3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An exploration of the perceptions of community health workers on the enablers and barries to providing services in Nyanga district, Zimbabwe(2016) Darikwa, PatriciaBackground: The work of Community Health Workers is appreciated in most setups in both developing and developed countries. In Zimbabwe there are a number of cadres who are working to bridge the health services and the community. There has however been limited documentation on the perspectives of Community Health Workers on what enables them to do their work and also barriers they face in providing their services. Aim: The study aimed to explore the perceptions of CHWs on the enablers and barriers to providing services in Nyanga district in Zimbabwe. Method: The study used a qualitative methods of in-depth interviews with Community Health Workers and key informants and document reviews. A thematic content analysis was used to identify key themes. The themes were then further analysed to identify the enablers and barriers to community health work. Results and Conclusion: The major enablers of the CHW work were perceived to be the benefits which have accrued to the communities the CHWs were working with, the benefits which the CHWs had gained and the support given by the hospital, NGO and the community leadership. The following were perceived to be the major barriers to CHW work: limited access to health services by the communities from the health facilities driven by the weak macroeconomic conditions in the country, gaps in support services, workload and geographical coverage. The recommendations include improving the motivation of the CHWs through efficient payment system, improving on quality of care and processes in the service provision. The results provide insights into CHW work which can assist policy makers and managers in making informed decisions on the investments they make for the CHW programmes in Nyanga district and Zimbabwe in general.Item Implementation of the ward based primary health care outreach teams in the Ekurhuleni health district: a process evaluation(2015) Whyte, CarmenIntroduction: One of the aims of the re-engineering of primary health care in South Africa is to strengthen the health system and improve accessibility of health services through ward based outreach teams (WBOTs) comprising of nurses and community health workers. Aim: To evaluate the implementation of WBOTs against national guidelines and identify Community Health Worker (CHW) characteristics that influence adherence to guidelines regarding the referral and follow up of maternal and child health clients. Methodology: This cross-sectional study was conducted during 2013. All 9 WBOTs at the time were included in the study. Data were collected through: a questionnaire survey; key informant interviews and a review of records of pregnant, post-natal women and unimmunized children under five. A process evaluation was conducted to describe inputs (training, team composition, resources, and knowledge); processes (service delivery, referral linkages, support and supervision) and outputs (number of clients referred and followed up). Logistic regression was performed to identify CHW characteristics (Age, education, experience, training, and knowledge) associated with adherence to national guidelines. Results: WBOT had sufficient numbers of CHWs within the team; however lacked sufficient knowledge and resources required to conduct household visits. CHWs adhered to the guidelines regarding the follow up of maternal clients with 85% of CHW having conducted the required number of follow up visits for pregnant and postnatal women. However, only 29% of unimmunized children were appropriately followed up. Challenges identified included: lack of supervision, limited resources, and poor knowledge. There was no statistically significant association between CHW characteristics and adherence to guidelines. Conclusion and recommendations: This study highlights the challenges that need to be addressed around the WBOT implementation. It is recommended that there is improvement in resource availability, CHW supervision, capacity and training to improve the implementation process of future teams. Key words: Ward Based Outreach Teams, Primary Health Care re-engineering, Community Health WorkerItem Inherited breast and ovarian cancer: a review of the available genetic counselling and testing services in Johannesburg(2013) Jefferies, MarianneFive to ten percent of both breast and ovarian cancer cases are attributable to dominantly inherited mutations in genes that predispose to cancer, with a large proportion caused by mutations in the breast and ovarian cancer predisposing genes BRCA1 and BRCA2. Testing for these inherited cancers is indicated for individuals identified as being at high risk, or moderate to high risk, of having a cancer syndrome based on their family history of breast and/or ovarian cancer. Screening for high-risk individuals through services such as genetic counselling, has the potential to improve outcomes for these individuals and lower mortality rates. This study focused on individuals who attended genetic counselling for breast and/or ovarian cancer at the Genetic Counselling Clinics of the Division of Human Genetics, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg from 2001 to 2010. The study was divided into a file review on 218 counsellees and a telephonic interview of 50 counsellees. Focusing on breast and/or ovarian cancer, the study aimed to review who attends genetic counselling and why; who is offered genetic testing; what testing is offered and performed and; who pays for the testing, as well as gain a better understanding of how the service is received by counsellees. The study found that the majority of counsellees are white females, at a high risk of inherited breast and/or ovarian cancer, attend the genetic counselling session alone and are self-referred. There is an under representation of the black and coloured populations and an over representation of the Ashkenazi Jewish population in the cohort. The study‟s findings showed that a main motivator for individuals attending genetic counselling was for BRCA mutation testing, with the majority of testing offered being nationally based testing. The study also demonstrated that the service is generally well received and counsellees reported having a positive experience. Overall, the study pointed to the general lack of understanding and public awareness of genetic counselling, with suggestions to market to both the general population and to other medical professionals in order to reach more high risk individuals. On a practical level, a follow up service was suggested to ensure counsellees adhered to screening measures, informing counsellees on changes to testing protocols and identifying family members who may be at an increased risk of inherited breast and/or ovarian cancer.