOs, not providing adequate numbers of the female condom
and denying patients antiretroviral drugs (ARVs).
The recommendations made on the basis of the study therefore
include strengthening the training of health workers in HIV/AIDS care and
management, improved provision of VCT services, wider distribution of the
female condom, provision of prevention of mother-to-child transmission of
HIV (PMTCT) services and the linking of research and care to provide evidence-based practice. Other recommendations are that there should be
support programmes for health workers with HIV, addressing gender issues in
implementation and provision of ARVs especially where it is already known
that they help. / AFRIKAANSE OPSOMMING: Die implementering van nasionale beleid is ‘n sleutelfunksie van die regering,
verrig deur sy onderskeie departemente. Dit is veral deurslaggewend in die
gesondheidsektor waar die lewens van individue op die spel is en die
implementering van die nasionale MIV/VIGS- beleid is baie belangrik in die
hantering van die epidemie.
In hierdie studie is beide kwalitatiewe en kwantitatiewe metodes
gekombineer om implementering van die Suid-Afrikaanse regering se
nasionale MIV/VIGS -beleid in die Vhembe-distrik van die Limpopo-provinsie
te analiseer. Die kwantitatiewe fase het ‘n gestratifiseerde steekproefproses
behels, wat gelei het tot die identifisering van 2 gesondheidswerkers uit elk
van die 25 gesondheidseenhede in die distrik, bestaande uit 22
gemeenskapsklinieke, die infeksie-beheereenheid, die beradingseenheid by
die hospitaal en die geledere van die dokters. So is ‘n totaal van 50
respondente geselekteer uit ‘n arbeidmag van ongeveer 500.
Die personeelprofiel dui aan dat 76% van die gesondheidswerkers wat
ondervra is jonger as 40 jaar was en dat 28% van hulle hoof professionele
verpleegsters was. Van die gesondheidswerkers was 78% vir 1 tot 5 jaar in
hul bestaande posisie , 6% vir 6 tot 10 jaar, 6% vir 16 of meer jare en 10%
vir minder as 1 jaar. Almal van hulle het ‘n diploma as ‘n minimum
kwalifikasie gehad, 8% het 2 diplomas, 2% het 3 of meer diplomas, 2% het
grade en 2% het ‘n graad plus diplomas gehad.
In terme van die MIV/VIGS beleidsimplementering het 100% van die
fasiliteite MIV- voorkomingsinligting aan kliënte verskaf, 60% van hierdie
fasiliteite in samewerking met ander organisasies , terwyl slegs 4%
vrywillige berading en toetsdienste verskaf het. Slegs 28% van die
gesondheidseenhede het oor personeel beskik met opleiding in MIV/VIGSkwessies. Verder het 96% van die gesondheidseenhede die manlike
kondoom in voorraad gehad teenoor slegs 12% eenhede die vroulike
kondoom.
In terme van die seksueel-oordraagbare siektebeheer, het al die klinieke die
sindroom-benadering in die bestuur van seksueel- oordraagbare siektes
toegepas en het beweer dat hulle dienste jeugvriendelik is. Daarteenoor het
slegs 80% van die fasiliteite beskik oor personeel wat opgelei was in
seksueel- oordraagbare siektebestuur met toepassing van die sindroombenadering.
Op die terrein van voorkoming van moeder- na- kind- oordraging van HIV het
geen van die klinieke oor vrywillige berading en toetsdienste vir swanger
vroue beskik nie en slegs 8% van hulle het wel moeder-na-kind–
oordragingsberaders gehad. As gevolg van die gebrek aan vrywillige
berading en toetsdienste het slegs 4% van die klinieke kennis gedra van
HIV- positiewe moeders wat voorgeboortelike sorgdienste bygewoon het.
Wat na-blootstellingsvoorbehoeding aanbetref, het alle klinieke protokolle
gehad en 88% het antiretrovirale medisyne in voorraad gehad vir nablootstellingsbehandeling
van gesondheidswerkers. Slegs 8% van hierdie
klinieke het egter ‘n betadine-spoeling(“douche”) as die enigste nablootstelling
intervensie vir verkragte vroue gehad.
Op die gebied van die behandeling van en ondersteuning aan pasiënte het
geen van hierdie klinieke die antiretrovirale medisyne aangebied nie, 24% het
protokolle vir die voorkoming en bestuur van geleentheidsinfeksies gehad,
4% was betrokke in enige vorm van tuisgebaseerde sorg, 4% het oor
MIV/VIGS -gerigte dienste beskik en 24% het met
gemeenskapsvrywilligerorganisasies saamgewerk in die voorsiening van
MIV/VIGS-sorg. Die kwalitatiewe fase van die studie fokus op wat gesondheidswerkers beskou
as prominente kenmerke van die nasionale MIV/VIGS- beleid en wat insluit
die voorkoming van HIV deur die gebruik van kondome, getrouheid en voortoets-
berading. Die respondente vertolk die regering se sosiale reaksie as
insluitend die verskaffing van tuisgebaseerde sorg, die versorging van
weeskinders, voedselvoorsiening en die beveiliging van slagoffers se regte.
Ander kwessies wat ook gesien word as deel van die nasionale MIV/VIGS
beleid is seksueel- oordraagbare siektebeheer, gesondheidopvoeding, die
verskaffing van opleiding aan gesondheidswerkers in MIV/VIGS-probleme, die
voorsiening van tuisgebaseerde sorg en beroepsgesondheid en veiligheid vir
gesondheids werkers.
Die regering se houding teenoor VIGS vrywilligerorganisasies is ook as
negatief vertolk deur onvoldoende hoeveelhede van die vroulike kondoom te
verskaf en antiretrovirale medisyne te weerhou van pasiënte.
Die aanbevelings wat op grond van die studie gemaak is, sluit in die
verbeterde opleiding van gesonheidswerkers in MIV/VIGS-sorg en -bestuur,
verbeterde verskaffing van vrywillige berading en toetsdienste, wyer
verspreiding van die vroulike kondoom, verskaffing van MIV-dienste vir die
voorkoming van moeder-na-kind-oordraging en die konnektering van
navorsing en sorg om ‘n inligtingsbaseerde praktyk te skep. Ander
aanbevelings is dat daar ondersteuningsprogramme vir gesondheidswerkers
met MIV behoort te wees wat geslagskwessies aanspreek in die
implementering en verskaffing van antiretrovirale medisyne waar dit reeds
bekend is dat dit wel help.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/16383 |
| Date | 12 1900 |
| Creators | Luyirika, Emmanuel B. K. (Emmanuel Bruce Kaweeri) |
| Contributors | Cloete, Fanie, University of Stellenbosch. Faculty of Economic and Management Sciences. School of Public Management and Planning. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | xiv, 83 leaves : ill., maps |
| Rights | University of Stellenbosch |
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