Browsing by Subject "Health services - South Africa"

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    Regionalization of health services in the Cape Province : a framework
    (1989) Pick, William M; Klopper, J M L
    Post-graduate students specializing in Community Health, are attached to different health authorities during their training. During these attachments they are exposed to the day-to-day management of health services and experience at first hand, the difficulties as well as the successes that are encountered in tending to the health needs of communities. It is also expected that post-graduate students do research projects during their attachments, usually on topics on which the health services managers need information. The topic discussed in this report was an assignment given to the author at the start of his attachment to the department of Hospital (Health) Services of the Cape Provincial Administration. The period of attachment was from February to May 1987. The whole question of the regionalization of health services is a complex one, and it is necessary that any proposals for a system of regionalization benefit from the inputs of many experts in different fields. However, as has been the experience in the United States of America, such inputs are no guarantee -that a successful system of regionalization will result. (1) In the local front, the Department of Works, at the request of the Director of Hospital Services, began an investigation into the existing system of regionalization of hospital services in 1985. This attempt was aborted, possibly because of the magnitude of the task, among other things. (2). What follows hereafter should therefore be seen as merely a framework for the development of a system of regionalization rather than as a blueprint for such a system. Perhaps a few remarks about the age-old problem of line-staff conflict would not be amiss at this stage. During the development of this framework, it became apparent that line officials might be expecting a quick proposal of regions and/ or sub-regions for the delivery of health services based on a purely management approach. As a staff official, the author naturally had different expectations. The report is an attempt to marry the two sets of expectations and it is left to the reader to judge to what extent, if at all, the author has succeeded in this attempt. Much of the data used in the study are new, and computation was done largely by hand. The generation of the data, was therefore time-consuming and much of the first phase of the study was devoted to the generation of the data and collection of data that were available from other sources. The study has proved to be a fascinating one and it is hoped that permission will be obtained to pursue the study in more detail. This report should therefore be seen as a preliminary report which addresses the question of regionalization of health services in the Cape Province in 'macro' terms. And finally, the author hopes that some of the information in this report may prove of value to those responsible for the delivery of health services to the people of the Cape Province.
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    Survey of medical, dental and nursing services in centres for intellectually and physically disabled children in Cape Town and its environs
    (1992) Westwood, Anthony Thomas Read; Jacobs, Marian
    This study describes the present medical, dental and nursing services in and used by centres for intellectually and physically impaired children in Cape Town and its environs. The information was gained by means of a structured questionnaire. Thirty three of the 34 centres with a total of 3480 children are included. Twelve are Special Care Centres, 15 Training Centres and 6 are Special Schools. The number of children enrolled ranges from 9 to 400. At the time of the study 9 of the centres were for white children, 17 for coloured children, 5 for black children and 2 were multiracial. Nine of the 11 Special Care Centres were not government supported while only 6 of the other centres were mainly funded from non-government sources. Nurses employed at the centres had worked an average of 8 years at their centres, 23,5% of them having worked with disabled children prior to taking up their present posts. Of the Special Care Centres, only the two residential ones had a nurse on the staff. All the Special Schools had at least one nurse. 57,5% of the centres have a doctor or doctors visiting the centre. Two of the others have regular medical care for the children arranged with local health centres. All the Special Schools are visited while 25% of the Special Care Centres and 33% of the Training Centres receive medical visits. The number of doctors visiting a centre varies from 1 to 7. The doctors come from a variety of services both private and public. Most of the doctors do not receive remuneration for their services. Of the 1 7 centres who have no doctors visiting, the majority depend on parents to take their children to a medical facility if there are problems related to the child's disability. For 7 of them, there is no other option. A similar pattern exists for medical problems unrelated to the child's disability. Six centres make use of medical facilities as a first option in these circumstances. For emergencies only 1 centre can count on a doctor to come to the centre. Ten centres may be able to get a doctor to come. The General Hospitals are the most common facility used in an emergency. Dentists visit 4 of the centres. Twelve of the remaining 29 centres arrange regular dental visits for the children. Eleven of the 13 Special Care Centres do not have regular visits to a dentist arranged. Fifteen centres receive visits from Community Nurses and these are local authority nurses in the main. Their functions are limited in all but one case to contraception, immunisation, Heaf testing or genetic services. There are 10 centres which receive visits from neither doctor, dentist nor nurse (7 Special Care Centres, 3 Training Centres). 32% of the interviewees were satisfied with the services received. The most common improvement sought was to have a doctor visit the centre. Of those with a doctor visiting, 28% wanted the doctors to deal with intercurrent problems as well as the child's disability. The need for paramedical services was also expressed. Further detail is presented and the implications of the findings discussed.