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Collaboration between midwives and traditional birth attendants for maternal and child healthcare is a challenge in rural South African communities due to the absence of a guiding framework. To address this, this study sought to develop and validate an inclusive framework informed by the Donabedian structure–process–outcome (SPO) framework for collaboration between these healthcare professionals. Method: Key stakeholders were invited to participate in a co-creation workshop to develop the framework. Twenty (20) participants were purposively sampled based on their maternal and child healthcare expertise. A consensus design using the nominal group technique was followed. Results: Participants identified the components needed in the framework, encompassing (i) objectives, (ii) structures, (iii) processes, and (iv) outcomes. Conclusion: This paper will contribute to the development of an inclusive healthcare framework, providing insights for stakeholders, policymakers, and practitioners seeking to improve maternal and child healthcare outcomes in resource-constrained, rural settings. Ultimately, the proposed framework will create a sustainable and culturally sensitive model that optimises the strengths of midwives and TBAs and fosters improved healthcare delivery to rural South African communities. [ABSTRACT FROM AUTHOR]

Background: Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. Methods: A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and academia, members of the AYHP Advisory Panel, youth representatives from the National Department of Health Adolescent and Youth Advisory Panel, as well as adolescent and youth health and gender policy actors, in government, academia and civil society. Qualitative data was collected via in-depth, semi-structured interviews with 30 policy actors between 2019 and 2021. Thematic data analysis was used, as well as triangulation across both respondents, and the document analysis of the AYHP. Results: Despite gender power relations and more gender-transformative approaches being discussed during the policy making process, these were not reflected in the final policy. Interviews revealed an interrelated constellation of diverse and juxtaposed actor gender narratives, ranging from framing gender as equating girls and women, gender as inclusion, gender as instrumental, gender as women's rights and empowerment and gender as power relations. Some of these narrative framings were dominant in the policy making process and were consequently included in the final policy document, unlike other narratives. The way gender is framed in policy processes is shaped by actor narratives, and these diverse and contested discursive constructions were shaped by the dynamic interactions with the South Africa context, and processes of the Adolescent Youth Health Policy. These varied actor narratives were further contextualised in terms of reflections of what is needed going forward to advance gender equality in adolescent and youth health policy and programming. This includes prioritising gender and intersectionality on the national agenda, implementing more gender-transformative programmes, as well as having the commitments and capabilities to take the work forward. Conclusions: The constellation of actors' gender narratives reveals overlapping and contested framings of gender and what is required to advance gender equality. Understanding actor narratives in policy processes contributes to bridging the disconnect between policy commitments and reality in advancing the gender equality agenda. [ABSTRACT FROM AUTHOR]

Curriculum reform was high on the agenda of South Africa's post-apartheid governments. Yet as time passed, the initial reforms were seen as increasingly problematic, especially when pedagogical realities met policy priorities. There was reluctance on the part of policymakers to give up what was seen as the democratic imperative behind the reforms. Yet as schools struggled, public responses blamed inadequate attention to practical issues as undermining the implementation of the reforms. This perspective on curriculum implementation, blaming teachers for the failure of policy reforms, is not uncommon. This paper argues, however, that such a perspective is very often misinformed because it deflects attention from the specific nature of policies and the role of policymaking in neglecting key issues that might have better facilitated implementation. South Africa's democratic curriculum reforms were essential for dismantling a key aspect of the apartheid state. The paper highlights this point arguing that an understanding of policies rather than a focus on the failure of schools provides a better lens for understanding the trajectory of curriculum reform processes in South Africa. [ABSTRACT FROM AUTHOR]

The author discusses the geostatistical methods used to examine mortality and morbidity in South Africa. He is critical with the collection of geographic data which is not a priority for public health surveillance system in developing countries. He also mentions that the analysis employs more advance statistical techniques.

In December 2003 the Traditional Leadership and Governance Framework Act, 2003 (No 41 of 2003) was eventually promulgated. This was the culmination of an extended process of submissions, consultation, releasing of a draft White Paper, workshops, activities of a White Paper Task Team and its subcommittees, meetings with the responsible minister and between various ministries. Stemming from the experiences and perceptions of an anthropologist commissioned to become involved in a part of this process, this paper seeks to interrogate some of the issues which emerged in the course of proceedings. In arguing that policy development and implementation is about intentional human behaviour, and that some preceding ideas, conceptions or notions are always involved, it follows that many variables can play a role in the decision-making and strategies involved. Thus the information available, perceptions of such information, political (and other) agendas and power relations between individuals and groups, and between levels of authority, all come into play. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. Methods: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Results: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Conclusion: Policymakers should consider PWCDs when responding to a public health concern in the future. Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs. [ABSTRACT FROM AUTHOR]

Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub‐district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration‐aware community‐based programmes that included the training of community‐based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi‐structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non‐state interventions and the fragmented state approach to community‐based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community‐based interventions that do not recognise community‐based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls. [ABSTRACT FROM AUTHOR]

Purpose A healthcare system in any country is rarely the product of one logical policy-making experience, but rather a manifestation of many years of historical development. The purpose of this paper is to examine the characteristics, components, and variables of South Africa’s healthcare system in the context of global patterns. It leverages a dynamic period in South Africa since 1994, and applies a comparative health systems analysis to explain where the country’s healthcare system is, and where it is potentially going.Design/methodology/approach This paper reviews literature related to South Africa’s healthcare system, outlines its historical development, and discusses three fundamental challenges experienced in the country. This paper also reviews the literature on healthcare system typologies and identifies three framework models that have been used to categorise national healthcare systems since the 1970s. This paper then discusses the categorisation of South Africa’s healthcare system in these models, in comparison to Canada and the USA.Findings This paper finds that the framework models are useful tools for comparative analysis of healthcare systems. However, any use of such typologies should be done with the awareness that national healthcare systems are not isolated entities because they function within a larger context. They are not static, since they are constantly evolving with many nuances, even with very similar healthcare system categorisations.Originality/value This paper charts the trajectory of change in the South African healthcare system, and demonstrates that the change process must keep internal conditions in mind if the outcome is to be successful. Imitating policies of countries with well-functioning systems, without regard to local realities, may not work, as the government attempts to usher in changes within a short span of time. [ABSTRACT FROM AUTHOR]

Background: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider's knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. Methods: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. Results: Registration of abortion medicines—misoprostol or a combination of mifepristone and misoprostol—was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone—countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula—no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. Conclusion: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access. Plain Language Summary: Unsafe abortion is a leading cause of death and disability among women of reproductive age. Medical management of abortion with mifepristone and misoprostol pills, or just misoprostol, is a safe and effective way to end a pregnancy. Owing to an increase in the number of medical abortion products that have entered country health systems, we examined access to these medicines from supply to demand in selected countries. The overarching goal of the national landscape assessments was to produce evidence to support advocacy efforts and policymaking for improved access to quality medical abortion products that is appropriate to the needs of the country. This paper aims to describe key findings across eight country settings on the availability of medical abortion medicines and identify key opportunities to improve access to them across countries. [ABSTRACT FROM AUTHOR]

Examines the impact of the economics of technological change on the reformulation of science and technology policy in South Africa. Influence of technological change on the economy; Review and reform of science and technology institutions; Concrete policy initiatives from the ST White Paper.

A growing body of evidence indicates that excessive sugar consumption is driving epidemics of obesity and related non-communicable diseases (NCDs) around the world. South Africa (SA), a major consumer of sugar, is also the third most obese country in Africa, and 40% of all deaths in the country result from NCDs. A number of fiscal, regulatory, and legislative levers could reduce sugar consumption in SA. This paper focuses on a sugar-sweetened beverage (SSB) tax. The purpose of the paper is to highlight the challenges that government might anticipate. Policies cannot be enacted in a vacuum and discussion is focused on the industrial, economic, and societal context. The affected industry actors have been part of the SA economy for over a century and remain influential. To deflect attention, the sugar industry can be expected either to advocate for self-regulation or to promote public–private partnerships. This paper cautions against both approaches as evidence suggests that they will be ineffective in curbing the negative health impacts caused by excessive sugar consumption. In summary, policy needs to be introduced with a political strategy sensitive to the various interests at stake. In particular, the sugar industry can be expected to be resistant to the introduction of any type of tax on SSBs. [ABSTRACT FROM PUBLISHER]

From a policy perspective, the question naturally arises as to whether there have been major changes in policy making and associated issues in South Africa since 1994. Arguably, the first five years or so focused on institutional reforms and legislative interventions. In the late 1990s the South African government established specific processes and institutions for policy development and coordination. In 2005-6, specific processes and institutions for longterm planning and monitoring and evaluation were formally established. The paper examines the evolution of policy making and coordination in South Africa since the late 1990s, it also reflects on monitoring and evaluation as well as long-term planning. The erstwhile Policy Coordination and Advisory Services (PCAS), which had been the main engine of policy (coordination and other aspects) in post-apartheid South Africa that was established towards the end of 1997 in the Office of Deputy President Thabo Mbeki (at the time) was disbanded in 2010. The PCAS, popularly known as the Policy Unit, coordinated all policies and reforms, and led in planning as well as monitoring and evaluation, among other responsibilities. From 2010, functions were institutionalised or strengthened (e.g. government departments have been established to deal with planning as well as monitoring and evaluation). There have not been major shifts and/or changes in policy coordination, planning as well as monitoring and evaluation since the late 1990s. However, there appears to be a shift in emphasis to focusing more on implementation. This might have been one of the biggest mistakes of the Jacob Zuma administration because capacity for policy thinking is critical. It would seem that the Thabo Mbeki administration focused specifically on policy. The Nelson Mandela administration, which was a Government of National Unity, was largely focused on various policy, legislative and institutional reforms with very limited capacity for policy making, coordination and monitoring and evaluation as well as long-term planning. [ABSTRACT FROM AUTHOR]

Background: While there is a growing body of legally-focused analyses exploring the potential restrictions on public health policy space due to international trade rules, few studies have adopted a more politically-informed approach. This paper applies an integrated political economy and power analysis approach to understand how power relations and dynamics emerging as a result of the international trade and investment regime influence nutrition and alcohol regulatory development in a case study of South Africa.Methods: We interviewed 36 key stakeholders involved in nutrition, alcohol and/or trade/investment policymaking in South Africa. Interview transcripts and notes were imported into NVivo and analyzed using thematic analysis. We used a conceptual framework for analyzing power in health policymaking to guide the analysis.Results: Under the neoliberal paradigm that promotes trade liberalization and market extension, corporate power in nutrition and alcohol policymaking has been entrenched in South Africa via various mechanisms. These include via close relationships between economic policymakers and industry; institutional structures that codify industry involvement in all policy development but restrict health input in economic and trade policy decisions; limited stakeholder knowledge of the broader linkages between trade/investment and food/alcohol environments; high evidentiary requirements to prove public health policy effectiveness; both deliberate use of neoliberal frames/narratives as well as processes of socialization and internalization of neoliberal ideas/values shaping perceptions and policy preferences and ultimately generating policy norms prioritizing economic/trade over health objectives.Conclusions: Exposing power in policymaking can expand our own ideational boundaries of what is required to promote transformative policy change. This work points to a number of potential strategies for challenging corporate power in nutrition and alcohol policymaking in the context of international trade and investment liberalization in South Africa. [ABSTRACT FROM AUTHOR]

Policy flows are not quantifiable and calculating processes but part of the uneven movement of ideas and experiences that involves power and personalities. Processes of learning and policy circulation have thus proven difficult to study especially as the exchanges taking place between actors and localities rarely lead directly to uptake. This paper outlines a conceptual and methodological framework for conducting policy mobilities research by attending to the plethora of ordinary practices – be it through engagements with fellow practitioners, their toolbox of material solutions, or a particular moment of discovery – that form the assemblages of learning. The paper then unveils a set of procedures for unravelling the assemblage, first by “following the people” and their understandings of mobile policy; second, by “following the materials” to experiment with a Latourian approach to materiality; and finally, by “following the meetings”, that is, the conferences, workshops and seminars where the people and materials mingle. The proposed methodology is sensitive to the ephemeral, ethereal and experiential assemblages that carve and sustain the pathways for the movement of knowledge. This interpretation of the methods for studying mobile knowledge is a critical predecessor to any empirical analysis of policy mobilities. [ABSTRACT FROM AUTHOR]

This paper explores barriers to gender policy implementation arising from the narratives framing gender as a policy issue. Through examining the influence of gender policy narratives on practitioners, it challenges those who represent policy failures as the result of unsupportive cultural contexts. The paper draws on Fraser’s (1995, 2005; Fraser and Honneth, 2003) conceptualisation of recognition and redistribution to highlight tensions between three different gender policy narratives: (1) gender as instrumental for development; (2) gender as women’s rights and empowerment; and (3) gender as relations of power requiring personal transformation. Interviews with 32 gender practitioners in 26 South African non-governmental organisations and observations of meetings between these organisations show how these narratives lead to unhelpful conflicts between practitioners. These conflicts inhibit both the uptake of gender policy recommendations and collaboration between practitioners in ways that undermine efforts to address gender inequalities in the South African context. [ABSTRACT FROM AUTHOR]

• Globalisation of smart cities involve mobile policies and cosmopolitisation. • There is a lexical change from digital to smart city in South Africa since 2009. • Lexical change is more than rhetoric and indicative of a digital neoliberalisation. • Processes at local level are more variegated due to municipal autonomy. This paper explores how the smart city phenomenon becomes nearly ubiquitous in countries and cities around the world. Drawing on policy mobility studies and cosmopolitisation – defined as globalization from within – it focuses on the roll-out and take-up of smart city narratives and interventions in South Africa since 2005. Based on a media analysis on national and local scales, the paper shows that the smart city effect is an entangled phenomenon. Generally speaking, it consists of a lexical glue that holds together processes of data-driven neoliberalisation of urban governance. However, at municipal level we observe more variegated effects of reverse-scale policymaking, labelling and territorialisation where the smart city appears as a more-than-mobile but also as a more-than-local urban policy. [ABSTRACT FROM AUTHOR]

Background: The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement.Methods: This was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted.Results: The majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11-3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06-5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10-7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35-7.25, p value: 0.008) than unemployed participants.Conclusion: The levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred. [ABSTRACT FROM AUTHOR]

The concept of the ‘polycentric urban region’ has been popularised both as a theoretical concept for understanding regional urban systems in an era of reduced transport and communication costs, and as a normative policy objective in its own right. This paper explores its relevance to the rapidly urbanising Cape Town city-region. First, empirical evidence for the emergence of polycentric regional development patterns was considered. Shifts in relative settlements sizes (morphological polycentrism) over the period 1991–2011 were examined using population data, and patterns of inter-settlement interactions (functional polycentrism) were explored by analysing commuting information. Contrary to expectations, trends toward polycentric development were found to be weak. Second, the paper considers the relevance and value of polycentric development thinking for regional economic and spatial planning policy, concluding that there are insufficient grounds for policy intervention aimed at encouraging polycentric regional development or countering the dominance of Cape Town in the region. [ABSTRACT FROM PUBLISHER]

The aim of this study article is to present an analysis of the first national policy framework, which provides a coherent approach to integrating nursing education into a newly defined band for higher education programmes in South Africa. The significance of this policy framework is ensuring the seamless transition from legacy nursing programmes to NQF-registered nursing programmes. It explores the agenda-setting process, analyses the prevailing context and outlines the rationale for the policy. Walt and Gilson's policy triage analysis process outlines the key elements of the policy development process. Drawing upon Tarlov's two-phased public policy development process, the article outlines the steps completed in the policy development process. Recommendations are proposed to expand access, improve quality and diversify the provisioning of nursing education and training in South Africa. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level. Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level. [ABSTRACT FROM AUTHOR]

This theoretical paper looked at the possibility of incorporating the social learning concept of achievement-oriented behaviour in promoting children's public participation in policy-making in the educational system. The paper highlighted how the concepts of public participation and achievement-oriented education could be used in the governance of the educational system in South Africa. The paper explored concepts such as goal-directed behaviour, achievement standards, achievement beliefs, and how the educational system could use the concepts in the promotion of children's public participation. Future studies could focus on the empirical relationship between achievement-oriented behaviour and child involvement in participatory democracy in the governance of the educational system in South Africa. [ABSTRACT FROM PUBLISHER]

Background: The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. Objective: As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training. Methods: SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches. Results: SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services remains mixed. Conclusions: SDH training is currently in short supply, and there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods. [ABSTRACT FROM AUTHOR]

Background: This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method: Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results: Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion: A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development. [ABSTRACT FROM AUTHOR]

This paper discusses the discourses by which land reform policies in South Africa have been justified and criticized. Critical thought is needed about the underlying assumptions and frameworks informing policy and critique. While key aspects of populist, 'Left' and liberal ideologies helped mobilize support for land reform after 1994, they framed questions of equitable transformation and justice in ways that obscured the terrain of struggle rather than revealing it. The broad consensus on the legitimacy of land reform in the initial decade after 1994 was underpinned by narratives about redress and reconciliation that privileged reparative justice above distributive equity. It tended to obscure the complex trade-offs and impacts involved in implementation. Coherent policy-making was further undermined by simplistic oppositions between 'market' and 'rights-based' approaches that often led to ill-targeted policies. Land and agrarian reform needs to be liberated from this symbolic burden. It should be informed by an understanding of the nature of inequality in South Africa and the contribution that agrarian change can make to reducing it. [ABSTRACT FROM AUTHOR]

This paper reviews some of the existing economics of education literature from the perspective of South Africa's education policymaking needs. It also puts forward a suggested research agenda for future work. The review is arranged according to five areas of research: rates of return, production functions, teacher incentives, benefit incidence analysis and cross-country comparisons. Production functions, especially if translated to cost-effectiveness models, can point to important policy solutions. Teacher incentives is a policy area that is in need of a better theoretical and empirical basis. Rates of return are difficult for policymakers to interpret, but suggest a need for a qualification below the Grade 12 level. While benefit incidence analysis can demonstrate large improvements in the equity of public financing, cross-country comparisons reveal that not only is the distribution of schooling outcomes particularly unequal, on average it is well below what the country's level of development would predict. [ABSTRACT FROM PUBLISHER]

This paper examines the complexity of the South African policy-making context and its official and non-official actors and investigates the challenges that scientists face when trying to exert their influence here in order to strengthen the science-policy interface. Based on this analysis, the paper makes preliminary recommendations on how scientists can venture to lobby policy-makers in spite of the many obstacles they face. The main areas of interest in this paper are the science-policy interface, the policy-making process and lobbying. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

There are two broad views on the policy role played by manufacturers during the first decades of Union. The influence of manufacturers has either been regarded as insignificant, or they have been held responsible for the narrow protectionism of the post-1924 Hertzog government. This article demonstrates that both judgements are unfair, and that the policy the manufacturers worked with and helped to shape before 1924, was, in many ways, very positive. Within the restrictions of the racial exclusiveness dominant at the time, it was based on a relatively broad and inclusive nationalism, which underpinned the co-operation and support essential for promoting entrepreneurship. The state saw its role within this framework as providing as much assistance to manufacturers as possible, while keeping the long-term needs of the nation firmly in the forefront. In contrast to the idea that manufacturers increased their influence after the 1924 regime change, the paper demonstrates that the opposite occurred, a development that had negative long-run consequences for South Africa. [ABSTRACT FROM AUTHOR]

Sustainable development is now widely accepted as a policy framework in planning and development both internationally and in South Africa. Within this framework, technocentric scientific approaches to environmental management, which are reflective of weak ecological modernization, have dominated environmental practice both in the developed and developing world. South Africa is a country in transition and as a result environmental law and policy have undergone significant reform. However, implementation and practice remains embedded within a weak ecological modernization approach. Through the lens of two case studies reflecting changing approaches and practices within state institutions, this paper explores the shifts taking place in the construction, adaptation and application of policy frameworks and tools used in the drive towards sustainability in South Africa. The research uses critical approaches to ecological modernization (Hajer, 1995; Christoff, 1996) and deliberative policy analysis (Hajer and Wagenaar, 2003; Hajer, 2003, 2003; Hajer, 2004) to explore these shifts. It suggests that the shift towards strong ecological modernization has taken place as a result of the adaptation of international practice to the South Africa context, the global acceptance of more integrated approaches, the opportunities for change that ‘institutional ambiguity’ and ‘multi-signification’ create, and pockets of innovation that have developed when intellectual actors shift the boundaries of environmental practice. [ABSTRACT FROM AUTHOR]

This article deals with the North West experience of managing national transformation policies. It suggests that the absence of policy analysis skills and practice are major impediments to the implementation of policies. An improvement in policy analysis skills is essential if the government is to improve its performance. Stakeholder analysis, which clarifies a decision maker's strategic options, is another area which has received insufficient attention in the public sector in South Africa, Implementation problems in the North West Province include a lack of reliable data and information upon which to make decisions, which is in turn a consequence of an inadequate Management Information System, However, the problems of implementation cannot only be ascribed to poor management by provincial governments. National policies and directives are often imposed upon provinces without regard to their specific circumstances. Thus, for example, some heads of departments in the North West felt that the publication of the White Paper on the Transformation of Public Service was premature in that at most provinces lacked the capacity to implement its recommendations, A further problem relates to the fact that a number of policies have been initiated by national government with apparently little regard to the enormous financial obligations they impose upon provinces. For example. The Basic Conditions of Employment Act of 1997 imposes onerous overtime burdens upon provincial administrations. [ABSTRACT FROM AUTHOR]

Background: This paper uses the concepts of organisational culture and organisational trust to explore the Implementation of equity-oriented policies -- the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". Methods: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. Results: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. Conclusions: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected. [ABSTRACT FROM AUTHOR]

Background: Governance, which includes decision-making at all levels of the health system, and information have been identified as key, interacting levers of health system strengthening. However there is an extensive literature detailing the challenges of supporting health managers to use formal information from health information systems (HISs) in their decision-making. While health information needs differ across levels of the health system there has been surprisingly little empirical work considering what information is actually used by primary healthcare facility managers in managing, and making decisions about, service delivery. This paper, therefore, specifically examines experience from Cape Town, South Africa, asking the question: How is primary healthcare facility managers' use of information for decision-making influenced by governance across levels of the health system? The research is novel in that it both explores what information these facility managers actually use in decision-making, and considers how wider governance processes influence this information use. Methods: An academic researcher and four facility managers worked as co-researchers in a multi-case study in which three areas of management were served as the cases. There were iterative cycles of data collection and collaborative analysis with individual and peer reflective learning over a period of three years. Results: Central governance shaped what information and knowledge was valued -- and, therefore, generated and used at lower system levels. The central level valued formal health information generated in the district-based HIS which therefore attracted management attention across the levels of the health system in terms of design, funding and implementation. This information was useful in the top-down practices of planning and management of the public health system. However, in facilities at the frontline of service delivery, there was a strong requirement for local, disaggregated information and experiential knowledge to make locally-appropriate and responsive decisions, and to perform the people management tasks required. Despite central level influences, modes of governance operating at the subdistrict level had influence over what information was valued, generated and used locally. Conclusions: Strengthening local level managers' ability to create enabling environments is an important leverage point in supporting informed local decision-making, and, in turn, translating national policies and priorities, including equity goals, into appropriate service delivery practices. [ABSTRACT FROM AUTHOR]

This paper summarizes a debate on whether meta-analyses and systematic reviews are decisive in formulating guidelines for dietary fat. Held during the 12th congress of the International Society for the Study of Fatty Acids and Lipids in Stellenbosch, South Africa, September 7, 2016, the debate was hosted by the International Union of Nutritional Sciences and the International Expert Movement to Improve Dietary Fat Quality (IEM, www.theiem.org). Clemens von Schacky, Ludwig Maximilians-University, Munich, Germany, supported the statement, describing the types of weaknesses in individual studies and clinical trials. With examples of how to overcome such limitations, he concluded that nutritional guidelines on fat need a proper scientific basis in which randomized controlled trials (RCTs) with clinical end-points and their meta-analyses are essential and decisive. In contention, Ingeborg Brouwer, Vrije Universiteit, Amsterdam, declared that recommendations on dietary fat intake should always be based on the totality of the evidence, including physiologic and biochemical knowledge and associations from observational epidemiology. RCTs and meta-analyses have their shortcomings, but well-conducted systematic reviews and meta-analyses support a transparent process for developing dietary fat guidelines. Participants agreed that evidence-based decision-making for dietary guidance should consider all the best available evidence using a transparent, systematic review. [ABSTRACT FROM AUTHOR]

Firms and economic policy makers need an enhanced understanding of universities, in terms of what academics value and how they interact, if they are to enhance collaboration around the generation and transfer of knowledge and technology between universities and industry. The literature increasingly focuses on identifying incentives and barriers within universities, but is largely limited to contexts in Europe and the USA, and favours individual over institutional determinants. The paper contributes by situating university-industry linkages within the total pattern of academic interaction with external actors, in diverse types of institutions. Empirically, it extends the literature to investigate trends in an immature national system of innovation in a late developing economy context, South Africa. The analysis maps the heterogeneity of academic engagement, focusing on firms, through principal component analysis of an original dataset derived from a survey of individual academics. It concludes that the incentives that drive academics and that block university-industry interaction in contexts like South Africa, are strongly related to universities' differentiated nature as reputationally controlled work organisations, and to the ways in which they balance and prioritise their roles in national development. [ABSTRACT FROM AUTHOR]

Background: Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective: To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design: In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results: For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions: This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs. [ABSTRACT FROM AUTHOR]

Poverty alleviation remains a pressing concern for South African policy-makers. Implementing effective anti-poverty policies requires a clear understanding of the nature and extent of poverty. The extant literature on South African poverty dynamics shows a decline in the headcount ratio over the first decade of the twenty-first century. However, the prior research largely adopts a narrow money-metric approach, or uses multi-dimensional indices that include welfare indicators based on private assets (e.g. television sets) or those that are provided publicly (e.g. access to water). This paper uses multiple correspondence analysis to measure non-income poverty trends for the period 2005–12. The novelty in this undertaking lies in an attempt to include a measure of the perceived quality of public assets and services to complement the standard indices. This provides some measure of ‘success’ of public service delivery, accounting for both changes in access and quality. [ABSTRACT FROM PUBLISHER]

Background: There has been increased emphasis globally on nurses' involvement in health policy and systems development. However, there has been limited scholarly attention on nurses' participation in policy-making in South Africa. Objective: This paper analyses the dynamics, strengths, and weaknesses of nurses' participation in four national health workforce policies: the 2008 Nursing Strategy, revision of the Scope of Practice for nurses, the new Framework for Nursing Qualifications, and the Occupation-Specific Dispensation (OSD) remuneration policy. Design: Using a policy analysis framework, we conducted in-depth interviews with 28 key informants and 73 frontline nurses in four South African provinces. Thematic content analysis was done using the Atlas.ti software. Results: The study found that nurses' participation in policy-making is both contested and complex. The contestation relates to the extent and nature of nurses' participation in nursing policies. There was a disjuncture between nursing leadership and frontline nurses in their levels of awareness of the four policies. The latter group was generally unaware of these policies with the exception of the OSD remuneration policy as it affected them directly. There was also limited consensus on which nursing group legitimately represented nursing issues in the policy arena. Shifting power relationships influenced who participated, how the participation happened, and the degree to which nurses' views and inputs were considered and incorporated. Conclusions: The South African health system presents major opportunities for nurses to influence and direct policies that affect them. This will require a combination of proactive leadership, health policy capacity and skills development among nurses, and strong support from the national nursing association. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We contribute to the lack of tools to support efficient industrial policy-making, especially in the mineral beneficiation policy literature. To address this vacuum, we adapt the product space analysis approach to incorporate an input-output value chain lens. This framework is applied to the case of steel in South Africa to derive novel insights regarding the (in)efficiency of implementing a downstream linkage-based beneficiation policy. Our dynamic analysis approach allows for interactions with the rest of the product space. We find that a 'leap-frogging' approach to development within the value chain may be more optimal than a strict beneficiation based industrial policy. [ABSTRACT FROM AUTHOR]

The Draft National Open Science Policy, which was shared by the South African government with stakeholders in 2022, is an encouraging step forward as it aims to promote the practice of open science in South Africa through a system of incentives. Since South Africa is constitutionally committed to be an open and democratic society, this approach is preferable to the approach of state control that characterizes the Draft National Policy on Data and Cloud—another data-related policy initiative by the South African government. However, there is room for improvement in the Draft National Open Science Policy. In particular, it should: (a) rely on the right to freedom of scientific research to strengthen the policy; (b) rectify the omission of ownership from its policy analysis; and (c) retain a clear differentiation between human and non-human genetic data. This will ensure that the final policy is clearly anchored in the South African Constitution, and that the principle of “as open as possible, as closed as necessary” can be applied to human genetic data in a legally well informed and accountable way. [ABSTRACT FROM AUTHOR]

This paper aims to analyse how to encourage science uptake, here defined as the uptake and use of scientific research products (including journal articles, scientific reports, tools, expert knowledge, etc.), in the South African context. While science uptake into implementation is a very case- and context-specific process, the authors propose that a general framework for analysis of the policy-making context in South Africa needs to be considered when analysing how to promote science uptake in specific cases. In this paper, the National Freshwater Ecosystem Priority Areas (NFEPA) project is used as an example to illustrate how to apply this framework and how science projects in South Africa can be better positioned for impact and use. The paper starts by introducing the framework for conceptualising the complex set of dynamic processes and actors that can be involved in science uptake by government in South Africa, i.e., the policy-making context. From this theoretical platform the authors analyse to what extent the NFEPA project will be able to support more effective implementation of existing environmental and water legislation. This is done by exploring the challenges that hinder the uptake of science in government departments and then offering recommendations on how to address these. [ABSTRACT FROM AUTHOR]

Community participation is not only a human right in itself but an essential underlying determinant for realizing the right to health, since it enables communities to be active and informed participants in the creation of a responsive health system that serves them efficiently. As acknowledged by the Rio Political Declaration on Social Determinants of Health, participatory processes are important in policymaking and in the implementation of laws relating to health. Collective deliberation improves both community development and health system governance, resulting in more reasoned, informed, and public-oriented decisions. More recently, attention has focused on the elements of health system governance that enable greater responsiveness to community needs. However, there is relatively little by way of interventions linking human rights approaches to governance in ways that recognize participation as a critical social determinant of the right to health. This paper provides perspectives from a three-year intervention whose general objective was to develop and test models of good practice for health committees in South Africa and Uganda. It describes the aspects that we found critical for enhancing the potential of such committees in driving community participation as a social determinant of the right to health. [ABSTRACT FROM AUTHOR]

This paper explores the making of the National Qualifications Framework (NQF) in South Africa, and asks how a policy that was intended to unite education and training, and build new forms of equality, failed to become hegemonic as the new state established itself. In so doing, it engages, and argues for, theoretical tools that help keep ‘the state’ at the centre of policy analysis. The paper explores a rupture within the NQF between the fields of education and training by examining practices through which the policy developed between 1985 and 2007. Informed by involvement in these events, the author draws on data gathered from documents and interviews with over 70 participants engaged in making the NQF. Using a conceptual vocabulary derived from Laclau and Mouffe''s discourse theory the paper analyses the way social antagonisms were constructed and political frontiers drawn in changing political conditions [Laclau, E., Mouffe, C., 1985. Hegemony and Socialist Strategy. Towards a Radical Democratic Politics. Verso, London]. The paper argues that the emergence, development and rupture in the NQF can be explained in relation to shifting hegemonic practices that sought to organise social relations throughout the transition and within the post-apartheid era. The policy is portrayed as a feature of the political transition, marking the articulation of elements within the fields of education and training by hegemonic formations concerned with securing a democratic economy within a global market. The analysis runs that there has been a failure to maintain hegemony and that a rupture has occurred along a fault line within the South African state between practices building a corporatist state and those constructing a developmental state. The paper argues that the fractures built into the South African NQF point to complex challenges that states ‘at the margins’ face when simultaneously articulating with differing, contradictory globalised practices, whilst also seeking to build equitable national education systems. Local concerns remain significant in struggles to re-make the state, and education and training policy. [Copyright &y& Elsevier]

Copyright of IFLA Journal is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Loss of topsoil is one of the principal soil degradation problems confronting agriculture throughout South Africa and receives special attention by policy-makers. For effective prevention and remediation, the spatial extent of the problem has to be established and monitored. Recent developments in the application of remote sensing and GIS to the study of soil erosion offer considerable potential in this regard. This paper outlines key technologies available for monitoring, and highlights the problems to be solved at a regional scale. The status of the technologies used in South Africa are reviewed and the more recent studies related to soil erosion are presented in a comparative context. Spatial, temporal and measurement variabilities are major constraints in erosion assessment. Previous erosion studies conducted in South Africa at the regional scale have disregarded important erosion factors and have overvalued less important ones. Different processes and interactions are likely to emerge as dominant when crossing scale boundaries. Such considerations highlight the need to establish a methodological framework to guide and standardize future regional soil loss monitoring efforts. [ABSTRACT FROM AUTHOR]

Objective: The objective of this article was to analyse women's perceptions of ICMC and to propose a framework for ICMC decision-making that can inform ICMC policies. Method: Using qualitative interviews, this study investigated twenty-five Black women's perceptions of ICMC decisionmaking in South Africa. Black women who had opted not to circumcise their sons, were selected through purposive and snowball sampling. Underpinned by the Social Norms Theory, their responses were analysed through in-depth interviews and a framework analysis. We conducted the study in the townships of Diepsloot and Diepkloof, Gauteng, South Africa. Results: Three major themes emerged: medical mistrust, inaccurate knowledge leading to myths and misconceptions, and cultural practices related to traditional male circumcision. Building Black women's trust in the public health system is important for ICMC decision-making. Conclusions for Practice: Policies should address misinformation through platforms that Black women share. There should be an acknowledgement of the role that cultural differences play in the decision-making process. This study developed an ICMC perception framework to inform policy. Significance: What is already known on this subject? Male circumcision decision-making is complex because multiple, interrelated factors influence it. Deciding about circumcising infants and children is a challenge that many parents face. What this study adds? This study found that social pressure from the social network, myths and misconceptions resulting from inaccurate knowledge, medical mistrust and traditional male circumcision practices influence the decisions of Black women not to circumcise their sons. The study proposes a perceptions framework to demonstrate consideration for Black women's voices in the male circumcision discourse. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore 232 service providers' and policymakers' experiences of supporting children's well-being during the pandemic, across sectors, in 22 countries – including Kenya, the Philippines, South Africa, India, Scotland, Sweden, Canada and the USA, in the last quarter of 2020. Design/methodology/approach: A smartphone survey delivered via a custom-built app containing mostly open-ended questions was used. Respondents were recruited via professional networks, newsletters and social media. Qualitative content analysis was used. Findings: The findings reveal numerous system-level challenges to supporting children's well-being, particularly virus containment measures, resource deficiencies and inadequate governance and stakeholder coordination. Those challenges compounded preexisting inequalities and poorly affected the quality, effectiveness and reach of services. As a result, children's rights to an adequate standard of living; protection from violence; education; play; and right to be heard were impinged upon. Concurrently, the findings illustrate a range of adaptive and innovative practices in humanitarian and subsistence support; child protection; capacity-building; advocacy; digitalisation; and psychosocial and educational support. Respondents identified several priority areas – increasing service capacity and equity; expanding technology use; mobilising cross-sectoral partnerships; involving children in decision-making; and ensuring more effective child protection mechanisms. Practical implications: This study seeks to inform resilience-enabling policies and practices that foster equity, child and community empowerment and organisational resilience and innovation, particularly in anticipation of future crises. Originality/value: Using a novel approach to gather in-the-moment insights remotely, this study offers a unique international and multi-sectoral perspective, particularly from low- and middle-income countries. [ABSTRACT FROM AUTHOR]

The 4-A Framework suggests that all inclusive education systems must be available, accessible, acceptable and adaptable. South Africa is committed to establishing an inclusive education system that does not exclude students with disabilities. South African university disability policies translate the imperatives of the United Nations Convention on the Rights of Persons with Disabilities into institutional mandates that govern the implementation of inclusive education. The aim of this study was to determine to what extent disability policies at South African research-intensive universities addressed the markers contained in the 4-A Framework. The framework was reworked and operationalised for the higher education context, and expanded to include a fifth marker, namely affordability. A deductive thematic analysis, using a protocol based on the five markers, was used to analyse these policies. Results indicate that, of the five markers, affordability was not sufficiently addressed. Various disclaimers also limit policy provisions related to other markers. [ABSTRACT FROM AUTHOR]