Browsing by Author "Deghaye, Nicola"

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    Measuring enrolment and support for children with disabilities at the school level
    (Stellenbosch : Stellenbosch University, 2023-03) Deghaye, Nicola; van der Berg, Servaas; Hanass-Hancock, Jill; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
    ENGLISH SUMMARY: The overall purpose of this dissertation was to critically assess how disability inclusion in schools is and should be measured in South Africa and to develop and report on new measures of disability inclusion. Measurement of school-reported enrolment of learners with disabilities and inputs, processes and enablers of disability-inclusion in mainstream (ordinary) schools is considered. Despite the development of inclusive education policy in post-apartheid South Africa, implementation of disability inclusion in mainstream schools has been poorly documented and disability-related educational inequalities have persisted. Very few quantitative studies have addressed teacher training for inclusion, physical accessibility of schools, accessibility of learning materials or availability of disability support structures in mainstream schools in low- and middle-income countries (LMICs). This study develops new indicators of these aspects of disability inclusion and employs them in a nationally-representative school survey. A comprehensive analysis of school-reported enrolment of learners with disabilities was conducted to determine the reliability of disability-disaggregated enrolment data. The analysis demonstrates that school-level data on enrolment of learners with disabilities collected in annual surveys was inconsistent over time and incomplete and produce estimates that are much lower than rates of disability prevalence among learners estimated from household surveys. School reporting has, however, become more complete following the introduction of a learner-level Education Management Information System (EMIS). This study demonstrates that ordinary schools in South Africa have no financial incentive to enrol or report the presence of learners with disabilities. The importance of question wording when eliciting data on disability status has been demonstrated by previous research. This study demonstrates that the disability questions used in the EMIS in South Africa are not aligned with current education policy nor with the biopsychosocial model of disability. It recommends that the questions on disability status in EMIS are aligned with those used in the screening and identification processes used in schools since 2014. Multivariate analysis was used to show that schools in wealthier areas of South Africa are more likely to report enrolment of learners with disabilities than schools in more deprived areas. This suggests that schools in less wealthy areas experience greater difficulty identifying or reporting learner’ disability status. This has resulted in skewed reporting of disability-disaggregated enrolment by school wealth quintile. New (or improved) indicators of disability inclusion were developed and added to the School Monitoring Survey (SMS) 2017 (a nationally-representative sample of approximately 2,000 schools). The analysis was supplemented by a qualitative follow-up study examining ease of use of the teacher questionnaire. The improved indicators provide more comprehensive evidence on the proportion of schools that are physically accessible, have disability support structures in place, and where teachers have received training in inclusive education. These factors are critical in enabling ordinary schools to provide reasonable accommodation of learners’ individual needs. This study uses multivariate analysis to show that prior training is associated with improved teacher confidence in addressing learning barriers. This is the first study to use multivariate analysis of the SMS in relation to disability-inclusion. This study provides the first set of comparable nationally-representative data on disability inclusion at two time points. It shows that some progress has been made over time but that substantial provincial inequality across several indicators of disability inclusion remains. The performance of full-service schools is compared to that of ordinary schools in SMS 2017. A large, fairly-representative sample of full-service schools is shown to perform better than ordinary schools in various aspects of disability inclusion, but still fall short of the expectations in current guidelines. This study results in a much more comprehensive depiction of disability inclusion in ordinary schools than has been achieved by previous studies. It adds substantially to the body of evidence on operationalising the biopsychosocial model of disability in school indicators in middle-income countries.
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    Modelling the healthcare costs of skin cancer in South Africa
    (BioMed Central, 2016) Gordon, Louisa G.; Elliott, Thomas M.; Wright, Caradee Y.; Deghaye, Nicola; Visser, Willie
    Background: Skin cancer is a growing public health problem in South Africa due to its high ambient ultraviolet radiation environment. The purpose of this study was to estimate the annual health system costs of cutaneous melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in South Africa, incorporating both the public and private sectors. Methods: A cost-of-illness study was used to measure the economic burden of skin cancer and a ‘bottom-up’ micro-costing approach. Clinicians provided data on the patterns of care and treatments while national costing reports and clinician fees provided cost estimates. The mean costs per melanoma and per SCC/BCC were extrapolated to estimate national costs using published incidence data and official population statistics. One-way and probabilistic sensitivity analyses were undertaken to address the uncertainty of the parameters used in the model. Results: The estimated total annual cost of treating skin cancers in South Africa were ZAR 92.4 million (2015) (or US$15.7 million). Sensitivity analyses showed that the total costs could vary between ZAR 89.7 to 94.6 million (US$15.2 to $16.1 million) when melanoma-related variables were changed and between ZAR 78.4 to 113.5 million ($13.3 to $19.3 million) when non-melanoma-related variables were changed. The primary drivers of overall costs were the cost of excisions, follow-up care, radical lymph node dissection, cryotherapy and radiation therapy. Conclusion: The cost of managing skin cancer in South Africa is sizable. Since skin cancer is largely preventable through improvements to sun-protection awareness and skin cancer prevention programs, this study highlights these healthcare resources could be used for other pressing public health problems in South Africa.