Thesis (MA)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Globalization is changing the face of health concerns worldwide and states are reacting by modifying their foreign policies to keep up with the resultant challenges and opportunities. The purpose of this study is to investigate, using the case studies of South Africa and Norway, the similarities and differences in how emerging and traditional middle powers respectively approach the new foreign policy phenomenon of health diplomacy. The study is interested in the reasons for how and why these similarities and differences manifest themselves in practice. Health diplomacy is a multifaceted concept which envelops negotiation involving health in a number of different concerts and across a wide spectrum of actors. Despite its novelty within the fields of both Global Health Governance and International Relations, the literature offers limited but sufficient frameworks that have utility for its study. The study surveys the literature on middle powers, and its sub-categories of emerging and traditional middle powers. Whilst identification with the middle power category requires the fulfilment of a number of criteria, this further categorization is made on the background of both quantifiable and behavioural characteristics, making their respective members’ inclinations and rationales for engaging in specific foreign policy types typically divergent on a number of issues. The two countries selected for case studies, South Africa and Norway, are generally regarded as exemplars of the two respective middle power categories. In these case studies the health diplomacy of these countries is assessed on the basis on the frameworks developed in the first half of this study, serving as the empirical foundation upon which the subsequent analysis is based. The findings speak volumes both for the two different middle power types and for the respective case study states. A common emphasis on multilateralism is one unsurprising similarity, as middle powers of both types tend to share this general preference in their foreign policy undertakings. However, as South Africa’s health diplomacy is nascent and Norway’s well-developed, divergences are obvious in terms of what strategies the respective countries use in order to gain the international influence that they covet. Furthermore, domestic and regional issues clog the agendas of emerging middle powers, whilst traditional ones enjoy stability in this regard and are able to seek opportunities elsewhere. These characteristics are exemplified in an extreme sense in South Africa, where a genuine health crisis is ravaging the country; conversely, in Norway, domestic issues are relatively minor, and niche diplomacy has bred massive success. At bottom, health diplomacy is a significant nascent area of interest within International Relations broadly, and in niche diplomacy and global health governance specifically, and demands further study. / AFRIKAANSE OPSOMMING: Globalisering verander wêreldwyd die aard van gesondheidsoorwegings en state reageer hierop deur hul buitelandse beleide aan te pas om tred te hou met die gevolglike uitdagings en geleenthede. Die doel van hierdie studie is om die ooreenkomstige en verskille duidelik te stel van hoe ontluikende en tradisionele middelmoondhede (met Suid-Afrika en Noorweë as onderskeidelike voorbeelde) die nuwe buitelandse beleidsfenomeen van gesondheidsdiplomasie benader. Die studie stel belang in die redes waarom en hoe hierdie ooreenkomste en verskille in die praktyk manifesteer. Gesondheidsdiplomasie is ‘n veelkantige konsep wat onderhandelings aangaande gesondheid in verskillende kontekste en oor ‘n wye spektrum akteurs heen omvat. Ondanks die nuutheid van beide Globale Gesondheidsregering en Internasionale Betrekkinge as studievelde, bied die literatuur beperkte maar voldoende raamwerke aan vir die doel van hierdie studie. Die tesis bied ‘n oorsig van die literatuur aangaande middelmoondhede, sowel as die subkategorieë van ontluikende en tradisionele middelmoondhede. Alhoewel lidmaatskap van die middelmoondheid kategorie die bevrediging van ‘n paar kriteria vereis, word hierdie verdere kategorisering gemaak teen die agtergrond van beide kwantifiseerbare en gedragspatrone, en dit maak hul onderskeie lede se oorwegings en beweegredes i.t.v. buitelandse beleidstipes uniek oor ‘n hele paar kwessies heen. Die twee state waarop besluit is as gevallestudies, Suid-Afrika en Noorweë, word algemeen beskou as kernvoorbeelde van die twee onderskeie middelmoondheid kategorieë. In hierdie gevallestudies word die gesondheidsdiplomasie van die twee state oorweeg aan die hand van raamwerke wat in die eerste helfte van die studie ontwikkel word, en dit dien dan as die empiriese ondersteuning vir die analise wat daarop volg. Die bevindings spreek boekdele beide oor die twee verskillende middelmoondheid tipes en vir die onderskeie gevallestudie state. ‘n Gedeelde fokus op multilateralisme is een onverrassende ooreenkoms, aangesien alle middelmoondhede hierdie voorkeur in hul buitelandse beleidsondernemings openbaar. Maar tog, aangesien Suid-Afrika onluikend is en Noorweë goed-ontwikkeld is, is uiteenlopendheid bespeurbaar i.t.v. die strategieë wat die onderskeie state gebruik ten einde die internasionale invloed te kry waarna hulle op soek is. Voorts verlangsaam plaaslike en streekskwessies die agendas van ontluikende middelmoondhede, terwyl tradisionele middelmoondhede in hierdie verband stabiliteit geniet, en dit dan moontlik word vir lg. om elders geleenthede te ondersoek. Sodanige kenmerke is duidelik in Suid-Afrika, waar ‘n ernstige gesondheidskrisis die land verlam; in Noorweë, aan die ander kant, is plaaslike uitdagings nie ernstig nie, en nisdiplomasie word met groot sukses onderneem. Die kernboodskap van die studie is dat gesondheidsdiplomasie ‘n beduidende nuwe ondersoekveld is binne Internasionale Betrekkinge in die algemeen, en dan spesifiek in nisdiplomasie en globale gesondheidsregering, en dit vereis verdere studie.

This thesis reports from a telecare evaluation in a Norwegian municipality (2012-2016). The project was established to provide domestic results from a hitherto new field in the country to underpin future policy. This evaluation includes pre- and post-implementation data collection, which has been scarce in telecare. The methodological approach was realist evaluation that seeks to explore how telecare works, for whom, why and in which circumstances – or why it does not work. The research aimed to explore the hypothesis elicited from national policy documents: ‘If telecare is used, then people are enabled to remain safe in their own home for longer’. Various methods were used to gather data from multiple stakeholders as they have different knowledge about how the implementation developed. The methods in this evaluation included literature reviews, observations, and sequential interviews with users and relatives in addition to sequential focus groups with frontline staff. Realist evaluation was particularly suitable in demonstrating how and why telecare is useful to some users but not to others. Telecare had to match users’ abilities and needs for them to benefit from it. Telecare operates in a dynamic context, and therefore requires adjustment according to the user’s current situation, taking into account changes as they occur. This appears to have been often underestimated. Telecare holds a different position from other devices and technologies in people’s everyday life, which also needs to be acknowledged. Correct assessment is significant for users to obtain the intended effect from telecare. When telecare is correctly adjusted to users, it increases safety, which is essential for enabling older people to remain living at home. Several challenges in establishing telecare projects are identified and alternative ways to understand multi-disciplinary partnerships are suggested. By using realist evaluation the findings are nuanced and point to elements that are significant for achieving the intended outcomes.