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Scalling up ART in Rwanda: the financial and economic costs
No full textRwanda has been rolling-out free antiretroviral treatment (ART) since 2004. This scale up could only be realised through significantly increased funding to the HIV/AIDS sub-account. Funding grew from US43 million in 2004 (UNAIDS, 2006b) and has continued to grow since this time given increased grants from GFATM and PEPFAR. Although international funding has been pivotal in the initiation of ART roll-out in resource poor settings, national programmes must look inwards for long term sustainability. This raises the question of whether the country will be able to sustain this level of funding once these grants cease or are significantly reduced. This question could be answered to a large extent if one knew the lifetime costs of providing ART in Rwanda and the capacity of the country to raise domestic revenue. Unfortunately the body of evidence on unit and lifetime costs for providing ART in Rwanda is nonexistent. The study aimed to determine the economic costs of scaling up ART in Rwanda. Costing from the provider's perspective was undertaken based on data from 3,310 patients in 3 ART sites. The health care utilisation and cost data obtained, supplemented by appropriate secondary data, were used to estimate the cost per-patient period and lifetime costs. These were then used to model the costs of scaling up and to explore the financial sustainability of ART in Rwanda. Key findings: The modelled costs per-patient period were US306 annually thereafter. Once firstline had been failed, costs increased to US1,299 during each annual period thereafter. Costs were US4,440 discounted at 3% and US741 or US206 million, or US187 million or US19 million in 2007 to US243.4 million from Global Fund and PEPFAR is expected to cover nearly all patient specific costs during the scaling up period. The total health care resource envelope allocated to the Ministry of Health from public revenue in the financial year 2006/07 was US50.1 in 2005 to US62 million by 2011 if scaling up achieves 130,000 patients in care. At this level of scale, ART funding would need to grow by a rate exceeding 50% annually. It is difficulty to sustain such a level of funding from public revenue alone. Innovative health care financing mechanisms that exclude user fees need to be devised. Given that user-fees paid at the point of treatment have negative equity implications, other innovative financing approaches are needed to improve the financial sustainability of the ART programme
Representations of writers as public ntellectuals Jean-Paul Sartre, Nadine Gordimer, Gao Xingjian and Pablo Neruda
Get PDFThis thesis takes as its subject the various public roles and representations of writers, using Said's 1993 Reith lectures on the subject of the intellectual as a starting point. The main questions raised are how writers, in various political and historical contexts, have functioned as public intellectuals, and how they have negotiated the tensions between their various private and public commitments and responsibilities, whether artistic, social, or political. To gain insight into these issues, this thesis turns to the essays, memoirs and lectures ofJean-Paul Sartre, Nadine Gordimer, Pablo Neruda and Gao Xingjian. Chapter I is concerned with Sartre's attempt to systematize a conception of the writer as an intellectual through the writer's commitment in the work itself. Chapter 2 looks at the development of Gordimer's explorations of her own positioning in such a public role, as well as how these explorations point towards a transformative view of literature. Chapter 3 sets up a comparison between Neruda and Gao, who share an important conviction that literature provides an "alternative" historical record of human experience despite their opposed ideas regarding the writer's relationship to society. As winners of the Nobel Prize for literature, these writers have been "officially" recognized as public intellectuals, and thus their emblematic position affords an important opportunity to examine how such writers deal with public pressures, clarify their commitments and attempt to construct a feasible identity within the matrices of art and politics. By looking at their nonfictional and often deeply autobiographical writings, this thesis hopes to locate these writers at their most candid, reflective and even contradictory moments, in which they attempt to delineate a certain credo that informs their public and private activities as writers
[Apart] space valuing community: focused on incidental learning and wayfinding thresholds
Get PDFThe study aims to reimagine and intervene in the space of Khayelitsha. The intentions are to integrate and alter current smart parks designs by the City of Cape Town. To offer social empowerment to the surrounding context, residents by tempting to provide a detailed design which could offer a space of economic generative platforms/facilities within the landscapes. I've tasked the study also with the aim to uplift all age groups and a target of providing a safety spine moving to and from space, providing a network of movement spaces. The incorporation of pillars aimed at learning by attempting to go into detail with the design of outdoor educational learning spaces intended at structuring the youth mind-set to the current workspace paradigm linked to the forth-industrial revolution. The learning pillars to be triggered in space are Visual, verbal, social, physical, aural and Solitary. The space aims to provide a link for the youth to young professionals in the spaces where they will be facilitated for in the container spaces. To start-up new businesses, allowing for an innovation hub which could generate an ideal cosmos for networking and offer a pulse to activate the green corridor. There will also be the exposure to 24/7 video tutorials in the space allowing for a link to stimulate the mind to future career paths in the global market. The issue of crime in the space is also one I wish to engage with by providing a street language by reading into the literature of street DNA (Simpson,2018) coupled with human desirability links along walkways to best attract the highest amount of foot traffic in space to allow for the safety in numbers approach. The ideas of adding WI-FI hotspots along space and assessing the current desire lines of space for the best accommodation of the masses. The title 'Apart-space', disassembled links the “apart” to the Apartheid ideology denoting on the spatial formation of the township of Khayelitsha, hinting at how it was formed as an influx zone with no much spatial planning for recreational use taken into account. The dash composing the ideology of transformation in post-apartheid South Africa. The “space” denoting to the green corridor (lost space) that had been left as buffer zones by the planners of the time in the space
The Secret Lives of Polygamous Wives: African Feminist Consciousness and Writing in Selected Nigerian Polygamous Narratives
Get PDFThis dissertation considers three novels by Nigerian women writers, which grapple with patriarchy within the context of polygamous marriage. These novels are The Secret Lives of Baba Segi's Wives (2010) by Lola Shoneyin, Stay with Me (2017) by Ayọ̀bámi Adébáyọ̀, and The Joys of Motherhood (1979) by Buchi Emecheta. This dissertation examines the ways in which Shoneyin, Adébáyọ̀ and Emecheta demonstrate African feminist theory and consciousness in writing women characters in these novels. These authors not only expose patriarchal systems but also write women characters in ways that distance them from past, static, and stereotypical representations by male writers of African literature. This recasting of women characters gives the women characters a sense of agency, room for potential friendships and releases them from the pressures of being blamed for infertility. Shoneyin, Adébáyọ̀ and Emecheta expose how patriarchal rule in these novels manifests in more than one way. Traditionally, this rule comes from the man or husband; however, it is also enacted by the other wives in the marriages represented, as well as the mothers of patriarchs. Since African feminism concerns the liberation of women, it is vital that polygamous marriage narratives such as these are investigated as these kinds of marriages are often considered patriarchal
Reimagining Gaborone main mall: precinct urban design framework
No full textThe city of Gaborone is growing at an unprecedented rate, the bustling and oldest economic hub of the city, Main Mall located in the capital core is currently in decline, gradually losing its pioneering role and reputation as a symbol of Botswana's post-colonial identity and economic engine. This may cause massive detriment to the local surrounding community, as it is seen as heritage ground. Studies have shown that urban design interventions that preserve the local character of urban space are essential for successful urban regeneration. Through precedent studies, interviews, observations, and analysis of site data, this project developed an urban design framework that aims to regenerate Gaborone's Main Mall while simultaneously strengthening the economics of the precinct. It is with anticipation that this urban design framework will contribute to Gaborone's objectives of becoming a model city internationally
Long-term neurodevelopmental effects of acute organophosphate poisoning amongst South African children
Get PDFBackground: Pesticide poisoning is a significant cause of morbidity and mortality amongst children in developing countries. In addition to the well described acute effects, organophosphates (OP), can cause long-term neurotoxicity. This study aims to evaluate long-term neurodevelopmental outcomes in a sample of paediatric survivors of acute organophosphate poisoning (OPP) a subject which has, to date not been well described. Objectives: This study determines the performance of South African children surviving acute OPP on a validated set of paediatric neurodevelopmental tests. It compares the performance of acute OPP survivors to two control groups matched for age, sex, and home language. Methods: A case-control study was conducted. A group of OPP survivors (cases) was compared to two control groups: (1) children admitted for paraffin poisoning; and (2) children admitted for conditions other than poisoning. Participants were identified through hospital records. Consenting participants were interviewed and evaluated using six neurodevelopmental tests. 47 cases of acute OPP were recruited and matched to 46 cases of paraffin poisoning and 29 non-poisoned controls. Results: In the comparison of the OPP and control groups, The OPP group performed significantly worse in grooved pegboard, fingertap repetition, total problem score and anxious/depressed clinical syndrome scale. In the comparison of the OPP and paraffin groups, the OPP group performed significantly worse for grooved pegboard, total problem score, social problems clinical syndrome scale, attention deficit/hyperactivity disorder (ADHD) and conduct diagnostic and statistics manual (DSM) scales. Conclusion: This study suggests that OPP in children can result in neurodevelopmental deficits across a range of domains: motor functioning and speed, behavioural problems, attention and emotional wellbeing. These impacts appear to be specific to OP and not just the result of hypoxia associated with poisoning. It highlights the need for more effective poisoning prevention measures, and long-term follow up, neurodevelopmental assessment and support of OP-poisoned children into adolescence
Early human social transmission during Marine Isotope Stage 5: a perspective from the Kalahari Basin
Get PDFThe social transmission of cultural information is widely recognized as a crucial component contributing to the survival and prosperity of our species. This thesis studies lithic technological systems to assess the extent of the transmission of cultural information between different early human groups across the Kalahari Basin and adjoining regions during Marine Isotope Stage (MIS) 5 (~130-74 ka), a key time and place for understanding the emergence and expansion of complex behaviors in Africa. It has been proposed that glacial periods (e.g., MIS 4) in southern Africa were characterized by coalescence, while interglacial periods (e.g., MIS 5) were characterized by population fragmentation. While these previous hypotheses represent important examples for testing the degrees of population interconnectedness during MIS 5, they were based primarily on sites outside of the Kalahari Basin and its environs. Therefore, the central inquiry of this thesis is to investigate the presence and extent of cultural transmission among hunter-gatherer populations in and around the Kalahari Basin, assessing whether patterns of population fragmentation observed during MIS 5 are discernible in these regions. This inquiry is achieved by studying lithic assemblages from multiple sites and comparing them using a behavioral approach to cultural transmission. The samples studied are from Ga-Mohana Hill North Rockshelter, Kathu Pan 6, Erfkroon, and Florisbad in South Africa, and ≠Gi and White Paintings Rockshelter in Botswana. The results of this study indicate there are many technological similarities across most of the studied sites, including the predominant use of local raw materials, recurrent Levallois methods, hard hammer percussion technique, core maintenance primarily by débordant removals, manufacturing of similar products, mostly with faceted platforms, and a low frequency of formal tools. This homogeneity may reflect technological information exchange and connections between human groups at these sites. The connectivity is inferred to be closely linked to their adaptation to the drier climatic conditions that persisted in the Kalahari Basin and its adjoining regions, in contrast to coastal and other inland areas. The arid and semi-arid environments may have necessitated the formation of social ties to access scarce and potentially unpredictable resources. In contrast to some other regions that show fragmentation during interglacial periods, the Kalahari Basin and adjacent regions did not follow the same pattern
The challenges in the capture and storage of digital information by rural clinics in Hammarsdale, KwaZulu-Natal Province
No full textThe study examined the capture and storage of patient information by rural health care clinics in Hammarsdale in KwaZulu-Natal. The study was supported by the Digital Curation Centre Life Cycle model and the primary aim of the study was to identify the nature and scale of the challenges faced in the capture and storage of patient medical records. A mixed-method approach was adopted to the collection of data that was relevant to addressing the research objectives. The study used convenience, self-selection, and expert sampling to select participants for the questionnaires and interviews. Interviews were carried out with selected staff in the records office at the clinics with a target sample of at least one staff in each clinic. Data collection methods included interviews and questionnaires. Triangulation was also adopted for crosssectional analysis of the data collected. The study revealed that the rural clinics operated a duplicate system for the capture and storage of patient medical information. Furthermore, the systems did not complement each other as both the paper and electronic records systems had their own weaknesses. However, the use of the paper records systems was predominant. The conclusion from the findings was that there was a need to institute policy measures to guide the capture and storage of patient medical records. The recommendations are that the DCC Life Cycle can be used as a guide in developing policies and guidelines on how both paper and electronic records can be captured and stored
The foreign direct investments and their impact on Canadian and South African telecommunications industry
Get PDFThe scope of this paper is to demonstrate that countries should abolish the restrictions on FDI in order to create a successful telecommunications market. FDI can increase competition with amazing consequences for consumers. In Canada, FDI restrictions apply on basic suppliers and are a major burden for companies competing in this market. The illustration of this issue occurred with the take over of one of the incumbent companies, Bell Canada Enterprise (BCE). In South Africa, the telecommunications industry is stagnate and needs the influx of FDI to compete on an international level. FDI restrictions thwart the expansion of the South African telecommunications industry by turning down foreign capital. Countries around the world are benefiting from FDI and it is time for Canada and South Africa to liberalise their telecommunications market and step forward in this new trend
Analysing the impact of cultural diversity on stakeholder engagement in multinational construction projects
Get PDFA significant challenge faced by project managers in multinational construction projects is effectively managing stakeholders from various national cultures. Effective engagement of stakeholders from diverse cultural backgrounds significantly enhances the likelihood of success in project management and project. This study utilizes a systematic method to qualitative approach, employing three empirical case studies to reveal the elements that influence stakeholder engagement in multinational projects. The main research questions are: What are the impacts of national culture in the engagement of project stakeholders in international construction projects, and how can project managers utilize and improve standard stakeholder engagement tools and procedures in managing multinational stakeholders? Section 1 included a concise overview of the problem and established the precise meanings of important terminology by outlining the introduction of the research. Section 2 outlined the literature review of the subject and research area. The author provide a comprehensive explanation of the methodology employed for the study in Section 3, while Section 4 presents and analyse the data collected from empirical study and the elements that were identified as being associated with the literature review. Building upon the previous part's, section 5 offers insights into prospective future avenues of research for managing multi national projects and offers recommendations on the subject. The study's findings suggest a significant inverse relationship between stakeholder engagement methods and cultural disparities in multinational construction projects. Especially in the areas of bias, work performance, communication, behaviour, decision-making, and conflict management. The study further discovered that effective communication, cultural awareness, challenging stereotypes, and early stakeholders' identification might enhance stakeholder engagement methods