Integration of HIV/ AIDS, Tuberculosis and Patients’ Services into the General Health Care Systems: Implementation Challenges and Impact on TB Control Programme in O.R. Tambo District, Eastern Cape, South Africa.
- Authors: Dlatu, Ntandazo
- Date: 2024-08
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12987 , vital:76186
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05. , Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
- Full Text:
- Date Issued: 2024-08
- Authors: Dlatu, Ntandazo
- Date: 2024-08
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/12987 , vital:76186
- Description: Tuberculosis (TB), a disease of poverty and inequality, is a leading cause of severe illness and death among people with human immunodeficiency virus (HIV). In South Africa, both TB and HIV epidemics have been closely related and persistent, posing a significant burden for healthcare provision. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Studies have observed that TB and HIV integration reduces mortality. However, the operational implementation of integrated services is still challenging. Gaps exist between the challenges of combining TB and HIV control with evidence-based knowledge, affecting the implementation process of this highly recommended strategy. Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. Objectives: The goals of this study consisted of: (i) investigating the associations between socio-economic deprivation and tuberculosis (TB) treatment outcomes, alongside well-known TB risk factors. The effects of healthcare expenditures and their growth on trends in TB incidence from 2009 to 2013 were also assessed. (ii) Exploring patients’ and healthcare workers’ perceptions of TB and HIV integration as well as a strategy for integrating these programs. (iii) Describing patients’ perceptions on barriers to scaling up of TB-HIV integration services at selected health facilities; and (iv) Developing a paradigm for integrating TB, HIV, and patient services in a single facility and highlighting the importance of TB-HIV services for greater accessibility under one roof. Methods: In Phase 1 of the study, secondary data analysis was performed on data obtained from various sources including governmental, non-governmental, and research institutions. Indicators for TB treatment outcomes included TB death rate, TB rate among the household contacts of the Index TB cases, TB treatment failure, HIV-associated TB death rate, TB defaulter rate, and new TB smear-positive cases. Analysis of variance (ANOVA) and Turkey’s tests for post-hoc analysis were used to P a g e xvii | compare means of variables of interest considering a type I error rate of 0.05. , Thesis (PhD) -- Faculty of Medicine and Health Sciences, 2024
- Full Text:
- Date Issued: 2024-08
An assessment of electronic-governance as a support system for service delivery in the public sector
- Maramura, Tafadzwa Clementine https://orcid.org/0000-0002-4419-1887
- Authors: Maramura, Tafadzwa Clementine https://orcid.org/0000-0002-4419-1887
- Date: 2014-11
- Subjects: Civil service -- South Africa , Electronic government information , Internet in public administration
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26053 , vital:64786
- Description: This is an exploratory research that is aimed at assessing the role of e-governance tools and initiatives on how they can be support systems for service delivery in the public service sector. The rationale of this research came as a response to the ever increasing and recurring service delivery protests that are underpinning the Government of South Africa. Hence the inception of electronic-governance (e-governance) comes at the right time with the aim of mordernising and reforming the public sector for efficient and effective service delivery. E-governance is about transforming governance to be more citizens centered and thus technology is the tool in this effort which can enable change in how the government works and how public officials interact with the public at stake. Cloete (2012:128) asserts that e-governance is the future of public governance and public service delivery globally. Thus governments that do not make the transition from paper-based systems of public administration to electronic platforms of public service delivery may swiftly undermine their chances of developing their societies as 21st century information societies. This research however does not imply that e-governance will be a miraculous panacea to poor service provision in South Africa, but it implies that its role in the public service sector can be as a support system for efficiency and effectiveness in service delivery. This is coupled by the research findings which are espoused on through a secondary data approach and thematically analysed to assess the role of e-governance as a support system on service delivery in the public service sector. Thus from the literature it is remarkable to acknowledge that the South African public service sector has successfully established and implemented a significant number of e-governance initiatives from 1994 to present day. Simultaneously to reveal how e-governance can be a support system for the public service, it is not one-dimensional, it is however multidimensional and thereby cutting across the entire field of public administration inter alia the public service sector. The already initiated e-governance tools in South Africa also range from national, provincial and municipal level thereby clearly revealing how e-governance can also be a support system to cooperative governance and intergovernmental relations inter alia. This research does not imply that e-governance can be a panacea to the public service sector ills but however with the fast moving techno-global world the move to an ICT driven public service sector has more merits than demerits to the general public who are at the receiving end of public services. , Thesis (MPA) -- Faculty of Management and Commerce, 2014
- Full Text:
- Date Issued: 2014-11
An assessment of electronic-governance as a support system for service delivery in the public sector
- Authors: Maramura, Tafadzwa Clementine https://orcid.org/0000-0002-4419-1887
- Date: 2014-11
- Subjects: Civil service -- South Africa , Electronic government information , Internet in public administration
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26053 , vital:64786
- Description: This is an exploratory research that is aimed at assessing the role of e-governance tools and initiatives on how they can be support systems for service delivery in the public service sector. The rationale of this research came as a response to the ever increasing and recurring service delivery protests that are underpinning the Government of South Africa. Hence the inception of electronic-governance (e-governance) comes at the right time with the aim of mordernising and reforming the public sector for efficient and effective service delivery. E-governance is about transforming governance to be more citizens centered and thus technology is the tool in this effort which can enable change in how the government works and how public officials interact with the public at stake. Cloete (2012:128) asserts that e-governance is the future of public governance and public service delivery globally. Thus governments that do not make the transition from paper-based systems of public administration to electronic platforms of public service delivery may swiftly undermine their chances of developing their societies as 21st century information societies. This research however does not imply that e-governance will be a miraculous panacea to poor service provision in South Africa, but it implies that its role in the public service sector can be as a support system for efficiency and effectiveness in service delivery. This is coupled by the research findings which are espoused on through a secondary data approach and thematically analysed to assess the role of e-governance as a support system on service delivery in the public service sector. Thus from the literature it is remarkable to acknowledge that the South African public service sector has successfully established and implemented a significant number of e-governance initiatives from 1994 to present day. Simultaneously to reveal how e-governance can be a support system for the public service, it is not one-dimensional, it is however multidimensional and thereby cutting across the entire field of public administration inter alia the public service sector. The already initiated e-governance tools in South Africa also range from national, provincial and municipal level thereby clearly revealing how e-governance can also be a support system to cooperative governance and intergovernmental relations inter alia. This research does not imply that e-governance can be a panacea to the public service sector ills but however with the fast moving techno-global world the move to an ICT driven public service sector has more merits than demerits to the general public who are at the receiving end of public services. , Thesis (MPA) -- Faculty of Management and Commerce, 2014
- Full Text:
- Date Issued: 2014-11
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