Magister Legum - LLM / South Africa

Master thesis deals with functioning and development policy of the World Bank. The main objective is to summarize the Bank's strategies applied during the several decades of its existence and evaluate selected tools that organization uses in the fight against poverty.

The purpose of this study was to critically analyse the evidence-based revelations from the South African Office of the Auditor-General on the records management challenges being encountered in the local government sector. The aim of the study was the analysis of available evidence and the proposal of solutions for collaborative planning and implementation. The lack of strategic planning in ensuring the accessibility of authentic information sources required during auditing remains unchallenged by the South African public archivists and records managers. These audit reports are required to demonstrate governance, transparency and accountability. This information held in the records of local government is also required to satisfy service delivery and plan development ventures. The World Bank, International Monetary Fund and United Nations formulated an ambitious agenda to eradicate world poverty by 2025. Eight millennium development goals were identified that would provide impoverished communities with better access to basic services and conditions spurring sustainable development. Governance-based criteria were identified as barometers to gauge transparency, accountability, respect for the rule of law and citizens’ rights. Consolidated audited reports from 2000 to 2013 were scrutinised to unravel the conundrums relating to governance, transparency and the management of public sector information sources. According to the 2013 report, only 5% of the local government sector managed to attain clean audits. Related evidence revealed in the unclean audit reports and media narratives related to service delivery and community protests. The approach used for the study was the qualitative methodology, regarded as an appropriate method for the archival discipline. This research method allowed for the incorporation of interdisciplinary and multidisciplinary fields of interest. The case study method design enabled the focus of the study to be on local governments and six selected community development ventures in different areas of South Africa. The latter method enabled information collection from records officials and persons involved with socio-economic development projects. Sound interventions are needed to ensure evidence-based governance. This, in turn, would create favourable conditions for development endeavours in post-apartheid South Africa. / Information Science / D. Litt. et Phil. (Information Science)

Philosophiae Doctor - PhD / Introduction: National community health worker (CHW) programmes are to an increasing extent being implemented in health systems globally, mirrored in South Africa in the ward-based outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge impacting the performance and sustainability of scaled-up CHW programmes is ensuring adequate support from and supervision by the local health system. Supervisory systems, where they exist, are usually corrective and hierarchical in nature, and implementation remains poor. In the South African context, the absence of any guidance on CHW supportive supervision has led to varied practices across the country. Improved approaches to supportive supervision are considered critical for CHW programme performance. However, there is relatively little understanding of how this can be done sustainably at scale, and effective CHW supervisory models remain elusive. Research to date has mostly positioned supervision as a technical process rather than a set of relationships, with the former testing specific interventions rather than developing holistic approaches attuned to local contexts. This doctoral study was exploratory in nature, seeking to generate an in-depth and contextualised understanding of the supervision phenomenon in one specific district in the North West Province (NWP) in South Africa. Using co-production methodology in an iterative approach, the study culminated in the formulation of a supportive supervision framework with CHWs and other frontline actors. Methods: The study was based on a holistic conceptual framework of supportive supervision, which was viewed as comprising three core functions ‒ accountability, development and support ‒ embedded in a complex and multi-level system of resources, people and relationships. To address the study objectives, the research used a mix of qualitative and quantitative methods. Three studies were conducted in a phased process: study 1 comprised a qualitative description of policy and practices in two districts related to the supervision of WBOTs; study 2 identified the main actors and mapped the supervisory system of WBOTs in the district, using social network analysis (SNA); and study 3 involved a qualitative exploration of workplace and interpersonal trust factors in the district and the supervisory system of WBOTs in the district. These three studies provided inputs for a workshop aimed at developing recommendations for a district-level, WBOT supportive supervisory framework. Four published papers reporting on the research conducted are presented in this thesis. It should be noted that the research was conducted during a turbulent political and administrative period in the NWP, when the WBOT programme changed from being a flagship programme for the country to one in crisis. This shifting context needs to be borne in mind when the findings are viewed and interpreted. Results: The study identified weaknesses in both the design and implementation of the supervisory system of WBOTs, with the absence of clear guidance resulting in WBOTs and PHC facilities performing their roles in an ad hoc manner, defined within local contexts. The study documented evidence of high internal cohesion within WBOTs and (where present) with their immediate outreach team leaders (OTLs). However, the relationships between WBOTs and the rest of the primary health care (PHC) and district health system were characterised by considerable mistrust – both towards other workers and the system as a whole. This occurred against a backdrop of increasing OTL vacancies, and the perceived abandonment of WBOT training and development systems and career opportunities. These findings are not dissimilar to those reported previously on the WBOT programme in South Africa and in programmes in other low-resource settings. Nevertheless, through its in-depth, exploratory and participatory approaches, this study provides additional insights into the phenomenon of supportive supervision. Firstly, in conceptualising supportive supervision as a set of ‘bundled’ practices within complex local health systems, the findings reflected the complexity of everyday realities and lived experiences. Secondly, through the embedded nature of the research and the phased data-collection process, the study was able to observe the impact of wider health system contexts and crises on the coalface functioning of the WBOT programme. Thirdly, the study emphasised how supportive supervision depends on healthy relational dynamics and trust relationships, and, finally, how a co-production approach can translate broad guidance, experience and theoretical understanding into meaningful, local practice owned by all the actors involved. Ultimately, the process of engagement, building relationships and forging consensus proved to be more significant than the supportive supervision framework itself. Conclusion: The lack of explicit, coherent and holistic guidance in developing CHW supportive supervision guidance and the failure to address supervision constraints at a local level undermine the performance and sustainability of CHW programmes. Effective supportive supervisory systems require bottom-up collaborative platforms characterised by active participation, sharing of local tacit knowledge and mutual learning. Supervisory systems also need to be designed in ways that promote relationships and generate trust between CHW programmes, other actors and the health system.

This doctoral thesis focuses on the evaluation of the World Bank (WB) performance in delivering development aid to the Least Developed Countries (LDCs). For this purpose, an extensive research was performed to analyze a set of 790 Implementation Completion and Results reports for key economic and financial indicators. Results of this research provide various insights for the appraisal and the results stage of project delivery of the LDCs in different continents. In the final part of the economic and financial analysis the minimum Social Return on Investment (SROI) of the LDCs including all project costs was calculated. This SROI ratio outcome of 1 and 1.06 in the weighted and 1.3 and 1.72 in the unweighted case indicate that projects delivered by the WB have a positive effect on the poor countries. In the second part of this research project the data set of the ICR reports was qualitatively researched for negative ratings according to 3 core assessment categories for the overall project performance: Sustainability, bank performance and borrower performance. As a result the most critical categories respectively risks were outlined. In conclusion, the research analyses and findings support the general demand to provide even more development assistance to poor countries.:Table of Tables and Figures List of Equations List of Abbreviations 1 Introduction 1.1 Introduction to the Topic 1.2 Assessing Poverty Problems and Achieving Economic Growth 1.3 Millennium Development Goals 1.4 Development Aid 2 Research Approach 2.1 Objective 2.2 Structure 2.3 Least Developed Countries 2.4 World Bank 2.5 Data Access and Relevance 2.5.1 Data Basis 2.5.2 Implementation Completion and Results Reports 2.5.3 Project Types 2.6 Term “Performance” 2.7 Study and Research Questions 2.8 Challenges of this Doctoral Thesis 2.9 Contribution of this Thesis 3 Economic and Financial Analysis 3.1 SROI Concept 3.1.1 SROI Definition 3.1.2 SROI Process and Impact Map 3.1.3 Cost-Benefit-Analysis 3.1.4 SROI Calculation 3.2 SROI of World Bank Projects 3.2.1 Purpose of the Cost-Benefit-Analysis 3.2.2 Indicators of the SROI Calculation 3.2.2.1 Net Present Value 3.2.2.2 Capital and Recurring Costs 3.2.2.3 Project Dates and Duration 3.2.2.4 NPV-horizon 3.2.2.5 Discount Rate 3.2.3 Types of NPV-Cost-Ratios 3.2.3.1 Pro-Rata-Capital-Costs Ratio 3.2.3.2 Total-Capital-Costs Ratio 3.2.3.3 Pro-Rata-Capital plus Recurring-Costs Ratio 3.2.3.4 Total-Capital plus Recurring-Costs Ratio 3.2.4 Calculation of the proper SROI Ratio 3.2.5 Portfolio Analysis 3.2.6 Sensitivity Analysis 3.3 Additional Economic and Financial Indicators 3.3.1 Economic Rate of Return 3.3.2 Benefit-Cost-Ratio 3.3.3 Net Benefit 3.3.4 Financial Net Present Value 3.3.5 Financial Rate of Return 4 Results of the Economic and Financial Analysis 4.1 Analysis Approach and Setup 4.2 NPV Outcomes at the Appraisal Stage 4.2.1 Appraisal NPVs of the LDCs 4.2.2 Appraisal NPV Continent Comparison 4.3 NPV Outcomes of the Result Stage 4.3.1 Result NPVs of the LDCs 4.3.2 Result NPV Continent Comparison 4.4 Appraisal vs. Result NPVs 4.4.1 Results of the LDCs 4.4.2 Continent Comparison 4.5 Economic Rate of Return Result Values 4.5.1 Results of the LDCs 4.5.2 Continent Comparison 4.6 Additional Economic and Financial Indicator Result Values 4.6.1 Benefit-Cost-Ratio and Net Benefit 4.6.2 Financial Net Present Value and Financial Rate of Return 4.7 Overall Project Performance 4.7.1 Definition 4.7.2 Overall Project Performance Ratings 4.7.3 Outcome Calculation for Non-Financial Indicator Projects 4.7.4 Verification of Outcomes and Conclusion 4.8 NPV-Cost-Ratios and SROI Calculation 4.8.1 NPV-Cost-Ratios of the ICR Reports 4.8.1.1 Overall Results 4.8.1.2 Continent Comparison 4.8.2 Standardized NPV-Cost-Ratios 4.8.2.1 Overall Results 4.8.2.2 Continent Comparison 4.8.3 Calculating the Minimum SROI Ratio 4.8.3.1 Overall Results of the Capital SROI Ratio 4.8.3.2 Continental Comparison of the Capital SROI Ratio 4.8.3.3 Overall Results of the Minimum SROI Ratio 4.8.3.4 Continental Comparison of the Minimum SROI Ratio 4.8.4 Making Meaning of the Results 4.9 Summary and Conclusion 5 Qualitative Data Analysis 5.1 Content Analysis 5.2 Sustainability 5.2.1 Sustainability Rating Definition 5.2.2 Sustainability Rating Categories 5.3 Bank Performance 5.3.1 Bank Performance Definition 5.3.2 Bank Performance Categories 5.4 Borrower Performance 5.4.1 Borrower Performance Definition 5.4.2 Borrower Performance Categories 6 Results of the Qualitative Data Analysis 6.1 Sustainability 6.1.1 Quantitative Assessment of Sustainability Ratings 6.1.2 Outcome of the Content Analysis 6.1.2.1 Types of Reasons 6.1.2.2 Overall Results 6.1.2.3 Results in Haiti 6.1.2.4 Continent Comparison 6.1.3 Excursus: Positive NPV Projects 6.1.4 Summary and Conclusion 6.2 Bank Performance 6.2.1 Quantitative Assessment of Bank Performance Ratings 6.2.2 Outcome of the Content Analysis 6.2.2.1 Types of Reasons 6.2.2.2 Overall Results 6.2.2.3 Results in Haiti 6.2.2.4 Continent Comparison 6.2.3 Summary and Conclusion 6.3 Borrower Performance 6.3.1 Quantitative Assessment of Borrower Performance Ratings 6.3.2 Outcome of the Content Analysis 6.3.2.1 Types of Reasons 6.3.2.2 Overall Results 6.3.2.3 Results in Haiti 6.3.2.4 Continent Comparison 6.3.3 Summary and Conclusion 7 Overall Summary and Conclusion 8 Critical Acclaim and Recommendations 9 Outlook and Future Research List of Appendices Appendix References

With the advent of the new National Health Act, health care in South Africa is at a critical point as this will be the first time in history that a National Health Insurance is being implemented in this country. Globally National Health Insurance has been around for more than a hundred years, however some countries with long established national health schemes are currently grappling with funding issues surrounding their health systems. South Africa should take note of these issues as it embarks on this journey. The objective of this study was to perform a literature review on how South Africa’s National Health Insurance can be funded taking cognisance of the history of the country and experiences of other countries. It is imperative for each country to achieve optimal health care funding to ensure the success and long-term sustainability of National Health Insurance. The analysis of the problems experienced by other countries revealed that balancing the three main funding options namely, allocated from the national revenue fund, user charges and or donations or grants from international organisations, is critical as the funds needed in a system to achieve coverage at an affordable cost is dependent on the current state of health care in a country. Considering South Africa’s history and current inequality in society and health care it is clear that the majority of funding for the National Health Insurance should be supplied by the national revenue fund. The required funds can either be raised by increasing existing taxes or introducing a new tax specifically aimed at financing the National Health Insurance. The use of user charges is important however, although not purely for a revenue collection point, but from a cost control point of view as well. Some studies have revealed that the lack of user charges results in a misuse of the system. / Financial Accounting / M. Phil. (Accounting Science)

This research focuses on assessing the extent to which the Principles of Aid Effectiveness were followed and translated into action by taking the General Education Quality Improvement Programme (GEQIP) in Ethiopia as an example. Outcomes of the secondary reviews conducted on the selected government institutions and development partners documents demonstrate that these Principles are taken as overarching strategies to guide the undertakings on GEQIP. The study attests that a number of factors influence the realization of aid effectiveness in Ethiopia. These include, at the recipient level, existence of strong national development plans while demanding improvement on absorptive capacity. At the level of development partners, compliance with pledges made on the provision of resources and better coordination is needed. A common country framework to guide the aid effectiveness process including mutual accountably is important. The study most importantly identifies that beyond sector specific reviews, emphasis should also be given to assess the contribution of the Principles of Aid Effectiveness for efficient delivery of support to the GEQIP. / Development Studies / M.A. (Development Studies)

Obesity and obesity-related diseases – such as type 2 diabetes – have become the most crucial indicators of population health in the 21st century. Formerly understood as ‘diseases of affluence’, obesity is now prevalent in the Global South posing serious risk to socioeconomic development. This is particularly true for rapidly developing countries where nutrition transitions are most apparent. There are many factors which impact on risk of obesity (e.g. gender, culture, environment, socioeconomic status, biological determinants). The problem is further aggravated within small island developing states where food security is exacerbated by factors associated with globalization and development. The thesis examines the surge of obesity and type 2 diabetes within Caribbean populations, using Barbados as a case study. A holistic approach was applied using an ecological health model. Moving away from the lifestyle model, the theoretical framework underpinning included sub-theories (e.g. social constructivism, feminism, post-colonial theory, concepts of memory and trauma).

L’Éducation Pour Tous mobilise la communauté internationale et les gouvernements depuis 1990. Cet engagement global renouvelé en 2000 sous l’auspice de l’UNESCO puis des Nations-Unies, porte notamment sur un objectif de base : l’universalisation de la scolarisation primaire complète pour tous les enfants d’âge scolaire à l’horizon de 2015. Plusieurs études sur la réalisation de cet objectif montrent que les pays en développement sont les plus à risque et que les progrès accomplis dans la plupart de ces pays, pourraient être plus importants si la pratique du redoublement faisait davantage l’objet de régulation et de contrôle. Cela contribuerait à améliorer la réussite scolaire et accroître la rétention des élèves au sein des systèmes éducatifs. La pratique du redoublement est en effet une tradition dans plusieurs systèmes éducatifs. Elle est particulièrement prépondérante dans certains groupes de pays ou régions, notamment en Afrique francophone au sud du Sahara. Dans ces pays, le PASEC - Programme d’Analyse des Systèmes Éducatifs de la CONFEMEN (Conférence des Ministres de l’Éducation Nationale des pays ayant le français en partage) - œuvre à améliorer l’accès à une éducation de qualité pour tous, par exemple, en informant les politiques sur la situation nationale du redoublement. Cette recherche sur le redoublement, la réussite scolaire et l’objectif de la Scolarisation Primaire Universelle (SPU) privilégie la dimension pédagogique, l’analyse empirique et étudie le cas du Sénégal. Elle présente et discute les indicateurs internationaux de suivi de l’objectif de la SPU, fait le point de l’état des connaissances sur le redoublement et la réussite scolaire et montre le défi que représente la réalisation de l’objectif de la SPU notamment dans les pays francophones d’Afrique sub-Saharienne. Exploitant les données existantes de l’enquête longitudinale de suivi de cohorte du PASEC au Sénégal entre 1995 et 2000, cette recherche examine le parcours scolaire des élèves en vue de la réalisation de l’objectif de la SPU. L’examen effectué combine des approches d’analyse transversale et longitudinale du redoublement et des apprentissages par rapport aux caractéristiques personnelles, familiales et scolaires de l’élève. Les résultats d’analyse montrent des variabilités, notamment par rapport aux caractéristiques personnelles de l’élève et à celles de sa classe et de son milieu de scolarisation. L’analyse longitudinale du redoublement s’est appuyée sur le diagramme de flux scolaire et a permis de produire un ensemble d’indicateurs d’efficacité interne du système éducatif du Sénégal. Pour la cohorte étudiée, du fait de l’importance des redoublements et des abandons scolaires, il faut en moyenne 9,4 années de scolarité pour que l’élève progresse du deuxième au sixième (dernier) grade du primaire. Seulement 39% de l’effectif de la cohorte survivent au dernier grade ce qui suggère que si cette tendance se maintenait, le Sénégal serait à risque de ne pas réaliser l’objectif de la SPU. Une évaluation de la situation courante à partir de données plus récentes serait requise. Le diagramme de flux scolaire constitue un outil de planification de l’éducation et représente de ce fait un important levier aux mains des autorités politiques pour agir sur les paramètres du système éducatif (paramètres liés à la qualité de l’éducation, à l’efficacité interne, etc.) afin de répondre à des objectifs spécifiques ou d’étapes pouvant conduire, par exemple, à la réalisation de l’objectif de la SPU. / The Education for All is mobilizing the international community and national governments since 1990. This global commitment which was renewed in 2000 under the auspices of UNESCO and the United-Nations has set a basic goal: the universalization of a complete primary education for all school-age children by 2015. Several studies on the achievement of this goal show that developing countries are most at risk and that progress in many of these countries could have been higher if the practice of grade repetition was better regulated and controlled. This measure would contribute to the improvement of academic achievement and increase retention within the education systems. Indeed, grade repetition practice is a tradition in several education systems. It is particularly overwhelming in some groups of countries or regions, especially in Francophone sub-Saharan Africa. In these countries, the PASEC – «Programme d’Analyse des Systèmes Educatifs de la CONFEMEN (Conférence des Ministres de l’Éducation National des pays ayant le français en partage)» - works to improve access to quality education for all, by for example, informing policies on the national situation of grade repetition. This research on grade repetition, school success and the Universal Primary Education (UPE) goal favors the pedagogical dimension, the empirical analysis and studies the case of Senegal. It presents and discusses the international indicators for UPE goal monitoring, takes stock of current knowledge on grade repetition and academic achievement and shows the challenge that represents the realisation of UPE goal especially in Francophone sub-Saharan Africa countries. By using the existing 1995-2000 PASEC longitudinal survey data in Senegal, this research examines pupils’ school careers toward the realisation of UPE goal. Transversal and longitudinal analyses of grade repetition and learning achievement based on the pupil’s personal, family and school characteristics have been used. Results from these analyses show variabilities related especially to individual, classroom and school location factors. The longitudinal analysis of grade repetition is based on the school flowchart which allows the calculation of a set of indicators about the internal efficiency of Senegal education system. For the cohort studied, due to the high grades repetition and dropout rates, pupils are required, on average, 9.4 years of schooling to progress from the second to the sixth (final) grade of primary. Only 39% of the initial cohort survives to the last grade, which suggests that if this trend remains unchanged, Senegal would be at risk of not achieving the UPE goal. An assessment of the current situation based on more recent data would be required. The school flowchart is an educational planning tool. Thus, it represents an important lever for political authorities to act on education system parameters (parameters related to education quality, internal efficiency, etc.) in order to effectively attain specific objectives or milestones resulting, for example, to the achievement of the UPE goal.

Introdução:A mortalidade materna é um dos melhores indicadores do desenvolvimento socioeconômico de um país. O Brasil implementou políticas públicas para redução da mortalidade materna até 2015. A região do Grande ABC Paulista no Brasil apresenta grande heterogeneidade socioeconômica entre seus municípios, podendo refletir a desigualdade social do país, porém apresentando dimensões que permitem maior controle de dados da mortalidade. Objetivo: Avaliar a tendência da mortalidade materna na região do Grande ABC Paulista no período de 1997 a 2011. Metodologia: Estudo ecológico de série temporal, cujos dados foram obtidas no banco de dados do Departamento de Informática do Sistema Único de Saúde do Brasil (DATASUS) do Ministério da Saúde do Brasil (MS). Os dados foram transformados em Índices da Mortalidade Materna Direta (IMMD), estratificados por municípios, índices de desenvolvimento humano (IDH), causas de óbito materno segundo Classificação internacional de doenças (CID-10), local e período de ocorrência do óbito, dados sóciodemográficos e submetidos a comparações (teste U de Mann-whitney, teste de Kruskal-Wallis e teste de Dunn) e associações pela regressão linear, com significância de 5%. Resultados: Os IMMD predominaram em mulheres solteiras, entre 20-34 anos de idade, brancas, escolaridade entre 4-7 anos, intra-hospitalar, no puerpério imediato, por hemorragias/tromboses/embolias e eclâmpsias. Não houve diferença nos IMMD em relação ao grupo IDH. Rio Grande da Serra atingiu IMMD alto (OMS) na maioria das covariáveis analisadas. Apenas São Caetano do Sul apresentou IMMD baixo (OMS), alto IMMI (p=0,03), queda nos IMMD no período de 1997 a 2011 (beta= -0,67/ano, p=0,03) e tendência neste milênio (2000 a 2011, beta=-0,55/ano, p=0,07) com estimativa de queda de 65,1% até 2015. A soma dos óbitos não investigados, não se aplica e de fichas sem investigação para qualquer variável analisada ultrapassa 50%. Conclusão: Os índices da Mortalidade Materna Direta na região do Grande ABC Paulista apresentaram níveis altos e queda discreta no tempo. Apenas o município de São Caetano do Sul apresentou queda expressiva de IMMD nos 15 anos de estudo e tendência a queda neste milênio com estimativa de atingir 65,1% até 2015. Descritores: Mortalidade materna; Políticas públicas; Mulheres; Saúde da mulher/estatística & dados numéricos; Complicações na gravidez/mortalidade; Mortalidade; Sistema Único de Saúde; Estudos epidemiológicos; Saúde da mulher/estatística & dados numéricos; Período pós-parto; Objetivos de desenvolvimento do milênio; Brasil/epidemiologia / Introduction: Maternal mortality is one of the best indicators of socioeconomic development of a country. Brazil has implemented public policies to reduce maternal mortality by 2015. The Grande ABC Paulista region in Brazil shows great socioeconomic heterogeneity among its municipalities, which can reflect the country social inequality, however presenting dimensions that allow greater control of mortality data. Objective: To evaluate the trend of maternal mortality in the Grande ABC Paulista region in the period of 1997-2011. Methodology: Ecological time series, where data was obtained from the database of the Information Technology Department of the Public Health Care System (DATASUS) of the Health Ministry of Brazil (MS). The data was transformed into direct maternal mortality indices (DMMI), stratified by municipalities, Human Development Indices (HDI), causes of maternal death according to the International Classification of Diseases (ICD-10), period and local of maternal death, socio-demographic parameters. Data were submitted to comparison tests (Mann-Whitney U test, Kruskal-Wallis test, followed by Dunn\'s multiple comparisons test) and association tests (linear regression) when applied and a significance of 5%. Results: The DMMI predominated in single women, aged 20-34 years old, white, 4 to 7 school age, in-hospital, postpartum, by bleeding / thrombosis / embolism and eclampsia. There was no difference in DMMI when comparing by HDI group. The Municipality of Rio Grande da Serra reached high DMMI values in the most of the analyzed covariates. São Caetano do Sul presented the lowest DMMI values and was the only municipality which presented decrement in the DMMI during the 15 years of the studied period (beta = - 0.67/year, p=0.03) and a trend in this millennium (2000-2011, beta- 0.55/year, p=0.07) with an estimated fall of 65.61% by 2015. The sum of not investigated, not applied and files without investigation for any analyzed variable exceeded 50%. Conclusion: The DMMI in the Grande ABC Paulista showed high levels and downward trend in time. São Caetano do Sul was the sole municipality where the DMMR dropped in 15 years of study and presented a tendency to decrease in this millennium with an estimated fall of 65.1% by 2015