Zambia has one of the highest HIV seroprevalence rates in the world, estimated in 1995 at 17%. Rural Monze district in the Southern province, the site of the study, has high rates of HIV, estimated at 10-12% in 1991. During the study, the district was affected not only by AIDS but also by the 1991-92 drought and by a bovine epidemic of East Coast Fever. This study documents the impact of HIV and AIDS on the health services and on the district economy, and draws some long term implications for the national economy. At the district hospital, approximately 44% of inpatients and 30% of outpatients were HIV seropositive as were 18% of rural health centre patients. Tuberculosis, other respiratory infections, and diarrhoea accounted for the majority of days in hospital. The HIV epidemic was found to be affecting the hospital staff as well, with mortality at Monze and neighbouring Choma hospitals rising from 2 per 1,000 nurse years in 1980 to 27 in 1991 - a 13-fold increase. Measures to increase supply, reduce losses, and make better use of existing staff are proposed. The household survey found that while patients were better off overall than the district population, there was no appreciable difference in wealth between patients with HIV infection and those without. HIV-positive patients were younger than HIV-negative patients, and had fewer children. The loss of a member with HIV would cause a rise in the average household's dependency ratio of 16-17%. Production was affected by HIV disease, with an average of 94 days' loss of labour (patients plus carers) in the final year of life. Implications for policy include the need to decentralize care of patients with HIV disease to health centres, and to protect and make better use of the health human resources. The impact of HIV/AIDS on rural production, with approximately 1 in 3 district households having a member with AIDS, combined with external factors such as removal of subsidies, changes in marketing processes under structural adjustment, and long term drought, makes it increasingly difficult to eke out a living from farming. Combined with the lure of apparent employment opportunities in urban areas created by deaths due to AIDS, these factors may contribute to increased urbanization, making it difficult for Zambia to replace declining copper revenues with increased yields from agricultural production.

Sub-Saharan African is experiencing major sociodemographic trends that include population aging, the proliferation of both Christianity and Islam, and the contribution of migration to the dynamics that exist between urban and rural areas. The need to better understand the health of older adults in a setting largely lacking the formal means to support them is essential. The purpose of this research is to examine various factors related to the health of older women and men in rural Malawi, using quantitative data from the Malawi Longitudinal Study of Families and Health (MLSFH). Analysis begins in the residential setting but extends to include social and religious spaces beyond the family, and how some of these factors influence the likelihood of migration for older respondents. The primary measures of health are the mental and physical health scores from the Short-Form 12 (SF-12). Overall, the findings of the three studies in this paper show that: (1) co-residence with offspring has a positive relationship with health for older women, while older men who live in a larger household or with a greater number of females have better health; (2) older adults affiliated with most Christian denominations are less healthy compared to Muslims; (3) participation in religious activities may be particularly important for the health of older women, especially at lower levels of wealth; and (4) the likelihood of migration for older women increases with age and with HIV-positive status, while for older men the likelihood of migration decreases with age but increases with physical health. Overall, these findings indicate that certain factors within and beyond the residential setting have an important relationship with health, and that these factors can serve as determinants of migration in older age in rural Malawi. / 1 / Jacob Evans Kendall

This thesis examines the use of the right to health as a legal tool for ensuring access to better health care in Africa and as a means of dealing with threats to human health on the continent. The thesis critically assesses some of the key ways in which the right to health has been used at the local, regional and global levels as part of efforts to improve health on the continent. The aim of the thesis is to assess the utility of the right to health in Africa particularly in light of challenges posed by the power of international economic actors, local and international structural constraints and the paradoxical position of the state as both a potential violator and protector of the right. / As this thesis shows, human rights are a powerful and inspirational language for people struggling against degradation, domination and deprivation for the reason that they give expression to the notion that human dignity, equality and freedom ought to be respected and protected. They are also a tool for resisting oppressive power, in addition to providing legitimacy for the redistribution of material resources necessary to meet basic human needs and to alleviate human suffering. The thesis further shows that these benefits of human rights have been enhanced through legalisation, a process through which human rights have been translated from moral or natural rights into legal rights capable of being enforced through judicial and quasi-judicial processes. But legalisation has its drawbacks, as the thesis demonstrates. / The thesis argues that despite the significant advances that have been made, particularly in the last fifteen years, in the elaboration and clarification of the content and justiciability of the right to health, its limitations as a legal right are particularly evident in light of a number of factors. These include the power of international economic actors, local and international structural constraints and the problematic potential of the state as both a protector and violator of the right to health. By examining concrete instances in which efforts have been made to use the right to health in the context of some or of all these factors, the thesis demonstrates the limits and potential of the right as a legal right. The thesis thus argues that a proper account of the utility of the right to health should not overemphasise the legalisation of the right but must include an analysis of the power relations and structural constraints at play at both the international and local levels, which jeopardise good health in Africa in the first place. It is further argued that such an account offers a better understanding of how the moral, legal and political forms of the right to health might be strategically and productively combined in the struggle for better health in Africa.

Abstract not available. / Thesis (M.A.) - University of Natal, Pietermaritzburg, 2000.

Wits Business School University of Witwatersrand Johannesburg, South Africa Master in Finance and Investment (2014) / Following decades of under-investment, gaps in Africa’s healthcare infrastructure are becoming disturbingly obvious. The interplay of governments’ fiscal policies of budget imbalance reduction and other political considerations present a seemingly insurmountable obstacle to overcoming the backlog in Africa’s healthcare infrastructure. The two main objectives of this study were to understand the sources of financing and the best way to structure the financing of healthcare infrastructure in Africa. Looking at financing arrangements in various industries; and how healthcare sectors in developed countries have been financed, the report draws on perspectives from the financiers on how the healthcare infrastructure gap should be filled in Africa. This study, which utilised survey questionnaires and in-depth interviews, identified government revenues, regional development banks, private equity and donor financing numbers as dominant funding sources for the financing of healthcare infrastructure in Africa. Further, the study explored various ways in which finance could be structured and found that within those various models of financing, donor financing and government revenue were statistically significant on structuring the finance, especially within public-private partnership arrangements. These include sale and lease back arrangements (p=0.0022), complete ownership of projects by the private sector (p=0.003), management operation contracts (p=0.00034) and other forms of PPPs. More perspectives were obtained on enablers and barriers to improving investability of the healthcare sector. Africa’s economic growth and the improving ease of doing business were major enablers for healthcare sector’s investability. However, the role played by government as both a financier and a regulator seemed a barrier. Some structural models that would need government back-up include subordinated debt; with pricing at marginal cost and matching risk and return recovered through the taxation system. The latter continues to characterise much of Africa’s publicly provided healthcare infrastructure. In conclusion, investments in healthcare may not be separated from a country’s level of financial deepening. As the sector develops, it then becomes possible to utilise the models aforementioned. It is recommended that any governments’ investments in healthcare be more catalytic, to unlock value that allows the private sector to compete, both as financiers and innovators in healthcare. Furthermore clear strategies on PPPs are urgently needed for healthcare in Africa including policy consistency in financing and regulating healthcare.

Eastern and southern Africa, a region that is home to a twentieth of the world’s population, accounts for half the number of people living with HIV globally, including an increasingly drug resistant Tuberculosis epidemic. The high mortality and untold human suffering associated with HIV in the region during the late 1990s and early 2000s has mostly been mitigated by a rapid scale up of national HIV treatment programmes over the past decade, largely made possible by generic competition from Indian pharmaceutical manufacturers. The sustainability of treatment programmes in the region depends on various factors. National HIV treatment programmes are largely financed by multilateral donor mechanisms which are facing a decline in funding for the first time in the history of the AIDS response. Indian pharmaceutical manufacturers are increasingly encountering patent barriers stemming from the country’s implementation of its intellectual property obligations under the World Trade Organisation’s TRIPS Agreement. As eastern and southern African countries increasingly focus on local pharmaceutical production and south-south co-operation as vehicles for treatment sustainability, this thesis examines the extent to which public health related flexibilities present in the TRIPS Agreement can be used to as enablers of affordable treatment, both in domestic intellectual property legislation, and relevant regional platforms. The thesis undertakes case studies of the policy and legislative environment in two countries with very different profiles: The United Republic of Tanzania as a least developed country with a nascent local pharmaceutical manufacturing industry and South Africa, as the country with the largest pharmaceutical industry on the continent present the full range of country profiles in the region. Conclusions are drawn regarding the optimization of legislative and policy frameworks to facilitate both the importation and local production of health technologies. Finally, the thesis explores challenges and opportunities facing various south-south co-operation initiatives in the region.

No description available.

The purpose of this thesis is to show through a chain of events how the Lutheran Mission societies in their quest to provide health care through biomedicine to indigenous people in Southern Africa ended up co-operating with the South African government in the implementation of the policy of apartheid. The question that this thesis will thus seek to answer is the following: If foreign missionaries were motivated to the extent that they left their homes in Europe and North America, why did they allow their hospitals to be subjected to government takeovers without offering much by the way of resistance? Biomedicine was not introduced to supplement the existing traditional health systems but to replace them. Black people had ways and means to attend to their sick through traditional health systems such as izinyanga, izangoma, and izanusi among the Zulu, and dingaka and didupe among the Sotho-Tswana. In Southern Africa, the missionaries saw suffering and great need, and worked as lay medical practitioners to alleviate health problems long before apartheid was formally introduced after the National Party came to power in 1948. Subsequently, they worked with trained medical missionary nurses and doctors. The Lutheran missionaries saw biomedicine as being not far-removed from advancing their mission work of converting the indigenous people to Christianity. In their provision of basic biomedicine from small structures, the Lutheran missionaries developed their health centres into hospitals by means of assistance from home societies before apartheid became the policy of the government. Financial assistance was also received from the South African government especially in the 1960s to combat the tuberculosis epidemic. However dedicated the missionaries were, they were condemned to see their influence gradually reduced because they were forced to rely on government subsidies in the running of the hospitals. In the 1970s, the apartheid government nationalized Lutheran and other mission hospitals. The hospitals were taken over and handed to the newly-established homelands and self-governing states to run. Under this new management, the mission hospitals’ quality of service was compromised. The question is: why did the Lutheran missions allow their hospitals to be nationalized? Overall, one can see that the Lutheran missions were influenced by race when they excluded black people from participating in the running of the mission hospitals, despite Blacks having taken over the running of the former mission churches since the 1960s. In Botswana, nationalization occurred differently. There was no total take-over of mission hospitals and the attendant exodus of white medical missionaries. From the time of independence in 1966, the Botswana government decided to work with mission societies in health care. The government formulated health policies and provided part of the financial needs of the hospitals, while the mission societies provided personnel and ran the hospitals. For example, the Bamalete Lutheran Hospital (BLH) in Ramotswa continues to be run by the Hermannsburg Mission Society. The national Lutheran Church played an important role in the hospital as the Church was part of the governing board. This thesis has attempted to show that, while the Lutheran missionaries were motivated to develop a health care system for the indigenous people through the introduction of biomedicine and the building of hospitals, they were so dependent on the assistance of the apartheid government, especially in the 1960s and the 1970s, that they could not see that their collaboration with the government in the nationalization of mission hospitals was in fact a collaboration with apartheid. Some individual mission doctors and nurses, especially in the Charles Johnson Memorial Hospital in Nquthu, resisted the nationalization programme, but not the Lutherans. These were paralysed in the face of the pseudo-nationalization programme of the apartheid regime. The interpretation of the Lutheran doctrine of the ‘Two Kingdoms’, which dissuades Christians from interfering in the sphere of secular governance, may have had bearing on their reluctance to challenge the apartheid regime to provide better health care. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Magister Public Health - MPH / The purpose of this study is to gain a greater understanding of the perceptions and barriers that influence condom use amongst male and female students at the Polytechnic of Namibia (Technical Vocational Education & Training Department). The specific objectives of this study include the following: To obtain a better understanding of knowledge amongst students about the correct use of condoms. To identify some of the problems students have in accessing condoms. To identify the common sources of information regarding condoms, the common perceptions that exist about condoms, and the extent to which students discuss condoms with others. / South Africa

"Poverty Reduction Strategy Papers (PRSPs) were born out of the policies of the World Bank (WB) and the International Monetary Fund (IMF). They were introduced 'in the wake of the failure of Structural Adjustment Programmes (SAPs) to reduce the incidence of poverty'. PRSPs have been linked with the IMF and WB Heavily Indebted Poor Countries (HIPC) debt relief initiative. In order to have access to debt relief, countries have had to draw up PRSPs and start moving towards their effective implementation. PRSPs are now meant to be the national guide informing almost every facet of the human development framework. They are being used as benchmarks for the prioritization of the use of public and external resources for poverty reduction. Further, multilateral as well as bilateral donors and lending institutions are using them as an overarching framework from which policies and actions of developing countries are to be gauged and decisions on further assistance or loans made. In that light, PRSPs have become pivotal to the social fabric of the countries concerned as they affect the daily undertakings of the people through, among other things, their allocative and redistributive roles. ... The PRSPs of Malawi and Uganda are not premised on the human rights based approach to poverty reduction. They largely address issues of economic and social rights from a benefactor and beneficiary perspective rather than from a claim-holder and duty-bearer perspective. Further to that, these policies are largely premised on the requirements of the Bretton Woods Institutions (BWIs) that have received heavy criticism for not factoring in human rights considerations, when implementing their policies towards developing countries. This problem thus calls for a harmonisation of PRSPs with the obligations of the states as well as the BWIs to ensure the full realisation of these rights. ... This study is divided into six chapters. Chapter two is a concise analysis of the PRSP processes in Malawi and Uganda. It addresses issues of participation and national ownership, among others, and locates the role of the BWIs in the process. Chapter 3 is a general overview of the international legal obligations that the two governments have in the area of economic and social rights. Chapter four provides an overview of the scope of the rights to health and housing. Chapter five is a critical analysis of the extent to which the PRSPs of the two countries act as effective tools for advancing the rights to health and housing in the two countries. Chapter six concludes the discussion. It makes necessary recommendations in order to strengthen the human rights based approach to poverty reduction within the framework of the PRSPs, with a view to ensuring the progressive realisation of economic and social rights." -- Introduction. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2004. / Prepared under the supervision of Dr. Baker G. Wairama at the Faculty of Law, Makerere University, Kampala, Uganda / http://www.chr.up.ac.za/academic_pro/llm1/llm1.html / Centre for Human Rights / LLM