4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    Community-orientated primary health care: Exploring the interface between community health workers, the healthcare system and communities in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Malatji, Hlologelo; Goudge, Jane; Griffiths, Frances
    Background: To achieve universal health coverage, low and middle income countries (LMICs) are extending primary health care (PHC) services using community health worker (CHW) programmes. However, CHWs are marginalized within the healthcare system. Community-orientated primary health care (COPC) and supportive supervision are two interventions being used to strengthen CHW programmes. Primary aim: To understand whether and how the COPC and supportive supervision approaches strengthen CHW programmes in South Africa. Methods: Data was collected between 2016 and 2019 using qualitative methods in nine PHC facilities in rural and semi-urban areas of Mpumalanga and Gauteng provinces, South Africa. Purposive and snowball sampling techniques were used to recruit participants. The participants included: CHWs, supervisors, facility staff members and community members. Data was collected using focus group discussions, individual interviews and observations, and was analysed thematically. Findings: In line with the COPC approach, there were efforts to engage communities in the implementation of the CHW programmes but community members prioritised other challenges such as lack of housing and running water. In some facilities, in-service training increased CHWs knowledge and skills but challenges such as lack of supervision, lack of resources and outsourced employment without benefits demotivated the CHWs (Paper 1 / Objective 1, Published). In response to challenges, in the semi-urban sites, CHWs unionised to present their grievances to government. This resulted in an increase in stipend but not permanent government employment. During the height of the COVID-19 pandemic, when decision- makers recognised the essential role of CHWs higher remuneration was secured. CHWs in rural areas were not active in demanding permanent employment (Paper 2 / Objective 2, Published). Supportive supervision provided by a nurse mentor over 14 months, (1) trained CHWs and their supervisors resulting in increased knowledge and new skills, (2) addressed their fears of learning and failing and (3) established operational systems to address inefficiencies in CHW core activities (household registration and medication delivery). The intervention was disrupted by union activities. The communities’ demonstrated little interest in the functioning of CHW programmes (Paper/ Objective 3, Published). Conclusion: Both the COPC approach and supportive supervision can reduce marginalisation of CHW within the health system
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    Exploring drivers of vertical forward integration in South Africa’s platinum mining industry
    (University of the Witwatersrand, Johannesburg, 2023) Pheto, Simon; Oro, Ufuo
    Historically, South Africa has positioned itself as a net exporter of refined and semi-finished Platinum Group Metals (PGMs) related products, which has stayed the same. This position generates much-needed foreign capital during commodity booms, but it has a long-lasting catastrophic impact on the economy. As a result, the South African PGMs industry is experiencing the lock-in effect of only specialising in exports of refined and semi-finished PGMs-related products. This trade pattern impairs South Africa’s capability to develop a comparative advantage in the export of finished PGMs-related products. This research seeks to identify, explore, and obtain an in-depth understanding of the drivers of vertical forward integration to migrate the PGMs industry from the export of refined and semi- finished PGMs-related products to finished PGMs-related products. The drivers of vertical forward integration were identified in the literature review. An in-depth understanding of these drivers was obtained through a qualitative research study. The themes associated with these drivers were identified by running structured interviews and analysing the data in Atlas.ti software. The structured interview results show that export-led industrialisation policies targeting international trade, innovation capabilities, relatedness of capabilities and foreign direct investments (FDI) will transform the South African PGMs industry into a manufacturing sector and exporter of finished PGMs-related products. However, the above drivers of forward vertical integration require a strong and progressive institutional regime with large institutional capital. The input-output model of the forward vertical integration process in South Africa’s PGMs industry takes the PGMs reserves as an input transformed resource and institutional regime as transforming resource. The four remaining drivers, international trade, innovation capabilities, the relatedness of capabilities and FDI are important components in the transforming process. The transforming process entails the creation of new knowledge and new technology, absorption of foreign knowledge and technology, the liberalisation of international trade and entrepreneurship. The output of the above model is finished PGMs-related products
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    Transitioning to a Platform Business: A Resource-Based View Case Study of a South African Bank
    (University of the Witwatersrand, Johannesburg, 2022) Ramrup, Kashil; Lee, Gregory
    Traditional incumbent banks have seen upstart digital-only banks and fintech, free of legacy systems, challenging their market share. In an effort to avoid disruption by fintechs, banks are embracing the platform strategy. Developing a platform makes it possible to interact with current communities and benefit from shared network effects that can hasten growth, save costs, and increase brand awareness. This research report investigates the impact on a large incumbent bank's resources transitioning to a platform business. A case study was completed on one of South Africa’s big five banks, focusing on the corporate and investment banking(CIB) division. The division is considered a thought leader around platforms within the bank and is actively engaged in shaping and driving its transitional journey. A qualitative study was conducted through semi-structured interviews with senior management and executive leadership. The study population comprised employees of the CIB division of Bank X, South Africa. The sample was selected based on seniority and exposure to the bank's platform business strategy formulation and implementation. The study found that, despite the bank intentions to pursue the platform strategy, there was an internal misalignment in precisely what it meant at the various levels within the organisation, compounded by the lack of platform and technical skills in multiple areas to support the transition. As CIB is a high-touch banking model, there was little understanding of how the physical network would be impacted or could be leveraged/integrated into the platform model. It also found that transitioning to a platform requires individuals with a platform thinking mindset, the ability to challenge the traditional linear pipeline business model, and an enabled and aligned culture with a new operating model that could blend the physical and digital worlds
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    Assessing the impact of covid-19 on monitoring and evaluation functions of the gauteng department of health
    (2023) Dlamini, Nqobile Minenhle; Pophiwa, Nedson
    The Covid-19 pandemic brought unprecedented challenges that required enforced adaptation in all aspects of human life globally. With such an outbreak the government sector was forced to develop mitigation factors and implement precautionary measures useful for curbing the pandemic. Hence, the research focuses on the Gauteng Department of Health as it is at the forefront of the healthcare sector. The main research objective is to understand ways in which the pandemic disrupts the Gauteng Department of Health’s Monitoring and Evaluation functions mechanisms adopted to ensure function continuity. Therefore, it was also important to understand the tools and mechanisms that were adopted and how the pandemic changed their implementation. A total of 10 key participants within the department were interviewed and a question guide was used as a data collection tool during the interview process. The participants interviewed were purposively sampled as a form of non-probability sampling. This study is a qualitative case study research design with an exploratory research approach. During the interview process, the majority of the participants indicated that lockdowns, restrictions on travel, isolations, quarantines, and the shutdown of non-essential activities were highly implemented. However, these restrictions impacted how raw data was collected in the field. Remote data collection had to be introduced and it became common because face-to-face data collection was limited due to contracting the virus. The findings of this study revealed that the Monitoring and Evaluation practices in the department were no longer treated as a priority due to the urgent response to the pandemic. The data that has been collected throughout the research indicates that there are ways in which Monitoring and Evaluation can be developed and innovated. The study also highlighted the best possible interventions or recommendations that can be taken into consideration should a pandemic of this nature arise in the future. This becomes a contribution to the knowledge gap concerning the disruption of an unexpected pandemic