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ACCESSIBILITY AND UTILIZATION OF THE PRIMARY

HEALTH CARE SERVICES IN TSHWANE REGION.


BY: THEMBI PAULINA NTETA
STUDENT NUMBER: 200602978
SUPERVISOR: MATHILDA MOGATLE!NTHABU
CO!SUPERVISOR: DR OLUWAFEMI OGUNTIBE"U
T#$% D$%%&'()($*+ $% %,-.$((&/ $+ )00*'/)+0& 1$(# (#& '&2,$'&.&+(% 3*' (#& /&4'&& *3
MASTER OF PUBLIC HEALTH 5MPH6 )( (#& N)($*+)7 S0#**7 *3 P,-7$0 H&)7(#8
F)0,7(9 *3 H&)7(# S0$&+0&%8 U+$:&'%$(9 *3 L$.;*;*.
DECEMBER 2009
DEDICATION
This dissertation is dedicated to my beloved mom, my husband, my three sons Katlego,
Thabang and Mogomotsi, for their continued encouragement, support and love they
showed upon me.
i
ABSTRACT
B)0<4'*,+/
Primary Health Care is a basic mechanism that brings healthcare as close as possible to
the people. n !outh "frica, it is seen as a cost effective means of improving the health of
the population. t is provided free of charge by the government. This service should be
accessible to the population so as to meet the millennium health goals.
A$.%
The aims and ob#ectives of the study were:
To investigate whether Primary Health Care services were accessible to the
communities of Tshwane $egion.
To determine the utili%ation of the health care services in the three Community
Health Care centres of Tshwane $egion.
M&(#*/*7*49
&ata were collected at the three Community Health Care centres of Tshwane $egion
using self'administered (uestionnaires. " document review of the Community Health
Care centres records was conducted to investigate the utili%ation trends of services.
&escriptive statistics were used. The analysis was based on the information that was
elicited from the (uestionnaires that the people who utili%e the Community Health Care
centres of Tshwane $egion provided. The e)tracted data emanating from the records
from the three centres were also used.
R&%,7(%
The study demonstrated that in terms of distance, the Community Health Care centres of
Tshwane $egion are accessible as most participants lived within *+m. They traveled ,-
minutes or less to the clinic. The ta)i and wal+ing was the most common form used to
access the clinic. The services were utili%ed with the Tuberculosis clinic being the most
visited. .enerally, people were satisfied with the service and their health needs are met.
C*+07,%$*+
The Community Health Care centres of Tshwane $egion are accessible and utili%ed
effectively.
&9 1*'/%: Primary Health Care, accessibility, utili%ation.
ii
ACRONYMS
ACRONYM NAME IN FULL
PHC Primary Health Care
! " !outh "frica
&/H &epartment of Health
CHCs Community Health Centres
!T& !e)ually Transmitted &isease
H0 Human mmunodeficiency 0irus
"&! "c(uired mmune &eficiency !yndrome
T1 Tuberculosis
&/T! &irectly observed treatment service
"2C "ntenatal care
3P 3amily planning
P! Pap smear
0CT 0oluntary Counseling and Testing
"$0 "nti'$etroviral Treatment
$4PC $esearch 4thics and Publication Committee
M$4C Medical $esearch 4thics Committee
iii
T"154 /3 C/2T42T!
&4&C"T/2......................................................................................................................i
"1!T$"CT........................................................................................................................ii
"C$/26M!.....................................................................................................................iii
CH"PT4$ /24..................................................................................................................7
7.2T$/&8CT/2............................................................................................................7
7.7 ntroduction and bac+ground.........................................................................................7
7.9 !tatement of the problem...............................................................................................,
7., !ignificance of the study...............................................................................................:
7.: "im of the study............................................................................................................:
7.* /b#ectives......................................................................................................................:
7.; $esearch (uestions.........................................................................................................*
7.< &efinitions.....................................................................................................................*
7.<.7 Primary health care.....................................................................................................*
7.<.9 "ccessibility...............................................................................................................*
7.<., 8tili%ation...................................................................................................................;
7.= Conclusion.....................................................................................................................;
CH"PT4$ T>/.................................................................................................................=
9.5T4$"T8$4 $404>.................................................................................................=
9.7 ntroduction....................................................................................................................=
9.9 "ccessibility of the service ...........................................................................................?
9., 8tili%ation of the service..............................................................................................79
CH"PT4$ TH$44....................................................7;
,.M4TH/&/5/.6.........................................................................................................7;
,.7 !tudy design.................................................................................................................7;
,.9 !tudy setting................................................................................................................7;
,., !ampling and sampling method ..................................................................................7;
,.: &ata sources.................................................................................................................7<
,.* &ata collection.............................................................................................................7<
,.; &ata analysis................................................................................................................7=
,.< $eliability and validity of study..................................................................................7?
iv
,.= 5imitation of the study.................................................................................................7?
,.? 4thical considerations..................................................................................................7?
,.7- Conclusion.................................................................................................................9-
........................................................................................................................................97
CH"PT4$ 3/8$.............................................................................................................97
:.&"T" "2"56!! "2& 2T4$P$4T"T/2............................................................97
:.7 &ata analysis and interpretation...................................................................................97
:.9 &emographic information............................................................................................97
:.9.7 Participants...............................................................................................................97
Table :.7: &istributions of Participants, "ge against .ender.......................................99
3igure :.7: &istribution of "ge by .ender @nA9=*B......................................................99
:.9.9 "ge............................................................................................................................9,
:.9., .ender.......................................................................................................................9,
Table :.9: &istributions of !outh "frican citi%ens, "ge against .ender......................9:
:.9.: &istance....................................................................................................................9*
3igure :.9: Cross tabulation of &istance, .ender and "ge...........................................9*
:.9.* Traveling time ..........................................................................................................9;
3igure :.,: &istribution of traveling time .....................................................................9;
:.9.; Means of transport ...................................................................................................9<
Table :.,: &istribution of "ge and .ender by transport...............................................9<
:., Clinic information........................................................................................................9=
:.,.7 !ic+...........................................................................................................................9=
3igure :.:: !ic+ respondents..........................................................................................9=
:.: $easons for coming to the clinic.................................................................................9?
Table :.:: &istribution of utili%ation of chronic disease services.................................9?
:.:.7 &iabetes....................................................................................................................9?
:.:.9 Hypertension.............................................................................................................9?
:.:., Tuberculosis .............................................................................................................,-
:.:.: "sthma......................................................................................................................,-
:.:.* mmuni%ation ...........................................................................................................,7
3igure :.*: &istribution of immuni%ation among children C*yrs..................................,7
v
:.:.; 3amily planning........................................................................................................,9
3igure :.;: 3emales reporting to 3amily Planning .......................................................,9
:.:.< Pap smear .................................................................................................................,,
3igure :.< 3emales reporting for Cancer Test...............................................................,,
:.:.= "ntenatal care ..........................................................................................................,:
3igure :.=: 3emales using "ntenatal Care.....................................................................,:
:.:.? 0oluntary counseling and testing.............................................................................,;
Table :.*: &istribution of "ge, .ender and 0CT ........................................................,;
:.:.7- "nti'retroviral treatment ........................................................................................,<
Table :.;: "ge .ender "$0 Cross tabulation..............................................................,<
:.* 2umber of clinic utili%ation ........................................................................................,=
3igure :.?: &istribution of Clinic utili%ation ................................................................,=
:.; &octor or nurse ...........................................................................................................,?
Table :.<: &octor or 2urse............................................................................................,?
:.< $eferral........................................................................................................................:-
3igure :.7-: $eferral distribution..................................................................................:-
:.= Prescription and medicine issued.................................................................................:7
Table :.=: &istribution of prescription and medicine issued against age......................:7
:.=.7 Prescription issued....................................................................................................:7
:.=.9 Medicine issued........................................................................................................:7
:.? Health needs.................................................................................................................:9
3igure :.77: 3re(uency &istribution of Health 2eeds...................................................:9
Table :.?: &istribution of !ervice and /perational Hours ...........................................:,
:.7-.7 !ervice "vailability................................................................................................:,
:.7-.9 /perational hours....................................................................................................:,
......................................................................................................................................:,
:.77 $ecommendation and change ...................................................................................::
Table :.7-: &istribution of recommendation and change against age...........................::
Table :.77: The p' values for the accessibility of services ...........................................:*
CH"PT4$ 304...............................................................................................................:;
*.C/2C58!/2! "2& MP5C"T/2!.....................................................................:;
vi
*.7 !ummary of research findings.....................................................................................:;
*.9 &iscussion of summary................................................................................................:;
*.9.7 &emographic data.....................................................................................................:;
*.9.9 Clinic information.....................................................................................................:=
*.9., 8tili%ation of services at the three chcDs of Tshwane region....................................:?
*., 5imitations of the study...............................................................................................*-
*.: $ecommendations........................................................................................................*-
*.* Conclusion...................................................................................................................*7
;.$434$42C4!...............................................................................................................*9
<."224E8$4!................................................................................................................*;
"224E8$4 ": Fuestionnaire.........................................................................................*;
"224E8$4 1: &ipotso...................................................................................................;-
"224E8$4 C: &ata e)traction tool................................................................................;*
"224E8$4 &: nformed consent ........................................................;;
"224E8$4 4: 3oromo ya go neelana +a tetla...............................................................;<
"224E8$4 3: Permission letter from the &epartment of Health..................................;=
"224E8$4 .: Permission letter from Medunsa $esearch and 4thics Committee........;?
"224ET8$4 H: &ata collection confirmation sheet from !tan%a 1opape CHC...........<-
"224ET8$4 : &ata collection confirmation sheet from !oshanguve CHC.................<7
"224ET8$4 G: &ata collection confirmation sheet from 5adium CHC........................<9
vii
CHAPTER ONE
=. INTRODUCTION
=.= I+('*/,0($*+ )+/ -)0<4'*,+/
Primary Health Care @PHCB is being adopted as a basic mechanism for the provision of
health care in !outh "frica @!"B. t is delivered through the &istrict Health !ystem. The
government is the main service provider of PHC. This system brings healthcare as close
as possible to where people live and wor+ and it constitutes the first element of a
continuing health care process. t was formally introduced in !". in "pril 7??: @!"
&epartment of Health 9--7, p.<B.
The nternational Conference on Primary Health Care at "lma'"ta, Ka%a+hstan @8!!$B
on the 79th !ept 7?<= was organi%ed in response to widespread dissatisfaction with
e)isting health care services. t was at this Conference that a declaration was made that
the main social target of governments, international organi%ations and the whole world
community in the coming decades should be the attainment of a level of health that will
permit all people to lead a socially and economically productive life by the year 9---.
Primary health care was seen as the +ey to attaining this target. 4ach country was to
formulate national policies, strategies and plans of action to sustain PHC as part of a
comprehensive national health system @Hall H Taylor 9--,, p.7<B.
n addressing the previous legacy of apartheid in the health sector and in accordance with
its recognition of fundamental human rights, the !outh "frican Constitution has, in
!ection 9< @7B@aB included the right of access to health care services. The principle of
1atho'Pele @people firstB was introduced. This principle governs public service delivery
and promotes access to decent public services. "lso the 2ational PatientsD $ights Charter
that is aimed at improving the (uality of health care facilities was adopted in 9---. The
7
implementation of PatientsD Complaints Procedures also helps to improve the service
@Pillay 9--9, p.7B.
The new !outh "frican health system adopted the PHC approach because it was seen as
the most effective and cost effective means of improving the populationDs health.
Preventive care conse(uently leads to less costly medical care @Pillay 9--,, p.;B.
" comprehensive PHC service pac+age was developed in !eptember 9--7 by the !outh
"frican &epartment of Health @&/HB. The purpose of this pac+age, in the perspective of
e(uity, was to define comprehensive PHC services, which within a period of *yrs
following implementation, will be common to the whole country. "n integrated pac+age
of essential PHC services made available to the entire population will provide a solid
foundation for a single unified health system. This pac+age would contribute to greater
social #ustice and promote e(uity by reducing the gap between those who have access to
an appropriate level of care and those who do not. t also acts as guidance for provincial
and district health authorities on how to provide these services, to assist them to assess
the unmet needs of their population, and draw up plans to bring services up to national
standards. The overall ob#ective was to improve access to high (uality effective care, to
reduce ine(ualities between the PHC services and to help meet the millennium health
goals. The services that should be provided include: immuni%ation, mother and child care
services, antenatal and postnatal care including family planning, se)ually transmitted
disease, treatment of minor ailments and curative services, mental health, school health
services @early detection, correction and prevention of diseases from which school aged
children can sufferB, treatment of chronic disease, e.g. hypertension and diabetes,
treatment of communicable diseases, e.g. tuberculosis and H0I"&!, oral health,
rehabilitative services and provision of essential drugs. " clinic should render a
comprehensive integrated PHC service using a one'stop approach for at least eight hours
a day, five days a wee+ @!" &epartment of Health 9--7, p.77B.
n 7??:, two policies were implemented, namely J3ree health for pregnant mothers and
children under the age of ; yearsD and J8niversal access to PHC for all !outh "fricans.D
9
n this regard, the emphasis was on the improvement and development of clinics and
essential health care programmes, li+e mother and child health care, nutrition, e)panded
immuni%ation and management of communicable diseases. The introduction of the
Termination of Pregnancy "ct 2o ?9 of 7??; provided women with the legal freedom of
reproductive choices @!" &/H. PHC Progress $eport 9---, p.,B.
"ccording to the &epartment of Health, by 9--9, over :-- clinics in !outh "frica were
constructed and upgraded. This helped to improve the utili%ation rate of the primary
health care services as communities now travel shorter distances to health care services,
although there is shortage of e(uipment, staff and essential drugs @Pillay 9--,, p.7<B.
n 9--,, .auteng Province had =;K of facilities that open for five days or more per
wee+, with a small percentage @*KB of the primary health care services providing 9:'hour
services. This is because the distribution of the population is clustered in big cities where
hospitals provide emergency services for a number of neighbouring clinics @Pillay 9--,,
p.7=B. &espite positive measures, there were still significant numbers of people in !.".
who do not have ade(uate access to health care services due to geographical, physical,
population growth and language barriers @Pillay 9--,, p.7,B. Health care'system barriers
that were identified include long waiting periods, unfriendly and uncaring behaviour on
the part of health wor+ers and poor health facilities. This resulted in patients with minor
ailments trying self'care. t also had an impact on preventive and chronic disease
treatment, and people defaulting on their follow'up appointments @$ispel et al.,7??;,
p.77:B.
=.2 S()(&.&+( *3 (#& ;'*-7&.
" study by $ispel et al. @7??;B has indicated that our Primary Health Care services were
e)periencing the following problems:
' overcrowding
' long waiting times
' lac+ of resources, e.g. medication. @$ispel et al., 7??;: p.77,B.
,
&espite positive measures of adopting a &istrict Health !ystem, health services have
remained inaccessible in some respects, and have therefore affected utili%ation. @Pillay
9--,, p.7,B.
=.> S$4+$3$0)+0& *3 (#& %(,/9
The problems of overcrowding, long waiting times and lac+ of resources li+e medication
that impacted the utili%ation of primary health care services in !outh "frica has been
identified before by the study of $ispel et al., 7??;, p.77:
This study is important to investigate whether the primary health care services in
Tshwane $egion are accessible and being utili%ed by the communities of Tshwane
$egion. The findings will be communicated to the !outh "frican &epartment of Health.
The insights gained will help to improve the primary health care service delivery.
=.? A$. *3 (#& %(,/9
The study aims at assessing the accessibility and rate of utili%ation of the Community
Health Centres @CHCsB of Tshwane $egion.
=.@ O-A&0($:&%
To investigate whether the PHC services are accessible to the communities of
Tshwane $egion.
To determine primary health care services utili%ation in the three CHCs of
Tshwane $egion.
:
=.6 R&%&)'0# 2,&%($*+%
"re PHC services at the Tshwane $egion accessibleL
>hat is the e)tent of utili%ation of these services by the communities in this areaL
=.7 D&3$+$($*+%
=.7.= P'$.)'9 #&)7(# 0)'&
Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible to individuals
and families in the community, through their full participation, and at the cost that the
community and the country can afford to maintain at every stage of their development, in
the spirit of self'reliance and self'determination. t forms an integral part both of the
countryMs health system, of which it is the central function and main focus, and the overall
social and economic development of the community. t is the first level of contact of
individuals, the family and the community with the national health system, bringing
health care as close as possible to where the people live and wor+, and constitutes the
first element of a continuing health care process @Hall H Taylor 9--,, p.7=B.
=.7.2 A00&%%$-$7$(9

n general terms, NaccessO means the ability to get care or the ease of getting care
Penchans+y @9--7, p.7B e)plained that access to health services must capture the
relationships between supplyIsuppliers and demandIdemanders in the following five
dimensions:
=. A:)$7)-$7$(9 P the (uantity and types of population needs relative to the volume and
type of e)isting services.
*
2. A00&%%$-$7$(9 P the relationship between the location of supply and the location of
users, ta+ing into account the user transportation resources and travel time, distance and
cost.
"ccording to the Comprehensive Primary Health Care !ervice Pac+age for !outh "frica
@9--7B, geographical accessibility means that the distance, traveling time and means of
transport must be acceptable to the community. "ccess is measured by the population of
people living within *+m of a clinic.
>. A00*..*/)($*+ P the way resources are organi%ed for entry P hours of operation,
waiting time, scheduling systems, wal+'in facilities and the e)isting clientDs ability to be
accommodated by these.
?. A33*'/)-$7$(9 P the resources @income, health benefitsB for purchasing care related to
the price I cost of the supply.
@. A00&;()-$7$(9 P the socialIcultural concerns P attitudes on religion, gender, race,
neighbourhood, tribe P of patients and providers as they relate to the attributes of each
other. t is believed that all these factors affect supply and demand and have influence on
utili%ation of health services @Penchans+y, 9--7, p.7B.
=.7.> U($7$B)($*+
This provides the +nowledge of whether the available services are being used.
=.8 C*+07,%$*+
Two factors will be assessed. These include the accessibility and utili%ation of the
services within the community.

;
CA00&%%$-$7$(9D:
This will involve loo+ing at the e)isting services and resources relative to (uantity
of need or demand @availabilityB.
How far do people travel to the clinic @distanceB, travel time and cost of travelL
"re the services within wal+ing distance or are people compelled to use different
modes of transport to reach the serviceL
The organi%ation of the healthcare system as it relates to the ease with which
people can use care @waiting time and the length of waiting time for an
appointmentB.
CU($7$B)($*+D P if the different services provided are being utili%ed.
f the Primary Health Care services provide efficient care, it is presumed that the health
of the community will be improved.
<
CHAPTER TWO
2. LITERATURE REVIEW
2.= I+('*/,0($*+
n 7?<<, the >orld Health "ssembly concluded that globally, governments and
communities should wor+ towards the attainment of a level of health for all peoples of
the world that would permit them to lead a socially and economically productive life.
This was later +nown as Jhealth for allD. The nternational Conference on Primary Health
Care @PHCB held at "lma'"ta in 7?<= defined PHC @>H/I82C43, 7?<=B and was seen
as the vehicle to achieving Jhealth for allD. PHC in sub'!aharan "frica was seen not as a
level of service provision, but as an overall health strategy. @Chatora HTumusime 9--:,
p. 9?;B.
"ccording to literature @Tarimo H >ebster 7??;Q $ispel et al.,7??;Q Pillay 9--,Q Chatora
H Tumusime 9--:B, since its adoption @PHCB, the health status of the world population
has improved as indicated by lower mortality rates in most countries. 4pidemiologically,
childhood diseases, such as poliomyelitis, measles, tetanus and pertussis have decreased
owing to rapid e)pansion of immuni%ation programmes. There is overall decline in infant
and child mortality.
n the report written by The Health &epartment in 9---, it stated that: !outh "frica
would enter the new millennium with one of the challenges being to provide good (uality
integrated health care to all !outh "fricans. t was declared that PHC be delivered
through the &istrict Health !ystem in order to achieve this goal. @&epartment of Health.
Primary Health Care Progress $eport 9---, p.,B.
=
PHC was seen as the +ey element in the plan to transform the health services. The >hite
Paper on Health specifically recogni%es that services must be accessible to the ma#ority
of the population @Pillay 9--,, p.7-B.
3or the purpose of this study, the literature review will focus on two main areas, namely
accessibility of the service and utili%ation of the service.
2.2 A00&%%$-$7$(9 *3 (#& %&':$0&
t is reported that access to basic health services was affirmed as a fundamental human
right by the &eclaration of "lma'"ta in 7?<=. The >orld Health /rgani%ation @>H/B
stated that access to health is everybodyDs right and that the ethical basis of any countryDs
health policy should be NHealth for allO @Hall H Taylor 9--,, p.7<B.
Chatora and Tumusime @9--:, p. 9??B indicated that in some countries in sub'!aharan
"frica, health centres should be set up so that each serves *--- to 7- --- people, or such
that those in the catchment area would not to travel more than = +m or one hour travel
time to reach the nearest facility.
There were significant disparities in access to primary care in >ashington by population
and geography. n a study that was done in 9--- by the >ashington !tate &epartment of
Health, =;K of >ashington residents reported that they had a usual place to receive
primary care. 1arriers to access included language, culture, geography, weather and lac+
of affordable public transportation, including medical transportation services. This
inade(uate access to health care contributed to an estimated *: --- unnecessary
hospitali%ations in 7???. >ith respect to geographic access, rural populations can be
isolated by weather'related closures and long distances to health care services. n urban
areas, traffic congestion and comple) public transport routings can be barriers to care.
Many "merican ndian Health !ervice facilities provide coverage only during wee+days.
People see+ing for care after hours and during wee+ends must turn to the private sector
@>ashington !tate &epartment of Health 9--9, p.7B.
?
n the 8K, 7=K of teenagers stated that they were not aware of their local PHC clinic.
Those who were aware indicated that the main barriers to accessing PHC were perceived
lac+ of confidentiality, embarrassment and unsympathetic staff @.leeson H $obinson
9--9, p.7=;B.
Rambia also suffers from inaccessibility of health services when it comes to the distance
to the nearest health care provider. ndividuals living in rural areas have appro)imately
<.?* +m to the nearest PHC facility, while individuals living in urban areas only have to
travel between 7.:; +m and ,.7= +m to reach a PHC facility. t is stated that *;K of
households in rural areas perceived distance as a big problem, including poor
infrastructure and lac+ of transport. The poor are much less li+ely to see+ health care
when ill than non'poor individuals. Cost of access is also a barrier to PHC service use
@H#ortsberg H Mwi+isa 9--9, p.<,B.
Hall and Taylor @9--,, p.7=B reported that in the 7?;-s and 7?<-s, China, Tan%ania,
!udan and 0ene%uela initiated successful programmes to deliver a basic but
comprehensive programme of PHC services. However, a problem of poor accessibility of
health services still occurred, especially in poor populations.
" few studies @&oherty et al.,7??;Q Pillay, 9--,Q Tlebere et al., 9--<B conducted in !outh
"frica regarding accessibility of health services indicated transport, distance to services
and money needed for travel to services as the biggest problems. The negative attitude of
nurses was also stated as a barrier. t has been observed that large numbers of people
remain with no access to essential health care, even in developed countries and it is
believed that access to essential health care can be achieved when facilitators e)ceed
barriers @Penchans+y, 9--7, p.*B.
4(uity and access to health care were declared as the fundamental principles that were to
strengthen the transformation of health services in !outh "frica. The government
formulated norms and standards for health clinics so that all citi%ens should have e(ual
7-
access to health irrespective of geographical area @The PHC pac+age for !outh "frica
9--7, p.9B. t is suggested that PHC services should be accessible closest to where
people live. n !outh "frica, it should be within * +m. The doctor and other speciali%ed
professionals should be accessible for consultation, for support, referral and provide
periodic visits. t should provide a multipurpose service.
.overnance, technology and transport combined with community partnership, hold the
+ey to ma+ing this vision a reality @The PHC pac+age for !outh "frica, 9--7, p.79B.
n 7??;, PHC services became free of charge for every !outh "frican and this helped to
eliminate the cost of health care services as a barrier to access. There was an escalation of
attendance in services, li+e antenatal care, family planning and immuni%ation @Pillay,
9--,, p.7*B.
The survey conducted by Pillay @9--,B in KwaRulu'2atal, !outh "frica showed that
there was an increase in access to services, li+e antenatal care, from *-.*K in 7??= to
*?.,K in 9---. "ccess to care of tuberculosis @T1B and se)ually transmitted diseases
@!T&sB and the treatment for each disease increased marginally by less than 9K since
7??= @Pillay, 9--,, p.7=B. Magnani et al. @7??;, p.*;?B conducted a study in which
access to health services was defined in terms of geographical pro)imity, i.e. * +m
and

* +m. t was revealed that there was an increased percentage usage of maternal and
child care services. >omen who reside near the health care services were more li+ely to
receive antenatal care services in connection with their most recent births. Children were
more li+ely to be immuni%ed and to have a health card and those with recent episodes of
diarrhea were referred to a health wor+er more often than children in far places.
" study conducted in KwaRulu'2atal, !outh "frica, by Tanser et al. @9--;B indicated
that, in accessing health care facilities, people often wal+ed to service centres. t was
indicated that about ;-.=K of people wal+ed to clinics in order to access to health
services, C ,=.=K reported using some form of public transport and few reported using
their own vehicle. The average travel time was 7 hour to attend a clinic.
77
t is currently estimated that 9,K of !outh "fricans @and even fewer blac+ !outh
"fricansB have access to the private health care sector on a regular basis due to advanced
health care in the private sector and a large proportion of the population have to access
public sector facilities @&oherty et al., 7??;, p.,?*B.
2.> U($7$B)($*+ *3 (#& %&':$0&
Penchans+y @9--7, p.9B, revealed that utili%ation of services can be influenced by several
factors, such as availability, accommodation and acceptability, where acceptability in
turn influences utili%ation as much as it influences satisfaction.

5i @9--,, p.,B claimed that Hong Kong provides a PHC service for a fi)ed number of
patients on a daily basis and is often clogged up with patients with chronic illnesses who
need a refill of their medication. Most of these clinics are closed during public holidays
and none are open 9: hours a day. /nly a few of those clinics are staffed with a (ualified
family physician.
!T& services, in most countries li+e the 8nited Kingdom @8KB, are not utili%ed properly
because the group designed to use them are mostly adolescents and young adults. " study
conducted in Maryland, 8!", by .leeson and $obinson @9--9, p.7=<B showed that
young adults @77'97yearsB are at high ris+ of !T&, but were reluctant in going to the
service because they were concerned about the confidentiality of the service. They also
felt uncomfortable with discussing se)uality, and especially when they were
accompanied by parents, the youth was <9K less li+ely to have a discussion about se).
n 9--9, the 2amibian government reported disparities between the patterns of utili%ation
of the services and allocation of staff where the poorer localities were relatively
underprovided. 8tili%ation of services in >indhoe+ was said to be satisfactory as people
travelled shorter distances to the clinic and the poor were e)empted from user fees. 5ac+
79
of staff and long waiting periods were found to be deterrents in using the nearest clinics
@1ell et al., 9--9, p.;<=B.
" study by Chatora and Tumusime @9--:, p.,-9B that reviewed the implementation of
PHC in sub'!aharan countries, indicated that child immuni%ation coverage has increased
remar+ably in most countries, with almost two'thirds of all children less than 7 year
being immuni%ed.
mmuni%ation programmes have improved accessibility to immuni%ation through
increased public education on the value of PHC. $egarding the H0I"&! strategy,
success has been variable. The control of communicable diseases, for e)ample @T1B using
&/T!, have also shown improvement. . @Chatora HTumusime 9--:, p. ,-9B.

t is said that immuni%ation coverage in most parts of 2igeria remains low and this
contributes to high morbidity and mortality among children due to the poor transportation
system, ineffective cold chain, shortages of trained manpower and inade(uate community
support and involvement @"%ubui+e H 4hiri, 7??=, p.,;,B. t has been noted that over
*-K of the sub'!aharan "frican population do not have regular access to the most basic
essential drugs.
Malison et al. @7?=<B, in a study to estimate childhood morbidity and mortality and the
utili%ation of health care services in Mbale &istrict, 8ganda, observed that high rates of
mortality and low levels of utili%ation of PHC services were found despite easy access to
the health facilities. This is related to a variety of constraints, for instance, severely
limited budgets, shortages of supplies, unmet training needs and lac+ of transportation,
which limit the effective delivery of health services, even to those who live in the
immediate vicinity of health facilities. t was also reported that there was underutili%ation
of preventive health services among households in immediate vicinity of e)isting health
facilities. 1asic PHC services, li+e immuni%ation and treatment of diarrhea were poorly
utili%ed, even in the homes very close to a health facility. This survey showed the need to
7,
improve the utili%ation of health services among populations who already have easy
access to health facilities.
t has been reported that geographical accessibility of health services has a direct bearing
on utili%ation of services. &istance to a facility has been associated with increasing
maternal and infant mortality, decreased vaccination coverage and decreased
contraceptive use. mproving geographical access to PHC can help to improve these
adverse health outcomes @Tanser et al., 9--;, p.;?9B.
"ccording to Tlebere et al. @9--<, p.,:;B, transportation and distance were the biggest
hindrancesB to utili%ation of services, particularly in rural areas. " lac+ of financial
resources for transport was the barrier most often cited by women who did not attend
antenatal care. These factors include limited financial resources, influence of family
members, family responsibilities, women not reali%ing they are pregnant and difficulty in
obtaining time off from wor+. >ith regard to barriers to utili%ation of child health
services, the following factors were stated: socioeconomic constraints @no money for
transport to a facilityB , beliefs about causes of illness @witchcraftB, lac+ of awareness of
danger signs @several mothers stated that they did not reali%e the seriousness of the childDs
condition and therefore delayed see+ing careB, poor (uality of care @improper diagnosis
and treatmentB and the role of traditional healers @several caregivers reported consulting a
traditional healer if their infantDs condition did not improve following care at a clinic or
hospital or if clinic was out of stoc+ of relevant drugsB. @Tlebere et al., 9--<, p.,:;B.
t has been shown that anti'retroviral service in !outh "frica is not utili%ed because of
stigmaQ health wor+ers negative behavior, and people were re(uired to travel to a health
facility fre(uently to collect their medication @Pari+h H 0eenstra, 9--=, p.:;=B.
"fter removing user fees on attendance of PHC, attendance for curative services
increased but subse(uent clinic congestion and reduced consultation times may have
discouraged some women from attending antenatal clinic and bringing their children for
growth monitoring and immuni%ation. " large sustained increase in health service
7:
utili%ation has been reported throughout !outh "frica @>il+inson et al., 9--7, p.;;<B.
Pillay @9--,, p.7<B stated that by 9--9, over :-- clinics in !outh "frica were constructed
and upgraded. This has helped to improve the utili%ation rate of the primary health care
services as communities now travel shorter distances to health care services, although
there is shortage of e(uipment, staff and essential drugs. There have been reports that
utili%ation rates were uneven across services, e.g. antenatal care services being the most
utili%ed service @$ispel, 7??;, p.77,B.
&oherty et al. @7??;, p,?;B stated that the location of clinics affects utili%ation. 3or
instance, if clinics are located far away from the people, persons in need these clinics
may not utili%e them, especially for services that appear less urgent @such as preventive
care, the treatment of mild illness or collection of medication for chronic diseaseB. !uch
location may cause the neglect of mild and chronic conditions and the avoidance of
preventive care which may have serious conse(uences in terms of ill health and the
eventual cost of treatment for both the individual and the community.
" survey has shown that the utili%ation of services in .auteng region has increased,
although it differs according to the type of service. The antenatal clinic, immuni%ation
and family planning are the most utili%ed services. The service for chronic illness differs
from one area to another @!outh "frican 2ational Primary Health Care 3acilities !urvey,
9--,, p.7=B.
.rowth in utili%ation of Primary Health Care services in Tshwane $egion has been
reported to have increased by :,K in 9--9. This could be e)plained by the
implementation of the district health minimum data set and hence improved reporting,
but it also shows improved confidence in the clinic system. The increase in PHC
utili%ation has resulted in the reduction of the utili%ation of hospital outpatient
departments @!outh "frican &epartment of Health $eport on performance of the delivery
of services, 9--9, p.7;B.
7*
CHAPTER THREE
>. METHODOLOGY
>.= S(,/9 /&%$4+
The study will employ a cross'sectional, descriptive survey design where self'
administered (uestionnaires will be used to assess accessibility of services, and a
document review of community health centresD records @register boo+ or electronic
monthly statisticsB will be chec+ed to investigate utili%ation trends of services.
>.2 S(,/9 %&(($+4
The study was conducted at three Community Health Centres of Tshwane $egion
because they are open for 9: hours and provide all PHC services. They are all provincial
clinics. They are:
!oshanguve CHC is situated in the 2orthern side of Tshwane. The population is
reported to be ,7- ---, mainly 1lac+s of low to middle socio'economic
status.
!tan%a 1opape CHC is situated in the Central part of Tshwane. The population is
reported to be 9*; ---, mainly 1lac+s of low to middle socio'economic
status.
5audium CHC is in the !outhern part of Tshwane. The population is reported to
be 9- ---, mainly ndians of middle to high socio'economic status.
@!tatistics ! " 9--<, p.7B.
>.> S).;7$+4 )+/ %).;7$+4 .&(#*/
7;
" probability sampling method @a simple random samplingB techni(ue was used for
sampling. n this techni(ue, all persons attending the clinic had an e(ual chance of being
selected for the study. 8sing the register of the people who registered to utili%e the clinic
that day, 7-- were sampled at each CHC. The CHCDs see S *-- people per day on
average and 7-- of them @9-KB were given (uestionnaires. The 3ishbowl techni(ue was
used @placing numbers in a container and drawing out the numbers one at a timeB. The
following steps were followed:
" number was written from the sampling list, on a separate slip of paper.
The slips were put into the containerIfishbowl.
The slip was drawn, the number noted, the slip replaced, the bowl sha+en and the
second one selected and so on until the re(uired number @7--B was reached.
@1rin+ 9--,, p.7,;B.
>.? D)() %*,'0&%
3or the survey, any patient that came to the clinic between <am and :pm, and who gave
consent for the (uestionnaire would be included in the study. The researcher would stay
at the clinic between <am and :pm.
Computeri%ed demographic and medical records of people who utili%ed the clinic from
-7 /ctober 9--< to ,7 May 9--= were e)amined. Monthly statistics of utili%ation of
different services were captured.
>.@ D)() 0*77&0($*+
Two methods of data collection were used. 3irstly, a self administered (uestionnaire was
used for collection of (uantitative data. The (uestionnaire was divided into two sections:
the demographic data and the clinic information data.
7<
!elf'administered (uestionnaires were given randomly to people who utili%ed the clinic
that day. The CHCs see *-- people per day on average and 7-- people @9-KB were
given (uestionnaires. !econdly, a data e)traction tool was used for scoring information
regarding utili%ation of services at the three CHCs for a period of eight months, i.e. -7
/ctober 9--< P ,7 May 9--=. The register boo+ or electronic monthly statistics records
were loo+ed at using the data e)traction tool to obtain the following information:
!taff component
8tili%ation trends by:
"ge i.e. total number of people C *yrs, 7;P9*yrs, 9;',*yrs, ,;':*yrs H
T:*yrs.
2umber of patients seen by nurse per day.
2umber of patients seen by doctor per day
Total number of patients seen at the CHC for that month.
Total number of patients who utili%ed:
Curative service @child health and minor ailmentsB
!e)ually transmitted diseases
mmuni%ation
Preventive service @antenatal care, family planning and pap smearB.
H0 @0CT and "$0B.
Chronic diseases @hypertension, diabetes and asthmaB.
$eferrals @to the doctor, hospital or speciali%ed servicesB.
Pharmacy @items being usedB.
>.6 D)() )+)79%$%
&escriptive statistics were used to analy%e the data in this study. The analysis was based
on completed (uestionnaires and e)tracted data emanating from records at the three
centres. n analy%ing the data, an assessment of the monthly data on clinic attendance and
utili%ation was conducted. &ata were imported into !!P! software. "nalysis included
7=
fre(uency distributions of different types of services utili%ed, demonstrated by pie charts,
bar charts and tables.
>.7 R&7$)-$7$(9 )+/ :)7$/$(9 *3 %(,/9
" pilot study @small'scale version run of the ma#or studyB was done to test the instrument.
1y doing a pilot study, feasibility of the study was investigated @the validity of the
measuring tools and the acceptability of the study to the study populationB so that any
problems could be identified early and information may be obtained for improvement.
The (uestionnaire was handed out to a small group of people @tenB at one of the CHCs.
The findings of the pilot study helped the researcher to remove (uestions that were
vague.
>.8 L$.$()($*+ *3 (#& %(,/9
1ecause of time and financial constraints, it was not possible for the researcher to
conduct surveys on all the clinics in Tshwane region, i.e. 9= 5ocal "uthority Clinics and
nine Provincial Clinics. The researcher selected the three Community Health Centres
because they are open for 9: hours and provide all the Primary Health Care services.
>.9 E(#$0)7 0*+%$/&')($*+%
The proposal was submitted to the following committees for ethical clearance:
The !chool of Public Health, $esearch, 4thics and Publications Committee
@$4PCB H
Medical $esearch, 4thics Committee @M$4CB, !chool of Public Health,
8niversity of 5impopo @Medunsa CampusB.
7?
"lso because the study involves using self'administered (uestionnaire, informed consent
was obtained from study participants. Participants were given information to enable them
to ma+e decisions to either participate in the study or not. The benefit of ta+ing part in the
study was e)plained in the informed consent document, i.e. to improve the (uality of
health care services. Participants were assured that their identity would remain
anonymous and that all the discussions would be held confidential.
Participants were e)pected to have read and understood the content and the purpose of
the study before participating. Consent forms and (uestionnaires were in both 4nglish
and !etswana to address language barriers. "lso clinic records were reviewed. !ources of
information were ac+nowledged and official permission to use clinics was obtained from
the &epartment of Health. "ll records were +ept confidential and used solely for the
purpose of the study.
>.=0 C*+07,%$*+
" (uantitative and descriptive research approach was adopted by using a (uestionnaire to
elicit information from people who utili%e the Community Health Care centres in
Tshwane region. The aim of the study was to investigate whether the PHC services are
accessible to the communities of Tshwane $egion, and to determine if primary health
care services utili%ation in the three CHCs of Tshwane $egion are ade(uately utili%ed.
3indings of this study would be forwarded to the &epartment of Health for improvement
of the services.
9-

CHAPTER FOUR
?. DATA ANALYSIS AND INTERPRETATION
?.= D)() )+)79%$% )+/ $+(&';'&()($*+
The results of this study were analy%ed using statistical software, namely the !P!! 7:.-
computer programme. The information obtained is presented in fre(uency tables, pie
graphs and bar charts for all variables in order to determine the distribution of variables.
Cross tabulation is also done to determine the relationship between the predictor variables
and the response. The Chi's(uare test was also used to test if the PHC services were
accessible to the community fol+s. !ignificance was put at p C -.-*.
?.2 D&.*4');#$0 $+3*'.)($*+
:.9.7 Participants
Three hundred (uestionnaires were distributed. 3ifteen @*KB of them were not returned.
The total participants were 9=* @?*KB. " large proportion were self respondents 9,*, of
which <* @9;.,,KB were males and 7;- @*;.9KB were females. ParentsIguardians who
responded on behalf of children below * years of age were *- @7<.:;KB, of which 7*
@*.9;KB were male and ,* @79.9KB female. Table :.7 and figure :.7 below summari%es
the participantsD age and gender distribution.
97
T)-7& ?.=: D$%('$-,($*+% *3 P)'($0$;)+(%8 A4& )4)$+%( G&+/&'.
0ariables
.ender Male 3emale
Participants "ge in years 2o. K 2o. K
ParentsI.uardian C * yrs 7* *.9; ,* 79.9
!elf 7; P 9* yrs , 7.-* ,? 7,.<
9; ' ,* yrs 7= ;.,7 :: 7*.:
,; P :* yrs 7* *.9; 9- <.-
T:* yrs ,? 7,.< *< 9-
43.3%
16.7%
20%
3.3%
16.7%
29.2%
10.3%
22.6%
20%
17.9%
0
10
20
30
40
50
60
70
80
90
100
<5 yrs 16-25yrs 26-35yrs 36-45yrs >45yrs
Male
Female
F$4,'& ?.=: D$%('$-,($*+ *3 A4& -9 G&+/&' 5+E28@6
99
:.9.9 "ge
2inety'si) @,,.<KB of participants were above :* years of age, followed by ;9 @97.=KB
with age range of 9; to ,* yearsQ *- @7<.*KB were below the age of * years, :9 @7:.<KB
ranged from ages of 7; to 9* years and ,* @79.,KB ranged from ,; to :* years with the
average mean age of =.* years. The standard deviation was 9.9 for 9=* participants.
:.9., .ender
There were more female @7?*B than male participants @?-B. "mong the females, those
who were above :* years were *< @9?.9KB, followed by :: @99.;KB who ranged from 9;
to ,* years of age, ,? @9-.-KB from 7; to 9* years, ,* @7<.?KB were children below *
years of age, and 9- @7-.,KB were between ,; to :* years of age. "mong the males, ,?
@:,.,KB were above :* years of age, followed by 7= @9-.-KB with age range of 9; to ,*
yearsQ 7* @7;.<KB respondents were less than * years of age and 7* @7;.<B were ,; to :*
years old and , @,.,KB were 7; to 9* years of age.
9,
:.9.: !outh "frican citi%enship
The respondents were as+ed to indicate whether they were !outh "frican citi%ens. The
information that was obtained is reflected in Table :.9 below.
T)-7& ?.2: D$%('$-,($*+% *3 S*,(# A3'$0)+ 0$($B&+%8 A4& )4)$+%( G&+/&'.
V)'$)-7&%
.ender Male 3emale
Y&% "ge in years 2o. K 2o. K
ParentI.uardian C * yrs 7* 7<.; ,* 7=.*
!elf 7; P 9* yrs , ,.* ,: 7=.-
9; ' ,* yrs 7* 7<.; :: 9,.,
,; P :* yrs 7: 7;.* 9- 7-.;
T:* yrs ,= ::.< *; 9?.;
T*()7 8@ 29.82 =89 66.>2
.ender Male 3emale
N* "ge in years 2o. K 2o. K
ParentI.uardian C * yrs - - - -
!elf 7; P 9* yrs - - * =,.,
9; ' ,* yrs , ;- - -
,; P :* yrs 7 9- - -
T:* yrs 7 9- 7 7;.<
T*()7 @ =.7@ 6 2.==
/ut of 9=* participants, 9<: @?;KB said they were !outh "frican citi%ens. /f these 7=?
@;;.,9KB were females and =* @9?.=9KB males. /nly 77 @,.=;KB said they were not
!outh "frican citi%ens @; females and * malesB.
9:
:.9.: &istance
The distance travelled by the respondents to the clinic was one of the parameters used to
assess accessibility as indicated by figure :.9 below.
9
3 3 3
0 0
11
5
2
5
8
2
16
17
6
18
16
1
19
16
4
17
22
5
9
7
4
22
18
17
0
5
10
15
20
25
< 5
km
5 - 10
km
> 10
km
< 5
km
5 - 10
km
> 10
km
< 5
km
5 - 10
km
> 10
km
< 5
km
5 - 10
km
> 10
km
< 5
km
5 - 10
km
> 10
km
< 5 years 16 - 25 years 26 - 35 years 36 - 45 years > 45
Male
Female
F$4,'& ?.2: C'*%% ()-,7)($*+ *3 D$%()+0&8 G&+/&' )+/ A4&
t can be observed from 3igure :.9 above that a significant proportion of the participants
79? @:*.,KB traveled less than * +m to the clinic, of which ;< were females, ,* males
and 9< children. This finding is true irrespective of gender. Participants who reported to
have traveled * to 7- +m were 779 @,?.9KB, of which ;, were females, ,- males and 7?
children. Those who traveled above 7- +m were :: @7*.:KB of which ,- were females,
7- males and : children.
9*
:.9.* Traveling time
The figure below indicates the time that the people too+ to reach the clinic.
202
70.9 69
24.2
14
4.9
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
30 min/< 30 min - 1 hr >1 hr
Freqen!y
"er!en#

F$4,'& ?.>: D$%('$-,($*+ *3 ('):&7$+4 ($.&
3igure :., shows that 9-9 @<-.?KB of the respondents reported to have traveled for ,-
minutes or less to the clinic. Those who traveled for ,- minutes'7 hour were ;? @9:.9KB
and those who traveled longer than an hour were 7: @*KB.
9;
:.9.; Means of transport
Participants were as+ed to specify the means of transport used to reach the clinic. t is
indicated in the table below.
T)-7& ?.>: D$%('$-,($*+ *3 A4& )+/ G&+/&' -9 (')+%;*'(
T')+%;*'( G&+/&' T*()7

A4& $+ 9&)'% M)7& F&.)7&
>al+ C * years < 7* 99
7; ' 9* years 9 7< 7?
9; ' ,* years ? 7= 9<
,; ' :* years 7- 7- 9-
T :* 7= 7< ,*
T*()7 ?6 77 =2>
Ta)i C * years < 7= 9*
7; ' 9* years 7 97 99
9; ' ,* years < 9: ,7
,; ' :* years * 7- 7*
T :* 7, 9= :7
T*()7 >> =0= =>?
1us 9; ' ,* years 7 - 7
T :* 7 - 7
T*()7 2 0 2
/wn
Transport
C * years 7 9 ,
7; ' 9* years - 7 7
9; ' ,* years 7 9 ,
T :* < 79 7?
T*()7 9 =7 26
Table :., shows that many @#ust under half of the total respondentsB people 7,: @:<KB
used a ta)i as a mode of transportation to go to the clinic. 3orty'one respondents @:,KB
were above :* years of age, ,7 @*-KB were 9; to ,* years, 9* @*-KB below * years, 99
@*9KB with an age range of 7; to 9* years, and * @7:KB being ,; to :* years of age. The
second common mode of transport was wal+ing 79, @:,.9KB. Those above :* years ,*
@,;KB, were the biggest groupQ 9; to ,* years were 9< @:,.*KB, 99 @::KB being below *
9<
years, 9- @*<KB ranged from ,; to :*years and 7? @:*KB ranged from 7; to 9* years of
age. Twenty'si) @?.7KB used their own transport and those above :* years showed the
highest fre(uency 7? @9-KB followed by , both under * years @;KB and those between 9;
to ,* years @*KB and 7 @9KB was in the age range of 7; to 9* years of age. Two people
used a bus, one above :* years and one between 9; to ,* years.
?.> C7$+$0 $+3*'.)($*+
:.,.7 !ic+
/ut of the 9=* participants, children below * years of age were *- @7<KB, 7* being males
and ,* being females. The number of adults were 9,* @=,KB, <* males and 7;- females
@3igure :.:B.
F$4,'& ?.?: S$0< '&%;*+/&+(%
9=
17%
83%
$el%
&hil'
?.? R&)%*+% 3*' 0*.$+4 (* (#& 07$+$0
The respondents were as+ed to indicate the reason@sB for coming to the clinic and the
different disease conditions for coming to the clinic is shown in Table :.:.
T)-7& ?.?: D$%('$-,($*+ *3 ,($7$B)($*+ *3 0#'*+$0 /$%&)%& %&':$0&%
AGE
@6earsB
DIABETES HYPERTENSION TUBERCULOSIS ASTHMA
Male 3emale Male 3emale Male 3emale Male 3emale
C *yrs - - - - - - - 7
7; ' 9* yrs 7 - 7 9 - - - -
9; ',* yrs 7 * 7 9 , 7 9 ,
,; ' :* yrs * 9 : * : < 9 ,
T :* yrs 9, 99 9 , 97 ,; : ,
S,- T*()7 ,- 9? = 79 9= :: = 7-
TOTAL *? 9- <9 7=
:.:.7 &iabetes
People who came to the clinic because of diabetes were *?. Males above :* years were
9, @<;.<KB, followed by * @7;.;KB within the age range of ,; to :* years, and 7 @,.,KB
each for age 9; to ,* years and 7; to 9* years. 3emales above the age of :* were 99
@<*.?KB, * @7<.:KB for age 9; to ,* years, and 9 @;.?KB for age ,; to :* years.
:.:.9 Hypertension
$espondents who utili%ed the health care service because of hypertension were 9- @79
females and = malesB. 3our males @*-KB ranged from ,; to :* in years, 9 @9*KB above :*
years, and 7 @79.*KB in each between 7; to 9* and 9; to ,* years. 3emales between the
ages of ,; to :* were * @:7.<KB, , @9*KB were above :* years, followed by 9 @7;.<KB
each with age ranging from 7; to 9* and 9; to ,* years.
9?
:.:., Tuberculosis
/f the seventy'two respondents who reported to the clinic due to tuberculosis :: were
females and 9= males. ,; @=7.=KB females were above :* years @highest numberB, <
@7;KB were within the age range of ,; to :* years, followed by 7 @9.,KB from 9; to ,*
years, while males above :* years were 97 @<*KB. 3our respondents @7:.,KB were in the
age range of ,; to :* years, and , @7-.<KB were from 9; to ,* years.
:.:.: "sthma
Those who reported to the clinic due to asthma were 7= @7- females and = malesB. There
were : @*-KB males above :* years, and 9 @9*KB respondents in the age range of 9; to ,*
years and ,; to :* years. There were , @,-KB females above :* years, and those in the
age range of 9; to ,* and ,; to :* comprised , @,-KB. There was 7 @7-KB child below
the age of * years.
,-
:.:.* mmuni%ation
The figure below indicates the number of children who came to the clinic for
immuni%ation.
239
46
83.9
16.1
0
20
40
60
80
100
120
140
160
180
200
220
240
260
280
300
(es )*
Freqen!y
"er!en#
F$4,'& ?.@: D$%('$-,($*+ *3 $..,+$B)($*+ ).*+4 0#$7/'&+ F@9'%
There were :; @7;.7KB children who came to the clinic for immuni%ation. The other 9,?
@=,.?KB respondents came for different reasons.
,7
:.:.; 3amily planning
The figure :.;. below indicates the number of females who reported for family planning.
92%
8%
(es
)*
F$4,'& ?.6: F&.)7&% '&;*'($+4 (* F).$79 P7)++$+4
3igure :.; shows the total number and percentage 9:@=KB of females who reported to the
family planning. The other 9;7 @?9KB participants came for different reasons.
,9
:.:.< Pap smear
The below figure shows the number of participants that came to the clinic for cancer test
and the others came for other reasons.

93%
7%
(es
)*
F$4,'& ?.7 F&.)7&% '&;*'($+4 3*' C)+0&' T&%(
3igure :.< above shows that out of 9=* participants, only 9-@<KB females reported to
have come to the clinic for Pap smear.
,,
:.:.= "ntenatal care
The number of females that utili%ed the clinic for pregnancy chec+'up is shown in figure
:.=. below.
34
11.9
251
88.1
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
(es )*
Freqen!y
"er!en#
F$4,'& ?.8: F&.)7&% ,%$+4 A+(&+)()7 C)'&
,:
n 3igure :.= above, it can be seen that a total of ,: @77.?KB females out of 9=*
participants utili%ed the clinic for antenatal care @pregnancy chec+'upB. The other 9*7
@==.7KB participants came for various reasons.
,*
:.:.? 0oluntary counseling and testing
The table below shows the number, age group and gender of respondents that came to the
clinic for voluntary counseling and testing.
T)-7& ?.@: D$%('$-,($*+ *3 A4&8 G&+/&' )+/ VCT
AGE
5Y&)'%6
VCT
M)7& F&.)7&
7; '9* yrs 7 79
9; ' ,* yrs = =
,; ' :* yrs * 9
T :* yrs 9 7
S,- T*()7 7* 9,
TOTAL >8
&ocumentation records of the clinic showed that ,= respondents came to the clinic for
0oluntary Counseling and Testing @9, females and 7* malesB @refer to Table :.* aboveB.
/f the 9, females, 79 @?9.,KB were 7; to 9* years old, = @*-KB were 9; to ,* years old,
9 @9=.;KB ranged from ,; to :* years and one was above :* years. There were = @*-KB
males in the age range of 9; to ,* years. 3ive @<7.:KB ranged from ,; to :* years and
there was one male in the age group 7; to 9* years and 7 above :* years.
,;
:.:.7- "nti'retroviral treatment
The number of respondents, age group and gender that reported to the clinic for anti'
retroviral treatment is shown on the table below.
T)-7& ?.6: A4& G&+/&' ARV C'*%% ()-,7)($*+
AGE
5Y&)'%6
ARV
M)7& F&.)7&
7; '9* yrs - 9
9; P ,* yrs * ;
,; P :* yrs 7 7
T :* yrs , :
S,- T*()7 ? 7,
TOTAL 22
"ccording to Table :.; above, twenty'two respondents reported to the clinic for anti'
retroviral treatment @7, females and ? malesB. There were ; @*:.*KB females whose age
ranged from age 9; to ,*, : @*<.7KB were above :* years, 9 @7--KB were in the range of
7; to 9* years and one @*-KB was aged between ,; to :* years. 3ive males @:*.*KB
ranged from 9; to ,* years, , @:9.?KB were above :* years and one @*-KB was aged
between ,; to :* years.
,<
?.@ N,.-&' *3 07$+$0 ,($7$B)($*+
The figure below shows participants who utili%ed one or more services when they visited
the clinic.
27%
73%
1
2--3
F$4,'& ?.9: D$%('$-,($*+ *3 C7$+$0 ,($7$B)($*+
/ut of 9=* participants, 9-? @<,KB people reported to have come to the clinic and utili%ed
one service. !eventy'si) @9<KB people utili%ed 9 or , services.
,=
?.6 D*0(*' *' +,'%&
People that came to the clinic were either seen by a nurse or a doctor as shown in the
table below.
T)-7& ?.7: D*0(*' *' N,'%&


!een by T*()7
&octor 2urse
"ge









F @ 9&)'% Count - *- @0
K - 7-- =00
=6 ! 2@ 9&)'% Count * ,< ?2
K 77.? ==.7 =00
26 ! >@ 9&)'% Count 7: := 62
K 99.: <<.: =00
>6 ! ?@ 9&)'% Count , ,9 >@
K =.; ?7.: =00
G ?@ Count 7? << 96
K 7?.= =-.9 =00
T*()7

C*,+( ?= 2?? 28@
H =?.? 8@.6 =00
Table :.; shows that << @=-.9KB people above :* years of age were seen by a nurse and
7? @7?.=KB people were seen by a doctor. $eports showed that all the *- @7--KB children
below * years were seen by a nurse. n the age group of 9; to ,* years, := @<<.:KB were
seen by a nurse and 7: @99.:KB by a doctor. Thirty'seven @==.7KB of those within age
range of 7; to 9* years were seen by a nurse and * @77.?KB by a doctor. /f the age range
of ,; to :* years, ,9 @?7.:KB were seen by a nurse and , @=.;KB by a doctor.
,?
?.7 R&3&'')7
3ig :.7- below shows the number of people that were not referred to other services and
those who were referred to the doctor @for further consultation or alternative treatmentB,
hospital @very ill patients or emergencies that need admissionB and speciali%ed services
@physiotherapy, occupational healthB.

2%
5%
12%
81%
+*!#*r
,*s-i#al
$-e!iali.e' ser/i!e
)*ne
F$4,'& ?.=0: R&3&'')7 /$%('$-,($*+
/ut of 9=* people that were seen at the clinic, 9,9 @=7 KB were not referred to other
services. Those referred to the doctor were ,* @79 KB while those who were referred to
the hospital were 7, @* KB. t was reported that * @9 KB were referred to speciali%ed
services.
:-
?.8 P'&%0'$;($*+ )+/ .&/$0$+& $%%,&/
$espondents were as+ed about their prescription and medicine issued according to their
age @refer to Table :.= belowB.
T)-7& ?.8: D$%('$-,($*+ *3 ;'&%0'$;($*+ )+/ .&/$0$+& $%%,&/ )4)$+%( )4&
P'&%0'$;($*+
A4& Y&% N* T*()7
C*yrs * :* *-
7;' 9*yrs 9, 7? :9
9;' ,*yrs :* 7< ;9
,;' :*yrs 9? ; ,*
T:*yrs ?, , ?;
T*()7 =9@ 90 28@
M&/$0$+& I%%,&/
A4& Y&% N* T*()7
C*yrs * - *
7;' 9*yrs 99 7 9,
9;' ,*yrs :* - :*
,;' :*yrs 9< 9 9?
T:*yrs ?7 9 ?,
T*()7 =90 @ =9@
:.=.7 Prescription issued
" total of 7?* prescriptions were issued. /f these, ?, were issued to persons above :*
years of age, :* prescriptions were issued to those in the age range of 9; to ,* years, 9?
to those in the age range of ,; to :* yearsQ 9, were issued to participants in age ranging
from7; to 9* years and * were issued for children below the age of * years.
:.=.9 Medicine issued
:7
/ut of 7?* prescriptions that were issued, 7?- people received their medicine and only *
people did not receive medication because it was out of stoc+ @
9
A ,-.; and p A -.---B.
?.9 H&)7(# +&&/%
The table below indicates the response of participants to whether their health needs were
satisfied or not.
5%
95%
(es
)*
F$4,'& ?.==: F'&2,&+09 D$%('$-,($*+ *3 H&)7(# N&&/%
" large proportion of participants 9<7 @?* KB stated that their health needs or re(uests
were met. However, 7: participantsD @* KB health needs or re(uests were not met.
?.=0 S&':$0& )+/ *;&')($*+)7 #*,'%
:9
The participants were as+ed if they were satisfied with the hours or period that the clinic
is available and the service they received as indicated in table :.? below.
T)-7& ?.9: D$%('$-,($*+ *3 S&':$0& )+/ O;&')($*+)7 H*,'%
RESPONSE SERVICE OPERATIONAL HOURS
28M14$ K 28M14$ K
YES 9;: ?9.; 9,; =9.=
NO 97 <.: :? 7<.9
:.7-.7 !ervice "vailability
The ma#ority of participants @9;:B reported that services were available. However, 97
reported that services were not available.
:.7-.9 /perational hours
Two hundred and thirty'si) participants were satisfied with the hours or period that the
services were available whilst :? participants were dissatisfied. @
9
A *:.: and p A -.--B.

:,
?.== R&0*..&+/)($*+ )+/ 0#)+4&
The table below shows the response of participants to whether they would recommend
someone to go to the clinic and if change was needed. The Chi'!(uare Tests was used to
confirm if the response was true.
T)-7& ?.=0: D$%('$-,($*+ *3 '&0*..&+/)($*+ )+/ 0#)+4& )4)$+%( )4&


Change T*()7
6es 2o
$ecommendation 6es ;= 7?- 2@8
2o 9< - 27
T*()7 9@ =90 28@
C#$!S2,)'& T&%(%
0alue df p'value
Pearson Chi'!(uare *?.;*7@bB 7 .---
Continuity
Correction@aB
*;.,=, 7 .---
5i+elihood $atio ;*.9-= 7 .---
2 of response 9=*
/ut of 9=* participants, 9*= said that they would recommend a friend or family to come
to the clinic when sic+ @
9
A *?.< and p A -.---B. The other 9< participants would not
recommend a friend or family to come to the clinic, and 7?- respondents are of the
opinion nothing needs attention or needs to be changed at the clinic. The other ?*
participants felt that change in the management of the clinic is needed.
This table below shows the p'values for the accessibility of services.
::
T)-7& ?.==: T#& ;! :)7,&% 3*' (#& )00&%%$-$7$(9 *3 %&':$0&%
S&':$0&%: Health needs, !ervices, /perational hours, $ecommendation and Change
;!:)7,&% 3*' )77 )00&%%$-$7$(9 *3 S&':$0&%: -.---
Mean !td. &eviation !td. 4rror
Mean
?*K Confidence
nterval of the
&ifference
T df p'value
5ower 8pper
H&)7(# +&&/% .;,* .*-: .-,- .*<; .;?: 97., 9=: .---
S&':$0&% .;77 .*,- .-,7 .*:? .;<9 7?.* 9=: .---
O;&')($*+)7 #*,'% .*79 .*?7 .-,* .::, .*=7 7:.; 9=: .---
R&0*..&+/)($*+ .*=? .*9< .-,7 .*9= .;*7 7=.? 9=: .---
C#)+4& .:?7 .;9- .-,< .*;: .:7? 7,.: 9=: .---
" p value less than -.-* indicated statistical significance. This shows that participants
were ?*K satisfied with services rendered at the Community Health Centres.
:*
CHAPTER FIVE
@. CONCLUSIONS AND IMPLICATIONS
@.= S,..)'9 *3 '&%&)'0# 3$+/$+4%
/f the 9=* respondents from the three Community Health Centres of the Tshwane
$egion, there were more females than males. Most were !outh "frican citi%ens who
traveled less than *+m to the clinic. The ma#ority were seen by nurses. The respondents
indicated that they were satisfied with the service and their health needs were met. They
would recommend that people utili%e the services that were provided.
@.2 D$%0,%%$*+ *3 %,..)'9
*.9.7 &emographic data
"ge
The ma#ority of participants were females at the time of the study @Table :.7B. The
services attracted females most probably because of the +ind of services offeredQ
antenatal care, family planningQ pap smear and immuni%ation are more female'orientated.
There were no speciali%ed male services, such as urology.
&istance
The study showed that in terms of distance, the clinics were accessible as most of the
participants lived within * +m @3igure :.9B. "ccording to the set norms and standards of
!outh "frican Primary Health Care !ervices, access is measured by the proportion of
people living within * +m of a clinic @The Primary Health Care Pac+age for !." 9--7,
p.79B.
:;
!imilarly, a study done by 1el et al. @9--9, p::B in 2amibia concluded that accessibility
was said to be satisfactory as people in urban >indhoe+ traveled shorter distances to the
clinic. Chatora and Tumusime @9--:, p.9??B pointed out that in sub'!aharan "frica,
health centres were set up so that people in the catchment area would not travel more than
=+m or one hour travel time to access the nearest health facility.
Travelling time
" significant proportion of participants reported to have traveled ,- minutes or less to the
clinic. /thers traveled between ,- minutes to an hour and only a minority traveled for
more than an hour @3igure :.,B. The travelling time in .auteng $egion is reported to be
shorter as opposed to a study that was conducted in 9--; at the Hlabisa health sub'
district, Kwa Rulu 2atal, !outh "frica, where it was reported that the median travel time
to the nearest clinic was =7 minutes, and that ;*K of homesteads traveled 7 hour or more
to attend the nearest clinic @Tanser et al., 9--;, p.;?7B.
The current study revealed that the .auteng $egion clinics are accessible as most
respondents @<-.?KB indicated that they had traveled ,- minutes or less to the clinic.
Means of transport
The results indicated that the most common form of transport that the respondents used to
access health care services was the ta)i. The second form was wal+ing, with only a few
people using their own transport. n comparison, Tanser et al. @9--;, p.9??B reported that
in accessing health care facilities at Hlabisa health sub'district, Kwa Rulu 2atal, !outh
"frica, people often wal+ed, which was followed by public transport. !ome individuals
reported having wal+ed very long distances or long times because there was no public
transport available in their area or they were too poor to afford the fare.
n 7??=, it was estimated in !outh "frica that nationally :?K, :7K and 7-K of blac+
!outh "fricans wal+ed, used public transport and their own transport respectively, to
access health care @!mith et al., 7???B. n the current study, the values for Tshwane
$egion were :,.9K, :<K and ?.7K respectively. The higher use of own transport at the
e)pense of wal+ing in the national survey probably reflects the urban influence. Public
:<
transport usage and wal+ing were the most popular mode of transport to access the health
services. These results are in agreement with the study by Tanser et al 2006 that has
shown a relationship between pro)imity to clinic and proportion of the population
choosing to wal+ to the clinic.
*.9.9 Clinic information
The results of this study revealed that the Tuberculosis @T1B clinic was most visited.
"ccording to the Henry G. Kaiser 3amily 3oundation @!ept -:, 9--<B, !outh "frica has
the fifth largest number of people living with T1 in the world. /ur *7K treatment
success rate is below the >orld Health /rgani%ationDs target of =*K. n 9--*, there were
,9-, --- cases of T1 recorded in the country. The incidents of T1 have almost doubled
in .auteng since 7??<. t increased from 9:7 per 7-- --- in 7??< to ,<? per 7-- --- in
9--<.T1 was further complicated by co'infection with H0 @www.gautengonline.gov.%aB.
T1 is treatable but re(uires a combination of drugs that are ta+en over several months.
&ue to this e)tended treatment period, many people did not complete their treatment and
were not cured. n 7??;, in recognition of this problem, the Minister of Health declared
T1 a health priority and thus mar+ed the introduction of &irectly /bserved Treatment,
!hort Course @&/T!B as a national strategy to curb the problem @!outh "frica, PHC
Progress $eport, 9---, p.7?B. 1ecause of directly observed treatment by health wor+ers,
this e)plains the T1 clinic being mostly used at the time of the study. n contrast, a study
that was conducted by >il+inson et al., 9--7 at Hlabisa health district, KwaRulu'2atal,
revealed that mostly curative services @treatment of ailmentsB were used for children, with
consultations being initiated by their carers who perceived them to be sic+ and in need of
medical attention.
.enerally, the current study found that the health needs of people were met @3igure :.77B.
They were also satisfied with the service and time availability. The minority of people
that were not satisfied stated that, because of long (ueues, they were sometimes turned
bac+ without being seen, and that diagnostic procedures, such as E'rays were not always
available as the machine was forever bro+en. There was also a lac+ of resources. The
following e)amples were cited: a dentist was not present most of the time, staff
:=
shortagesQ slow service delivery, negative attitude of health care staff, and other services,
such as immuni%ation, family planning and chronic services @hypertension, diabetesB not
being available for 9: hours.
$ispel et al. @7??;, p77,B also identified health care system barriers that included long
waiting periods, unfriendly and uncaring behaviour of health wor+ers and poor health
facilities. &espite those health care barriers, a significant number of participants
@Table :.7-B said they would recommend to a friend or family to utili%e the clinic when
sic+.
*.9., 8tili%ation of services at the three chcDs of Tshwane region
The survey revealed that all the services provided at the clinics were utili%ed, i.e. curative
and preventive services, "2C, 3P, Pap smear, and H0, plus chronic diseases, li+e
diabetes mellitus, hypertension and asthma. Hypertensive clinic was mostly utili%ed,
probably due to the fact that most people who utili%ed the clinic were above :* years, an
age group in which hypertension is common.
" study conducted by Pillay @9--9, p.7=B revealed that in KwaRulu'2atal, immuni%ation
and antenatal care services were mostly utili%ed whereas in Mbale &istrict, 8ganda, basic
primary health care services, such as immuni%ation and treatment of diarrhea were poorly
utili%ed, even by homes very close to a health facility resulting in high rates of childhood
mortality @Malison et al., 7?=<, p.,9?B.
"n earlier survey by the !.". Health !ystems Trust and &epartment of Health 9--,, has
shown that the utili%ation of services in .auteng $egion has increased although it differs
according to the type of service. The antenatal clinic, immuni%ation and family planning
are the most utili%ed services. The service for chronic illness differed from one area to
another @!outh "frica, The 2ational PHC 3acilities !urvey 9--,, p.7=B.
:?
@.> L$.$()($*+% *3 (#& %(,/9
&ue to time and financial constraints, it was impossible to include all the clinics in
Tshwane $egion in the study. There are 9= 5ocal "uthority Clinics and ? Provincial
Clinics in the region. The researcher therefore conducted the study at the #ust three
Community Health Centres that were open 9: hours a day and provided all the Primary
Health Care services. "s a result, the results cannot be generali%ed to all clinics that are
only open until 7;h-- every day in the Tshwane $egion. 2either can the findings be
generali%ed to health services in other regions.
@.? R&0*..&+/)($*+%
1ased on the findings of the current research, the following recommendations are made
which could be implemented to further improve the accessibility and utili%ation of
Primary Health Care !ervices:
The &epartment of Health should increase the number of Community Health
Centres in Tshwane regionQ these should be open for 9: hours and render all
primary health services.
More doctors and especially nurses should be appointed at the e)isting Primary
Health Centres since most of the patients are seen by nurses.
>ages of staff be improved and professional development be encouraged, i.e. to
train more nurses as primary health care practitioners and speciali%e in their field
of interest. This would improve (uality of care.
The &epartment of Health should develop and implement an 4mployee
"ssistance Programme @programme offered by employers to help employees to
deal with their personal problems e.g. counseling, budgeting or dealing with
substance abuseB, which might help to eliminate unfriendly and uncaring
behaviour of health care personnel.
The government should subsidi%e services, such as a bus service to and from the
clinic, plus laboratory tests since everybody has a right to health.
*-
@.@ C*+07,%$*+
"ccording to the Constitution of !outh "frica, 7??;, everyone has the right to have
access to health care services. The Primary Health Care approach was adopted in order to
promote accessibility to the use of health services and also to respond to the call of the
>orld Health /rgani%ation, JHealth for all by the year 9---D, and therefore Primary
Health Care is rendered free of charge in !outh "frica. /verall, the results of the study
were positive in that it was indicated that the Primary Health Care services in Tshwane
region were accessible.
*7
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*,
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services. - ,id3ifery Womens2 Health. 2o. *9.,:9',*-.
>il+inson, &., .ouws, 4., !ach, M. H "bdool Karim, !.!. 9--7. 4ffect of removing user
fees on attendance for curative and preventive primary health care services in rural !outh
"frica. Bulletin of the World Health Organization. 2o <?. ;;*';<7.
>H/I 82C43 7?<=. &eclaration of "lma P "ta. 0nternational !onference on rimary
Health !are, %lma8%ta, 9))". .eneva: >orld Health /rgani%ation.
**
7. ANNEIURES
ANNEIURE A: J,&%($*++)$'&
INSTRUCTIONS:
"lease rea' #he qes#i*ns !are%lly. 0i!k #he a--r*-ria#e ans1er 1i#h an 2
in #he s-a!e -r*/i'e'. "r*/i'e in%*rma#i*n/ e3-lana#i*n 1here nee'e'.
4n !ase *% min*rs5 #he -aren#/ 6ar'ian may !*m-le#e #he qes#i*nnaire.
"lease ans1er #he qes#i*ns as h*nes#ly as -*ssi7le.
0he in%*rma#i*n *7#aine' 1ill 7e se' %*r resear!h -r-*ses *nly5 n*# %*r
-ers*nal 6ains.
0he res-*nses #* #he qes#i*ns 1ill 7e #aken as -resen#e' 7y #he
res-*n'en#s.
0akin6 -ar# in#* #his s#'y 1ill remain an*nym*s.

QUESTIONS
)ame *% &lini!8
+a#e8
DEMOGRAPHIC DATA:
1. "ar#i!i-an#8

2. 96e8

3. :en'er8

4. 9re y* a $*#h 9%ri!an !i#i.en;

5. 9''ress8 <<<<<<<<<<<<<<<<<.
<<<<<<<<<<<<<<<<<.
<<<<<<<<<<<<<<<<<.
6. =ha# 'is#an!e '* y* #ra/el #* #he !lini!;
*;
$el% "aren#/6ar'ia
n
>n'er 5
years
6-15
years
16-25
years
26-35
years
36-45
years
97*/e
45 years
Male Female
(es )*



7. ,*1 l*n6 '*es i# #ake y* #* rea!h #he !lini!;

8. Means *% #rans-*r#8
CLINIC (CHC) INFORMATION:
9. ?eas*n@sA %*r !*min6 #* #he !lini!8
9.1 (* *r !hil' n*# 1ell @si!kA
9.2 F*r +ia7e#es @s6ar !he!k--A
9.3 F*r ,y-er#ensi*n @hi6h 7l**' !he!k--A

9.4 07er!l*sis #rea#men# @!hes# 'isease / 0BA
9.5 F*r 9s#hma @!hes# -r*7lemA

9.6 4mmni.a#i*n @7a7y -r*#e!#i*n / immni#y #* in%e!#i*s 'iseaseA

9.7 Family -lannin6 @-re/en#i*n *% -re6nan!yA
9.8 "a- smear @%emale !an!er #es#A

9.9 9n#i C)a#al &are @-re6nan!y !he!k--A

*<
Dess #han 5 km 5 C 10 km M*re #han 10 km
30 min *r less 30min C 1hr M*re #han 1hr
1alk #a3i 7s #rain E1n #rans-*r#
Me &hil'
(es )*
(es )*
(es )*
(es )*
(es )*
(es )*
(es )*
(es )*
9.10 F*ln#ary &*nselin6 an' 0es#in6 @,4F 7l**' #akin6A
9.11 9n#i-re#r*/iral #rea#men# @,4F #rea#men#A
10. ,*1 many !he!k--s 'i' y* 6e# #*'ay;
11. $een 7y8

12. +i' #hey re%er y* #*;

13. "res!ri-#i*n @me'i!ineA !har# isse'

13.1 4% yes all -res!ri7e' me'i!ine 1ere isse';

13.2 4% n*5 1hy; .................................................................................
14. =ere all y*r heal#h nee's @1ha# y* !ame %*rA a##en'e' #*;

14.1 4% n*5 6i/e reas*n@sA8 <<<<<<<<<<<<<<<<<<<<<<<<.
<<<<<<<<<<<<<<<<<<<<<<<<.
15. 0he ser/i!e@sA #ha# y* se *r nee'5 are #hey a/aila7le e/ery #ime y* /isi#
#he !lini!;


15.1 4% n*5 6i/e reas*n@sA8 <<<<<<<<<<<<<<<<<<<<<<<<.
16. 9re y* sa#is%ie' 1i#h #he #ime@sA #ha# #h*se ser/i!es are a/aila7le;

(es )*

16.1 4% n*5 6i/e reas*n@sA8 <<<<<<<<<<<<<<<<<<<<<<..
<<<<<<<<<<<<<<<<<<<<<<..

17. =*l' y* re!*mmen' s*me*ne @%rien' / %amilyA #* !*me #* #he !lini! 1hen
si!k;


17.1 4% n*5 6i/e reas*n@sA8 <<<<<<<<<<<<<<<<<<<<<<<..
<<<<<<<<<<<<<<<<<<<<<<<..
*=
(es )*
(es )*
1 2-3 4-5 97*/e 5
+*!#*r )rse
+*!#*r ,*s-i#a
l
$-e!iali.e' ser/i!es n*ne
(es )*
(es )*
(es )*
(es )*
(es )*
18. in y*r *-ini*n is #here any#hin6 #ha# y* %eel nee' a##en#i*n *r #* 7e
!han6e';
(es )*

18.1 4% yes5 6i/e 'e#ails8 <<<<<<<<<<<<<<<<<<<<<<<<<
<<<<<<<<<<<<<<<<<<<<<<<<...
<<<<<<<<<<<<<<<<<<<<<<<<<
Thank YOU
*?
ANNEIURE B: D$;*(%*
DITAELO
Ga k*-*5 7ala 'i-*#s* #s*hle ka kel*#lh*k*. 0sh1aya kara7* ka le#sh1a*
la 2 m* 6* #sh1ane#sen6. )eelana ka 'in#lha m* 6* #lh*ka6alan6.
Fa e le n61ana 1a 'in61a6a #se 'i ka #lase 6a #lhan*5 m*#s1a'i k6*#sa
m*#lh*k*me'i * le#lele#s1e 6* ara7a 'i-*#s*.
Ga k*-*5 ara7a 'i-*#s* ka 7*#she-e6i.
0she'im*se#s* e * #la neelanan6 ka y*na e #la 'irise#s1a 'i#ira6a#sa #sa
7*ne#si %eela.
+ikara7* #s*hle 'i #la #se1a Haaka 'i nee#s1e ke m*#sayakar*l*.
:* #saya kar*l* 6a 6a* m* 'i#lh*#lh*mis*n6 e #la nna kh-amarama.
DIPOTSO
Deina la Gliniki8
De#lha8
TSHEDIMOSETSO KA GA WENA:
1. M*#sayakar*l*8

2. +in61a6a8


3. B*n68

4. 9 * m*a6i 1a 9%rika B*r1a;
5. De%el* la 7*nn*8 <<<<<<<<<<<<<<<.
<<<<<<<<<<<<<<<
<<<<<.........<<<<<<<..
6. E #samaya sek6ala se se ka na kan6 @'ikil*mi#araA 6* ya k1a klinikin6;
;-
)na M*#sa'i/M*#lh*k*me'i
0lase 6a 5 6-15 16-25 26-35 36-45 :* %e#a
45
M*nna M*sa'i
Ie )yaa
G1a #lase 6a #se #lhan* Ma6aren6 a #se #lhan* 6* ya
6* #se les*me
:* %e#a #se
les*me
;7
7. :* 6* #saya nak* e ka kan6 6* ya k1a klinikin6;
8. E 'irisa en6 6* %ihla k1a klinikin68

Ma*#* 0ekisi Bese $e#imela $enamel1a sa 6a6*

TSHEDIMOSETSO KA LEFELO LA BOITEKANELO (KLINIKI):
9. De7aka Da 6* #la klinikin68
9.1 :* l1ala man6

9.2 B*l1e#se 7a skiri

9.3 B*l1e#se 7a k6a#elel* ya ma'i

9.4 B*l1e#se 7a ma%a#lha
9.5 B*l1e#se 7a 6* h-el1a
9.6 M*en#* 1a 7ana

9.7 0hi7ela -ele6i
9.8 0ek* ya kankere ya m*l*m* 1a -*-el*

9.9 0lh*k*mel* ya 7aimane -ele 6a -ele6i
9.10 B*i#ha-* 7a k6ak*l*l* le #ek* ya ,4
;9
Me#s*#s* e mas*me a
marar* k6*#sa k1a #lase
:* ya 6* ra >ra le 6* %e#a
)na )61ana
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
9.11 +i#lhare #sa kali%i ya ,4F
10. E 7*n1e k* ma%el*n6 a makae m* klinikin6 ka Hen*;


11. E 7*n1e ke man6;

12. 9 7a 6* r*me#se k*
)6aken6 B**kel*n6 +i#ek* #sa maem* a 6*'im* :*-e

13. 9 * %il1e lek1al* la 'i#lhare;

13.1 Fa * 'mela5 a * %il1e 'i#lhare #se #s*#lhe;

13.2 Fa * 6anela5 le7aka ke en6; <<<<<<<<<<<<<<<<<<<<...
14. 9 'i#lh*ke6* #sa 6a6* #sa 7*i#ekanel* 'i seke6il1e;
14.1 Fa * 6anela5 neelana ka ma7aka <<<<<<<<<<<<<<<<<<.
15. 9 'i#irel* #se * 'i'irisan6 m* klinikin6 'i #en6 m* nak*n6 #s*hle;

15.1 Fa * 6anela5 neelana ka ma7aka8 <<<<<<<<<<<<<<<<<<.
16. 9 * k6*#s*%alela nak* e e7eil1en6 ya 'i#irel*;

16.1 Fa * 6anela5 neelana ka ma7aka8 <<<<<<<<<<<<<<<<<<.
<<<<<<<<<<<<<<<<<<
17. 9 * ka r*#l*e#sa m*n61e 1a l*sika /#sala 6* #la m* klinikin6 e;

17.1 Fa * 6anela5 neelana ka ma7aka <<<<<<<<<<<<<<<<<<...
<<<<<<<<<<<<<<<<<<..
18. Ga kakany* ya 6a6*5 a 6* na le se se ka %e#*l1an6 k6*#sa sa seke6el1a
#se7e 6* #lisa 'i-he#*6*;
18.1 Fa * 'mela5 re neelana ka 'i#shi#shiny*8 <<<<<<<<<<<<<<<
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<..
;,
Ie )yaa
1 2-3 4-5 :* %e#a 5
)6aka M**ki
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
Ie )yaa
RE A LEBOGA
;:
ANNEIURE C: D)() &K(')0($*+ (**7
F9&4D40( )9MI8
+90I8
$#a%%in68 )m7er *% nrses
)m7er *% '*!#*rs
)m7er *% allie' s#a%%
9)& - 9n#ena#al &are ,E$" - ,*s-i#al
F" C Family "lannin6
"$ - "a- smear $$ C $-e!iali.e' $er/i!es
F&0- F*ln#ary &*nselin6 an' 0es#in6
9?F- 9n#i re#r*/iral #rea#men#
+B C +ia7e#es Melli#s E$ C E# *% s#*!k
,0- ,y-er#ensi*n
9$- 9s#hma
;*
Head
Count
!een
1y
&r
!een
1y
2urs
e
Curative
!ervice
!
T

4
P

Preventiv
e !ervice
H
0
Chron
ic
diseas
e
$eferrals Pharmacy
C
*yrs
T
*yr
s
Child
health
Min
or
"il
"
2C
3
P
P
!
0
C
T
"
$
0
&
1
H
T
"
!
&
$
H
/
!
!
!
"ll
ite
ms
2ot
give
n
/!
ANNEIURE D: I+3*'.&/ 0*+%&+(
UNIVERSITY OF LIMPOPO 5M&/,+%) C).;,%6 CONSENT FORM
S()(&.&+( 0*+0&'+$+4 ;)'($0$;)($*+ $+ ) R&%&)'0# P'*A&0(
2ame of !tudy
ACCESSIBILITY AND UTILIZATION OF THE PRIMARY HEALTH CARE SERVICES
IN TSHWANE REGION
have read the information on the aims and ob#ectives of the proposed study and was provided
the opportunity to as+ (uestions and given ade(uate time to rethin+ the issue. The aim and
ob#ectives of the study are sufficiently clear to me. have not been pressuri%ed to participate in
any way.
understand that participation in this !tudy is completely voluntary and that may withdraw from
it at any time and without supplying reasons. This will have no influence on the regular treatment
that holds for my condition neither will it influence the care that receive from my regular doctor.
+now that this !tudy has been approved by the $esearch, 4thics and Publications Committee of
3aculty of Medicine, 8niversity of 5impopo @Medunsa CampusB I &r .eorge Mu+hari Hospital.
am fully aware that the results of this results of this Trial I !tudy I Pro#ect will be used for
scientific purposes and may be published. agree to this, provided my privacy is guaranteed.
hereby give consent to participate in this !tudy.
........................................................... ........................................................
2ame of patientIvolunteer !ignature of patient or guardian.
................................ .................................... ................................................
Place. &ate. >itness
S()(&.&+( -9 (#& R&%&)'0#&'
provided written information regarding this !tudy.
agree to answer any future (uestions concerning the !tudy as best as am able.
will adhere to the approved protocol.
....................................... .................................... ...............WW
2ame of $esearcher !ignature &ate Place
;;
ANNEIURE E: F*'*.* 9) 4* +&&7)+) <) (&(7)
S&(#&* %& %& <1) 4*/$.* %) (#,(* %) L$.;*;* 5M&/,+%)6 F*'*.* 9) 4* +&&7)+) <)
(&(7)
L&<1)7* 7) -*;)<$ .* 4* (%&&+4 <)'*7* .* /$(7#*(7#*.$%*+4
5eina la tlhotlhomiso
GO FITLHELELA LE GO DIRISIWA GA DITIRELO TSA DILINII TSE DI
LENG A TLASE GA GAOLO YA TSHWANE
Ke buisile tshedimosetso, e be +a utlwa le +a mai+aelelo a tlhotlhomiso gape +a neiwa
tshono ya go botsa dipotso, +a be +a newa na+o e le+aneng go nagana +a leba+a le o.
Ke utlwisisa mai+aelelo a ditlhotlhomiso. .a +e a gapeletswa le +a mo+gwa ope go tsaa
+arolo.
Ke tlhaloganya gore go tsaa +arolo mo ditlhotlhomisong tse, +e +a gorata game, gape +e
letlelelwa go +a i+gogela morago go tswa mo ditlhotlhomisong na+o ngwe le ngwe ntle le
go fa maba+a. !e, se +a se be le +amano mo tsamaisong ya pholo e +e e fiwang +a metlha
gape e +a se +goreletse +amogelo ya pholo e +e e fiwang +e nga+a ya +a metlha.
Ke itse gore ditlhotlhomiso tse di dumeletswe +e ba lefapha la pholo le la ditlhotlhomiso
tsa !etheo se se +wa godimo sa thuto ya 5impopo @MedunsaBI boo+elo ba &r .eorge
Mu+hari. Ke tlhaloganya gore dipholo tsa ditlhotlhomiso tse, di tla dirisiwa go ditiragatsa
tsa bonetsi gape di +a gatiswa. Ke dumelana le se fela fa e le gore &itlhagiso tsohle di tla
sirelediwa.
Ke fa tetla ya go tsaa +arolo mo ditlhotlhomisong tse.
WWWWWWWWWWWWWWW WWWWWWWWWWWWWWWW
5eina la molwetseImotsaa+arolo Tshaeno ya motsadiI motlho+omedi
WWWWWWWWWW WWWWWWWW WWWWWWWWWW.
5efelo 5etlha Pa+i
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
X
L&<1)7* 7) -*;)<$ <) .*/$')/$(7#*(7#*.$%*
Ke file tshedimosetso e e +wadilweng mabapi le ditlhotlhomiso.
Ke dumela go araba dipotso dingwe le dingwe tse di +a tlang mo isagong mabapi le
ditlhotlhomiso +a mo+gwa o +e tla +gonang.
Ke tla obamela melao e e beilweng.
WWWWWWWWW. WWWWWWW.. WWWWWW.. WWWWWWWW..
Modiraditlhotlhomiso Tshaeno 5etlha 5efelo
;<
ANNEIURE F: P&'.$%%$*+ 7&((&' 3'*. (#& D&;)'(.&+( *3 H&)7(#
;=
ANNEIURE G: P&'.$%%$*+ 7&((&' 3'*. M&/,+%) R&%&)'0# )+/ E(#$0% C*..$((&&
;?
ANNEITURE H: D)() 0*77&0($*+ 0*+3$'.)($*+ %#&&( 3'*. S()+B) B*;);& CHC
<-
ANNEITURE I: D)() 0*77&0($*+ 0*+3$'.)($*+ %#&&( 3'*. S*%#)+4,:& CHC
<7
ANNEITURE ": D)() 0*77&0($*+ 0*+3$'.)($*+ %#&&( 3'*. L)/$,. CHC
<9

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