Browsing by Author "Burger, Ronelle"

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    Access in the South African public health system: factors that influenced access to health care in the South African public sector during the last decade
    (University of the Western Cape, 2014) Christian, Carmen Sue; Burger, Ronelle; Yu, Derek
    The aim of this mini-thesis is to investigate the factors linked to access in the South African public health sector - using General Household Survey Data - in order to contribute to a better understanding of the role of access in achieving the National Department of Health’s primary goal of universal coverage. Even though the multi-dimensional interpretation of health system performance has gained acceptance and traction in recent years, much of the research linked to it remains supply-focused. The implicit truth is that demand-side health issues are largely ignored, under-researched and ominously absent from health policies. This is particularly true with regard to the access dimension of health performance, where research and policy focus almost exclusively on availability and affordability perspectives of access while neglecting demand-side aspects of health-seeking behaviour, such as acceptability. The study, therefore, pursues an in-depth exploration of access across its three dimensions - availability, affordability and acceptability - in the South African public health sector and aims to empirically investigate access to public health care from 2002 to 2012. It also identifies the underlying reasons for the observed trends, supplementing and reorienting the current understanding of access to public health care. The empirical findings reveal mixed results: it supports current literature by suggesting that equity has been achieved in terms of making public health care services more affordable, especially for the most vulnerable groups of South African society. However, acceptability and availability issues persist. It is safe to say that the availability of public health care – mainly a supply-side issue – is being addressed in the South African context with Government taking steps to address it. Unfortunately the same attention has not been given to issues of acceptability on the demand-side. Failure to fully understand the demand-side dimension of access and the role health-seeking behaviour plays in public health issues threatens to weaken health policies aimed at improving access. It is imperative that demand-side aspects of health-seeking behaviour and institutional responsiveness to health-demand occupy a more prominent role in South African public health debates, research and policy.
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    Access to health care in post-apartheid South Africa: availability, affordability, acceptability
    (Cambridge University Press, 2018) Burger, Ronelle; Christian, Carmen
    We use a reliable, intuitive and simple set of indicators to capture three dimensions of access – availability, affordability and acceptability. Data are from South Africa’s 2009 and 2010 General Household Surveys (n=190,164). Affordability constraints were faced by 23% and are more concentrated amongst the poorest. However, 73% of affordability constraints are due to travel costs which are aligned with findings of the availability constraints dimension. Availability constraints, involving distances and transport costs, particularly in underdeveloped rural areas, and inconvenient opening times, were faced by 27%. Acceptability constraints were noted by only 10%. We approximate acceptability with an indicator measuring the share of community members bypassing the closest health care facility, as we argue that reported health care provider choice is more reliable than stated preferences. However, the indicator assumes a choice of available and affordable providers, which may often not be an accurate assumption in rural areas. We recommend further work on the measurement of acceptability in household surveys, especially considering this dimension’s importance for health reform.
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    Lockdown-associated hunger may be affecting breastfeeding: Findings from a large sms survey in South Africa
    (MDPI, 2022) Sayed, Nazeeia; Burger, Ronelle; Harper, Abigail
    The impact that the COVID-19 pandemic has had, and will continue to have, on food security and child health is especially concerning. A rapid, Short Message Service (SMS) Maternal and Child Health survey was conducted in South Africa in June 2020 (n = 3140), with a follow-up in July 2020 (n = 2287). This was a national cross-sectional survey conducted among pregnant women and mothers registered with the MomConnect mhealth platform. Logistic regression was conducted to explore the associations between breastfeeding, maternal depressive symptoms, and hunger in the household. High breastfeeding initiation rates and the early introduction of other foods or mixed milk feeding were found. The prevalence of depressive symptoms in this survey sample was 26.95%, but there was no association between breastfeeding behaviour and depressive symptom scores (OR = 0.89; 95% CI: 0.63, 1.27).
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    Measuring quality gaps in TB screening in South Africa using standardised patient analysis
    (MDPI, 2018) Christian, Carmen S.; Gerdtham, Ulf-G.; Hompashe, Dumisani; Smith, Anja; Burger, Ronelle
    This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
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    Predictors of mask-wearing during the advent of the COVID-19 pandemic: Evidence from South Africa
    (Oxford University Press, 2022) Burger, Ronelle; English, Rene; Maughan-Brown, Brendan; Christian, Carmen
    Background: In the absence of a vaccine, the global spread of COVID-19 during 2020 has necessitated non-pharmaceutical interventions to curb the rise of cases. Purpose: The article uses the health belief model and a novel rapid mobile survey to examine correlates of reported mask-wearing as a nonpharmaceutical intervention in South Africa between May and August 2020. Methods: Two-way tabulations and multivariable analysis via logistic regression modeling describe correlations between reported mask-wearing and factors of interest among a sample of 7074 adults in a two-period national longitudinal survey, the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM). Results: In line with the health belief model, results showed that self-efficacy, the prevalence of others’ mask-wearing in the same district, and affluence were positively associated with reported mask-wearing. Those who reported staying at home were significantly less likely to report wearing a mask. There was little evidence that the expected severity of the disease if contracted, affects these decisions. Hypertension, obesity, or being overweight (measured three years earlier) did not have a significant association with maskwearing. The prevalence of mask-wearing increased significantly from May to August 2020 as COVID-19 cases increased and lockdown restrictions were eased. Contrary to the health belief model, we found that despite having a higher mortality risk, the elderly had significantly lower odds of mask-wearing. Conclusion: In South Africa, the mask-wearing adherence has increased rapidly. It is concerning that the elderly had lower odds of mask-wearing. This should be examined further in future research.
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    A series of national accounts-consistent estimates of poverty and inequality in South Africa
    (Stellenbosch University, 2007) Yu, Derek; van der Berg, Servaas; Burger, Ronelle
    This paper makes a unique contribution to the South African literature in combining data from an alternative source of household survey data – the All Media and Product Survey (AMPS) – with national accounts income trends for this country, in the recent tradition of research on the world distribution of income performed by Bhalla (2002), Karshenas (2003), Bourguignon and Morrisson (2002), Sala-i-Martin (2002a; 2002b), and Quah (2002), amongst others. Its usefulness lies in arriving at alternative estimates of post-transition poverty and inequality that are consistent with the story that national accounts and other official data collectively tell us about the path of the South African economy during the post-transition period. While the method of scaling survey distribution data by national accounts means is somewhat controversial, it is not clear that the distributional trends obtained using the post-transition sets of either the IESs or the Population Censuses are more reliable, given serious deficiencies in both sources of data. Adjusted distributions yield lower levels of poverty and a stronger decline in poverty during the second half of the period than the figures obtained from the raw AMPS data. While the levels of poverty obtained using adjusted income distributions are artificially low, the derived downward trend is supported by a number of official data sources.