FCPHM(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Fellowship of the

College of Public Health Medicine of South Africa
16 March 2015
Paper 1

Long Questions

(3 hours)

Each question to be answered in a separate book (or books if more than one is required for the one answer).
Candidates must answer three of the following four questions.
All the questions carry equal marks. The use of personal hand-held calculators is permitted.

THREE OF THE FOUR QUESTIONS MUST BE ANSWERED

1

Following the 2014 World Health Assemblys resolution to encourage all member states to
prioritise palliative care in service delivery, the provincial department of health where you
work as a Public Health medicine specialist asks you to develop a policy that would outline
a model for the implementation of palliative care within the province. Motivate and outline a
model for palliative care delivery for the province.
[33 ]

New regulations promulgated in April 2011 under the National Health Act (Act 61 of 2003)
made the reporting of cancer cases by clinicians and hospitals compulsory. As the newly
appointed head of the national cancer registry, discuss the importance of these regulations
for cancer surveillance in South Africa. In particular, discuss
a)
The principles and purposes of public health surveillance, and the various
mechanisms for conducting population based surveillance.
(10)
b)
The existing national cancer registry and its shortcomings which led to the
promulgation of the 2011 regulations.
(6)
c)
The main objectives and mechanisms of reporting on cancer as per the 2011
regulations; the benefits and shortcomings of these regulations in improving cancer
surveillance in South Africa.
(7.33)
d)
Outline your overall plan to further develop a population based cancer surveillance
system in South Africa.
(10)
[33 ]

You are the medical manager at a specialised TB hospital in KwaZulu-Natal. One of the
medical officers has reported that he has recently observed that a high number of patients
have developed relapse of their TB disease and have had to be re-admitted for treatment.
Discuss how you would go about exploring the risk factors for relapse amongst TB patients
admitted to the hospital.
[33 ]

PTO/Page 2 Question 4

-24

The Expanded Programme on Immunisation (EPI) is one of the most powerful and costeffective public health programmes to improve child survival. South Africa has set the goal
of 95% coverage for the fully immunised child under 1 year, with every province achieving
at least 80% coverage. However out of the 52 districts, 16 (30.8%) and 11 (21.2%) did not
reach the target of 80% for fully immunised children in 2010 and 2011 respectively.
a) Describe the epidemiology of vaccine preventable diseases in children in South Africa,
the EPI goals and targets, and motivate why achieving a high immunisation coverage
rate is important in the control or eradication of these diseases.
(10)
b) Discuss the main factors contributing to suboptimal immunisation coverage in South
Africa.
(7)
c)
Identify and describe two evidence informed strategies to improve immunisation
coverage.
(6.3)
d) As a public health specialist supporting a health district with less than 80%
immunisation coverage of children under 1 year, outline a 5 year plan to improve
immunisation coverage in your district.
(10)
[33 ]

FCPHM(SA)

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain
Reg No 1955/000003/08

Examination for the Fellowship of the

College of Public Health Medicine of South Africa
18 March 2015
Paper 3

Short questions

(3 hours)

All questions are to be answered. Each question to be answered in a separate book (or books if more than one is
required for the one answer). The use of personal handheld calculators is permitted.

Please note: Choose 8 out of 10 questions.

1

A patient presents at a primary care facility with a history of fever and recent travel to West
Africa. Ebola is suspected. What steps would you follow to conduct an appropriate outbreak
investigation?
[10]

You are appointed as the new occupational health doctor at an underground gold mine.
You do an occupational health risk assessment of the mine. Tabulate the hazards you
found, the risk they hold and the effects it can have on the health of the workers and how
you can mitigate for the risk. Develop a scale for the risks and explain what your scale
means.
[10]

Adolescent development is a period associated with risky behaviour. There is an especially

high risk associated with sexual behaviour. Use an appropriate behavioural theory model to
explain how this behaviour is shaped. Describe the relevant concepts of the theory you
choose. Develop a logical framework to explain how the theory can be used to change the
behaviour of this group.
[10]

Fracking for gas in remote rural areas is proposed as one strategy to manage South
Africas energy requirement through sourcing a bio-mass fuel. As a policy advisor for the
national department of health, you have been asked to serve in a team tasked to conduct
an environmental health impact assessment (EHIA) for government on fracking. Outline the
key elements of your policy advice on EHIA and your role as a Public Health Medicine
specialist on such a task team on fracking for gas.
[10]

Nurse initiated anti-retroviral treatment (NIMART) programmes have been identified as a

useful task shifting strategy to make HIV treatment more accessible in South Africa.
Identify the issues that need to be addressed by policy makers for the implementation of
this strategy.
[10]

Cluster sampling is a useful method used in many cross-sectional surveys. Explain its use,
and the implications for data analysis.
[10]
PTO/Page 2 Question 7

-27

The South African Minister of Health appoints you as head of a task team that will make
recommendations on whether cannabis should be legalised for medical use in the country.
Discuss the key factors on which you will base your recommendations.
[10]

The CEO of a regional hospital seeks your advice midway through the financial year. He is
extremely concerned that his annual budget for goods and services will be exceeded with
several months still left of the financial year.
a)
List five possible reasons for a mismatch between the allocated budget and the
expenditure for goods and services.
(2 )
b)
Discuss the options the CEO could consider to deal with the likely over-expenditure
for goods and services? Provide appropriate examples where applicable.
(7 )
[10]

A risk adjusted capitation system is proposed as a payment mechanism for providers at

primary care level in the 2011 Green Paper for a National Health Insurance. Describe the
proposed mechanism, and discuss the advantages and disadvantages of such a payment
system.
[10]

10

Briefly describe the four basic principles of biomedical ethics and, in your own words, what
each means.
[10]