4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Realising the right to healthcare: the legislative frameworks pertaining to private health establishments and private healthcare funding models in South Africa(University of the Witwatersrand, Johannesburg, 2024) Labuschagne-Kom, Lindsie; Mahery, Prinslean; Martin, BlakeThe Universal Declaration of Human Rights recognises access to healthcare as a fundamental human right and is guaranteed by the South African Constitution. An analysis of this right reveals that it comprises of two main components, namely financing and delivery of healthcare services. These are fulfilled by the government in the public sector and by private healthcare funders and private health establishments in the private sector. However, an analysis reveals that access to healthcare is substantively inequitable due to the fragmentation of the health system and unveils significant inefficiencies in the private sector that impeded realisation of this right. This dissertation examines the cause of this fragmentation and the inefficiencies within the private healthcare funders and private health establishments market. It investigates how these issues can be resolved to realise the right to healthcare. This study applied a qualitative desktop review of governmental policies, direct and incidental legislation, and multidisciplinary fields of academic reviews such as competition, healthcare, constitutional law and international policies to evaluate the effect of historical, contemporary and prospective policies and legislation, on access to healthcare. This analysis reveals that access to healthcare was historically manipulated to achieve political ideology through a legislative framework that provided the foundation for private funding models and private health establishments to flourish. This occurred at the expense of the public sector and embedded the fragmentation and inefficiencies in the health system. Notwithstanding the enactment of the Constitution, which envisioned a transformed and equal society, access to healthcare remains substantively inequitable. This is due to governmental failings to regulate these stakeholders. Given this state of affairs, the government intends to enact legislative reform through the National Health Insurance Bill to meet its constitutional mandate to realise the right to healthcare. An analysis of the Bill’s framework, however, reveals that it will have a cascading effect with the collapse of the private healthcare funders and private health establishment markets. This will ultimately cause a regression in access to healthcare and impede the practical realisation of this right. An investigation into alternative mechanisms to fulfil the right to healthcare reveals that incorporation and collaboration with private healthcare funders and private health establishments is a pragmatic alternative to the National Health Insurance Bill that will aid with the practical realisation and vindication of this right. These findings indicate the need for government to improve its stewardship of the health system and provide pragmatic solutions to reform the legislative and regulatory frameworks governing these stakeholders to resolve inefficiencies and to foster collaboration to fulfil the right to healthcare.Item A Decomposition Analysis of Gender Disparities in Need and Unmet Need for Care and Support in Urban Gauteng(University of the Witwatersrand, Johannesburg, 2024) Lusanda Mhlahlo, Siphesihle; Booysen, FrederikGender inequalities are a pervasive issue with far-reaching effects across all aspects of society, including the economy. This study delves into gender health disparities, specifically focusing on need and unmet need for care and support. Using data from the Gauteng Quality of Life Survey of 2020/2021, the study employs logistic regressions and a decomposition model to analyse the prevalence of need and unmet need, and how these differ across sex. The findings of this study highlight a higher prevalence of need among women, with employment emerging as the most significant factor contributing to the gender gap in need. Equalizing employment levels between men and women could potentially reduce the gender difference in need by 15%. Additionally, the study identifies a self-reported history of intimate partner violence (IPV) as a key contributor to gender disparities in need, suggesting that reducing the prevalence of IPV among women to match that of men would help narrow the gender gap. Furthermore, the study reveals a greater prevalence of unmet need among men, once again linking a self-reported history of IPV to this disparity. These findings shed light on the complex interplay of gender, health, and societal factors, emphasizing the importance of addressing gender inequalities in healthcare and support systems.Item Investigating the attitudes of physiotherapists about telerehabilitation and their opinions on its feasibility in South Africa(University of the Witwatersrand, Johannesburg, 2022) Thomas, TyllaBackground: Telerehabilitation has not been a permitted nor been a focus in healthcare in South Africa. There is little awareness, knowledge, and skill amongst physiotherapists on how to conduct effective telerehabilitation. However, this is not the case globally, where telerehabilitation has been proven effective in the treatment of patients with various conditions. Advances in telerehabilitation worldwide are occurring daily but there is scarce literature on telerehabilitation in South Africa. Due to Covid-19, the HPCSA has granted permission to conduct telehealth, however, numerous barriers first need to be overcome for telerehabilitation to become a common therapeutic practice. The attitudes of physiotherapists on telerehabilitation and its feasibility have not been investigated and hence the current use, or willingness to use, is unknown amongst the South African population. Aim: To investigate the attitudes of physiotherapists and their opinions on the feasibility of telerehabilitation in daily practice in South Africa. Methods: This quantitative, cross-sectional study included 356 physiotherapists belonging to the SASP, recruited through convenience sampling. An electronic self-reported questionnaire was developed from existing literature and other exiting questionnaires e.g. the Physiotherapy Mobile Acceptance Questionnaire (PTMAQ) (Blumenthal, Wilkinson, and Chignell, 2018). The questionnaire was emailed to all physiotherapists belonging to the SASP and they could voluntarily answer it. Descriptive data analysis was conducted to describe the demographic profile of physiotherapists and to determine their attitudes on telerehabilitation as well as the feasibility thereof in South Africa. One-Way ANOVA (analyses of variance) was used to establish a relationship between participants’ demographics and their attitudes and feasibility 2 regarding the use of technology for rehabilitation in South Africa. The study obtained ethical clearance from the Human Research Ethics Committee (Medical), clearance number M200946. Results: Most participants were between the ages of 25-35 (170, 47.8%), working more than 20 years (101, 28.4%), mostly in orthopaedic manipulative therapy (137, 38%) and in outpatient practice (199, 55.9%). Most participants had positive attitudes regarding the perceived ease of use and perceived usefulness (Valdez et al., 2009). Only 18.3% of participants used telerehabilitation in their clinical settings and less than half of the participants state that they would be willing to use telerehabilitation in their clinical setting. Only 37.3% of participants thought that the South African population would be receptive to telerehabilitation. Most participants thought that there is not enough knowledge (308, 86.5%) and awareness (262, 73.6%) about telerehabilitation but do have the capacity and resources to conduct telerehabilitation sessions in their clinical settings (227, 63.8%). Participants in OMT and outpatient practice had a more favourable attitude toward telerehabilitation. No significant effects of age were found. Conclusion: Physiotherapists show positive attitudes on the use of telerehabilitation but are not willing to do it in their clinical settings due to numerous barriers that affect the feasibility thereof. This study is one of the first to investigate the attitudes of physiotherapists on the use of telerehabilitation, however, further studies need to be conducted to examine the effectiveness of telerehabilitation amongst physiotherapists in South Africa. It is the hope that the awareness, knowledge, and skill to conduct telerehabilitation increases among physiotherapists in South Africa so that use of telerehabilitation can become common practice.