The utilisation of the child support grant by caregivers : the case of Ba-Phalaborwa municipality in Limpopo Province

The Child Support Grant (CSG) represents a major policy response to child poverty in South Africa. Based on qualitative research, the article explored how caregivers in Ba-Phalaborwa sub-district in the Limpopo province utilise the CSG. The findings revealed that the CSG is mostly utilised to buy food, clothes and school necessities for children. There were perceptions, though, that some recipients did not utilise the grant in the best interest of children. It is recommended that the Department of Social Development should monitor closely the utilisation of the grant to ensure that beneficiaries use the grant in the best interest of the children

Resourcing single parents in a South African community rural setting: an exploratory study

Published ArticleThis study investigated the resource needs of single parents as child carers. Participants were a purposive sample of 40 single parents (female = 70%, Black = 95%, rural 80%; age range 30 to 55 years old). Data on resource needs of single parents were collected using semi-structured individual interviews. The data were thematically analyzed. The findings indicated that single parents need relationship and socio-emotional, material and time use supports to be successful in their carer roles. Resourcing single parents in their child care roles requires a holistic approach addressing both material and socio-relational support needs

Initiating a participatory action research process in the Agincourt health and socio–demographic surveillance site

Financial disclosure Funding: The research presented in this paper is funded by a Development Grant as part of the Health Systems Research Initiative from Department for International Development (DFID)/Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/N005597/1). The fieldwork was completed with the Umeå Centre for Global Health Research, with support from FORTE: Swedish Council for Health, Working Life and Welfare (grant No. 2006–1512). The School of Public Health at the University of the Witwatersrand, the South African Medical Research Council, and the Wellcome Trust, UK support the MRC/Wits Rural Public Health and Health Transitions Research Unit and Agincourt HDSS (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z). OW is a recipient of an MSc Chevening Scholarship, the UK government's global scholarship programme, funded by the Foreign and Commonwealth Office (FCO) and partner organizations (Chevening Ref.: NGCV–2015–1194).Peer reviewedPublisher PD

Strengthening Citizenship: Social Grants and the State–Citizen Relationship in South Africa

This study uses a citizenship lens to consider the extent to which social grants strengthen or weaken the state–citizen relationship, examining the case of the Child Support Grant in South Africa. There is a body of literature that stresses the importance of enforceable legal rights to social assistance for building a responsive and effective social assistance system. This literature suggests that there is potential for government-funded social grants to strengthen the relationship between citizen and state, but there is little research into the effect of social grants on this relationship. I argue that a rights-based framing of social assistance, although an important foundation, does not necessarily guarantee a strong state–citizen relationship. Although the theory of social grants in South Africa supports a concept of participatory, inclusive, dignified and justiciable citizenship for social grant recipients, there appears to be a gap between the policy framework and implementation. Aligning implementation with the policy documents would strengthen the relationship between state and citizen and the recognition of social assistance as a right

Inpatient case fatality rates improvements in children under 5: Diarrhoeal disease, pneumonia and severe acute malnutrition

Data on the number of admissions and deaths in children aged under 5 years from diarrhoea, pneumonia and severe acute malnutrition are routinely collected through the District Health Information System. These data, and the associated case fatality rates, are available for all public sector hospitals in South Africa (SA), and can be compared over time, as well as across different settings. This article presents these data for the period 2011/12 - 2016/17. It reflects on the remarkable improvements in these case fatality rates, and the likely reasons for their declines across all provinces. The article concludes by identifying the actions that need to be taken to ensure that SA achieves the Sustainable Development Goal aim of ending preventable child deaths by 2030

Structural drivers and social protection:Mechanisms of HIV risk and HIV prevention for South African adolescents

Introduction: Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can “cash plus care” social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. Methods: This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Results: Structural drivers were associated with increased onset of adolescent HIV risk behaviour (p<0.001, B=0.06, SE=0.01), fully mediated by increased psychosocial problems. Both cash and care aspects of social protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=−0.08, p<0.002 between structural deprivation and psychosocial problems, and B=−0.07, p<0.001 between psychosocial problems and HIV risk behaviour). Conclusions: Adolescents with the greatest structural deprivation are at higher risk of HIV, but social protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV-prevention approaches

Whole-system change: case study of factors facilitating early implementation of a primary health care reform in a South African province

BACKGROUND: Whole-system interventions are those that entail system wide changes in goals, service delivery arrangements and relationships between actors, requiring approaches to implementation that go beyond projects or programmes. METHODS: Drawing on concepts from complexity theory, this paper describes the catalysts to implementation of a whole-system intervention in the North West Province of South Africa. This province was an early adopter of a national primary health care (PHC) strategy that included the establishment of PHC outreach teams based on generalist community health workers. We interviewed a cross section of provincial actors, from senior to frontline, observed processes and reviewed secondary data, to construct a descriptive-explanatory case study of early implementation of the PHC outreach team strategy and the factors facilitating this in the province. RESULTS: Implementation of the PHC outreach team strategy was characterised by the following features: 1) A favourable provincial context of a well established district and sub-district health system and long standing values in support of PHC; 2) The forging of a collective vision for the new strategy that built on prior history and values and that led to distributed leadership and ownership of the new policy; 3) An implementation strategy that ensured alignment of systems (information, human resources) and appropriate sequencing of activities (planning, training, piloting, household campaigns); 4) The privileging of ‘community dialogues’ and local manager participation in the early phases; 5) The establishment of special implementation structures: a PHC Task Team (chaired by a senior provincial manager) to enable feedback and ensure accountability, and an NGO partnership that provided flexible support for implementation. CONCLUSIONS: These features resonate with the deliberative, multi-level and context sensitive approaches described as the “simple rules” of successful PHC system change in other settings. Although implementation was not without tensions and weaknesses, particularly at the front-line of the PHC system, the case study highlights how a collective vision can facilitate commitment to and engagement with new policy in complex organisational environments. Successful adoption does not, however, guarantee sustained implementation at scale, and we consider the challenges to further information.Web of Scienc

Cash transfers and caregivers : working together to reduce vulnerability and HIV risk among adolescent girls in Johannesburg, South Africa

Abstract: In South Africa adolescent girls have the highest HIV incidence of any sex or age cohort. Scalable HIV-prevention interventions targeting this group are critical for epidemic control. Reaching 12.2 million children, the Child Support Grant mitigates the socio-structural drivers of HIV risk. This qualitative study of eight adolescents and their caregivers in Westbury, Johannesburg, explored how caregiving increases protective potential. ‘Caregiving’ enhanced the HIV risk-reduction benefits of ‘cash’ when characterised by substantial positive caregiver-adolescent involvement and adequate levels of control and consistency. Results underpin the value of social protection as an HIV-prevention modality and endorse investment in caregiver support programmes

Cash transfers and the social determinants of health : a conceptual framework

Cash transfers (CTs) can play a significant role in tackling the social determinants of health (SDoH), but to date there is a lack of conceptual framework for understanding CTs linkages to the SDoH. This article proposes a framework that identifies the linkages between CTs and SDoH, discusses its implications, and argues for active involvement of health promoters in CT design, implementation and evaluation. The development of the framework followed two stages: evidence review and stakeholder involvement. The evidence review entailed a systematic literature search to identify published and unpublished impact evaluation studies of CTs in sub-Saharan Africa. Critical reflection on the evidence synthesized from the literature formed the basis for the development of the framework. Interviews with CT policy makers, managers and development partners were also carried out to help refine the framework. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. The study finds that there is limited recognition of SDoH in CT policy making and implementation. The evidence reviewed, however, points to strong impacts of CTs on SDoH. The framework thus conceptualizes how CTs work to influence a broad range of SDoH and health inequities. It also highlights how CT architecture and contexts may influence program impacts. The proposed framework can be used by policy makers to guide CT design, adaptation and operations, and by program managers and researchers to inform CTs’ evaluations, respectively. The framework suggests that to optimize CT impact on SDoH and reduce health inequities, health promoters should be actively engaged in terms of the programs design, implementation and evaluation

A qualitative application of Amartya Sen’s ‘development as freedom’ theory to an understanding of social grants in South Africa

Amartya Sen argued that poverty is the “deprivation” of a person’s capability to lead a “good life”, therefore ending poverty means meeting basic physical and social needs, and enabling meaningful economic and political choices. The aim of this paper is to investigate whether and how social grants enable “choices” in Sen’s sense. In-depth interviews conducted with social grants recipients’ in this study provided evidence that social grants reduce poverty, both in terms of helping grants recipients to meet basic needs, and enabling them to make more choices, such as buying food, accessing education and health care, as well as facilitating job searches and starting small businesses. However, there was also evidence that showed that grants are inadequate to entirely remove the “unfreedoms” facing the poor because the grants are too small to adequately cover basic needs in the context of large family sizes, a serious and long-term lack of resources, persistent unemployment, and high indebtedness. Further, these grants could enable only a limited expansion of “choices”. This paper argues that social grants in South Africa do enable recipients some “choices” although access to these “choices” is limited. It is envisaged that this paper will help academics to think more about the extent of the developmental impact of social grants in South Africa.Keywords: Amartya Sen, poverty, social grants, choices, development as freedo