Urban–rural inequalities in health care delivery in South Africa

Urban–rural inequalities in access to health care services continue to persist in South Africa, and in almost all cases discriminate against the poor. In certain cases disparities are even worse in urban areas, although levels of service delivery admittedly are consistently worse in rural areas. People in rural areas are generally more dependent on public and other health care services than on private services, compared with people living in urban areas. There is limited evidence of substantial intra-urban disparities, with inequality being worse in smaller urban settlements (i.e. towns) as opposed to larger ones (i.e. small cities and metropolitan areas). The article emphasises the important role the envisaged future decentralisation of selected health services to local government is likely to play in addressing these inequalities and the lack of service delivery at this level.     

The Child Support Grant and teenage childbearing in South Africa

This paper examines data on teenage fertility and patterns of uptake of the Child Support Grant in South Africa from 1998 to 2005, to assess how far this Grant is associated with the trend in teenage childbearing. Teenage fertility was fairly high during the 1980s when state financial assistance to teenage mothers did not adequately serve the majority of South Africans. Since the first half of the 1990s, however, teenage fertility has steadily declined. This trend was already underway when the grant was expanded in 1998 to reach beneficiaries in all sub-groups of the national population. If teenage girls were having children primarily to benefit from the Child Support Grant, then more would be making claims than is in fact the case. The findings of this study do not suggest any significant positive association between the grant and the trend in teenage childbearing in South Africa during the past decade.     

Estimating the future health care cost of population aging in South Africa

ABSTRACT

This paper analyses the relationship between health care expenditure and population aging in South Africa using yearly data from 1983 to 2015. Empirical evidence from an Autoregressive Distributed Lag approach to cointegration indicates that old dependency and life expectancy are major drivers of public health expenditure in South Africa besides the income. Particularly, when structural breaks are controlled for, income exhibits a long-term elasticity with respect to health spending greater than unity; suggesting that South African public health care has become a luxury good over time. Interestingly, South African public health spending is found to be responsive to demographic development only in the long run. This is consistent with the micro evidence that health expenditure increases with individual age with significant impacts in the long term. Finally, using economic and demographic projections statistics, we find that public health expenditure could roughly double in the next fifteen years ceteris paribus.     

Sub-Saharan Africa in depression: The impact on the welfare of children

This paper analyses the impact of the economic crisis on the welfare of children in Sub-Saharan Africa, an area which includes most of the least developed and most severely affected countries. These countries are characterized by: low levels of skilled personpower, dependency on their primary product exports, small industrial sectors, a lagging food production growth, a high proportion of rural population and a child dependency ratio that is virtually 1 to 1. The situations of Nigeria, Zambia and Tanzania are examined in detail. In Zambia where there is substantial evidence of worsening of the condition of children in the 1970s, the most urgent requirement is additional resources, particularly foreign exchange. Such is also the case with Tanzania, while Nigeria does have the resources to develop a more coherent economy and finance basic services adequately.     

The impact of tourism on poverty in South Africa

This paper evaluates the potential impact of tourism on poverty in South Africa on the basis of recent survey data on international tourism spending patterns. It looks at three scenarios, using an applied general equilibrium model. The main finding is that the poor benefit very little in the short term from additional tourism income. A further finding is that domestic and international tourist expenditure affect the economy differently; both markets are therefore important. In essence, the research confirms that tourism receipts can be used as a tool to alleviate poverty, but in South Africa this must be supported by policies that focus on the labour market and human resource development.     

The reach and impact of Child Support Grants: evidence from KwaZulu-Natal

This paper examines the reach and impact of the South African Child Support Grant, using longitudinal data collected through the Africa Centre for Health and Population Studies. The grant is being taken up for a third of all age-eligible resident children, and appears to be reaching those children living in the poorer households of the demographic surveillance area (DSA). Children who received the grant are significantly more likely to be enrolled in school in the years following grant receipt than are equally poor children of the same age. However, older brothers and sisters of grant recipients, when they were observed at younger ages, were less likely than other children to be enrolled in school – perhaps reflecting the greater poverty in grant-receiving households. Thus the grant appears to help overcome the impact of poverty on school enrolment.     

The impact of globalisation on local government in South Africa

Globalisation has been defined as a continuous evolutionary process whereby functions and influences cross boundaries from one state to another. The question is often raised as to whether a country such as South Africa can ignore global influences after years of isolation and integrate positively with the international community as a global player. The South African government has initiated the debate on the possible benefits of globalisation, especially in the local government sphere. Globalisation could, it is believed, facilitate economic and social upliftment in the communities served by local government. Whether it has the expertise and capacity needed to actualise these benefits is, however, debatable. The larger local authorities, or Category A municipalities, have supported the idea of globalisation and have begun formulating policies on international relations. The purpose of this article is, first, to determine the implications of globalisation for South African local authorities. Secondly, based on these findings, an attempt has been made to identify the criteria for integrating successfully into the international local government system. On the basis of these responses, a qualitative evaluation of the identified criteria was undertaken in order to determine the extent to which they have been met in South African local government.     

Development and health: The need for integrated approaches in South Africa

The impact of development policies on health are outlined within the context of epidemiological and demographic transition. Macroeconomic policies have a major impact on the nutritional status of the population; agricultural policy and particularly changing patterns of land use have in the past resulted in forced resettlement with concomitant health effects, while the development of new irrigation schemes has increased the risk of vector‐borne disease. Industrial and energy policies increase the risk of the population for a range of environmental and occupational pollutants. Several adverse health impacts associated with urbanisation include poverty‐related disease (measles, nutritional diseases); all forms of trauma (from motor vehicle accidents to interpersonal violence); behaviour injurious to health (associated with tobacco, alcohol and sugar consumption); and sexually transmitted diseases. Aids could well become a major impediment to all aspects of future development. The article concludes by recommending greater interaction between epidemiologists and economists so as to ensure that an integrated approach to development will result in enhancement of the health of people.     

The Medicaid program: The low-income health care subsidy

Conclusions While these data are inadequate to empirically test the foregoing three hypotheses, they are sufficient to caste doubt on the validity of the assumption upon which the design of the low-income medical care subsidy is based; i.e., that the private medical care market is efficient and therefore adequate to meet the health needs of all low-income groups. Further, analysis of the supply side of the market may show in-kind demand subsidies insufficient to improve the health status of the poor. A coordinated demand and supply subsidy may be necessary.     

The impact of education on health in China

In this paper, we investigate the causal effect of education on health using an instrumental variable approach. The instruments we employ consist of two institutional changes in China that generated discontinuities in educational attainment among individuals. To ensure the validity of the instruments and obtain prudent conclusions, we adopt more restrictive identification tests than previous studies. The results indicate no causal impact of education on either perceived health or anthropometric health. With regard to the impact of education on male health behavior, namely smoking, we cannot provide conclusive results due to a violation of the exogeneity of our instruments. Nevertheless, we can confirm that education has no causal effect on female health behavior. To overcome the widely documented shortage of quasi-experimental identification, we also employ spouse's education as an alternative instrument to examine the causal effect of education. Identical results are obtained, with the exception that the impact of education on the reduction of overweight among women becomes significant. We conclude that this provides some evidence of a causal impact of education on health.     

The impact of economic fundamentals on stock markets in southern Africa

The issue of whether stock markets reflect economic fundamentals or speculative bubbles is an important one for their potential role in allocating capital, and relates to a policy issue of whether stock markets should be encouraged in developing countries. This article examines the impact of both domestic and foreign economic factors on real stock market returns in three southern African stock markets – South Africa, Zimbabwe and Botswana, from 1985-95 – using cointegration and error correction techniques. It finds that, while in all cases stock markets are influenced by domestic economic growth, there are no common patterns beyond this. The influence of other domestic and economic variables depends on the size, openness and market-orientation of the individual economies, as well as the size and liquidity of the various stock exchanges. Where foreign economic variables are important, they appear to be those related to trade, rather than international capital flows, indicating that there is little integration of these capital markets, whether regionally or internationally.     

The survival of apartheid's last town council in Groblersdal,South Africa

The reconfiguration of South Africa's internal territorial spaces after 1990 was a logical outcome of the need to undo the effects of decades of territorial dismemberment under apartheid. In spite of the spatial reordering of areas which were controlled and administered by town councils established during apartheid, the Town Council of Groblersdal and its area of jurisdiction have remained unchanged up to the time of writing. This article attempts to explain and analyse the survival of the town council of Groblersdal in the Northern Province. It argues that the town council used the vacuum created by the provincial boundary dispute between Mpumalanga and the Northern Province to maintain the status quo in spite of legal struggles to determine its political future.     

Illiteracy in South Africa: Some preventive policies and strategies from a developmental perspective

Literacy plays an important role in the development process and is a mechanism to empower the poor. Illiteracy has reached unacceptably high levels in South Africa. Functional literacy implies more than the ability to read and write in a particular language. To embark on literacy programmes for adults is a valid strategy to combat illiteracy but this approach will only treat the symptoms. Shortcomings in the formal education system, poverty and lack of Government commitment are some of the main causes of this problem in South Africa, which calls for a comprehensive approach such as the introduction of a primary school support programme to help remedy the situation.     

Stability of production networks in East Asia: Duration and survival of trade

This paper sheds light on the stability of international production networks in East Asia from the perspective of the duration and survival of bilateral trade relationships at the product-line level. Using highly disaggregated data for intra-East Asian machinery trade, survival analysis is conducted as well as the examinations of the duration and volatility of trade relationships. The product-level analyses reveal that, compared to machinery finished products, machinery parts & components are traded through longer-lived and more stable relationships among East Asian countries. Once transactions are started, trade relationships of machinery parts & components are more likely to be maintained between countries even at a long distance, regardless of the exchange-rate fluctuations. The probability of discontinuing trade relationships of machinery finished products, on the other hand, are more likely to be sensitive to the level of trading cost as well as the exchange-rate fluctuations.