Postgraduate Diploma
in Public Health
Population Health and
Development: A Primary Health
Care Approach I
Module Guide
School of Public Health
University of the Western Cape
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
i
Population Health and Development: A Primary Health
Care Approach I
UWC Module Registration Number: SPH 732
First published: 2010
Writing Team: Lungiswa Tsolekile, David Sanders, Barbara Hutton
Editor/s: Lungiswa Tsolekile, David Sanders, Barbara Hutton. With editorial
assistance from Dawn Daniels.
Copyright © 2010, SOPH School of Public Health, UWC.
License:
Except where otherwise noted, this work is licensed under a Creative
Commons Attribution-NonCommercial 4.0 International License
[http://creativecommons.org/licenses/by-nc/4.0/]
Your use of this material constitutes acceptance of the above license and the
conditions of use of materials on this site. Use of these materials is permitted
only in accordance with license rights granted. Material is provided “AS IS”;
no representations or warranties are provided. Users assume all responsibility
for use, and all liability related thereto, and must independently review all
materials for accuracy. The module may contain materials owned by others,
all of which are acknowledged. The user is responsible for obtaining
permissions for use from third parties as needed
Readings: Reading material is listed at the end of the Module Introduction.
They were compiled for registered students in one or two Readers. Copyright
permission was sought and paid for per reading per student annually. Readings
are not included but their sources are indicated in the Module Guide.
Credit value of module: 20 (200 notional learning hours).
Study Materials for this module: Module Guide
Target group: Health and allied health and welfare professionals with a four
or more year degree (MPH)
Course delivery: This module was offered as a distance learning module with
optional contact sessions.
Design & layout: Cheryl Ontong, MultiTask
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
ii
CONTENTS
CONTENTS
Module Introduction
Unit 1
The burden, distribution and pattern of ill-health in
the world
PAGE
i
1
3
Session 1
Burden of disease in Africa and the world
Distribution of ill-health in the world and in developing
countries
13
Session 2
Patterns of ill-health in developed, developing and
underdeveloped countries
29
Session 3
43
Session 4
Situational analysis
Unit 2
The causes of ill-health in the world: The political,
social and economic context of health and disease
59
Causes of ill-health and their classification
61
The social determinants of health
75
Social equality, equity and health status
97
Session 1
Session 2
Session 3
117
Unit 3
Introduction to health, development and Primary
Health Care
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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The impact of colonialism, capitalism and
underdevelopment on health care
119
Session 1
The declaration of Alma Ata and the health care
approach
133
Session 2
Unit 4
The Primary Health Care approach
143
The implementation of the Primary Health Care
approach
145
Session 1
Application of the Alma Ata principles and the
Comprehensive Primary Health Care approach
161
Session 2
The vehicle for implementing Primary Health Care:
The District Health System
169
Session 3
Community participation and community health
workers
185
Session 4
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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I
MODULE INTRODUCTION
1
LETTER OF WELCOME
School of Public Health
University of the Western Cape
Private Bag X17
Bellville
7535
South Africa
Dear colleague
Welcome to your second module, “Population Health and Development: A
Primary Health Care Approach I”.
The main purpose of this module is to introduce you to the Comprehensive Primary
Health Care Approach: its origins, rationale, philosophy, theory, concepts and
practices. It aims to equip you with a basic understanding of how a Comprehensive
Primary Health Care Approach could be applied to the health system in your own
country.
Most of you are likely to be working in the public health sector, be it as part of your
country’s national department of public health, a non-governmental organization or a
sector which has some linkage with public health. This means that you have valuable
experience to bring to your studies as well as to the overall field or discipline of Public
Health and the practice of Primary Health Care.
In this module we also help you to develop the academic learning skills required for
studying more effectively at this level. These skills are developed alongside the Primary
Health Care content. For instance, many activities and tasks which focus Primary
Health Care content also help you develop the reading, writing, listening and other
skills needed to cope with the demands of academic study.
As far as is possible, we plan to engage you in active learning, even though you are
studying at a distance, and to this end you will be required to write two assignments,
and to prepare a portfolio. The assignments must be submitted during the course of
this module; the portfolio must be submitted by the end of your PG Diploma
programme which may be at the end of Year 1 or 2 of study, depending on your
chosen pace of study. You need to work consistently on the portfolio, as it is an
important component of your learning, but will hopefully also provide you with a helpful
addition to your curriculum vitae. There is more about the portfolio in this section.
By reading through this Module Introduction you will get a clearer picture of the topics
that will be covered, the activities you will engage in, the assignments and portfolio
requirements of the module and the outcomes we hope you will achieve. It will
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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therefore be of great benefit to you to read through it carefully. As a distance learner,
this is our main way of orientating you: if you skip over it, you will probably be lost. In
addition, acquaint yourself with the contents of the SOPH Programme Handbook
straight away. In it you will find all the information you need regarding, contacting us,
assessment, library usage, student support, and Summer and Winter Schools. We
have prepared this for your support: the onus is on you to find out how we operate.
Having explored these resources, if you still have questions, please get in touch with us
– we are there to help and we often find that it is the students who ask questions and
make demands, who succeed best.
All the contact information that you may need is contained in this introduction. You will
also find a Student Details Update Form in your SOPH Programme Handbook. If your
contact details change, please inform the Student Administrators at the School of
Public Health straight away as well as the UWC administration (details in Programme
Handbook).
We hope that you will give us feedback on your experience of the study sessions in this
module. An evaluation form will be sent to you on completion of your final assignment.
We hope you enjoy your studies.
Best wishes
Module Convenor
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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2
INFORMATION ABOUT THIS MODULE
2.1
Module Aims and Rationale
This overview introduces you to the content and the structure of the module. You will also
explore aspects of academic learning and practice some ways of learning more
effectively. You will examine the meanings of different basic concepts which underpin the
entire module and the readings.
2.2
Learning Outcomes
Here we present the intended learning outcomes of this module so that you can see
what competences you are expected to have developed by the end of the module.
By the end of this module, you are expected to be able to:
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Conduct a situational analysis of a local environment.
Analyse the burden and distribution of ill-health in selected contexts.
Discuss how physical, social, political, economic and environmental factors affect
health in a local setting (i.e. social determinants of health).
Apply this knowledge to analysing factors which affect Public Health practice in
your local environment.
Identify Public Health problems, explore their contexts, analyse their immediate,
underlying and root (IUR) causes and risk factors, and rank their priority using
selected models.
Discuss how the legacy of colonial health systems has impacted on Africa.
Explore how development can impact on the health status of the population.
Describe the origins, evolution and main features of Primary Health Care (PHC)
(and particularly Comprehensive Primary Health Care).
Discuss key current debates in relation to Primary Health Care (PHC).
Plan how to apply a Comprehensive Primary Health Care Approach to address a
local health problem.
Academic learning skills:
Apply a range of strategies to the reading of academic texts
Preview: To look quickly through a text to find out what it is about before reading it in
detail
Skim:
To quickly read the headings, illustrations, first and last paragraphs of sections,
the first sentences of paragraphs, and key words in the text
Predict:
To anticipate, foretell
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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2.3
Module Outline
The main topics covered in this module are:
Unit 1:
The burden, distribution and pattern of ill-health in the world
Unit 2:
The causes of ill-health in the world: The political, social and economic
context of disease
Unit 3:
Introduction to health development and Primary Health Care
Unit 4:
The Primary Health Care Approach
2.4
The Module Guide
This Module Guide is organised into four units. Each unit is divided into a number of study
sessions, each of which is about 5–6 hours of study time. The first page of a study
session provides an overview of the session, including a brief introduction, the contents of
the session, the learning outcomes (public health content and academic learning content),
and the main readings.
Each study session has a combination of input (content), tasks, and feedback for the
tasks. By doing the tasks, you should achieve the outcomes of the study session.
TASK 1 - Preview the Module Guide
1. Look quickly at the cover of this Module Guide. Then read the content page.
2. Skim through the pages of the Guide for a few minutes. Look at the main headings
of each unit, and the main headings of each study session.
3. Unit 1 is called, The burden, distribution and pattern of ill-health in the world. What
does this mean? What do the words, ‘burden’, ‘distribution’, and ‘pattern’ mean?
4. Unit 2 is called, The causes of ill-health in the world: The political, social and
economic context of health and disease. What does this mean? What do the words,
‘political’, ‘social’ and ‘economic’ mean?
5. Unit 3 is called, Introduction to health, development and Primary Health Care. What
does this mean? What do the words, ‘health’, ‘development’ and ‘primary health
care’ mean?
6. Unit 4 is called, The Primary Health Care approach. How do you think the four units
are linked?
7. Skim through the Guide and find the pages which introduce the four units. Read
these pages to find out what the units are about.
8. What do you think you will learn about in this Module? What are your first
impressions of the content of the Module Guide? For example, does it seem
interesting, challenging or too easy?
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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FEEDBACK
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Burden of disease refers to a problem of ill-health, how serious it is, how many
people get sick or die.
Distribution refers to how ill-health is shared, which people get ill and die before
their time, e.g. children in poor countries.
Pattern refers to the most common diseases in a population, e.g. infectious
diseases, chronic diseases.
Political is concerned with who has power and authority to control or to influence
the way in which society functions and the way in which resources and power are
shared.
Social refers to how people live and organise themselves.
Economic is concerned with resources such as money, land, jobs and food.
The four units are linked as follows:

Unit 1 examines the problem of ill-health in the world: who is mostly affected; which
diseases are the most serious, and the main causes of ill-health.

Unit 2 examines factors which have had a positive or a negative impact on the
situation of health and disease in the world.

Unit 3 examines the relationship between health, development and Primary Health
Care from a historical perspective.
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Unit 4 describes the development of the Primary Health Care Approach (PHC) – its
origins, principles, theories and implementation (which resulted in the Comprehensive
and Selective approaches). The Unit also looks at the District Health System, case
studies and at community involvement in health. The PHC Approach responds to our
findings around the burden, distribution and pattern of ill-health the world, as well as
the social, political and economic context of ill-health.
TASK 2 - Examine tasks
1. Skim through the Module Guide again. Look quickly at the names of the tasks. What
kinds of thinking skills do they encourage you to use?
2. Read some examples of Feedback given for tasks. Why do we provide feedback? How
does this help you? What are possible disadvantages of providing you with feedback?
FEEDBACK
1. Task headings usually use words such as analyse, evaluate, compare, extract
information, clarify, identify, preview, summarise, plan, and think about. These
tasks encourage you to practise and to develop these thinking skills. Tasks replace a
lecturer. They guide and support you as you grapple with new ideas and learn. They
are the most important part of the Module Guide. No-one will see your answers,
unless you want them to, so feel free to scribble notes and to try different ways of
answering questions.
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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2. Feedback provides answers to tasks and enables you to check if you are on track
and to work out where you went wrong. Feedback also helps you to assess yourself
and to judge your progress, in an informal way. When you succeed you can
congratulate yourself; when you struggle you can go back to the task and try again.
Tasks followed by feedback help to develop important skills for successful distance
learning. However, there is a danger that you might skip the task and just read the
feedback, in which case you would not benefit as much from the Module.
3
P
THE PORTFOLIO: INTRODUCTION
Preparation for the portfolio
For the PG Diploma in Public Health, you are required to prepare an electronic portfolio
– a file in electronic form – of tasks and documents produced in the course of your
studies. This portfolio serves to strengthen your learning as you study and allows you
to reflect on your progress and growth across the whole course, as well as the
challenges you have experienced. Through the Portfolio we are also trying to
encourage you to link and integrate the content of the six modules into a coherent
whole. At the same time, the portfolio should be seen as a collection of evidence of
your competence in the field of Public Health.
Some of you will have experience of portfolios providing evidence of learning in a
particular field or course. Parts of the portfolio could also serve to demonstrate your
competence in Public Health to current or prospective employers in furthering your
career.
The Portfolio should be developed across the duration of your PG Diploma in Public
Health programme, but the written report should only be completed as you are finishing
your last module - Health Promotion for Public Health I module, i.e. towards the end of
your studies. A study diary kept over the duration of your studies is therefore a good
idea. These guidelines are included so that you can prepare yourself.
Keep a study diary
While engaged in all modules, be sure to write regular notes on your learning and
achievements in a section of your study diary. It would be wise to write notes at the end
of each unit. This will help you in the end to develop your portfolio report as you may
not be able to recall everything that happened during the year (or two years) when you
reach the end of the programme.
These are the instructions for the Assignment you will be asked to complete at
the end of your programme as part of your assignment submission for the Health
Promotion module.
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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COMPILE AN ELECTRONIC PORTFOLIO
The portfolio contains two parts and should not be more than 25 pages. It should
include:
 Part I: A careful selection of your work compiled as you work through the six
modules. This may comprise of between six – eight (6-8) samples of your work
as evidence of your experience and growth; relevant items undertaken
alongside the programme for your work role may be part of the 6-8 samples;
and
 Part II: A reflective report in which you comment on your experience and
growth using the samples as evidence of this growth.
The portfolio should have a contents page listing the selection of work (Part 1) and
Reflective Report (Part 2). Each of the components of your portfolio should be clearly
labelled with Initial and Surname, Name of the component, and the number
corresponding with contents page, e.g. L Mdaka IPH Work Sample 1.1.
Part I: Selection of your work to provide evidence of your experience and growth
Guidance on what should be included
You have to select between six and eight samples of your work that
demonstrate your experience and growth within this postgraduate programme.
Be aware that you are required to be selective – so show your best evidence,
rather than include everything you have. LESS IS MORE. Your selection of
samples should be from the following two sources: any assignments or tasks
with the portfolio symbol and any other samples of work produced since
commencement of the PGD course.
1.
Assignments or tasks from your module that are marked with the symbol on the
right, mean that it must be included in the portfolio. There are only three
assignments or tasks marked with the symbol and these are in the first three
modules of the course.
1.1
Introduction to Public Health Module: Assignment 2 Question 1: CHW
PPT.
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Pretend you are a trainer from the Ministry of Health seeking to train a
group of Community Health Workers (CHWs). Develop a powerpoint
presentation on a communicable or a non-communicable disease aimed
at training CHWs on this disease and its prevention. The presentation
must be made up of 8 - 10 slides excluding the title slide and list of
References. Focus your attention particularly on the items which have
been underlined but include all items. Remember that the aim is
prevention, so select accordingly.
Disease description
Prevalence of this health problem within your district (Choose one of
your districts)
Mode of transmission (agents, vectors, reservoir) and incubation period
Risk factors
Symptoms
Susceptibility
Treatment
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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P
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Consequences and burden on the population
Prevention/Methods of control
Reference List.
1.2
Primary Health Care Module: Assignment 2 Part 2:
Reflect on your own practice/ programme or projects that you have been
involved in. How comprehensive or selective have these programmes or
projects been? How has this Module changed the way you think about
the Primary Health Care Approach? Write a 3-page reflection piece.
1.3
Descriptive Epidemiology: Assignment 1:
Compare health status datasets: use the indicators you collected in
Assignment 1 to compare your region with another region, or compare
last year’s data for your region with this year’s, and then, compare your
region’s data with the national policy goals.
1.4
Other samples of your work which show evidence of your learning and
growth over time. These samples could be selected from the following:
Any part of an assignment or task from the remaining three
Postgraduate Diploma modules (Strategies for Management, Health
Promotion I, Monitoring and Evaluation I).
1.5
Your portfolio may also include items developed in the course of your
professional work since you embarked on your studies, e.g. reports or
proposals you have written, training reports, audio recordings of your
input, course notes from anything you have taught, posters presented at
conferences … in fact anything that you consider evidence of your
competence and growth, e.g. a letter of appreciation from your
employees, or any similar item.
Part 2: Writing Your Reflective Report
This report constitutes 40 marks of Assignment 2 of Health Promotion for Public
Health I.
Write a reflective report in NO MORE than 1000 words, 1.5 spacing 12 pt Times
New Roman on your experience of the PG Diploma course. Your report should include
the following items:
1. A discussion of what you have learned and whether or how it influenced
your work. Use the evidence you provided in your list of samples in Part 1.
2. A diagram could be used to show how you see the different modules fitting
together.
3. Highlights and challenges you have experienced in the PG Diploma course.
4. Reflections on your own professional, personal or academic growth over
the period of this course.
5. Changes in your view of your role in Public Health.
6. Gaps in your capacity as a Public Health practitioner.
7. Goals for future learning in any area relevant to this course.
What is meant by reflection?
In the course of the first semester, we will send you some guidance on writing reflective
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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reports and their potential purpose, as a means of learning.
Tips on submission
Since this is an electronic portfolio, you will need to label your files clearly, and send
them in one (or two) emails to the Student Administrator with any special instructions
for printing out. Numbering and labelling pages is important.
Assessment Criteria for the Portfolio (Assignment 2B – Health Promotion
for Public Health)
Marks
i. Demonstrates insight into the field of Public Health
10
ii. Insightful reflections on own growth and development, with appropriate
selection of examples demonstrating this growth (incl. strengths and
weaknesses); has the student linked samples with the statements made in
the reflection report?
20
iii. Selection of samples shows evidence of professional growth
5
iv. Evidence of future learning goals
3
v. Presentation: clarity of organisation of the report
2
Total
4
ASSESSMENT
4.1
Information about assessment
40
There are TWO compulsory assignments in the Module. You must submit both, on
deadline. You will receive assignment deadlines from the SOPH Student Administrator.
Consider it your responsibility to ensure that you know the deadlines when the
semester starts. In addition, you are required to keep a diary of your reflections on this
Module, and all your Modules, in preparation for developing a Portfolio of your work
across the Postgraduate Diploma in Public Health. (See Portfolio Development at the
end of the Module Introduction).
The module is weighted as follows:
Assignment 1: 40%
Assignment 2: 60%
To pass the module:
 You are required to pass both assignments with a minimum of 50%.
 You must have a minimum aggregate of 50% or more for the module.
 If you get below 50% in Assignment 1, you may repeat it once only.
 If you do not pass it second time around, you cannot proceed to Assignment 2 and
must repeat the module the following year.
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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
If you do not achieve 50% in Assignment 2, you repeat the entire module the
following year.
IMPORTANT:
The following section contains the assignments for the module. Please read
questions and instructions carefully. There is important information about
assessment in the SOPH Programme Handbook, be sure to refer it before
submitting your assignment.
4.2
Your Assignments for Population Health and Development: A Primary
Health Care Approach I
Assignment 1 – Situational analysis (100 marks)
Weighted at 40% of your Module result; you will need to reach the end of Unit 1 to
undertake this assignment.
ASSIGNMENT 1:
TB has been identified as one of the top 10 causes of death in your district. You are
therefore assigned to design an intervention to try and curb this problem. However,
before designing such an intervention, it is necessary to conduct a situational
analysis. For the purpose of this assignment you will be required to collect qualitative
data as part of the situational analysis.
For the situational analysis you are required to do the following:
1. Interview seven stakeholders namely, health facility personnel (2), community
leaders (2) and community members (3). The interview should focus on:
 The perceived causes of TB;
 TB interventions that are present in the community;
 Attitudes towards those with TB; and
 Beliefs about TB.
2. Use any classification of causes from Unit 2 Session 1 to classify the causes that
have been highlighted by the interviewees.
3. Answer this question: What are the effects of TB on individuals and families?
Guidance on doing the assignment
Produce a mini report on your findings. The report should contain the following
information:
1. Introduction (include relevant literature review on TB prevalence, TB attitudes,
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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beliefs and practices and stigma)
Classification of causes
Effects of TB on the individual and family.
Description of interviewees (such as age, level of education, etc).
What were the advantages of using interviews to gather the information and what
were the disadvantages? What other data collection methods would have been
useful? Explain why?
6. Summary of findings (include transcripts or notes gathered during the interviews)
7. Conclusion (which summarises the main causes and effects)
8. References (Harvard style)
2.
3.
4.
5.
The assignment must not exceed 15 pages, excluding the references.
Assessment Criteria for Assignment 1
i)
Selection of information based on literature: evidence of reading
(8 marks for each concept)
Marks
/20
ii) Citation and referencing (Harvard style)
/5
iii) Appropriate classification of causes using an appropriate
framework
/20
iv) Identify the effects of TB on the individual and family
/10
v) Description of interviewees
/10
vi) Motivation on why a different data collection could have been
appropriate
/10
vii) Clear summary of the main findings
/15
vii) Clear summary of the main causes and effects of TB
/10
TOTAL
/100
Assignment 2 – Comprehensive Primary Health Care (100 marks)
Weighted at 60% of your result; you will undertake Question 1 as you work through
Unit 3; you will need to reach the end of Unit 4 to undertake this assignment.
Select a health programme in your district or a project that you are working on. It must
be one that is designed to address the problem of TB.
1. Describe the key strategies used in this programme (in other words, the various
activities that are implemented to address the problem).
2. Then, critically assess to what extent the programme is an example of a CPHC
programme: What is present? What is missing (gaps)? What needs to be done to
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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make this programme or project more comprehensive and contain more PHC
principles?
3. What resources could you utilise or would you need to make the programme more
comprehensive; and why do you need these resources (motivation)? For example,
would you reorganise current resources, retrain staff, and link to other departments
or sectors? Would you need additional inputs – and if so, what will they be?
4. What key challenges would you face in implementing such a comprehensive PHC
programme in the district?
Assessment Criteria for Assignment 1
i)
Marks
Description of the key strategies used in the programme/project
/15
ii) Critical assessment of the programme - identification of gaps,
application of PHC principles to improve the comprehensiveness of
the programme/project
/25
iii) Identification and description of resources
/10
iv) Clear reasons are given to motivate for resources
/15
v) Description of the challenges in implementing a comprehensive
primary health care programme
/15
TOTAL
/80
P
You may want to rework this question for your Portfolio at the end of your
course. Read the information in Section 3 of this Module Introduction.
In this Module you have learnt about the elements of PHC, CPHC and SPHC. Reflect
on your own practice/ programme or projects that you have been involved in.
How comprehensive or selective have these programmes or projects been? How
has this Module changed the way you think about the Primary Health Care
Approach? Write a 3-page reflection piece.
Guidance on doing the portfolio
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A personal reflection is a self-evaluation of your own learning progress or growth,
the challenges you have or are facing, your feelings about the content you have
been exposed to, your perspectives, your attitude and further needs at a particular
time.
When writing your portfolio, refer to some of the key concepts you have explored in
the Module.
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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Assessment Criteria for the Portfolio (part of Assignment 2 –
Population Health and Development: A Primary Health Care Approach
1)
Marks
i)
Demonstrates insight into the Primary Health Care Approach
5
ii)
Insightful reflections on own growth and development with
exemplification (including strengths and weaknesses)
15
TOTAL
4.3
20
Submitting Assignments
Read the SOPH Programme Handbook before submitting: Section 8 contains
instructions you must make sure to follow before submitting any assignment.
There is crucial information regarding referencing and plagiarism in Section 8.3.
These guidelines must be followed exactly every time you submit an assignment.
Getting this wrong wastes our time, and we WILL return the assignment to you to
correct.
 You may send assignments by email, fax or post. (Email and fax save time). Keep
a copy of everything you have sent. If you post, use fast mail or courier.
 Send assignments to the Student Administrators, not the lecturer.
 When you submit your assignment, you will receive acknowledgement that it has
been received. If you don’t, check that it has been received.
 Type your assignment on A4 paper, in 1,5 line spacing, in 12 pt Times New Roman,
and leave normal margins for the lecturer’s comments.
 Handwritten assignments will not be accepted.
 Keep to the recommended length. Excessively long assignments may be penalised.
 Number ALL pages.
 Include the Assignment Cover Sheet (completed fully) as the first page of the
assignment, i.e. the cover sheet and the assignment must be one document.
 Always put your name on every file you send, and label the file correctly, using
these instructions as a guideline if submitting by e-mail:
 Your Name (Surname, Initial) e.g. Mambwe R
 Module abbreviation (see Programme Handbook for Core module
abbreviations). Use CAPITALS, e.g. PHC I
 Assignment number, e.g. 1 or 2, and Draft or Final
 The year, e.g. 2015
e.g. Mambwe R, PHC I Asn 1 Final 2015; Mambwe R, PHC I Asn 1 Draft 2015.
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4.4
Assignment Deadlines
Assignments must be submitted by the due date, preferably by e-mail, but fax or post
are accepted if dated on or before the due date. You will receive assignment deadlines
from the Student Administrator once you have selected your modules.
PLEASE NOTE: Late submission of assignments will impact on the time you have
available for the next assignment, disrupt your lecturers’ schedules and result in late
submission of marks into the UWC marks administration system; should that happen,
you will have to repeat the entire module. It is therefore in your interests to manage
your time as effectively as possible. Section 4 in this Module Introduction offers some
general guidance and a blank work plan for you to work out your schedule for the
semester. Should you require more guidance, try the SOPH Academic Handbook.
Assignment Extensions
Under special circumstances, extensions may be granted. Even so, the extension will
not normally be longer than two weeks. To request an extension, contact the Student
Administrator (not the lecturer or Module Convenor) as soon as a problem arises. No
extensions will be given for Draft Assignments, and no late assignments will be
accepted in Semester 2.
4.5
Draft Assignments: Please read this section carefully
Lecturers will give you valuable feedback on your assignment if you send a draft.
However, Drafts will ONLY be reviewed if they are received TWO OR MORE weeks
before the final submission date; no extensions will be given for drafts.
If you want to submit a draft, do not submit a complete assignment. Select sections
with which you are having difficulty, or submit an outline of the whole, but not the whole
assignment.
Lecturers will make every effort to respond to submitted drafts timeously, but if they run
late, they will give you a full week to return the final assignment.
Over the page is the Cover Sheet for the assignments. Please note that it has been
included on the CD and sent to you by email.
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4.6
ASSIGNMENT COVER SHEET
School Public Health – University of the Western Cape
An Assignment Cover Sheet needs to be copied into the same file as every e-mailed
assignment. If you courier or fax your assignments, attach one to the front of your
assignment.
Full name:
______________________________________________________
E-mail address:
______________________________________________________
Postal address:
______________________________________________________
Student number:
Convenor:
Module name:
Assignment
______________________________________________________
1 (DRAFT)
2 (DRAFT)
1 (FINAL)
2 (FINAL)
Please
Tick
If faxed, state the total number of pages sent including this page: ________________
Student’s comments to tutor
________________________________________________________________________
________________________________________________________________________
Declaration by student
I understand what plagiarism is. This assignment is my own work, and all sources of
information have been acknowledged. I have taken care to cite/reference all sources as
set out in the SOPH Academic Handbook.
Signed by the student:
_________________________
The tutor’s comments are on the reverse of this form
-----------------------------------------------------------------------------------------------------Office Use
Date
received
Assessment/Grade
Tutor
Recorded &
dispatched
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5
WORKLOAD AND SUGGESTED WORK PLAN
There are 13 sessions in this module. Because the sessions vary in length, we suggest
you set your own goals for when to complete each Study Session, using the work plan
provided (this will be posted to you during the course of studying this Module). Keep
track of the time it takes you to study so that you can plan your schedule more
accurately.
Remember that your draft assignment must be sent at least two weeks before the due
date. Assignment 1 requires you to complete Unit 1 and; Assignment 2 requires you to
complete Units 2, 3 and 4.
Planning process
Use these steps to develop your own work plan:

Review the suggested work plan. Identify the weeks when you will be under other
pressures. Fill in fewer Study Sessions for those weeks.

Note the Discussion Group dates.

Spread the units across the time available. This means completing at least two
Study Sessions per week.

Reserve time for completing the draft and final assignment.

Write the Study Sessions you plan to complete in the final column in pencil, and
adjust the schedule if it becomes necessary.
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WORK PLAN FOR Population Health and Development I
WEEK
STARTING
DATE
UNIT &
SESSION
YOUR OWN WORKPLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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6
EXPLORE ACADEMIC LEARNING
Academic learning skills are special reading, writing and other skills and attitudes needed
in order to study successfully in an academic context. Reading and writing are the two
skills most crucial to your studies at this level.
Reading skills
Table 1 sets out a process that we strongly recommend you use each time you need to
read a text. This process helps you to read with meaning, understand what you are reading
about, take notes while you are reading, and draw conclusions.
Table 1: Reading skills
How you preview texts
What we learn from this
 Read the cover (title, author)
 Read the imprint page (author,
source/publisher, date of
publication)
 Read the notes about the author
and the text on the back cover
 The main purpose of the text.
 The perspective of the author and/or
the institution to which they are
attached.
If the text contains up-to-date or outdated
information.
To read the text more critically.
 Read the contents page.
 An overview of what the text covers
– this helps us to prepare our minds
so that we know what to expect from
the text.
 Think about how the text links
to the study session, unit and
Module.
 To read actively and to make
connections between ideas.
 Skim the headings, illustrations, first
and last paragraphs of chapters or
sections, the first sentences of
paragraphs, key
words in the text.
 To direct our thoughts in preparation for
reading the text in detail.
 To understand how the text is
structured, so as to have a framework in
our minds into which we can fit new
information that we read.
 To have a clear sense of the whole
before reading in detail.
 To predict the main ideas or arguments
and how they are linked.
 To understand the text and to remember
the ideas more easily.
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What is involved in thinking or reading ‘critically’?
TASK 3 – Examine what critical thinking or reading means
1. Think about this family of words: critic, criticise, criticism, critical, critique,
critically. Jot down as many meanings of these words as you can think of.
2. In a learning context, what is a ‘critical’ reader or thinker? How would you
expect the person to deal with information or ideas?
3. Imagine reading an author’s definition of what ‘health’ means. What kinds of
critical questions might you ask about this?
FEEDBACK
1. critic – someone who commentates, judges or reviews something
criticise – to make a judgement about something, to look for the strengths and
weaknesses
criticism – the judgement, evaluation or disapproval offered by a critic
critical – urgent or serious
2. A critical reader or thinker usually wants to get to the root causes or the essence of
something. They tend to question ideas rather than just accept and repeat them as
presented. They think deeply about something and look for inconsistencies, flaws,
gaps or missing information, aspects that do not add up or make sense.
3. You might ask:

Who is the author? How does his/her position affect his/her view of health?

How universally accepted is this definition?

Is this the only possible definition of health?

What does ‘health’ mean to me?

Who else has defined health? How do they support or argue their definitions?

What are the essential, most important features of the concept of health?

How has its meaning changed over time?

What are some of the main debates or controversies around this concept?
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The writing process
When you need to write an essay or assignment, we recommend that you follow
the writing process in the diagram below. The stages of the writing process follow
each other logically, like a cycle.
You begin by analysing the assignment or question and what it requires. This involves
looking carefully at the wording of the task and analysing the instructions or the actual
words. The second stage is to brainstorm ideas on the topic, asking yourself what you
already know about this topic and how you might approach it. Thirdly, you read and make
notes, always bearing your question in mind. Once you have done this, you can plan your
answer. This is the fourth stage. The fifth stage is to write a first draft. You then read over
it, or ask a fellow learner to read it and evaluate your answer. This is the sixth stage. The
final stage is to rewrite the assignment or exam answer.
You can repeat the process as many times as you would like until you are
satisfied with the final text. However, you do not have to strictly follow the
sequence of stages in the cycle. In fact it is quite usual for a writer to alternate
between the different stages. For instance, when you draft sections of the
assignment in Stage 5, you might find that you want to go back to Stage 3 to
collect more information, or to Stage 4 to revise the plan. So the writing process
cycle is flexible.
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These next tasks are designed to help you to identify other important academic learning
skills, and to clarify the meaning of the terms 'concept', 'theory', ‘evidence’ and 'argument’.
Identify academic learning skills
TASK 4 - List academic learning skills
1. In the diagram below, jot down very quickly some examples of academic learning
skills. Do not stop to think about them.
2. What do we call these kinds of diagram and how can they help us learn?
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TASK 5 - Identify academic learning tasks
1. Skim the Module. Find three or four tasks that you particularly like, which you think will
help you develop academic learning skills. List the skills that these tasks will help you
develop.
2. Why have we included the development of academic learning skills in this Module?
3. What academic learning skills do you feel you could improve or develop further?
FEEDBACK
1. A checklist of the main academic learning skills developed in this Module is provided
near the beginning of the Module Guide.
2. Academic learning skills are developed in this Module to assist those learners who
are unsure about some aspects of academic learning, especially if English is not their
first language. Even learners who feel confident about these skills could try some of
the tasks. This may heighten their awareness of what academic learning entails, and
what their strengths and weaknesses are. Also, some learners may discover new
ways of learning such as the ‘writing process cycle’ which they can incorporate into
their set of academic learning skills.
3. Keep the list of skills that you want to develop further. We discuss these later.
What are concepts?
You have probably noticed that the term 'concept' is used a great deal in academic study.
People also talk about 'conceptualising' and even 'reconceptualising'. But what do they
really mean? Most people find a concept difficult to define because it is an abstract,
general idea rather than a concrete or material object which we can see.
Concepts direct our thoughts and actions. We are often not aware of our concepts,
although they underlie the terms or names that we give to things, e.g. the world, history,
health, disease, war, poverty. If we examine the meaning or the definition of these terms
we find that they embody concepts or abstract notions.
Concept:
A general, abstract idea or set of ideas.
Often we have a shared, common understanding of the concept underlying terms. Here
is a simple example. Think about the term, 'a doctor'. What concept underlies this term?
Check the definition in a dictionary. You will probably discover very different concepts of
a medical doctor. Below are just a few.
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*
*
*
A trained, licensed professional expert
A healer of people's physical ailments
A person responsible for curing and preventing disease and promoting the allround health of people.
Often people use very different underlying concepts for the same term because they see
the main characteristics and functions in different ways. For some people, for example, a
doctor is a specialist, trained and licensed professional, an expert who cures them. For
others a doctor is responsible for the whole physical, emotional and psychological wellbeing of people. Yet we all employ the same term and rarely explain exactly what we mean
when we refer to a 'doctor'. These contrasting views have developed as a result of our life
experiences, beliefs, values and attitudes. Our understanding of these terms can also
change as we experience new things which alter our knowledge, beliefs and attitudes.
Because terms are not easily defined and competing or contradictory definitions exist, this
can create confusion, misunderstandings and even conflict between people.
Terms and their embedded concepts are important in our daily lives as much as in
academic study because they help us to think, and to describe and explain aspects of
the world and of our experience. They help us to organise our thoughts, to classify
random ideas, to objectify, to reflect on ideas, and to analyse and examine them critically.
As such, concepts are essential tools in helping us to understand and to make sense of
the world in which we live.
However, in academic study we strive to get to the truth, which means that concepts
become extremely important and the focus of intensive debate. For instance, most of the
concepts employed by social scientists are defined in different ways by different thinkers
who see the world in different ways. Social scientists argue constantly about whether the
concepts or their definitions are accurate and can be used to adequately describe reality.
Concepts are also important in that they form the basis for generating theory.
Concept terms:
Terms which embody or represent concepts.
What is theory?
A theory is a set of statements about reality or an aspect of it. It seeks to explain why
things are the way they are. These statements are in turn, based on concepts. When you
put together several concepts you build a theory or an explanation of why the world is like
it is, or why people behave in the way they do. Theories help us to explain and to make
sense of the world around us. But theories are only possible explanations. They are often
very difficult to prove.
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There are three other points to note about theories:
1. Much academic work is concerned with testing theory and deciding whether reality fits
the theory or not. If there is a poor 'fit' between theory and reality, if the theory does
not explain reality or the aspect of it that is being studied, it is usually rejected or reworked.
2. Theories should enable us to predict. If the world is the way the theory describes it,
then it should be possible to say that when x happens, y follows. For example, the
theory of gravity states that the earth pulls objects towards it. On the basis of this
theory we can predict that if we throw a stone from a building it will fall downwards. If it
does not, it means our theory has been challenged, and we need to rethink it.
3. All academic texts use evidence of various kinds to support their arguments or their
theories. The stronger the evidence, the less likely it is to be challenged. If the writer
does not provide solid evidence, people respond critically to the theory, which can lead
to much debate.
What is evidence?
Evidence to support theories or arguments is drawn from different sources. For instance,
historical evidence can be verbal, such as eye-witness accounts or accounts that have
been passed down through the generations, or written, such as official records,
newspaper reports, or physical artifacts, such as bones and remains of crockery and
jewellery. However, providing evidence means being selective and rejecting some
evidence in favour of other evidence.
Therefore the process of selecting evidence is always subjective or partial. It is
influenced by our viewpoint or our perspective on what we think is important, as much as
by what is available. For example, the feminist critique of much history is that it is the
history of important men. Women and women's contribution to society have been ignored.
Further, many black scholars would argue that much historical analysis is centred on the
history of important white men and ignores the achievements and contributions of other
people and African societies in particular.
Because evidence is selected, it is important to cite the source of the evidence used to
support a theory. This allows other researchers to check:

whether the evidence has been properly understood

whether all the available evidence has been reviewed before a selection was made.
Let us look at some ways in which we can challenge theory.
TASK 6 - Identify ways in which we challenge theories
1. Based on what you know about theories, how do people challenge them? On
what grounds do they challenge theories?
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FEEDBACK
1. Theories can be challenged in different ways:
a) People challenge the concepts that make up theories. For example, someone
could argue that the concept of language' as used in a particular theory of how
people learn language is incorrect. This casts doubt on the theory itself.
b) Theories are challenged empirically. This simply means that the theory is shown
not to fit the reality it says it describes. When theories are challenged empirically,
evidence is presented to show that the theory is inadequate.
c) Theories can also be based on emotional and/or irrational belief. When people
argue theories that are not true, it is very difficult to respond rationally.
As mentioned, arguments are often presented in a theory.
What is an argument?
'Argument' is yet another term which is used a great deal in academic study.
We usually use arguments:
 to convince or to persuade someone of something
 to share views and ideas, so as to reach a solution
In some ways an academic argument is similar to a written or verbal argument we might
have with a friend. Our purpose is often the same and we try to present our case in the
best possible way in order to win the argument. However, in the academic world, an
argument refers to a particular way of presenting a case for something, or opposing
another argument, by providing reasons, examples and evidence.
We can present an argument verbally, face-to-face as in a discussion, or we can present
an argument in a written text. In a written argument, the writer uses special language to
link ideas together to create a coherent, persuasive text.
The language of arguments
When we present or structure an argument, we often:
 describe something (e.g. It shows/ indicates/ appears ...)
 give examples (e.g. For example ... For instance ... e.g. ...)
 compare and contrast two things (On the one hand... on the other hand…)
 give arguments for and against a point of view
 discuss the cause and effects of something (e.g. The main cause is… / The
effects are…)
 draw conclusions (e.g. in conclusion…)
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The use of graphs
Graphs help show numbers and statistics. There are many different kinds of graphs,
but all have number scales and labels to identify the data.
Pie charts
A pie chart is a circle graph that is divided into sectors. Each sector represents or
illustrates a percentage in relation to the whole. Together, the sectors create a full
circle that represents 100%. The strength of this type of chart or graph is that it clearly
shows how the parts relate to the whole.
A. African children
B. White children
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Bar graphs
A bar graph is a chart with rectangular bars, with lengths proportional to the values that
they represent. Bar graphs are used for comparing two or more values that were taken
over time or on different conditions, usually on small data sets. The trait used to sort
the data on a bar graph is usually indicated on the horizontal axis. The count is usually
shown on the vertical axis.
Under-5 mortality rates by wealth quintile Namibia, DHS 2000
Note: rate for 10-year period preceding the survey
Source: DHS 2000
Under-5 mortality: Age-specific mortality rates
Namibia , DHS 1992, DHS 2000
Note: rate for 5 years preceding the survey
Source: DHS 1992, DHS 2000
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Line graphs
A line graph has two separate scales of numbers that organise the data – one along
the horizontal axis and one along the vertical axis. The line graph helps us make
counts, compare frequencies, determine highs and lows, and look for data patterns. It
is also used to show change over time.
Under-5 mortality: Estimated trend and MDG goal Namibia, 1980-2004
Source: i) WHO mortality database ii) World Health Statistics 2006
In addition to understanding abstract terms such as 'concept', 'theory' and 'argument',
academic learning also entails using effective learning strategies. This is the focus of our
last activity.
Develop Academic Learning Strategies
Learning strategies refer to the special habits, techniques or behaviours we use in order to
learn. These cover a range of things, such as, planning study time, organising notes,
discussing ideas with others, consulting reference books, time management, writing
notes and drawing mind-maps.
TASK 7 - Choose your preferred learning strategies
1. Think about your previous experiences of academic learning. Look at the list of
learning strategies below. Select and rank the top six on the list according to how
helpful you have found them to be in the past.
2. Then add as many new learning strategies as you can to the list.
3. Which strategies on your list develop general learning abilities and which develop
specific language skills? Which strategies develop both these skills? Tick the
appropriate column/s.
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Preferred Academic Learning Strategies
Rank
Academic Learning Strategy
I like:
studying on my own
Skills developed
General
Language
Both
studying in a group or with another student
previewing texts before I read them in detail
asking questions as I read
summarising in my own words what I have read
writing notes in the margin of the text as I read
keeping a personal dictionary of new words
discussing any learning difficulties with a good friend
planning a text before writing it
editing and rewriting texts
keeping a diary of my thoughts about learning
thinking about how to apply what I am learning in my
work
identifying the main argument in texts
checking my progress regularly
practising and applying new ways of learning
drawing diagrams to explain or to summarise ideas
identifying my weaknesses and strengths
looking up words in a dictionary
thinking of ways to remember unknown words
asking for help or finding more resources when I do
not understand something
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POPULATION HEALTH AND DEVELOPMENT: A PRIMARY HEALTH
CARE APPROACH 1 – READING LIST
When you want to quote a text from this reading list, use the details (including page
numbers) under “Publication Details”.
All sources are gratefully acknowledged.
Author/s
Publication details
Cunningham, P.,
Popenhoe. D. &
Boult ,B. (Eds.)
(1997) Chapter 11 – Health and Health Care. In Sociology. South Africa:
Prentice-Hall: 223–227.
Epstein, H. &
Julia, K.
(2007). AIDS and the Power of Women. In New York Review, February 15
Janovsky, K./
WHO
(1988) The Challenge of Implementation - District Health Systems for
Primary Health Care. Geneva: WHO: 9 – 16; 65-67
Marmot, M.
(2005). Social determinants of health inequalities. Lancet; 365: 1099–1104
Milne, S.
(2010) Haiti's suffering is a result of calculated impoverishment. From
guardian.co.uk, Wednesday 20 January 2010
Monekosso, G.L. /
WHO
(1994). District Health Management: From mediocrity to excellence in
health care. Geneva: WHO: 20 – 27
Pronyk, P.M.,
Hargreaves, J.R.,
Kim ,J.C.,
Morison, L.A.,
Phetla, G., Watts,
C. Busza, J. &
Porter, J.D.H.
Sanders, D. &
Carver, R.
Sanders D &
Carver R
(2006). Effect of a structural intervention for the prevention of intimatepartner violence and HIV in rural South Africa: a cluster randomised trial.
Lancet, 368: 1973–83.
(1985) .Chapter 3 - Health, Population and Underdevelopment. In The
Struggle for Health. London: Macmillan: 54-70.
(1985). Chapter 6 - Changing Medicine, Changing Society. In The Struggle
for Health. London: Macmillan: 185-193 and 204-213.
Schaay, N. &
Sanders, D.
(2008). International Perspective on Primary Health Care Over the Past 30
Years. In: P. Barron, J. Roma-Reardon (Eds). South African Health Review
2008. Durban: Health Systems Trust.
Schaible, U.E. &
Kaufmann, S.H.E.
(2007) .Malnutrition and Infection: Complex Mechanisms and Global
Impacts. PLoS Medicine, 4(5): 0806-0812.
Wagstaff, A.
(2002). Poverty and health sector inequalities. Bulletin of the World Health
Organization, 80 (2): 97-105.
Walt, G. &
Vaughan, P.
(1981). Introduction. In An introduction to the primary health care approach
in developing countries, London: Ross Institute of Tropical Hygiene: 1 -12.
SOPH, UWC, Postgraduate Diploma in Public Health: Population Health and Development: A Primary
Health Care Approach I – Module Introduction
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Werner, D. &
Sanders, D.
(1997) .Chapter 1 - The Life and Death of One Child: Rakku’s Story. In
Questioning the solution: The politics of Primary health care and Child
Survival. Palo Alto: HealthWrights: 11-12.
Werner, D. &
Sanders, D.
(1997). Chapter 2 - The Historical Failures and Accomplishments of the
Western Medical Model in the Third World. In Questioning the Solution: The
Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights:
13-17.
Werner, D. &
Sanders, D.
(1997). Chapter 3 - Alma Ata and the institutionalization of Primary Health
Care. In Questioning the Solution: The Politics of Primary Health Care and
Child Survival. Palo Alto: HealthWrights: 18-22.
Werner, D. &
Sanders, D.
(1997). Chapter 4 - The Demise of Primary Health Care and the Rise of the
Child Survival Revolution. In Questioning the Solution: The Politics of
Primary Health Care and Child Survival. Palo Alto: Healthwrights: 23-25.
Werner, D. &
Sanders, D.
(1997). Chapter 5 –Health Care as if People Mattered. In Questioning the
Solution: The Politics of Primary Health Care and Child Survival, Palo Alto:
Healthwrights: 23-25.
Werner, D. &
Sanders, D.
(1997). Chapter 11 - Health Status in Different Lands at Different Times in
History, A Comparative Perspective. In Questioning the Solution: The
Politics of Primary Health Care and Child Survival. Palo Alto: HealthWrights:
75-86.
Werner, D. &
Sanders, D.
(1997). Chapter 14 - A look at the situation today: Equity as a determinant
of Health. In Questioning the Solution: The Politics of Primary Health Care
and Child Survival. Palo Alto: HealthWrights: 108-120.]
Werner, D. &
Sanders, D.
(1997). Chapter 18 - Zimbabwe’s National Children’s Supplementary
Feeding Program. In Questioning the Solution: The Politics of Primary
Health Care and Child Survival. Palo Alto: Healthwrights: 138-141.
World Health
Organization
(2007). Community health workers: What do we know about them? Policy
Brief. WHO: Geneva.
World Health
Organization
(1998). Decentralization and Health Systems Change in Africa: Case study
Summaries. Prepared for the Regional Meeting on Decentralization in the
Context of Health Sector Reform in Africa. Geneva: WHO: 1-5 & 57-61.
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