APPENDICIES
4.1. Introduction
The overall aim of the present study is to understand and assess the wellbeing of nurses in the context of the Re-engineered PHC and the proposed NHI scheme. In order to achieve this overall aim, a sequential cross-sectional mixed methods research design divided into two phases was employed. The objectives of phase one was to investigate the
relationship between Job Satisfaction, Job Strain, PsyCap, Burnout and Wellbeing among nurses in both a NHI pilot site (Dr Kenneth Kaunda District = KK) and a non-NHI pilot site (Bojanala Platinum District = BP) and to explore whether there were any differences in the levels of positive psychological resources and stressors for nurses in the NHI pilot site and the non-NHI pilot site.
The second phase, which was qualitative in nature was conducted in the NHI pilot site (KK). This phase aimed to develop an understanding of the experiences and perceptions of nurses with regards to their Wellbeing, Job Satisfaction, Job strain, Burnout, the Re-
engineered PHC system and the pilot rollout of NHI through the use of a semi-structured interview schedule. Each phase had corresponding research questions to help achieve the objectives of this study.
104 4.1.1. Phase 1: Quantitative Study
i. What is the relationship between Psychological Capital, Job Satisfaction, Wellbeing, Job Strain and Burnout for nurses in the NHI pilot and non-NHI pilot site?
ii. Is there a difference in the Psychological Capital, Job Satisfaction, Wellbeing, Job Strain and Burnout of nurses in the NHI pilot and non-NHI pilot site?
4.1.2. Phase 2: Qualitative Study
i. What are the perceptions of nurses in relation to the Re-engineered PHC system and the NHI?
ii. What are the understanding of nurses in relation to Wellbeing, Job Satisfaction and Burnout?
iii. What are the roles and responsibilities of nurses in the Re-engineered PHC system and the NHI?
This chapter provides the rationale for the research design employed in answering the research questions of the study. It also includes a description of the study site, the research design, a description of both phases of data collection, the sampling strategies and the
appropriate analytical procedures employed. In order to ensure a distinct understanding of the research process employed, the two phases will be represented in two discrete sections with the relevant subsections. The chapter concludes with a discussion on the ethical
considerations of the study.
105 4.2. Study Site
This study took place in the North West Province of South Africa. According to the Annual Performance Plan 2015/2016, the North West Province has four district
municipalities; Bojanala Platinum, Dr. Ruth Segomotsi Mompati, Ngaka Modiri Molema and Dr. Kenneth Kaunda Districts. It is South Africa’s fourth-smallest province with an estimated population size of 3.6 million in 2014.
Figure 4.1. Map of North West Province. Adapted from “North West Municipalities”, 2017.
This study was conducted within the jurisdictions of the Dr. Kenneth Kaunda District Municipal area and Bojanala Platinum District Municipal area. The NHI intervention site comprised of 20 clinics in Dr Kenneth Kaunda District (KK) and the non-NHI control site
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consisted of 20 clinics from the Bojanala Platinum District (BP) that were selected through a randomisation process.
4.2.1. Dr Kenneth Kaunda District Municipal Area
According to the Annual Performance Plan 2015/2016, the Dr Kenneth Kaunda District (KK) has a total population of 695 933 (Statistics SA, 2011), and covers a
geographical area of 14,767 square kilometres. It has two peri-urban sub-districts, Matlosana and Tlokwe, and two rural sub-districts; Maquassi Hills and Ventersdorp. The majority of the population reside in Matlosana.
Figure 4.2. Population Distribution in Dr Kenneth Kaunda District and Sub-districts.
According to the “North West Municipalities” (2017), the main economic sectors are mining, trade and finance. The age demographics for the district are presented in Table 4.2.
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Figure 4.3. Age Demographics in Dr Kenneth Kaunda District and Sub-districts. Adapted from North West Kenneth Kaunda District Profile, 2013.
The majority of residents were aged between 15 to 64 years of age.
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Figure 4.4. Health Facilities in Dr Kenneth Kaunda District and Sub-districts. Adapted from North West Kenneth Kaunda District Profile, 2013.
From Figure 4.4 it is evident that health services were provided by 1 Regional and 3 District Hospitals; 9 Community Health Centres; 27 clinics; 6 satellite clinics and 2 mobile health service units. The two district hospitals as noted above are both situated in the rural area of the North West Province. In the urban areas, level 1 service was provided by the Regional Hospital (North West Kenneth Kaunda District Profile, 2013).
4.2.2. Bojanala Platinum District Municipal Area
Bojanala Health District is situated in the Eastern part of the North West Province and includes five sub-districts (Rustenburg, Kgetleng, Madibeng, Moses Kotane and Moretele). It has a total population of approximately 1.5 million (Bojanala Platinum Municipality,
2013/2014).
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Figure 4.5. Population Distribution in Bojanala Platinum District. Adapted from Bojanala Platinum Municipality 2013/2014.
There are 119 fixed health facilities in the Bojanala district that consist of 1 Provincial Hospital and 4 District Hospitals, 8 Community Health Centres, 19 Clinics that are open 24 hours,, 15 Clinics that are open 12 hours and 77 clinics that are open 8 hours, 674 Mobile points and 16 Health points (Bojanala Platinum Municipality, 2013/2014).
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Figure 4.6. Health Facilities in Bojanala Platinum District and Sub-districts. Adapted from Bojanala Platinum Municipality, 2013/2014.