ITEM VIEW

The assessment and improvement of the health status of vulnerable and low income individuals in South Africa: an analysis using quantitative and experimental methods

dc.contributor.advisorBurger, Ronelleen_ZA
dc.contributor.advisorVan der Berg, Servaasen_ZA
dc.contributor.authorRossouw, Lauraen_ZA
dc.contributor.otherStellenbosch University. Faculty of Economic and Management Sciences. Dept. of Economics.en_ZA
dc.date.accessioned2016-12-22T13:13:37Z
dc.date.available2016-12-22T13:13:37Z
dc.date.issued2016-12
dc.identifier.urihttp://hdl.handle.net/10019.1/100086
dc.descriptionThesis (DCom)--Stellenbosch University, 2016.
dc.description.abstractENGLISH SUMMARY : More than two decades after the end of apartheid, inequalities in health across socioeconomic subgroups are still a pervasive and persistent trend. South Africa also faces a high burden of disease which is disproportionate to its level of economic development. This dissertation contains three chapters on the contribution of demand-side factors to South Africa’s health burden, focusing on the health perceptions and eventual health choices of vulnerable individuals. Vulnerable individuals assessed in this dissertation include the income and wealth poor and, in particular, women living in low-resource areas with limited access to sexual and reproductive health services. Evidence is provided on innovative interventions aimed at improving the health-seeking behaviour and health outcomes of these individuals. Chapter two of the dissertation calculates the impact of reporting differences on the accurate measurement of health inequalities by wealth status. The analysis is performed by benchmarking the reporting behaviour of individuals using anchoring vignettes. A statistically significant difference in the reporting behaviour by wealth status is found, which will lead to an underestimation of health inequalities to the disadvantage of the poor. Chapter three explains how a package intervention to improve the health-seeking behaviour of pregnant women living in a low-resource area in the Western Cape was designed, implemented and tested. The results from a randomized controlled trial show that a community health worker programme and an incentive jointly led to a statistically significant improvement in the timing and frequency of antenatal care-seeking behaviour. The impact of the intervention on behaviour change is explored by measuring differences in the preferences for care. This heterogeneity in preferences for antenatal care is measured by looking at differences in time preferences and prioritization. The intervention also led to a statistically significant reduction in maternal depressive symptoms and a statistically significant improvement in the intention to exclusively breastfeed for six months. Lastly, the fourth chapter considers the cost-efficiency of two alternative approaches to providing women with better access to urine pregnancy tests. Even though having access to these tests have been linked to improved timing of healthcare-seeking behaviour, the availability and acceptability of test distribution at public health facilities is of poor quality. Two approaches, namely distribution at a mobile health facility and door-to-door distribution, are compared. Door-to-door distribution is found to be a more cost-effective approach. The dissertation is aimed at establishing a better understanding of the demand-side of health, the factors driving health-seeking behaviour and the factors affecting health reporting.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING : Meer as twee dekades na die val van apartheid is gesondheidsongelykhede steeds ‘n omvattende en blywende tendens in Suid-Afrika. Suid-Afrika sukkel met die teenwoordigheid van ‘n hoë siektelas wat buite verhouding is tot Suid-Afrika se vlak van ontwikkeling. In hierdie proefskrif word die vraagkant verwante faktore as bydraers tot Suid-Afrika se gesondheidslas ondersoek deur te fokus op gesondheidspersepsies en die gesondheidskeuses van kwesbare individue. Die kwesbare individue wat in hierdie proefskrif geanaliseer word sluit groepe in wat inkomste en welvaart arm is. Daar word spesifiek gefokus op vroue wat in lae-inkomste gebiede woon en beperkte toegang tot seksuele en reproduktiewe gesondheidsdienste het. In dié proefskrif word daar ook navorsing aangebied oor innoverende intervensies wat daarop gemik is om die gesondsheidsoptrede en gesondheidsuitkomstes van bogenoemde subgroepe te verbeter. In die tweede hoostuk word die impak van verskille in rapporteringsoptrede op die akkurate meting van gesondheidsongelykhede tussen groepe van verkillende welvaart gemeet. Statistiese vinjettes word gebruik om individue se gesondsrapportering te anker en te vergelyk. ‘n Statisties beduidende verskil word gevind in die rapporteringsoptrede van verskeie welvaartgroepe. Daar word ook gevind dat dit sal lei tot ‘n onderskatting van die gesondheidsverskille tussen welvaartgroepe, tot die nadeel van die armstes. In hoofstuk 3, word die ontwerp en implementering van ‘n multi-komponent intervensies beskryf en word die impak daarvan op die gesondheidsoptrede van lae-inkomste swanger vroue in die Wes-Kaap getoets. ‘n Ewekansigbeheerde proef is ingespan om die impak te meet. Die resultate toon dat ‘n gemeenskapswerkerprogram en insentief gesamentlik swanger vrouens kan motiveer om vroeër en meer gereeld antenatale sorg te besoek. Die bevinding is statisties beduidend. Die impak van die intervensie op die verandering in gesondheidsoptrede word gemeet deur die heterogeniteit van individue se voorkeure te analiseer. ‘n Poging word aangewend om vrouens se heterogene voorkeure vir antenatale sorg te verstaan deur te kyk na die gewig wat hulle op huidige, teenoor toekomstige, voordele en kostes plaas. Heterogene voorkeure word ook bestudeer deur te meet of vroue anders reageer op die intervensie indien hulle oorweldig word deur hulle daaglikse pligte, en dus besoeke aan antenatale sorg uitstel. In die laaste hoofstuk word die koste-effektiwiteit van twee alternatiewe benaderings tot die verspreiding van urine swangerskaptoetste bereken. Die beperkte literatuur dui aan dat vroue wat toegang het tot swangerskaptoetse meer geneig is om vroeër sorg te besoek. Ten spyte van die literatuur is dié toetse weinig beskikbaar by openbare gesondheidsfasiliteite. In hierdie hoofstuk word die koste-effektiwiteit van twee alternatiewe benaderings ondersoek, naamlik deur-tot-deur verspreiding en verspreiding deur ‘n mobiele uitreikkliniek. Die bevindings dui daarop dat deur- tot-deur verspreiding oor die algemeen meer koste-effektief is. Die proefskrif is daarop gemik om die vraagkant van gesondheid beter te verstaan, asook om vas te stel watter faktore affekteer gesondheidsrapportering en gesondheidsoptrede.af_ZA
dc.format.extentxviii, 254 pages ; illustrations
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.subjectPoor women -- Medical careen_ZA
dc.subjectSocioeconomic status -- South Africaen_ZA
dc.subjectPregnant women -- Medical careen_ZA
dc.subjectVulnerability (Personality trait)en_ZA
dc.subjectUCTD
dc.titleThe assessment and improvement of the health status of vulnerable and low income individuals in South Africa: an analysis using quantitative and experimental methodsen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch University


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

ITEM VIEW