Doctoral Degrees (Economics)

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A study of political accountability, service delivery and political participation in South Africa
(Stellenbosch : Stellenbosch University, 2024-03) Fransman, Tina; von Fintel, Marisa; van der Berg, Servaas; Yu, Prof. Derek; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Accountability in public service delivery has become a prominent issue, particularly for countries within the Global South. In theory, citizens ought to hold the state accountable for service delivery, which is usually done through voting. Existing literature, however, highlights that the relationship between citizens and government is highly complex when it comes to service delivery and accountability. To explore the nuances of this relationship, this dissertation examines political accountability, service delivery and political participation in South Africa. The relationship between service delivery and political participation is explored through two related themes. Firstly, this study considers what role access to public services plays in South Africans’ decision to engage in political participation, specifically by voting or taking part in protest action. In this regard, the research distinguishes between the provision of electricity and other public services (water, sanitation and refuse removal) since electricity provision in South Africa has its own unique challenges. Secondly, it considers how individuals' perceptions of their relative standing within South Africa affect their decision to participate politically. While previous research has indicated a general correlation between perceptions of relative deprivation or relative affluence and political participation, this dissertation examines the relationship for South Africa specifically. Chapter 2 investigates the different routes to political accountability in the context of service delivery in South Africa. The results indicate a breakdown in the relationship between public service delivery (i.e. water provision, refuse collection and flush toilets) and voting behaviour. Furthermore, the findings suggest that South Africans consider protest action as an alternative route to political accountability. In addition, there is evidence to support the notion that spoiled ballots could serve as another plausible alternative accountability route. Chapter 3 of this dissertation focuses on the dynamics between political participation and electricity specifically. The main results reveal that there is a significant link between both electricity access and reliability and the likelihood of political participation. More specifically, adequate electricity access is found to spur both voting and protest participation while unreliable electricity is found to depress both voting and protest participation. Chapter 4 explores the relationship between relative standing and political participation. The findings show that those with a higher relative standing are more likely to engage in voting compared to those with a lower relative standing, while those with a lower relative standing are more likely to engage in non-electoral forms of political participation (such as protest action) compared to those with a higher relative standing.
Essays on the economics of early childhood development : spatial inequalities, service provision, and parental investment
(Stellenbosch : Stellenbosch University, 2024-03) Leach, Grace Margaret Mary; von Fintel, Dieter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Healthy development in early childhood is a promising mechanism for the reduction of intergenerational poverty, but multiple inputs are necessary at the same time for this to occur, which renders healthy child development a challenge in resource constrained environments. While there is increasing consensus regarding the elements that children need for healthy development, there is a gap in the literature as to how these elements can successfully be provided, especially in low- and middle income countries (LMICs). The home, the neighbourhood and the local government capacity for service provision are all critical elements of the context for effective early childhood development (ECD), or they present risk factors. This thesis addresses this knowledge gap by exploring how children in LMICs can be provided with the socioeconomic and government services they need to support healthy development. ECD refers to the healthy physical, cognitive, and socioemotional growth of young children. Economists have added their voice to those of other social scientists, documenting how ECD lays the foundations for cultivating skills that ensure socioeconomic security later in life, but also improves labour market productivity and economic growth potential. The discourse has increasingly emphasised Early Childhood Education (ECE) intervention, however, at the expense of prioritising a wider package of ECD services of which ECE is only one critical component. This thesis addresses this gap and emphasises the wider package which is needed for healthy child development. This dissertation will explore three topics in three essays related to the economics and spatial distribution of early childhood development. Chapter two addresses the concept of nurturing care and proposes a measurement of ECD services to account for the combination of services needed. The study is conducted using South African data, and applies Multidimensional Poverty Index methodology. The result reveals that many children lack essential services for healthy growth in South Africa. A positive correlation between public infrastructure service delivery and child cognitive outcomes is also revealed, indicating that improved municipal environments complement attendance in Early Learning Programs. Chapter three investigates barriers to providing services like water, sanitation and roads, which support ECD but require a network of infrastructure. Uneven regional provision perpetuates developmental inequalities in children. The study analyses the impact of terrain ruggedness and local state capacity on the implementation of national policies and access to public health infrastructure. Regions with poor historical state capacity have lower access to services, but improved capacity overcomes the ruggedness effect. Chapter four analyses internal household caregiving dynamics and studies the health implications of parental death or absence. Unsurprisingly, orphans and children with absent parents face worse health outcomes than those living with their parents. Paternal orphans show severe disadvantages in chronic health by age four; children without fathers are disadvantaged in terms of food security. The household environment plays a crucial role in counteracting the negative effects of paternal orphanhood. Household resources moderate the stunting penalty, but some effects remain unexplained, not linked to reduced socioeconomic status. The study emphasises the importance of multiple good-quality inputs for healthy child development.
Using apple product prices to evaluate the law of one price and product derived real exchange rates
(Stellenbosch : Stellenbosch University, 2023-12) Walker, Ernest Edward; van Lill, Dawid; Hollander, Hylton; du Rand, Gideon; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Empirical literature on the law of one price or purchasing power parity suggests that real exchange rate deviations are more persistent than economic theory would predict. To evaluate these deviations, I construct two novel panel datasets consisting of Apple product prices. The first dataset covers iPod, iPad, and iPhone prices across almost 50 countries spanning more than 10 years, and supports the hypothesis that the law of one price holds for some Apple products in both absolute and relative terms, particularly after controlling for transaction costs. This finding is attributable to the homogeneity of Apple products and the ease of accounting for transaction costs. The results suggest that Apple prices are better suited than often-used alternative price measures to investigate international parity conditions (e.g., the Big Mac Index and the consumer price index). The second panel dataset consists of weekly Apple iPad prices across 35 countries from 2016 through 2021. I use this dataset to evaluate the short-term, nonlinear adjustment behavior of real exchange rates with a range of nonlinear estimation techniques, including locally-weighted scatterplot smoothing, threshold regression models, and piecewise linear approaches. I find that the stochastic law of one price hypothesis is supported. Moreover, real exchange rate half-lives derived from Apple iPads are significantly shorter (estimated to be only a few weeks) than what is typically found in the literature for similar studies on the law of one price and purchasing power parity. Overall, my findings provide new insights into the dynamics of real exchange rates, highlighting the importance of using appropriate price measures and nonlinear estimation techniques.
Access to healthcare services in resource-constrained environments : evidence from Zimbabwe
(Stellenbosch : Stellenbosch University, 2023-12) Chari, Abigail; Burger, Ronelle; von Fintel, Dieter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Access to healthcare services is fundamental to health and well-being, yet approximately half of the world’s population is unable to access healthcare services in times of need, which derails attainment of the Sustainable Development Goals. Weak access to healthcare services is a global health challenge, and is prevalent in Zimbabwe. This weak access is attributed to a fragile and fragmented health system, characterised by weak and ineffective service delivery. The fragmented health system affects particularly the already disadvantaged population through healthcare services that are either unaffordable or unavailable. As part of achieving the global Sustainable Development Goals, Zimbabwe aims to address inequality in and weak access to its healthcare services. This thesis examined fiscal incidence and inequality in access to healthcare services in Zimbabwe, using 2017 administrative health expenditure data from the Ministry of Health and Child Care and the Prices, Income, Consumption and Expenditure Survey of the Zimbabwe National Statistics Agency. Fiscal incidence was found to be, on average, pro-poor for Zimbabwe’s low-level facilities, and pro-rich for high-level facilities. It was further found that availability and affordability are, on average, pro-rich. Thus, differential access to health services between rural and urban areas was contributing to pro-rich inequality. Despite government healthcare expenditure, inequality in availability and affordability of healthcare services remains a challenge. Pockets of inequality persist in the healthcare sector, as the more affluent continue to benefit from well-resourced facilities. The government should, therefore, focus on poor and rural populations, who bear the brunt of weak access to healthcare services. While the effects and causes of drug stockouts are well articulated, there is a dearth of literature on the link between district-level drug stockouts and poverty. This thesis investigated the spatial inequality of drug stockouts and the relationship between drug stockouts and district poverty in Zimbabwe using data on district-level drug stockouts and poverty. The results showed that spatial inequality in drug stockouts and district poverty exists, while the relationship between drug stockouts and district poverty was weak and insignificant. Spatial interdependence in drug stockouts between districts also exists, indicating hot spots in drug stockouts. In times of drug stockouts, individuals tend to use alternatives to healthcare, some of which pose health dangers, and it is therefore important to improve drug availability in underserved districts by reducing spatial inequality and hot spots in drug stockouts. Given the negative effects of malaria on the vulnerable population, this thesis examined the association between malaria prophylaxis stockouts and birth- and maternal outcomes in Zimbabwe. Preventive efforts against malaria are crucial, given that pregnant women and neonates bear the greatest malaria burden. Therefore, it was hypothesised that women who do not receive malaria prophylaxis during pregnancy are at risk of malaria infections, which compromise birth weight and cause maternal anaemia. Combining the administrative data on malaria prophylaxis stockouts and 2015 nationally representative Demographic Health Survey data, the results showed that malaria prophylaxis stockouts occur frequently over time, and have a significant association with birth weight, especially for neonates with an average birth weight. Stockouts are associated with neonates tending towards the lower end of a normal birth weight, compromising their development. Thus, there is a need to invest in pharmaceutical information- and stock-ordering systems to improve drug availability at the point of care. In conclusion, there is inequality in healthcare services in Zimbabwe, which causes a heavy burden on poor and rural populations. These vulnerable populations have weak access to healthcare services, despite the government's efforts to improve service provision. This thesis sheds more light on access to healthcare services, to enhance relevant stakeholders’ understanding of this subject. To achieve an equitable society, policymakers should address the inequalities in access to healthcare services, together with the socio-demographic determinants of health. Policymakers should improve resource management, follow a needs-based approach, invest in pharmaceutical information systems and stock-ordering systems, and foster multi-stakeholder collaboration to ensure improved access to healthcare services.
Information asymmetry and the misalignment of incentives in the South African private healthcare sector
(Stellenbosch : Stellenbosch University, 2023-12) Vorster, Pamela Ann; Ronelle, Burger; Lungiswa, Nkonki; Helmuth, Reuter; Stellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.
ENGLISH SUMMARY: Healthcare markets are notorious for information asymmetry, which may result in the inefficient organisation of scarce resources. This dissertation examines information asymmetry occurring in both the demand for and supply of healthcare in the private sector of South Africa. This dissertation’s main contribution is of insights into inefficiencies within the private healthcare sector resulting from inherent information asymmetry in healthcare markets. These inefficiencies in the South African context make healthcare more expensive than it should be. The government has started implementing the National Health Insurance (NHI) which will require an efficient allocation of scarce resources. Research in South Africa is primarily focused on the public sector, although there are many lessons to learn from the private sector. The first essay discusses the presence of adverse selection in the market for health insurance in South Africa. It then examines individuals’ demand for insurance by identifying characteristics that influence their propensity to insure. The study found that some adverse selection may be built into the health insurance market. Individuals have a higher tendency to purchase insurance if they have a chronic condition or are pregnant. However, socio-economic factors appear to be major contributing factors to individuals’ insurance purchasing decisions. Once people join a medical scheme, they tend to maintain their membership. Therefore, measures to address wasteful healthcare spending that would decrease the overall cost of healthcare and, ultimately, the cost of insurance could sustainably increase the size of the risk pool. The second essay reports the results of a survey to investigate variations in treatment decisions among spine surgeons. It also identifies associations between surgeons’ characteristics and the treatment they select. The findings make a case for evaluating outcomes and costs to identify value-based care. Such research would assist countries seeking to contract with providers based on value. Greater uniformity in treatment and easy reporting of outcomes would provide guidance to patients. Further investment in training and participation in fellowship programmes may be necessary, along with greater dissemination of information from the literature. The third essay reports on a case study of rhizotomies to identify necessary conditions and red flags that could provide plausible signs of supplier-induced demand. A rhizotomy is a low-risk, discretionary procedure that is one of many treatments a patient can receive to address chronic back pain. The study used claims data from a large health insurer to investigate four broad themes: outcomes of the treatment, practitioner and patient characteristics, incidence and the total cost of trends, and practitioner landscape. This study found that some practitioners are likely to induce demand for rhizotomies. It illustrates how analysing claims data could assist in detecting supplier-induced demand. It indicates the need to pool claims data across the industry to provide funders with a useful tool to address such demand and overservicing, and to develop benefit options based on high-value treatment.

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