Southern African Journal of Gerontology; Produced within the framework of the Co-operative Research Programme on Ageing / The broad social issue of generational competition versus generational interdependence is discussed. The way elders are housed offers an excellent example of how benefits putatively allocated to older people in fact more often than not subsume benefits to family members of all ages. Data on generationally shared households from a number of countries and the results of recent studies from the United States are discussed in this context. Separate housing of generations is often preferred where feasible. Where economic, environmental. health, or social needs of either elder or young generations make autonomous households dysfunctional, members of each generation show in their household-formative behaviour their willingness to assist the other generation .

This special issue of SAJG on "The family and ageing in Africa" marks yet another step in the annals of the African Gerontological Society (AGES). The first major step was taken in December 1993 when the society held its first workshop in Accra, Ghana to discuss an agenda on ageing. The results of the workshop were published under the title Effective responses to ageing in Africa by the year 2000 (Apt, Bester & Insley, 1995). Twenty years ago it would have been an impossible task to assemble African scientists and social welfare practitioners to discuss the subject of ageing. Very little researched information existed then and many African governments were likely to assert that ageing was no problem in their country. Even in the 1980s a great deal of scepticism existed in Africa about the need for African gerontology research. Today, and taking a cue from the deliberations of the first AGES workshop, there is no country in our region that is not confronted with the negative impacts of development and urbanization as their country charts its route towards modernization. Even though an ageing agenda still has a low profile on the economic desks of many African governments, the realisation that there are indeed difficulties to be overcome regarding the care of elderly people in Africa is widespread.

[From Editorial] This issue comprises a transdisciplinary mix of interesting and relevant papers ranging from a community-development intervention, to gerontolinguistics, to guidelines for new legislation, to community services in China. The issue begins with an article on infrastructure and equity for the elderly, in which authors Ross, Lerer and Phillips investigate the attitudes of older residents of Elim, a village situated in South Africa's Western Cape province, towards electrification of their village and homes. The creation of basic infrastructure in historically-disadvantaged areas throughout South Africa is a priority under the government's RDP. However, in this case study of Elim, the utility company which provides electricity to the village failed to consult the elderly residents on the developmental intervention and the benefits which electrification might have for them. The majority of the older residents who were interviewed were consequently negative about this new energy source. The advantages which electricity has over other fuels have distinct health and other developmental benefits, and in rural households older members are important decision makers on energy use. The study's findings indicate that developmental interventions in ruralbased communities should include a social-marketing component targeting older members of the community. The article by Makoni on discourse practices in first-time encounters between old and young Xhosa-speaking women represents an exciting development in gerontological research in the Southern African region. As far as we know, this is a first report on a linguistics study in an older population in the region. In his analysis of the conversations, Makoni notes the sociohistorical background against which the old women try to retain status and respect. He points out that while the elderly are a marginalized group, the youth in South African society have become empowered through their contributions to the political changes, which along with other social changes are seen by some to destabilize traditional seniority respect norms. / In his article Van Dokkum makes out a case for the development of legislation to protect older South Africans against abuse. He uses examples of new South African legislation to deter child abuse and vast legislation in the United States to protect older Americans, in outlining a proposal for local activists to campaign for adequate protection of elderly citizens. Zhu gives us an update on a massive community social-services programme for older people being implemented in the People's Republic of China. The programme partly aims to assist an increasing number of older people who find that they are no longer able to live with kin and must live independently. The programme already serves a staggering proportion of China's 104 million persons aged 60 years and above, although it is estimated that it currently only meets 30 percent of the demand. pensions and household structure in Namibia by Adamchak published in SAJG Volume 4, No 2 (October 1995), and Adamchak's response are welcome additions to this number. The journal encourages debate on papers that it publishes, and the letters also reflect the development and growth of gerontology and research on ageing in the Southern African region. Finally, gerontolinguist Makoni reviews Hamilton's (1994) book in which the author analyses her conversations with Elsie, an Alzheimer's disease patient in a "total institution" (Goffman, 1961). The book contributes to understanding of losses and changes in language use in sufferers of this disease as the dementia progresses. Makoni proposes topics for studies on this subject which might be carried out in Southern African countries, where the majority of dementing older Africans are cared for within the community and not in a long-term care institution.

The October 1996 number of SAJG is a special issue on "Gender, ageing and empowerment in Africa." The guest editor of the special issue is Maria Cattell of Millersville University, Pennsylvania, USA, who has conducted substantial research on older Kenyans and more recently on Zulu grandmothers. Dr Cattell is the President of the global Association of Anthropology and Gerontology (AAGE). The issue will comprise research papers from authors in several African countries, and will provide valuable data and experience of ageing in Africa for transnational comparison.

[From Editorial] Articles in this Special Issue on health and ageing in Africa come from a broad spectrum of disciplines and the articles reflect a wide range of topics. Three contributions deal with the maintenance of good health. Remaining active is a key component of successful ageing which minimizes the loss of functional independence in the elderly. An investigation of the role of gender in the analysis of gait of older people by Macfarlane, Nicholson and Muller provides important methodological information which may be applied in practical outcomes-based assessments. The development of a reliable tool to assess gait, as a measure of lower-extremity function, is thus pertinent. There is growing evidence that good nutritional status is an important determinant of optimal cognitive and physical functioning in older people and influences both quality of life and health status. In a study of institutionalized elderly women in Cape Town, Charlton, Joosen and Jaffer report a high prevalence of suboptimal vitamin C status. The authors make out a case for low-dose micro-nutrient supplementation in residents of homes for the aged, particularly in homes where a cook-chill catering system is operated. They suggest that ongoing nutritional assessment should be an integral part of the care of older residents. In keeping with the topic of nutrition, Walker, a prolific author on public health issues in Africa over the past 50 years, has contributed a guest column in which he addresses the nutrition-ageing paradigm from an epidemiological viewpoint. He highlights opportunities for high-quality research on the association between life-style factors and healthy ageing in the continent. Moving on to a specific form of health-care delivery, Makoni examines language practices in the care that is rendered to older residents of a Cape Town nursing home. He describes barriers in communication between nursing staff and residents from different ethnic backgrounds, which compromise the quality of care that is rendered and which may result in conflict and tension between staff and residents. In her article, Tlou evaluates a community-based programme in which older women who live in rural areas of Botswana are trained to educate members of their communities in the prevention of the spread of the HIV I AIDS virus. The findings demonstrate the benefits of targeting lay persons for health education activities in rural Africa and the utilization of older persons, in this case women, as a valuable resource. The special issue also includes two opinion pieces and an item which opens debate. In separate contributions, Wilson and Duodu examine challenges facing effective health-care service delivery systems for older persons in African countries and express their opinions in this regard. Wilson's suggestions for multidisciplinary specialist teams, including incontinence teams, nutrition teams and vision teams, and for the development of training for lay people to become generic " rehabilitation assistants," are examples of appropriate community-based African solutions to health service delivery needs of the older population. Duodo makes similar suggestions to those of Wilson, specifically regarding geriatric care service delivery in Ghana. He also highlights the common practice of traditional self-medication in rural-dwelling older Ghanaians. Readers are invited to comment on, and indeed to augment, the authors' opinions in Letters to the Editor. To date, very little work has been done in South Africa on biological aspects of ageing. In a short contribution on the free radical theory of ageing, Van Rensburg and Potocnik open debate on this topic. Once again, readers are invited to contribute to debate in this area in letters to the editor, for publication in the following number of the journal.

[From Editorial] Four of the five articles in this issue either deal explicitly with or refer to the effects of the AIDS epidemics in the authors' countries. The fifth paper deals with late-life chronic diseases of life-style. In the first paper, Akinsola examines effects of the epidemic on older Batswana and evaluates the effectiveness of his country's Community Home-Based Care programme against the programme's objectives, with special reference to the situation of older persons as primary caregivers to PWAs and AIDS orphans. He concludes that the situation of older carers calls for strong and urgent policy action to assist this highly vulnerable and marginalized group in its critical and valuable role and function as carers. In her paper on the provision of housing and care for older persons in Zambia, Sichingabula considers implications of the anticipated increases in AIDS morbidity and mortality, in the form of an increased demand for formal housing and care by older Zambians in the face of diminished traditional support. Given effects of the country's Structural Adjustment Programme and the Zambian government's inability to expand provision of formal support for the older population, the author makes recommendations for initiatives which NGOs can undertake towards meeting the needs and improving the quality of life of older persons. Next, Shaibu examines the experiences of caregivers to older persons in Botswana within a context of pervasive, abject poverty and multiple, unmet basic needs. The author notes how the HIV I AIDS epidemic, in addition to other social forces, impacts family structures and the capacity of Batswana to care for older relatives. In their paper, authors Patel, Steyn, Charlton, Bourne, Laubscher, Fourie and Jooste describe the risk-factor profile for chronic diseases of life-style, such as hypertension, hypercholesterolaemia and obesity, in the older black population of Cape Town and compare it with risk profiles in other South African ethnic groups. The authors note that although the study population is still at low risk of cardiovascular disease - for example, demographic changes, including urbanisation and the adoption of urban life-styles, are likely to lead to an increase in chronic morbidity in future older cohorts in this population. In a second paper, Sichingabula assesses the physical and social environment of Divine Providence Home, a residential care facility for destitute older persons in Lusaka, Zambia. She draws practitioners' attention to the prudence of incorporating design features in facilities built for older persons which enhance the users' mobility, independence and quality of life. She also highlights a lack of social stimulation and the inactivity of the residents at the home. The author makes the point that given an anticipated increased demand for admission to residential care facilities as a result of AIDS-related deaths and loss of traditional support for older persons, living environments in these facilities must be optimized. In sum, the AIDS-related research papers in this number highlight a need to identify and to strengthen social and care systems which can assist older persons in Africa, as traditional systems are increasingly affected by demographic forces, particularly the effects of the HIV/AIDS epidemics. Finally, Moller reviews a recent, landmark Help Age International report (1999), which is a compilation of 15 papers on ageing in developing countries and challenges facing research, policy and practice.

[From Editorial] In this special issue of SAJG, an attempt is made to demonstrate how a selection of studies were conducted and how the research outcomes have been translated into action. Heslop, Agyarko, Adjetey-Sorsey and Mapetla give us a paper in which they have evaluated the methodology used in studies in Ghana and South Africa to determine the contributions of older people. After long periods of implementation and learning, this participatory-research methodology has become synonymous with HAl's research work. The authors take us through the methodology, describe the studies carried out in the two countries, and provide us with a vivid picture of not only the problems which older people in the countries face, but also the immense contribution which they make to the well-being of other people. The impact which this work has had in both countries is notable. Older participants in the studies have taken it upon themselves to advocate their rights, and the governments in the two countries have started to put measures in place to address some of the problems identified in the studies. The paper by Van Vuuren and Groenewald examines the pattern of expenditure of pension income by black pension beneficiaries in the Free State Province of South Africa, against a backdrop of these persons' living circumstances. It goes into detail about issues regarding the payment of pensions, pension sharing within households and expenditure of pension money on specific items, and challenges allegations that pensioners are frequently robbed of their pension money and that they lose this income to loan sharks. Some of the findings of this paper contrast with the findings of the HAl studies conducted with partners in the Northem, Gauteng and Kwazulu-Natal provinces of South Africa (see the first paper in this issue by Heslop and colleagues). In their paper, Kowal, Wolfson and Dowd point out that there is a dearth of empirical and credible data on older people in Africa. Although some research has been conducted on this population, the authors note that by and large the available data derive from small samples, are scattered, and have neither been widely disseminated nor shared. The authors further note a lack of common approaches to data collection. Realising these gaps, the World Health Organisation arranged a workshop in Harare, Zimbabwe in January 2000, to begin a process to develop a minimum data set (MDS) for use by researchers in Africa. An overall aim of the MDS project is to provide data to influence policy and decision makers in various areas which affect older persons. / Needs-driven research on nutrition and ageing, carried out by HAl in collaboration with the London School of Hygiene and Tropical Medicine, is reported by Busolo, Ismail and Peachey in their paper. Nutrition and ageing in developing countries is an area which bas received scant attention. The nutritional requirements of older persons in these countries have not only been inadequately investigated but as a result, nutrition practitioners in various settings simply shoot in the dark. The authors take us down the path which the research took, from bow the needs were identified, to how the research was conducted, to how an intervention programme was set up. They give us some key findings of the research, describe the dissemination process and the application of the findings, and suggest a way forward. An Africa-wide programme currently being implemented as a direct result of this work is aimed at providing knowledge and information on the nutritional requirements of older people to key nutrition institutes, older people's organisations, N GOs (particularly those working in emergency situations), donors and governments. HelpAge International earlier conducted research in the Magu district of Tanzania on the plight of older women who are victimised on suspicion of their being witches (cf. Forrester Kibuga, 1999). Forrester Kibuga and Dianga now draw on this work in their paper. The authors take us through facts pertaining to the witchcraft-related killings, some of the problems which older people in the district face, the changing roles of older people in that area, beliefs and customs of the communities, and the stance of the government and the church on witchcraft. The dynamics of gender issues are also discussed. Following on this research, HAl designed and is now implementing a programme aimed at addressing some of the factors which lead up to these killings and developing sustainable structures to protect older people from violence. In his paper, Gorman draws on the work of HAl in various parts of the world, particularly in Africa - including Tanzania, Ghana, South Africa and Kenya. He argues that violence against older women and men in Africa cannot be attributed to a single, straight-forward problem but must be understood within a complex web that touches on history, family structures, and social and economic factors. He makes practical suggestions on what needs to be done to deal with the problem of violence. HelpAge International will soon be implementing an Africa-wide programme as a response to some of the issues which have been raised in its research on violence. While there is a clear need for more research on ageing in Africa, the research should not be done in a vacuum. There is a simultaneous need for greater collaboration and sharing of research results, and perhaps most importantly, for more action based on research outcomes. At the end of the day researchers should never forget that they have an ethical commitment to their subjects, to society and to their colleagues. / Thanks are due to Karen Peachey and Alex Dianga in the HAl Africa Regional Development Centre for the co-ordination of this special issue. Special thanks are due to Monica Ferreira for dedicating the issue to the experience and work of HAl, and for her commitment to addressing issues pertaining to ageing in Africa. She has worked tirelessly to ensure the success of not only this issue of SAJG but of previous issues as well. I have found her a pillar of support and a pleasure to work with. Tavengwa M. Nhongo.

M.A. (Public Management and Governance) / The study deals with the nature and problems of the proposed National Health Insurance system in South Africa in order to develop a management and governance model to promote universal healthcare in South Africa. The general aim of the study is, therefore, to analyse the concepts and policy initiatives related to the resolution on the National Health Insurance (NHI) scheme being passed at the ANC’s 52nd National Conference in Polokwane in 2009. Calls for a NHI together with relevant legislation and programmes, have consistently formed an integral part of Government’s national effort to build a united national health system in which the public health sector plays a dominant role as provider of first choice. The proposed NHI is a state-mandated and state-administered health insurance scheme that provides universal and comprehensive cover to all South Africans in spite of their financial status. In essence therefore, the vision of the NHI system is to be inclusive of the unemployed and the indigent who will also be afforded the opportunity to receive healthcare which is on par with everyone else’s and not based on what they can or cannot afford. This enquiry is premised on the variables that have influenced the development of South Africa’s healthcare system, the implementation challenges of the proposed NHI, according to the National Health Insurance Policy Paper of 2011, and the lessons that South Africa can derive from the implementation of the national health insurance schemes of Brazil and Ghana. The dissertation concludes that there are certain challenges in the current NHI debate in terms of the lack of technical details on the proposed NHI system, a lack of transparency in terms of the process, as well as problems related to the exclusion of the main stakeholders in the public and private health sector.

M.Cur. / The purpose of this study is to compile a strategy for transformation management in a local authority. Traditionally local authorities rendered preventative and promotive services. The provinces were responsible for rendering of curative services. This service delivery was fragmented due to political policies and diversification. With the new political dispensation in South Africa, the White Paper for the transformation of health services in South Africa (1997), gives direction for the integration of health service delivery to achieve the following mission focussing on equity, acceptability, accessibility, affordability, availability and appropriateness. These policy/legislative changes therefore require a strategy for transformation management of primary health care services. This impacts on the current service delivery system. The type of service delivery has to be reconstructed, to accommodate free primary health care services for all South Africans, additional services like curative services, dental services and termination of pregnancy services. Human resource management will also undergo significant changes as the local authority is expected to take over the existing provincial staff allocated to clinics. This could result in labour unrest if not well managed. There are also financial constraints that will impact on this process of transformation. The scarcity or shortage of medicines, equipment and other supplies necessary for quality service delivery also impact on the transformation process. The changing environment is difficult to handle, especially as it involves human beings who react differently towards change. Some individuals adapt easily in a changing environment, others resist change. Many meetings have been held to discuss the transformation of health services. The outcomes of these meetings have clearly demonstrated that health personnel are experiencing problems which are a direct result of the transformation process. Therefore it is important for management in a local authority in the East Rand, to devise a transformation strategy in order to implement primary health care services effectively and efficiently. The transformation strategy requires careful planning and decision making, that will be beneficiary to all the role players involved. Management in a local authority will have to take a leading role in the transformation management of primary health care services. This situation can be either a "challenge" or a "dilemma".

Includes bibliography. / Die navorser het gepoog om vas te stel of drosgedrag in assosiasie met sekere veranderlikes plaasvind, dus of daar tendense bestaan. Die veranderlikes van belang vir die maatskaplike werk professie het voorkeur gekry in die studie. Die doel hiervan was om aan te toon dat hierdie professie 'n rol kan speel ten opsigte van hierdie gedrag. Die studie is beperk tot een inrigting, naamlik 'n plek van veiligheid. Tendense oor 'n 10 jaar tydperk, 1980-1989, is bestudeer sodat moontlik ook die invloed van personeelaangeleenthede en verskille in die bestuur van die inrigting indentifiseer kan word. Die data is vanuit argiefrekords, soos die persoonlike leêrs, straf-, opname-, en drostersregister, verkry. Ongestruktureerde onderhoude met die personeel het addisionele inligting verskaf. Oor sekere van die data is gegewens van die totale drosterpopulasie oor 10 jaar ingewin (N=492). Ander gegewens is vanuit die beskikbare persoonlike lêers (nl=413) verkry. Nie alle lêers het die verlangde gegewens beskikbaar gehad nie, en vir sekere gegewens is data vir kleiner groepe drosters ingewin. Hierdie gegewens is getabuleer, en waar van toepassing, is van grafieke of histogramme gebruik gemaak. Uit die resultate kon die volgende afgelei word: die omvang van die probleem is wyd en regverdig navorsing. 'n Hӧer drossyfer word in die maande van Februarie, Maart en November gevind. Daar is nie 'n tendens om op sekere dae van die week meer as ander dae te dros nie. Die meeste drosters dros binne 'n kort tyd na opname, en dros dan slegs enkele male van korte duur. Meer seuns dros as dogters. Die meeste drosters val binne die ouderdomsgroep 14-16 jaar en hierdie groep is ook vir die hoogste aantal drosinsidente verantwoordelik. Die meerderheid drosters dros in groepe, en in die geselskap van 'n ervare droster wanneer hulle die eerste maal dros. Die meeste drosters het 'n geskiedenis van wegloop- of drosgedrag. Die I.K. van drosters is ietwat laer as die van die normale bevolking, en hulle is ook meestal skolasties vertraag. Die meeste drosters meld mees gereeld hulle ongelukkigheid by die veiligheidsplek as 'n rede vir dros. Daar word tydens drosinsidente meestal huiswaarts gedros. Uit die resultate kon dus afgelei word dat, hoewel drosters waarskynlik ook emosionele probleme het, omgewingsfaktore 'n rol speel by drostery. Die belangrike implikasie van die bevinding is dat drostery deur omgewingsmanipulasie verminder behoort te kan word, en dat die maatskaplike werk professie 'n belangrike rol in die opsig kan speel.