Thesis (PhD)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: District hospitals play a pivotal role in the district health system of the Western Cape
and other provinces of South Africa. It is a dual role, supporting both primary health
care services and serving as a gateway to higher levels of care.
Most district hospitals are in rural areas, staffed by generalist medical practitioners
who provide health services often supplied by specialists in urban areas. There is a
paucity of research and published material on the scope of practice of district hospital
practitioners in South Africa, as well as the factors influencing the performance of
their duties.
There were two main objectives for this study. Firstly, to identify the professional
knowledge and skills of medical practitioners delivering district hospital services in
the Western Cape and to compare these with service platform needs. Secondly, to use
the information gathered to make recommendations regarding human resource
development and appropriate education and training and continuing professional
development of these doctors.
The study was conducted in three phases to ensure coherent evolution of
investigation, co-ordination and response.
Phase One was a comprehensive survey, utilising district hospital data, medical
officer questionnaires and in-depth interviews to determine the professional
knowledge and skills of medical practitioners working in district hospitals in the
Western Cape. This information gathering endeavour resulted in a skills and
knowledge compendium being formulated. It established that the spectrum of
functions required of these doctors was extremely wide - ranging from the
management of undifferentiated problems to performing complex surgical procedures,
as well as providing a vital public health function. Two main factors influenced their
performance, namely their working conditions and the education and training which
they received.In common with rural practice in other countries, it was apparent that the working
environment had a major impact on attitudes and functioning. These findings were
developed into a conceptual framework depicting the negative influences that can
build up and result in these doctors opting out of rural practice.
In addition, other influences were established having a profound effect on doctors’
satisfaction, mainly in the realm of education and training. This gave rise to a second
more comprehensive framework being evolved, encapsulating the positive and
negative factors enhancing or retarding efficiency and satisfaction in the workplace.
Phase Two of the study consisted of the validation of the findings of the basic
research data.
In keeping with the second aim of the study, the education and training perspectives
of rural and district hospital practice were explored. The deficiencies exposed have
implications for undergraduate and postgraduate education and training, as well as for
continuing professional development programmes.
Phase Three concentrated on the exploration of ways and means of defining and
maintaining ongoing professional competence for district hospital practice. This was
approached by using the data captured in Phase One and refined in Phase Two to pose
a series of educational problems to a group of experts. Using the Delphi Technique, a
series of electronic exchanges achieved consensus on a range of topics varying from
educational content to learning modalities and modern adult teaching techniques
applicable to district hospital practice.
This research presents information defining the circumstances, experiences and needs
of medical practitioners working in district hospitals in the Western Cape province of
South Africa.
It reveals clear challenges to the capacity, attitudes, costs, isolation, political will,
monitoring and organisation which will be crucial in the development of future human
resource strategies.It, furthermore, defines the educational objectives, content and methods required to
establish and maintain the ongoing professional competence of medical practitioners
delivering district hospital services in the Western Cape. / AFRIKAANSE OPSOMMING: Distrikshospitale speel ‘n sentrale rol in die distriksgesondheidstelsel van die Wes-
Kaap en ander provinsies in Suid-Afrika. Dit is ‘n dubbele rol wat beide primêre
gesondheidsorgdienste ondersteun en optree as ‘n deurgang vir verwysing na hoër
vlakke van sorg.
Die meeste distrikshospitale is te vinde in plattelandse gebiede. Dit is hier waar die
algemene geneeskundige praktisyn dienste lewer wat gewoonlik deur spesialiste in
stedelike gebiede verrig word. Daar is ‘n gebrek aan bestaande navorsing en
publikasies oor die omvang van praktyk van geneeshere in distrikshospitale in Suid-
Afrika, sowel as onvoldoende inligting in verband met faktore wat die funksionering
van hierdie praktisyns beïnvloed.
Hierdie studie het twee hoofdoelwitte vervat. Die eerste doelwit was die bepaling van
die professionele kennis en vaardighede van geneeshere werksaam in distrikshospitale
in die Wes-Kaap, en die vergelyking daarvan met die behoetes van die diensplatform.
Die tweede doelwit was om hierdie inligting te gebruik om aanbevelings te doen
aangaande menslike hulpbronontwikkeling en toepaslike onderrig, opleiding en
voortgesette professionele ontwikkeling vir hierdie geneeshere.
Die studie is in drie fases uitgevoer om samehangende ontwikkeling van ondersoek,
koördinasie en respons te verseker.
Fase Een het bestaan uit ‘n omvattende opname van die professionele kennis en
vaardighede van geneeshere werksaam in distrikshospitale in die Wes-Kaap deur die
gebruik van distrikshospitaaldata, vraelyste vir geneeshere, en in-diepte onderhoude.
Die resultate is gebruik om ‘n omvattende stel kennis en vaardigheidsareas te
identifiseer. Fase Een het bewyse gelewer dat die rol en funksie van dokters in
distrikshospitale uitsonderlik wyd is en wissel tussen die hantering van
ongedifferensieërde probleme en die uitvoer van komplekse chirurgiese prosedures,
sowel as ‘n belangrike rol in openbare gesondheid. Werksomstandighede en onderrigen opleiding is geïdentifiseer as die twee belangrikste invloede wat die uitvoer van
hierdie praktisyns se pligte beïnvloed.
Soortgelyk aan plattelandse praktyke in ander lande, het dit duidelik geword dat
werksomstandighede ‘n groot invloed op houdings en funksionering het. Hierdie
bevindings is saamgevoeg in ‘n konseptuele raamwerk om die negatiewe invloede toe
te lig wat veroorsaak dat hierdie geneeshere die plattelandse diens verlaat.
Ander faktore wat ‘n beduidende uitwerking op praktisyns se werksbevrediging gehad
het, veral wat onderrig en opleiding betref, is saamgevat in ‘n tweede en omvattende
raamwerk wat die positiewe en negatiewe invloede op effektiwiteit van dienslewering
en werksverrigting uitspel.
Fase Twee van die studie het bestaan uit die bevestiging van die bevindings van die
basiese navorsingsinligting.
Perspektiewe in die onderrig en opleiding vir plattelandse praktyk is ondersoek in
oorleg met die tweede doelwit van die studie. Verskeie implikasies vir voorgraadse en
nagraadse onderrig en opleiding en voortgesette professionele
ontwikkelingsprogramme is uit ontblote tekortkomings geïdentifiseer.
Die omskrywing en die behoud van professionele bevoegdheid is in Fase Drie
ondersoek. Data verkry in Fase Een, en verfyn in Fase Twee, is gebruik in die
ontwikkeling van ‘n reeks opvoedkundige vraagstukke. ‘n Groep deskundiges is
daarna die taak gestel om konsensus te bereik oor ‘n spektrum van onderwerpe,
insluitend toepaslike inhoud, metodes van leer en moderne volwasse onderrigtegnieke
vir distrikshospitaal praktykvoering. Die Delphi tegniek met herhalende elektroniese
rondtes is hiervoor gebruik.
Hierdie navorsing lewer inligting wat die omstandighede, ondervindings en behoeftes
van geneeshere werksaam in distrikshospitale in die Wes-Kaap provinsie van Suid-
Afrika beskryf.Die navorsing onthul duidelike uitdagings vir die kapasiteit, houdings, koste, isolasie,
politieke wilskrag, monitering en organisasie van strategieë vir die ontwikkeling van
menslike hulpbronne.
Dié navorsing definieër hierbenewens die opvoedkundige doelwitte, inhoude en
metodes wat nodig is vir die vestiging en instandhouding van die professionele
bevoegdheid van distrikshospitaalpraktisyns in die Wes-Kaap.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/16044 |
| Date | 04 1900 |
| Creators | De Villiers, Marietjie Rene |
| Contributors | De Villiers, P.J.T., University of Stellenbosch. Faculty of Health Sciences. Dept. of Family Medicine and Primary Care |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | xxii, [333] leaves : ill. |
| Rights | University of Stellenbosch |
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