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Healthcare reform priorities for South Africa: four essays on the financing, delivery and user acceptability of healthcare
No full textDespite expenditure levels on healthcare comparable to those of its upper-middle-income country
peers, South Africa is achieving health outcomes that are comparable to those of low-income
countries.
This dissertation contains four essays on the financing, user acceptability and delivery of healthcare
in South Africa. The main contribution of the dissertation is to determine how the user acceptability
of healthcare services influences not only health seeking behaviour in South Africa, but also
influences the ability of healthcare services to impact health outcomes. Without sufficient focus on
user acceptability, the success of the health system will be undermined by creating missed
opportunities for the prevention, detection and treatment of disease.
The first essay considers the potential role of private health insurance (medical schemes) in reducing
inequality to healthcare access and alleviating the burden from a constrained public healthcare
system by providing access to healthcare services of higher user acceptability levels. The analysis
indicates that, in the absence of a number of regulatory changes in the market primarily aimed at
increasing the affordability of medical schemes, the size of the formal skilled labour market will
continue to set the limits of the private health insurance market.
The second essay examines the causal impact of access to private health insurance (medical
schemes) on healthcare utilisation and healthcare provider choice by using the exogenous variation
in private health insurance coverage induced by the roll-out of the Government Employees Medical
Scheme (GEMS). Contrary to most of the findings in the literature, the analysis finds that providing
access to healthcare perceived to be of greater user acceptability in South Africa’s polarised
healthcare market has a large positive effect on total healthcare utilisation. It also increases the
likelihood of using private providers and, in particular, private doctors.
In the third essay, the dissertation considers the health seeking behaviour of adults with potential
tuberculosis (TB) symptoms (coughed ≥2 weeks) in the Western Cape. Only one third of adults
indicated they sought help for TB symptoms and only one fourth of those who coughed ≥2 weeks
reported these symptoms at primary healthcare facilities. Women were less likely than men to be
asked for a sputum sample at these facilities, indicating poor adherence by healthcare staff to the
well-defined TB testing protocol.
Lastly, the fourth essay explores the causes of late antenatal care access amongst a sample of
women in metropolitan Cape Town. More than a quarter of women attended antenatal care late In the third essay, the dissertation considers the health seeking behaviour of adults with potential
tuberculosis (TB) symptoms (coughed ≥2 weeks) in the Western Cape. Only one third of adults
indicated they sought help for TB symptoms and only one fourth of those who coughed ≥2 weeks
reported these symptoms at primary healthcare facilities. Women were less likely than men to be
asked for a sputum sample at these facilities, indicating poor adherence by healthcare staff to the
well-defined TB testing protocol.
Lastly, the fourth essay explores the causes of late antenatal care access amongst a sample of
women in metropolitan Cape Town. More than a quarter of women attended antenatal care late (≥20 weeks) and, of those who attended late, 48.2% indicated late recognition of pregnancy as the
major reason for delayed attendance. While late access was predominantly associated with demandside
factors, late recognition of pregnancy, together with high levels of unplanned pregnancies,
point towards issues related to effective access to contraception.
The analysis in the first two essays indicate that there is a demand for healthcare of greater user
acceptability, and the last two essays show that this would need to include improved preventative
care, enhanced health system effectiveness and better clinical quality monitoring.National Research Foundatio
De plek van transkulturele kinderprenteboeke in Suid-Afrika
No full textThis thesis is a critical analysis on the role of trans-cultural children’s picture books in
contemporary South Africa, done from my perspective as illustrator. Children’s picture
books have the inherent possibility to form children’s vision of the world, as well as
stimulate them visually and intellectually. These books may also expose children to
new knowledge and experiences that may stimulate their imagination and promote a
culture of reading. However, the value of this medium remains underestimated and
underutilized in South Africa. Most children’s books are published for educational
purposes. The high cost of books also contributes to the unsatisfactory reading culture.
Books are still published largely in Afrikaans and English, with only a small number
portraying a hybrid South African community. My approach with this study is to create
consciousness for the advantages transcultural children’s picture books could have
towards children’s cultural identity, visual literacy, as well as their opinion of other
cultures. The research also compares multicultural with transcultural children’s books
and why the later is more appropriate in a South African society. To achieve this goal, I
have investigated the place of children’s picture books in South Africa, since 1904
until the present. The way in which cultures are portrayed visually in these books, as
well as the effect thereof on children, emphasises the need for transcultural children’s
picture books. In order to comprehend the characteristics of a transcultural children’s
picture book, the content and composition of such a book is investigated. Finally, I
have implemented my conclusions by creating my own book, Thandi goes to Cape
Town. I have read this book to a primary school class to apply this practice-led
research practically. After this reading, the children’s positive response has indicated
that transcultural children’s picture books can influence children positively, confirming
the importance of further investigation in this field.National Research Foundatio
The global eye: international relations and cooperation newsletter edition two 2016
No full textThe Global Eye : International Relations and Cooperation Newsletter. Second Edition, 2016, Gender and Equality
Feminine intuition : does it enable females to identify the micro-expression of anger in males?
No full textIntuition is a construct that has resulted in much debate over the years. The present study attempts to enhance the study of intuition as well as micro-expression recognition by delving into feminine intuition and females’ ability to identify the micro-expression of anger in males. The study compared females’ psychophysiological responses to superimposed images of malicious males and superimposed images of non-malicious males. The study was conducted using a mixed methods design in that both quantitative and qualitative data were collected. The quantitative analysis was conducted on 22 participants of whom five were used in the qualitative analysis. Both physiological (heart rate, heart rate variability, breathing rate and estimated core temperature) and psychological (psychological interview and eye tracking data) were obtained for the study. The results of the study indicate that while females are able to identify the micro-expression of anger in males, they only respond psychologically and not physiologically to this expression.National Research Foundatio
Creative commons licenses seminar: what is it and why should you know about it?
No full textCreative Commons Licenses seminar, by Dr. Tobias Schonwetter, Director: IP Unit, UCT, Regional Coordinator for Creative Commons in Africa, May & July 2016, Pretoria | Cape Town | Grahamstow
Striking a balance in the research supervisory process
No full textPresentations SA PhD Project Conference: Free State 25-26 February 201
Understanding your discipline (SET)
No full textPresentations SA PhD Project Conference: Free State 25-26 February 201
Study meeting of the South African information and knowledge management practitioners
No full textStudy meeting of the South African information and knowledge management practitioners, held at the National Research Foundation, 8 July 2016
A low-d18O intrusive breccia from the Koegel Fontein complex, South Africa
No full textThe ~135 Ma Koegel Fontein complex, 350 km north of Cape Town, has rocks with abnormally low δ 18 O values, as low as - 5.2 ‰. The rocks with the lowest δ 18 O values belong to an intrusive breccia and have a fine - grained, black matrix. The silica content of these breccia rocks ranges between 44 - 68 wt %, their whole - rock δ 18 O values vary between - 5.2 ‰ and +1.8 ‰ , and their water content is between 0.2 - 1.1 wt %. The major and trace element composition of the breccia rocks is consistent with them containing variable proportions of bentonite, alkali basalt, gneiss, and epidote - and xenolith - rich material. Mapping indicates that the initial intrusion was an alkali basalt dyke and a bostonite dyke that were then intruded by two breccia plugs that extended along the planes of weakness created by the pre - existing dykes, forming two sub - parallel breccia dykes. The water content of the breccia rocks is low (average <1.0 wt %) and is consistent with interaction with fluids at a relatively high temperature (> 300°C). These fluids interacted with the rocks from both dykes and are responsible for their 18 O - depletion. On the basis of the O - and H - isotope composition of the breccia rocks, the δ 18 O value calculated for the fluids in equilibrium with the breccia rock s is approximately - 10.8 ± 0.2 ‰. This low δ 18 O value of the meteoric fluids is too low for the low latitude and warm climate at ~135 Ma and indicates that 18 O - depletion at Koegel Fontein predates the intrusion of the complex in the Cretaceous. It is possible that low - δ 18 O fluids circulated through the country rock during the Pan African when crustal reworking enabled deep circulation of surface water. This period of crustal reworking coincides with a 'Snowball Earth' event and would have been accompanied by 18 O - depleted meteoric water. In the Cretaceous, it is assumed that a mantle plume heated the crust, causing dehydration before partial melting of the crust. The initial low - δ 18 O fluids are effectively metamorphic fluids in equilibrium with the rock. It i s proposed that the initial loss of these fluids became explosive. These fluids migrated along the pre - existing alkali basalt and bentonite dykes, incorporating fragments of alkali basalt, bostonite, and country rock gneiss. This xenolith - rich fluidised material was then emplaced rapidly into the crustNational Research Foundatio
What to expect during PhD exam
No full textPresentations SA PhD Project Conference: KwaZulu-Natal Province 17 August 2016