Littérature scientifique sur le sujet « People with disabilities – Medical care – South Africa »

Objective: Providing desirable rehabilitation services to people with disabilities has always been one of the most critical concerns of the health system in all countries. Today, it is crucial for policymakers and health care providers to recognize the different systems for providing rehabilitation services to people with disabilities. In this regard, it is beneficial to conduct comparative studies and use successful countries’ experiences in this subject. This comparison-analytical study aimed to compare the systems for providing rehabilitation services to people with disabilities. Materials & Methods: This comparative study was conducted in nine countries in 2020. To determine the comparison framework in this research, four dimensions of health systems’ functions were used based on the 2000 report of the World Health Organization. The countries were compared in dimensions of stewardship, resource production, financing, and service provision. Findings obtained from each country were presented separately in the comparative tables. The model used in this comparative study was based on the Beredy Model that contains four stages of description, interpretation, proximity, and comparison. In the present study, the purposive sampling method was used. The statistical population included rehabilitation systems globally, and the research examples were Iran, China, Turkey, India, the USA, Mexico, Germany, England, and South Africa. Criteria for entering the research according to the functional model of the World Health Organization were the availability of data and selecting at least one country from each continent of America, Europe, Asia, and Africa. Results: The findings showed that in Iran, the Welfare Organization was responsible for providing rehabilitation services for people with disabilities, while in other countries, it was the Ministry of Health. Also, to compare resource production, two staff training indicators and access to comprehensive national data were used. In all countries studied, the training of specialized human resources is done through the university system. Iran, India, and Mexico did not have full access to comprehensive national data, but the United States, Germany, China, South Africa, and Turkey provided the platform for planning and policy-making. Moreover, funding in Germany, the United States, China, and Turkey is mainly provided through the insurance system. In the United Kingdom, it is mainly provided through tax, but in Iran, it is provided through subsidies from the public revenues and taxes. Finally, besides the private sector, rehabilitation services in Iran’s public sector were provided incoherently by various organizations. Some of these organizations are the Ministry of Health and Medical Education, the Exceptional Education Organization, the Red Crescent, the State Welfare Organization, and the Martyrs and Veterans Affairs Foundation, while in other countries, these services are often provided through hospitals and the private sectors. Conclusion: Despite the numerous strengths in the system of providing rehabilitation services to the disabled in Iran, the integration of the rehabilitation sectors of various organizations within the Ministry of Health not only increases the inter-sectoral and intra-sectoral coordination, the coherence of management, and unified policy, but also leads to reduced costs, proper allocation of resources and increased financial resources in this sector. Besides, it leads to a reduction in overlapping tasks and responsibilities and prevention of duplication of work, training of specialized personnel based on the needs, and finally providing more desirable services. Therefore, policymakers and planners must review and reform the laws and processes to form a system for providing rehabilitation services to the disabled in Iran.

Provision of antiretroviral therapy (ART) is not an end in itself but a means to achieving improved wellness for people living with HIV. Rehabilitation, broadly defined, is another key contributor to wellness within this context. Understanding the potential for rehabilitation requires that one is able to consider HIV not only within a biomedical model that focuses on body systems, diagnoses and symptoms, but also within a rehabilitation framework that focuses on how these diagnoses and symptoms affect people’s lives more broadly. Furthermore, rehabilitation is a human rights imperative, which deserves the energetic attention enjoyed by other aspects of HIV treatment and care. In particular, the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is shining a long-overdue spotlight on the human rights imperatives associated with disability. For South Africa and other countries, proactively and meaningfully engaging rehabilitation in the HIV response will require major shifts on several fronts, including practice, education, policy and research. We argue that in settings where ART delivery is now widespread, HIV should be understood not only as a medical issue, but as a rehabilitation and disability concern. Whereas medicine adds years to life, it is rehabilitation that aims to add life to years.

Background: Glaucoma is a group of chronic diseases of the optic nerve that, if not managed effectively, could lead to blindness of many people worldwide. Non-adherence to medical treatments typically lead to burdensome consequences such as progressive visual loss and disabilities. Fortunately, literature reveals that with timed appropriate treatment, such blindness can be prevented. Thus, patients’ adherence to follow-up plays an important role in maintaining vision. However, glaucoma patients in Vhembe District still miss their follow-up appointments. Objective: This study sought to explore factors contributing to loss to follow-up as experienced by glaucoma patients in South Africa. Methods: Qualitative, explorative, and descriptive research designs, using qualitative methodology, were adopted. The population consisted of glaucoma patients who had been on antiglaucoma medications for three years and above. The purposive sampling method was used to select 18 participants for the study. Data were collected using a semi-structured interview using an interview guide. Participants were between the ages of 24 and 80 years. Tesch’s eight steps of qualitative data analysis were used. Measures to ensure trustworthiness and ethical issues were observed. Results: The study findings revealed that some of the patients did not understand glaucoma disease and the importance of follow-up. Financial constraints, traditional/religious belief, shortage of medications, and negative staff attitude were the most cited barriers contributing to loss to follow-up. Conclusion: Follow up adherence amongst glaucoma patients was negatively influenced by low disease knowledge. Therefore an improvement in patient education, transportation services, and clinic efficiency may strengthen follow-up visits.

Relative to other low and middle-income countries, South Africa provides a generous set of cash transfers (social grants) targeted at people with disabilities. This article explores the influence of disability-related grants on family practices and configurations, care arrangements and household composition in the Western Province of South Africa. The article draws on the findings of two studies: 1) an ethnographic study of disability grant recipients and applicants in a low-income Cape Town community and; 2) a study of interactions between healthcare staff, disability grant applicants and their families. Findings show that disability grant income is shared within households and the contribution of a stable income provides opportunities for people with disabilities to exercise agency, be seen as valuable household members and secure care and support from other household members. However, conflicts may arise over how income is shared and may lead to the extortion, abuse and neglect of people with disabilities, particularly in cases of severe disablement. Given the lack of adequate social provisioning for those who are able-bodied and unemployed, disability also becomes highly valued in households and the potential suspension or cancellation of a grant can interfere with adherence to treatment. The study emphasises the influence of policy structures and economic conditions on household dynamics and care outcomes and contributes to the sparse international evidence-base on the role that disability welfare benefits play in household dynamics and care outcomes.

Decolonization of research is nowhere more pressing than in post-apartheid South Africa, where cross-cultural encounters characterize every aspect of society. The health system plays a critical role in realizing the rights of marginalized populations, particularly rural communities and people with disabilities. However, cultural divides between service users and health care workers render health care provision unexpectedly complex. Such divides likewise obscure the meanings embedded in qualitative data, rendering research interpretations challenging. A study of the engagement between rural isiXhosa-speaking people with disabilities and primary health care workers was conducted by the first author, a White English-speaking female health care worker, in partnership with the second author, a Xhosa male research implementer. Ethnographic and narrative methods were used to create an embedded case study of 11 households of people with disabilities. Lessons on conducting ethical and culturally congruent research with this population are presented, important limitations in the qualitative paradigm raised, and alternative stances explored.

The article is devoted to the experience of social services in South Karelia (region of Finland) in respect of different types of urban support for disabled people in the areas of employment, housing and hobbies. The article describes the work of institutions providing assistance to people with disabilities and the services which are being provided by social service Eksote in Lappeenranta, Imatra and Parikkale. The article describes the work of centers round the clock monitoring and employment for the day, as well as the daily lives of people with Down syndrome, severe autism, intellectual disabilities. The attention is focused on the best practices in Finland, enabling the disabled child to engage in open employment. The article informs about the kinds of financial support for disabled people in Finland and assistance from the National Insurance Institute Kela, including the payment of rental housing. This article describes the features and differences of the centers around the clock care for people with disabilities in South Karelia: Houses “Petyayamyaki” and Private accommodation center “Villa of Karelia “for people requiring intensive care. The article describes the features of the day centers of employment for people with disabilities in Finland: the Center for Independent Living Support “Arttu” and Center “Valtsy.” According to the official position of the Government of Finland, persons with disabilities have the same rights as all other citizens of the country, and they have possibility to make decisions about their own lives. The Finnish system of medical and social rehabilitation of people with disabilities deserves the attention and replication in Russia.

Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.

Background Home Internet of Things (IoT) services and devices have the potential to aid older adults and people with disabilities in their living environments. IoT services and devices can also aid caregivers and health care providers in conveniently providing care to those in need. However, real-world data on the IoT needs of vulnerable people are lacking. Objective The objective of this study is to conduct a face-to-face survey on the demand for IoT services among older people and people with disabilities, their caregivers, and health care providers in a real-world setting and to see if there are any differences in the aspects of need. Methods We conducted a face-to-face survey with 500 participants between January 2019 and March 2019. A total of 300 vulnerable people (200 older adults aged ≥65 years and 100 physically disabled people aged 30-64 years) were randomly sampled from either a population-based, prospective cohort study of aging—the Aging Study of Pyeongchang Rural Area (ASPRA)—or from the outpatient clinics at the Asan Medical Center, Seoul, South Korea. Simultaneously, their caregivers (n=150) and health care providers (n=50) participated in the survey. Detailed socioeconomic status, digital literacy, health and physical function, and home IoT service needs were determined. Among all commercially available IoT services, 27 services were classified into five categories: emergency and security, safety, health care, convenience (information), and convenience (operation). The weighted-ranking method was used to rank the IoT needs in different groups. Results There were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. The home IoT service category that was required the most by the vulnerable groups and their caregivers was emergency and security. However, health care providers indicated that the safety category was most needed by the older adults and disabled people. Home IoT service requirements differed according to the different types of disabilities among the vulnerable groups. Participants with fewer disabilities were more willing to use IoT services than those with more disabilities. Conclusions Our survey study shows that there were discrepancies in the demand of IoT services among the vulnerable groups, their caregivers, and health care providers. IoT service requirements differed according to the various types of disabilities. Home IoT technology should be established by combining patients’ priorities and individualized functional assessments among vulnerable people. Trial Registration Clinical Research Information Service (CRIS; KCT0004157); https://tinyurl.com/r83eyva

Thesis (MCur)- -University of Stellenbosch, 2011
ENGLISH ABSTRACT: It generally is a problem for persons with disabilities to have barrier free access to buildings, which is their constitutional right. It is however, not only the physical facility that causes barriers for persons with disabilities but also the attitudes of the able-bodied persons. The aim of the study was to explore what opinions the nurses and persons with disabilities held in two healthcare settings in Kimberley with reference to the nursing care provided to persons with disabilities. To the researcher, it was important to gather the opinions of the nursing staff on how they saw persons with disabilities, but also to hear what they thought the problem areas in caring for persons with disabilities were. On the other hand, it was equally important to understand the persons with disabilities’ perceptions of the hospitals, nursing and what they saw as solutions to the problems. The objectives of the study were: • To determine what the opinions and knowledge of nurses working in two healthcare services in Kimberley are regarding the nursing management of persons with disabilities. • To determine what the opinions of persons with disabilities are in healthcare settings in Kimberley, with reference to the nursing care provided for persons with disabilities. Data was collected in two phases namely Phase 1 amongst the nursing staff in the private and state hospital in Kimberley and Phase 2 amongst the persons with disabilities. A list of staff members which was obtained from the Human Resource office in both the private and state hospitals were sent to the statistician Prof Kidd and who prepared a randomised list which was used for the participants in the study. The same process was followed when a list of all the people who are members of the Association for Persons with Disabilities (APD) and with the help of the statistician a randomised list was compiled from which the participants in the study were chosen. The design of this research is an explorative, descriptive non-experimental study with a quantitative approach, utilizing a structured questionnaire with closed and open ended questions. In this study it was found that the nursing staff was aware of the problems and barriers persons with disabilities encounter. The nurses, however, were aware of their own shortcomings. For example, the nurses identified the lack of training to equip them to assist the persons with disabilities during nursing care, while persons with disabilities also saw this as a problem. By addressing this shortcoming, nurses would be able to provide more holistic care. Recommendations were made based on the findings regarding the facility, perceptions, caregivers, procedures, doctors and the training of the nurses.
AFRIKAANSE OPSOMMING: Om toegang te hê tot geboue wat hulle grondwetlike reg is, is vir die meeste mense met gestremdhede ‘n voortdurende stryd. Dit is egter dikwels nie net die fisiese ontoeganklikheid van die geboue wat dit vir die persone met gestremdhede onmoontlik maak om ‘n normale lewe te lei nie, maar die houding van verpleegpersoneel wat dikwels meer ontoeganklik is as die toegang tot die geboue. Die doel van die studie was om te bepaal wat die opinies die verpleegpersoneel sowel as persone met gestremdhede het ivm gesondheidsorg in die privaat en staatshospitale in Kimberley Dit was vir die navorser belangrik om te bepaal hoe die verpleegpersoneel mense met gestremdhede sien, maar ook om hulle opinies te hoor ivm die probleme wat hulle ondervind sowel as moontlike oplossings daarvoor. Aan die ander kant wou die navorser ook weet wat die opinie van mense met gestremdhede is van die hospitale wat hulle besoek. Doelwitte van die studie was: • Om die kennis van verpleegpersoneel in die staat sowel as privaathospitale te bepaal ivm die versorging van persone met gestremdhede.. • .Om die opinies van persone met gestremdhede te bepaal tov die verpleegsorg in die staat sowel as privaathospitale in Kimbelrey. Data is in twee fases versamel. In Fase 1 was die verpleegpersoneel in beide die staat sowel as die privaathospitaal ingesluit en in Fase 2 was die deelname van die persone met gestremdhede verkry. Nadat ‘n personeellys van die Menlike hullpbronafdeling van beide hospitale verkry is, is dit aan die statistikus, Prof Kidd gestuur is vir steekproefneming. .Die persone met gestremdhede is genader nadat ‘n lys van die Assosiasie vir persone met gestremdheide (APD) verkry is. Die lys is deur die statistikus herrangskik,en die personeel en persone met gestremdhede is gevra om deel te neem aan die studie na aanleiding van die orde op die lys, nadat hulle ingligting ontvang het en toestemming geteken het vir deelname aan die studie. Die studie is eksploratief, beskrywend en nie-eksperimenteel van aard met ‘n kwantitatiewe benadering. Gestruktureerde vraelyse wat oop en geslote –einde vrae bevat het, is gebruik.. In die studie is bevind dat die verpleegpersoneel bewus was van die leemtes in die versorging van persone met gestremdhede. Een van die leemtes wat geïdentifiseer is, was dat verpleegsters nie formele opleiding ontvang in die versorging van persone met gestremdhede nie. Die persone met gestremdhede het ook hierdie leemte identifiseer. Deur hierdie leemte aan te spreek behoort verpleegpersoneel ‘n meer holistiese versorging aan persone met gestremdhede te lewer. Aanbevelings wat gemaak is, is gebasseer op die bevindinge in die studie en sluit in: fasiliteitt, persepsies, versorgers, prosedures, dokters en die opleiding van verpleegsters.

The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research methodology for this study comprised the following steps: Firstly, the demographics of the world and South Africa were researched. The concept of frail (long-term) care in the United States of America and New Zealand was investigated to determine what is available. The subsidisation concept of the South African Government towards caring for the elderly was also investigated. Secondly, a questionnaire was sent to the residents of five retirement complexes in George to determine their interest in such a plan. The records of the frail care unit that these residents utilise were analysed to determine the number of residents needing frail care. A comparative study of the cost of frail care in the Southern Cape was undertaken. Thirdly, two options to partly subsidise the cost of frail care were examined, where the first option covers the running cost, and the second option, subsidising one third of the frail care cost, builds up a sustainable fund after the first five year period. The funds of the second option can then be utilised in the subsequent years to increase the subsidisation portion of frail care cost. The final step of this study entailed the formulation of recommendations to implement the frail care nursing levy as soon as possible, with special attention given to the following: a) It must be compulsory for new residents to join the fund. b) A yearly capital amount of R100 000 or more is needed to sustain the fund. c) A contract must be drafted to set out all the rules and regulations to the residents. d) An attitude change amongst some residents is required. Individuals must realise that the success of this plan depends upon themselves and with the necessary support could make a significant contribution towards their own peace of mind if and when frail care is needed.

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: South Africa has transformed its mental health service provision from in-hospital care to community-based rehabilitation. Although the idea is sound, the process places the caregiving families under an immense pressure. The aim of this study was to explore the impact that the de-institutionalisation process has had on the families as they care for their child with intellectual disability. The study was conducted by means of qualitative, unstructured interviews with families that have had a child de-institutionalised from Alexandra Hospital in the Western Cape. All of the patients were diagnosed with a dual diagnosis of intellectual disability and mental illness. Even though the patients were in group-homes or attended a day care centre, final responsibility for the patients lay with the parents. Three main themes emerged from the interviews that describe the impact of deinstitutionalisation, viz. the characteristics of the family member with intellectual disability (aggressive, abusive and self-destructive behaviour of the patient), the effect that these characteristics had on the family (marital stress and health risks to the care giver), and community and resource factors. The study placed the family central to its environment and discussed the impact deinstitutionalisation had on its environment as a whole. It was concluded that the burden that de-institutionalisation places on the families far exceeded their ability to cope with these circumstances. This status quo could be improved if adequate resources and skills are given to families prior to de-institutional
AFRIKAANSE OPSOMMING: In Suid-Afrika is geestesgesondheidsorg van hospitaliserende na gemeenskapsgebaseerde rehabilitasie, omskep. Terwyl hierdie stap wel as lewensvatbaar mag voorkom, plaas die proses ‘n hewige las op die sorggewende gesin. Die doel van hierdie studie was om die omvang van die impak hiervan op ‘n gesin met ’n lid met intellektuele gestremdheid en psiegiatriese siekte, te bepaal – nadat so ‘n pasient uit die inrigting ontslaan is. Die ondersoek is uitgevoer by wyse van kwalitatiewe, ongestruktureerde onderhoude met gesinne wie se lede met die diagnose uitgeplaas is deur die Alexandra Hospitaal in die Wes-Kaap. Elkeen van die pasïente is gediagnoseer met ernstige intellektuele gestremdheid, asook bykomende gedragsafwykings. Ten spyte van die feit dat die betrokke pasïente deur groepshuise of dagsorg eenhede versorg word, bly hulle hul ouers se verantwoordelikheid. Drie temas het ontstaan wat die impak van ontslag uit die inrigting omskryf, te wete die karaktertrekke van die gestremde gesinslid (aggressie, misbruikende en vernielsugtige gedrag van die pasïent), die effek van hierdie karaktertrekke op die gesin (stres op die huwelik en potensiële gesondheidsrisiko wat dit vir die versorger inhou), en die gemeenskap en ondersteunende faktore. Tydens die ondersoek is die gesin sentraal geplaas ten opsigte van die omgewing. Die impak van ontslag van die gediagnoseerde pasïent uit die inrigting op die omgewing as geheel, word bespreek. Daar is tot die slotsom gekom dat die vermoë van die gesin wat die las moet dra as gevolg van die ontslag, ver oorspan word. Hierdie toedrag van sake sou egter verlig kon word indien toereikende hulpbronne en vaardighede aan sulke gesinne beskikbaar gestel word alvorens so ‘n pasïent ontslaan is.

Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy. Centre for Rehabilitation Studies))--Stellenbosch University, 2008.
Purpose To date no health policy analysis tool has been developed to analyse access and equity for people with disabilities. Further, there is very little information available on health and disability policy implementation. The intention of this research is to develop a health policy framework to analyse access and equity, focussing on people with disabilities, that can be used by policy makers. This research analyses four health policies and focuses on the facilitators and the implementation barriers. The findings of this research will impact on new policies developed in the future. Method The study included both a desk - top review and a descriptive study. The desk - top review entailed the formulation of a disability - focussed framework for health policy. This was then used to analyse health policies in terms of their disability inclusiveness. Qualitative data was gathered from interviews and questionnaires and focussed on policy processes and implementation. This was incorporated into the analysis. An ideal seven - step policy process model was developed. This was used to compare the reported policy process with the four policies followed. The four health policies used in the research are: the Primary Health Care Policy, the National Rehabilitation Policy, the Provision of Assistive Devices Guidelines and the Free Health Care Policy. Four key informants with extensive experience and knowledge were interviewed on policy processes and implementation. Questionnaires were also sent to Provincial Rehabilitation Managers to obtain their viewpoints on barriers and facilitators to policy implementation. Results Analysis of the four health policies showed varying levels of access and equity features. In terms of policy processes: all four policies had different stakeholders who initiated the policy development process. Two of the policies viz. the National Rehabilitation Policy and the Provision of Assistive Devices Guidelines, had people with disabilities as part of the stakeholder group involved in the policy formulation. The National Rehabilitation Policy had a comprehensive monitoring and evaluation section whereas this was absent in the other three policies. From the information gained from interviews and questionnaires, it appeared that the barriers to policy implementation included: attitudes, environmental access, human and financial resources. Facilitators to policy implementation include: policy process and design, availability of human and financial resources, support systems, management support, organisational structures and finally positive attitudes that all impacted favourably on policy implementation. Conclusions The developed health policy analysis framework served its purpose. Most policies did not have monitoring and evaluation guidelines that make implementation difficult to assess. Recommendations are made to improve policy design and content, specifically related to access and equity. Intersectoral collaboration and disability coordination needs to be improved. People with disabilities also need to engage with government departments, to monitor implemented policies and to advocate for change from outside the health system.

Thesis (BTech (Surface Design))--Cape Peninsula University of Technology, 2010
The purpose of this research is to generate a social outreach project by raising funds as well as getting sponsors to enhance the living environment at an institution for deaf girls. The focus is on Huis Soekie, a hostel which accommodates 17 deaf girls between the ages of 11 and 15. It is one of eight hostels situated at the De La Bat School for the Deaf in the rural town of Worcester. Frank Vodvarka and Joice Manice Malnar's work about Multi-Sensory design was used as inspiration to establish creative ways in which to enhance the living environment of institutionalized deaf girls. The living room of the hostel was chosen as focus area, since interaction among deaf people is important and the girls spend most of their time in it. To contribute to a more relaxing environment in this living room, secondary research was done on how nature together with the correct choice of colours can have a positive effect on humans' emotions. The living area of the hostel therefore has a central narrative and theme portraying nature as inspiration. All of the products that were designed for this space also incorporate elements of multi-sensory design. This type of design should be beneficial to the Deaf, because their other four senses are better developed than those of able people. This should also enhance their experience of the products.

Thesis (MPhil)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The implementation of eugenic policies reached its peak during the zo" century when thousands of people with intellectual disabilities and other "undesirable qualities" were involuntary sterilized. Although most of the eugenic policies have been removed, countries such as South Africa, still make legally provision for the involuntary sterilization of people with intellectual disabilities. Torbjërn Tannsjë (1998) used the "argument from autonomy" to argue that involuntary sterilization practices are wrong because it involves compulsion. According to him, society should never interfere with people's reproductive choices and people should never be required to qualify for the right to have children. The aim of this assignment was to systematically assess the "argument from autonomy" as far as the policy of involuntary sterilization of people with intellectual disabilities is concerned. To this end, the concept of autonomy and the principle of respect for autonomy are discussed and applied to the intellectually disabled. It is argued that autonomy and respect for autonomy are useful concepts to apply to some people with intellectual disabilities. These individuals should not be automatically assumed to be incompetent, but their competence needs to be determined on an individual level, with reference to the complexity of the decision to be made. Special effort is needed from health care professionals to obtain (where possible) informed consent from people with intellectual disabilities. The application of the principle of respect for autonomy to matters of reproduction leads to the conclusion that people with severe to profound levels of disability, are unable to provide informed consent for sexual intercourse. Therefore some form of paternalistic protection is needed for these individuals. People with mild to moderate intellectual disabilities who are however competent to consent to sexual intercourse should never be prohibited from procreation by means of involuntary sterilization. State interference in matters of reproduction should be limited to interventions where (i) children are seriously harmed by parents and (ii) to protect those who are incompetent to consent to sexual interactions with others. Apart from these exceptions, the intellectually disabled is entitled to the same procreative rights as all other citizens.
AFRIKAANSE OPSOMMING: Die implementering van eugenetiese beleid het gedurende die 20 ste eeu 'n hoogtepunt bereik met die onwillekeurige sterilisering van duisende persone met intellektuele gestremdhede en ander "ongewensde kwaliteite". Alhoewel meeste van die eugenetiese wetgewing verwyder is, maak lande soos Suid-Afrika steeds wetlik voorsiening vir die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Torbjërn Tannsjo (1998) maak gebruik van die "outonomie argument" om te argumenteer dat onwillekeurige sterilisasie praktyke onaanvaarbaar is omdat dit dwang bevat. Hy voer aan dat die samelewing nooit in die reproduktiewe keuses van mense behoort in te meng nie en dat dit nooit vir mense nodig moet wees om vir ouerskap te kwalifiseer nie. Die doel van hierdie werkstuk was om sistematies die "outonomie argument" te analiseer ten opsigte van die beleid van die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Met hierdie doel voor oë word die konsep outonomie en die beginsel van respek vir outonomie bespreek en toegepas op die intellektueel gestremde persoon. Daar word aangevoer dat outonomie en respek vir outonomie nuttige beginsels is om in ag te neem in kwessies rakende intellektueel gestremdes. Hierdie individue moet nie outomaties as onbevoeg beskou word nie, maar hul bevoegdheid moet eerder op 'n individuele basis beoordeel word, inaggeneem die kompleksiteit van die besluit wat geneem moet word. Voorts word daar van gesondheidsorgpersoneel verwag om moeite te doen met die verkryging van oorwoê toestemming (waar moontlik) by persone met intellektuele gestremdhede. Die toepassing van die beginsel van respek vir outonomie op aspekte rakende reproduksie, lei tot die gevolgtrekking dat persone met ernstige intellektuele gestremdhede nie in staat is om toestemming tot seksuele omgang te verleen nie. Dus, is 'n vorm van paternalistiese beskerming in hierdie gevalle aangedui. Persone met intellektuele gestremdhede wat egter wel bevoeg is om toestemming tot seksuele omgang te verleen, moet nooit weerhou word van voortplanting deur middel van onwillekeurige sterilisering nie. Inmenging deur die staat in kwessies rakende reproduksie moet beperk word tot intervensies waar (i) kinders ernstige skade berokken word en (ii) die beskerming van persone wat onbevoeg is om toestemming tot seksuele interaksies met ander te verleen, benodig word. Afgesien hiervan, is die intellektuele gestremde persoon geregtig op dieselfde reproduktiewe regte as alle ander landsburgers.

Die Dissertation beschäftigt sich mit den Vorstellungen von Krankheit, Behinderung und HIV/AIDS in KwaZulu-Natal, Südafrika. Besonderer Augenmerk liegt dabei auf den kulturellen Wurzeln und sozialen Repräsentationen von Behinderung und HIV/AIDS. Die Ergebnisse der Studie zeigen dass die sozialen Interpretationen von Beeinträchtigung erheblich dazu beitragen dass Menschen mit Behinderungen in KwaZulu-Natal einem hohen HIV-Ansteckungsrisiko ausgesetzt sind und gleichzeitig dafür sorgen dass diese Menschen kaum Zugang zu Aufklärung und medizinischer Versorgung haben. Die Studie geht bei der Analyse über den Blickwinkel Behinderung hinaus und beleuchtet südafrikanische Gesellschaftsverhältnisse auf makrokultureller, mikrokultureller und individueller Ebene. Die Studie schließt mit einem Ausblick auf Veränderungsmögichkeiten im südafrikanischen Kontext.
The study focuses on the interweaving patterns of stigmatisation between disability and HIV/AIDS in KwaZulu-Natal, South Africa. The study was designed to understand the cultural roots of non-medical representations of disability and HIV/AIDS. The results show strong evidence that the way in which people are prone to think about and respond to disability and HIV/AIDS exposes people with disability to a particularly high risk of infection while simultaneously decreasing access to treatment and care. While unfolding hidden meanings and notions about disability and HIV/AIDS, the study analyses both phenomena on a macrocultural, microcultural and individual level. The study concludes with key messages emerging from the empirical research as well as from historical and policy analysis. Through this, it attempts to provide some guidance for transformation.

The purpose of this study was to explore the views of adults with disabilities and their care providers with regard to extent to which health promotion implementation was facilitated within Protective Workshops across several service areas in South Africa. Quantitative and Qualitative Data was collected via a combination of data collection approaches that included the use of a descriptive survey, a self-administered questionnaire and a semi-structured interview. Structured questionnaires and an interview schedule were used to generate data from both the patient and care provider participants in each of the selected facilities. Participants with disabilities and care providers working in the Protective Workshops were identified and sampled through a multi-stage sampling procedure. Participants from 48 facilities participated in the study. The findings revealed that health promotion in Protective Workshops was cursory and informal. Even though health education was provided whenever the need arose, it was neither individualized nor customized in accordance with reasonable accommodation of people with disabilities. There were provincial differences in terms of the levels of participation and organizational support for people with disabilities. In certain cases bureaucratic obstacles were identified during field work. Results show inconsistency regarding access to equal opportunities for people with disabilities, albeit some agreed to a lesser extent (30.5%), others moderately (21.5%) compared to only 22.6% who agreed, were exceeded by 25% of respondents who completely disagreed to the notion that equal opportunities existed for people with disabilities. The latter was confirmed by care providers. The study recommended an urgent need for the development of inclusive health promotion, the enforcement of the requirements for reasonable accommodation and adherence to policy and legal imperatives.
Health Studies
D. Litt. et Phil. (Health Studies)

The purpose of this study was to investigate the possibility of implementing community based care for moderately mentally retarded persons in a specific centre in the Port Elizabeth area. The objectives of the study were to identify • the needs of the moderately mentally retarded children. • the physical, psychosocial and vocational rehabilitation means of meeting these needs. • how involved the communities, parents and government were in the care of moderately mentally retarded children. A quantitative, exploratmy and descriptive design was used. A sample of 50 moderately mentally retarded children was utilised. Data were collected by means of questionnaires and semi-structured interviews. The major research findings indicate that community care for MMRPs could only be feasible with sufficient resources, expertise and community involvement. All these aspects appeared to be lacking in the centre where this research was conducted raising questions as to benefits which the mentally retarded children and their parents and the community could derive from these services. However recommendations were made on identified shortcomings, problems and needs.
Health Science
M.A.(Nursing Science)

This chapter looks at the personal experience of a Neurologist in caring for people with Non-Epileptic Seizures (NES) and illustrates the profession’s shortcomings. Like every other patient who presents to a health care professional, people with NES want a clear diagnosis, with a detailed explanation of how and why they developed the condition, and a clear therapeutic plan. Although there are limits to the understanding of NES, that may also be said of all medical conditions. Since emotionally difficult, deeply personal experiences typically lie at the heart of their condition, people with NES need no less empathy and understanding than any other person with a medical condition. However, numerous patients have recounted stories about how they abandoned the medical profession for help with their seizures after their experience of seeing a neurologist. The amount of harm done by medical professionals in the way that they interact with people with NES has yet to be quantified.

Gender equality and information and communication technology are important in the achievement of the Millennium Development Goals (MDGs) in policy, planning, and practice. The 2000 Millennium Declaration of the United Nations (UN) formed an international agreement among member states to work toward the reduction of poverty and its effects by 2015 through eight Millennium Development Goals: 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and the empowerment of women 4. Reduce child and maternal mortality 5. Improve maternal health care 6. Combat HIV and AIDS, malaria, and other major diseases 7. Ensure environmental sustainability 8. Develop global partnership for development Progress toward gender equality and the empowerment of women is one goal that is important to achieving the others. Poverty, hunger, illiteracy, environmental threats, HIV and AIDS, and other health threats disproportionately affect the lives of women and their dependent children. Gender-sensitive ICT applications to education, health care, and local economies have helped communities progress toward the MDGs. ICT applications facilitate rural health-care workers’ access to medical expertise through phones and the Internet. Teachers expand learning resources through the Internet and satellite services, providing a greater knowledge base for learners. Small entrepreneurs with ICT access and training move their local business into world markets. ICT diffusion into world communication systems has been pervasive. Even some of the poorest economies in Africa show the fastest cell-phone growth, though Internet access and landline numbers are still low (International Telecommunications Union [ITU], 2003b). ICT access or a lack of it impacts participation, voice, and decision making in local, regional, and international communities. ICTs impact the systems that move or inhibit MDG progress. UN secretary general Kofi Annan explained the role of the MDGs in global affairs: Millennium Development Goals are too important to fail. For the international political system, they are the fulcrum on which development policy is based. For the billion-plus people living in extreme poverty, they represent the means to a productive life. For everyone on Earth, they are a linchpin to the quest for a more secure and peaceful world. (UN, 2005, p. 28) Annan also stressed the critical need for partnerships to facilitate technology training to enable information exchange and analysis (UN, 2005). ICT facilitates sharing lessons of success and failure, and progress evaluation of work in all the MDG target areas. Targets and indicators measuring progress were selected for all the MDGs. Gender equality and women’s empowerment are critical to the achievement of each other goal. Inadequate access to the basic human needs of clean water, food, education, health services, and environmental sustainability and the support of global partnership impacts great numbers of women. Therefore, the targets and indicators for Goal 3 address females in education, employment, and political participation. Progress toward the Goal 3 target to eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015, will be measured by the following indicators. • Ratio of girls to boys in primary, secondary, and tertiary education • Ratio of literate females to males who are 15- to 24-year-olds • Share of women in wage employment in the nonagricultural sector • Proportion of seats held by women in national parliaments (World Bank, 2003) Education is positively related to improved maternal and infant health, economic empowerment, and political participation (United Nations Development Program [UNDP], 2004; World Bank, 2003). Education systems in developing countries are beginning to offer or seek ways to provide ICT training as a basic skill and knowledge base. Proactive policy for gender equality in ICT access has not always accompanied the unprecedented ICT growth trend. Many civil-society representatives to the World Summit on the Information Society (WSIS) argue for ICT access to be considered a basic human right (Girard & Ó Soichrú, 2004; UN, 1948). ICT capability is considered a basic skill for education curriculum at tertiary, secondary, and even primary levels in developed regions. In developing regions, ICT access and capability are more limited but are still tightly woven into economic communication systems. ICTs minimize time and geography barriers. Two thirds of the world’s poor and illiterate are women (World Bank, 2003). Infant and maternal health are in chronic crisis for poor women. Where poverty is highest, HIV and AIDS are the largest and fastest growing health threat. Ninety-five percent of people living with HIV and AIDS are in developing countries, partly because of poor dissemination of information and medical treatment. Women are more vulnerable to infection than men. Culturally reinforced sexual practices have led to higher rates of HIV infection for women. Gender equality and the empowerment of women, starting with education, can help fight the spread of HIV, AIDS, and other major diseases. ICT can enhance health education through schools (World Bank). Some ICT developers, practitioners, and distributors have identified ways to incorporate gender inclusiveness into their policies and practice for problem-solving ICT applications toward each MDG target area. Yet ICT research, development, education, training, applications, and businesses remain male-dominated fields, with only the lesser skilled and salaried ICT labor force approaching gender equality. Successful integration of gender equality and ICT development policy has contributed to MDG progress through several projects in the developing regions. Notable examples are the South-African-based SchoolNet Africa and Bangladesh-based Grameen Bank Village Pay Phone. Both projects benefit from international public-private partnerships. These and similar models suggest the value and importance of linking gender equality and empowerment with global partnership for development, particularly in ICT. This article reports on developing efforts to coordinate the achievement of the MDGs with policy, plans, and practice for gender equality beyond the universal educational target, and with the expansion of ICT access and participation for women and men. The article examines the background and trends of MDG 3, to promote gender equality and the empowerment of women, with particular consideration of MDG 8, to develop global partnership for development, in ICT access and participation.