South African case study on social exclusion potx

Laetitia Rispel, Boitumelo Molomo & Sellinah Dumela

South African

case study

on social exclusion

Free download from www.hsrcpress.ac.za

This work was made possible through funding provided by the World Health

Organization (WHO) via Lancaster University. It was undertaken as work for the SEKN

established as part of the WHO Commission on the Social Determinants of Health

(CSDH). The views presented in this report are those of the authors and do not

necessarily represent the decisions, policy or views of WHO or CSDH Commissioners.

Published by HSRC Press

Private Bag X9182, Cape Town, 8000, South Africa

www.hsrcpress.ac.za

First published 2008

ISBN 978-0-7969-2231-1

© 2008 Human Sciences Research Council

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List of tables, figures and boxes iv

Acknowledgements v

Acronyms and abbreviations vi

Executive summary vii

Chapter 1 The global and national context 1

Global response to health inequities 1

South African case study 2

Country profile 2

The current context 6

Chapter 2 Aims and methodology 15

Aims and focus 15

Methodology 16

Chapter 3 Social exclusion:

constructs and policies 19

Constructs of social exclusion 19

Affected groups 22

The impact of social exclusion 23

Social inclusion policies 25

Chapter 4 Appraising South African policies 29

Free healthcare 29

Cash transfers and support grants 31

Bana Pele 33

Summary 38

Chapter 5 Key issues and recommendations 41

Key issues 41

Recommendations 41

References 43

CONTENTS

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iv

Tables

Table 1.1: Health inequalities in South Africa by race (1994) 5

Table 1.2: Selected indicators for South Africa from HDR (2006) 9

Table 1.3: Selected maternal and child health indicators for South Africa (1998) 12

Table 1.4: The ten leading underlying causes of death (2004) 12

Table 1.5: Rank comparison of the five leading causes of death by race (2004) 13

Table 2.1: Key informant interview topics 16

Table 3.1: Health inequities in South Africa (1998) 22

Table 3.2: Categories of policies addressing social exclusion or its proxies 26

Table 4.1: Types of CSGs and eligibility criteria 32

Table 4.2: Bana Pele principles 35

Table 4.3: Summary of policies appraised 38

Table 4.4: Enabling factors for policy implementation 38

Figures

Figure 1.1: South Africa and its provinces 3

Figure 1.2: South Africa’s population pyramid – percentage of the total South African

population in each five-year age group by sex (October 2001) 3

Figure 1.3: Official unemployment rate among those aged 15–65 years by province

(October 1996 and October 2001) 8

Figure 1.4: Burden of disease by province (2005) 10

Figure 1.5: The HIV epidemic among South African antenatal clinic attendees

(1990–2002) 10

Figure 1.6: HIV prevalence by age and sex, HSRC household survey of HIV (2005) 11

Figure 4.1: Bana Pele identification and referral form 36

Boxes

Box 1.1: The legacy of apartheid health services 4

Box 1.2: Summary of the National Household Survey of Health Inequalities

in South Africa (1995) 5

Box 1.3: Trends for social determinants of health (1996–2001) 7

Box 3.1: Constructs of social exlusion 19

LIST OF TABLES, FIGURES AND BOXES

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v

This case study was funded by the World Health Organization (WHO) via Lancaster

University. Nico Jacobs is thanked for his excellent administrative and logistical support.

We wish to acknowledge the support of Professor Jennie Popay, the overall Social

Exclusion Knowledge Network (SEKN) coordinator.

We also want to thank Karl Peltzer for his input and comments on drafts of the report.

We have greatly benefited from the input and contributions of the 22 key informants,

and other network members. Marijke van Vuuren is thanked for editorial assistance.

We are grateful to the South African Human Sciences Research Council (HSRC) for giving

home to the sub-regional hub.

Lastly, we thank Mary Ralphs and her production team at the HSRC Press.

ACKNOWLEDGEMENTS

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