A critical assessment of the quality of community home-based care
- Authors: Morton, David Gerard
- Date: 2012
- Subjects: Home care services -- South Africa -- Eastern Cape , Home nursing -- Equipment and supplies , Caregivers -- South Africa -- Eastern Cape , Community health nursing -- South Africa -- Eastern Cape , Home health aides
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:16133 , http://hdl.handle.net/10948/1606 , Home care services -- South Africa -- Eastern Cape , Home nursing -- Equipment and supplies , Caregivers -- South Africa -- Eastern Cape , Community health nursing -- South Africa -- Eastern Cape , Home health aides
- Description: Volunteer home-based caregivers are critical role players in South Africa‘s health care system and in the South African government‘s strategy to fight HIV and AIDS. In order to achieve the aims that the government seeks to attain, it is important that the care and treatment provided to patients receiving community home-based care (CHBC) be of a high quality. While the need for quality care is supported by government and civil society, research indicates that it is not clear whether quality care is indeed being provided and therefore there is a need for research into the quality of CHBC. The research aimed to undertake a critical assessment of CHBC programmes to determine the quality of care provided by volunteer caregivers using social capital theory as a theoretical framework. The study examined the quality of CHBC by analysing the context of CHBC, by investigating the support that volunteer caregivers and their clients receive and by discussing the support that volunteer caregivers and their clients still need. The study used one-on-one in-depth interviews and focus groups to obtain relevant data. The participants included volunteer caregivers, clients and supervisors who took part in the one-on-one interviews. The focus groups consisted of key informants and supervisors respectively. The quantitative data consisted of descriptive statistics which helped describe the participants. The qualitative data was coded and themes and sub-themes were developed. The data was also analysed by an independent coder. The results showed that poverty, and the related problems of poor living conditions and a lack of food security affects the quality CHBC. In addition, unemployment and the problem of stipends also affect quality CHBC. Certain socio-economic factors were also found to lead people to choose to become volunteer caregivers and unemployment was found to be an important driving force behind the choice to undertake volunteer caregiving. Furthermore, the volunteer caregivers in the sample received organisational support from their supervisors and their fellow caregivers or peers. They also received social support from their families and their communities. Regarding the clients of the volunteer caregivers, it was found that they received a number of types of support including psycho- iv social counselling, spiritual counselling and care of a holistic nature. In addition, the study found that there is a need for standardised quality training of volunteer caregivers, which will equip them with multiple skills. It was also found that volunteer caregivers require mentoring and quality supervision in order to be able to provide quality CHBC to their clients. Government has the ability to put the necessary systems and structures in place, such as a scope of practice for volunteers, standardised training and monitoring and evaluation, to enable CHBC and its relevant role players to operate at optimum levels. It also has the authority to make the changes and to enforce rules. Furthermore, it has the ability to unite CHBC organisations and can create the necessary conditions that can lead to increased social capital. Furthermore, the study recommends that two additional dimensions of quality care be added to existing dimensions of quality in health care. The first is the holistic approach to caregiving and the second is social support systems, namely supervisor/mentor and peer support and family and community support. This second dimension is also closely linked to social capital and the networks that make up CHBC.
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- Date Issued: 2012
A comparison of ecosystem health and services provided by subtropical thicket in and around the Bathurst commonage
- Authors: Stickler, Meredith Mercedes
- Date: 2010
- Subjects: Ecosystem services -- South Africa -- Bathurst , Ecosystem management , Commons -- South Africa -- Bathurst , Natural resources, Communal -- South Africa -- Bathurst , Land use, Rural -- South Africa -- Eastern Cape , Ecosystem health -- South Africa -- Bathurst
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:4766 , http://hdl.handle.net/10962/d1007169 , Ecosystem services -- South Africa -- Bathurst , Ecosystem management , Commons -- South Africa -- Bathurst , Natural resources, Communal -- South Africa -- Bathurst , Land use, Rural -- South Africa -- Eastern Cape , Ecosystem health -- South Africa -- Bathurst
- Description: Municipal commonage in South Africa offers previously disadvantaged, landless residents access to both direct ecosystem goods and services (EGS) that provide additional income options and indirect social and cultural services. Given that EGS production is a function of ecosystem health, it is imperative that commonage land be managed to maximize current local benefit streams while ensuring future options through the maintenance of natural ecosystem functions. The payments for ecosystem services (PES) model potentially offers an opportunity for contributing to local economic development while providing fiscal incentives for environmentally sustainable natural resource management. PES depends on the demonstration of quantifiable changes in EGS delivery due to improvement in or maintenance of high ecosystem health that are a verifiable result of modifications in management behavior. This thesis therefore compared spatial variations in (i) ecosystem health and (ii) nine direct and indirect EGS values derived from natural resources on the Bathurst municipal commonage and neighboring Waters Meeting Nature Reserve (NR) to explore how different land use intensities affect ecosystem health and the resulting provision of EGS. The results indicate that the total economic value of annually produced EGS on the study site is nearly R 9.8 million (US$ 1.2 million), with a standing stock of natural capital worth some R 28 million (US$ 3.4 million). Nearly 45% of the total annual production is attributed to Waters Meeting NR, with roughly 34% from the low use zone of the commonage and the remaining 22% from the high use zone. Of the total annual production value on the study site, roughly 59% is derived from indirect (non-consumptive) uses of wildlife for the study site as a whole, though this proportion varies from 25% in the high use zone of the commonage to 94% on Waters Meeting NR. The two largest annual production values on the study site derive from ecotourism (R 3.5 million, US$ 0.4 million) and livestock production (R 2.6 million, US$ 0.3 million), suggesting that while increased production of indirect EGS could generate significant additional revenues, especially on Waters Meeting NR and in the low use zone of the commonage, direct (consumptive) EGS will likely remain an important component of land use on the commonage. A PES project to support the adoption of silvo-pastoral practices could provide positive incentives for improved land use practices on the commonage and potentially be financed by conservation-friendly residents of the Kowie River catchment and/or increased ecotourism revenues from Waters Meeting NR. Allowing carefully designed and monitored local access to natural resources within Waters Meeting NR could also reduce pressure on commonage resources. Together, these approaches could lead to a more sustainable subtropical thicket landscape and ensure that critical natural resources remain available to support local livelihoods in the long-term.
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- Date Issued: 2010