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Background: South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. Methods: The cross‐sectional epidemiological study used an active case‐ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered‐screening recruitment and diagnostic process. Results: Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6–251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5–78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4–89.9). Conclusions: As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the issues and accomplishments in the efforts to achieve universal health care in the U.S. Also cited are the key tensions in achieving said objective like the availability of resources, the need to assign priority-setting to accountable government actors rather than through court orders, and reasonableness as standard of justifiable bases for priority setting.

Although the term 'equity' exudes fairness, what equity really means remains unclear. Framed within the distributive justice framework, the article explored the different meanings and principles of equity within the discourse of water allocation reform. Equity has been a central guiding principle in the allocation of resources, yet very little is known about what it is and how it can be recognised in practice. This gap in understanding is also found in water allocation reform, a process meant to address the inherited water access and allocation inequalities in post-1994 South Africa. The article is built from focus group discussions and interviews from a select group of participants of a qualitative study. Necessitated by the dismissal of the relevancy of a discussion on equity, the article deconstructed the assumptions that equity, as an option for distributing resources, is obvious and paves the way for fairness. The article revealed that the choice of equity in the allocation of water in post-1994 South Africa was not really interrogated prior to use. Findings from interviews from a select group of participants on alternative options for the allocation of water were also discussed. The article recommended that principles for the allocation of resources be clear and measurable. [ABSTRACT FROM AUTHOR]

Objective: To identify spatial clusters with unusually high levels of MDR‐TB, which are highly unlikely to have arisen by chance in Mpumalanga Province, South Africa. Methods: Home addresses of all MDR‐TB patients were collected from four MDR‐TB facilities from 2013 to 2016. We mapped all addresses, linking them to the nearest ward with population estimates. A spatial analysis was conducted using kernel density in ArcGIS to estimate and map the distribution of the disease and used Gertis‐Ord Gi to test for significant clustering. Results: A total of 4065 MDR‐TB patients were mapped. Ten significant clusters (p‐value <0.05) were found across the province in six sub‐districts: Mbombela, Nkomazi, Emalahleni, Govan Mbeki, Lekwa and Mkhondo. Mbombela has the highest number of significant clusters. The central region did not have any MDR‐TB clusters. Conclusion: There is clear evidence of MDR‐TB clustering in Mpumalanga. This calls for concentrated TB prevention efforts and proper allocation of resources. Further investigations are needed to identify MDR‐TB predictors. [ABSTRACT FROM AUTHOR]

The coronavirus disease-2019 pandemic affected the countries differently. South Africa is a middle-income country with a struggling economy and a resource-constrained public healthcare system. Three aspects of the pandemic in South Africa are examined, the lockdown and its effect on personal freedoms, how health care resources were used and the novel stratification of health workers into vulnerability categories. It is a perspective written after experiencing the first pandemic peak in 2020. [ABSTRACT FROM AUTHOR]

Children in foster care face disproportionate rates of biopsychosocial challenges but social and extracurricular activities (SEAs) may support their healthy development. The Reasonable and Prudent Parenting Standard (RPPS), a 2014 federal policy, aims to increase access to these opportunities for children in foster care. Analyses of statutes from 50 US states and the District of Columbia (n = 51) revealed similarities and differences in state-level RPPS policy implementation. Building on these findings, researchers conducted semi-structured retrospective telephone interviews with foster parents across one southeastern state (n = 20) to identify local retrospective perspectives on RPPS implementation. Using thematic inductive coding two unique themes emerged about SEAs prior to RPPS: 1) negative social impacts and 2) complicated activity approval processes. Three unique themes emerged after RPPS: 1) empowerment, 2) implementation disparities and 3) resource recommendations. Policy implications include the need to support foster parents by increasing resources (funding, transportation, access), clarifying liability and clarifying motivation expectations. [ABSTRACT FROM AUTHOR]

Health promotion (HP) capacity of staff and institutions is critical for health-promoting programmes to address social determinants of health and effectively contribute to disease prevention. HP capacity mapping initiatives are the first step to identify gaps to guide capacity strengthening and inform resource allocation. In low-and-middle-income countries, there is limited evidence on HP capacity. We assessed collective and institutional capacity to prioritize, plan, deliver, monitor and evaluate HP within the South African Department of Health (DoH). A concurrent mixed methods study that drew on data collected using a participatory HP capacity assessment tool. We held five 1-day workshops (one national, two provincial and two districts) with DoH staff (n =  28). Participants completed self-assessments of collective capacity across three areas: technical, coordinating and systems capacity using a four-point Likert scale. HP capacity scores were analysed and presented as means with standard deviations (SDs). Thematic analysis of verbatim transcripts of audio-recorded group discussions that provided rationale and evidence for scores were conducted using deductive and inductive codes. At all levels, groups revealed that capacity to develop long-term, sustainable HP interventions was limited. We found limited collaboration between national and provincial HP levels. There was limited monitoring of HP indicators in the health information system. Coordination of HP efforts across different sectors was largely absent. Lack of capacity in budgeting emerged as a major challenge, with few resources available to conduct HP activities at any level. Overall, the capacity mean score was 2.08/4.00 (SD = 0.83). There is need to overcome institutional barriers, and strengthen capacity for HP implementation, support and evaluation within the South African DoH. [ABSTRACT FROM AUTHOR]

Biological control is an effective and sustainable method for management of invasive alien plants (IAPs), and has been implemented on 68 of the 367 plant species that are listed as legally requiring management strategies under South Africa's National Environmental Management: Biodiversity Act (10/2004): Alien and Invasive Species Regulations. With limited resources and funding available, it can realistically only be considered for a subset of the remaining alien plants for which biocontrol has not yet been implemented. Considerable funding has been allocated towards biocontrol in South African in the past, principally through the Working for Water Programme of the Nature Resource Management Programmes (Department of Environment, Forestry and Fisheries), and this support is expected to continue with the intention of increasing the number of IAPs under this management approach in the future. To ensure appropriate targets are selected, the Biological Control Target Selection (BCTS) system was applied to the alien plants on this list that are not under biocontrol (299 species). This paper presents the resultant list of top priority species that represent good investments for biocontrol when funds are available. [ABSTRACT FROM AUTHOR]

A review of global trends in water governance reveals a paradigm dominated by political and institutional change which becomes increasingly aligned with global shifts towards sustainability and also a rapid decline in the hydraulic mission. Closely aligned to these trends, but distinct in its own trajectory, South Africa's water governance dynamics have evolved through a period of considerable socio-political change marked by inequitable resource allocation and water scarcity. This paper presents the results of a review of water governance research and development (R&D) trends in South Africa, aimed at informing the national funding agency -- the Water Research Commission (WRC) -- in its agenda-setting process for future water governance research. Through a bibliometric analysis, a data-mining exercise, and stakeholder consultations, this paper distils four key areas of focus for the future of water governance research in South Africa: (i) that future water governance research needs to be more needs-based, solution-oriented and embedded within real-life contexts; (ii) the need for a paradigm shift in water governance research to a constructive, adaptive and rapid response research agenda in an environment of increasing change and uncertainty; (iii) the need for the enabling environment to be strengthened, including acknowledgement of the role of individuals as agents of change, and the role of WRC in establishing a community of practice for water governance experts that can respond to issues with agility; and (iv) a consolidation of fragmented project-based knowledge to a programmatic approach that builds the pipeline of expertise in the water governance R&D domain. [ABSTRACT FROM AUTHOR]

Objective: Cost functions linked to transmission dynamic models are commonly used to estimate the resources required for infectious disease policies. We present a conceptual and empirical approach for estimating these functions, allowing for nonconstant marginal costs. We aim to expand on the current approach which commonly assumes linearity of cost over scale.Methods: We propose a theoretical framework adapted from the field of transport economics. We specify joint functions of production of services within a disease-specific program. We expand these functions to include qualitative insights of program expansion patterns. We present the difference in incremental total costs between an approach assuming constant unit costs and alternative approaches that assume economies of scale, scope and homogeneous or heterogeneous facility recruitment into the programme during scale-up. We illustrate the framework's application in tuberculosis, using secondary data from the literature and routine reporting systems in South Africa.Results: Economies of capacity and scope substantially change cost estimates over time. Cost data requirements for the proposed approach included standardized and disaggregated unit costs (for a limited number of outputs) and information on the facilities network available to the program.Conclusions: The defined functional form will determine the magnitude and shape of costs when outputs and coverage are increasing. This in turn will impact resource allocation decisions. Infectious diseases modelers and economists should use transparent and empirically based cost models for analyses that inform resource allocation decisions. This framework describes a general approach for developing these models. [ABSTRACT FROM AUTHOR]

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country's first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio ¼ 1.07, 95% confidence interval: 1.02-1.11; P ¼ .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality. [ABSTRACT FROM AUTHOR]

Introduction: self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. Methods: a cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. Results: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. Conclusion: this study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system. [ABSTRACT FROM AUTHOR]

Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART. The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load ≥400 copies/ml on second-line ART between January 2013-July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (≥400 copies/ml). A total of 128 patients were included in the analysis, and of these 39% (n = 50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%). These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART. [ABSTRACT FROM AUTHOR]

Purpose This study aims to examine six South African universities with a particular focus on the quality of teaching and learning.Design/methodology/approach A qualitative case study approach was adopted and data were mainly generated by means of open-ended questionnaires. The questionnaire was circulated to approximately 1,800 students and 746 completed it. The data were categorized and analysed thematically, using both national and international benchmarks for quality teaching and learning.Findings The findings reveal that teaching and learning in South African universities is marred by a plethora of challenges. Lecturers lack basic skills and essential resources to effectively facilitate teaching and learning. Furthermore, quality benchmarks set by the Council on Higher Education are only met on paper and little or nothing is done to translate this into practice.Originality/value The study proposes among others that clearer policies on funding are recommended to ensure proper allocation of resources, staff development and institutional comeliness. Finally, to enhance transformation, universities should prioritize teaching and learning and take steps to ensure that those teaching in the classroom are qualified to do so. [ABSTRACT FROM AUTHOR]

Determining the efficacy of available counter-trafficking strategies is just as important as understanding the phenomenon of human trafficking itself. This is so if anti-trafficking practitioners wish to make in-roads in preventing and combating human trafficking in South Africa. At the heart of the matter are the ways in which counter-trafficking governance is structured in the South African context. In this article we use the KwaZulu-Natal intersectoral task team, an un-resourced agency of provincial government mandated to prevent and combat human trafficking, as a case study to analyse the ‘4P model’ of counter-trafficking favoured in South Africa. We find that while such an integrated model has great potential, issues of institutional cooperation and coordination, pervasive public official corruption and budgetary constraints hamper its current impact and efficacy. We conclude that these issues must be addressed by South African policy-makers once legislation has been promulgated. [ABSTRACT FROM PUBLISHER]

Background: Tuberculosis control programs rely on accurate collection of routine surveillance data to inform program decisions including resource allocation and specific interventions. The electronic TB register (ETR.Net) is dependent on accurate data transcription from both paperbased clinical records and registers at the facilities to report treatment outcome data. The study describes the quality of reporting of TB treatment outcomes from facilities in the Ehlanzeni District, Mpumalanga Province.Methods: A descriptive crossectional study of primary healthcare facilities in the district for the period 1 January - 31 December 2010 was performed. New smear positive TB cure rate data was obtained from the ETR.Net followed by verification of paperbased clinical records, both TB folders and the TB register, of 20% of all new smear positive cases across the district for correct reporting to the ETR.Net. Facilities were grouped according to high (>70%) and low cure rates (≤ 70%) as well as high (> 20%) and low (≤ 20%) error proportions in reporting. Kappa statistic was used to determine agreement between paperbased record, TB register and ETR.Net.Results: Of the100 facilities (951 patient clinical records), 51(51%) had high cure rates and high error proportions, 14(14%) had a high cure rate and low error proportion whereas 30(30%) had low cure rates and high error proportions and five (5%) had a low cure rate with low error proportion. Fair agreement was observed (Kappa = 0.33) overall and between registers. Of the 473 patient clinical records which indicated cured, 383(81%) was correctly captured onto the ETR.Net, whereas 51(10.8%) was incorrectly captured and 39(8.2%) was not captured at all. Over reporting of treatment success of 12% occurred on the ETR.Net.Conclusions: The high error proportion in reporting onto the ETR.Net could result in a false sense of improvement in the TB control programme in the Ehlanzeni district. [ABSTRACT FROM AUTHOR]

This article is about changing patterns of collective identities among Rand-based migrants from Zebediela between the 1930s and 1970s. Based on archival and oral sources, the article shows how, in the face of a hostile and alienating urban environment, these migrants promoted a sense of group identity from the bottom up by clustering around people from their home areas and establishing organisations that looked after their interests. During the 1940s and 1950s, these migrants formed groupings not on the basis of ethnicity but on the basis of a shared geographical place of origin or home, i.e. the area of Zebediela, as well as on the basis of allegiance to chieftaincy back home. However, these localised collective identities would soon give way to broader ethnic affiliations in the following decades the moment the state started using ethnic differences to determine the allocation of resources to different groups. The central argument of this article is that whilst prior to the 1950s the kinds of collective identities developed by migrants found expression in the formation of region-based associations that looked after their immediate interests in cities as well as in the countryside, by the 1960s and 1970s many of these migrants had been drawn into a larger, more ambitious and explicitly ethnic organisation that agitated for a separate ‘homeland’ for all Ndebele people in South Africa. [ABSTRACT FROM AUTHOR]

A number of informal areas in Nelson Mandela Bay Municipality, South Africa have experienced rapid expansion over the past decade. Census data available for these areas is outdated and does not provide enough information for local authorities to plan tasks such as service delivery management and resource allocation. In this study, a GIS based demographic study of informal settlements within Nelson Mandela Bay was undertaken. The study aimed to significantly improve the collection, analysis, interpretation, display and management of demographic survey data and provide the accurate and necessary updates required between census collections. Data relating to informal settlements were captured from 1996 aerial photographs and 2007 satellite imagery, and demographic data were collected from field surveys. Specific demographic trends identified through spatial analyses included a 71% and 109% decline and increase in informal and formal dwellings respectively. A significant increase in backyard shacks paradoxically came with the development of many formal structures in settlements. The capture and collection of data at household level and creation of customized boundaries for informal settlements facilitated analyses independent of any fixed set of areal units. The study concluded that GIS based demographic studies are vital for providing the necessary updates to decennial censuses for municipalities, particularly in urban environments of developing countries. [ABSTRACT FROM AUTHOR]

Abstract: This literature review of Conservation Agriculture (CA) adoption among smallholder farmers in southern Africa (Malawi, Zambia and Zimbabwe) analyses the historical background of the upsurge in CA promotion, the various definitions of CA that have emerged since the 1990s, the barriers to its adoption, as well as uptake figures and adoption studies. First tested as soil and water conservation measures, large-scale promotion followed a reframing of CA as a production-enhancing set of practices. Different definitions of what constitutes and is promoted as CA in southern Africa complicates the assessment of adoption across the region, while a commonly used, reductionist notion of CA adoption – as the uptake of minimum tillage – in adoption data collection, casts doubts on the validity of adoption figures. As CA uptake is often also incentivized by means of input support (fertilizers, seeds, herbicides) provided by promotional projects, adoption claims have limited value. Current CA adoption studies are methodologically weak as they are biased by the promotional project context in which are carried out, and build on farm-scale analyses of standard household surveys. A more thorough analysis of farming households and their resource allocation strategies is required to understand the farm-level adoption constraints different types of farmers face. As contextual factors appear key influences on smallholders’ farming practices, studies focusing on the wider market, institutional and policy context are also needed if we are to understand (limited) CA adoption in southern Africa. [Copyright &y& Elsevier]

Medical and health sciences institutions and organisations are faced with challenges in resource allocation for research and publishing. The aim of this study was to retrospectively analyse South African publication trends in medicine to provide guidance for future strategic planning in academic medicine. We used the Scimago database spanning the years 1996-2011 to analyse South African publication outputs in a number of categories in medicine, as defined in the Scopus database. The data reveal a number of significant growth areas but also reveal areas that should potentially be growing but remain static. In some areas, growth has aligned with the expectations of health and disease trends, but other areas, in which growth would have been expected, have remained static. Interesting features are also revealed when the data are compared with those of other developed and developing countries. For 1996-2011, South African medical publication output ranked 33 in the world based on the number of publications, but 28 based on the h-index. Interestingly, whilst South Africa produced less than 25% of the output of India, the h-index for South Africa is 153 compared with 145 for India. South Africa's medical publication output has steadily increased over the 14-year period but the number of citations per document has declined. This analysis provides a useful strategic overview for medical institutions and government funding organisations to guide the allocation of research budgets and resources in a discipline- or category-specific manner to influence research outputs. [ABSTRACT FROM AUTHOR]

In Mbatha and Antrobus (2008), an argument was put forward against an importation or adoption of universal models or general theorems to explain locally prevailing socio-economic conditions and predict outcomes in varied geographical contexts such as in the Kat River basin. In response to this argument a comment in this edition argues that our “results are caused by, metaphorically speaking, comparing apples and oranges. If, however, all of the relevant information is taken into account, a simple economic model may suffice to depict the situation within the KRV.” Here we illustrate that the comment comes from a misreading of basic details in the original discussion and in its construction and presentation of an alternative model of the KRV conditions the comment reiterates our original argument that general models and theorems are likely to fail to explain local intricacies primarily because they are not founded on local historical institutions. [ABSTRACT FROM PUBLISHER]

The escalating expenditure on patients with HIV/AIDS within an inadequately funded public health system is tending towards crowding out care for patients with non-HIV illnesses. Priority-setting decisions are thus required and should increasingly be based on an explicit, transparent and accountable process to facilitate sustainability. South Africa's public health system is eroding, even though the government has received extensive donor financing for specific conditions, such as HIV/AIDS. The South African government's 2007 HIV plan anticipated costs exceeding 20% of the annual health budget with a strong focus on treatment interventions, while the recently announced 2012–2016 National Strategic HIV plan could cost up to US$16 billion. Conversely, the total non-HIV health budget has remained static in recent years, effectively reducing the supply of health care for other diseases. While the South African government cannot meet all demands for health care simultaneously, health funders should attempt to allocate health resources in a fair, efficient, transparent and accountable manner, in order to ensure that publicly funded health care is delivered in a reasonable and non-discriminatory fashion. We recommend a process for resource allocation that includes ethical, economic, legal and policy considerations. This process, adapted for use by South Africa's policy-makers, could bring health, political, economic and ethical gains, whilst allaying a social crisis as mounting treatment commitments generated by HIV have the potential to overwhelm the health system. [ABSTRACT FROM PUBLISHER]

ABSTRACT This paper reports findings from a research study on adoption in South Africa conducted in 2009. The research included secondary data analysis of the South African National Adoption Register to establish trends and patterns of adoption in South Africa between 2004 and 2009, and primary data collection through qualitative interviews with key informants in public and private social welfare services to explore attitudes, knowledge and experiences of social work practice related to adoption. The quantitative findings report the number of national and international adoptions along with trends and socio-demographic patterns of national adoptions. Qualitative findings report on social work practice, systemic barriers and social worker attitudes as barriers to improved social work practice around national adoptions. The paper highlights comparisons to adoption literature in the USA, a country with a similar legislative framework and cultural complexities, but significantly more resources for implementation. Recommendations are offered for social work practice, national data collection and policy implementation efforts to support efforts to increase adoption. [ABSTRACT FROM AUTHOR]

Measures of poverty are much used, but also much criticised as having limited value in debates on public resource allocation. Some argue that the measures are too conservative and do little more than complicate important issues of inequality and injustice. However, poverty measurement can be sensitive to these concerns if grounded in the field's well-developed theoretical foundation. In South Africa, poverty measures over more than 50 years have consistently taken into account distributional issues and the causes and implications of deprivation, and most South African analyses of poverty have recognised and incorporated the multi-dimensional nature of poverty. Recognising different perceptions of aggregation, time horizon and the role of states and markets is perhaps more important than methodology when assessing what poverty measures can contribute. With proper theorisation, and attention paid to the purpose of poverty diagnostics, measurement is more than sleight-of-hand and can provide both a tool for advocacy and a means to implement policies that promote greater social justice. [ABSTRACT FROM PUBLISHER]

Institutions utilizing projects for policy implementation and service delivery initiatives should make provision for adequate institutional arrangements for the governance of projects. Governance includes authoritative decisions regarding resource allocation, performance monitoring and oversight, powers of the project manager, accountability issues and the establishment of structures to facilitate clear interfaces between municipal leadership and project teams. Governance arrangements typically include the establishment of mechanisms such as a steering committee and/or a project management unit to facilitate decision-making. This article explores the governance arrangements of projects and the challenges they represent to the political and administrative leadership of municipalities. Leadership challenges centre specifically on political and administrative interfaces, the physical organizational placement of project governance structures, and the monitoring and oversight of projects. For this purpose, research was conducted at several local and district municipalities in North-West Province to explore existing practices and leadership challenges. The challenges identified can lead to further research into the underlying issues causing service delivery failures in municipalities. [ABSTRACT FROM AUTHOR]

Abstract: Sustainable natural resource management requires inputs from both the natural and the social sciences. Since natural and social systems are inter-related and inter-dependent, it is essential that these data can be integrated within a given analysis, which requires that they are spatially compatible. However, existing environmental and socio-economic monitoring networks tend to observe, collect and report socio-economic and biophysical data separately; with the result that much of these data are spatially incompatible, adding to the complexity of objective and consistent resource management. We present an approach for overcoming spatial incompatibilities between socio-economic and biophysical data; based on a meta-modelling approach using Geographical Information Systems and an application of a water-use simulation model. The method is developed and applied to the irrigation agriculture sector in the Inkomati Water Management Area in South Africa. Agricultural census data, which are measured on a magisterial district scale, are integrated with geo-referenced land-cover data, which are independent of political boundaries. This allows us to increase the resolution at which data on the economic value derived from irrigation water are presented, from coarse magisterial district scale to a finer ‘meso-zone’ scale, enabling more efficient allocations of irrigation water within magisterial districts. [Copyright &y& Elsevier]

South Africa's unallocated water resources have dwindled to precariously low levels. Furthermore, it is generally recognised by the authorities and specialists alike that it is likely that water demand will outstrip water supply within the next decade. Macro-economically and strategically speaking, the question therefore is how to make best use of the country's available water resources? We ask this question since South Africa is a country classified as having chronic water shortages, a condition exacerbated by climate change and the presence of invasive alien plant species. In this paper we address the question of sectoral water allocation by applying a macro-economic comparative static Computable General Equilibrium (CGE) Model using an integrated database comprising South Africa's Social Accounting Matrix (SAM) and sectoral water use balances. We refer to AsgiSA, the South African Government's Accelerated and Shared Growth Initiative for South Africa, and conclude that introducing the proposed programmes in a business-as-usual and water-intensive manner will strengthen the current growth in the demand for water. This will bring forward, or accelerate, the need for introducing water rationing among sectors. The importance of this conclusion cannot be emphasised enough. Water is essential, and recognised in as much in the preamble to the National Water Act of 1998, with regards to livelihoods, health and from a socio-economic development perspective since there are no substitutes for it. While water rationing is imminent, the reality thereof has not yet led to a rethink of macro-economic policies. This delayed effect can create a degree of comfort and ill-founded complacency leading to non-action, whereas there is an urgent need for proactive measures towards water conservation. [ABSTRACT FROM AUTHOR]

Southern Africa is faced with the complex challenge of achieving sustainable economic development and food and energy security while protecting the environment. The region is currently experiencing an energy crisis, a result in part because of global increases in crude oil prices and limited generating capacity in some countries. We examined the potential of biofuels to address the aforesaid problems and their role in the agroecological and socioeconomic systems in the region, highlighting the challenges to be overcome before biofuels can become an integral part of the regional socioeconomic dynamics. Major hurdles to biofuels establishment include relatively poor awareness of the potential and opportunities presented by biofuels, technology challenges, food insecurity vulnerability associated with the use of grains such as maize as feedstocks, potential conflict in resource allocation between food and fuel crops, and good governance and its impact on stability of food supply. Resource allocation and the balance between the need for food security and fuel is discussed in the context of selection of a crop matrix that does not compromise food security or limit development of the biofuels sector. While the use of maize for ethanol might enhance producer prices, it may contribute to high food inflation and political unrest. Sweet sorghum on the other hand, presents an opportunity to provide food and bioethanol without compromising food security. Biofuels have great potential in southern Africa, but there is a need to establish and nurture the development of capacity, in the value chain from production to consumption, to realise the benefits of biofuels in the region. [ABSTRACT FROM AUTHOR]

Research into management interventions that create the required enabling environment for growth and development in South Africa are both timely and appropriate. In the research reported in this paper, the authors investigated the level of efficiency of the Air Quality Units within the three spheres of government viz. National, Provincial, and Local Departments of Environmental Management in South Africa, with the view to develop a resource allocation model. The inputs to the model were calculated from the actual man-hours spent on twelve selected activities relating to project management, knowledge management and change management. The outputs assessed were aligned to the requirements of the mandates of these Departments. Several models were explored using multiple regressions and stepwise techniques. The model that best explained the efficiency of the organisations from the input data was selected. Logistic regression analysis was identified as the most appropriate tool. This model is used to predict the required resources per Air Quality Unit in the different spheres of government in an attempt at supporting and empowering the air quality regime to achieve improved output efficiency. [ABSTRACT FROM AUTHOR]

The Physical Externality Model is used to illustrate the potential limitations of blindly adopting formal models for economic investigation and explanation in varied geographical contexts. As argued by institutional economists for the last hundred years the practice limits the value and relevance of most general economic inquiry. This model postulates that the geographical location of farmers along a given watercourse, in which water is diverted individually, leads to structural inefficiencies that negatively affect the whole farming community. These effects are felt more severely at downstream sites and lead to a status quo where upstream farmers possess relative economic and political advantages over their counterparts elsewhere. In the study of the Kat River basin these predictions appear to be true only in astir as they relate to legal and political allocations and use of water resources. In terms of lawful uses of land resources aimed at expanding citrus production, the model's predictions are not met. The status quo is however fully explained by the implications of having adopted formal water scheduling rights by upstream farmers as well as other geographical factors. Hence, the case for investigating the effects of important institutions within general economic research is strengthened. [ABSTRACT FROM AUTHOR]

It is increasingly evident amongst practitioners and academics alike that the management approaches of the past have failed to deal adequately with the challenges posed by complex and rapidly changing systems. Indeed the call for integrated approaches such as those embodied in integrated water resource management (IWRM) reflects such concerns. This is because these systems are characterised by complexity in which an understanding of linkages, multiple drivers and unpredictable outcomes is critical. It is also widely recognised that the management of such systems requires an iterative, 'learning-by-doing' approach that is reflexive in nature and builds learning into the next management cycle. We suggest that any attempt to define and implement viable and effective governance of water resources, as well as rehabilitation measures, requires understanding that catchments are complex systems showing the aforementioned characteristics. As a corollary, an adaptive management approach appears best suited to such conditions. In this paper we argue that South Africa's highly-acclaimed National Water Act and associated policy documents such as the National Water Resource Strategy is an example of a policy document that reflects this thinking, as is evident in the guidelines for the development of catchment management strategies which are introduced and described. These offer a framework for the development of a holistic, systems understanding which is strategic and adaptive. In particular, under such a framework, we select the two cornerstones of the Act -- sustainability and equity -- to explore this theme. We show that under such a framework ensuring that both these principles are achieved is not through one simplistic management action but through an integrated, systems approach. The development of strategies is driven by principles which help one to navigate issues that emerge in complex systems in a flexible way. Visioning and scenarios offer important management tools for establishing a hierarchy of actions that can achieve the overarching principles and that can accommodating change. In complex systems, the users must be part of deriving management solutions since this is where and how they learn. Self-organisation, identity and embeddedness are all essential characteristics of building resilience in a catchment system. [ABSTRACT FROM AUTHOR]

This paper provides a synthesis of the main issues discussed at a conference (International Conference on Integrated Water Resource Management (IWRM) entitled: Lessons from Implementation in Developing Countries which took place from 10 to 12 March 2008 in Cape Town, South Africa, at the Cape Town International Convention Centre) which was coordinated to share experiences and lessons learned on the implementation of IWRM in developing countries. This paper discusses six themes that emerged from the conference. These themes provide a perspective on the current status of IWRM and assist in formulating the agenda for further research and implementation approaches based on lessons learned. Firstly, although there is considerable history and international acceptance of IWRM, there is still ongoing debate on how IWRM is defined. However, aside from these debates there is general agreement on the principles underlying IWRM and the potential it holds for managing complex systems that cannot be adequately achieved through the single-sector management approach of the past. To overcome past management paradigms, new capacity building approaches are required. Secondly, implementation of IWRM requires a balance between policy and institutional support and community level projects that have small-scale tangible results for the poor. Thirdly, IWRM involves integration across many spheres, specifically the integration of groundwater management into long-term water resource planning. Fourthly, although there is general endorsement of the importance of public engagement in supporting IWRM approaches, effective public engagement requires considerable strategic planning to ensure that efforts are both applicable and relevant to those involved. Fifthly, the conference highlighted the importance of developing appropriate economic methods and instruments to address the economic trade-offs and decisions that are apparent in water management. Finally, appropriate data, information systems and indicators are required to adequately monitor progress with IWRM implementation. [ABSTRACT FROM AUTHOR]

It is generally assumed that gathering more data is a good investment for conservation planning. However, the benefits of additional data have seldom been evaluated by analyzing the return on investment. If there are diminishing returns in terms of improved planning, then resources might be better directed toward other actions, depending on their relative costs and benefits. Our aim was to determine the return on investment from spending different amounts on survey data before undertaking a program of implementing new protected areas. We estimated how much protea data is obtained as a function of dollars invested in surveying. We then simulated incremental protection and loss of habitat to determine the benefit of investment in that data on the protection of proteas. We found that, after an investment of only US$100,000 (∼780,000 South Africa Rand [ZAR]), there was little increase in the effectiveness of conservation prioritizations, despite the full data set costing at least 25 times that amount. [ABSTRACT FROM AUTHOR]

Conflict is inherent to development, but the intensity of conflicts over small-scale projects is often severely underestimated. Effectively managed conflict can strengthen relationships and enhance productivity, but unresolved conflict undermines relationships, morale and projects. This paper examines conflict management during the development of ten South African outreach nurseries situated within communities experiencing high levels of poverty. Sources of conflict included: (1) Contestations over scarce or limited resources, or (2) ownership; (3) Disputes over accountability; (4) Struggles over social boundaries or (5) individual or collective identities; (6) Deteriorating interpersonal relationships; (7) Power struggles between community participants and (8) Structural imbalances between implementing organisations and community stakeholders. Conflicts spiraled into violence or near-violence in two cases, with threats of violence in two others. Fostering cooperative relationships and operational environments requires concerted effort from the outset, including the development of effective institutions. Development fundamentals cannot be exchanged for expediency; adequate time, staff, and resources have to be allocated to projects. [ABSTRACT FROM AUTHOR]

This article reports on an investigation into the extent to which South African publishers comply with legal deposit. Measuring publishers' level of legal compliance is an important factor in the process of establishing an efficient system of legal deposit in a country, but this study showed such measuring procedures to be lacking. A feasibility study was undertaken, using a variety of methods to check lists of publications, to determine whether they had been received as legal deposit. This investigation proved that measuring publishers' compliance levels is practical and possible in South Africa. The article concludes with a number of recommendations for determining the levels of compliance and with a number of recommended techniques that legal deposit institutions can implement. [ABSTRACT FROM AUTHOR]

The assessment of research activity linked to the allocation of resources according to the results of those evaluations is now undertaken in a number of countries. Numerous debates in Human Geography have emerged to reflect upon how research assessment systems affect professional human geographers and whether or not anything truly positive has been achieved through these assessment systems. Within South African Human Geography similar debates have not to date been documented. Against this backdrop, the key objective of this investigation is to address the paucity of critical reflection upon South Africa's National Research Foundation's (NRF) rating system and to assess the position of human geographers in this research "surveillance system". It is argued that the NRF rating system perpetuates the imposition of the norms of distantly located rating schemes — principally the United Kingdom's Research Assessment Exercise (RAE) — upon the South African academic imagination. In the process South African human geography is entrapped; either serving the theoretical needs of the discipline's Anglo-American heartland, or serving local needs and becoming an irrelevance to "international" human geography. Human geographies that can "make a difference" to both audiences is, it is argued, unlikely. [ABSTRACT FROM AUTHOR]

Fresh water resources provide a platform for complex and often emotional issues to develop, particularly in resource scarcity situations. Bulk water infrastructure contains elements of a public good and proved vulnerable to failures in market and government driven allocation strategies. Common to both are uncaptured costs and benefits due to shortcomings in cost quantification techniques. Natural ecosystems stands to lose the most since ecosystem services are often not quantifiable in monetary terms and therefore neglected in allocation decision-making. This paper took on the challenge of expanding current decision-support in order to promote more inclusive long-term water management. A case-study approach with the focus on a choice related problem regarding different long-term bulk water resource management options was applied in the Western Cape province. The paper incorporated components of economic valuation theory, a public survey and a modified Delphi expert panel technique. Both spatial and temporal dimensions of the decision-making context were expanded. Two surveys were completed to accommodate these expansions. The first focused on public preference in water allocation management and the relative merit of accommodating public preference in highly specialised decision-making such as long-term water allocation decision-making. The second survey utilized a modified Delphi technique in which an expert panel indicated the relative merit of two alternative long-term allocation strategies. A willingness to pay for "greener" water was observed and may be used to motivate a paradigm shift from management's perspective to consider, without fear of harming their own political position, "greener" water supply options more seriously even if these options imply higher direct costs to public. [ABSTRACT FROM AUTHOR]

The past decade has brought substantial transition to South Africa. The introduction of democracy in 1994 has yielded important political and socioeconomic transformations affecting millions of people. Here, we explore the impact of institutional and structural changes on the availability and management of fuelwood, a key natural resource in rural South Africa. As in other developing regions, many households depend on natural resources for both sustenance and energy needs. Drawing on qualitative data from 32 interviews, our objective is to describe, from the perspective of the respondents, (1) resource scarcity, (2) the underlying causes of resource scarcity, (3) the role of traditional authority in managing resources, and (4) strategies used by community members in the face of resource scarcity. The results have important implications for the well-being of both social and natural systems in many transitional, rural developing societies. [ABSTRACT FROM AUTHOR]

Aim: Field-testing a paediatric mortality audit system at eight sites in South Africa to assess its feasibility, to collect local data on common causes of death in children under 5 y, and to determine health system failure, missed opportunities of intervention and substandard care (modifiable factors). Methods: The study tested the Under-5 Healthcare Problem Identification Programme (U5PIP). The sites represent different levels of paediatric healthcare. Study period: 1 September 2003–31 August 2004. Study population: Under-5 patients admitted to study hospitals. Cases: Under-5 patients who died in study hospitals. Results: In total, 1532 under-5 deaths occurred, representing a case-fatality rate of 7.8%. Main causes of death were lower respiratory tract infections (33%), gastroenteritis (15%) and septicaemia (12%). Sixty per cent of the deaths were HIV/AIDS related. Sixty-nine per cent of children who died were underweight. Administrative modifiable factors were present in 31% of deaths. Clinical personnel-related modifiable factors were detected in 26% at the clinic level and in 33–37% at the hospital level.Conclusion: The U5PIP is feasible for ongoing mortality reviews by paediatric teams as part of routine work. Information on common causes of death and modifiable factors in this study focus on the impact of HIV/AIDS, malnutrition and resource allocation, and can be used for interventions to improve paediatric healthcare. [ABSTRACT FROM AUTHOR]

The article explores the degree to which social welfare has attempted to integrate gender rights into the allocation of resources in South Africa. It focuses on the elaboration of a social policy framework. It argues that there has been a slower translation of political rights into social rights, despite the efforts of women in gaining recognition for their particular political disadvantages. It also asserts that inconsistencies exist between the rights-based framework of the constitution and the framework of social welfare.

Background Recently, a global commitment has been made to expand access to antiretrovirals (ARVs) in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only limited number of health-care facilities (HCFs) will be available for ARV distribution. Deciding how to allocate the limited supply of ARVs among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria. Methods and Findings Here we use operations research techniques, and we show how to determine the optimal strategy for allocating ARVs among HCFs in order to satisfy the equitable criterion that each individual infected with HIV has an equal chance of receiving ARVs. We present a novel spatial mathematical model that includes heterogeneity in treatment accessibility. We show how to use our theoretical framework, in conjunction with an equity objective function, to determine an optimal equitable allocation strategy (OEAS) for ARVs in resource-constrained regions. Our equity objective function enables us to apply the egalitarian principle of equity with respect to access to health care. We use data from the detailed ARV rollout plan designed by the government of South Africa to determine an OEAS for the province of KwaZulu--Natal. We determine the OEAS for KwaZulu--Natal, and we then compare this OEAS with two other ARV allocation strategies: (i) allocating ARVs only to Durban (the largest urban city in KwaZulu--Natal province) and (ii) allocating ARVs equally to all available HCFs. In addition, we compare the OEAS to the current allocation plan of the South African government (which is based upon allocating ARVs to 17 HCFs). We show that our OEAS significantly improves equity in treatment accessibility in comparison with these three ARV allocation strategies. We also quantify how... [ABSTRACT FROM AUTHOR]

This paper presents a review of the research undertaken in the field of hydrological modelling over roughly the last three decades, concentrating primarily on South African work in an international context. The focus is on deterministic, rainfall-runoff models and addresses issues related to model design as well as to the application of models in practice. I provide a brief description of what hydrological models are and what they are used for and discuss also the following issues: • Developments in understanding hydrological process and the extent to which these have filtered down into models. • Model calibration and parameter estimation. • Trends in data availability and how these have affected model development. • Trends in computer technology and their impacts on model development. I suggest that there have been substantial developments in the science and practice of hydrological modelling, but that there remain many problems that need to be addressed to improve the ability of models to contribute to the solution of problems of water resource management. Southern African scientists have contributed to the body of knowledge on hydrological modelling, despite the limited resources available compared to resources elsewhere. Internationally, the focus has not always been on the practical issues of model application and has commonly tended towards the more theoretical and mathematical issues of model calibration. This is not a trend that has found much favour in southern Africa (particularly amongst research funding agencies), where there are many problems of water resource management that have the potential to be resolved with existing models, applied in an appropriate way. The paper concludes by suggesting that further research needs to focus on the integration of the best in international developments with the tried and tested models that have been developed locally. The context of this research should be the search for more reliable estimations of water resource availability. [ABSTRACT FROM AUTHOR]

Providing all citizens with free and equal access to information allows democracy to flourish. Integral to democratic governments, public libraries have both social and political responsibilities. South Africa's 1994 shift from apartheid to a democratic republic makes it an ideal nation through which to investigate the struggles and issues faced as a public library system adapts to a new political structure. South Africa's public libraries did not automatically receive the assumed benefits of the shift from apartheid's oppressive regime of segregation and inequality to a democratic government. Rather, it is a work in progress. South African libraries face social, political, and economic issues such as: unfair allocation of resources, severe social conditions and problems with support from the government including problematic rhetoric within the New Constitution. LIASA (Library & Information Association of South Africa) has admirably begun to fulfil an important role in library development in South Africa. With appropriate funding and support from all levels of government and from local, national, and international library organizations, the public libraries in South Africa can become the beacons of democracy that they are intended to be. [ABSTRACT FROM AUTHOR]

The South African financial sector, defined as the banking, insurance and securities industries, has contributed to the growth of the economy since democracy in terms of growth in assets and value added, although its provision of financial services to the poor has been less impressive. The article takes a broad approach to evaluating the performance of the sector in terms of the balance between stability and innovation, and the balance between efficiency and allocation of resources. While the financial system has proved to be stable, innovation has generally been for the high-value, contested market. In terms of cost efficiencies and provision of services to small businesses and poorer consumers, there is room for improvement. The performance of the sector is linked to the regulatory regime, and the extent to which the sector will be able to improve its allocative performance will be influenced by mooted regulatory changes. [ABSTRACT FROM AUTHOR]

The article examines the political resource allocation in the South African Constitutional Court based on four decisions of the South African Constitutional Court in which it was required to review the allocation of resources by the political branches. The discretionary gaps exploited by the court in its manipulation of the applicable legal rules were identified. The institutional role of courts in the South African political system was also discussed.

In this paper we draw on research conducted on the system of supply of learner support materials (LSMs) in Region 2 of the Northern Province of South Africa. The study used a qualitative methodology where a case study design was adopted. Purposive sampling was used in the selection of five schools. Three methods of data collection were used, namely: interview, observation and documentation. It was found that the system of supply of learner support materials in the Northern Province was in a chaotic state. For example, books were not delivered in time, or not delivered at all, there were wrong deliveries, and a lot of wastage on unused materials. [ABSTRACT FROM AUTHOR]

Although racial data are no longer available, this article uses a 1997 dataset to compare education spending with the pre-democracy situation. The new government emphasised fiscal resource shifts to eliminate spending discrimination rather than changing educational outcomes. Fiscal resource shifts in education and increased education spending were concentrated in formerly black schools. At the geographic level, non-metropolitan regions gained massively. Yet, as qualified teachers remain scarce in poorer schools, fiscal inequalities have remained, also among black schools. In addition, private resources have considerably supplemented the resources of affluent schools. The large spending shift was mainly a fiscal one (higher teacher salaries in poor schools), although real resource shifts (in pupil/teacher ratios) were not insubstantial. However, poor matriculation results indicate that additional resources, whether fiscal or real, were poorly translated into improved educational outcomes. As equity in education should be measured by equitable educational outcomes rather than equity in educational resource allocation, much work remains to be done. [ABSTRACT FROM AUTHOR]

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. [ABSTRACT FROM AUTHOR]

Focuses on the inequalities pertaining to unequal resource allocation and health finance in the health care sector in South Africa and options for reducing them. Analysis of public health expenditure and health status in South Africa and other countries which have comprehensive health expenditure; Average public health expenditure in the poorest magisterial districts.