3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Moral justification of continued exceptionalism of HIV care in South Africa(2024) Maserumule, Letjie CharmainSouth Africa has the largest population of people living with HIV (PLWHIV) in the world, and specialized HIV clinics to treat them are unsustainable. Decentralisation of care to primary health care (PHC) facilities reduces the burden on HIV clinics, but the PHC facilities are already overburdened with limited human and infrastructure resources. My aim is to defend that it is morally and legally justified to temporarily continue exceptionalism of HIV care in South Africa while strengthening health systems. My arguments are based on patients’ right to healthcare, the bioethical principles of beneficence and non-maleficence, and deontological moral theory. I contend that the complete abandonment of HIV clinics would burden PHC facilities even more, thus affect rendered care negatively, and violate patients’ intrinsic dignity. The complete decentralization of HIV care will be morally and legally justified when PHC facilities are improved for the progressive realisation of access to quality healthcare for all.Item Community health worker's perceptions (CHWS) of their role in Primary Health Care of Ga-Segonyana rural community(2019) Mkhondwane, AnnBackground: Primary Health Care (PHC) is globally recognized as one of the effective strategies for the implementation of Sustainable Developmental Goals (SDGs). The global shortage of health care workers weakens the health care system, which impacts negatively in the achievement of universal health coverage and the SDGs. Community Health Workers (CHWs) are recognized as an integral resource in addressing the shortage of health workers in health care. In the rural villages of Ga-Segonyana, access to healthcare services remains a challenge and the use of CHWs to address the problem is strongly advocated. Aim: The study sought to explore the perceptions of community health workers (CHWs) of their role regarding the services they render to the community and their contribution towards strengthening PHC services in Ga-Segonyana local municipality. Methods: This study utilised an exploratory research design to conduct semi-structured interviews with nine purposefully selected CHWs in the Ga-Segonyana. All the interviews were translated from Setswana to English language and transcribed verbatim. Directed content analysis was used to analyse data from the transcribed interviews. Atlas ti computer software, version 7.0, was used for data analysis. . Results: Despite their lack of a written scope of work, the CHWs were able to outline their roles and responsibilities as expected by the employers. In terms of their work as CHWs, the results indicated that they have had both good and bad experiences. CHWs perceived the training received to be related to the nature of their work. However, there were no support systems to assist them with issues like psychological trauma and other pertinent situations in which they find themselves. The perceived barriers and challenges to CHWs pertain to ill-treatment to which they have been subjected by patients, lack of support systems, lack of recognition for their contribution, lack of training, lack of co-operation and collaboration from the relevant departments and organisations and other stakeholders, lack of resources and late payment of stipends. Conclusion: The study successfully explored the CHWs’ perceptions of their role on the services they render to the community and their contribution towards strengthening PHC services in the rural district of Ga-Segonyana. Understanding CHW roles will assist in examining how their roles might determine how they perform their daily tasks. So the study managed to highlight the importance of investing in CHWs for the empowerment of impoverished areas in South Africa.Item The development of an advanced practice nursing (Child Health Nurse Practitioner) curriculum framework for Sub-Saharan Africa: a multi-method study(2018) Christmals, Christmal DelaBackground: Nurses are the majority of readily available healthcare professionals in Sub- Saharan Africa (SSA), therefore, improving access to Advanced Practice Nursing (APN) programmes in order to improve healthcare within SSA where preventive services are much needed is essential. Sub-Saharan Africa is unique in terms of its challenges, opportunities and health need hence an APN (Child Health) curriculum must be designed and continually reviewed to meet the needs of the continent. Professional education has not kept pace with SSA’s special healthcare challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates. Aim: The aim of this study is to develop a curriculum development framework to guide governments and Nursing Education Institutions in the development of relevant Advanced Practice Nursing (Child Health Nurse Practitioner) curriculum that responds to the child healthcare needs of Sub-Saharan Africa Methodology: A sequential multi-method research design was employed in this study. The study began with a scoping review, followed by a Delphi, then concept development, and the development, confirmation and evaluation of the curriculum framework. Findings: Children are the majority of Sub-Saharan Africa. Between 70-90% of the Sub- Saharan African population is rural and lack access to quality and cost-effective healthcare services as most healthcare facilities are located in the cities and small towns. The implementation of Advanced Practice Nursing programmes is essential in increasing access to quality healthcare services for the majority and marginalized rural population of Sub-Saharan Africa. The introduction of Advanced Practice Nursing programmes is challenged by the opposition from the medical profession, the existence of lower cadre medical professionals, meagre resource allocation, lack of scope of practice, lack of context-specific benchmark programmes and lack of political will. The need to increase access to quality healthcare to the rural population, the push for Primary Health Care, the dominance of nursing professionals in the healthcare system of Sub-Saharan Africa, the existence of resource sharing opportunities were facilitating factors. A concept-based Child Health Nurse Practitioner curriculum framework for Sub-Saharan Africa was developed. Conclusion: The Child Health Nursing Practitioner curriculum framework is comprehensive, context-specific, has the potential to respond to the special child healthcare needs of Sub-Saharan Africa and is adaptable for other Advanced Practice Nursing speciality programmes in Sub-Saharan Africa.Item Space, tradition and comprehensive health care:(1997) Chabikuli, Eugene NThe theoretical case that architecture should he functionally responsive to user needs is examined with particular reference to tne design of Primary Health Care (PHC) facilities in rural South Africa, In particular, the study investigates the effectiveness of architectural practice in meeting the spatial demands of health care facilities in a changing social and cultural environment. The functlonal requirernents of modern and traditional health care facilities are examined, the aim being to examine to what extent important traditlonal requirements are taken into account in the modern sector. The research relies on: 1. A comparative literature review on the interaction between the social requirements, architectural practices, traditional and modern healing systems. 2. Data collection on the study case (Mhala). 3. In-depth interview with 'users' (patients, relatives and health professionals) from both formal and informal health sectors. 4. A physical survey of traditional healers stations and Primary Health Care (PHC)facilities. 5. Analysis. 6. Conclusions and recommendationsItem Neonatal hearing screening services at primary health care clinics in Gauteng.(2012-07-03) Casoojee, AishaHearing impairment has been hailed a silent epidemic. Early Hearing Detection and Intervention (EHDI) models of service delivery have therefore been proposed for infants in South Africa so that they may be provided with timely, and appropriate audiological, educational and medical intervention. Neonatal hearing screening in South Africa is currently primarily conducted at Primary Health Care (PHC) clinics. The main objective of the study was to determine whether the neonatal hearing screening services provided at PHC clinics in the City of Johannesburg (CoJ) adhere to the guidelines, norms and standards as outlined by the Integrated National Disability Strategy [INDS] (1997), the Health Professions Council of South Africa [HPCSA] Position Statement (2007) on EHDI and the PHC Package (2002). This was achieved through a non-experimental, descriptive, survey research design. Nurses employed at PHC clinics and children who attended the PHC clinics formed the two participant groups. Data was collected via a self-administered questionnaire, a retrospective data compilation form and observations. Descriptive statistical measures were used to describe the information obtained during data collection. Results indicate that nurses employed within the CoJ PHC clinics do not comply with the proposed neonatal hearing screening practices as outlined in the INDS and the PHC Package. Context specific barriers, including limited knowledge, service delivery gaps, and workload inequities have been identified as contributory factors to the variations and inconsistencies of protocol adherence by PHC nurses. Effective referral systems are important to ensure that these children are provided with appropriate services within the critical period for language development. The optimisation of current governmental hearing screening protocols are thus a feasible, temporary measure until such time that EHDI programmes be mandated at a governmental level.