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Item Open Access 'n Sosiologiese studie van die Bybelse interpretasie van die plek van die vrou in die gesin, kerk en staat met die oog op die bepaling van norme(University of the Free State, 1952) Fourie, Dirk Cornelius GroblerAbstract not availableItem Open Access 'n Sosiologiese ondersoek van die huislike agtergrond van onbeheerbare jeugdiges, gebaseer op die amptelike rekords van die streekkantoor van die Departement van Volkswelsyn te Pretoria(University of the Free State, 1961) Roode, Christiaan Dawfre; Keyter, J. de W.Abstract not availableItem Open Access Afwykende gedrag binne die teoretiese raamwerk van simboliese interaksionisme. 'n kritiese evaluering(University of the Free State, 1977-01) De Klerk, Gerhardt Willem; Van Rensburg, H. C. J.Abstract not availableItem Open Access The social epidemiology of sexually transmitted diseases among adolescents and young adults in Transkei(University of the Free State, 1993-11) Mbananga, Nolwazi Daphne; Van Rensburg, H. C. J.Respondents (patients) between the ages 15 years and 30 years (N=146) from each selected health clinic of the ten selected districts in Transkei were interviewed using a structred interview schedule. The respondents interviewed were patients who visited health centres and who were diagnosed to be suffering from STDs. The interviews were conducted to obtain information on the influences of geographic, demographic/biographic, socio-cultural and socio-economic factors in the transmission, treatment, prevention and control of STDs. The study was undertaken to provide information for planning STD preventive strategies and to argue why there should be a change in the management of STDs to community-based control measures. Most patients suffered from gonorrhoea and gonoccal urethitis more than any of other STDs. Some patients reported that they had STDs before, whle others did not know. Some patients knew that STDs were infectious and that one contracts them through sexual contacts with infected persons. The most popular source of information on STDs was Radio Transkei Broadcasting Corporation. Pamphlets and other sources of information seem not to be popular. Nurses played limited role as source of information. Most patients did not use condoms during their sexual activities and some of the patints reported to have had sexual intercourse during their illness without condoms. Fourty seven percent of the patients did not like condoms and associated them with people who are HIV positive or had AIDS. Some patients reported that they have heard about condoms, however condoms were not available in their areas. Some patients reported that there were no clinics near their residential areas. Patients reported that even where there were clinics nearer the one they had attended, there was no transport to such clinics. Distances to these clinics were long to be walked. A significant number of patients reported that they consulted traditional healers for their STD problems, because they associated their STD with witchcraft while others did so and when they did not get help from westernised health institutions. It was found that patients visit health centres with some expectations that are related to choice of treatment. Injection appeared to be preferred more than other forms of treatment. Patients did not see AIDS as a greater killer than STDs. Fifty percent of all patients reported that the youth of their areas have promiscuous behaviour and need more information on STDs. Some patients reported that they were ashamed of their STD problems and did not want tot tell other people, even their sexual partners. Patients wanted preventive strategies such as campaigns on prevention of STDs, but did not know how these could be conducted. On whether they found it important to have a sexual contact on the first date of a relationship a significant percentage said yes, while some said no. It would appear that most patients involved themselves in sexual contact with people whose sexual history they did not know. It was deduced that sexual behaviours of this nature were associated with a high risk of transmission of STDs. Most patients did not know what further research could be done on the question of STDs. The few thought that further research should be directed on causes and better methods and strategies of preventing STDs. The study revealed that there is a link between STDs and geographic, demographic / biographic, socio-cultural and socio-economic factors.Item Open Access The village health worker programme in primary health care in the Maseru health service area: a case study(University of the Free State, 1998-11) Maieane, Malika Veronica; Pretorius, EngelaEnglish: Health in Lesotho is similar to many developing countries, where health care facilities are poor. The delivery of health care services is especially poor in the rural villages. The aim of this study was to find out whether the implementation of the Village Health Worker Programme has improved the provision of health care services and the health status in the Maseru Health Service Area. The Village Health Workers' support in the villages and the problems, which may have resulted in poor delivery of services, were also investigated. In the empirical phase a qualitative survey was undertaken using Focus Group Discussions for three categories of respondents, namely the trainers, Village Health Workers (VHWs) and villagers. The interviews in the villages were arranged with the consent of the chiefs in Ha Foso and Ha Thamae. The interviews with the respondents were conducted in English and Sesotho. The reason was that the respondents in the villages could only communicate in Sesotho, while the VHW staff was proficient in English. The following factors can be highlighted regarding the Village Health Worker Programme in the Maseru Health Service Area: + Firstly, the greater percentage of Lesotho's population resides in the rural villages. The findings of this study reveal that many people in these villages are old, poor and unemployed. This situation results in poor health status in the villages. + Secondly, the delivery of health care services in the villages is poor. The researcher found that where the Programme was implemented properly, it was accepted and supported by the communities involved for example Ha Foso. Here the Programme also managed to improve the delivery of health care services, which resulted in a good health status within the community. On the other hand, the opposite was found in the villages that did not support the Programme, for example in Ha Thamae. Thirdly, the problems in the VHW Programme have affected its implementation in the villages. The respondents asserted that if the aim of the Government is to improve health in the villages, incentives to the VHWs must be a priority. In the light of the data obtained from the .literature study and from the respondents, one may conclude that unless the structure and policies of the VHW Programme are changed to suit the interests of all the people involved, it has no future in the Maseru HSA.Item Open Access Community participation in the upgrading of informal settlements: theoretical and practical guidelines(University of the Free State, 1999-05) Botes, Lucius Johannes Snyman; Van Rensburg, H. C. J.; Beukes, E. P.English: The emergence of participation as an alternative paradigm of development has been phenomenal. All over the world, and in South Africa in particular, enthusiasm for community participation in development exists. Moreover, many development initiatives in South Africa aspire to be participatory and people-driven processes. However, the difficulties of achieving participation at grassroots level is not always fully recognised or analysed. Therefore, participatory development, specifically in urban upgrading in South Africa, was the focus of this research. This study attempted to move beyond both the development rhetoric and the lofty sentiments associated with participatory development, and to search for a deeper understanding of community participation in development. In this search for a more in-depth understanding of the dynamics of participatory development, the study firstly traced the roots of community participation back to some of the social and development theories and paradigms from which community participation originated. The acceptance of participatory approaches to development reflects an awareness of the inadequacy of previous development efforts that failed to communicate effectively with local persons and considers their felt needs and potential contributions. Participatory development was developed primarily in a Third World context, albeit with Western influences, and it grew out of a wide range of alternative and divergent ideas, theories and paradigms, from all over, and from a multitude and rich legacy of development forces and approaches that influenced and co-shaped it. Secondly, this thesis attempted to achieve conceptual clarity on community participation in relation to development projects. Community participation is for the purposes of this study, defined as a collective process that has its focus on the active collaborative involvement of keystakeholders in joint decision-making that will influence the outcome of development decisions and of actions impacting on the broader development context of an end-beneficiary community. Thirdly, this research paid some attention to community participation in low-income urban housing projects. Important impediments or obstacles to community participation were exposed, with some reference to their application in urban upqradinq contexts. This study highlighted the emergence and evolution of participatory housing processes in urban low-income communities, both internationally and in South Africa. The global nature of shelter poverty, specifically in urban environments, was explored and the extent of shelter poverty in South Africa's urban areas and related low-income housing initiatives was discussed. r,e emergence of participatory urban development in South Africa was also analysed. Fourthly, the research described and analysed the community participation dynamics of a selected case study of informal settlement upgrading. For this purpose Freedom Square (an informal settlement on the outskirts of Bloemfontein, the capital of the Free State Province in South Africa) was selected as a case study. The findings demonstrated that informal settlers do have the inherent ability to participate meaningfully in their own development, albeit not without conflict among the different stakeholders involved. Lastly, the study proposed some emergent guidelines for promoting or facilitating community participation in urban upgrading projects. These guidelines could serve as a developmental strategy of conduct for the practice of participatory development and also as a development ethical code. Participatory development, and for that matter human development, is about processes whereby people empower themselves to participate continuously in improving their own destiny. A constant reorientation of the thinking of development professionals is therefore necessary, during which process they should rather adopt the motto of planning with and not for the people. In this reorientation they should change from being implementers to being facilitators and enablers who foster the principle of minimum intervention and who respect the indigenous knowledge of ordinary community members. The participatory development paradigm is here to stay, but the challenge remains to make community participation more than an empty catchword. Although there are major issues and problems associated with community participation in development, the benefits of participation by far outweigh these problems. Despite its ambiguities and limitations, the participatory approach enables ordinary people to assume responsibility for policies and decisions, and also for actions which concern them.Item Open Access A sociological analysis of industrial action among blue-collar workers at South African universities with reference to two campuses in the Free State(University of the Free State, 1999-11) Motloung, Lekaota Azariel; Heunis, J. C.; De Klerk, G. W.English: In recent years, the South African university sector has come to be characterised by trade union and student backlash. The roots of the crises lie in the need to transform this sector. The acceptability and effectiveness of tertiary education institution rest fundamentally on visible institutional change that parallels the change the country is currently undergoing. One of the flashpoints in the transformation process in this sector has been a wave of industrial action by the blue-collar workers amidst the arbitrary and often paternalistic authority of almost an all white management in virtually all the university campuses nationally. The 2nd of February 1990, however, brought into the scene the whole array of changes that overhauled the draconian-type social policy of the apartheid regime. The constitutional talks in the Convention for Democratic South Africa (CODESA) gave way to democratic elections that resulted in the Government of National Unity (GNU). In the first five years in office, the African National Congress (ANC) led government introduced far-reaching legislative mechanisms including the supreme law of the land, (the Constitution) within which transformation and nation building objectives were envisaged. Part of these vicissitudes relates to democratisation of labour relations in South Africa. Applicable pieces of legislation were accordingly revised. The most fundamental change is the introduction and implementation of the new Labour Relations Act 66 of 1995 (LRA) which became operational in November 1996. The labour movement and management view these changes differently. The blue-collar workers on the one hand have certain expectations about these changes. They expect that things would change for the better at their respective workplaces/campuses, that their working conditions and security of their jobs would improve. The university management on the other hand views itself as being hard-pressed by imposing government directives that prescribe inflexible preconditions to transform their institutions. The protracted labour disputes and accelerated incidences of industrial action in this sector were largely propelled by abysmal conditions perpetrated by banditry oriented policies of the past system. The current labour disputes especially in the early nineties between the bluecollar workers and management authorities should be seen in this context. This study undertook an investigation, clarification and delineation of the full range of factors (i.e. social, economic, political, organisational, institutional, ete) causing labour disputes and industrial action at South African universities. The _ investigation was performed both through the literature and empirical studies. Two university campuses in the Free State, the University of the Orange Free State (UOFS) and Vista University in Bloemfontein formed case studies for the empirical part of the research. The literature study consists of the reconstruction of the history of labour relations system in South Africa in which the influences that this broad labour relations practice on industrial action -pattern in the South African university sector in particular were evinced. The literature study also covers the historical background of the two case studies as well as background of their labour relations practice. A detailed explication on the objectives of the new Labour Relations Act (LRA) and on how the parties in labour relations practice in this sector would be affected by this law also formed part of the literature study. The main objective of the LRA is to promote productive employment relationships. In the empirical phase of the study, insightful findings regarding labour relations practice were noted on two methodologically relevant case studies, the "historically Black" and "historically White" institutions. The empirical study consists of descriptive and exploratory investigations of the biographical profile of the respondents at both campuses. There has been compelling evidence that generally defines more severe consequences of industrial action in the former category of institutions as opposed to the latter. Although the findings of this study cannot simply be generalised to other campuses, the study provides useful insights that can be drawn to enhance amity in labour relations in the rest of the campuses nationally. The value of the study lies in the sociological contribution it seeks to make in terms of attempting to magnify a deeper understanding of the nature, problems and dynamics of labour relations at South African universities. The study also attempts to make a revelation regarding some of the subtle transformatory factors that have come to riddle labour relations practice in the university sector in South Africa.Item Open Access The delivery of health care to the farm community in Bothaville(University of the Free State, 2000-05) Janse van Rensburg, Ega; Van Rensburg, H. C. J.; De Klerk, G. W.English: The master plan according to which the ANC government envisages to achieve transformation in the South African health care system, is the implementation of a National Health System (NHS), based on a District Health System (OHS) model, with the primary health care (PHC) policy as its foundation. In the process of implementing the OHS, an important challenge has emerged, that is, to translate provincial policy and administrative reorganisation into real improvements in health care delivery at local level. In order to address this challenge at grassroots level, a pilot programme of "bottomup" support to a selected number of health districts in the country was introduced, i.e. the Initiative for Sub-district Support (ISDS). One of the pilot sites selected for this support programme, is the Bothaville sub-district, which is the geographical location of this study. The study was primarily conducted to supply health care managers and governors concerned with the Bothaville sub-district with needed information on the conditions of the farm community and the delivery of health care. This information should enable them to improve the delivery of PHC and facilitate the implementation of the OHS. This is done by providing a broad explanation of development of the South African health care system with particular focus on policy and organisation; general background information on the Bothaville sub-district; a profile of mobile clinic services; an evaluation of the current system of mobile clinic health care; an explanation of the differences between the previous and the new system (implemented approximately five months prior to thë 'survey); baseline information on the rural community and thëir health status; and an assessment of the perceptions of health care providers concerning aspects of health care , delivery. The overall design of the study is exploratory and descriptive. It consists of a literature study and empirical data. The literature study was conducted to contextualise the Bothaville subdistrict within the ISOS and the broader South African health care context. The empirical study consisted of a combination of qualitative and quantitative methods of data gathering, i.e. a survey among a sample of rural dwellers and interviews conducted among farm school teachers, the professional nurses working on the mobile clinics, and general health care personnel in Bothaville. The main findings of the empirical part of the study include: more than half of the rural dwellers interviewed had never made use of the mobile clinics; information is inadequately disseminated to rural clients; transportation difficulties to mobile visiting points in the new system is a serious constraint; there is a lack of community participation in rural health matters; the promotive and preventative functions of PHC are lacking; a lack of communication and cooperation exist among the different public health services; conflict among health care personnel is rife; integration of services would solve numerous problems; and users of the mobile clinic services are generally satisfied with all aspects of mobile clinic services and appreciate the services. The main recommendations comprise: additional modes of transport for rural dwellers need to be provided; a more effective information dissemination strategy to rural clients is needed; the rural community need to be actively involved in health matters; more emphasis needs to be placed on the preventative and promotive dimensions of PHC; communication and cooperation among public health care workers in the area need improvement; and all the public health care services need to be integrated under one authority. In conclusion, the researcher is confident that the results of the study would supply health workers, managers and governors with ample information to optimise health care rendered to rural dwellers in the area, as well as to assist with the implementation of the DHS.Item Open Access The effectiveness and efficiency of labour relations processes and practices in the public hospital system with specific reference to Pelonomi Hospital (Bloemfontein, Free State)(University of the Free State, 2001-04) Matebesi, Sethulego Zacheus; Heunis, J. C.The general aim of this study is to analyse and assess the factors/issues that have an impact on the effectiveness and efficiency of labour relations processes and practices in the public hospital system. Thus, the study is directed towards the analysis and assessment of "structural factors" (joint worker-employer committees) and "procedural factors" (discipline, dismissal, performance appraisal and grievance procedures) that direct and influence the labour relations process at public hospitals. The overall study design was first of all exploratory and descriptive, but of necessity also directed towards the development of suggestions for practical interventions in problem solving, decision-making and policy-making. The study was conducted at Pelonomi Hospital in Mangaung, Greater Bloemfontein. Eighty nurses and forty-two blue-collar workers, were the primary respondents. Other respondents included management at provincial and national level, trade union representatives and supervisors of blue-collar workers. Data was collected by means of structured questionnaires and a focus group session with supervisors of blue-collar workers. The systems and open systems theories directed the study. In this regard five themes were identified: working conditions and remuneration, trade unionism, strikes, grievance and disciplinary procedures, and labour relations practices. The majority of the respondents were female. Most respondents (nurses and blue-collar workers) reported dissatisfaction with their salaries and the late and/or nonpayment of allowances. Despite the important role that unions play at institutional level, there is a perception that they are fuelling discontent among workers. Potential causes of strikes appeared to be more closely linked to discrimination than to ineffective grievance and disciplinary procedures. Respondents' knowledge about the existence of grievance and disciplinary procedures was extensive. Largely because of a perception that workers are treated differently, the vast majority of respondents indicated that these procedures are handled inconsistently. In conclusion, it is essential that the poor chain of labour relations is broken. Firm foundations have been laid for transformation of labour relations in the public health sector, in general. A healthy public hospital system can only be created and preserved if all parties embrace the current changes.Item Open Access Experiencing stigma: The physically disabled perspective(University of the Free State, 2001-11) Hopkins, Mandy-Liesel; De Klerk, G. W.; Van Vuuren, S. J. E. J.The field of physical disability is a relatively unexplored one. In particular, it is evident that little has been done to attempt an explanation of the reactions of people with physical disabilities to the labels, and consequent stigmas that are applied to them by the able-bodied. It is important to note that whilst people with physical disabilities are generally not considered deviant, many of them experience the same societal reactions to their conditions as other 'deviants' do. This occurrence is probably due to the fact that physically disabled people are seen by society as different, 'abnormal', or even 'deviant'. People with physical disabilities are isolated, stigmatised, segregated and discriminated against as a result of their disabilities. They are however, not intrinsically deviant because of their disabilities, but rather because of the undesirable differences that are imputed to them by society. The presence of a physical disability thus renders the disabled individual 'deviant', partially because of the limitations it imposes upon the person's range of activities and behaviour, but mainly because of the reactions of the able-bodied to the disability. People with physical disabilities are forced to remain socially and economically marginalised, not because of their disabilities, but because of discriminatory and exclusionary attitudes and practices on the part of the non-disabled. People with obvious physical disabilities, such as those confined to wheelchairs, are disadvantaged during everyday societal interaction, unless they constantly attempt to minimise their differences from the able-bodied. In this regard, many of the physically disabled suggested that non-disabled people believed them to innately possess the following characteristics: helplessness, dependency, an inability to take on any responsibility, and a constant need for guidance and supervision. The interviewees maintained that the aforementioned beliefs supplied 'normals' with seemingly legitimate reasons for the stigmatisation of groups such as them. They also noted that many 'normals' felt that they, as physically disabled individuals, deviated from the 'highly admirable state' of physical perfection. The physically disabled are often expected to cope with their limitations in ways not expected of other 'normal' people. In this regard, they are conditioned to 'manage' and 'overcome' their disabilities, to be 'independent' and above all else to be 'normal'. The limitations that result from physical disability, however, .often render these individuals dependent, and therefore deviant, as they are forced to break the norms of adult independence and self-reliance. According to the physically disabled, their disabilities stem from the fact that physical and social environments are designed without any consideration of the needs of particular individuals or groups, and not from their own functional limitations. They therefore maintain that the problems that they encounter in interaction with the able-bodied could be minimised if the latter group was better educated concerning the requirements and 'lifeworids' of people with physical disabilities. In this regard, it is evident that people with physical disabilities have been portrayed as 'flawed able-bodied people' throughout history. The physically disabled however, suggest that although they differ physiologically from their ablebodied counterparts, they are no different from any other 'normal' person. Finally, people with physical disabilities desire the same consideration, social courtesies and acknowledgement as any other 'normal' person, expects and receives. The physically disabled state that the fact that their bodies do not function in the same manner as those of the non-disabled, does not exclude them from assuming any of the roles that they previously held in society, should they choose to. As such, the physically disabled maintain that, given the opportunity, they would gladly take part in all the areas of 'normal' life, and particularly in the employment area. Physically disabled people want to be treated by their nondisabled counterparts as 'normal', they neither require, nor desire 'special' treatment because of their physical limitations.Item Open Access An exploration of the underlying social dynamics that make women vulnerable to HIV infection(University of the Free State, 2002-05) Ackermann, Leáne; De Klerk, G. W.English: In South Africa, as in the rest of Sub-Saharan Africa, HIV/AIDS has become a source of national and international concern. After many prevention campaigns and education programmes the viruscontinues to spread at an alarming rate, forcing one to look more carefully at the underlying social organization that could be conducive to the spread of thisdisease. In particular the position of women isbeing investigated in order to uncover the social dynamics that increase their vulnerability to this disease. In the year 2000, almost a quarter (24,5%)of South African women attending antenatal clinics were HIV positive. Physiologically,women appear to be at greater riskof contracting HIV than men. Apart from the physiological vulnerability of women it is important to consider the social aspects that put women at risk.This thesis considers the following social factors that put women at risk: violence against women, rape in particular; the unfavourable economic position of women that threatens the well- being of women as it encourages behaviour that increases the riskof HIV infection: the low educational status of women; a sexual culture which includes practices and expectations that put women at risk. This exploratory study revealed that women lack specific knowledge concerning the disease and hold certain misconceptions about how being in a stable relationship protects one against the disease. Another important finding was that these women, who acquired the disease, were in stable relationships that were generally positive and rewarding and that the overriding motivation to have sex was based on love. This emphasizes the fact that all women are at risk and that the very nature of a stable relationship (that encourages trust and complacency) is what puts women at risk. Some relationships were negative and this involved forced sex. Regarding the non-use of condoms, the main reason cited was that people who trust one another, do not use condoms. Unfortunately the real culture of infidelity coupled with the emphasis on trust (no condoms) was one important reason why these women acquired HIV. In addition to the above, the study revealed that the trans-gender and trans-generational lack of communication regarding sexual matters makes it difficult for women to insist on condom use when they suspect their partners to be unfaithful. This study recommends that action to protect women must be taken on an individual, organisational and ideological level. On an individual level, it is important that all women perceive themselves to be at risk and that they know exactly how to go about protecting themselves. In addition to this, individuals should continuously be motivated to practice behaviour that will protect them from HIV infection. This motivation can come through socialisation agents such as schools, parents, churches and the media. It is also important that women have the power to dictate sexual behaviour. Regarding the organisational level, HIV counselling and anti-retrorviral therapy should be available. Sexually transmitted diseases should be prevented with the help of the health care sector and the mobilisation of organisations that work to combat violence against women. Ideologically, the patriarchal nature of our society must be changed before wide spread behavioural change will occur. The rampant spread of this disease can only be stemmed if the subordinate position of women is acknowledged and addressed.Item Open Access Hospitalisation for tuberculosis in the Free State, South Africa(University of the Free State, 2004-05) Heunis, James Christoffel; Van Rensburg, H. C. J.; Meulemans, H.Abstract not availableItem Open Access Living with TB: the ‘career’ of the tuberculosis patient in the Free State, South Africa(University of the Free State, 2004-05) Matebesi, Sethulego. Zacheus; Van Rensburg, H. C. J.; Meulemans, HermanThis thesis has three main aims. The first aim is to profile the ‘career’ of tuberculosis patients. In this regard, the focus is broadly on the socio-economic and socio-cultural variables impinging on the health-seeking behaviour and adherence to treatment of pulmonary TB patients. Secondary to this aim, the intention is to provide all stakeholders with insight into the living circumstances and experiences of pulmonary TB patients. The third main aim is to propose criteria for innovative behavioural prevention strategies and health-seeking behaviour for TB patients. The study was conducted at nine primary health care clinics in three geographic areas or health districts in the Free State province (South Africa). The areas were purposively selected to represent different regions in the Free State, including rural and urban areas. Together, the selected areas represent the broad spectrum of socio-economic and socio-cultural variables impinging on the illness ‘career’ of TB patients. The study was conducted using a combination of quantitative and qualitative research methods. Face-to-face interviews was conducted with 220 randomly selected pulmonary TB patients. In addition, nine focus group discussions (FGDs) were conducted with 85 PTB patients. Fifty-five percent of interviewed patients were male and 45% female. The majority of patients were new patients (68%), while almost a third was re-treatment patients (32%). Of the re-treatment patients, just more than half were on re-treatment following previous cure (53%), while just more than a fifth (21%) was on re-treatment following treatment completion. A third (35%) of the patients was married. On average, the patients lived in families of 4.4 persons per household with an average of 2.1 persons per room.The majority of the patients indicated that they had access to electricity (80%), piped water (85%) and to refuse removal services at least once a week (77%). However, a third (35%) reported having no proper sanitation. While the average monthly per capita income of patients increased from R985.36 immediately prior to illness with TB to R1 113.16 afterwards, the mean cumulative monthly household income decreased from R1 214.50 before being diagnosed with TB to R946.85 afterwards. It was shown that the illness ‘career’ of individuals with TB is characterised as a long-term experience in which the individuals had to rely families and friends to overcome daily challenges. In an attempt to provide a meaningful separation of events constituting the illness experience, the illness ‘career’ of the TB patient was divided into five different phases from experiencing symptoms, to assuming the sick role, to contacting a health care provider, to being a patient and, finally, relinquishing the sick role. The findings indicate that the patients in this study not only had to cope with physical disabilities and the side effects of treatment, but also with the psychological traumas of fear of recurrence of the disease and social stigma, and the disappointment of a considerably reduced range of future possibilities for career and marriage. It was also indicated that few of the patients in this study were treated negatively by their spouses/partners, family members or their communities. Living with TB in “modern” society where stress, AIDS and an array other social and psychological factors are seen to threaten the individuals, is an enormous burden In respect of determinants of treatment adherence, the quantitative evidence shows that stigma, the socio-economic circumstances of the patient, and migrancy play an important role in explaining non-adherence. In addition, patients whose tablet taking was supervised were more likely to adhere to treatment. Based on the qualitative evidence, some of the perceived factors affecting adherence included lack of knowledge about TB, non-sustainability of educational campaigns, side effects of drugs, hunger and lack of family support, stigma attached to TB, and the attitude of health care workers and the long delay in obtaining a diagnosis. Based on this evidence, recommendations are made regarding a number of provider-, patient- and communitycentred interventions that can improve adherence.Item Open Access A community-based conservation programme for the management and conservation of land resources in Lesotho(University of the Free State, 2004-11) Esenjor, Akinagum Fidelis; Pelser, A. J.; Botes, L.English: Literature abounds with discussions regarding land degradation and the sustainability of land resources conservation programmes in sub-Saharan Africa. A thorough understanding of past and present intervention mechanisms and the consequences both to humans and to the entire ecosystem is necessary to advise stakeholders in conservation initiatives. This study employs comprehensive multiple participatory methodologies in analysing both the causes of land degradation and the importance of local communities’ real involvement in land resources conservation initiatives. The participatory methodologies include focus group discussions. The consequences of the paternalist classical model of land resources conservation programmes practised in the developing countries include endless conflicts between conservation officers and local communities, a lack of unequivocal acknowledgement of indigenous knowledge, denial to local communities of access to rights and adequate benefits, and a lack of local support and community participation which results in the sudden collapse and abandonment of conservation programmes. This indicates a wasting of government agencies’ heavy investment in conservation initiatives. Yet, worldwide advocation of a shift from official to community-based conservation approaches does not mean the total withdrawal of government agencies. It only means a trimming down of government agencies’ “do it all” recurrent roles to one of facilitation of the conservation initiatives of local communities. Government agencies may also give unconditional support in community-based initiatives. It has been established that the continuous occupation of the centre stage in land resources conservation programmes by government agencies has accelerated land degradation, has intensified conflicts between government officers and local communities, has wasted local available resources input, has denied local communities access, rights and benefits of land resources, and has increased the number of abandoned conservation projects. The hope of effectively practising real community-based land resources is an uphill task. This is so because government agencies operating in Lesotho have raised unsustainable expectations of food-for-work and/or cash payment incentives to local community members for participating in conservation work. This poor practice has established a false impression that land resources conservation is the sole responsibility of government agencies. This study has established that to practise community-based conservation would require drastic new training of government agencies; it would necessitate providing more sustainable incentives to local communities, and also re-orientating, empowering and capacitating the people for the challenging tasks ahead. Real involvement of local communities in the processes of identification of conservation needs, planning, implementation, monitoring and evaluation are sure ways of ensuring sustainable land resources conservation programmes.Item Open Access The role of practitioners of traditional medicine in the treatment, care and support of people living with HIV/AIDS(University of the Free State, 2005-05) Summerton, Joy Violet; Van Rensburg, H. C. J.; Pretorius, E.; Ngwena, C.The ravaging impact of the HIV/AIDS epidemic on societies, especially in developing countries, has evoked a renewed urgency to consolidate all available resources to address the health needs of individuals living with HIV and AIDS. One such resource to the avail of many resource-ridden countries is the traditional healing system. Despite global proclamations and national policies that propagate the inclusion of traditional health practitioners into national health systems and priority programmes in order to address the health care needs of communities, in practice, traditional healing remains shadowed by its western health care counterpart. The South African government has declared traditional health practitioners partners in the national emasculation of the HIV/AIDS epidemic. However, significant results to this effect have not as yet been produced. The lack of effective integration of traditional health practitioners into national health programmes, such as for HIV/AIDS in South Africa, points towards a discrepancy between policies and proclamations propagating the inclusion of traditional health practitioners into the mainstream of health care, and actual integration. It is in the light of this discrepancy that this study proposes the exploration of factors that hinder collaboration between practitioners of the traditional and western health care systems. Key factors to successful collaboration between traditional and western health practitioners are identified from various initiatives in Africa and Asia, and against the backdrop of the WHO suggested integrated health care systems. These success factors are used as a bench mark to analyse collaboration in the study area and propose recommendations towards successful and meaningful collaboration. The study explores the perceived value and weaknesses of the traditional healing system in the treatment and care of people living with HIV/AIDS. This entailed ascertaining impediments to effective collaboration between traditional and western health practitioners for the purpose of informing the two categories of practitioners as well as policy developments aimed at integrating traditional and western health care. A literature study of the traditional healing system, international and national policies relating to HIV/AIDS and traditional healing, and lessons learnt from developed and developing countries on collaboration between the two health care systems informed the development of the research instruments and served as a conceptual framework for interpretation of the findings. The study was conducted in five urban settlements in the Buffalo City Municipality, in the Eastern Cape Province. The Eastern Cape was selected due to the researcher’s affiliation to the culture and vernacular of the research respondents, and due to the venerable nature of traditional health practitioners in many communities in the Eastern Cape. Preliminary investigations in preparation for the research revealed that the organisation and regulation of traditional health practitioners is more problematic in urban than in rural areas, thus the selection of an urban area to conduct the research. Due to the exploratory nature of the research, a qualitative research design was applied whereby indepth semi-structured individual interviews were conducted with 23 western health practitioners, 20 traditional health practitioners and three managers from the Department of Health. The focus of the interviews was to explore the perceived strengths and weaknesses of traditional health practitioners; impediments to collaboration between traditional and western practitioners; the structure and organisation of the traditional healing system; and views about the legalisation and professionalisation of traditional health practitioners. Purposive, snowball and sequential sampling was applied to select respondents. The main findings of the research points towards a dire need for closer collaboration between traditional and western health practitioners. The need for collaboration is based on both the perceived weaknesses and strengths of the traditional healing system. However, the nature of collaboration envisaged differs significantly between the two groups of practitioners. On the one hand, traditional practitioners envisage collaboration as entailing a bilateral (two-way) referral system between traditional and western practitioners, and joint decision making about certain patients and conditions between the two practitioners. On the other, western health practitioners envisage a far more unilateral collaboration which entails a one-way referral system from traditional to western practitioner, traditional practitioners receiving training in western medicine and traditional practitioners sharing information about the contents of proclaimed curative medicines/remedies. Furthermore, the absence of unequivocally delineated guidelines for collaboration is one other major hindrance to effective collaboration between the two traditions of practitioners. In general, the legalisation and professionalisation of traditional health practitioner is welcomed by both genres of practitioners. However, the lack of knowledge about the content and implications of the Traditional Health Practitioners Bill posses major threats to the successful implementation of the proposed Act. Overall, the research indicates that traditional healing has a role to play in the provision of health care to people living with HIV/AIDS. However, the weaknesses of this system of health care, which undermine its value, need to be addressed. Furthermore, clearly delineated policies need to be developed in close collaboration with the major stakeholders, namely traditional and western practitioners, to guide effective collaboration as envisaged by both groups of practitioners. Local government should adopt a more active role in initiating collaboration as well as monitoring its effective and culture-sensitive implementation.Item Open Access Basotho culture and domestic violence: case studies of men as perpetrators and women as victims(University of the Free State, 2005-12) Mashiloane, Ntja Patrick; Crause, E. J.; Venter, A. P.The aim of this study was to summerize and provide an overview of domestic violence and the law, in South Africa and the role of Basotho Culture in domestic violence especially in instances where men are perpetrators and women are victims. To achieve this, a literature study on domestic violence was done and a questionnaire generated . Case studies were made of ten respondents, who reported cases or were arrested in 2005 as an empirical study. The respondents are five perpetrators and five victims in Mak:wane Police Station Policing precinct. The study illustrates the multi-dimensionality of human behavior. While there are relationships between traditional culture and violence towards women, its emphasis on male dominance is counterbalanced by obligations to protect. The study results/findings rather illustrates the gap between South Africa as an ideal state, and where the reality of some of its citizens are. The importance of previous learning as a common denominator between victims and perpetrators and the impact of crumbling social networks were highlighted. A major recommendation relates to creating an opportunity to guide and support the more violent citizens in making the transition to a behavior system that is more in line with the general orientation portrayed in the systems of law relating to domestic violence and protection of women and children. Recommendations were made for the prevention of domestic violence by the South African Police Service, Non Governmental Organizations and Government departments and for further study.Item Open Access The socio-economic impact of the Lesotho Highlands Water Project resettlement programme at Makhoakhoeng(University of the Free State, 2007) Kotelo-Molaoa, Mampho N.; Pelser, A. J.; Botes, L. J. S.Large dams are constructed for irrigation, generation of hydroelectricity, consumption and so forth. In the case of Lesotho, the LHWP was constructed with the sole purpose of selling water to South Africa in order to earn royalties and to generate hydroelectricity. Although a number of factors are used to justify the construction of large dams, worldwide experience has shown that the consequences emanating from their construction are sometimes irreversible and painful like having to be resettled. This study therefore sought to establish the extent of the impacts emanating from the LHWP Resettlement Programme at Makhoakhoeng, whether the standard of living of resettlees as measured in terms of access to services has improved or not, the extent of their participation in the resettlement programme, and their perception on their standard of living. The specific study objectives were to: i) determine the socio-economic impacts of the resettlement on the resettled communities; ii) elicit the perceptions of the displaced people about their participation in resettlement programme decision making; iii) evaluate the adequacy of the compensation and resettlement packages; and iv) ascertain the level of satisfaction of the resettlees with the resettlement programme. A combination of research techniques was used to collect both the qualitative and the quantitative data. Data collection instruments employed were: i) A literature review was undertaken to provide background information to the problem statement, the design of the methodology, and also on the theories and other factors used to justify the construction of large dams. Perusal of the existing literature also led to a deeper understanding of the impacts of large dams, international experiences and reaction towards construction of large dams and Lesotho’s experience regarding the construction of large dams. ii) Key informants interviews were conducted with selected individuals who in one way or another were key in terms of implementing the resettlement programme at Makhoakhoeng. iii) A questionnaire survey was conducted with the households who came from Molika-Liko and were resettled at Makhoakhoeng. iv) A focus group discussion was held with some of the resettlees. Information collected through filling in the questionnaire was keyed into the microcomputer network system using Microsoft Excel to produce graphs and tables. The data collected through key informants, special cases and focus group discussions were collated and written into descriptive reports, i.e., summarised field discussion records. The LHWP Resettlement Programme at Makhoakhoeng has resulted in both positive and the negative impacts. Furthermore, the study has concluded that there is a need to: i) engage with all the stakeholders affected by involuntary resettlement through an open and transparent public participation process ii) pay attention to the identification of more sustainable means of livelihoods iii) conduct SIAs that can point to those intangible aspects of resettlement iv) put in place an appeal system that is affordable and accessible to people who are dissatisfied with the resettlement package v) present resettlees with information on each of the options so as to enable them to make informed decisions vi) honour promises in order to build trust with the resettlees. The following recommendations are being made for future resettlement programmes: i) Change the mindset of those charged with the management of resettlement programmes so that they are more empathetic towards resettlees ii) Reform institutions within the water sector iii) Adopt a multidisciplinary approach in resettlement programmes iv) Differentiate resettlees into subgroups v) Engage in an open and transparent public participation process vi) Conduct SIAs with a monitoring and evaluation component vii) Identify sustainable means of livelihoods for the resettlees viii) Compensate affected people for loss of access to common property.Item Open Access International conflict over fresh water resources: the formulation of preventive and interventive guidelines(University of the Free State, 2008) Redelinghuys, Nola; Pelser, A. J.The pressures of human society on available water resources lead to the grave and everworsening scarcity of this resource, which locally and internationally, strains policy and institutional capacity to deal with the issue cooperatively. While conflict over fresh water, to the extent even of war, is not generally characteristic of relations over water, tension is nevertheless felt between countries over various issues surrounding access to water. It is thus imperative to determine the nature and extent of issues that may give rise to future tension and conflict over freshwater resources. Given the above situation, this study aimed to meet the following objectives: - To gain in-depth understanding of the social, economic and political dynamics that underlie current relations over water, globally and more specifically in the Southern African region. - To assess current ways in which water issues are being addressed at the international and the regional level, by focusing on the existing global and regional policy frameworks for dealing with water scarcity. - To assess the institutional frameworks within which water issues are currently being dealt with at the international and the regional levels. - To develop a set of policy guidelines that can be used to facilitate cooperation over water issues in Southern Africa. The research design of this study was qualitative and interpretative, and four sources of information were utilised in data collection, namely primary and secondary literature sources; secondary demographic and environmental data; policy and legislative documents; and, information obtained from personal key-informant interviews. The following conclusions were drawn from the study - The dominant social paradigm underlying decision making with regard to natural resources does not support closer cooperation over fresh water. - The emphasis on political sovereignty in policy is inconsistent with the international commitment to cooperation over freshwater resources. - The policy obligation of equitable distribution of water between sectors and states is hampered by unresolved tensions in policy and institutional frameworks. - As a result of the vagueness with which contentious issues are addressed in international policy, current policy options may neither be adequately able to intervene in nor to prevent conflicts over fresh water. - A lack of both ratification and enforcement of the existing international policy framework renders these instruments powerless to prevent or intervene in future conflicts over fresh water. - Effective cooperation between water-resource institutions is hampered by significant shortcomings in vertical and horizontal communication linkages between such institutions. Recommendations made based on the study are: - A transition needs to be made from a technocentric approach focused on managing the issues arising from water scarcity, to an ecocentric approach focused on radical changes in policy formulation. - Current vague statements and terms in the international policy framework need to be conceptualised more clearly. - Policy makers at the regional and national levels should specifically work toward diffusing subtle tensions in current policy and institutional arrangements through closer integration of sectoral policies. - A regional perspective on the issues of water scarcity, conflict and cooperation over fresh water needs to be strengthened. - In line with the IWRM strategy’s emphasis on decentralisation, appropriate mechanisms need to be found to link institutions horizontally. - The capacity and functioning of multistakeholder platforms in the water sector need to be strengthened.Item Open Access Adherence and sustained access to antiretroviral treatment in the Free State public health sector: a gender perspective(University of the Free State, 2008-11) De Reuck, Chantell Jacqualine; Pretorius, E.; Van Rensburg, H. C. J.English: Sustained access to ART and adherence to ARV medications remain crucial for reducing AIDS-related mortality and morbidity, minimising the development of drug resistance, and for appropriate treatment decision-making by health care providers. Thus, the factors associated with non-adherence to ARV medication and poor sustained access need to be identified and addressed. Although there is a preponderance of treatment adherence research, in which social aspects that affect the way patients manage HIV/AIDS and related treatment have been identified, far less attention has been paid to the relevant gender dimensions of treatment, care and support. The aim of this study was to examine how gender influences adherence to ARV medications and sustained access to treatment among patients on ART in the Free State public health sector. To achieve this aim, several methods were deemed necessary. First, current literature was reviewed to identify factors that predict nonadherence to ARV medications and impede sustained access to ART. Second, a framework was adapted to focus on inequalities in treatment from a gender perspective, and to take cognisance of both biological sex and socially constructed gender influences on the health of patients on ARV treatment, with specific reference to access and adherence to treatment. Masculinity and femininity is discussed in respect of the varied resources that an individual has access to and control over, an individual’s decision-making power, the gender norms held by society, and gender roles that men and women are expected to adhere to. Third, an empirical investigation of data from a prospective cohort study was conducted to identify similarities and differences in factors associated with nonadherence to ARV medications and to poor sustained access among men and women on ART in the Free State’s public health sector. A total of 1609 patients were interviewed in face-to-face interviews using semi-structured questionnaires. Patients were interviewed six times during the course of this study with an average six-month interval between interviews. The outcome variables assessed included self-reported seven-day adherence to ARV medication regimens and self-reported adherence to scheduled appointments over a six-month period as a measure of sustained assess to treatment. Sex was used as the dependent variable in all analyses. Demographic, psychosocial/behavioural, clinical, and service delivery variables were all tested for a statistically significant association with non-adherence to medications and appointments in separate sex-disaggregated multivariate regression analyses (P≤0.05). Logistic regression models showed that the strongest predictors of medication nonadherence among men included financial difficulties in visiting hospital facilities and poor treatment knowledge. Among women, tobacco use and perceived stigma were identified as the strongest predictors of medication non-adherence. Self-reported depression or anxiety and experiencing difficulties in visiting clinic and hospital facilities were similarly associated with non-adherence to appointments for men and women. Service satisfaction at clinics and having few self-reported service needs were also independently associated with appointment non-adherence among women, but not among men. Findings for men do however need to be interpreted with caution, as both outcomes, despite being valid measures for the combined sample and among women, were not valid for men. Marked differences and similarities in the factors influencing medication adherence and sustained access to treatment between men and women were identified, reflecting the different lived experiences of men and women on ART in the Free State. Gender-sensitive interventions - as opposed to standardised ones - are thus required to improve adherence and sustained access in this population. Further research and possible interventions are required in respect of gender-sensitive outcome measures for adherence, improving treatment knowledge among men, coping responses to gender role stressors among women, less stigmatising means for taking medications, improving mental health and improving the quality of services rendered at health care facilities.Item Open Access Housing options for mineworkers in arid and semi-arid regions: the case of Kathu(University of the Free State, 2009-05) Cloete, Jan Sebastiaan; Marais, J. G. L.; Matabesi, S. Z.English: This dissertation entitled “Housing options for mineworkers in arid and semi-arid regions: the case of Kathu” was conducted against the background of a dearth of research into the provision of housing options for mineworkers in post-1994 South Africa. Furthermore, it was conducted against the background of the influence that arid locations may bring to bear on housing provision. The dissertation calls in question the applicability of current mineworker housing provision, given the realities of being located in an arid mining town. The dissertation initially reviews the international literature regarding development in arid regions and the effects that such arid locations have on the livelihoods of the residents. It is suggested that the residents of mining towns engage in multiple forms of livelihood because of the danger associated with dependence on a single livelihood. The cycles of development and stagnation of resource-dependent towns, which affect livelihoods, are discussed, as is an alternative to settlement. These international perspectives are followed by an investigation of the relevant South African literature to illustrate the effects of past social and economic developments on the historical provision of housing in South African mining towns. The discussion then moves on to more recent attempts by both the mining companies and national government to address the consequences of past injustices. The housing options available to mineworkers are illustrated by reflecting on the formulation and implementation of policies both by mining companies and government. Through reflection on two surveys conducted in Kathu (one among residents of a mining hostel and another among residents of a private housing scheme), it is shown that a significant number of mineworkers prefer not to settle permanently near the mine and would prefer to continue with circular migration between the mine and their areas of origin. While several factors have – for either sample – had an influence on the preference to settle permanently, only the presence of a/another home in their areas of origin indicated a statistically significant relationship for both samples. This gives an indication of both the existence of ties with the areas of origin and of the existence of access to multiple livelihoods. The data from the surveys further reflect the respondents’ preferences in terms of housing and their evident ability to afford such preferences. It is shown that while respondents’ choices are not always a reflection of their housing needs, most would not have problems in respect of affordability. While most respondents indicated that they would prefer to own, the long-term effects of settlement are questioned by reflecting on respondents’ lack of alternative livelihoods. Generally, respondents expressed high levels of satisfaction both regarding the housing scheme and the housing in their areas of origin. Addressing the overcrowding of the hostel should significantly increase the satisfaction of living in them. Against this background, the dissertation proposes that: the roll-out of rental subsidies be increased to those eligible in mining areas; the role of social housing be re-evaluated with a view to providing rental housing to mineworkers; alternative settlement patterns be encouraged in arid regions; alternative systems of infrastructure and service provision in arid regions be investigated; the choices of individuals be facilitated by increasing their range of housing options; current production decisions at the mine be taken into account to improve the benefits and reduce the costs of migrancy; a greater variety of housing options be provided to mineworkers so that they may choose one that is most compatible with their preference and livelihood; and that more education be provided to mineworkers regarding the possible consequences of both ownership and settlement choices for their livelihoods.