Interrogating health coverage in Africa

Seminar
28 April, 2015 - 12:45 to 14:00
Nicoli Nattrass/Danielle Pagano
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

 

The International Labour Organisation has recently released data on 'health care coverage'.  We interrogate this variable by examining the sources for the estimates, and by exploring whether it is correlated with key outcomes, notably the percentage of poor women who give birth with health professionals in attendance.  We find that the ILO's new measures of legal coverage and deficits pertaining to health care workers are predictors of pro-poor outcomes in Africa. However we are concerned that the estimate of legal coverage is misleading in many cases.

Technocrats, Elections and Social Protection in Ghana

Seminar
21 April, 2015 - 12:45
Eduard Grebe
Rm 4.29, Leslie Social Science
Abstract / Description: 

During the 2000s, Ghana introduced substantial social protection policy reforms. These included reform of the contributory pensions system from a single statutory defined-benefit scheme and a colonial-era defined benefit scheme for civil servants (the former introduced and the latter closed to new entrants in 1992) to a new three-tier system with mandatory and voluntary privately-administered schemes augmenting the SSNIT. A new contributory national health insurance scheme was introduced in 2003 and several forms of social assistance targeted at the (largely rural) poor, including a school feeding programme, ‘capitation grants’ to expand free primary education and the flagship Livelihood Empowerment Against Poverty (LEAP) cash transfer scheme. All of these reforms were initiated under the right-of-centre Kufuor/New Patriotic Party administration, who had won the 2000 elections and unseated Jerry Rawlings’ National Democratic Convention which had been in power since democratisation in 1992. The NDC returned to power in 2008 and has continued the implementation NPP-introduced reforms and with broadly similar economic and social protection policy. Given Ghana’s experience with poor performance during statist experiments under military rule and the return to sustained economic growth after painful ‘structural adjustment’ reforms in the 1980s, the broad cross-party consensus on macroeconomic policy is not surprising. What requires more explanation is how and why Ghana opted for an unusually contributory social insurance-oriented social protection policy framework augmented by various forms of social assistance and a (relatively parsimonious and small, but largely domestically-funded) conditional cash transfer scheme – and that this policy path too enjoyed broad consensus. It introduced cash transfers earlier than many African countries and in a less donor-driven fashion, despite early resistance from some parts of the polity to handouts’. However, despite highly-competitive elections with two dominant parties, neither party appears to have seized a populist social assistance agenda (for example, broad expansion of LEAP or universal social pensions) in order to attract poor rural voters, the urban poor is largely left out of the social protection system, and the LEAP programme has remained small under the rule of both parties. This paper examines the ‘technocratic’ agenda (among both donors and bureaucrats) and the political/ideological agendas as well as electoral incentives on politicians in an attempt to help explain the path of Ghanaian social protection policy reform since 2000.

Men, Masculinity and HIV Care Work in Cape Town

Seminar
14 April, 2015 - 12:45 to 14:00
Lesley Gittings
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

Caring is typically constructed as a feminized practice, resulting in women shouldering the burden of care-related work. Health-seeking behaviours are also constructed as feminine and men have poorer health outcomes globally. Employing men as carers may not only improve the health of the men they assist but also be transformative with regard to gendered constructions of caring.

Using semi-structured interviews and observational home visits, this study explores the gendered dimensions of relationships between community care workers (CCWs) and male clients. The empirical analysis draws on the perspectives of eight CCWs and three of their male clients from the Cape Town area.

The interviews reveal that CCWs and clients perform and negotiate masculinities as they navigate around hegemonic masculine norms which require men to act tough, suppress emotion and deny weakness and sickness. They bump up against these ideals of what it means to be a man as they strive to provide care and receive support. In an attempt to avoid rupturing hegemonic masculine norms, CCWs use techniques such as indirectly broaching sensitive subjects, acting friendly and being clear about the intention of their work.

Lesley recently submitted her Masters dissertation to meet the requirements for the degree of MPhil in Public Policy and Administration at the University of Cape Town. Her research focused on masculinities and HIV community care work.

Between 2007 and 2011 Lesley worked as a policy analyst with the Canadian government and chaired the board of a community-based HIV organization. Following this, she worked in the Malawian HIV sector where she supported policy advocacy activities and managed an income-generating sanitary pad project.

Her research interest includes governance, gender and sexual and reproductive health. Lesley holds a BComm (Honours) from the University of Ottawa in Canada.

The Double Misperception? Public Expectations and MP Orientations to Legislative Roles in Africa

Seminar
7 April, 2015 - 12:45 to 14:00
Robert Mattes
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

 

Most analysts of African politics claim that the relationship between citizens and elected representatives is not one of principals and agents, but rather one of clients and patrons.  I provide an initial interrogation of this common wisdom with data from the African Legislatures Project, describing across 17 countries how members of parliament understand their own roles, and what African citizens expect from their MPs.  Neither MP role orientations nor citizen expectations neatly conform to the common wisdom.  There is a great deal of variation across the continent, and much of it has to do with electoral system design.  Single member constituencies, particularly, provide a range of interesting dynamics that produce surprising gaps between what citizens want and what their MPs do.

Sex and secrecy: knowledge of HIV status, disclosure and sexual practices among HIV-positive adolescents in South Africa

Seminar
24 March, 2015 - 12:45 to 14:00
Rebecca Hodes (AIDS and Society Research Unit, Centre for Social Science Research, UCT) and Elona Toska (Social Policy and Intervention, Oxford University)
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no large-scale, mixed methods studies have explored the effects of adolescent knowledge of one’s HIV status, knowledge of partner status, and disclosure to partners on safer sex. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. 684 HIV-positive adolescents who had ever initiated ART in 39 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers, and their caregivers and healthcare workers. Knowledge of HIV-status among HIV-positive adolescents was associated with safer sexual practices, but knowing partner’s status and disclosure of HIV-positive status to sexual partners were not. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents.

Families and the State: National, International and Transnational Perspectives

Conference
26 March, 2015 - 09:15 to 27 March, 2015 - 09:15
Key Note Presenter: Lynn Jamieson Discussants: Debbie Budlender ,Prof. Nhlapo,Ariane de Lannoy,Leah Mundell
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

The Centre for Social Science Research is hosting a two-day symposium on the relationship and interaction between the diversity of families and households, on the one hand, and the institutions and policies of the state, on the other. The symposium will include four sessions. Each session will examine a specific issue and engage with claims about the benefits and harms of state actions for specific individuals and families such as vulnerable children, female headed households, transnational families and individuals in customary marriages. The symposium aims to engage with scholars and policy makers on a discussion that analyses how and whether state policies and laws are supporting families. A distinguished global scholar, Prof. Lynn Jamieson (University of Edinburgh and Director of Centre for Research on Families and Relationships), will present at a plenary session. The symposium will launch the official opening of FaSRU (the Families and Societies Research Unit) within the CSSR and act as the symposium of the ‘The functioning and consequences of transnational child raising arrangements in South and North: Angolan, Nigerian and Ghanaian migrant parents living in South Africa and The Netherlands (TCRA-SAN)’ project, a collaboration between the CSSR and the Faculty of Arts and Social Sciences at Maastricht University, The Netherlands.

 

Symposium programme [PDF]

Measuring the effects of interventions to address substance abuse

Rajen Govender is the Chairperson of the Service Quality Measurs (SQM) National Advisory Committee, which has been developing measures of the quality of interventions to address South Africa's massive problem of substance abuse. The SQM initiative comprises a partnership of researchers, practitioners, administrators, and other role-players and stakeholders drawn from treatment services providers, government, NGOs and universities/research facilities. The SQM methodology comprises a rigorous set of administrative and consumer perception measures which address key issues of access, equity, quality and outcomes in substance abuse health care. Additionally, to account for co-occurring health conditions, the SQM also collects information on HIV and HIV testing. The SQM measures have been tested and validated through two pilot studies and are now ready for implementation.

Does the African Middle Class Defend Democracy? Evidence from Kenya

Seminar
17 March, 2015 - 12:45 to 14:00
Nic Cheeseman
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

Barrington Moore’s famous line “no bourgeoisie, no democracy” is one of the most quoted claims in political science. But has the rise of the African middle class promoted democratic consolidation? This paper uses the case of Kenya to investigate the attitudes and behaviors of the middle class. Analysis of Afrobarometer survey data reveals that the middle class is more likely to hold pro-democratic attitudes. This suggests that Moore’s argument deserves to be taken seriously, at least in some African countries, and that contemporary demographic changes will improve the prospects for democratic consolidation. However, qualitative evidence from the Kenyan 2013 general election raises important questions about the resilience of these attitudes. The middle class may be more inclined to democratic attitudes than their less well off counterparts, but class continues to intersect with ethnicity and its political salience is likely to wax and wane as a result.

 Nic Cheeseman is an Associate Professor of African Politics at Oxford University and the co-editor of African Affairs. His research addresses a range of questions such as whether populism is an effective strategy of political mobilization in Africa, how paying tax changes citizens’ attitudes towards democracy and corruption, and the conditions under which ruling parties lose power. In addition to a number of book chapters and articles, he has published two co-edited collections: Our Turn To Eat (2010), which covers the politics of Kenya since independence, and The Handbook of African Politics (2013). A monograph, Democracy in Africa, has just been published by Cambridge University Press and a second book, How to Rig An Election, is currently under contract with Yale. Nic is also an advisor to a number of policy makers including the Cabinet Office, Foreign Office, and the Department for International Development of the UK government, the Instituto Rio Branco of the Brazilian government, the Lagos State Government, and the African Progress Panel

Working with the Grain: Integrating Governance and Growth in Development Strategies

Seminar
10 March, 2015 - 12:45 to 14:00
Brian Levy
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

“Best practices” prescriptions for reform have long dominated the development discourse, but they  confuse the goals of development with the journey of getting from here to there. In this seminar, Brian Levy will lay out an alternative approach which he develops in his recent book, Working with the Grain (New York: Oxford University Press, 2014). 

The book takes as its point of departure  the realities of a country’s economy, polity and society, and  directs attention towards the challenges of initiating and sustaining forward development momentum. It  builds on new institutional economics, organizational theory and political economy analysis to explore “good fit” approaches to the analysis of how  divergent developing country contexts influence the feasibility of alternative  reform options. The analysis distinguishes between “top down” options which endeavor to strengthen formal institutions, and options supporting the emergence of “islands of effectiveness”.  Sometimes the binding constraint to forward movement can be institutional, making governance reform the priority; at other times, the priority can better be on inclusive growth. Taking the decade-or-so time horizon of policymakers, the book explores how to nudge things along --  seeking gains that initially may seem quite modest but can, sometimes, give rise to a cascading sequence of change for the better.

 Brian Levy is the Academic Director of the Graduate School of Development Policy and Practice at the University of Cape Town. He also teaches at the School of Advanced International Studies, Johns Hopkins University in Washington DC. He worked at the World Bank from 1989 to 2012, including as manager of the  Africa Vice Presidency Public Sector Reform and Capacity Building Unit, and as head of the secretariat responsible for the design and implementation of the World Bank Group's governance and anti-corruption strategy. He has published widely on the interactions among institutions, political economy and development policy. He  completed his Ph.D in economics at Harvard University in 1983.

A Resilience Focused Family Intervention Addressing Intersections of HIV Risk and Poor Mental Health

Seminar
3 February, 2015 - 12:45 to 14:00
Caroline Kuo, DPhil, MPhil
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

 

 

 

Early adolescents (13-15 years) are an ideal target for preventive interventions targeting healthy sexual and mental behaviors. Engaging families in adolescent prevention is developmentally appropriate for early adolescents (13-15 years). However, few family-based adolescent HIV interventions have been empirically tested in South Africa and few HIV interventions take an integrated HIV-mental health approach.

We describe a set of preliminary studies in South Africa and the existing literature documented the intersections between poor mental health and HIV risk. We then describe preliminary qualitative work conducted to inform the design of a resilience-focused family preventive intervention targeting prevention of adolescent HIV risk and depression. This intervention is derived from the integration and adaptation of two existing best-evidence models for HIV risk reduction and prevention of depression. Adaptation needs were assessed utilizing k=8 focus groups with Xhosa-speaking mixed gender adolescents and parents or guardians and n=25 interviews with HIV and mental health experts. Qualitative data were recorded, transcribed verbatim, translated from Xhosa to English, and analyzed in NVivo using a thematic analysis. Respondents identified social and contextual challenges for HIV prevention including age disparate sexual relationships driven by economic needs, adolescent gang violence, and sexual violence. Respondents described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent-child communication on mental health and sexual topics were taboo, with these conversations perceived as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and animosity towards children who asked about sex. However, respondents also identified unique cultural conceptions of family resilience that could be leveraged to increase intervention engagement, including family meetings and communal parenting. Qualitative findings guided alteration of existing intervention content, and the addition of new content, topics, and delivery modalities for South Africa. This included a strengthened emphasis on family resilience; how mental health affects sexual decision making; parental monitoring, positive parenting; and building efficacy around parent-adolescent communication on the topics of sex and mental health are important target foci for a family-based intervention. The adapted family intervention will be tested in a randomized pilot trial in 2015-2016.

The Social Consequences of Class Formation among Black South Africans in the 2000s: Evidence from the South African Reconciliation Barometer

Seminar
24 February, 2015 - 12:45 to 14:00
Jeremy Seekings
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

I examine whether the African elite and middle classes have distinctive social attitudes, relative to poorer or lower class African people, and whether this has changed over the 2000s, in order to understand better how the rapid growth of the African middle classes affects social and political life in post-apartheid South Africa. The chapter uses survey data (from the Institute for Justice and Reconciliation’s South African Reconciliation Barometer) to show that the African middle classes assess much more positively than the poor the economic changes that have taken place in post-apartheid South Africa, and that this differential has grown over time. The middle classes are aware of their privilege, but seem to underestimate the challenges facing the poor. They are also more positive about improved inter-racial relations since 1994, perhaps because they enjoy very much more inter-racial interaction than do the poor. In terms of public policy, the middle classes support more strongly affirmative action, but are also more likely to say that the government does too much for people and probably see less need for active policies around employment creation. Overall, the growth of the African middle classes seems to be good for race relations but reduces the likelihood of pro-poor policies to challenge inequalities of class.

 

The Political Economy of Social Protection in Latin America

Seminar
17 February, 2015 - 12:45 to 14:00
Armando Barrientos
CSSR Seminar Room 4.29, Level 4 Leslie Social Science Building, Upper Campus
Abstract / Description: 

The recent expansion of budget-financed antipoverty transfer programmes in Latin America reflects a shift away from the stratified, Bismarckian, social protection institutions which dominated social policy in the 20th century. The inclusion of low income and informal groups through emerging social assistance institutions has been largely vertical, as opposed to horizontal, leading to parallel institutions supporting formal and informal groups. The paper discusses the main trends and considers the political sustainability of dual institutions in the region. 

 

 Armando Barrientos is Professor and Research Director at the Brooks World Poverty Institute at the University of Manchester in the UK. His research focuses on the linkages existing between welfare programmes and labour markets in developing countries, and on policies addressing poverty and population ageing. His most recent books are ‘Social Protection for the Poor and Poorest’ (2008, edited with D. Hulme, Palgrave); ‘Just Give Money to the Poor’ (2010, with J. Hanlon and D. Hulme, Kumarian Press); ‘Demographics, Employment and Old Age Security: Emerging Trends and Challenges in South Asia’ (2010, edited with Moneer Alam, MacMillan), and ‘Social Assistance in Developing Countries’ (2013, Cambridge University Press).

Rebecca Hodes takes over as Director of ASRU

Dr Rebecca Hodes is the new Director of the AIDS and Society Research Unit (ASRU), which is one of four research units within the CSSR. Rebecca is the author of Broadcasting the Pandemic: A History of HIV on South African Television HSRC Press, 2014), based on her doctoral thesis (from Oxford), as well as journal articles and book chapters in the field of public health and the history of medicine with a focus on sexual and reproductive rights and the AIDS epidemic. After completing her doctorate she worked for the Treatment Action Campaign (TAC) as manager of the policy, communications and research department, before coming to UCT as a post-doctoral fellow, first in ASRU and then in the Institute for Humanities in Africa (HUMA). In 2013, Rebecca was awarded a grant by the International AIDS Society, as a part of the Collaborative Initiative for Pediatric HIV Education and Research (CIPHER), and she returned to ASRU.

In Memoriam: Ncedeka Mbune

 

Our colleague and friend, Ncedeka Mbune, passed away tragically last weekend. Ncedeka worked in the CSSR for almost 10 years. During this time, she worked across a range of projects, and provided much-needed organisational and administrative support to many students and staff members. Ncedeka was known for her gentle presence, her warmth and her wit. She will be missed and mourned by us all.

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