921 research outputs found
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Household formation and service delivery in post-apartheid South Africa: Evidence from the Agincourt sub-district 1992-2012
No full textSouth Africa has seen a rapid rate of new household formation since 1994. The same period has also
seen an impressive roll-out of housing and services. These interact since new household formation
delays the elimination of backlogs. Based on data from the Agincourt study site and a novel
decomposition technique we suggest that service delivery may actually fuel new household
formation.JEL codes: C42, D19, I3
More than just a black-board: Cash transfers and adolescent education in South Africa
No full textPlease note: This paper has been updated. Cash transfers are a well-known tool in the developing world to alleviate poverty. However, much of the research evaluating these programs has focussed on short term outcomes, in populations of younger children. Using exogenous changes in the age eligibility limit of an unconditional cash transfer to South African children, this paper examines the current and cumulative impact of grant receipt on the educational outcomes of older adolescents. We find that while current grant receipt raises enrolment rates, longer exposure to this cash transfer does not predict higher years of education attained, or other similar measures of cumulative attainment. This finding emphasises the crucial nature of school quality for educational attainment - a hypothesis that the data supports. It is clear that education is a function of more than just a blackboard - quality of school matters too
Persistent High Burden of Advanced HIV Disease Among Patients Seeking Care in South Africa’s National HIV Program: Data From a Nationwide Laboratory Cohort
No full textBackground
The South African national HIV program has increased antiretroviral therapy (ART) coverage over the last decade, supported by policy changes allowing for earlier ART initiation. However, many patients still enter care with advanced (<200 cells/μL) and very advanced (<100 cells/μL) HIV disease. We assessed disease progression at entry to care using nationwide laboratory data.
Methods
We constructed a national HIV cohort using laboratory records containing HIV RNA loads and CD4 counts from 2004 to 2016 to determine entry into care. We estimated numbers and proportions of adults with the first CD4 count <100 cells/ μL or 100–199 cells/μL. We calculated relative risks of presenting with advanced disease associated with male sex.
Results
8.04 million first CD4 results were identified. From 2005 to 2011, the proportion of patients entering into care with CD4 count <200 cells/μL declined from 46.8% to 35.6%. From 2011 onward, the proportion of patients entering ART with advanced HIV disease has remained relatively unchanged. In 2016, we estimated that of 654 868 patients entering care, 32.9% had advanced HIV disease, and 16.8% had very advanced HIV disease. Men were almost twice as likely as women (23.1% vs 12.6% ) to enter care with very advanced HIV disease.
Conclusions
The proportion of patients presenting with advanced HIV disease in South Africa remains consistently high despite ART scale-up, representing a large and avoidable burden of morbidity. Early HIV diagnosis, rapid linkage to ART and approaches to attract men into early ART initiation should be prioritized
A Conditional Economic Incentive Fails to Improve Linkage to Care and Antiretroviral Therapy Initiation Among HIV-Positive Adults in Cape Town, South Africa
No full textInterventions to improve antiretroviral therapy (ART) access are urgently needed to maximize the multiple benefits from ART. This pilot study examined the effect of a conditional economic incentive on linkage to care and uptake of treatment following ART referral by a mobile health clinic. Between April 2015 and May 2016, 86 individuals (≥18 years old) referred for ART in a resource-limited setting were randomized (1:1) to a control group or to an incentive: R300 cash (∼$23, or 3.5 days minimum wage in the domestic worker sector), conditional upon starting ART within 3 months. Outcome data were obtained from clinic records. The incentive effects on linkage to care (first clinic visit within 3 months) and ART initiation (treatment uptake within 3 months) were assessed using logistic regression. Overall, 67% linked to care and 42% initiated ART within 3 months after referral. No significant differences were found between the incentive and non-incentive group in terms of linkage to care [adjusted odds ratio (aOR): 0.70, 95% confidence interval (CI): 0.26–1.91] and initiation of ART (aOR: 0.67, 95% CI: 0.26–1.78). Ordinary least-squares regression analysis showed that incentivized individuals linked to care in fewer days (−7.9, 95% CI: −18.09 to 2.26) and started treatment in fewer days (−7.3, 95% CI: −27.01 to 12.38), but neither result was statistically significant. Our findings demonstrate poor treatment uptake by both the intervention and control participants and further highlight the challenge in achieving universal early treatment access. Further research is required to understand how economic incentives, which have been shown to have many benefits, can be applied to improve linkage to HIV care and treatment
Youth Livelihoods in the Cellphone Era: Perspectives from Urban Africa
No full textssues surrounding youth employment and unemployment are central to the next development decade. Understanding how youth use mobile phones as a means of communicating and exchanging information about employment and livelihoods is particularly important given the prominence of mobile phone use in young lives. This paper explores and reflects on youth phone usage in Ghana, Malawi and South Africa, drawing on mixed‐methods research with young people aged approximately 9–25 years, in 12 (high density) urban and peri‐urban sites. Comparative work across these sites offers evidence of both positive and negative impacts. The final section of the paper considers policy implications.UK Economic and Social Research Council and the Department for International Development. Grant Number: ES/J018082/
Exploring South Africans’ understanding of social cohesion
No full textSince the late 1980s, there has been a growing interest among governments, international organisations and others in promoting and pursuing social cohesion. This has particularly been the case in societies undergoing transition or navigating internal divisions or challenges, related to events such as major economic downturns, changing migration patterns or ethnic or cultural conflict. A critical yet often elusive challenge, achieving social cohesion has become a panacea for a wide range of societal issues, and is often associated with positive outcomes including more stable and participatory democracies, greater economic productivity and growth, inclusivity and tolerance, effective conflict management and resolution, and a generally better quality of life for people (Lefko-Everett, 2016, p. 8).
South Africa, a country deeply divided by hundreds of years of colonialism and apartheid, has similarly recognised the importance of social cohesion. It has been identified as a national priority in numerous policies and plans, including the President’s Twenty-Year Review and the National Development Plan (NDP) 2030. The Medium Term Strategic Framework (MTSF) 2014 – 2019 (Department of Planning, Monitoring and Evaluation [DPME], 2014a, p. 6) identifies social cohesion – together with nation building – as one of eight main priorities associated with the electoral mandate for this period, attached to specific and measurable outcomes, plans and activities. Acknowledging that the “privilege attached to race, class, space and gender has not been fully reversed” and that the “social, psychologic and geographic elements of apartheid continue to shape the lives and outlook of many South Africans”, Outcome 14 of the MTSF focuses specifically on nation building and social cohesion (DPME, 2014b, p. 2).This paper was prepared by the Poverty and Inequality Initiative (PII) at the University of Cape Town, with the support of the Agence Française de Développement (AFD)
Tobacco Industry Strategies to Reduce Tax Liability
No full textLiterature review and data collection from key stakeholders from low- and middle-income countries. The collected data were categorized and analyzed using an economic framework. I have identified six strategies used by tobacco companies to influence the debate about tobacco tax policies: messaging on negative effects of tobacco tax increases, negotiating tax road maps, threating to move business out of the country, demanding reduction or elimination of import tariffs, establishing a favorable tax climate as a condition for an investment, and direct lobbying. The messaging strategy has at least five different elements. The discussion of each strategy addresses the motivation for tobacco companies to engage in such strategies, the consequences of the strategy for governments and companies, and measures that governments can take to counter tobacco industry actions to undermine tobacco tax increases. Each strategy is illustrated with one or more country case studies. The article also focuses on illegal activities by the industry that reduce its tax liability and mitigate the impact of tax increases: illegal imports, illegal exports, and illegal production and sale. The tobacco industry often pulls together multiple strategies and adapts them over time for maximum impact. The governments can engage in monitoring and surveillance that will provide data for formulating effective responses to the industry's effort to reduce the impact of tobacco control.Funding provided by the Campaign for Tobacco Free Kids
Readiness for Antiretroviral Therapy: Implications for Linking HIV-Infected Individuals to Care and Treatment
No full textUsing survey data collected immediately after referral for ART (N = 87), this study examined ART-readiness among individuals (18 years and older) attending a mobile health clinic in South Africa. Most participants reported being very ready (84%) and motivated (85%) to start ART, but only 72% were assessed as ready for ART on all measures. Treatment readiness was lower among individuals who did not think they would test HIV-positive (aOR 0.26, p < 0.05) and among individuals who reported being in good health (aOR 0.44, p < 0.1). In contrast, higher readiness was associated with better ART knowledge (aOR 4.31, p < 0.05) and knowing someone who had experienced positive health effects from ART (aOR 2.65, p < 0.05). Results indicate that post-test counselling will need to be designed to deal with surprise at HIV diagnosis, and that health messaging needs to be carefully crafted to support uptake of ART among HIV-positive but healthy individuals. Further research is needed on effective post-test counselling approaches and effective framing of health messaging to increase awareness of the multiple positive benefits of early ART initiation and corresponding readiness to engage in treatment
Reducing inequalities and strengthening social cohesion through inclusive growth: a roadmap for action
No full textThe authors propose a policy compact to achieve more inclusive growth in G20 countries so that economic growth regains the ultimate sense of improving all people’s lives. Guiding principles are: 1) prosperity is not just about income but about all relevant outcomes of well-being and capabilities to overcome the initial social disadvantage; 2) it is also about including people in participatory decision-making to enhance their dignity and control over their lives; 3) excluding people from reaping the benefits of growth will thwart social cohesion and well-being; 4) integrated policy approaches are needed to achieve inclusive growth, across policy domains and between national and global actions, including responsible management of migratory movements. Concrete policy actions are described that span education, labor, fiscal instruments, public and private governance
Washing with hope: evidence of improved handwashing among children in South Africa from a pilot study of a novel soap technology
No full textWhile regular handwashing effectively reduces communicable disease incidence and related child mortality, instilling a habit of regular handwashing in young children continues to be a challenging task, especially in developing country contexts. This randomised controlled pilot study assessed the effect of a novel handwashing intervention – a bi-monthly delivery of a colourful, translucent bar of soap with a toy embedded in its centre (HOPE SOAP©) – on children’s handwashing behaviour and health outcomes.We are grateful to Rachel Glennerster and seminar participants at the University of Cape Town for valuable comments on previous version of this manuscript and to Laura Costica and Emmanuel Bakirdjian for valuable suggestions on the research design. We gratefully acknowledge funding provided by the Abdul Latif Jameel Poverty Action Lab (J-PAL) Incubation Fund. We thank Young & Rubicam, and Safety Lab for permission to test their product and for valuable research support. We are extremely grateful to the Foundation for Community Work and their team of Community Workers for invaluable assistance with developing the study design, implementation of the intervention and with data collection. We thank the social pensioners at Neighbourhood Old Age Homes (NOAH) for their effort and care in manufacturing high-quality soap for this study