Dissertations / Theses on the topic 'Primary Health Care Centres (PHCCs)'

Master of Public Health - MPH
Nigeria is experiencing shortages of health care workers within its national health services, especially with respect to doctors, nurses and pharmacists. These shortages are traceable to, among other factors, low job satisfaction, which leads to health care workers exiting the national health services, as well as reduced entry of health care workers into the health care system. Understanding the nature of job satisfaction and its causes is critical to informing strategies to halt attrition of the health workforce. The current study surveyed job satisfaction among 180 health care workers, employed in 20randomly selected primary health care centres in the Bwari Area Council of Abuja in the Federal Capital Territory, Nigeria. An observational, descriptive cross-sectional survey was conducted using the abbreviated form of the Minnesota Satisfaction Questionnaire. Descriptive and inferential statistics were calculated using Epi Info v3.1 statistical software. The results from the study revealed that more than half of the respondents (53.2%), were dissatisfied to varying degrees with their current employment. Out of the respondents that said they were dissatisfied, 33.3% stated that they were likely to leave their current employment. The most salient causes for job dissatisfaction were: (1) Institutional factors such as management support (69%); (2) Implementation of policies and procedures (66%); (3) Employee benefits including salaries and wages (33%) and other benefits (56%). It is pertinent to note that issues related to poor implementation of policies and procedures in the work place, and poor conditions of employment need to be addressed urgently to prevent the imminent loss of a third of the workforce to either private health institutions in the country or international migration.

Client satisfaction is an outcome measure of quality care. Therefore, health care providers (HCP) have a responsibility to provide quality care services in order to satisfy clients’ health needs. The aim of this study was to establish the satisfaction level of persons with disabilities regarding health services provided at primary health care centres (PHCC) in Ndola, Zambia. The study employed a crosssectional descriptive design and quantitative research method. The sample comprised 200 male and female persons with disabilities aged between 18-65 years old, selected using a convenience sampling technique. The clients were health care service beneficiaries from four PHCCs and four community based rehabilitation centres (CBR). The self-administered General Practice Assessment Questionnaire (GPAQ) was used to collect data on client satisfaction.The results showed that majority of clients were dissatisfied with availability of health services. There was a significant association between care providers’ skills and clients’ satisfaction level at p<0.0001. There is need to increase and assign specifically trained health professionals to health centres. Besides this, a multi-disciplinary approach that incorporates other professionals might help to deliver quality care services to persons with disabilities.

Magister Public Health - MPH
Background: Point of Care Testing (POCT) refers to qualitative or quantitative tests done in health facilities where the patient is being attended to (on-site), and not in the conventional hospital laboratory setting. As a consequence of many developing countries not having access to conventional laboratory services (with trained laboratory personnel), diagnostic testing often relies on the availability of valid POC tests. All pregnant women attending antenatal care clinics in the Sedibeng District Primary Health Care (PHC) centres should be screened for syphilis, anaemia and HIV. This can be done by means of POC testing, which is easy to perform. These POC tests provide results promptly allowing treatment to be commenced immediately, if required. Despite this highly desirable benefit of POCT, there is circumstantial evidence which suggests that staff is choosing to send specimens to the laboratory for testing, instead of doing POCT themselves. The extent to which this happens and the factors contributing to this practice are not clear. Aim: The aim of this study was to assess the prevalence of screening for syphilis, anaemia, and HIV amongst pregnant women during their first antenatal care visit to PHC facilities in the Sedibeng District, and to establish the factors affecting the prevalence of appropriately using POCT for screening tests. Methodology: Study design: A quantitative, analytical, cross-sectional study was conducted. Study Population and Sample: Patient registers, staff expected to perform POCT and facility managers. 33 District’s health care workers expected to perform POCT on pregnant women during the first ANC visit and 30 facility managers from these facilities; 360 patient records (these were collected from a total of 7 200 patients’ records). The data was collected over a six month period (from 1st July 2012 to 31st December 2012). Data collection: Data was collected from 360 patient records to determine the rate, appropriateness and mechanism of screening for syphilis, anaemia and, HIV in pregnant women on their first antenatal visit. Interviewer-administered closed-ended questions was asked from 30 antenatal care clinic staff tasked with performing POC tests and from 30 PHC facility managers to determine the factors affecting the rate of conducting POCT. Data analysis: Data was analysed using univariate, bivariate and multivariate analyses. Ethical considerations: No harm was anticipated to anyone participating in the study or from the findings of the study. A major benefit of the study was that clarity on the factors affecting the rate of screening and the use of POCT was gained. This will hopefully facilitate the implementation of evidence–based interventions to improve POCT uptake if required.

Magister Psychologiae - MPsych
An epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.

Research report (MMed) -- Interdisciplinary Health Sciences, Stellenbosch, 2010.
ENGLISH ABSTRACT: Background The referral system is an important component of the health care system. In public health facilities, a high number of patients’ attendance has lead to a huge burden on the secondary and tertiary level of the care system in terms of manpower, equipments and resources. Public health in South Africa consumes around 11% of the government's total budget. The state contributes about 40% of all expenditure on health; the public health sector is under pressure to deliver services to about 80% of the population. Despite the huge spending on health care in most developing countries, health outcomes and services remain poor. Few studies are available to give insights into reasons for this disparity. Therefore the findings of this may help to explain some of the reasons for this overburden of public health facilities and further to make recommendations on how health service delivery may be improve on. The results of this study can be useful in future planning; this may lead to a reduction in huge health expenditure incurred by most developing countries. Methods A cross sectional survey of three different groups of people which comprises of 273 patients, 28 referral centre participants and 19 referring centre participants was carried out. All patients referred from Motherwell community health centre to Dora Nginza hospital were eligible for the study. Questionnaires were interview administered to patients after they had finished consultations in Dora Nginza Hospital. Health professionals from both facilities were also interviewed with the use of self administered questionnaires. Results Three out of every four patients interviewed were of the opinion that their referral to hospital was appropriate which is consistent with the results from referring health professionals, eighteen of nineteen respondents. However, only one-quarter (7) of the referral centre health professionals felt the referrals from referring centre to hospital were appropriate p<0.01.The majority of the patients were satisfied with the level of service received at the referral centre. 77% (210) reported that the staff at the referral centre was friendly and 84% (230) were happy with the explanation given for their illness. However, a source of concern is that, in most of the referred patients 58% (215), there was no formal response back to their primary care. In the referring centre, participants identified transportation of patients to referral centre as the major problem encountered when referring patients 68 % (13), whereas 32 % (6) felt it is communication. In addition, 73 % (14) were of the opinion that transportation was inadequate and 89 % (17) reported the response rate of transport was unsatisfactory. In the referral centre, results showed participants were more concerned about the adequacy of information provided in the referral letters with 78% (22) reporting they were often not adequate information on the referral letters. However, half of the respondents agreed that they do not have clear referral guidelines. Conclusion Primary care health professionals and patients in this study view the referrals to higher levels of care as appropriate. However, the referral centres health professionals were of the opinion that most referrals were inappropriate. The opinion of the referral centre can be attributed to their negative attitudes towards referrals. The referral centres needs to provide more support to primary care for a more efficient referral system .They also need to improve on the continuity of care by providing feedback to referrals. On the other hand, the primary health care needs to be strengthened in terms of resource allocation in order to gain more confidence from both patients and referral centres.
AFRIKAANSE OPSOMMING: geen opsomming

Magister Scientiae (Nutrition Management) - MSc(NM)
Globally, health workers play a critical role in the establishment and sustenance of breastfeeding due to their frequent contacts with mothers at the antenatal clinics, maternity/birthing units, Primary Health Care Centres (PHC) and postpartum clinics. Their knowledge and attitude regarding breastfeeding will affect the quality of information about infant and young child feeding practices passed along to mothers who visit their health facilities.

The introduction of Primary Health Care (PHC) in Saudi Arabia has given nurses excellent opportunities and more responsibility to provide health education and advice in health promotion activities. Provision of appropriate and affordable dietary advice is an important role of the nurses in the Primary Health Care Centres (PHCC). Maternal nutrition is an essential element for the health status of the child, the family and the wider society. Many studies have suggested that there is a relationship between good nutritional intake during pregnancy and the successful outcome of the pregnancy. The present study was conducted to explore the knowledge and understanding of Saudi women and nurses in PHCC regarding nutritional intake during pregnancy. The study also looked at the effect of a short education programme on the nurses' nutritional knowledge and their subsequent practice. The aims of the study were to identify the understanding of Saudi women of pregnancy and nutritional intake during pregnancy, and to evaluate the effect of a short nutritional programme on diploma nurses. To achieve the aims, data collection was carried out in three phases. Phase one used semi-structured interview (tape recorded) on 10 pregnant women, selected randomly, to elicit the general understanding pregnant women had on pregnancy and pregnancy related areas. Phase two used a structured interview schedule on 100 pregnant women attending PHCC, selected systematically, to assess nutritional knowledge and their perception of nutritional advice given by the nurses in PHCC. Phase three was divided into two stages. The first stage used a self-administered questionnaire on 20 diploma nurses working in antenatal clinics in PHCC to assess their nutritional knowledge in relation to pregnancy. The questionnaire was used as both a pre-test and post-test instrument. Thereafter, based on the findings from phase one and two, a 20-hour continuing education (CE) programme was developed by the researcher on maternal nutrition for the diploma nurses. The second stage was to implement the programme to the nurses in five days. The effect of the programme was evaluated by an immediate post-test on nurses' knowledge and a follow-up post-test (after six months) to assess any lasting changes. Data analysis was carried out using content analysis for phase one. For the phase two and three, SPSS programme was used. Chi square was used to look for any association between knowledge scores and personal variables, paired Hest was used to assess the difference between pre-test and post-test. The results from the study showed that the majority of women attending the PHCC were illiterate or had little formal education, had a high pregnancy rate and had poor nutritional knowledge in relation to pregnancy. They preferred female health professional care and they preferred to have female doctors attending their antenatal care rather than the nurses. There was no significant difference between nurses' and women's nutritional knowledge. The results also showed a significant correlation between poor nutritional knowledge scores of the women and certain factors: the scores correlated positively with the level of education and negatively with the number of pregnancies. Regarding the programme, the results showed a significant increase in the nurses' nutritional knowledge scores from pre-test to post-test at p< 0.05, indicating that participants demonstrated increased nutritional knowledge as a result of participation in the programme. There was no significant difference between the initial post-test and the six-month follow-up. No significant relationships were identified between the nurses' scores and their age and years of experiences. The study also indicated that nurses in PHCC were not giving adequate nutritional advice to pregnant women in the views of these women and in my own observation. The findings suggest that frequent continuing education is essential for nurses in PHCC in Saudi Arabia to improve their skills and nutritional knowledge to be able to provide better care for women.

Includes bibliographical references.
Most patients with type 2 diabetes in Cape Town are attending at primary care community health centers (CHCS) and have unsatisfactory glycaemic control. Insulin therapy is indicated in patients with type 2 diabetes, with inadequate metabolic control on maximum oral therapy. Insulin can be initiated in these CHCs.

Magister Scientiae (Physiotherapy) - MSc(Physio)
Bell’s palsy (BP), a fairly common disorder predominantly prevalent in the adult age group, affects nerves and muscles in the face causing paralysis or dropping of one side of the face. Clients with Bell’s palsy face many challenges, including psychological, physical and emotional. A long recovery period and/or delayed complete healing could lead to a negative effect on many aspects of an individual's life. How society perceives the person could negatively influence the client’s self-confidence. The management of Bell’s palsy depends on the individual case and may include medication, physiotherapy and as a last option, surgery. The aim of the study was to investigate the management of Bell’s palsy at primary health care level in the Cape Metropolitan District of the Western Cape. The study specific objectives was to investigate the management or treatment protocol of clients with Bell’s palsy, to determine the tendency for referral for physiotherapy, to determine whether an association exists between the type of management or treatment received and the recovery of clients with Bell’s palsy and to explore the impact Bell's Palsy has on the clients. The over-arching design of the study was the sequential explanatory mixed methods design where qualitative data was used to assist in explaining and interpreting the findings of a primarily quantitative study. Stratified random sampling was done proportionately to ensure equal representation. A self-administered questionnaire, comprising of four sections, was used to collect quantitative data that was analysed using SPSS version 21. Descriptive statistics was employed to summarise the data on the socio-demographic information of the clients. Inferential statistics was used to determine the distributions of cases in the various groups. Significant differences tested for using the Chisquare test and effect size through Cramer’s V tests. A semi-structured interview guide was developed based on the results of the analysis of the quantitative data. Focus group discussions were employed to a sub-sample of the clients with Bell’s palsy. Permission an ethical clearance will be obtained from Senate Higher Degrees Committee at the University of the Western Cape (UWC), the Western Cape Department of Health and the facility managers of the participating CHCs.

Magister Artium (Development Studies) - MA(DVS)
South African health professionals’ competencies, especially those of managers have been placed under the spotlight. In the community health centres (CHCs) situated in low socio-economic status areas in Cape Town, a shortage of human resources has been an area of importance, as it exacerbates the impact of competence and service delivery by the healthcare managers.

Magister Scientiae (Physiotherapy) - MSc(Physio)
According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients experiences regarding provision of these services. The aim of this study therefore was to explore the persons with physical disabilities experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers particularly information regarding disability and support services available for them. Experiences regarding participants involvement in their rehabilitation were generally positive. Generally, the participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved.
South Africa

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre.
Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

International Conference on Population and Development (ICPD ), Cairo, 1994 focussed the importance of reproductive health issues and since then a wide attention has been given in this area of research. Prior to that, the second half of the last century has shown a dramatic change in the technological advancement and thus improved the health situation of the population. Moreover, many of the underdeveloped and developing countries could reduce its infant and child mortality and such health hazards with the use of proper health measures. Thus many of the researches were given due priority to cope with such problems, particularly in the developing nations. Also attention has been given in particular areas of health care delivery system and many of the governments directed their large part of economy towards this direction. Health care services, particularly prenatal, antenatal and post-natal care services, draw attention widely, which in turn not only determine the families' health status, but also improves the expectancy of life at birth.

Master of Public Health - MPH
Sub-Saharan African countries including Rwanda are facing a double burden of communicable and non-communicable diseases (NCDs). As HIV and AIDS management improves, the AIDS related mortality rate is thus reduced, and people living with HIV/AIDS (PLWHA) live longer and have more risk of developing diabetes mellitus. Despite the benefits of screening for T2DM on mortality reduction among PLWHA, this practice is not routinely performed in Rwanda. Therefore, data on the burden of T2DM in PLWHA and associated factors are limited in this country.

L'intégration de la santé mentale dans les soins primaires a été décrite comme une stratégie efficace pour s'attaquer au fardeau toujours croissant de la maladie mentale, faisant d’elle une priorité mondiale. Des expériences réussies sont rapportées dans plusieurs études aussi bien dans les pays en développement que dans les pays développés. En Guinée, une expérience d’intégration des soins en santé mentale dans des centres de santé est en cours depuis 20 ans. Initiée par l’Organisation Non Gouvernementale Fraternité Médicale Guinée dans le cadre du projet Santé Mentale en Milieu Ouvert Africain (SaMOA), cette expérience concerne actuellement 5 centres de santé associatifs et 5 centres de santé publics. Notre recherche doctorale analyse cette expérience et examine dans quelle mesure et par quels mécanismes l’intégration de la santé mentale en première ligne peut non seulement améliorer l’accès aux soins de santé mentale mais aussi renforcer la qualité des soins en général à travers une approche plus centrée sur le patient. Nous avons évalué l’expérience à travers plusieurs études, menées dans une approche d’évaluation basée sur la théorie. La première étude a permis de décrire minutieusement l’expérience menée, en l’organisant par une ligne du temps, sur base de la documentation rassemblée. Cette expérience pilote a trouvé un terreau favorable dans les centres de santé associatifs de Fraternité Médicale Guinée caractérisés par un fonctionnement peu bureaucratique. Elle a été ensuite étendue à d’autres centres de santé publics et associatifs.La seconde étude avait pour objectif d’appréhender les éventuelles attitudes de stigmatisation parmi les étudiants de première et dernière année en médecine à l’Université de Conakry, à partir de focus groups interrogeant leurs représentations de la maladie mentale, des malades mentaux et de la psychiatrie. Beaucoup regrettent la discrimination dont font l’objet les malades mentaux dans la société guinéenne, mais partagent néanmoins avec la population générale des attitudes de stigmatisation. Le stéréotype dominant est la grande folie, même si les étudiants de dernière année citent des troubles mentaux plus diversifiés. Il y a une forte adhésion aux modèles explicatifs profanes intégrant les forces occultes ainsi qu’au recours aux soins traditionnels pour les traiter, y compris parmi les étudiants de dernière année de médecine. La troisième étude analyse les effets de l’intégration de la santé mentale sur les attitudes du personnel :déstigmatisation de la maladie mentale d’une part, approche centrée sur le patient d’autre part. Elle repose sur des entretiens semi-structurés avec 27 soignants de centres ayant intégré la santé mentale (SM+) et 11 soignants de centres n’offrant pas de soins en santé mentale (SM–). Contrairement aux soignants SM– au discours stigmatisant, tous les soignants SM+ ont surmonté leurs peurs et développé des attitudes positives envers les malades mentaux, notamment grâce à l’expérience de succès thérapeutiques. Une partie des SM+ a en outre découvert et adopté une approche centrée sur le patient, tandis que d’autres restaient dans une logique biomédicale. Un facteur favorable à l’approche centrée sur le patient a été un dispositif de formation in situ (consultations conjointes, travail en équipe, action communautaire) prenant en compte les besoins émotionnels des soignants et proposant un modèle de rôle centré sur le patient. Mais ce dispositif n’a pu fonctionner de manière optimale que dans le contexte non bureaucratique d’un centre associatif à orientation communautaire, implanté dans la capitale et disposant d’une équipe stable et qualifiée.La quatrième étude évalue l’utilisation des soins en santé mentale dans les 5 centres ayant intégré ces soins à partir des données des registres de consultation et des dossiers individuels de malades. Dans ces centres, les problèmes de santé mentale représentent en moyenne 3% des premiers contacts. Toutes les pathologies mentales courantes sont rencontrées et prises en charge. L’utilisation des soins varie assez fortement d’un centre à l’autre.Enfin la cinquième étude a analysé 450 consultations menées par 18 prestataires dans des centres de santé, afin d’évaluer dans quelle mesure l’intégration des soins de santé mentale avait amélioré la qualité des relations soignants-soignés dans des soins de première ligne en général. Les données ont été recueillies par l’observation des 450 consultations sur base de l’outil Global Consultation Rating Scale (CGRS), des entretiens individuels avec les patients à la sortie de la consultation sur base du Patient Participation Scale (PPS) et des questionnaires auto-administrés par les prestataires. La comparaison des 175 consultations menées dans des centres ayant intégrés les soins de santé mentale avec les 275 consultations menées dans des centres non intégrés, met en évidence un score de participation plus élevé pour les patients consultant dans des centres intégrés. La qualité de la communication soignants-soignés est également meilleure pour les consultations menées dans ces centres. Le discours des soignants SM+ est plus centré sur le patient et se distingue du discours plus biomédical des SM-.L’expérience a donc montré que, dans des conditions favorables, il est possible d’intégrer la santé mentale dans la pratique des centres de santé, avec des bénéfices en termes d’accès aux soins, de pathologies prises en charge, de réduction de la stigmatisation, du renforcement d’une approche plus globale de la santé mentale et de l’évolution des soins de santé primaires en général vers une approche plus centrée sur les patients. Plusieurs pistes de réflexions pour l’élargissement et la poursuite de l’intégration de la santé mentale en Guinée et dans d’autres pays à faibles revenus sont discutées :(1) un processus de formation intégrant le transfert de connaissances et l’acquisition d’attitudes centrées sur le patient ;(2) un encadrement continu des soignants ;(3) une culture organisationnelle non bureaucratique encourageant l’initiative et la réflexivité ;(4) la disponibilité en médicaments psychotropes essentiels et génériques ;(5) l’établissement de ponts avec la médecine traditionnelle et (6) la mise en réseau des acteurs du domaine de la santé mentale. L’enjeu actuel pour la Guinée est le passage à échelle de manière à étendre significativement la couverture en soins de santé mentale tout en favorisant leur qualité. Les leçons que nous en tirons pourront guider les gestionnaires des systèmes de santé à développer des soins de santé mentale et d’en tirer les bénéfices en termes d’accès, d’utilisation et de qualité.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

The aim of this study was to investigate whether patients were satisfied with midwifery services rendered at the two Community Health Centres in the Eastern Cape Province.The study sites were Empilweni Gompo and Nontyatyambo Community Health Centres. Descriptive quantitative study design was employed, using a questionnaire with closed and open ended questions as the data collecting tool. Likert Scale was used to measure the following variables: quality care variables to measure level of satisfaction with midwifery services rendered and to determine positive and negative perceptions regarding quality of care received during antenatal, labour and postnatal period. Non-random convenience sampling of sixty pregnant women, thirty from each Community Health Centre, with two or more antenatal subsequent visits and forty postpartum women, twenty from each health facility, six hours after delivery if there were no complications. Out of 60 participants interviewed n=60 (100 percent) agreed that individual counseling and importance of HIV testing was explained.The majority of participants n=53(88 percent) disagreed that they were educated about focused antenatal visits. Out of 60 participants interviewed n=41(68 percent) agreed that delivery plan formed part of their ANC visits and n=18 (30 percent) disagreed. Of the 60 participants interviewed n=11(18 percent) agreed that they were told that they had the right to choose labour companions and n=48 (80 percent) disagreed.Out of 60 participants interviewed n=23 (38 percent) stated that they waited a long period of time without being attended to by midwives. In general, the study revealed high satisfaction level with intrapartum and postnatal care due to functional accessibility of both Community Health Centres. Both health centres delivered normal healthy babies and mothers. However, the participants were dissatisfied with antenatal care rendered at the two facilities. The researcher’s recommendations were based on the closing of gaps that were identified with regard to the implementation of Basic Antenatal Care; birth companions: health education deficiency; community involvement and participation.

Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The objectives of this study were to explore patients’ experiences about long waiting time at the Vanguard Community Health Care Centre in the Western Cape and to explore possible solutions for this problem from the patients’ perspective. A qualitative research approach was applied. A sample size of (n=12) was drawn from a total population of 2829 (N=2829) using a non-random convenient sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection took place. Approval for the study was obtained from the Ethics Committee at the faculty of Health Sciences, Stellenbosch University and from the facility manager of health centre where the study was to be undertaken. The presentation of the results was categorised into themes and sub-themes that emerged from the data analysis. According to the findings in chapter 4 the themes that emerged were: Causes of long waiting time Areas of concern where waiting occurs most Emotions experienced when waiting long for service Possible solutions to waiting long for service The findings support the conceptual framework developed for the purpose of this study which includes the Patient’s Bill of Rights, the Principles of Batho Pele, Quality Care, Patients’ Representation and Patient satisfaction. The results of the study suggests that the conceptual framework needs to be implemented as a guideline to address the problems of long waiting time with the input from the participants’ opinions about possible solutions to be incorporated to the problem of long waiting time at the community health centre.
AFRIKAANSE OPSOMMING: Die doelwitte van die studie was om pasiente se gevoelens oor lang wagtye by Vanguard Gemeenskapsgesondheidsentrum in die Wes-Kaap te ondersoek en om moontlike oplossings vir hierdie probleem vanaf die pasient se perspektief te bepaal ‘n Kwalitatiewe navorsingsbenadering is gebruik. ‘n Steekproefgrootte van (n=12) is verkry vanaf ‘n totale bevolking van 2829 (N= 2829) deur die gebruik van ‘n nie-ewekansige gerieflike steekproefneming tegniek. ‘n Semi-gestruktureerde onderhoudgids is ontwerp gebaseer op die doelwitte van die studie. Die onderhoudgids is geldig bevind deur spesialiste in die gebied voor data insameling plaasgevind het. Goedkeuring vir die studie is verkry van die Etiese Komitee by die Fakulteit Gesondheidswetenskappe, Stellenbosch Universiteit en van die bestuurder van die gesondheidsentrum waar die studie uitgevoer sou word. Resultate is rangskik in temas en subtemas wat afgelei is van die data analise. Die volgende temas is bepaal vanuit Hoofstuk 4 se bevindinge: Redes vir lang wagtye Areas waar lang wagtye voorkom Emosies ondervind wanneer lank gewag moet word vir diens Moontlike oplossings vir lang wagtye Die bevindinge ondersteun die konseptuele raamwerk ontwikkel vir die doel van die studie wat die Handves van Regte vir pasiente, die beginsels van Batho Pele, Kwaliteitsorg, Pasient verteenwoordiging en Pasienttevredenheid insluit. Die bevindinge van die studie dui aan dat die konseptuele raamwerk geimplementeer moet word as riglyn om die probleme wat ervaar word met lang wagtye aan te spreek. Die deelnemers se menings oor moontlike oplossings moet deel moet wees van die aanspreek van die probleem van lang wagtye in die gemeenskapsgesondheidsentrum.

Background: A randomised control trial (RCT) was conducted in the Torres Strait and Northern Peninsula Area (NPA) Health Service District (HSD) during the period 1998-2000. The main intervention strategy for this trial was the introduction of a simple recall/patient reminder system in Primary Health Care Centres (PHCCs) in an attempt to improve the organisation and management of diabetes care. After a twelve-month period, there was a significant reduction (40 per cent) in the number of patients admitted in the intervention sites between baseline and followup. However, as hospitalisation data was derived from the PHC clinic records, it has been suggested that this methodology may have underestimated both the number of patients and hospital episodes captured in the RCT study population.

Aim: To conduct a retrospective re-evaluation study of the hospitalisation component of the original RCT in an attempt to better assess the impact of the clinic recall system for patients with diabetes in the Torres Strait and NPA, 1998-2000. All patients from the RCT were to be tracked manually through three local public hospitals for hospitalisation episodes in a bid to validate the total number of admissions for these Torres Strait Islanders (TSIs) with diabetes.

Methods and Subjects: Subjects included all those patients suffering with diabetes living in the Tones Strait and NPA whose PHC records had been audited during the original RCT. Instead of using PHC clinic patient files, hospital -based patient information systems were used (as a different data source) in order to validate the number of admissions for each individual from the trial. Analysis of the data used the same methodology as the RCT (that is, communities were clustered into intervention and control sites) in order to interpret results in terms of whether or not the implementation of a recall system in the intervention sites had any impact on the hospitalisation rates of patients with diabetes in the Torres Strait.

Results: In comparison with the RCT, the new hospitalisation study found some degree of underestimation in the number of patients identified as having hospitalisations and secondly, considerable underestimation in terms of the number of hospital episodes found. At baseline, the hospital -checking methodologyidentified one extra person and 102 additional episodes of care. At followup, this new methodology found an extra 30 persons and an additional 119 episodes of care. In comparison to the RCT, the new study showed an overall 6.7 per cent increase in the number of individual patients detected having had an admission in the study period. However, there was a large 47.1 per cent increase in extra hospital episodes detected across both audit timeframes.

Discussion: This study supports the main findings of the original RCT. That is, the new study also found a reduction in the proportion of patients hospitalised for any kind of `diabetes -related condition' in the intervention sites between baseline and followup. This reduction was slightly less at 29 per cent in the intervention sites (compared to 40 per cent in RCT across intervention sites) for 'total diabetes -related conditions,' however this new study finding was not statistically significant. The re-evaluation study also found that at followup, those in the intervention sites were 19 per cent significantly less likely to be hospitalised for a diabetes -related condition than those in the control sites (compared with a significant 40 per cent in the RCT). Therefore, admissions for diabetes -related conditions can be reduced or avoided through better organisation and a systematic approach to the management of PHCCs. Although hospital -based information systems may have been more sensitive in detecting patients with hospitalisation episodes and additional episodes for known patients, the tracking of individuals through the public hospital system (without a unique identifier) was problematic and time consuming.

Conclusion: The main aim of the RCT was to improve the organisation and management of PHC in the Tones Strait, in terms of clinical management for the large number of diabetic clients that are served. The original RCT findings suggested that improvements in diabetes care in the intervention sites such as the introduction of a patient recall system was successful in reducing the numbers of patients subsequently admitted to hospital. The re-evaluation study of hospitalisations using a different methodology has also been successful in recording a reduction in the number of people with diabetes being hospitalised from the intervention sites despite a 47 per cent increase in the number of hospital episodes being detected overall.

ABSTRACT: People who experience any type of mental disorder not only face difficulties with their health challenge they also suffered from negative responses that come from their social environment in many forms such as discrimination, denial or social rejection and this leads to stigma. Mental illness stigmatization within the healthcare professional has an impact on the delivery and provision of care services to the patients and is an obstacle to health seeking and maintaining good health management. This study aims to explore stigma for mental disorder in primary health care physicians and nurses because they are the first contact when a patient needs help. The study took place in Dammam Primary Health Centres and recruited physicians and nurses who completed the Opening Mind Scale for Health Care Providers as a tool of measuring levels of stigma. The results of the questionnaire were compared between both groups and correlated with their sociodemographic data. Result prove the existence of stigma in primary health physician and nurses the mean score is 55.13 out of 100. with Saudi staff having more stigma than non- Saudi , another factor that associated with more stigma is gender as female express more stigma than male . At the end of the study stigma in physicians and nurses was almost equal. This needs to be considered in future planning to minimize negative perception of people with a mental illness by initiating anti-stigmatization program for health care provider as a means of primary prevention and health promotion.

According to the United Nations, more than half a billion people (about 650 million) worldwide are disabled. Disability can have a vast impact on both the individual and the family. Rehabilitation is therefore a fundamental need for the persons with disability to achieve functional independence and have an improved quality of life. To enhance the effectiveness of rehabilitation, it is important to seek clients&rsquo
perspectives of the rehabilitation services and to incorporate these perspectives into the planning and delivery of rehabilitation services. In areas where rehabilitation services are available in South Africa, minimal research has been done to explore the clients&rsquo
experiences regarding provision of these services. The aim of this study 
therefore was to explore the persons with physical disabilities&rsquo
experiences of the rehabilitation services they received at community health centres (CHCs) in the Cape Town Metro Health 
District. Data was collected using a mixed methods design in the form of a sequential exploratory strategy. Qualitative data collection was done using in-depth interviews and this was followed 
by administration of an interview questionnaire. The questionnaire was developed using results from the in-depth interviews together with information from literature. Ten persons with physical 
isabilities, who had received rehabilitation services at participated in the in-depth interviews and 95 responded to the interview questionnaire. The interviews were tape-recorded and 
transcribed verbatim and they were analysed using predetermined themes. The SPSS version 16.0 was used to analyse the quantitative data which was presented in frequencies, medians, quartiles and percentages. The results 
of the study revealed that the participants experienced problems with getting transport to travel to the community health centres and getting adequate information from the service providers, 
 
particularly information regarding disability and support services available for them. Experiences regarding participants&rsquo
involvement in their rehabilitation were generally positive. Generally, the 
participants reported positive experiences regarding their interaction with service providers and family support and involvement and this study recommends the staff to maintain their standards 
 
regarding these two dimensions of rehabilitation. However most of the participants were not concerned about whether the service providers gave them an opportunity to express their preferences or not. The results indicate the need to improve transport services for persons with physical disabilities and to give them more information regarding support services. The service providers 
should also give the clients more opportunities to get involved in their rehabilitation and educate them about the benefits of them getting involved.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introduction: Diabetes is a major cause of death and, in addition to the human suffering caused by its complications, both in the patient and his/her family, the economic costs are important. In the centre region of Portugal, the proportion of patients diagnosed with diabetes in primary care health centres has been increasing, and since there is no concrete data regarding the dissociative characteristics of patients with controlled and uncontrolled diabetes in Portugal, this study aimed to identify such characteristics in the coastal region of the centre region of Portugal, in particular, in the geographical area of Coimbra.Methods: Observational, cross-sectional, randomized study with replacement and size representative of the population with type 2 diabetes in primary care health centres. Variables: age, sex, race, type of family, Graffar and SEDI, level of education, BMI, abdominal circumference, smoking, number of follow-up visits for diabetes in the last year, time since the beginning of the follow-up, mean value of the last two measurements of HbA1c, number of antidiabetic drugs, type of antidiabetic drugs, macro and microvascular complications and concomitant prescription of diabetogenic drugs. Descriptive and inferential statistical analysis.Results: 190 patients were studied, 49.7% were male and 31.6% were under 65 years of age. The statistically significant variables for glycaemic control were: being aged more than 65, the type of antidiabetic drug, the shorter number of people in the household, lowest BMI, smaller number of follow-up visits per year and the lowest number of antidiabetic drugs prescribed.Discussion: In unprecedented results a possible bias factor was the fact that the control limits for HbA1c are different depending on the age group. There is space for improvement to the support provided to diabetic patients in the Portuguese National Health Service.Conclusion: It was possible to identify groups that need better attention by health care professionals, as well as, to identify flaws in the Portuguese health system.
Introdução: A Diabetes Mellitus constitui uma das principais causas de morte e, para além do sofrimento humano que as complicações relacionadas com a doença causam nas pessoas com Diabetes e nos seus familiares, os custos económicos são importantes. Na Região Centro, a proporção de utentes com diagnóstico de diabetes, registados nos Cuidados de Saúde Primários, tem vindo aumentar e, uma vez que não existem dados concretos relativamente às características dissociativas de doentes com Diabetes Mellitus controlados e não controlados em Portugal, o presente trabalho tem como objetivo identificar tais características na região litoral do centro de Portugal, em concreto, na área geográfica de Coimbra.Materiais e Métodos: Estudo observacional, transversal, aleatório com reposição e representativo da dimensão da população com Diabetes Mellitus tipo 2 em Unidades de Medicina Geral e Familiar especificamente convidadas. Variáveis: idade, sexo, raça, tipo de família, classe Graffar e SEDI, escolaridade, IMC, perímetro abdominal, tabagismo, número de consultas de seguimento pela Diabetes Mellitus no último ano, tempo de seguimento e consultas, valores das duas últimas medições de HbA1c, número de medicamentos antidiabéticos, tipo de medicamentos antidiabéticos, complicações microvasculares, complicações macrovasculares e toma de medicamentos diabetogénicos. Análise estatística descritiva e inferencial.Resultados: Estudados 190 doentes, 49.7% do sexo masculino e 31.6% tinham menos de 65 anos de idade. As variáveis estatisticamente significativas para o controlo glicémico foram: idade superior a 65 anos, o tipo de medicamento antidiabético, o menor número de pessoas do agregado familiar, o menor IMC, o menor número de consultas por ano e o menor número de antidiabéticos prescritos.Discussão: Um possível fator de viés é o facto de os limites de controlo para a HbA1c serem diferentes consoante o grupo etário. Há espaço para melhorar o apoio prestado ao doente diabético no Serviço Nacional de Saúde Português, sendo estes resultados inéditos.Conclusão: Foi possível identificar, desde já, grupos que carecem de melhor atenção por parte dos profissionais de saúde, bem como, identificar falhas no sistema de saúde.

Classificações do JEL Classification System: M10 (Business Administration: General), M29 (Business Economics: Other), I1 (Health), I19 (Other).
Sabe-se que a espiritualidade no trabalho pode influenciar o desempenho percebido pelos profissionais. Este princípio foi aplicado a um estudo na área dos cuidados de saúde primários, tendo sido comparados centros de saúde clássicos com unidades de saúde familiar. Os objectivos deste trabalho contemplam (1) verificar se existem diferenças na espiritualidade entre os profissionais das USF e dos CS (2) verificar se existem diferenças no desempenho percebido entre os profissionais das USF e dos CS e (3) verificar que dimensões da espiritualidade são preditivas do total do desempenho percebido. A amostra engloba 267 profissionais de saúde (médicos, enfermeiros e administrativos). Para medir o desempenho percebido foi usado um conjunto de seis indicadores (just-in-time, GQT, capacitação, desenvolvimento de competências, trabalho em equipa e satisfação percebida) que permitiram obter um olhar mais profundo do posicionamento da percepção actual dos profissionais destas unidades e comparar as diferenças de opiniões entre os dois modelos de organização, as USF e os Centros de Saúde clássicos. Para medir a espiritualidade usaram-se três dimensões: vida interior, sentido de comunidade e trabalho com significado. Apesar de os dois grupos (CS e USF) apresentarem valores acima do meio da escala, encontraram-se diferenças significativas no desempenho percebido, sendo o grupo das USF o que apresenta valores mais elevados. No tocante à espiritualidade, os grupos diferem significativamente nas dimensões sentido de comunidade e trabalho com significado, com resultados mais elevados para as USF. No grupo dos CS o sentido de comunidade obteve o resultado mais baixo. Não houve diferenças entre os grupos no tocante à influência da espiritualidade no desempenho percebido. Em ambos os contextos as dimensões que surgiram positivamente correlacionadas com o desempenho percebido foram o trabalho com significado e o sentido de comunidade. Verificou-se por regressão múltipla que, nos dois grupos, a dimensão preditora do desempenho percebido (tendo em conta as restantes) é o sentido de comunidade. Com recurso a equações estruturais foi possível construir um modelo em que o sentido de comunidade é explicado em 33% pelo trabalho com significado e o desempenho percebido é explicado em 53% pelo sentido de comunidade.
Spirituality at work can influence perceived performance as understood by workers. This principle was tested in a study at the primary health care setting, in which health centres (HC) were compared with family health units (FHU). The goals of this study were: (1) to verify the existence of differences in spirituality between HC and FHU (2) to verify the existence of differences in perceived performance between HC and FHU (3) to verify which dimensions of spirituality could predict perceived performance. The sample included 267 health workers (doctors, nurses and administrative staff). To measure the perceived performance a set of six indicators was used (just-in-time, TQM, empowerment, skills enhancement, team-based work and perceived satisfaction) allowing a deeper look at the positioning of the current perception of the professionals of these units and to compare the differences of opinions between the two models of organization, the FHU and the HC. To measure spirituality three dimensions were used: inner life, sense of community and meaningful work. Although the two groups (HC and FHU) presented values above the middle of the scale, significant differences were found in perceived performance, with the FHU respondents presenting higher values. Concerning spirituality, the groups differ significantly in the dimensions sense of community and meaningful work, with higher results for the FHU. In the HC group the dimension sense of community received the lowest score. No differences were found between the two groups regarding the influence of spirituality in perceived performance. In both groups the dimensions that were positively correlated with perceived performance were meaningful work and sense of community. Multiple regression showed that, in both groups, the dimension that predicts perceived performance (taking the other dimensions into account) is the sense of community. The use of structural equations allowed the design of a model in which the sense of community is explained in 33% by meaningful work and perceived performance is explained in 53% by sense of community.