Namibian primary health care nurses’ perceptions on factors influencing the successful implementation of the Integrated Management of Neonatal and Childhood Illness (IMNCI)

Thesis (MNur)--Stellenbosch University, 2021.ENGLISH SUMMARY : Background: The Integrated Management of Neonatal and Childhood Illness (IMNCI)/Integrated Management of Childhood Illness (IMCI) improves nurses’ skills on the assessment and treatment of children. The correct implementation of the IMNCI is attributed to the global reduction of mortality rates among children under five years. Namibia is among the countries where poor adherence to the IMNCI guidelines was observed. The aim of the study was to describe and explore the perceptions of primary health care (PHC) nurses on what promotes or hinders the implementation and integration of IMNCI in public PHC facilities in Windhoek, Namibia. Methods: The study used the Normalisation Process Theory (NPT) as the theoretical departure. A qualitative, exploratory, descriptive and contextual design, was applied in this study. The study was conducted at Katutura and Khomasdal Health Centres. A purposive sampling method was used. Data collection was done through individual, semi-structured, face-to-face interviews, guided by a semi-structured interview guide. Ten interviews, including the pilot study, were conducted by the researcher. Ethical approval was obtained from Stellenbosch University, the Ministry of Health and Social Services and the Khomas Regional Health Directorate. Qualitative content analysis of data, using Tesch’s eight steps was done. Findings: Despite efforts to implement the IMNCI, challenges such as negligence by the nurses, lack of training, high workload in the PHC facilities, absence of accountability to superiors and lack of adequate control, were reported to have a negative influence on the successful implementation of the IMNCI. Furthermore, lack of resources such as human resources, time, equipment and materials as well as medicines, were also found to be negatively affecting the implementation of the IMNCI. Conclusion and recommendations: Although Namibian nurses were found to have a sound understanding of the IMNCI, their ability to implement the strategy was reported to be hindered by various factors. Recommendations include availing of IMNCI training opportunities, provision of adequate human resources, IMNCI equipment and medicine to the PHC facilities, as well as strengthening of control measures such as supervision and support visits.AFRIKAANSE OPSOMMING : Agtergrond: Die Geïntegreerde Hantering van Neonataal- en Kindersiektes (GHNKS)/ Geïntegreerde Hantering van Kindersiektes (GHKS) verbeter die vaardighede van die verpleegsters vir die assessering en behandeling van kinders. Die korrekte implementering van GHNKS word toegeskryf aan die wêreldwye afname in die sterftesyfers van kinders onder die ouderdom van vyf jaar. Daar is bevind dat Namibia onder die lande is waar GHNKS riglyne swak nagekom word. Die doel van die studie is om die persepsies van primêre gesondheidsorg (PGS) verpleegsters te ondersoek en te beskryf oor wat bevorder of verhinder die implementering en integrasie van GHNKS in Staatsgesondheidsorg fasiliteite in Windhoek, Namibië. Metodes: Die studie het gebruik gemaak van die Normalisering Prosesteorie (NPT) as die teoretiese vertrekpunt. ‘n Kwalitatiewe, ondersoekende, beskrywende en kontekstuele ontwerp is in die studie toegepas. Die studie is by Katutura en Khomasdal Gesondheidsentrums uitgevoer. ‘n Doelbewuste steekproefmetode is gebruik. Data-insameling is deur individuele, semi-gestruktureerde, van aangesig-tot-aangesig onderhoude gedoen, gelei deur ‘n semi-gestruktureerde onderhoudsgids. Tien onderhoude, insluitende die loodsprojek is deur die navorser voltooi. Etiese goedkeuring is van de Universiteit van Stellenbosch, die Minister van Gesondheid en Maatskaplike Dienste en die Khomas Streeksgesondheid Direktoraat verkry. ‘n Kwalitatiewe inhoudelike analise van die data is met behulp van Tesch se ag stappe uitgedra. Bevindings: Ten spyte van pogings om die GHNKS te implementeer, is uitdagings soos nalatigheid van verpleegsters, ‘n tekort aan opleiding, hoë werklading in die PGS fasiliteite, afwesigheid van verantwoording doen aan gesagdraers en gebrek aan voldoende beheer, gerapporteer wat ‘n negatiewe effek op die geslaagde implementering van GHNKS het. Vervolgens, ‘n gebrek aan menslike hulpbronne, tyd, toerusting en gereedskap, asook medisyne het ook die implementering van GHNKS negatief geaffekteer. Gevolgtrekkings en aanbevelings: Alhoewel daar bevind is dat Namibiese verpleegsters ‘n goeie begrip het van GHNKS, is hulle vermoë om die strategie te implementeer, verhinder deur verskeie faktore. Aanbevelings sluit in die beskikbaarstelling van GHNKS opleidingsgeleenthede, voorsiening van voldoende menslike hulpbronne, GHNKS toerusting en verskaffing van medisyne aan die PGS fasiliteite, asook die versterking van beheermaatreëls soos toesighouding en ondersteuningsbesoeke.Master