The delivery of health care to the farm community in Bothaville - Janse van Rensburg, Ega (University of the Free State, 2000)
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.

Die breë beleid waarvolgens die ANC regering hervorming in die Suid-Afrikaanse gesondheidsorgsisteem teweeg wil bring, is dié van 'n Nasionale Gesondheidsisteem, gebaseer op 'n Distriks-gesondheidsisteemmodel, met die primêre gesondheidsorgbeleid as grondslag. Die implementering van die Distnks-qesondheidsorgmodel het 'n formidabele uitdaging teweeggebring, en dit is die oorsetting ovan provinsiale beleid en administratiewe herorganisasie van gesondheidsorg na 'n werklike verbetering van gesondheidsorg. Om hierdie uitdaging op qrondvlak aan te spreek, is 'n loodsprogram van qrondvlak-ondersteuninq in sommige gesondheidsdistrikte in die land, van stapel gestuur. Ditword die Inisiatief vir Sub-distrikOndersteuninq (ISDO) genoem. Een van die loodsdistrikte vir hierdie program geselekteer, is Bothaville, waar hierdie studie gedoen is.' Die studie is hoofsaaklik onderneem om gesondheidsorgbestuurders en -reëlaars van nodige inligting in verband met die lewering van primêre qesondheidsorqsdienste aan die landelike gemeenskappe in die Bothaville distrik, te voorsien, en hulle op hierdie manier in staat te stelom die dienste te optimaliseer en die implementering van die Distriks-gesondheidsisteem, beter te fasiliteer. Die ontplooiing van die studie soos in hierdie dokument vervat sluit inligting in verband met die volgende onderwerpe in: die ontwikkeling van die Suid-Afrikaanse gesondheidsisteem, agtergrondsinligting aangaande die Bothaville sub-distrik; 'n profiel van mobiele kliniekdienste, die evaluering van die mobiele kliniekdienste, die identifisering van verskille tussen die vorige en nuwe sisteme van dienslewering ('n nuwe sisteem van landelike dienslewering is ongeveer vyf maande voor die studie onderneem is, geïmplementeer in die area); die insameling van algemene basiese en gesondheids- en gesondheidsorgverwante inligting onder die landelike gemeenskap van Bothaville; en 'n ondersoek na die persepsies van publieke gesondheidsorgpersoneel oor sekere aspekte van gesondheidsorgdienslewering. Die studie is beskrywend en verkennend van aard en bestaan uit 'n literatuurstudie en 'n empiriese gedeelte. Die literatuurstudie is ter kontekstualisering van die Bothaville sub-distrik, as deel van die Suid-Afrikaanse gesondheidsorgsisteem en die ISOO, onderneem. Die empiriese studie bestaan uit 'n kombinasie van kwalitatiewe en kwantitatiewe data-insamelingstegnieke. Vier steekproewe is vir data-insameling getrek, naamlik onder: landelike gemeenskapslede; plaasskool onderwysers/onderwyseresse; personeel verwant aan die mobiele klinieke; asook ander personeel wat deel is van die publieke gesondheidsorgsisteem in Bothaville. Die belangrikste bevindinge van die studie sluit die volgende in: meer as die helfte van landelike respondente het nog nooit van 'n mobiele kliniek se dienste gebruik gemaak nie; inligting in verband met gesondheidsdienste word nie effektief na landelike kliënte versprei nie; vervoerprobleme na punte waar mobiele klinieke stop is 'n ernstige probleem vir die landelike gemeenskap; die landelike gemeenskap is nie genoegsaam aktief betrokke by die reëling van gesondheidsake in die distrik nie; die voorkomende en bevorderende dimensies van primêre gesondheidsorg geniet nie genoeg aandag in die lewering van landelike gesondheidsdienste nie; daar is 'n tekort aan samewerking en kommunikasie tussen publieke gesondheidsdienste; konflik is 'n gereelde verskynsel tussen gesondheidspersoneel in Bothaville; die integrasie van publieke gesondheidsdienste kan van hierdie probleme oplos; en gebruikers van die mobiele kliniekdienste het aangedui dat hulle tevrede is met die meeste aspekte van diens wat julle van die mobiele klinieke ontvang. Die belangrikste aanbevelings sluit die volgende in: bykomende vervoermiddele moet aan landelike gemeenskappe verskaf word sodat punte bereik kan word; die landelike gemeenskap behoort aktief betrek te word by die reëling van publieke gesondheidsdienste; die voorkomende en bevorderende dimensies van primêre' gesondheidsorg behoort meer aandag te geniet; kommunkasie 'en samewerking tussen die verskillende publieke gesondieriste in Bothaville behoort verbeter te word; en alle publieke gesondheidsdienste behoort onder ee'n beheerliggaam geïntegreer te word. Die navorser vertr.ou dat die bevindinge van hierdie studie personeel, bestuurders en reëlaars van gesondheidsdienste in die Bothaville sub-distrik met genoegsame inligting sal voorsien om gesondheidsorg. soos gelewer aan die landelike gemeenskap daar, te kan optimaliseer, en sodoende ondersteuning sal kan bied met die implementering van die ISOO.
Dissertation (M.Soc.Sc. (Sociology))--University of the Free State, 2000
Keywords: Mobile clinic services; Primary health care delivery; Bothaville farm community; User-friendliness of mobile health services; Accessibility of mobile health services; Public health care transformation; Initiative for Sub-district Support; District Health Systems; Information dissemination; Optimisation of rural health care delivery 168; Primary health care -- South Africa -- Bothaville; Public health -- South Africa -- Bothaville; Community health service -- South Africa -- Bothaville