Electronic Theses and Dissertations (Masters)

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Browsing Electronic Theses and Dissertations (Masters) by SDG "SDG-16: Peace, justice and strong institutions"

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    Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province
    (2024) Sibisi, Nthabiseng
    Aim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.
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    Understanding the roles and experiences of key stakeholders involved in the design of the novel imagine social outcomes-based contract in South Africa
    (2024) Moodley, Gillian Pryadarshini
    The Imagine Social Outcomes-Based Contract (SOBC) is an innovative health financing mechanism in South Africa applied to sexual and reproductive health outcomes of adolescent girls and young women. The Imagine SOBC is led by the South African Medical Research Council (SAMRC) and supported by other stakeholders. Its uniqueness stems from the role played by the SAMRC, as an intermediary on behalf of the South African government. Eleven semi-structured interviews were held with stakeholders who played intermediary, technical advisor, and implementation service provider roles during the Imagine SOBC design phase. Interviews were transcribed and analysed using the six steps of thematic analysis. The thematic findings of this study are the dynamics of working together, politics and processes, challenges and looking to the future. Despite internal collaboration and alignment among interviewees, the biggest challenge during the design phase of the Imagine SOBC was obtaining approvals from the government departments due to complex approval processes in the public sector. The lessons generated are important as the SAMRC intends to replicate the outcomes-based contract model for other disease priorities. These findings are valuable for policymakers and future outcomes-based contract practitioners who are considering a transaction of this nature and its application to public health. The findings will also assist in the development of a guiding practice note for policymakers and government officials who grant approvals.