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Background: The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings. Aim: The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict. Setting: Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study. Methods: Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed. Results: Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support. Conclusion: If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients. Contribution: Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Longitudinal training dams (LTDs) are a promising alternative for river groynes. Here we summarize findings of a recent study focused on the along river transition from a series of river groynes to an LTD, where the flow divides between the fairway and the side channel between the LTD and the river bank. A scale model is setup using lightweight granulates made of polystyrene to create conditions that are dynamically similar to a prototype situation in the River Waal. The key advantage of using lightweight granulates is that both the Shields number and the Froude number are similar in the model and the prototype. A high flow and a low flow experiment were carried out. The bedforms in the physical model have dimensions that correspond to theoretical dune height predictions, and also the channel incision due to width reduction is in accordance with expectations. The scour holes that develop near the tip of the groynes, however, are too deep, which may relate to improper scaling of the local turbulent vortices, initiated at the groynes. The morphodynamic developments in the flow divergence zone are subtle, and are overwhelmed by the mobile bed response to the presence of groynes. Considering that the physical model over-predicts the erosion caused by groynes, this suggests that the LTD configuration subject to study results in a comparatively stable bed morphology.