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Critical evaluation of the influence of ideal clinic status on the quality of primary care services provision in eThekwini District, South Africa
Get PDFThesis submitted in fulfillment of the requirements for the Doctoral Degree in Nursing at the Durban University of Technology, Durban, South Africa, 2025.Introduction and background
As the global world commits to achieving universal health coverage by 2030, there
is a growing acknowledgement that optimal cannot be delivered by simply
ensuring the coexistence of infrastructure, medical supplies and providers.
Improvement in delivery requires deliberate focus on quality of health services
that include providing effective, safe, people-centered care that is timely,
equitable, integrated and efficient. Global quality reports note that billions of
people will not gain from potential universal coverage benefits unless
improvements in health system quality are realised. In South Africa, several
quality improvement initiatives have been implemented, the Ideal Clinic
Realisation and Maintenance initiative being the latest initiative aimed at
improving quality services provision, especially at primary care level as the
entrance point into the system. Research on improved quality provision in facilities
with ideal status is thus crucial to providing quality health services for all South
Africans based on their needs, irrespective of socio-economic status.
Aim of the study
The study aimed to critically evaluate the influence of Ideal Clinic status on the
quality of primary health care service provision in eThekwini District, South Africa,
thereby proposing an Ideal Clinic practice framework that will enhance an
improved quality of healthcare service provision in primary health care facilities.
Objectives of the study
The objectives of the study were to determine the current practices of providers
and the status of user records in ideal primary facilities; to explore the
perspectives of healthcare providers regarding the influence of Ideal Clinic status
on quality of patient care; to ascertain the perspectives of the health care users
on the quality of care received in facilities with ideal status; and, to propose an
Ideal Clinic prctice framework that can be used to enhance improved quality
healthcare service provision in primary health care facilities irrespective of Ideal
Clinic status.
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Methodology
A convergent parallel design, where both qualitative and quantitative methods
were used to collect data within a short period to avoid potential threats to validity.
The quantitative data collection consisted of (n = 360; 88.8%) retrospective record
reviews of adult clinical records and (n = 45; 11.1%) children’s records and a self administered questionnaire from (n = 54; 85.7%) professional nurses and (n = 9;
14.2%) facility operational managers. The qualitative data collection consisted of
semi-structured interviews with (n = 8) healthcare providers to explore their
perspectives regarding the influence of Ideal Clinic status on the quality of care
provision to healthcare users and (n = 14) healthcare users. The perspectives of
the healthcare users regarding the quality of care received in facilities with ideal
status were ascertained. Data analysis of the quantitative data was via descriptive
and inferential statistics, and the qualitative analysis was via thematic analysis.
The two data strands were analysed independently and inferences made from
each strand were synthesized to form conclusions about the findings. The results
of the two separate analyses were mixed for an overall interpretation of the
findings.
Findings
Although the PHC facilities included in the study had been awarded Ideal Clinic
status, it was evident that Ideal status did not automatically translate to quality of
care in most facilities. There were important care assessments that had been
inadequately performed or not done at all. These included physical examinations
that were not performed, poor or no documentation on clinical records, shortage
of medical supplies, and lack of training and support for staff.
Recommendations
Recommendations are of a short-term nature and can be achieved with buy-in
from the policy makers. Long-term recommendations include renovation of
primary health care facilities to cater for the full package of primary health care
services, human resources and medical equipment.
Conclusion
Based on the findings, a practice framework was developed to provide structure
using evidence-based practices on interventions that would assist policy makers
and implementers to engage in relevant actions for improving quality service
provision irrespective of the Ideal Clinic status.
An investigative study into the challenges impacting the South African public sector construction industry
No full textWithin South African literature, there exists an empirical gap on the key challenges that impact the successful delivery of construction and engineering projects in the public sector. Earlier research has focused on select aspects of construction and engineering project delivery within a refined context. This study focuses on obtaining a greater understanding of various unique influences that influence and impact the South African construction and engineering industry. An empirical investigation assists the study by refining the key challenges that impact the successful delivery of public sector construction projects in South Africa.
DESIGN
The study employs methodological triangulation to discern the views of research participants and their respective opinions regarding the challenges impacting the South African public sector construction industry. The research data collected through triangulation methods were empirically analysed through the adoption of Statistical Product and Service Solutions and AMOS for the purpose of structural equation modelling.
FINDINGS
The findings highlighting the key project challenges contribute theoretically and practically to the current body of knowledge.
The findings also provide the base for public sector stakeholders to develop a Strategic Model for implementation by public
sector institutions.
RESEARCH LIMITATIONS
The study was limited to Kwazulu-Natal due to the coronavirus pandemic. It was conducted among 750 construction and engineering sector stakeholders from organisations registered with the Construction Industry Development Board through the adoption of survey questionnaires, which present the views and opinions of their respective organisations.
VALUE
The study contributes directly to the existing body of knowledge and promotes a basis for further research into the South African public sector construction industry and the management systems within
A comprehensive study on pre-retirement planning amongst Botswana public officers
No full textPurpose: The main purpose of this paper was to comprehensively assess the level of
knowledge of pre-retirement planning for public officers in the Central District Council of
Botswana. Specifically, the paper assessed the pre-retirement planning awareness of public
officers by looking at the variables of financial education and retirement investment. In
addition, the paper gauged the retirement preparedness of employees nearing retirement by
assessing the psychosocial aspects of attitude towards retirement and retirement
counselling preparedness. Methodology: the paper adopted a descriptive research design.
Using a random sampling method which targeted 100 respondents, a population paper on
62 respondents was conducted, translating to a 62% response rate. The Questionnaires
were used for data collection and the results were analysed using description statistics
which included frequency tables, pie charts and graphs. Findings revealed that most public
officers are aware of retirement planning and those employees falling within retirement
age brackets of 45 years old and above, tend to have positive attitudes towards retirement
planning. Implications: the paper concluded by observing that majority of public servants
does not plan well for their retirement. Therefore, the concept of retirement planning
should be introduced in the initial part of public officers’ work life. Originality this paper
strategically provides and impetus for the retirement planning and investment among pubic
officers in Botswana. The paper assessed pre-retirement planning in the concept of
financial retirement planning, as well as the psycho-social aspect of retirement planning
Sisterhood in academia : storying our experiences in higher education
No full textBreaking the barriers for women in higher education institutions has been on the global agenda for over a decade. Women's lived experiences in academia has notably focused on issues of inequality and systemic gendered barriers that lead to women opting out of academia. This study acknowledges that many black women academics feel caged and overlooked in their positions and argues that despite these challenges, women are resilient and need to carve out spaces to navigate their paths in the academy. Using the autoethnography inquiry approach, we reflect on how our experiences shaped our academic journey in higher education institutions. The principles of Communities of Practice (CoP) is adopted as a framework underpinning this paper. It is envisaged that this framework will help examine the challenges and opportunities black women academics experience in higher education. Our reflective discussion on the sisterhood we embraced during our academic journeys has suggested that institutions need to provide mentorship opportunities, and spaces to talk, support and be supported
An interdisciplinary collaboration of the writing centre support and the nursing department on the development of academic research writing
No full textThis qualitative study explores the interdisciplinary collaboration between the Writing Centre (WrC) and the nursing department at the Durban University of Technology (DUT) in developing undergraduate (UG) nursing students' academic research writing skills. Guided by the Social Learning Theory, the study aims to evaluate the role of the WrC support in enhancing nursing students' research writing proficiency. Semi-structured interviews in a focus group discussion with WrC tutors were conducted, and thematic analysis was employed to identify common themes and patterns related to the WrC's role in supporting academic research writing. The findings reveal the WrC's best practices in assisting UG nursing students, including creating a supportive and collaborative learning environment that addresses individual students' unique learning styles and research writing needs. The study also provides insights into the challenges faced by WrC tutors and the strategies they employ to overcome them. Furthermore, the benefits of WrC support for students' academic success are highlighted. The study underscores the importance of academic writing in higher education and the critical role of interdisciplinary collaboration in developing students' research writing skills, particularly in the nursing discipline. The findings contribute to the understanding of effective interventions for improving academic writing and supporting student success in higher education
The relationship between anti-Mullerian hormone (AMH) levels and pregnancy outcomes in patients undergoing assisted reproductive techniques (ART)
No full textA variety of predictors are available for ovarian stimulation cycles in assisted reproductive technology (ART) forecasting ovarian response and reproductive outcome in women including biomarkers such as anti- Müllerian hormone (AMH). The aim of our present study was to compare the relationship between AMH levels and pregnancy outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). Overall, fifty patients (n = 50), aged 20-45 years were recruited for the present prospective study. Three AMH levels were presented with high often poly cystic ovarian syndrome (PCOS) amongst 52.4% patients, 40.5% in normal and 7.1% in low to normal, correspondingly. There was statistically significant relationship between AMH and day of embryo transfer (p p p > 0.05). The area under the receiver operating characteristic curve for E2 was 0.725 and for AMH levels as predictors of CPR was 0.497 indicating E2 as better predictor than AMH. The number of oocytes, mature oocytes and fertilized oocytes all presented a weak positive relationship to AMH. Our results confirm the clinical significance of AMH to accurately predict ovarian reserve as a marker and its limitations to use as predictor for a positive pregnancy outcome. Additional prospective studies should be conducted to validate the predictive capability of AMH levels for the outcome of clinical pregnancy
Renewable energy source utilization progress in South Africa : a review
No full textRenewable energy has emerged as a promising solution to address the challenges of climate change, energy security, and socio-economic development. South Africa, with its abundant renewable energy resources, has made significant strides in the utilization of renewable energy over the past decade. This paper provides a comprehensive review of the progress of renewable energy advancement in South Africa, examining the policies, initiatives, and achievements in various renewable energy sectors. This study explores the country’s transition from a heavily coal-dependent energy system to a diversified and sustainable energy mix. It analyses the growth of renewable energy technologies, such as wind power and solar photovoltaic (PV), highlighting the key milestones, challenges, and opportunities. Furthermore, this paper discusses the role of government support, regulatory frameworks, and private sector investments in driving renewable energy deployment in South Africa. Finally, it identifies the prospects and potential areas for further advancement in the renewable energy sector. This review aims to contribute to the understanding of South Africa’s renewable energy journey and provides valuable insights for policy-makers, researchers, and stakeholders involved in the sustainable energy transition
Leadership approaches to talent development and retention : a case study of a UOT in South Africa based on system dynamics
No full textSubmitted in fulfilment of the requirements of the degree of Doctor of Philosophy in Leadership and Complexity, Durban University of Technology, Durban, South Africa, 2023.Higher Education (HE) in South Africa has been recently affected by high staff turnover in the science faculties. The higher education system is under severe pressure given that the academic cohort of scientists comprises a majority of ageing white males. Thus, the higher education sector will have to ensure it attracts and retains scientific staff to address this potential crisis. High turnover sometimes occurs as a result of poaching from ‘sister institutions’ but, in the main, is due to staff losses to the private sector because universities cannot match the salaries offered in the private sector. A shortage of scarce skills has left universities with no option but to appoint foreigners in some faculties. This has a negative impact on staff retention. Furthermore, a career in academia is sometimes embraced through default rather than conscious choice. This results in lower productivity as there is little motivation for new staff to perform to their potential since they see academia as a stepping-stone to their ‘real career.’ Therefore, this study, sought to evaluate leadership approaches to talent development and retention using a qualitative system dynamics model.
System dynamics modelling is a computer simulation approach to addressing social issues that is rooted in the agency-structure debate. The fundamental thesis of system dynamics is that the behaviour or observed phenomena in any system over time is largely determined by its structure and that effective changes or modifications can only be achieved through an understanding of the structure. The research was primarily qualitative, as system dynamics requires elicitation and understanding of the prevailing mental models in a system as the basis for developing a simulation model. System dynamics modelling primarily follows the systems thinking paradigm, which is a philosophical world view that is rooted in holism. The system thinking paradigm holds that all things and events inadvertently form part of a larger whole and they can be best understood within the context of this larger whole. A purposive sample of 30 members of staff from human resources management, executive management and members of the University Council was used to collect data through interviews and focus groups.
Data was analysed using NVivo and a qualitative system dynamic modelling approach. The findings of the study led to identification of four consolidated themes, viz. talent development and retention; a system for talent management and retention; a process for talent management and retention, and recommendations for talent management and retention. The afore-mentioned themes were further categorised into nine sub-themes. The results show that several factors impact talent management, including bureaucracy and a lack of proper promotion processes. The findings from the system dynamics approach led to the formulation of four key variables: work pressurised induced turnover, resource dynamics for staff development, training dynamics and consultative strategic planning. The identified variables led to the development of an integrated SD-CLD model on leadership approaches to talent development and retention, which is a key contribution of this study. Therefore, institutions of higher learning must come up with talent development strategies that adhere to the prevailing laws such as the Employment Equity Act to achieve their strategic goals. A targeted training initiative is fundamental in developing the skills of academics in terms of teaching and learning and research. Hence, departmental courses, seminars and workshops for teaching and learning research excellence and general academic development need to be seriously debated within a given collegial, intellectual, and academic environment. This study has contributed to the literature on talent management, leadership, and retention from a university of technology where resource, constraints, culture, and politics play a crucial role on the final recipe. The study has further provided a springboard for altering or reviewing institutional policies so that the needs of employees are properly addressed, and the talent management framework is enhanced. Future research should consider expanding the scope of the study by other variables that are key to organisational effectiveness using a system dynamics approach.
Drum magazine project : a decolonial shift in teaching fashion theory and history
No full textThe Drum Magazine Project is a cross-institutional teaching and research project designed to explore a decolonial approach to teaching fashion theory and history. The project used the 1950s and 1960s archives of Drum magazine, found at Bailey's African History Archives (BAHA) in Johannesburg, South Africa. Fashion was considered by looking at South Africa's political, social, and cultural landscape during the 1950s and 1960s. Students wrote biographical essays based on individuals who, despite having been featured in Drum magazine, were not widely documented in South Africa. Essay writing was followed by developing magazine covers designed to capture themes related to these individuals. The text- and visual-based modes enabled students to deploy historical media archives using fashion and dress to communicate narratives of alternative fashion histories and imaginaries. Semi-structured interviews were conducted to analyse students' impressions of the magazine, the individuals they researched and the overall project. In some instances, students expressed the view that incorporating this part of South African history into fashion curricula can be uncomfortable but that addressing history in its fullness is necessary to achieve decolonial imperatives and shifts. For these reasons, this study contributes to the decolonial fashion discourse by showing how infusing context-specific examples in teaching and learning offers options for renewing, stretching, and decentering the teaching of fashion theory and history. </p
Understanding tacit knowledge loss in public enterprises of South Africa
No full textOrientation: South African state-owned enterprises (SOEs) are facing a perpetual struggle of institutional tacit knowledge loss, which poses a risk to these entities and threatens their sustainability. The research project endeavoured to tackle these challenges from knowledge management (KM) and human resource management (HRM) perspectives and proposes a plethora of integrated knowledge-driven HRM processes to mitigate risks associated with loss of tacit knowledge. Research purpose: The study provides an integrated understanding of the issues relating to the causes of enterprise tacit knowledge loss and extent to which there is recognition of company knowledge loss in selected SOEs in South Africa. Motivation for the study: There is limited research that provides an integrated approach to tacit knowledge loss from KM and HRM standpoints. Research approach/design and method: The exploratory sequential mixed-methods research design was used in this study. In the qualitative phase of this research, data were collected from the annual reports of the SOEs and unstructured interviews with 20 purposively selected human resource (HR) managers, which was subsequently analysed thematically using ATLAS.ti software. The quantitative data from 145 out of 585 respondents were analysed statistically using Statistical Analysis Software (SAS). Main findings: The study revealed that organisational tacit knowledge loss is largely caused by voluntary and involuntary employee turnover and a lack of retention strategies. This adversely affects the knowledge base and the knowledge absorptive and protective capacities of the SOEs. Practical implications/managerial implications: The study concludes that the journey for ensuring effective knowledge transfer and retention of valuable enterprise knowledge starts with the appreciation of knowledge as a key firm-specific strategic issue. Contribution/value-add: This study offers an integrated understanding of the causes of tacit knowledge loss for effective management in SOEs researched interdependently from KM and HRM perspectives